Annual report and accounts 2011/12 - Homerton University Hospital

Annual report and accounts
2011/12
www.homerton.nhs.uk

Homerton University Hospital NHS Foundation Trust
Annual Report and
Accounts 2011/12
Presented to Parliament pursuant to Schedule 7,
paragraph 25(4) of the National Service Act 2006

4 Annual report 2011/12

Homerton University Hospital NHS Foundation Trust
Annual Report and Accounts 2011/12
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
Introduction 7
consisting of a statement by the Chairman.
Chief Executive’s report 9
including our strategic vision, performance against corporate objectives
2011/12 and details of our corporate objectives 2012/13.
Performance report 11
including our financial performance and non financial performance
against national targets.
Governance report 22
including details of the Board of Directors, Council of Governors and
Foundation Trust membership.
Quality Account 33
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 2012/13.
Finance 81
including the full Annual Accounts for the financial year 2011/12.
Annual report 2011/12 5

Trust Infection Control Nurse Vickie Longstaff with one of
the new Kwick screens used in wards to form a mobile
infection control barrier
The arrival of the new MRI scanner at the hospital during
the summer of 2011
A patient tries out the new gym sports training equipment
in the Physiotherapy Department
Radiologists Nan Mutsau and Beverley Bvute with the new
mammography machine donated to the hospital as part
of the GE Healthcare Olympic legacy
WAWASHSH – artist Kevin Harrison’s work forms the
centre piece of the newly refurbished back entrance to
the hospital – part of a major facelift given to signs, wards
and corridors during the year
A mother and child are seen by Health Visitor Nana
Larbi-Amoah at one of the Trust’s community locations
6 Annual report 2011/12

Chairman’s statement
Despite the recent passing of the new Health and Social
Care Bill, parts of the NHS continue to be buffeted by the
ongoing transition of power within the system and the
need for the NHS to meet the efficiency challenge at this
time of unprecedented change has in no way diminished.
North East London and the populations we serve are not
immune from these factors. Indeed, we have experienced
their impact at close quarters.
We also face important changes to our own leadership in
the year ahead in light of the planned retirement of our
strong and dedicated Chief Executive.
I am pleased to report that the belt-tightening exercise
I referred to last year has proved successful. Despite the
significant challenges on our doorstep, we have maintained
and improved the safety and quality of the services
we offer, with positive reports from the various quality
inspections, while delivering strong financial performance.
Over time this will be reflected in patient surveys when we
can get the response rate up to better levels.
Closer to home, we have forged ahead in developing
stronger relationships with our local and neighbouring
GPs. We welcome the introduction of the Commissioning
Groups and are greatly encouraged by our shared aims of
securing the best health care available for the residents of
Hackney, the City, and beyond.
Our first year providing both acute and community care has
filled us with immense pride. We have made great progress
in bringing the services together and improving the
environment and infrastructure supporting their delivery.
We, in conjunction with our commissioning partners,
are committed to building on this success to continue to
transform these services to the significant benefit of our
patients.
We have good standing with our local GPs, we have
short waiting times, and we can offer patients brilliant
consultants and nurses. The hospital has never been
looking better and we are committed to ensuring the
community service environments achieve a similar standard.
We are well prepared for the Olympics and will play our
part if called upon to do so.
So I am very confident of the important role Homerton will
play as the new world continues to take shape. The Board
is committed to growing our hospital and community
services to compete with the best in our sector and
compare favourably with the best in class.
I thank all of my colleagues and all our staff for their
continued support through a period of major change.
Michael Cassidy CBE
Chairman
30 May 2012
Annual report 2011/12 7

How our health services pan out across Hackney and The City –
health services are run in over 30 health centres, GP surgeries and
people’s homes as well as Homerton Hospital
7
A105
6
Islington
A503
9
8
26
1
STOKE
NEWINGTON
10
32
27
28
29
A10
A10
2
3 4
13
11
14
30
19
5
12
Hackney
Downs
UPPER
CLAPTON
Hackney
15
20
23 21
HACKNEY
33
25
24
A1207
DALSTON
HAGGERSTON
A107
A104
LOWER
CLAPTON
16
Waltham Forest
LEA BRIDGE
17
18
34
22
H o m e r t o n H
i g h S t r e e t
HOMERTON
A12
Tower Hamlets
London
2012
Olympics
Newham
R I V
31
City
E R T H A M
E S
Sites and locations
1. Cranwich Road Health Centre
2. Stamford Hill Group Practice
3. Stamford Hill Community Centre
4. Tyssen Children’s Centre
5. Fountayne Road Health Centre
6. Woodberry Downs Children’s Centre
and Lillyput Nursery
7. John Scott Health Centre
8. Norwood Bearstead Health and
Wellbeing Centre
9. Statham Grove Surgery
10. Barton House Health Centre
11. Linden Children’s Centre
12. Nightingale Practice
13. Somerford Grove Health Centre
14. Hackney Ark
15. Lower Clapton Health Centre
and CHYPS Plus
16. Homerton Hospital
17. Sorsby Health Centre
18. Daubeney Children’s Centre
19. Dalston Practice; Sandringham
Practice (Madinah Road)
20. Learning Trust
21. Elsdale Street Surgery
22. Wick Health Centre
23. Sickle Cell and Thalassaemia Centre
24. Ann Taylor Children’s Centre
25. Well Street Surgery (Shore Road)
26. Shoreditch Park Surgery;
Hoxton Surgery (Rushton Street)
27. St Leonard’s Hospital
28. Lawson Practice
29. Defoe Block, Hackney College
Hackney Community College,
B Block
30. Sebright Children’s Centre
31. Neaman Surgery
32. Mary Seacole Nursing Home
33. Greenhouse Walk-in, Tudor Road
(Managed by the London Borough
of Hackney)
34. South East Resource Centre
8 Annual report 2011/12

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.
This is Homerton University Hospital NHS Foundation Trust’s
(Homerton) first Annual Report as an integrated acute and
community foundation trust.
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.
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.
Progress in 2011/12 in developing the range and
scope of services
Community based services
This is our first year as an integrated acute and community
trust, and it has been a real privilege to work alongside the
community teams, many of whom work with individuals
and families experiencing enormous challenges. It is
humbling to witness their work. Our focus this year has
been on home support for mothers and new babies and
community services for the frail elderly but there is so much
more we aspire to do.
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.
Services in the hospital
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 provide more
specialist services, particularly in the areas of stroke and
neuro-rehabilitation, retinal screening, obesity surgery and
intensive care for the newborn.
Buildings and equipment
Our new Elderly Care Unit has opened offering support
and rehabilitation for the elderly and those with dementia.
Our Main Entrance, corridors and signage have all been
upgraded and complemented with new art work. Work
will soon complete on a new and enlarged Endoscopy
Unit. Investment in IT has been significant, with a state of
the art maternity management system installed and a new
contract agreed for our core patient systems agreed.
I must take this opportunity to once again thank the
Olympic sponsor General Electric (GE) for supporting us
with their Olympic legacy donation which has allowed
us to equip our specialist neonatal services with the most
sophisticated equipment available.
London 2012 Olympic and Paralympic Games
We are fully prepared for and proud to support the Games
in our role as an Olympic hospital. The Olympic Torch passes
in front of hospital on 21 July and the roar of the crowd at
the Opening Ceremony on 27 July will be easily heard from
here. It will of course be business as usual for all of our
services during the Games.
Service performance and quality
There are not many organisations that can say that the
year has passed without a single patient acquiring an
MRSA blood infection but Homerton can. In a challenging
climate, we met or surpassed our financial, activity and
key performance targets, and demonstrate in our Quality
Account that this was without compromise to service
quality.
There are of course areas where we could and should have
done better. Not every patient – whether in our hospital
or looked after by us at home – received the thoughtful,
effective care they deserve. We exist to provide health care
and must never let up in our endeavours to make this of
the highest standard.
Annual report 2011/12 9

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 12.
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,
in London hospital mergers and service changes are taking
place, and the economic situation remains challenging. In
setting our corporate goals we have done so with these
risks in mind.
Final word
This will be my last Annual Report. After nearly 20 years at
Homerton I am to retire at Christmas. In this Olympic year, it
is with pride that I hand the baton on.
Nancy Hallett
Chief Executive
30 May 2012
10 Annual report 2011/12

Performance Report
The Trust’s strategic vision in 2011/12
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.
With the transfer of the contract for Hackney and the City’s
community health services, Homerton this year achieved an
important strategic advance.
In 2011/12 we defined three medium-term overarching
strategic goals.
Strategic goal 1: ‘Our Services, Our Business, Our
Purpose’
To maintain, grow or develop health and education
‘services’ which contribute to core business and meet
health need and quality requirements.
Strategic goal 2: ‘Quality: Everyone – patient, visitor,
staff member – treated safely, effectively and
decently’
To, at all times, ensure that whatever we do we continually
strive to improve the quality and relevance of the services
we provide to our patients, their friends and loved ones and
our staff. A specific objective was to demonstrate real year
on year progress against Quality Account measures.
Strategic goal 3: ‘strengthening our reputation’
To define and focus on a realistic range of areas where
Homerton can build or develop its national profile,
including:
• community and hospital service integration and, where
appropriate, the delivery of integrated care
• further develop our already strong clinical informatics
capability, and
• strengthen and build on our reputation for quality
academic output.
Immediate aims for 2011/12
We identified a small number of more immediate aims for
2011/12:
i. Community health service integration: to integrate
fully hospital and community services for the benefit of
the patients we serve, our community and the Trust.
ii. Quality and innovation (QIPP): to demonstrate with
confidence that patient safety and quality of care are at
the forefront of our work.
iii. Performance and prevention (QIPP): to meet the
challenging efficiency requirements we face through
improving performance and productivity.
Performance against corporate objectives 2011/12
During the course of 2011/12 we have recorded a number
of achievements:
1. Successfully transferred and integrated Hackney and
the City’s 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 our CQC inspections demonstrated safe and
effective care for our patients
4. Achieved our financial targets without compromise
to quality standards, allowing us to invest further in our
buildings, equipment and services.
5. Sustained performance against all measures, with
community immunisation and screening rates seeing
major improvements since transfer to us.
6. Grew and developed services in response to
commissioner and patient choice and using the
opportunities provided by integration with community
services.
7. Placed ourselves back at the vanguard of health
informatics, with an upgraded Electronic Patient
Record system commissioned and bespoke systems
such as Maternity Management in place and changing
the way we work.
8. The refurbishment of the hospital Main Entrance and
corridors, landscaping of open spaces, and new art
works and signage have revitalised the environment.
9. New buildings and departments for our endoscopy,
elderly care, operating theatres, HIV and sickle cell
services are complete or in development.
10. We were in the top 20% in the country for overall
staff engagement.
11. Continued to benefit from Olympic legacy donations,
with the commissioning of the GE state of the art MRI
scanner.
12. We looked forward to and finalised preparations for
the London 2012 Olympic and Paralympic Games
which take 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,
Annual report 2011/12 11

PERFORMANCE REPORT
and this we must continue to strive to do, but we do know
that overall our hospital and community serves worked
well, providing safe, effective, thoughtful care for those in
need.
Corporate Objectives 2012/13
Our Corporate Objectives for 2012/13 and beyond are
designed to guide staff, services and departments in setting
their work programme for the year. The objectives are
divided into those things we must do and those which we
aspire to do.
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 CQC essential
standards and those of related agencies; maintain
compliance with Monitor’s financial and governance
requirements; comply with legislation including fire, carbon
reduction, equalities; and achieve national requirements for
service delivery, teaching and research.
In addition, a must-do for us is 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.
1. Quality and safety 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.
2. Expanding the organisation
To grow the organisation, 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.
3. 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 2014.
4. Short waits
To be a ‘short-wait’ organisation, with all patients
being offered an appointment for a consultation or
investigation within four weeks of referral. 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.
5. 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.
6. Preparing and supporting our staff
To prepare staff for the 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 objectives.
Principal risks & uncertainties facing the Trust
All of the principal risks identified by the Trust are
monitored regularly through standing performance reports
to the 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. (both in-year and future risk),
• Risks to Trust business associated with the health
economy reconfiguration in North East London (in-year
and future risk),
• 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 (future risk), and
• Risk to organisational continuity due to change of Chief
Executive Officer (future risk).
The Trust has comprehensive action plans in place to
mitigate the above risks which are monitored by the Risk
Committee and Trust Board.
The Trust’s Corporate 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.
12 Annual report 2011/12

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.
The objectives with the highest potential negative impact
if not achieved, are identified within the Board Assurance
Framework. This document is reviewed regularly by the
Board with independent assurance being provided by
KPMG, the Trust’s internal auditors.
Review of financial performance
The Trust achieved an Income & Expenditure (I&E) surplus
of £6.2m for financial year 2011/12 (before an impairment
loss of £0.9m), which exceeds the planned for surplus
of 1% of our turnover. The main source of income for
the Trust is contracts with commissioners in respect of
healthcare services; the Trust’s main Commissioner being
NHS North East London and the City.
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.
2011/12 2011/12 2011/12
Plan Actual Variance
Income £m £m £m
Clinical contracts 209.2 213.3 4.1
Other income 22.7 30.4 7.7
Total Income 231.9 243.7 11.8
Expenses
Pay (150.9) (158.8) (7.9)
Non pay (68.8) (69.3) (0.5)
Total Expenses (219.7) (228.1) (8.4)
EBITDA* 12.2 15.6 3.4
Depreciation and
amortisation
(6.3) (6.0) 0.3
PDC Dividends (3.5) (3.3) 0.2
Interest receivable 0.1 0.1 -
Interest payable on loans (0.2) (0.2) -
Net Surplus before
Impairment
2.3 6.2 3.9
*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, particularly
in surgical, intensive care, and diagnostic departments.
The Trust achieved £9.6m of savings during the year as part
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, due partly
to ongoing slippage in the capital programme. Capital
expenditure totalled just over £4.9m, including £1.5m
related to the expansion of the endoscopy suite, a new
fluoroscopy room and new and replacement medical
equipment. The cash balance held by the Trust at the end
of the financial year was £30.6m.
The Trust complied with the cap on private patient income
and 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 2012 the Trust
paid 87% of all non-NHS suppliers, by volume, within 30
days and we will endeavour to improve this performance in
future years.
The Trust is 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 £8.5m.
Our forecast financial position can be projected with a
reasonable degree of certainty in the short term as in
excess of 70% of our clinical income is derived from one
commissioner with which we have a good relationship.
The Trust’s treasury management strategy is routinely
reviewed by the Finance and Performance Committee,
a subcommittee of the Board. The most recent review
occurred in March 2012. The Committee did not identify
any immediate liquidity concerns. We are confident that we
Annual report 2011/12 13

PERFORMANCE REPORT
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
105 of the Annual Accounts.
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.
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 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
2010/11 and 2011/12.
2010/11
Financial
risk rating
Governance
risk rating
2011/12
Financial
risk rating
Governance
risk rating
Annual
Plan
Q1 Q2 Q3 Q4
3 4 3 3 3
Green Green Green Amber/
Green
Annual
Plan
Amber/
Red
Q1 Q2 Q3 Q4
3 4 4 4 4
Green Green Green Green
Financial risk rating
For 2011/12 the planned financial risk rating of 3 was
exceeded with all key financial targets met.
Amber/
Green
Governance risk rating
In the first three quarters 2011/12 the Trust was rated
“green” for governance risk. The “amber/green” rating
for Homerton in Q4 2011/12 was due to the Trust’s minor
under achievement against the 62 day cancer target.
14 Annual report 2011/12

Review of non-financial performance
Patient activity
With the transfer of City & Hackney’s community health
services, there has been a significant increase in patient
activity in the Trust. In addition, there has been a marked
increase in activity within a number of our hospital services.
The table below shows the reported activity levels against
the contractual plan for 2011/12.
The Trust has decreased clinically unnecessary outpatient
follow up appointments and outpatient DNA (did not
attend) rates. These improvements have been possible
through effective joint working with City & Hackney GPs
and through the implementation of initiatives such as the
expansion of telephone and email advice services for GPs.
These measures have allowed the Trust to accommodate
the increase in new GP referrals identified above.
Category 2011/12
plan
2011/12
activity
% above/below
plan
Hospital (acute) elective spells 16,620 18,047 8.6%
Hospital (acute) non-elective spells (including deliveries) 28,989 30,912 6.6%
Hospital outpatient attendances 258,494 258,498 0 %
A&E attendances (including pucc) 116,173 111,533 -4.0%
Adult community services – attendances and contacts* 332,101 315,496 -5.0%
Children’s community services – attendances and contacts* 275,831 287,416 4.2%
Adult critical care and rehabilitation – occupied bed days 30,377 26,189 -13.8%
Neonatal critical care – occupied bed days 11,049 13,960 26.4%
Direct access diagnostics (radiology, pathology, cardiac) – tests 836,731 902,833 7.9%
Outreach neurological rehabilitation – sessions 1,125 1,317 17.1%
Other (inc. fertility, regular attenders, therapies and podiatry) - attendances 13,547 14,522 7.2%
* The Trust is continuing to review the way in which community
activity is defined and recorded
The services with the most marked increase in activity
are: Neonatal Critical Care; Oral & Maxillofacial surgery;
Gastroenterology; Children’s Specialist Nursing; Wheelchair
services; Community Paediatrics; Community Sexual Health
services
In 2011/12, there was a small reduction in Emergency
Department attendances (4%) but an increase in the
number of emergency admissions (excluding deliveries) by
5.2%. This may suggest that patients who are less acutely
ill are accessing services outside of hospital locations.
Despite this, the average length of stay for emergency
admissions has been reduced from 5.1 days to 4.9 days.
Although Outpatient activity overall was on plan, the
Trust has seen a growth in demand for first Outpatient
attendances (3.7% above plan). This reflects increased
referrals for both City & Hackney patients (1.6%) and
out of borough patients (8.9% above plan). A new
Nephrology service was introduced this year, offering City &
Hackney patients suffering from chronic kidney disease the
opportunity to be seen at their local hospital.
2011/12 saw the Trust deliver over 5,000 babies, with an
increase in women from out of area booking with us for
maternity care. The implementation of a new electronic
maternity management system is expected to contribute to
improved service outcomes.
With the national focus on the care of older people,
significant changes were made to the Homerton Elderly
Care service in 2011/12. A daily care of the elder consultant
ward round has been implemented on the Acute Care
Unit (emergency receiving ward). This ensures that patients
are identified early and are transferred quickly to the new
integrated Elderly Care Unit. This unit combines both
the acute medical and rehabilitation elements of older
people’s care, with improved outcomes for elderly patients
anticipated.
The Regional Neurological Rehabilitation Unit (RNRU)
increased its capacity in 2011/12 by three beds (12.5%)
enabling the Trust to admit and rehabilitate more
neurological patients than it has in previous years.
Annual report 2011/12 15

PERFORMANCE REPORT
Sickle Cell related emergency admissions continued
to rise in 2011/12. To help avoid clinically unnecessary
admissions for Sickle Cell patients, the Trust has invested in
the provision of a dedicated psychological service and has
implemented an automated exchange transfusion system.
It is anticipated that this will lead to a reduction in both the
frequency of admissions and length of stay.
A number of acute and community services were
integrated for the first time in 2011/12. This includes the
sexual health services who now share patient information
systems and clinical governance structures, resulting in
anticipated better clinical outcomes.
With the transfer of community services to the Trust, it
has been possible to integrate the hospital’s Emergency
Department and Primary and Urgent Care Centre (PUCC),
enabling clinical teams to work more effectively in providing
emergency and urgent care to the local population. This
has also led to an increase in the proportion of patients
seen in PUCC rather than the Emergency Department.
Other anticipated benefits of acute and community
integration have, we believe, been realised including the
reduction in attendances to the Emergency Department, a
reduction in emergency length of stay and a reduction in
the number of hospital follow up appointments patients
receive.
The Hackney referrals processing service and the
Homerton outpatient booking team now have an
integrated management structure. This has supported an
improvement in the handling of patient calls to book or
change appointments.
Community paediatric services have improved the links
with the acute paediatric team; this has led to improved
psychology support for the hospital paediatric service and
improvement in the case management of children with
complex needs.
Our operational performance
The Trust performed strongly in 2011/12. Our average
waiting time for an outpatient appointment was five weeks
and for elective or day surgery was 11 weeks.
The Trust was set challenging targets with regard to MRSA
and Clostridium difficile infections but achieved these,
making Homerton one of the highest achieving Trusts with
regard to infection control in the country with no cases
of MRSA in 2011/12. The Trust has also seen a reduction
in the number of mixed sex accommodation breaches it
has reported in 2011/12 and this remains a focus area for
2012/13.
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
A&E patients
discharged < 4hrs
2011/12
Target
2011/12
Performance
95% 96.8%
Cancer Waiting List
2 Week Wait 93% 96.0%
31 Day Target 96% 100%
62 Day Target 85% 89.4%
Infection Control
MRSA ≤ 3 0
Clostridium difficile (C diff) ≤12 9
18 Week RTT Indicator
Admitted
(95th percentile)
Non Admitted
(95th percentile)
23 weeks 18 weeks
18.3 weeks 15 weeks
Whilst we performed strongly, we recognise that there are
always areas for improvement.
Despite seeing a continued improvement in our cancer 62
day waits, our Q4 performance dropped below the national
threshold.
With regard to community health services, the Trust is
performing well against the National KPIs for sexual health
services, referral to treatment time targets and breast
feeding targets. However, immunisation targets remain the
area presenting the greatest challenge.
Patient care
The Trust’s new Patient Experience Strategy, launched in
September 2011, ensures 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.
16 Annual report 2011/12

Comprehensive detail regarding the quality of patient care
and patient satisfaction is included in the Trust Quality
Account.
Complaints
The Trust received a total of 253 complaints for the year
ending 31 March 2012. The graph below shows the
comparison of the complaints received in 2011/12 with
previous years.
Total formal complaints April 2009 – March 2012 by month
35
30
25
20
15
10
5
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2009/10 2010/11 2011/12
Jan
Feb
Mar
Six complainants have asked the Parliamentary Health
Service Ombudsman (PHSO) to review their cases. Of these
complaints, the Trust is awaiting the ombudsman’s decision
on two cases. No further action has been taken on the
remaining four.
The Trust recorded the theme for all complaints received
during 2011/12. The table below shows that the main area
of concerns for patients and service users were:
Area of concern
All aspects of clinical treatment 110
Attitude of staff 44
Communication/information to patients
(written and oral) 25
Appointments, delay/cancellation
(outpatient) 19
Admissions, discharge and transfer
arrangements 13
Failure to follow agreed procedures 11
Others 31
Total: 253
Response times
A total of 253 formal complaints were received between
April 2011 to March 2012, of these the Trust responded
to 195 (77%) within 25 working days excluding those
complaints where the case was ‘clock stopped’ due to
meetings being arranged with the complainant, or the
complaint was declared a Serious Incident. The Trust aims
to respond to 75% of complaints within 25 days however,
we recognise that in more complex cases a longer period is
required to fully investigate the issues raised.
Learning from complaints
Whilst it is disappointing to receive any complaints about
the services we provide, we want to know when patients
or their carers are dissatisfied with any aspect of their
involvement with the Trust, so that we can take actions
to improve services. Some specific actions that have been
taken as a result of complaints included:
• changes to the processes for managing GP patient
referrals through the Accident and Emergency
Department
• increased security and changes to entrance/exit doors to
the Trust’s Nursing Care Home
• reviewed arrangements for patient property in the Trust
surgical centre, and
• introduction of a new twins information leaflet in
Maternity.
Annual report 2011/12 17

PERFORMANCE REPORT
Working with staff
With the integration of community health services, the
number of people directly employed by Homerton grew
from 2,573 in 2010/11 to 3,354 in 2012/13 (3044 wte).
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.
The integration of the hospital and community teams
is considered to have gone well, with staff appearing
comfortable with the change and no drops in service
performance or quality noted.
In the national staff survey for 2010/11 and 2011/12 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
steady, with the Board and managers receiving monthly
performance information.
We have seen a small reported increase in average sickness
absence rates in the last year from 3.2% to 3.5%. The Trust
has well established policies and procedures for managing
sickness absence, and also has onsite occupational health
services.
The Trust’s staff influenza vaccination campaign resulted
in 1,744 staff vaccinated, including just over 53.2% of
frontline staff, putting the Trust in the top four performing
acute Trusts in London.
The Homerton Health Works initiative continues, offering
exercise and lifestyle improvement activities for staff
with the support of a personal trainer providing lifestyle
coaching. Other staff benefits include child care support,
social events and staff discounts.
Staff survey response rate
Top four ranking scores
Percentage of staff able to contribute towards
improvements at work
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 with a Staff
Newsletter and item specific briefings. Payslip attachments
(or personal letters) are also used where assurance is
required that 100% of staff have received information on a
specific matter.
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 experienced a reduction in response rate from
52% to 42%; we did not campaign as hard as we normally
do to secure respondents and we will need to refocus for
next year.
In the ‘staff engagement’ category we continued to be in
the highest 20% for the country; strong performance was
shown in the facets; ‘staff feel they are able to contribute
towards improvements at work’; ‘staff motivation’;
‘recommend Homerton as place to work and as a place to
be treated’. These continue to be encouraging results.
There are areas where improvements need to be made.
Our action plan will include a focus on: further increasing
appraisal and mandatory training including equalities
training rates; reducing the sources of pressure and stress in
the workplace and ‘long hours’ culture. We are concerned
that staff are reporting abuse from patients and focused
work will be required to ensure our staff feel safe.
2010/11 2011/12
Change
Trust Nat. Ave Trust Nat. Ave
52% 52% 42% 53% 10%
2010/11 2011/12
Change
Trust Nat. Ave Trust Nat. Ave
71% 62% 77% 61% + 6%
Quality of job design (clear job content, feedback 3.60* 3.41* 3.59* 3.41* - 0.01
and staff involvement)
Percentage of staff satisfied with the quality of work 89% 74% 85% 74% - 4%
and patient care they are able to deliver
Support from immediate managers 3.84* 3.61* 3.79* 3.61* - 0.05
*5 point scale summary score
18 Annual report 2011/12

Bottom four ranking scores
2010/11 2011/12
Trust Nat. Ave Trust Nat. Ave
Change
Percentage of staff experiencing harassment, bullying or
abuse from patients, relatives or public in last 12 months
Percentage of staff suffering work-related stress in last
12 months
Percentage of staff having equality and diversity training
in last 12 months
Percentage of staff experiencing discrimination at work
in last 12 months
18% 15% 20% 15% + 2%
26% 28% 34% 29% + 8%
35% 41% 29% 48% - 6%
16% 13% 19% 13% + 3%
Education and related activities
Statutory and mandatory training, functional skills for
work, and personal and professional staff development
skills are delivered through the Learning & Development
Department. The national Staff Survey 2011 results
reported the Trust was in the highest 20% in the
country for staff having opportunities to develop their
potential at work over the last 12 months receiving wellstructured
appraisals and job-relevant training, learning or
development.
The Trust is committed to providing a safe and healthy
environment for its patients, members of the public and
staff. The Trust is required by law and national guidance to
provide a range of training in order to maintain a healthy
working environment and ensure the workforce has the
correct level of knowledge and skills to operate safely.
This is known as statutory and mandatory training (SMT).
In recent years the Trust has had inadequate compliance
rates for SMT. In the last 18 months, the delivery of SMT
has been restructured, and the appraisal process has been
updated to include a review of SMT compliance. These
measures have resulted in an increase in compliance.
Further work is continuing to ensure that satisfactory levels
are achieved.
Professional nursing & midwifery education
Homerton continues to provide educational placements for
pre and post registration students in nursing, midwifery and
health visiting as well as a range of opportunities for our
own nursing, midwifery and health visiting staff.
The placement of the year is an award given to clinical
areas where City University pre-registration students in
nursing and midwifery have had an exemplary learning
experience. In 2011/12 the Acute Care, Respiratory
Community team, the Emergency Department, Starlight
Ward, Somerford Grove Health Visiting and Barton House
District Nursing were all commended by students in the
awards.
We received funding from NHS London to establish a
nursing and midwifery academic research unit here at the
Homerton.
Medical education
In the 2011/12 the Trust continued to demonstrate
its commitment to the delivery of undergraduate
and postgraduate education. The annual inspections
undertaken by Barts and the London School of Medicine
and Dentistry, North East Thames Foundation School and
the London Deanery were all positive. Although the results
of the 2011 National Trainee Survey identified some areas
requiring improvement, the results were generally strong.
The Simulation Centre was officially opened in October
2011 and both the Simulation Centre and the Library won
awards for their work in 2011. The Trust hosted its first
annual Simulation Conference in 2011. Other innovations
included a project exploring new ways of improving the
teaching skills of foundation programme trainees.
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 & development.
Research and development (R&D) in the Trust continues
to develop and support research studies in areas of local
relevance for example HIV, respiratory disease/TB, allergy,
neuro-rehabilitation, stroke, diabetes, fertility, community
services and neonatal care. We have 157 active research
projects within the Trust in 23 different specialties. In
addition the Trust is an active member of the Central
London Comprehensive Local Research Network and
currently hosts 70 NIHR Portfolio Studies.
Annual report 2011/12 19

PERFORMANCE REPORT
Equality & diversity
The Board Executive lead for equality and diversity is the
Chief Nurse & Director of Governance. The Equalities
Report 2011 and our Equality Objectives 2012 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:
1. To establish a Governor-led equality and diversity group
in order to lead and champion our programme of work
related to equality and diversity.
2. To foster an organisation which understands the cultural
needs of our patients and staff through a series of
activities including a cultural awareness campaign.
3. 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.
4. 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.
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
Summary of Trust workforce and Foundation Trust membership diversity data
Staff
Membership
2010/11 % 2011/12 % 2010/11 % 2011/12 %
Age
Age
16-25 193 8 230 7 17-21 89 1 72 1
26-35 758 31 1041 31 22-29 458 7 420 6
36-45 712 29 904 27 30-39 713 11 735 11
46-55 512 21 774 23 40-49 655 10 717 11
56-65 237 10 337 10 50-59 441 7 511 7
66+ 20 1 31 1 60-74 426 7 481 7
75+ 156 2 185 3
Not Stated Not stated 3571 55 3698 54
Total 2432 3317 Total 6509 6819
Ethnicity
Ethnicity
White 1044 43 1488 45 White 2175 33 2256 33
Mixed 68 3 74 2 Mixed 185 3 198 3
Asian or Asian British 423 17 495 15 Asian or Asian British 545 8 560 8
Black or Black British 749 30 1055 32 Black or Black British 1078 17 1198 17
Undefined 22 1 5 0.1 Other - Specified 230 4 233 4
Other Specified 76 2 107 3 Undisclosed 2296 35 2374 34
Not Stated 50 2 93 3
Total 2432 3317 Total 6509 6819
Gender
Gender
Male 630 26 776 23 Male 2293 35 2326 34
Female 1802 74 2541 77 Female 3949 61 4134 60
Total 2432 3317 Undisclosed 267 4 359 5
Total 6509 6819
Recorded Disability 26 1 34 1 Recorded Disability 6 0.1 30 0.4
Total 2432 3317 Total 6509 6819
20 Annual report 2011/12

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 Social Care Partnership
Board for Hackney. The Trust is now 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 Scrutiny Commission meetings,
which are held in public, providing them with regular
service and performance updates.
Sustainability/Climate change 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 and to develop a Board approved carbon
management strategy. The Board approved the Carbon
Management Strategy in June 2010 and this is available
on the Trust website. Our plan indentifies opportunities
for carbon reduction, target setting and outcome
measurement, to reduce our carbon footprint by the
mandated 10% by 2015. The Trust successfully completed
the Carbon Trust’s NHS Carbon Management Programme
in March 2011.
Water consumption and expenditure has reduced
significantly following the implementation of water
efficiency measures.
Electricity consumption appears to be stabilising, reversing
the previous trend of a 3% increase per year. This is most
likely due to awareness raising activities, staff training and
the higher profile of environmental sustainability at the
Trust. However electricity costs were higher and this is
reflected in expenditure. Gas and Oil consumption have
reduced in line with demand reduction measures and a
mild winter. On average the price of utilities has increased
in 2011/12.
Summary environmental performance is shown in the
table below
Non-financial data
Financial data(£k)
Type 2010/11 2011/12 2010/11 2011/12
Utilities
Water (m3) 94,070 86,445 192 148
Electricity
(MWh)
Gas
(MWh)
Oil
(MWh)
9,793 9,892 950 1,054
3,880 3,145 154 185
20,643 18,426 765 889
Total 2061 2276
Waste
Residual
(tonnes)
Recycling
(tonnes)
Clinical
(tonnes)
Offensive
(tonnes)
High Temp
Incineration
(tonnes)
508 488
86 88
309 252
7 96
32 36
Total 942* 960 241 193
*2010/11 amount of waste produced has been restated to correct
an understatement in last year’s Annual Report.
The total amount of waste generated by the Trust has
increased and this may be due to increased activity. The
Trust has now rolled out an “offensive” waste stream to
most general wards and outpatient departments which
is reducing costs and benefiting the environment as this
waste stream does not need to be sterilised before final
disposal. The financial savings reflect this and the new
contract for clinical waste management that started in
October.
The Trust’s Carbon Footprint, associated with emissions
from energy, waste, water and business travel, have fallen
from 11,150 tonnes in 2010/11 to 10,920 tonnes in
2011/12 representing a 2% reduction CO2.
Annual report 2011/12 21

GOVERNANCE REPORT
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 2012 the Trust complied with
all the provisions of the Code.
Board of Directors
Composition of the Board
In accordance with our Constitution, the Board of Directors
had seven executive and seven non-executive directors
including the Chairman at the start of 2011/12. 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 2011/12 the Board had the following members:
Non-Executive Directors
Chairman, Michael Cassidy; Deputy Chairman and Senior
Independent Director, Stephen Hay, Prof Michael Keith,
Imelda Redmond, Prof Christopher Griffiths, David Stewart,
Sir John Gieve (from November 2011) and Eric Sorensen
(until October 2011).
Executive Directors
Nancy Hallett, Chief Executive; Dr John Coakley, Medical
Director and Joint Deputy CEO; Tracey Fletcher, Chief
Operating Officer and Joint Deputy CEO; Charlie Sheldon,
Chief Nurse & Director of Governance; Jo Farrar, Director
of Finance; Cheryl Clements, Director of Workforce and
Education; and Andrew Panniker, Director of Environment
(until October 2011).
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 fulfill
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.
During the year the Board conducted a review of its
committees and confirmed that each committee is fit for
purpose and functions effectively.
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 2011/12.
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
Stephen Hay 10/11
Prof. Michael Keith 9/11
Prof. Chris Griffiths 9/11
Imelda Redmond 10/11
David Stewart 10/11
Sir John Gieve* 4/5
Eric Sorensen** 6/6
*appointed from November 2011
**retired from the Trust in October 2011
22 Annual report 2011/12

Executive Directors
Meetings
Nancy Hallett, Chief Executive 11/11
John Coakley, Medical Director 10/11
Tracey Fletcher, Chief Operating Officer 10/11
Charlie Sheldon, Chief Nurse & Director
of Governance
11/11
Jo Farrar, Director of Finance 10/11
Cheryl Clements, Director of Workforce
and Education
5/11*
Andrew Panniker, Director of Environment** 6/6
*period of sickness absence
**finished working for the Trust in October 2011
Members of the Board of Directors
Non-Executive Directors
Michael Cassidy CBE, Chairman
Mr Cassidy has 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
completes in 2012. 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 chairs
the Remuneration Committee. He is a member of the Risk
Committee and also sits on the Trust’s Charitable Funds
Committee.
Stephen Hay, Senior Independent Director and
Deputy Chair
Mr Hay was re-appointed by the Council of Governors
to serve for a second three year term in 2009, which
completes in 2012. He is a self-employed management
consultant and prior to this he was a managing director at
Goldman Sachs. Mr Hay chairs the Audit Committee.
Professor Michael Keith
Professor Keith was re-appointed by the Council of
Governors to serve for a second three year term in 2010,
which completes in 2013. He is Professor of Anthropology
at Merton College Oxford having previously been Professor
and Director for the Centre for Urban and Community
Research at Goldsmith’s, University of London. He was
previously leader of the London Borough of Tower
Hamlets. Professor Keith is a member of the Audit and Risk
Committees.
Imelda Redmond CBE
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 was the Chief Executive of
Carers UK from 2003 to 2011. She is now 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.
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 Accounts 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 is a member of the
Finance Committee and chairs the Risk 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 and Performance
Committee.
Eric Sorensen
Mr Sorensen was re-appointed by the Council of Governors
to serve for a second and final three year term in 2008,
which completed in October 2011.
Executive Directors
Nancy Hallett, Chief Executive
Ms Hallett has 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. Ms Hallett sits on the Charitable Funds
Committee, Risk Committee and Finance and Performance
Committee.
Dr John Coakley, Medical Director, Joint Deputy Chief
Executive
Dr Coakley has been an Intensive Care consultant at
Homerton since 1992. He became Medical Director of
Annual report 2011/12 23

GOVERNANCE REPORT
Homerton in 1998, having previously been Director of
Postgraduate Medical Education. Dr Coakley sits on the
Charitable Funds and Risk Committees.
Tracey Fletcher, Chief Operating Officer, Joint Deputy
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 holds the post of joint deputy
Chief Executive Officer. Ms Fletcher sits on the Finance and
Performance Committee.
Charlie Sheldon, Chief Nurse & Director Governance
Mr 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
Visiting Professor, City University. Mr 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.
Cheryl Clements, Director of Workforce
Mrs Clements joined the Trust in June 2009. Mrs Clements
left the Trust in April 2012.
Andrew Panniker, Director of Environment
Mr Panniker joined the Trust in 2002. Mr Panniker left the
Trust in October 2011.
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’ interest should
make enquiries to the Foundation Trust Secretary on
020 8510 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 Stephen Hay, a Non-
Executive Director, and includes three other Non-Executive
Directors – Imelda Redmond, Eric Sorensen (until October
2011) and Prof Michael Keith. It met four times in 2011/12
Title
Attendance at meetings
Stephen Hay NED (Chair) 4/4
Imelda Redmond 3/4
Eric Sorensen* 2/2
Michael Keith 2/4
*retired from the Trust in October 2011
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 system 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 2011/12 were
£79,000. 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.
Risk Committee
The Risk Committee is constituted as a standing committee
of the Board of Directors and monitors all aspects of clinical
and non-clinical risk. The purpose of the committee is to
ensure that all risks are identified, assessed and evaluated
according to the risk management framework. The
24 Annual report 2011/12

committee seeks assurance that all risks are being managed
effectively and, where necessary, directs what action is
required to mitigate risk or to gain further assurance. The
Committee is chaired by David Stewart, a Non-Executive
Director, and its membership also includes Michael Cassidy,
Chairman and Prof Michael Keith, Non-Executive Directors.
It met four times in 2011/12.
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
who is appointed by the Council of Governors.
There were three meetings of the Nominations Committee
of the Council of Governors in 2011/12 which met to
reappoint three Non-Executive Directors for second three
year terms and to appoint two new Non-Executive Directors
to replace outgoing Non-Executive Directors.
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 Nominations Committee of the Board of Directors met
once in 2011/12 to review the Board structure and consider
the reappointment process for the Chief Executive 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 month’s 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 £687k for early
retirements relating to ex-members of staff.
The Remuneration Committee of the Council of Governors
met once in 2011/12 to consider Non- Executive
remuneration. No pay inflation award was given to Non-
Executive Directors.
The Remuneration Committee of the Board of Directors
met twice in 2011/12. The Chairman and all six Non-
Executive Directors were in attendance. The meetings were
also part attended by the Chief Executive and Director of
Workforce and Education for the purpose of providing
advice or services to the committee that materially assisted
the committee with the matters before them. No pay
inflation award was given to Executive Directors.
Salary and pension entitlements of senior managers are
available in the Accounts. Page 105
Nancy Hallett
Chief Executive
30 May 2012
Annual report 2011/12 25

GOVERNANCE REPORT
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
• 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.
During the year, a Guidebook for new Governors was
published providing information about the Trust and
Governor responsibilities.
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 2011/12
including two joint meetings of the Council of Governors
and the Board of Directors, and the Annual Members’
meeting. 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 5/6
Clyde Baker Public (Hackney) Sept 2010 (1st term) 5/6
Eli Kernkraut Public (Hackney) Sept 2011 (1st term) 3/3
Patricia Bennett Public (Hackney) Sept 2010 (1st term) 3/6
Suri Friedman Public (Hackney) Sept 2010 (2nd term) 6/6
Talaat Qureshi (1 year) Public (Hackney) Sept 2011 (1st term) 3/3
Jude Williams Public (Hackney) Sept 2011 (1st term) 3/3
Jamie Bishop Public (Hackney) Sept 2009 (1st term) 6/6
Florence Osaigbovo Public (Hackney) Sept 2009 (2nd term) 4/6
Christopher Sills (1 year) Public (Hackney) Sept 2011 (1st term) 5/5
Sarah Weiss (2 year) Public (Hackney) Sept 2011 (3rd term) 6/6
Doug Hiza Public (Hackney) Sept 2008 (1st term) 3/3
Sarah Horsfield Public (Hackney) Sept 2010 (1st term) 2/2
John Bootes Public (City) Mar 2010 (1st term) 5/6
Geoffrey Rivett** Public (City) Sept 2010 (3rd term) 6/6
Fatmata Sesay Public (Outer) Sept 2011 (1st term) 2/3
Eric Sorensen Public (Outer) Sept 2011 (1st term) 1/2
Dr Katherine Coyne Staff (Clinical) Sept 2011 (1st term) 2/3
Val Dimmock Staff (Clinical) Sept 2010 (1st term) 2/6
Mr Andrew Ezsias Staff (Clinical) Sept 2011 (1st term) 2/3
Ros Constable Staff (Clinical) Sept 2011 (1st term) 2/3
26 Annual report 2011/12

Name Constituency Date elected or appointed Attendance*
Dr Helen Cugnoni Staff (Clinical) Aug 2008 (1st term) 1/3
Dr Paul Cannon Staff (Clinical) Mar 2010 (2nd term) 1/1
Henry Muss Staff (Non Clinical) Sept 2011 (1st term) 1/3
Robert Duke Staff (Non Clinical) Mar 2010 (1st term) 6/6
Jonathon McShane Hackney Council Appointed Oct 2011 0/3
Deborah James Queen Mary Westfield Appointed Feb 2010 2/6
Gareth Moore City of London Appointed Jul 2009 1/6
Dr Lesley Mountford East London and City Appointed 2004 4/6
Prof. Stan Newman City University Appointed Jan 2011 1/6
*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 six meetings including two joint
meetings of the Council of Governors and Board of Directors were
held in 2011/12
**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 four constituencies
(Hackney, outer, Staff (non-clinical) and Staff (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 embraces the concept of a wide membership
base. There is no set limit on the number of people who
can register as members within the eligibility criteria.
Patient Experience and Engagement Committee will be
overseeing the recruitment and involvement of members
through the Membership Development Strategy. Previously
membership development activities were reported to and
monitored by the Patient and Public Involvement and
Membership Development Group.
The overall public and staff membership has increased over
the past year with 640 new members recruited and 254
members leaving.
At year start
(April 1 2011)
New
members
Members
leaving
Public 4467 277 88 4656
Staff 2024 363 166 2221
Total 6491 640 254 6877
At year end
(March
31 2012)
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, are eligible to join.
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
Annual report 2011/12 27

GOVERNANCE REPORT
• 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, and
• 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 2001 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 2011
Census data will be used when it becomes available later
this year.
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 2011/12 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.
28 Annual report 2011/12

Annual report 2011/12 29

30 Annual report 2011/12

Quality Account
Annual report 2011/12 31

32 Annual report 2011/12

Quality Account
Contents
Section 1:
Chief Executive’s statement 34
Section 2:
Priorities for improvement 35
Section 3:
Homerton acute and community services 2011/12 38
Section 4:
Quality improvements 2011/12 50
Section 5:
Quality improvement plans 2012/13 70
Section 6:
Consultation and feedback 73
Section 7:
Statement of Directors’ responsibilities 77
Annual report 2011/12 33

QUALITY ACCOUNT
Quality Account 2011/12
SECTION 1 – Chief Executive’s Statement
Introduction and welcome
I am pleased to present our Quality Account for 2011/
12, our first 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.
That said, there is of course plenty of room for
improvement. We have made the decision to join 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.
2012/13
In terms of our quality programme for 2012/13 much is
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.
2011/12
Measuring and assessing for quality and safety in health
care is not straightforward. There is no one measure that
can tell us precisely where we are. We have to use a range
of measures, interpret the findings with care and challenge
ourselves to keep testing the evidence.
When I say now that in 2011/12 we saw some very positive
indicators of safety and quality at Homerton I do so in the
light of the statement above. I have however highlighted
below two measures from our basket where we did
particularly well because I believe they are important.
In the entire year we had not one case of MRSA
bacteraemia (blood infection). The importance of this is
that, taken in conjunction with other findings, it shows that
standards of infection control in the hospital are high.
The other area is external inspection. These are increasing
in their intensity, with the Care Quality Commission (CQC)
undertaking unannounced inspections to all hospitals,
care homes and health centres. Since May 2011, both
the main Homerton Hospital and our care home, Mary
Seacole received visits, with no prior warning. For our
community services we participated in a combined Ofsted/
CQC inspection of children’s safeguarding services. These
were not ‘spot checks’; there were many assessors over a
number of days. We were found to be meeting the CQC
standards.
Nancy Hallett
Chief Executive
34 Annual report 2011/12

SECTION 2 – Priorities for improvement
In this section we look at 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. We consulted
between December 2011 and February 2012 with;
patients, staff, Members, Governors, commissioners, NHS
London, LINks and 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 two
of our existing quality improvement priorities, retire two
and add four new. These priorities are all linked to the
Trust’s strategic objectives and the work of the QUEST
programme.
Trust strategic objectives
The Trust strategic objectives for the coming year are;
Our core objective:
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
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; achieve national
requirements for service, teaching and research.
In addition, a must-do for us is to fulfil the requirements of
our 2012 Olympic 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 safety for patients
To provide the public with confidence that Homerton
is a very safe hospital by maintaining hospital mortality
markers at a level which demonstrates 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, 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 2014.
iv. Short waits
To be a ‘short-wait’ organisation, with all patients
being offered an appointment for a consultation or
investigation within four weeks of referral. 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 patients,
GPs 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; summaries from
inpatient stays and emergency attendances within 24
hours.
vi. Preparing and supporting 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 objectives.
NHS QUEST
NHS QUEST is an organisation of 14 foundation trusts in
England who work together to innovate and share learning
to improve quality.
QUEST members work as partners on improvement
projects, e.g. Harm-Free Care, Reducing Readmissions, and
Reducing Mortality. Members learn together and from one
another, consistently measure and report improvement and
together, galvanise collective leadership and staff capability.
Annual report 2011/12 35

QUALITY ACCOUNT
Foundation trusts who are members of NHS QUEST focus
on the following:
• improving quality and safety
• aspire to a level of excellence beyond all current
expectations
• build the capability of our workforce to improve
• support our leaders to create the right culture for
reliability
• measure and report our outcomes
• learn from one another and share through actionorientated
projects
• believe we can always do better for our patients.
In the context of the Trust strategic objectives and
becoming a member of NHS QUEST, Homerton sets out its
quality priorities for the year ahead below.
Priorities for quality improvement for the
coming year April 2012 to end March 2013:
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.
(Linked to Trust objective I, the NHS QUEST programme and
the Patient Experience Strategy Campaign One: Delivering
thoughtful care).
Description of the issue and reason for making it a
priority: The use of a tool called the Safety Thermometer
is a National Commissioning for Quality and Innovation
(CQUIN) scheme and an operating framework requirement.
The four harms to be monitored are:
• pressure ulcers
• slips, trips and falls
• patients with a urinary catheter who develop a urinary
tract infection
• venous thrombo-embolism.
Aim
To be fully involved with the safety thermometer
measurement programme and to reduce harm, over the
coming year, to acute and community patients, from the
four harms listed above.
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.
(Linked to Trust objective I, the NHS QUEST programme and
the Patient Experience Strategy Campaign One: Delivering
thoughtful care).
Description of the issue and reason for making it a
priority: The Standardised Hospital Mortality Indicator
(SHMI) compares the expected rate of death in a hospital
with the actual rate of death. The SHMI model removes
palliative care coding and focuses on 30 day mortality. The
SHMI is an indicator of the quality of care in a hospital.
Aim
NHS QUEST organisations aim to score a Standardised
Hospital Mortality Indicator (SHMI) of 75 or below by
January 2013 by focusing on the following four work
streams:
• moving to a 24 hours a day, seven days a week, 365
days a year service
• reviewing systems for measurement
• reducing harm and deterioration
• excellence in end of life care.
This will indicate that we are a safer organisation.
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.
(Linked to Trust objective I and the Patient Experience
Strategy Campaign One: Delivering thoughtful care).
Description of the issue and reason for making it a
priority: NICE provides national guidance on promoting
good health and preventing and treating ill health in
acute and community settings. This guidance provides an
important benchmark for any Trust in ensuring effectiveness
of care. We have a responsibility to review their guidance,
see if it applies to what we do at the Trust and check
whether our practice meets a similar standard of care. It is
also vital that we audit our practice against the guidance
to clearly show that over time we are maintaining the high
standards of care we expect to provide.
36 Annual report 2011/12

Aim
Ensure that the Trust has evidence of the implementation of
NICE clinical guidelines that are relevant to the Trust (acute
and community). This will include regular audit of the
guidelines to demonstrate that clinical practice continues to
be of the highest standard.
Priority 4
Reduce hospital readmissions.
(Linked to Trust objective I, III, IV, V, the NHS QUEST
programme and the Patient Experience Strategy
Campaign Two: Leaving or transferring from our care with
confidence).
Description of the issue and reason for making it a
priority: The readmission of patients to hospital within
30 days for the same condition, if avoidable, is something
we want to prevent. It is disruptive for the patient and
requires that we review our discharge planning process and
our collaborative working with community and social care
services.
Aim
Reduce readmission rates within 30 days of discharge by
20% by implementing the QUEST Reducing Readmission
improvement programme.
Review the care of all patients who are readmitted within
30 days to see if this could have been avoided and what
actions we can take to improve our processes for the
efficient discharge of all patients.
Priority 6
We will improve the effectiveness of discharge from
our care.
(Linked to the Patient Experience Strategy Campaign two;
Leaving or transferring from our care with confidence).
Description of the issue and reason for making it a
priority: We have had feedback from patients and their
carers concerning delays they have experienced whilst
being discharged from our care. Leaving hospital to go
home should be a smooth and efficient process that
enables patients to depart as soon as they are medically fit
to do so. Being discharged from community care should
also be smooth and efficient with patients feeling confident
to manage their ongoing care.
Aim
We will improve the effectiveness and timeliness of hospital
discharge. We will review and improve the discharge of
patients from community care/support. We will measure
patient satisfaction in relation to; communication, waiting
for medicines/transport, the level of support patients have
and whether they feel confident to manage their on going
health.
These six priorities will be reported on in forthcoming
Annual Reports.
THOUGHTFUL
Priority 5
Sharing care and treatment information with
patients.
(Linked to the Patient Experience Strategy Campaign Three:
Getting the information right).
Description of the issue and reason for making it a
priority: We will ensure that every patient receives a copy
of every letter sent to their GP or referring practitioner.
Following feedback from patients and carers and the aims
of the Health and Social care bill, we are keen to ensure
that patients are fully involved with their care. Copies of all
letters sent to other professionals about patients ongoing
treatment and care will be shared with the patient.
Aim
For 100% of letters sent to the patient’s GP or referring
practitioner to be copied to the patient concerned.
Annual report 2011/12 37

QUALITY ACCOUNT
SECTION 3 – Homerton acute and
community services 2011/12 and
registration with the Care Quality
Commission
In this section we have provided information about the
services that are currently provided at Homerton.
During 2011/12 we provided 61 NHS services which are
grouped into three clinical divisions as illustrated in Table 1.
Table 1: Homerton Clinical Divisions
Children’s Services, Diagnostics and Outpatients
Integrated Medical and Rehabilitation Services
Surgery, Women’s and Sexual Health Services
Each Clinical Division comprises both acute and community
services. Services were reorganised following integration
with Community Health Services in April 2011 and these
three Divisions were established in September 2011.
The Trust has reviewed the data available for the quality
of care in the 61 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
2011/12 represents 100% of the total income generated
from the provision of NHS services by Homerton for
2011/12 – this income is divided into two contracts; an
acute and a community contract.
Management of quality at service level
Service level quality groups review specific information
including; infection control, reports on incidents,
complaints, litigation, implementation of new guidance
relevant to the specialty, progress on audits, positive
feedback from patients.
Specialty groups report to the Division which in turn report
to the Trust’s Quality Improvement Committee. This process
ensures that the three elements of quality are reviewed as
an integral part of everyday working in the Trust.
Information received by the Trust Board
The Trust Board receives monthly information on:
• patient experience and quality (the quarterly quality
report)
• 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 and the
average length of stay in particular patient groups
• 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:
• patient experience (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
group)
• serious incidents
• hospital acquired infection rates
• local and national audit
• mortality rates
• patient related outcome measures (PROMS).
The report includes details of actions that are being taken
to address any areas of concern.
Quality initiatives driven from outside the
Trust
National Audits: Homerton involvement in national
audits
During 2011/12, 55 national clinical audits and four
confidential enquiries covered NHS services.
Of these, 41 national clinical audits and three confidential
enquiries covered services that Homerton provides. 14
national clinical audits and one confidential enquiry were
not applicable to the Trust (services we did not provide).
During 2011/12 Homerton participated in 35 (85%) national
clinical audits and three (100%) national confidential
enquiries of those it was eligible to participate in.
Six national clinical audits were applicable but no data was
submitted – in five cases, the audits related to; Paediatric
Asthma, Seizure Management, Risk Factors (occupational
health related), Diabetes and Childhood Epilepsy Clinical
Audit, the data collection deadline was not met. In one
case the audit is carried out two yearly and data will be
collected next year.
38 Annual report 2011/12

The national clinical audits and national confidential
enquiries that Homerton participated in and for which
data collection was completed during 2011/12 are listed in
table 2. This also includes 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:
Table 2 – Audits we took part in and the amount of
information we sent in for each audit
Audit title
Percentage of data submitted
Peri- and Neonatal
Perinatal mortality 100
Neonatal intensive and special care (NNAP) 100
Paediatrics
Paediatric pneumonia 100
Pain management 100
Childhood epilepsy (RCPH National Childhood Epilepsy) -
100
Organisational Audit
Acute care
Emergency use of oxygen 100
Adult community acquired pneumonia Data collection in progress until 31/5/2012
Non invasive ventilation (NIV) - adults Data collection in progress until 31/5/2012
Pleural procedures 100
Cardiac arrest 100
Severe sepsis & septic shock 100
Adult critical care 100
Potential donor audit 100
Long term conditions
Baseline data completed on 31 January – further
Heavy menstrual bleeding
questionnaires being sent until February 2013
Chronic pain 100
Ulcerative colitis and Crohn’s disease 100
Parkinson’s disease 100
Chronic obstructive pulmonary disease (COPD) 100
Adult asthma 100
Bronchiectasis 100
Elective procedures
Hip, knee and ankle replacements 100
Elective Surgery PROMs 100
Cardiovascular disease
MINAP (inc ambulance care): acute myocardial infarction
(AMI) & other acute coronary syndromes (ACS) 100
Heart failure 100
Acute stroke 100
Annual report 2011/12 39

QUALITY ACCOUNT
Audit title
Percentage of data submitted
Cancer
Lung cancer 100
Bowel cancer 100
Head & neck cancer 100
Oesophago-gastric cancer 100
Trauma
Hip fracture 100
Severe trauma 100
Falls and non-hip fractures 100
Blood transfusion
Bedside transfusion 100
Medical use of blood 100
End of life
Care of dying in hospital 100
NCEPOD
Cardiac arrest procedures 100
Peri-operative Care 100
Bariatric surgery 100
National audit reports – our response
The Trust reviewed the 13 reports that were published in relation to national clinical audits during 2011/12. Table 3 shows the
action being taken or planned as a result of a review of the report to improve the quality of health care provided:
Table 3: Trust response to national clinical audit reports 2011/12
National audit reports
issued in 2011
College of Emergency
Medicine: Paediatric
Fever
Date issued
Apr-11
Action taken as a result of recommendations
Local policy reflects the recommendations - ambulant patients are
assessed within 20 minutes, patients via ambulances within 15 minutes
of arrival
All vital signs and requests are documented on the Electronic Patient
Record (EPR)
College of Emergency
Medicine: Vital Signs
Apr-11
The Trust Wide Policy on Vital Signs covers the recommendations from
the report
College of Emergency
Medicine: Renal Colic
Apr-11
A pathway for the management of renal colic was written and is
available on the Trust intranet
40 Annual report 2011/12

National audit reports
issued in 2011
National Falls and Bone
Health Audit: Falls and
Non Hip Fractures
Date issued
May-11
Action taken as a result of recommendations
The recommendations from the report have been incorporated into local
guidance and provide evidence of compliance with NICE guidance
National Confidential
Inquiry into Suicide and
Homicide by People
with Mental Illness
Jul-11
There are processes in place that address the recommendations of this
report
Homerton and East London Foundation Trust have meetings at an
operational and a strategic level to enhance joint working to improve the
care of patients mental and physical health
National Confidential
Enquiry into post
operative death:
Surgery in Children
Oct-11
This report will be evaluated by the paediatric team by the end of July
2012
British Thoracic Society -
Non Invasive Ventilation
Nov-11
This report will be evaluated by the chest physicians by the end of June
2012
Depression and Anxiety Nov-11 This report will be evaluated by the psychology service by the end of July
2012
NCEPOD Peri-Operative
care
Dec-11
Two of the recommendations are already routine practice in anaesthesia
– high risk patients are assessed pre –operatively and an assessment of
mortality risk is calculated
Urgent surgical patients also have a robust pre operative review and
preparation for surgery
Further review of the report is underway with regard to how the
recommendations are implemented within the surgical specialties
Paediatric Inflammatory
Bowel Disease
Feb-12
This report will be evaluated by the multidisciplinary team by the end of
July 2012
National Inflammatory
Bowel Disease
Feb-12
This report will be evaluated by the multidisciplinary team by the end of
June 2012
Lung Cancer Mar-12 The report has been reviewed, Homerton compares favourably to similar
service providers. This report will be reviewed at the Network Tumour
Advisory Board
National Pain Audit -
Chronic Pain
Nov-12
This was a phase one organisational report only - no implementation
plans will be required until Phase 2 has been completed in 2012
Annual report 2011/12 41

QUALITY ACCOUNT
Local audit
Homerton reviewed 89 local clinical audits and is taking
action as a result to improve the quality of healthcare
provided. Table 4 provides a selection of actions taken from
audits carried out in the Trust.
Table 4: Selection of actions taken to improve care as a
result of audits carried out in the Trust
Local audit title Actions Done
Evaluating use of occupational
therapy equipment within
Therapy at Home
Produce a bid to re-establish ordering rights for rehabilitation
equipment for the Therapy at Home team
4
Evaluating changes in Therapy
at Home discharge reports
Continue to use the new Therapy at Home discharge reports and
re-audit in six months time to see if they are used correctly
4
The use of TILEE (task,
individual, load, environment,
equipment- A manual handling
assessment for patients during
therapy) in the Therapy at
Home team
Carry out teaching sessions on TILEE (task, individual, load,
environment, equipment) and the paperwork to ensure that TILEE
paperwork is completed properly
4
An audit of the quality of spinal
plain films (x-rays)
Breast imaging requests
• Encourage reporters to utilise the inadequate images files on the
Picture Archiving Communication Systems (PACS)
• Organise tutorial to recap spinal techniques and protocols
• Re-audit of film quality and audit other body parts to improve film
quality.
• General Practitioner (GP) direct access clinic to open
• Audit the (GP) direct access breast imaging requests and numbers
• Gather data for an audit next year
4
4
4
4
4
4
Audit of 100 abdomen X rays
• Provide staff training on criteria for abdomen x-ray
• Organise lunchtime continuous professional development sessions
on abdominal x-rays
4
4
City and Hackney Young
Peoples Services (CHYPS) Plus
consent and HIV Screening
Audit
• Remind staff to always complete the sexual health section on RIO
when undertaking any Sexually Transmitted Infection checks
• Remind staff to ensure that patients receive a pre-test discussion
prior to testing
• Remind staff to ensure that consent to tests is obtained prior to
testing
• Staff to record pertinent information on patients’ manual files
• Deliver training to staff on consent and patient risk awareness
• Increase offer of HIV testing to young people attending the service
for matters relating to their sexual health by offering HIV testing
as part of sexual health screening to patients
• Identify training needed by staff to ensure they are competent in
the use of point of care testing for HIV
4
4
4
4
4
4
4
42 Annual report 2011/12

Local audit title Actions Done
Clinical Manual Handling Risk
Assessment Audit
Redesign new patient handling form; include new form in training
and in the policy
4
Quality of information given
to patients before fertility
procedure
• Provide training update for all staff concerned on a regular basis
• Make the latest statistical information easily available on the
fertility database
• To ensure that emergency/out of hours contacts numbers are
present on all treatment information leaflets
4
4
4
Audit to assess consent taking
in Fertility
• Provide training update on using consent forms
• Provide training update for time schedules required for; giving,
signing and returning consent forms to ensure that treatment
consent is properly signed
4
4
Priorities of Care
Documentation Audit
• Ward managers to disseminate information to staff.
• Ward managers to monitor nursing documentation on a regular
basis.
4
4
Research
The total number of patients receiving NHS services
provided or sub-contracted by the Trust between 1 April
2011 and 28 February 2012 who were recruited to
participate in research approved by the research ethics
committee was 1,125.
Participation 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.
Homerton was involved in conducting 146 clinical research
studies in 23 specialties from April 2011 to the end of
March 2012.
A total of 53 clinical staff led on research approved by a
research ethics committee at Homerton during April 2011
to the end of March 2012.
In the last three years, 164 publications have resulted from
our involvement in Nation Institute for Health Research
(NIHR), which shows our commitment to transparency and
desire to improve patient outcomes and experience across
the NHS.
Commissioning for quality and innovation (CQUIN)
schemes
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. For example being seen in a timely
way once admitted to hospital and improving the way we
interact with patients.
We recognise that these issues continue to be important to
our patients following the 2011 patient surveys.
In 2011/12 1.5% of the Trust’s clinical income was
conditional on achieving the quality improvement and
innovation goals agreed between the Homerton, our
commissioners NHS North East London and the City and
our specialist commissioners, through the Commission
for Quality and Innovation payment frame work. Over the
past year we have been running three CQUIN schemes;
one for the acute care in the hospital, one for care in the
community and specialist schemes.
Further details of the agreed goals for 2011/12 and for the
following 12 month period are available online at: http://
www.institute.nhs.uk/commissioning/pct_portal/cquin.html
As a result of the schemes we received a total of
£2.2 million.
See section four for further details.
Annual report 2011/12 43

QUALITY ACCOUNT
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 against Homerton during 2011/12.
Homerton has participated in special reviews or
investigations by the CQC in relation to the following areas
in 2011/12:
• Dignity and Nutrition Inspection (DANI) (older people)
May 2011
• Mary Seacole Nursing Home on 13 October 2011
• Homerton University Hospital NHS Foundation Trust
headquarters (comprising Homerton University Hospital
and all the services provided by the Trust in community
locations including those delivered in patients’ homes)
on 15 and 22 November 2011
• Review of termination of pregnancy services in March
2012 – the report from this inspection is being finalised
by CQC
• Safeguarding and Looked After Children Inspection in
March 2012 – the report from this inspection is being
finalised by CQC
All of these inspections were positive and constructive
feedback was given by the regulator. The Trust was found
to be compliant with all assessed outcomes.
Homerton intends to take the following actions
(see tables 5, 6 and 7) to address the conclusions or
requirements reported by the CQC. The action plan also
shows the progress Homerton has made with these plans
by 31 March 2012.
Table 5: Action Plan following the DANI May 2011
Regulation/ Outcome
17/1
Respecting and involving
people who use services
CQC Judgement on compliance
Outcome met
14/5
Meeting nutritional needs
Outcome met
Minor concern
Improvement action to maintain compliance
The observations of care during the spot check will be:
• disseminated widely and
• key lessons will be embedded in clinical staff training
• access to adapted cutlery and assistance for eating and drinking to be included in the ward nutrition audits and
monitored.
Activity
The CQC Dignity and Nutrition Inspection report was emailed to all Trust staff with a covering email from
the Trust Chief Executive, Nancy Hallett, on 26 May 2011. The covering email noted that areas of good
practice were found by the inspection team. The email also set out the improvements needed, including
increasing access to specialist eating equipment and improving communication with patients.
Status
Completed
The Council of Governors discussed the inspection report findings at their June meeting together with the
action plan which was presented to them by the Chief Nurse/Director of Governance. The Trust Board of
Directors also discussed the inspection report findings at their June 2011 meeting.
The findings from the report were included in mandatory clinical update training which takes place every
fortnight. Key points included in the training session are:
Completed
• the importance of ensuring that patients are assessed by an Occupational Therapist (OT) where
relevant so that people who use services are enabled to maintain their independence supported by the
provision and use of specialist eating equipment such as adapted cutlery
44 Annual report 2011/12

Activity
Status
• the importance of patients being positioned properly when eating
• the importance of engaging with patients when assisting them with eating.
Seventy members of staff have completed this training since the end of May 2011.
Awareness of the need to refer patients for assessment by an OT has been raised through mandatory
clinical update training and this message has been reinforced with all of the ward managers.
Completed
The stock of adapted cutlery has been increased and access to this cutlery has been improved by ensuring
that patients are referred for assessment by an OT. The proportion of inpatients assessed as needing
assistance with eating and drinking and who received assistance improved between June and August.
Direct feedback from patients using the Patient Experience Tracker shows that over 80% of patients
reported they were given help with their meals when needed. The Commissioning for Quality and
Innovation (CQUIN) target last year was for 75% of patients to report that they were given help with
meals.
2. Inspectors found that patients on Aske ward were waiting a long time for their lunch since it took
approximately an hour between the arrival of first and last meal.
The reasons for delays in the delivery of meals to the wards and service to patients were reviewed.
The review by catering services and the dietetics staff found that the key factors behind any delays in
the service of hot food to patients was not related to the capacity of the microwaves on the wards.
Communication between ward staff and the ward hostess was the most important factor in ensuring that
hot meals are served on the ward without delay.
Key performance indicators (KPI) for the time of service of the first and last meal on the ward have been
developed and are monitored in the monthly nutrition audits of all 10 wards. The total time between
service of the first meal and the last meal must be no more than 30 minutes. Meals are served by 12:10,
12:40 or 13:10 depending on the arrangements for the individual ward due to the nature of the patients
on the ward. These KPIs are also included in the monitoring of the contract with the catering supplier.
Completed
3. Patients with communication difficulties or who have difficulties reading the menu should be
assisted by the provision of large print menus with large images
A pictorial menu has been developed by the Trust Speech and Language therapists for use on Graham
ward stroke unit.
The monthly nutrition audits capture whether patients have seen the pictorial menu(s).
The Nutrition Steering Group is working with the catering supplier (Medirest) to ensure that menus with
appropriate pictures of foods are developed for all the wards.
Improve the access to Kosher meals.
In addition, discussion is ongoing with the Charedi Forum to ensure that all Orthodox Jewish and other
patients requiring Kosher food have access to the Kosher meal menus. The Kosher meal menus have
been laminated and are distributed to patients on the breakfast trays each morning.
Completed
Completed
Ongoing
Ongoing
Annual report 2011/12 45

QUALITY ACCOUNT
Table 6: Action Plan from visit to Mary Seacole Nursing Home
Regulation/ Outcome
9/4
Care and welfare of people
who use services
CQC Judgement on compliance
Minor concerns
The home was providing safe and effective care. However, the home did not always fully
document people’s social background, preferences and interests and how these were
being addressed, for example, through the activities on offer.
1. Improving the documentation of the social background, preferences and interests of residents through the
reintroduction of the existing ‘Getting to know you’ booklet
Activity
Implementation of the ‘Getting to know you’ booklet
It is planned that the ‘Getting to know you’ booklet will be implemented in a phased manner.
Engaging with Mary Seacole staff and monitoring the use of the ‘Getting to know you’
booklet
The ‘Getting to know you’ booklet was reintroduced to staff at the staff meeting in December 2011
and was followed up through a reminder memo after six weeks. In addition the completion of
the ‘Getting to know you’ booklet with each resident will be a standing item for discussion at the
monthly staff meetings and in one to one meetings with the activity coordinator.
Status
Ongoing
2. Using the information in the ‘Getting to know you’ booklet to shape activities offered
and participated in by residents
The nursing home has a daily living activity profile template which is used to record participation
of residents in a wide range of activities. The template will be amended to make an explicit link
between the activities that each resident is offered and chooses to participate in and their ‘Getting to
know you’ booklet profile.
Ongoing
3. Improving the recording of the views of residents on their participation in activities
The views of the resident (positive and negative) on different types of activities will be recorded in
their personal record. At present this record is used to document when a resident has not been able
to participate in an activity through tiredness or other reasons, but tends not to include when they
have enjoyed an activity.
Ongoing
Regulation/ Outcome
13/9
Management of
medicines
CQC Judgement on compliance
Minor concerns
Staff generally administered and stored medicines safely. However the provider
did not record its handling and disposal of medicines appropriately.
1. Recording the handling and disposal of medicines in the medication administration record chart.
Activity
Obtaining duplicate stickers for each medication from the dispensing pharmacist
The consultant nurse for medicines management and acute pain is in discussion with the pharmacy
that dispenses medication for Mary Seacole Nursing Home so that a duplicate medication label will
Status
Completed
46 Annual report 2011/12

Activity
Status
be generated whenever medication is dispensed. This sticker will contain details of each medicine,
including the quantity of medicine dispensed. It will be put on the medical administration record chart
to facilitate the logging of medication.
Developing a new medication administration record chart
The consultant nurse for medicines management and acute pain is discussing the development
of a new medication administration record chart with the company that produces these charts
for the Trust.
The medication administration record chart will be amended so that the sticker containing
information about the medicines prescribed (as noted above) will be placed on the chart. When
medication is administered to the resident, the quantity of medication given will be recorded on
the chart and a running balance of medication remaining will be calculated and recorded on the
chart. When medication is disposed of this will also be recorded on the chart, and the balance of
medication remaining at the nursing home will also be noted.
In addition, the new medication administration record chart will contain a box where allergies
will be recorded.
The new chart will be piloted in the nursing home before full implementation.
Audit of the use of the new medication administration record chart.
Completed
Table 7: Action Plan from visit to Homerton Hospital
Regulation/ Outcome
17/1
Respecting and involving
people who use services
Regulated activity
Treatment of disease,
disorder or injury
CQC Judgement on compliance
Minor concern
Patients reported having to wait for care (for example, help with getting dressed) on
the Regional Neurological Rehabilitation Unit. The Trust provided some information
about improvements planned for this unit, but this did not explain in any detail how
this concern would be addressed.
Improve the way in which the Trust monitors and records how the multi-disciplinary team on the Regional
Neurological Rehabilitation Unit (RNRU) operates so that the care provided continues to respect and involve
people who use services.
Activity
When/Status
1. Strengthening the means by which feedback from people who use services is gathered and used to
improve patient care
The Trust has recently developed a Patient Experience Strategy a key part of which is to use
patient involvement to improve the services delivered by the Trust. The strategy recognises
that ‘one size does not fit all’ and encourages each of the Trust’s services and divisions to
set their own patient experience campaign objectives and report on these to the Patient
Experience and Engagement Committee (PEEC).
Annual report 2011/12 47

QUALITY ACCOUNT
Activity
Head of Nursing (acute) Integrated Medical and Rehabilitation Services (IMRS) and the senior
sister in charge of RNRU will meet with the RNRU patient family carers group and patients to
discuss the contents of the CQC inspection report and to gain their views and suggestions
on the actions planned.
This meeting will also be an opportunity to set up regular meetings at a time (including
evenings or on a Saturday) and frequency to suit the family carers. These meetings will
complement the regular individual meetings between the key worker and each family.
The Head of Occupational Therapy will develop a patient feedback questionnaire which will
be implemented and reported on to the PEEC.
When/Status
March 2012
completed
September 2012
2. Monitoring the way in which nursing staff and therapists work together to provide
personal care to patients
Joint sessions between nursing staff and therapists are recorded and reported to UK specialist
Rehabilitation Outcomes Collaborative (UK-ROC) as well as recorded in the individual patient
record.
A summary of these sessions will be discussed at the quarterly Head of Department meeting. July 2012
3. ‘Priorities of Care’ audits to assess, plan, implement and evaluate nursing care
The unit will continue to carry out monthly ‘Priorities of Care’ audits. Particular attention will
be paid to the results for the ‘hygiene and continence’ element of this framework.
A summary of these audits and the follow up action needed will be discussed at the
quarterly Head of Department meeting.
November 2012
4. Improving the recording of feedback from nursing staff
There is a weekly meeting for nursing staff on the unit. These meetings are an opportunity to
discuss a variety of issues such as workload including any occasion where breaks are missed.
The agenda and notes of these meetings will be formalised to include issues such as
workload and staffing resources and any effect on patient care.
A summary of issues raised at the weekly nursing staff meeting will be discussed between
the senior sister in charge of the unit and the IMRS divisional Head of Nursing (acute).
May 2012
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
48 Annual report 2011/12

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 on going
basis, for errors.
• A suite of reports was been 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 the 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.
• There has been significant improvement over the year,
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 2011/12 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 the patients’ valid NHS numbers was:
- 95.6% for admitted patient care
- 97.4% for outpatient care, and
- 86.5% 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.
Information governance (IG)
The Trust’s Information Governance Assessment Report
overall score for 2011/12 was 71%. This is graded as not
satisfactory.
This figure is an improvement on last year (67%) but trusts
are expected to achieve level two in all areas in order to be
graded as satisfactory. Homerton is at level one for three
areas.
The key actions to address the three areas are managed by
the Information Governance Committee, these are:
• improvements in training - trusts are required to
demonstrate that 95% of staff have had IG training
every year.
• carry out a clinical records keeping audit – this is
currently underway (April 2012).
• pseudonomisation – this is about ensuring we do not
use personal identifiable information for secondary use.
The information team have the software in place to
assist with this, but we are not permitted to score this
element of the toolkit at level 2 until we have level 2 in
all other areas.
Alternative ways of delivering IG training to staff are being
discussed with Connecting for Health in order to improve
and maintain training rates over the coming years.
Payment by Results
The Trust was subject to the Payment by Results clinical
coding audit during the reporting period by the Audit
Commission and the error rate* in the latest published
audit for that period for spells with an error affecting price
(clinical coding) was: 3.7%
Primary diagnoses incorrect 7.5%
Secondary diagnoses incorrect 13.8%
Primary procedure incorrect 4.0%
Secondary procedures incorrect 8.7%
These results should not be extrapolated further than the
actual sample audited; the following services were audited:
Total sample size was 200 finished
consultant episodes (FCEs)**
Obstetrics: sample size 100 FCEs
Randomly chosen: sample size 100 FCEs
*This audit was of 200 patient records in 2011/12 selected
at random by the Audit Commission from SUS data. The
audit showed that of this sample 3.7% had the inaccurate
code for the patients episode of care recorded.
**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.
Annual report 2011/12 49

QUALITY ACCOUNT
SECTION 4 – Quality improvements
2011-2012
This section of the report summarises our performance
from April 2011 to the end of March 2012 in relation to:
national targets; the priorities we set in last year’s Quality
Account, CQUINS, and other work streams directly relating
to the quality of care.
The information is divided into four sections: specific
National Targets; Safety; Clinical Effectiveness; and Patient
Experience.
National targets
The Trust is required to monitor regularly its position against
a number of performance targets set buy the Department
of Health. Table 8 shows the Trust’s position against these
targets for the years 2011/12 against the required target.
Table 8: Trust position against national performance targets
for 2011/12.
2011/12
Actual
2011/12
Target
Emergency Care patients seen in

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 three cases.
We have not had a single patient develop MRSA
bacteraemia this year. This is due to the hard work of
our Infection Control Team working together with staff,
patients and visitors.
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 now screened on admission to hospital for
MRSA and some prior to coming in for planned procedure.
Work continues in relation to invasive devices such as drips
and drains to reduce the risk of patients developing an
infection.
Our rate of MRSA bacteraemia not to be exceeded for next
year is no more than one case.
Clostridium difficile (C.diff)
Our C.diff rates this year have been low - a total of nine
patients developed C.diff in hospital – this is one patient
less than the year before. We are maintaining very low
rates of C.diff in the hospital (see page 54 for further
information).
Priorities 2011/12
In 2011/12 following consultation with our Council of
Governors and our Foundation Trust members we identified
four priorities that the Board of Directors agreed we should
strive to achieve. These were put together with the local,
regional and local CQUINS to formally provide our quality
priorities for 2011/12.
Safety Standards: safety of patient, staff
and visitors
Maintaining the safety of patients, staff and visitors is a vital
part of running the Trust; anyone who visits us for clinical
care or to work needs to be confident that they will be safe
whilst they are here.
Priority 1 – Maximise safety for patients – ensure that
clinical incidents are regularly reported in the Trust and
demonstrate improvements to safety gained from this
information.
This year we aimed to increase our clinical incident
reporting to demonstrate that our safety culture is
improving. Figure 1 shows the total clinical incidents
reported from April 2009 to the end of March 2012 (data
from the Trust’s risk management database).
Figure 1: Total reported clinical incidents April 2009 to
March 2012
4100
4000
3900
3800
3700
3600
3500
3400
3300
3200
3100
3000
09/10 10/11 11/12
2009/10 2010/11 2011/12
We reported 4033 clinical incidents last year, 641 more
than the year before. The fact that we have become a
larger organisation, with the integration of community
health services, does not in itself account for this increase.
There has been a general rise in clinical incident reporting.
This is a positive sign and indicates that staff are confident
to report all clinical incidents no matter how small.
Information collated from data we sent to the National
Patient Safety Agency (NPSA) for 1 April 2011 and 30
September 2011 shows that we were reporting 7.9 clinical
incidents for every 100 patient admissions to the hospital.
When we compare ourselves to other NHS trusts of a
similar size in England, eight out of 30 trusts are reporting
a greater number of incidents per 100 admissions than
us. We are just below the top 25% of trusts with high
reporting rates. The top trust in the group reports 14.5
incidents for every 100 patient admissions.
Because we have seen an improvement over the year with
no increased harm this priority will be retired from the
Quality Account for the coming year. Despite not being
a Quality Account priority our work will continue to train
more staff to use the risk management database and carry
on encouraging reporting as part of routine practice within
the Trust. We aspire to be in the top 25% of trusts for
reporting by the end of March 2013.
Figure 2 shows the total incidents reported by the degree
of harm to the patient. The majority (77%) of reported
incidents resulted in no harm to the patient. The number
of patients who sustained minor harm has increased
compared to last year from 14% to 18%. Moderate and
severe harm incidents have made marginal increases.
We will be closely monitoring all clinical incidents that result
in any type of harm and reviewing the data to ensure that
Annual report 2011/12 51

QUALITY ACCOUNT
the correct information is recorded. For incidents where
there is no harm, risk reducing actions are put into place to
guard against harm.
Figure 2: Degree of harm to patients from clinical incidents
April 2009 to March 2012
3500
3000
2500
2000
1500
1000
500
0
None Minor Moderate Severe Catas
2009/10 2010/11 2011/12
The trend in increased reporting indicates that we are
becoming more safety aware and reporting incidents even
though no one was injured. This is a trend we want to
encourage as it gives us an early opportunity to address any
issues and take steps to reduce risks to the patients in our
care.
The top three reported types of clinical incidents were
related to: falls, medication, and treatment. The top three
have remained the same for the last three years.
Serious incidents (SI)
A serious incident or SI covers incidents with serious
consequences including those that compromise the Trust
from providing care e.g. fire, power failure, adverse serious
media coverage or a patient sustaining a major injury or
avoidable death as a result of a clinical incident whilst in
the care of the Trust. These incidents are reported to the
Strategic Health Authority, NHS London and the Trust
commissioners NHS North East London and the City.
As our incident reporting rate has risen so has our SI
reporting rate. During the past year 2011/12 we have
reported 62 serious incidents. These SIs represent 1.5% of
all reported clinical incidents; an increase of 0.5% on last
year.
All SIs are investigated using root cause analysis methods
to establish precisely why the incident occurred so
recommendations can be made for changes to practice.
This process reduces the risk of a similar incident occurring
again.
The highest number of SIs last year related to pressure
ulcers (see page 52 for further information on pressure
ulcers). Pressure ulcers occur in both hospital and
community settings. The investigations into these pressure
ulcers have led to the following changes:
• The implementation of a Trust wide policy on the
prevention and treatment of pressure ulcers.
• The development of an information leaflet for patients
and their families.
• Increased education and awareness amongst staff of
how to prevent ulcers occurring.
• Increased education amongst staff on the grading and
management of pressure ulcers that do develop.
Never Events
The National Patient Safety Agency and the Department of
Health have identified certain incidents that should never
happen; these are known as Never Events.
This list of never events was extended from eight to 25 last
year. Please see the following web site for more information
http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_124552
Last year at Homerton we had three Never Events: two
involving a retained swab following a procedure and one
wrong site surgery. We have reviewed current clinical
practice to establish how these events occurred and audited
the areas where similar activities are carried out. The fact
that these incidents have happened has been shared with
staff so that they can learn from them.
The procedure for checking the details of a patient and
the planned procedure prior to surgery was audited in
November 2011, the results demonstrated good practice.
Some areas for improvement were identified and the
clinical teams have discussed the audit and changed
practice. The audit will be repeated again in the summer.
The policy and practice related to the counting of swabs
following any clinical procedure, has been reviewed
and made more stringent. An audit of this policy will be
repeated in the summer.
Pressure ulcers
Pressure ulcer prevention remains of the utmost importance
at Homerton, whether for patients in hospital or patients
we are caring for at home.
Figures 3 and 4 show the total number of pressure ulcers
of all grades that were detected in the Trust in 2011/12.
The ulcer grading runs from: 1 being the mildest blanching
effect on the skin and surrounding tissues to 4 being the
most severe.
Prevention of pressure ulcers is imperative, however if a
patient does develop a pressure ulcer it is essential that this
52 Annual report 2011/12

is reported as a clinical incident so that the extent of this
problem is clear and can be addressed.
The reporting of pressure ulcers is a vital tool in reducing
their occurrence. These figures are higher than last year
partly due to increased awareness amongst staff. Staff are
acutely conscious of the importance of; monitoring patients
skin and reporting even the most minor blemish, calling for
assistance and initiating treatment as soon as possible.
We are working toward zero tolerance of pressure
ulcers, this is one of the elements of the harm free care
programme that the Trust will be part of next year.
Figure 3: Total Hospital acquired pressure ulcers by month
20
18
16
14
12
10
8
6
4
2
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Figure 5: Total Homerton community acquired pressure
ulcers by month
5
4
4
3
3
2
2
1
1
0
The total number of pressure ulcers acquired in the
community by grade 2 to 4 is shown in figure 6
Figure 6: Total community pressure ulcers by grade April
2011 to March 2012
12
10
8
6
4
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2
Figure 4: Total hospital acquired pressure ulcers grade 2 to 4
April 2011 to March 2012
90
80
0
Hommerton
Community Care
acquired pressure
ulcer grade 2
Hommerton
Community Care
acquired pressure
ulcer grade 3
Hommerton
Community Care
acquired pressure
ulcer grade 4
70
60
50
40
30
20
10
Falls
Over the course of the year the number of reported falls
has increased, this is thought to be due to increased
awareness of staff to the requirement to report all
incidents. Figure 7 provides information on the number of
falls reported.
0
Hospital acquired
(>72 hours)
pressure ulcer
grade 2
Hospital acquired
(>72 hours)
pressure ulcer
grade 3
Hospital acquired
(>72 hours)
pressure ulcer
grade 4
Figure 7: Total reported patient falls April 2010 to
March 2012
790
780
770
760
750
740
730
720
2010/11 2011/12
The main increase appears to be the type of fall where the
patient has sustained minor harm; this could be anything
from a bruise to a laceration.
Annual report 2011/12 53

QUALITY ACCOUNT
Figure 8 shows actual harm to patients in 2010/11
compared with 2011/12
Figure 8: Degree of actual harm to patients as a result of a
fall April 2010 – March 2012
600
500
400
300
200
100
0
None Minor Moderate Severe Catas
2010/11 2011/12
All patients who fall in the hospital are reviewed by the Falls
Prevention Nurse Specialist. Staff training is on going to
ensure all patients are assessed on admission for their risk
of falling and that appropriate measures are put in place to
reduce the risks to the patient.
There is also a Falls Prevention Clinic which works together
with patients to help them to take actions that can reduce
their risk of falling, particularly at home.
Summary Hospital‐Level Mortality Indicator (SHMI)
The way mortality rates are calculated nationally has been
altered to a new measure called the Summary Hospital‐
Level Mortality Indicator (SHMI). This 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. In the data produced by the NHS
Information Centre in January 2012 (coving the period July
2010 to June 2011) our 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 on the data from the NHS
information centre.
The percentage of our admitted patients during this time
period with a palliative care coding was 0.1%.
The percentage of patients that died with a palliative care
coding was 2.7%.
We will be focusing on improving safety and reducing our
mortality rate next year as a Quality Account priority and
part of the QUEST programme.
Clostridium difficile (C.diff)
Our C.diff rates have been very low - a total of nine patients
developed C.diff infection in hospital last year – this is one
patient less than the year before. We are maintaining very
low rates of C.diff in the hospital.
This is due to a combination of:
• hand hygiene which 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
shared on the Trust intranet. These audits show that
staff are washing/using alcohol gel on their hands on
average 90% of the time. 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.
• the work of the infection control team and other staff.
• if any patient does develop C.diff whilst in hospital
they continue to be looked after by their own team of
doctors and nurses but they are also seen at least once
a week on a multidisciplinary ward round – the team is
made up of; infection control nurses, a microbiologist
(doctor), dietitians and the antibiotic pharmacist. These
patients are monitored and followed up by this team for
the rest of their stay in hospital.
Our C.diff rate per 100,000 bed days is not yet available
for last year, but the figures for the preceding three years
indicate the improvements we have made in reducing the
number of patients developing C.diff in hospital. Figure
9 shows C.diff rates in patients over two years of age (all
patients) and also in patients over 65 years of age.
Figure 9: Rates of C.diff per 100,000 bed days at Homerton
from 2008 to 2011
80
70
60
50
40
30
20
10
0
2008-09 2009-10 2010-11
C.diff rate per 1000,000
bed days in patients >2
C.diff rate per 1000,000
bed days in patients >65
When we compare our rates of C.diff to other trusts, we
are one of only nine trusts in England that currently has a
C.diff rate of fewer than 10 cases per 100,000 bed days for
all patients. We are also in the top five of trusts with a rate
of fewer than 20 cases per 100,000 bed days for patients
over 65.
54 Annual report 2011/12

This data was taken from:
http://www.hpa.org.uk/Topics/InfectiousDiseases/
InfectionsAZ/ClostridiumDifficile/EpidemiologicalData/
MandatorySurveillance/cdiffMandatoryReportingScheme/
High impact interventions (HIIs)
We are continuing with the activities that have a high
impact on reducing the risk of infection related to care.
These are the bundles of care for specific interventions that
involve; how to carry out that care and how to measure
that it has been done correctly. Using the care bundle
approach keeps the risk of infection to patients low. The
high impact interventions that we use include:
• Central venous catheter care (insertion and ongoing)
• Peripheral venous catheter care (insertion and ongoing)
• Renal dialysis catheter care (insertion and ongoing)
• Prevention of surgical site Infection (pre operative and
peri operative)
• Care of ventilated patients (ongoing)
• Urinary catheter care (insertion and ongoing)
• Reducing the risk of C.diff.
• Clinical equipment decontamination (Not contaminated
and HCAI)
• Stoma care (planning and ongoing)
All clinical teams collect data on how they are carrying out
the high impact interventions, this data is then sent to the
Infection Control Team who monitor activity, collate the
information and work with any areas that require support.
Patient safety CQUINS
Table 9 shows the Trust position against the patient safety
CQUINS
Table 9: Patient safety CQUINS
CQUIN
What were we
aiming to do
Did we
achieve it
What is the evidence
National
Introduce the Department
of Health’s patients risk
assessment for venous
thrombosis (blood clots) for
all adult patients
Demonstrate that 90%
of all eligible adult
patients have been
assessed for VTE risk in
quarter 4 (January to
end March)
No
See below.
London wide
Continue with and extend
the Enhanced Recovery
Programme to reduce
length of stay and improve
the patient’s experience of
surgery.
Report on the national
ERP database
Partial
This CQUIN is also about Clinical
effectiveness and the patient experience
Gynaecology did not come in to the
programme until October 2011 which
meant reporting on the national database
did not included gynaecology for the full
year.
Reduce length of stay
to agreed targets in
orthopaedics, colorectal,
gynaecology and
urology (for specific
procedures)
Use of fluid directed
therapy in colorectal
patients.
Carry out surgery on the
day of admission
50% Length of stay targets have not been met
in colorectal and orthopaedics.
100%
(see below for more detail)
85% This figure is due to gynaecology data not
being included on the national data base
for the full year.
Annual report 2011/12 55

QUALITY ACCOUNT
CQUIN
What were we
aiming to do
Did we
achieve it
What is the evidence
Homerton
Discharge communications
Reduce the amount of
discharge summaries
not received by GPs
(ELC/GP audit
showed the
following)
Quality: 70%
Timeliness:47%
Reduce the time for
outpatients letters to
reach GPs
Yes
Data collected by the commissioners
Homerton
Surgical Theatres
Programme
For 95% of patients
requiring emergency
surgery to have the
surgery done in

In orthopaedics, an audit by junior doctors showed that
it would be advantageous in helping patients get home
quickly to; enhance preparation of patients preoperatively
and ensure early action to address any patient not
recovering as rapidly as expected post operatively. To
address these elements of the ERP a multidisciplinary,
orthopaedic specific, Enhanced Recovery Group has been
set up to work on every element of the patients pathway to
ensure that optimum conditions are in place for patients to
go home on the expected day following surgery.
Although ERP will not be a CQUIN for 2012/13 we will
be continuing our work to become an ERP hospital. All
patients having surgery when they need to stay overnight
in hospital will benefit from ERP.
Clinical effectiveness: Effective treatment
with good outcomes
Priority 2 – Promote effective care – 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 or planning to use them
in everyday practice. This year we aimed to develop a
formal audit programme to ensure that established clinical
guidelines from NICE that are relevant to the Trust are
audited regularly to demonstrate that clinical practice
continues to be of the highest standard.
NICE guidance is broad ranging and affects a significant
proportion of our services. Some cover the entire
patient pathway, others specific treatments with specific
medications.
Over the last year we have reviewed all NICE guidance
that has been released since 2003 to see which ones
are relevant to the Trust – as of April 2012 a total of 184
guidelines apply to our services. These are broken down as
follows:
Clinical Guidelines 96
Interventional Procedures 40
Technology appraisals (not medicines) 15
Public Health Guidelines 31
Medical Technologies 2
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 10.
We are currently assessing 45 guidelines to see if they are
relevant to our practice (public health and interventional
procedures) and waiting for information on compliance
from clinicians on 18 guidelines (clinical guidelines).
There are challenges involved in collecting this information
and we currently do not have a complete picture. For this
reason this remains a priority for next year.
Fourteen audits have been carried out by departments in
the past year against their use of NICE guidelines; these
ranged from smoking cessation to the use of analgesia in
patients with dementia to use of the falls pathway by the
Therapy at Home Team. In any audit where a shortfall in
practice was identified an action plan was put in place to
address any issues the audit had highlighted.
Table 10: Implementation of NICE guidance from
March 11 to March 12
Type of Guideline
Number Fully Implemented
March 2012
Percentage of relevant
guidelines fully
implemented
March 2012
Percentage of relevant
guidelines fully
implemented
March 2011
Clinical Guidelines 69 72% 27%
Interventional Procedures 16 35% 19%
Technology Appraisals 15 (non medication) 100% 8%
Annual report 2011/12 57

QUALITY ACCOUNT
Table 11 shows the Trust’s position against clinical
effectiveness indicators.
Table 11: 2010/11 position against clinical effectiveness
indicators CQUINS
CQUIN
What did we have to do
Did we
achieve it
What is the evidence
In the community
The Virtual Ward
(community)
N/A
This CQUIN has been
discontinued. There is another
project beginning relating to
regular, case conferences with all
professionals to discuss patients
being looked after at home or in
the community
London Wide
Adult patients should be
reviewed by a consultant
within 12 hours of
admission to hospital
75% of adult emergency patients
should be reviewed by a consultant
within 12 hours of admission
Yes
This CQUIN is also about patient
safety and the patient experience
Locally collected data
In the community:
End of Life Care (EoLC)
Ensure 80% of patients who die at
home are to be on the Liverpool Care
Pathway
100% This CQUIN is also about patient
safety and the patient experience
Local data
Repeat the patient equipment audit
and report on outcomes.
Achieved
Local audit
Increase referrals to Palliative Care
For 95% of patients who die at home
to have a documented advance care
planning discussion
100%
Achieved
Local data
Local data
Report the progress on actions set
out in 11/12 LCP improvement Plan,
including:
Evidence of engagement of staff
through ongoing training sessions and/
or meetings with District Nurses, team
leaders, community matrons
End of Life Facilitator and/or Link
Nurses to be informed of all new EoLC
patients within 24 hours of referral to
the service
Process to ensure proactive case
finding of EoLC patients on ACN
caseload
The report
has been
produced
which
demonstrates
all the
requirements
listed.
Local data
Improving the 0-5 year
pathway for children
Development of a systematic approach
to recording the 0-5 year old pathway
developed in 2010/11.
A systematic
approach
has been
developed
This CQUIN is also about patient
safety
58 Annual report 2011/12

CQUIN
What did we have to do
Did we
achieve it
What is the evidence
New Birth Visits at 14 days to be 100%
New Birth Visits at 21 days to be 100%
8-10 month Development Checks
to be 75%
Over all areas
90% was
achieved
Local data
27 month Development Checks to be
75%
Specialist CQUINS
Neonatal Intensive Care
(NICU) CQUIN
Reduction in length of stay in NICU
Increase the number of outcome
assessments at 2 years of age
Yes
Yes
Local data
Local data – measure was on
appointments issued
HIV
Improve involvement of HIV patients in
decisions about their care
Yes
Local data demonstrated an
increase in all areas
Increase the numbers of HIV positive
patients consenting to GP notification
Yes
Increase the numbers of HIV positive
patients consenting, letter sent to GP
Yes
Reports from clinical services demonstrating
effectiveness
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.
An audit carried out by the team this year looked at their
activity between June and November 2011 and compared
this with previous data from June to November 2009:
• There has been a 19% increase in patients being seen
by FRDT in the Emergency Department (ED) to prevent
unnecessary admission to hospital.
• There has been an increase of 4% in the patients
discharged home from the ED when seen by FRDT, this is
from 82% to 86%.
• There has been a 67% increase in community referrals
(patients seen urgently by FRDT at home) in the last two
years. GPs know of the service and are using it to help
their patients.
• There has been a 10% increase in the number of
patients kept at home when seen urgently in the
community by FRDT, this is from 87% to 97%.
• The team has seen a 13.7% increase in total referrals for
their expertise, from 2009/10 to 2011/12.
FRDT are instrumental in a multiagency group reviewing
patients that frequently attend the ED, initial figures have
shown that patients discussed at this group and actions
taken to support them has resulted in a 42% reduction in
the frequency of attendance to the ED in this patient group
from 2010 to 2011.
This indicates that the work of FRDT and the frequent
attenders group is assisting people to be cared for in the
most effective way and helping patients to stay at home
unless there is an overriding clinical need for them to be
admitted to hospital.
HIV team
There is a project that has been running for two years, run
by one of the HIV liaison nurses and a TB outreach worker,
to de-stigmatise perceptions of HIV and TB in Hackney’s
faith communities.
The aim of the project team is to normalise discussion
around HIV and TB within traditionally hard-to-reach faith
groups, with the expectation that this will make routine
screening for both conditions more acceptable and improve
rates of early disease detection.
Annual report 2011/12 59

QUALITY ACCOUNT
To support this, they aim to develop culturally appropriate
information about HIV and TB, in terms of signs and
symptoms, diagnosis and treatment, and to train peer
educators.
This year’s report from the team carrying out the work
indicates a number of points.
• They have used all networking opportunities to access
groups of people and talk about TB and HIV. In some
cases the team has been asked back to develop a
relationship with specific groups.
• Achieving their aims and objectives, this year has
been harder and slower than they anticipated. The
most successful work has been done with the Turkish
and Polish communities, which looks as if it will be
sustainable beyond the life of the project.
• In certain ways, the team have strayed from their original
objective of working exclusively with faith communities,
but they have gone into areas where the need is
greatest.
• The demographic recording includes asking everyone
what their religion is, and no-one has objected to being
screened for HIV or TB on the grounds of faith or stigma,
so far.
• Because for many populations in Hackney, faith and
culture are synonymous, the team had anticipated
that pathways into communities would be via clerics,
churches and mosques. This past year has shown other
access points, such as the women’s coffee mornings, the
team will be exploring these during the next year.
The team have also managed to gain some further grant
money for equipment to help them run their Wednesday
evening clinic at a homelessness drop-in centre run by
North London Action for the Homeless.
Detecting TB and HIV early enables staff to manage
the patient as effectively as possible, reduce the costs
of treatment and help to reduce the risk of onward
transmission.
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 ran a survey in April 2011 to identify the views
of staff that used their services, to assist with the care of
acutely ill patients. The team had a 75% response rate to
their questionnaire.
100% of staff knew how to contact CCOT and 95% of
them had done so. 96% of staff thought that the CCOT
were supportive and helpful to them.
Of concern was that 43% of staff felt that staff in their
clinical area lacked the skills to care for an acutely sick
patient, but that the members of CCOT had made a
difference to this knowledge deficit in 85% of cases.
Staff also thought that through the team’s efforts,
particularly teaching, they had enabled the ward staff
to reduce risks for deteriorating patients and improved
the care of patients being transferred to a ward from the
Intensive Care Unit.
Staff commented as part of the survey that they would like
more teaching and training about the deteriorating and the
unwell patient. CCOT are currently reviewing what further
help and support they can offer staff within their current
resources.
Training on the deteriorating and unwell patient is provided
to all newly qualified nurses and junior doctors in the Trust’s
Simulation Centre. This training is evaluated well particularly
the aspect of nurses and doctors learning together.
Readmission rates
We monitor readmissions to hospital within 30 days of
the last discharge it is essential for patients that when they
are ready to go home everything is in place so that they
can look after themselves, with appropriate community
support and not have to return to hospital. Our current
readmission rate is 6.9% (this was calculated over the year).
Readmission to hospital is an issue across the county and
reducing the rate will be one of our priorities for the year
ahead, in line with the QUEST programme.
Patient Experience: a good experience for
patients and staff
Improving the experience patients have when they are
treated remains a high priority.
Patients’ experience can be positive or negative and we
want and need feedback on all types of experience from
our patients. We use this information to support services,
change them where necessary, and in the case of new
services, set them up with patients’ input.
Priority 3 – Further improve the experience of our
patients – increase the number of patients who answer
“Yes always” to the question posed in the national patient
survey: Overall, did you feel you were treated with respect
and dignity while you were in the hospital
Our score remained the same in both 2009 and 2010 at
68%.
60 Annual report 2011/12

There is still work to be done in terms of a greater
percentage of “yes always“ answers in the patient survey
which is a publicly scrutinised document and used to
compare our Trust to others in the country.
Our target for the year was to improve this response rate by
at least 3%.
We did not achieve this target – our percentage from the
patients responses in the national inpatients survey was
66% for “yes always” which is a decrease compared to
previous years. There is insufficient information in the PET
data to add information from another source to this data.
However the information from the maternity survey is
positive (see page 65 for details)
Even though we did not achieve this specific priority we
are retiring it from the Quality Account because the need
to ensure patients are treated with dignity and respect
underpins the patients’ experience strategy and the three
campaigns within the strategy. Improvements in patients’
experience in the Trust and their responses to this question
in the national survey will be managed and improved
through the patients experience strategy. We think that this
approach will work more effectively than having this as a
single Quality Account priority.
Local, more frequent surveys will be undertaken to ensure
that the patients’ experience of dignity and respect in all
clinical areas is feedback to staff regularly, so actions can be
taken quickly to address any concerns that are raised. These
surveys will be monitored by the Patient Experience and
Engagement Committee.
Priority 4 - Increase involvement and engagement of the
local community in planning our services and developing
the Trust.
Develop the new strategy with key stakeholders for patient
and public involvement. Improve communication and
feedback from members of the community that are not
members of the Foundation Trust.
Strategy
The Homerton Patient Experience Strategy has been
developed following a large listening exercise where the
views of patients, users, members, staff and Governors
were sought. Often, informing users of developments is
mistaken for involving users in developments. This strategy
aims to ensure users are involved in designing solutions to
issues which arise, within the constraints of commissioning
and financial frameworks. The strategy was launched in
September 2011.
The aims of the strategy are:
• to ensure patients and their families receive an
experience that not only meets but exceeds their
expectations of services at the Trust
• to enable to maintain and increase public confidence
and to sustain its reputation as a health care provider of
choice and for that to be reflected in an improvement in
the national patient survey scores
• to demonstrate that we are able to listen and respond
to the views of patients, their families and the local
community to drive service improvements
• for the Trust to meet its regulatory and statutory
requirements in relation to patient and public
involvement.
There are three campaigns as part of the strategy:
Campaign One: Delivering Thoughtful Care
Campaign Two: Leaving our care with confidence
Campaign Three: Getting the Right Information
Each Division is working to demonstrate real improvements
for patients in these key areas. Over the coming year
the Patient Experience Strategy will provide a successful
framework to enable patients, not only to feel more
involved in the Trust, but to receive the best possible
experience whilst in our care.
Engagement
Engaging our patients, the public, members, staff and
stakeholders in the planning and delivery of high quality
services is key to our model of improving the patient
experience. Within the strategy, engagement is divided into
two separate activities
• Gathering feedback
• Building involvement to improve services
The information that we can use to transform services
comes from the experiences of people using those services.
A ‘User Engagement Group’ is to be set up which will work
closely with the Council of Governors to develop new and
innovative ways to involve and elicit views from a broad
spectrum of users and staff.
One example is organising large community events
where people will have the opportunity to hear about
developments planned within the Trust and give their views
or active support.
The user engagement group will report into the Patient
Experience and Engagement Committee.
Annual report 2011/12 61

QUALITY ACCOUNT
Feedback
The Patient Feedback Committee works proactively and in
partnership with our Governors, members, patients and
the wider community to learn from the patient experience;
identifying themes from feedback and reporting them to
Patient Experience and Engagement Committee for further
action.
Our patient feedback strategy includes a programme of
planned audits within our three clinical divisions using the
Picker Institute portable hand-held electronic devices. The
survey period will be for one month followed by action
planning and then a repeat survey.
Currently we are gathering feedback from people using
the following: patient questionnaires, staff questionnaires
and mealtime surveys. These are carried out by Homerton
Helper volunteers. Patients are also telephoned after
discharge from hospital so we can to gather their views
about their experience of care.
These surveys began at the end of February 2012. So far
we have gathered views from:
• 206 patients in outpatient clinics
• 20 responses from children’s community services
• 113 from patients talking about eating and drinking
• 55 inpatients, and
• 21 staff surveys.
Monthly reports are sent to each Division for discussion and
the implementation of any actions.
Because we have achieved this priority (the implementation
of the strategy) we are retiring it as a Quality Account
priority. The strategy is a three year plan, progress will be
monitored by the Patient Experience and Engagement
Committee chaired by the Associate Director: Patient
Experience.
The Quality Account priorities for the coming year have
been mapped to the relevant; patient experience strategy
campaign, Trust objective and element of Quest. This
mapping demonstrates our commitment to working
collaboratively towards an essential goal – safe, effective
and thoughtful care.
Face-to-face patient feedback day in Outpatients
A survey was carried on 7 July 2011 in the main entrance
of the hospital and in Starlight Ward (our children’s ward).
Patients were invited to sit with staff and discuss set
questions on their experience in Outpatients that day.
Outpatient managers, reception staff and nursing assistants
helped to collect the feedback.
Staff actively asked patients to participate rather than just
wait for patients to come to them. 83 out of a possible 904
patients gave feedback on their Outpatient visit; this was
9% of all patients attending an outpatient appointment
that day.
The results were positive, some areas for improvement were
identified and a follow up survey is planned for July 2012 to
ensure that recommendations have been actioned.
Introduction of the Purple Book for patients with
learning difficulties
Seven hundred copies of the Purple Book - which is
designed for patients to be able to communicate clearly
with staff - have been distributed across Hackney. Positive
feedback has been given by people with learning disabilities
to the work done by Homerton over the past year.
The Trust web site has an enabled map showing the
route to the hospital from the train station in photos
and plain text. The route was photographed and the
map was developed by Hackney mappers, who all have
learning disabilities. This map was tested by the Camden
easy information group. Please follow this link for further
information:
http://enabledmaps.com/tool/index.php/view/map/a-stepfree-route-from-homerton-overland-station-to-homertonhospital
62 Annual report 2011/12

Patient experience CQUINS
Table 12 shows the Trust position against the patient experience CQUINS
Table 12: Patient experience CQUINS
CQUIN
Goal
Did we
achieve
it
What is the evidence
National
Improve the experience
of patients being
cared for at Homerton
(measured by answers
to five specific questions
in the National Patient
Survey) that are about
the over arching theme
of “responsiveness to
personal needs”
We were asked to improve the
answers to these questions in the
national survey by 5%
1. Were you involved as much as
you wanted to be in decisions about
your care and treatment
2. Did you find someone on the
hospital staff to talk to about your
worries and fears
3. Were you given enough privacy
when discussing your condition and
treatment
No
Results in the in patient survey
The “yes definitely” response had
gone down by 1% i
The “yes definitely” response had
gone down by 5% i
The “yes definitely” response had
gone down by 1% i
4. Did a member of staff tell you
about medication side effects to
watch for when you went home
The “yes completely” response had
gone down by 6% i
5. Did hospital staff tell you who to
contact if you were worried about
your condition or treatment after
you left hospital
The “yes” response to t his
question had gone up by 6% h
Homerton specific
Maternity patient
experience (in the
maternity patient survey)
We focused on out patients
responses to five questions in the
maternity survey
1. Percentage of women who have
a named midwife documented on
notes – currently approx 30% would
like to see this rise to 50% over this
year
Yes
We commissioned the national
maternity survey to be carried out
again just with Homerton patients.
83% this is considerable
improvement
h
2. Increase numbers of women who
confirm having the opportunity for
skin to skin contact following birth
currently 72% would like to see that
increase by 8%
79% of women had skin to skin
contact - this is an increase of 5%.
3. Increase the numbers of women
sutured within 1hr currently 55%
increase to 65%
Results show only 6% of women
waited for more than an hour for
sutures – this is below the national
result of 11%
84% were sutured within an hour
h
Annual report 2011/12 63

QUALITY ACCOUNT
CQUIN
Goal
Did we
achieve
it
What is the evidence
Homerton specific
Maternity patient
experience (in the
maternity patient survey)
4. Inconsistency in feeding advice
given in postnatal period – only 56%
women said advice consistent – see
this increase to 66%
5. Only 68% of women said they
were treated with dignity & respect
–this has improved since 2007 survey,
however would like to see this
increase to 75% over the year
Yes
71% of women felt they had
consistent advice on feeding.
h
This has increased to 86% which
is over the expected increase and
a really positive reflection on the
service.
h
Local patient
experience (hospital)
Aim to achieve a 85% “Yes”
for each of the following questions:
No
This information was collected using
our new hand held devices managed
by the Picker institute
1. Were you greeted in a friendly
manner by a member of staff when
you arrived
81%
2.When you first arrived were you
made to feel welcome by hospital
staff
80%
3.Have hospital staff asked you how
you would like to be addressed (For
example by your first name or title)
35%
4.Do the nurses caring for you keep
you informed about what is going to
happen each day
44%
5.As far as you know, do hospital
staff wash or clean their hands
between touching patients
79%
In the community
patient experience
Implement a structure to enable the
patient experience in the community
to be captured.
Yes
The survey was undertaken – the
results are in the process of being
analysed.
Carry out an assessment of patients
experience in the community aiming
for an 80% positive response rate
The only element not achieving 80%
was:
“Did staff ask you what you want to
be called”
The positive response rate to this
question was 23%.
This is the same question that
received the lowest score when
asked of patients in hospital.
64 Annual report 2011/12

Specialist CQUIN
Regional Neurological
Rehabilitation Unit
(RNRU)
May
baseline
Data collected on PET from May
to September demonstrated the
following improvements
up to September.
A patient feedback
survey was required to be
carried out covering the
following five questions
Were staff friendly, approachable and
sensitive to your needs
How long did you usually wait after
using the call bell
71%
47%
h 84%
h 62%
Were your family and visitors made to
feel welcome
88%
h 95%
Were you satisfied with the overall
cleanliness of the ward
82%
h 91%
Did you receive adequate assistance
with choosing and eating your meal
79%
h 89%
National inpatient survey
The Quality Health National Inpatient Survey was sent to
850 patients who were discharged from our acute hospital
in June, July or August 2011. The expected response
rate for the National Patient Survey is 60% (approx 500
responses)
Homerton had responses from 330 patients - a response
rate of 41%. Our results have to be read bearing this in
mind.
From the results, the overarching areas where the survey
indicates a review and possible actions may be required are:
• communication between staff and patients
• the involvement of patients in their care
• the type and quality of information that is given to
patients particularly pre operative and post operative.
• delays to discharge.
All of these elements, that patients indicated they
are concerned about will be addressed by the Patient
Experience Strategy campaigns
Campaign One: Delivering Thoughtful Care
Campaign Two: Leaving our care with confidence
Campaign Three: Getting the Right Information
Maternity
In August/September 2011 a survey of women’s experience
in maternity services was carried out.
The survey was completed by 154 women and covered
all aspects of their care during pregnancy, delivery and the
post natal period.
The five questions being monitored for the CQUIN are
detailed in table 12 above. The survey results demonstrated
significant improvements in certain areas of care; there was
considerable reduction in the time women were waiting for
suturing following delivery, women felt they were getting
consistent feeding advice and an increased number of
women had a named midwife.
Though the number of women stating they had an
opportunity for skin to skin contact immediately after
delivery was higher than the previous survey, this did not
improve as much as we were anticipating.
The areas that we aim to address over the coming year are:
• increasing the consistency of information given to
women prior to consenting for tests, this has already
been discussed at the Hackney Maternity Board
meeting which is chaired by a local GP. GPs have equal
responsibility, with midwives, for this aspect of ante natal
care.
• improving consistency in the advice given by midwives
and carers regarding women breast or bottle feeding
their babies
• looking at ways we can increase the percentage of
women who feel that in the postnatal period they were
treated with respect and kindness.
Annual report 2011/12 65

QUALITY ACCOUNT
The final survey report will be shared with staff and action
plan developed to address areas of concern. The action
plan will by monitored at the Maternity Risk Management
and Clinical Governance Committee.
Outpatients
The National Outpatient Survey was carried out between
June and October 2011, a questionnaire was sent to
patients who had recently attended an outpatient
appointment for each NHS trust in England. Responses
were received from 355 patients at Homerton.
Our results showed improvements over the last year in:
• choice of appointment time and waiting time (for an
appointment)
• answers that could be understood from the doctor by
the patient
• involvement in decisions about their care and treatment.
Patients’ trust and confidence in the doctors /other health
professionals also improved since last year but other Trusts
had improved more. We are monitoring this aspect of
patient experience using the surveys in our hand held Picker
devices.
One of our lowest scores were about patients not being
seen on time for their appointment and the lack of
information about whether a clinic was running late.
Waiting times are monitored and this information is feed
back to the relevant division and the consultants so that
actions can be taken to reduce waiting times. We now have
boards which display information in order that patients
know if there is a delay and an update announcement is
given every 15 minutes.
Our scores for the outpatient environment were:
8.5 /10 for describing the Outpatients Department as clean.
7.4 /10 for describing the toilets in the Outpatients
Department as clean.
We have refitted the toilets and ensure they are checked
regularly by the domestic staff to ensure they are kept as
clean as possible. We have also installed new chairs in the
waiting area.
In both our community and hospital based sexual health
clinical patients responded as follows:
• 95% of them said they were made to feel welcome by
reception staff
• 95% they had trust and confidence in the staff treating
them
• 95% said they were treated with dignity and respect
• and >95% would recommend the service to family or
friends
• the only question where we scored in the 80% range
was patients view of whether staff had explained their
medications and any possible side effects to them.
This positive feedback has been maintained from the year
before and demonstrates the consistently high quality care
that is provided for all patients in our sexual health clinics.
Patient Experience Tracker (PET)
During the year our contract with Dr Foster Intelligence
(who provided the services for our PET trackers) came to
an end. We have data from the first six months of the year
April to September 2011. Almost 5500 patients answered
questions via the PET. These responses are amalgamated
information from across the Trust and do not relate to any
particular department.
A selection of the questions they responded to with their
views is below:
Figure 10: PET question “Were staff friendly, approachable
and sensitive to your needs”
82% stated “yes”
Yes - 1041
Most of time - 70
Some staff were - 57
No - 48
Survey in sexual health
A survey of patients’ experiences of using sexual health
services in North East London was carried out in June 2011.
This was the third year the audit had been carried out.
Between the sexual health clinic at the acute site and those
in the community we see the highest proportion of patients
in the sector.
66 Annual report 2011/12

Figure 11: PET Question – “Were you satisfied with the
overall cleanliness of the ward/ department”
98% of people said yes
Figure 12: PET question – “Did you have confidence and
trust in the nurses treating you”
75% said yes always
Yes - 2169
No - 47
Yes - 2169
Some staff - 47
No - 67
Figure 13: PET question – “Overall how would you rate the
care you received”
69% of patients said excellent or very good
Excellent - 451
Very good - 317
Good - 197
Fair - 88
Poor - 49
Figure 13 shows that the majority of patients responding to
this question thought their care was; excellent, very good
or good. But 12% of patients thought that their care was
fair or poor. This is the same percentage as last year. In
the PET responses this equates to 137 patients who were
disappointed with the care they received between April
and September 2011. It is imperative that we receive this
feedback in order to be able to take action to reduce that
number of patients who have had a fair or poor experience
in hospital.
Our new contract for patient feedback using hand held
devices is with Picker – these devices are currently being
introduced into the Trust.
Patient related outcome measures (PROMS)
Patient related outcome measures (PROMs) measure quality
from the patient perspective. Initially they covered four
clinical procedures and calculate the improvements to a
patients health, as they perceive it, after surgical treatment
using pre and post operative surveys.
The four procedures are:
• hip replacements
• knee replacements
• hernia
• varicose veins (we do not carry out this surgery at
Homerton).
From April 2010 to March 2011 there were 332 patient
episodes for which a patient could complete a pre operative
questionnaire – 188 did so, this a 56.6% participation rate.
Patients undergoing orthopaedic surgery showed the best
response rates. The participation rate across England was
69.8%.
Following their operation we sent 93% of patients a follow
up questionnaire – 70.9% of patients returned these
(national average response rate 89%).
However PROMS can only calculate the patient’s perceived
improvement in their health following surgery when both
questionnaires have been fully completed. Our numbers
of questionnaires that could be used for these calculations
were under the threshold to provide meaningful data for
hernias and hip replacements.
Patients that had knee replacements demonstrated
that they viewed their health had improved following
their operation in line with the national average level of
improvement.
For April to December 2011 we had 280 patients eligible
to be part of PROMS (provisional data), our response rate
to the first questionnaire was 46% - this is in contrast to
the national response rate of 72.5%. Again the patients
who returned the most questionnaires were those
having orthopaedic surgery, 80% for those having knee
replacements. It is likely that this response rate is high as
the Clinical Nurse Practitioner for orthopaedics is involved
Annual report 2011/12 67

QUALITY ACCOUNT
in each patient’s pre-operative preparation and explaining
PROMs is part of this process.
Our overall response rate for patients completing the
second questionnaire was 55% compared to the national
average of 64%. Our response rate is stable at this level.
However in this time period there were not enough fully
completed questionnaires to extract data.
Source for information:
http://www.hesonline.nhs.uk/Ease/servlet/ContentServersit
eID=1937&categoryID=1632
Complaints
There have been more formal complaints from patients in
2011/12 than in the previous two years; the Trust received
253 complaints in 2011/12. Figure 14 shows comparisons
with previous years Trust wide.
Five cases were reviewed by the Ombudsman, in four
cases no action was taken, the fifth case is currently being
assessed.
Figure 14: Total formal complaints April 2009 – March 2012
by month
35
30
25
20
15
10
5
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Figure 15: shows the complaint figures cumulatively over
the year
300
250
200
150
100
2009/10 2010/11 2011/12
The complaints were about the following concerns:
Complaints by type
Area of concern
Number
All aspects of clinical treatment 110
Attitude of staff 44
Communication/information to patients
(written and oral) 25
Appointments, delay/cancellation (out-patient) 19
Admissions, discharge and transfer arrangements 13
Failure to follow agreed procedure 11
Others 31
Total: 253
They were distributed over the following service areas
Complaints by area
Service Area
Number
Inpatient 105
Outpatient 92
Maternity 23
A&E 16
Community Health 15
Elderly 4
Totals: 253
Further information on complaints can be found in the
Annual Report
Patient Advice and Liaison Service (PALs)
The PALs service received 1187 enquiries during the year –
this is 87 more than last year.
These enquiries came from patients, carers, family members
and members of the public.
The top five enquiries are shown in figure 16:
50
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2009/10 2010/11 2011/12
68 Annual report 2011/12

Figure 16: top 5 enquiries to PALs
200
180
160
140
120
100
80
60
40
20
0
Communication
Information
requested
Positive
feedback
Administration
Attitude
of staff
The top five are the same topics as last year, it is gratifying
to know that positive feedback about the Trust and staff
remains in the top five. When combined, requests for
information and positive feedback made up 20% of all
PALs enquiries; this is marginally less than last year.
Information from the PALs queries is reviewed at the weekly
Complaints, Litigation, Incidents and PALs (CLIP) meeting to
identify emerging themes (positive or negative).
Actions are then taken forward to address any negative
themes. For example in the last year there has been a focus
on departments where problems with communication have
been flagged up by the PALs enquiries.
Single sex accommodation
Homerton is committed to providing every patient with
same sex accommodation, because it helps to safeguard
their privacy and dignity at a time when they are often at
their most vulnerable.
Patients who are admitted to our hospital, will only share
the room where they sleep with members of the same sex.
Same sex toilets and bathrooms will be close to their bed
area.
Sharing with members of the opposite sex will only happen
by exception based on clinical need; for example where
patients need urgent specialist equipment such as in our
cardiology ward or acute stroke unit. Any breaches of
same sex accommodation have to be authorised by the
senior manager on call to ensure all alternatives have been
considered first. In the past year we have had only one
breach – this affected six patients for a short amount of
time.
Homerton will not turn patients away just because a “rightsex”
bed is not immediately available.
We have 13 inpatient wards at Homerton (including
Intensive Care and Paediatrics), two of these wards are
entirely single sex; the remaining wards have male and
female patients cared for in single sex bays or rooms.
In the last year the Trust has:
• built privacy screens across the bays in; Edith Cavell Ward
and part of the new Elderly Care Unit
• reconfigured the Day Stay Unit so it now has separate
male and female areas.
Any breaches are reported monthly to the Board of
Directors and quarterly to the Council of Governors. We
monitor complaints and PALS enquiries for issues related
to mixed sex accommodation. This year’s responses from
patients completing the National Inpatient Survey resulted
in the following recommendation in the report:
• Review progress on eliminating mixed gender rooms,
bays and bathroom facilities in the light of information
contained in the survey.
This recommendation came from patients being unhappy
that only the bay they slept in was single sex.
An ‘Enter and View’ visit was carried out by representatives
from the Hackney LINk in May 2011, they visited two
surgical wards: Thomas Audley, male surgical ward,
Priestley, female surgical ward.
In their report LINks identified as an area of concern on the
visit to Thomas Audley Ward that there were two female
patients. Due to bed pressures the end bay had been
changed into an area for female surgical patients. The use
of the end bay ensured that females did not have to cross
the male bay to go to the bathroom and vice versa, the
toilet near the bay was dedicated to female patients and
the signs on the doors were changed to indicate this.
Since this visit the ward configurations have changed.
All areas have been reviewed to see what actions can
be taken. There are limits to the actions we can take
considering the architecture of our hospital, but we are
putting into place all we can.
Feedback from staff
This year staff gave us positive feedback in the staff survey,
331 staff responded – our scores were in some cases
within the top 20% of all trusts across the country. Our top
four scores that ranked more positively than the national
average were:
• percentage of staff able to contribute towards
improvements at work
• quality of job design (clear job content, feedback and
staff involvement)
• percentage of staff feeling satisfied with the quality of
work and patient care they are able to deliver
• support from immediate managers.
Annual report 2011/12 69

QUALITY ACCOUNT
Staff also reported that 72% 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 62% to this question.
Staff responses show that we were below the national
average for acute trusts in the following areas:
• percentage of staff experiencing harassment, bullying or
abuse from patients
• relatives or the public in last 12 months
• percentage of staff suffering work-related stress in last
12 months
• percentage of staff having equality and diversity training
in last 12 months
• percentage of staff experiencing discrimination at work
in last 12 months.
• there were four areas where staff experience had
diminished since the 2010 survey, these were:
• percentage of staff feeling pressure in last three months
to attend work when feeling unwell
• percentage of staff receiving job-relevant training,
learning or development in last 12 months
• percentage of staff suffering work-related stress in last
12 months
• percentage of staff feeling there are good opportunities
to develop their potential at work.
An action plan has been developed to address these and
some other concerns raised by the staff survey. This action
plan is part of the Trust’s overall Workforce Strategy.
SECTION 5 – Quality improvement plans
2012 - 2013
Homerton University Hospital NHS Foundation Trust:
Incorporating hospital and community health services,
teaching and research.
In this section of the report Homerton is setting out the
plan for the coming year and how we intend to progress in
order to improve the quality of care our patients receive.
As we identified at the very beginning of the quality
account we have six specific priorities for the coming year:
SAFE
Priority 1
Reduce harm to patients caused by pressure ulcers, falls,
catheter infections, falls and venous thrombo-embolism
identified within the Safety Thermometer / Harm Free Care
Programme.
(Linked to Trust objective I, the NHS QUEST programme and
the Patient Experience Strategy Campaign One: Delivering
thoughtful care)
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.
(Linked to Trust objective I, the NHS QUEST programme and
the Patient Experience Strategy Campaign One: Delivering
thoughtful care)
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.
(Linked to Trust objective I and the Patient Experience
Strategy Campaign One: Delivering thoughtful care)
Priority 4
Reduce hospital readmissions.
(Linked to Trust objective I, III, IV, V, the NHS QUEST
programme and the Patient Experience Strategy Campaign
Two: Leaving or transferring from our care with confidence)
70 Annual report 2011/12

THOUGHTFUL
Priority 5
Sharing care and treatment information with patients.
(Linked to the Patient Experience Strategy Campaign Three:
Getting the information right)
Priority 6
We will improve the effectiveness of discharge from our
care.
(Linked to the Patient Experience Strategy Campaign two;
Leaving or transferring from our care with confidence)
Priorities for quality improvement have also been identified
by the commissioners that purchase services from us for the
year ahead. The Commissioning for Quality and Innovation
scheme (CQUIN) has identified elements of care where we
must demonstrate improvement to be paid accordingly. The
proportion of funding that CQUINS are worth has increased
for 2012/13 to 2.5% of the Trust’s income (about £3.17
million). This funding is dependent on the Trust achieving
the improvements listed below.
There are three levels of CQUIN; national, regional and
local that we will be working on in the next 12 months.
Table 16 provides a summary of the CQUINs the Trust will
be working on next year for acute care. Table 17 is the
summary of community care CQUINS.
Table 16: Commissioning for Quality and Innovation scheme
(CQUIN) Targets 2012/13 acute care
What are we going to do
The details of these CQUINS are being established
Which element of Quality does
this relate to
National 1. Venous Thrombo-embolism risk assessment Safety and effectiveness
2. Dementia: identifying and assessing patients with dementia Safety and effectiveness
Regional
Local
3. Safety thermometer –
Reduce harm from : falls, pressure ulcers, urinary tract
infections (patients with catheters) and VTE
Baseline to be set in Q1
4. Patient Experience –
This is the same national patients experience CQUIN as the past
two years improvement on five questions in the national survey
5. Cancer Staging
Details being negotiated
6. Older People’s Care
Details being negotiated
7. Patient Experience in Maternity
Details being negotiated
8. Smoking Cessation
Details being negotiated
9. Discharge Communication
Details being negotiated
Safety
Patient experience
Safety and effectiveness
Safety, effectiveness and experience
experience
effectiveness and experience
Safety, effectiveness and experience
Annual report 2011/12 71

QUALITY ACCOUNT
Table 17: Commissioning for Quality and Innovation scheme (CQUIN) Targets 2012/13 Community Care
What are we going to do
Local 1. Patient Experience –
A local survey will be commissioned from the
Picker Institute across all services.
2. Discharge Communication
Details being negotiated
3. Smoking Cessation
Details being negotiated
4. Older People’s Care
Details being negotiated
Which element of Quality does this relate to
Experience
Effectiveness
Experience
Effectiveness
Experience
Safety, effectiveness and experience
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
providing; help, support, training and guidance.
How will we monitor progress on all these
aspects of quality improvement
All quality improvements; the Trust priorities and the
CQUINS will have actions plans developed to address the
requirements needed to implement them. The progress on
these action plans will be monitored every two months by
the Trust Quality Improvement Committee. This committee
will report to the Trust Board of Directors.
A half year update will be presented to the Board and the
Council of Governors.
72 Annual report 2011/12

SECTION 6 – Consultation and comment
on the Quality Account
Chief Executive Statement for Homerton University Hospital
Foundation Trust Quality Account 2011/12
NHS North East London and the City welcomes the opportunity to provide this statement on
Homerton University Hospital Foundation Trust’s Quality Account. 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 contract/performance monitoring discussions and
is accurate in relation to the services provided.
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 Homerton University Hospital Foundation Trust. We have discussed the development of this
Quality Account with Homerton University Hospital Foundation Trust over the year and have
been able to contribute our views on consultation and content.
This Account has been reviewed within NHS North East London and the City by colleagues in
commissioning, quality and clinical governance, Clinical Commissioning Groups (CCGs), as well
as specialists in infection control and safeguarding.
Overall we welcome the vision described within the Quality Account, agree on the priority areas
and will continue to work with Homerton University Hospital Foundation Trust to continually
improve the quality of services provided to patients.
Alwen Williams
Chief Executive
NHS North East London and the City
Annual report 2011/12 73

QUALITY ACCOUNT
Chairman, City of London Health and Social Care Scrutiny Sub
(Community & Children’s Services) Committee
The Rev’d Dr. Martin Dudley
Melanie Mavers
Head of Clinical Quality
Quality and Risk Department
1st Floor Brooksby House
Homerton University Hospital NHS Foundation Trust
Homerton Row
Hackney
E9 6SR
Dear Ms Mavers,
Due to the level of other scrutiny issues that Members have been dealing with over the last
two months, including the GP Choice Pilot, new Public Health responsibilities and LINk reports
on Mental Health and Hospital Discharge from Bart’s and the London, the Homerton Quality
Accounts have not been formally considered by the Health and Social Care Committee.
However my officers have reviewed the accounts and have informed me that apart from
improving the information on the usage of Homerton Hospital, and in particular Community
Services provided by Homerton, by City residents we have no major concerns and are happy to
endorse them.
Yours sincerely,
The Rev’d Dr. Martin Dudley,
Chairman,
City of London Health & Social Care Scrutiny Sub
(Community & Children’s Services) Committee
74 Annual report 2011/12

Hackney LINk
1. CQC inspection
Hackney LINk congratulates Homerton on the generally favourable CQC Inspection which LINk members
heard about at a Steering Group meeting. We also note that in one area where the CQC Inspection
was less favourable, the RNRU, Homerton had already run a patient feedback survey between May and
September showing an improvement in patient responses on some of the issues identified.
2. Patient safety
Hackney LINk welcomes the work Homerton has done to improve Clinical Incident Reporting, which was the
focus of work against this the first priority set for 2011/12. However we also note
• NEVER incidents increased from zero in 2010/11 to three in 2011/12 (and that only the 2011/12 figure is
given in the report). We also note that the number of events covered by this category has increased this
year.
• An increase in the number of reported falls, largely in the minor falls category, and that this is partly
attributed to increased awareness of the requirement to report all incidents. We welcome the work
on reporting, and would be keen to work with Homerton to look into any other possible causes of this
increase.
3. Dignity and respect
We have some concerns that the Dignity and Respect priority has not been achieved but is being
removed. There are several indicators in this report showing that this priority continues to be an issue,
particularly the Patient Experience CQUINS data.
Hackney LINk welcomes the response in the Quality Account to the issue of mixed wards picked up in the
LINk’s May Enter and View, and the action to address this. A later visit to the Intensive Care Unit which
Homerton has not had the chance to respond to, also found a mixed ward, and although this makes it more
flexible from the hospital’s point of view we question if this is appropriate from the point of view of patient
dignity and privacy, but recognise the work Homerton has done to reconfigure wards given the demand for
beds and the limits of the architecture.
4. Patient Experience Strategy
We welcome the other two strands of the Patient Experience Strategy (Sharing Care and Treatment
Information with patients, and Improving the effectiveness of discharge) being identified as priorities for
2012/13.
5. Sample comments from patients
More than half the comments received by the LINk from patients using Homerton were favourable.
Examples are:
• “Great experience with Homerton Hospital. Good aftercare. I was an inpatient for five weeks”
• “The nurse was amazing when I was first admitted to Homerton as I was very upset and crying.
She comforted me and sat with me at night when I could not sleep”.
The less favourable comments varied widely, with waiting times, noise at night from staff and the need for
more advocacy being the only ones that came up more than once.
Hackney LINk, May 2012
Annual report 2011/12 75

QUALITY ACCOUNT
Health in Hackney Scrutiny Commission for the Homerton Quality Account
Comments
The Commission would like it noted in reference to the Patient Experience CQUIN (table
12 on page 39) the results noted from the questions asked, match with the comments the
Commission has repeatedly heard from members of the public that attend its regular meetings.
The Commission expresses concern about the emphasis placed on the PET in what appears to
be the main source of intelligence gathering of patient views and experience by the Trust. The
Commission is of the opinion that this is largely getting the views of patients that are in contact
with the service and very little from the wider population (people using the service are less likely
to be critical). This being the case the Commission is keen to see the Trust continues to improve
in this area and find ways to hear the voice of the wider population too. The Commission
would like to recommend developing proposals to engage with the wider population about
services and service development. To obtain the views not only from service users in contact
with the Trust and using services; but also members of the population who may not necessarily
be in contact with services, who may have preconceived views about the trust or prejudices
against using the Trust services. This could give the Trust valuable insight into its public
reputation and general views from people in the population not using the service that could
start if they were convinced their preconceptions were unfounded.
76 Annual report 2011/12

SECTION 7 – 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 2011/12;
• 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 2011
to June 2012
––
Papers relating to Quality reported to the Board over
the period April 2011 to June 2012
––
Feedback from the commissioners dated 17/05/2012
––
Feedback from Governors dated 10/05/2012
––
Feedback from LINks dated 21/05/2012
––
The Trust’s complaints report published under
regulation 18 of the Local Authority Social Services
and NHS Complaints Regulations 2009, dated
30/05/2012;
––
The national patient survey February 2012
––
The national staff survey January 2012
––
The Head of Internal Audit’s annual opinion over the
Trust’s control environment dated 18 May 2012
––
CQC quality and risk profiles dated April 2011 to June
2012
• 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 Account’s
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.
Michael Cassidy CBE
Chairman
30 May 2012
Nancy Hallett
Chief Executive
30 May 2012
Annual report 2011/12 77

78 Annual report 2011/12

Annual Accounts
Annual report 2011/12 79

80 Annual report 2011/12

Annual Accounts
Contents
Foreword to the Accounts 82
Annual Governance Statement 83
Statement of Accounting Officer’s Responsibilities 88
Independent Auditor’s Report 89
Statement of Comprehensive Income
for the year ended 31 March 2012 90
Statement of Financial Position as at 31 March 2012 91
Statement of Changes in Taxpayers’ Equity 2011/12 92
Statement of Changes in Taxpayers’ Equity 2010/11 92
Statement of Cash Flows for the year
ended 31 March 2012 93
Notes to the Accounts 94
Annual report 2011/12 81

ANNUAL ACCOUNTS
Foreword to the Accounts
Homerton University Hospital NHS Foundation Trust
These accounts for the year ended 31 March 2012 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.
Nancy Hallett
Chief Executive
28 May 2012
82 Annual report 2011/12

Annual Governance Statement 2011/12
Homerton University Hospital NHS Foundation Trust
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
2012 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 & 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
risk issues 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:
• 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
Environment who has Board level responsibility for
Health and Safety.
• As required by the Trust’s Risk Management Strategy,
clinical 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 is continuing to develop a comprehensive risk
register, identifying risks at both 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
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.
Annual report 2011/12 83

ANNUAL ACCOUNTS
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 Board
Assurance Framework and risk register to ensure that
appropriate action is being taken against key risks.
The Trust continues to carry out an annual exercise
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 in place
undertaken 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.
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 evidence.
Additional assurance has also been gained through
participation in CQC special reviews or investigations,
specifically in the last 12 months:
• Dignity and Nutrition Inspection (DANI) - May 2011
• Mary Seacole Nursing Home Inspection - October 2011
• Homerton University Hospital Inspection - November
2011
• Review of Termination of Pregnancy Services - March
2012, and
• Safeguarding and Looked After Children Inspection -
March 2012.
All of these inspections were positive and constructive
feedback was given by the Regulator.
The foundation trust is fully compliant with the registration
requirements of the Care Quality Commission.
The Trust has established a 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 Board Assurance Framework detailing the principal
risks to the achievement of the Trust’s objectives was in
place for the whole of the financial year. This was based
on the objectives set out in the Trust’s 2011/12 Annual
Plan and identified the 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 Board Assurance
Framework has been reviewed regularly and updated
through the year by the Board with the latest version
reflecting the position at 31 March 2012. The risks in the
Board Assurance Framework are monitored and reviewed
by the Risk Committee at each of its meetings and reports
provided to the Board on key issues arising. All of the
principal risks identified are monitored regularly through
standing performance reports to the 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. (both in-year and future risk)
• risks to Trust business associated with the health
economy reconfiguration in North East London (in-year
and future risk)
• risks to Trust business associated with commissioner led
actions (both in-year and future risk)
84 Annual report 2011/12

• risks associated with the Olympic travel change
impacting on access to the Trust (future risk), and
• risk to organisational continuity due to change of Chief
Executive (future risk).
The Trust has comprehensive action plans in place to
mitigate the above risks which are monitored by the
Risk Committee and Trust Board. Outcomes are assessed
through performance 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 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 with 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, and
• The Health and Social Care Partnership Board; and
membership of the Local Strategic Partnership.
Pensions
As an employer with staff entitled to membership of the
NHS Pension Scheme (the 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
Scheme records are accurately updated in accordance with
the timescales detailed in the Regulations.
Equality, diversity and human rights
Control measures are in place to ensure that all the
organisation’s obligations under equality, diversity and
human rights legislation are complied with.
Carbon reduction
The Foundation 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 the Trust’s obligations under the Climate
Change Act and the Adaptation Reporting requirements
are complied with.
5. 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 cost improvements, 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.
6. 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 Report 2011/12 has been developed
in line with relevant national guidance and legislative
requirements. Assurance over the content and quality
of the information in the report is gained through the
following:
• The Chief Nurse & Director of Governance leads on the
production of the Quality Report at Board level. The
Head of Clinical Quality is responsible for compiling
and writing the draft Quality Report, managing the
Annual report 2011/12 85

ANNUAL ACCOUNTS
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 they set
quality priorities 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 in place a range of policies and procedures
to support the achievement of quality priorities.
• 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.
7. 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 NHS foundation 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.
• 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 Board Assurance Framework 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 Strategy and Policy
for Risk Management and the development of the
Board Assurance Framework. The Risk Committee also
monitors 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
control, governance and risk management processes,
based on an audit plan approved by the 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 and monitored within their area of
responsibility and the necessary action taken to address
them. Executive Directors were also directly involved
in producing and reviewing the Board Assurance
Framework.
• Internal Audit have provided consistent support and
advice with regard to the system of internal control
including the ongoing development of the Board
Assurance Framework.
• The Finance & Performance Committee is responsible
for overseeing performance management and ongoing
regulatory compliance, and of developing the Trust’s
longer term financial strategy.
• The Quality Improvement Committee is responsible for
the governance and management of clinical risk.
Internal Audit’s review of the Board Assurance Framework
has concluded that it provides reasonable assurance that
there is an effective system of internal control to manage
the principal risks identified by the Trust.
86 Annual report 2011/12

As noted above, the Board Assurance Framework 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 control issues have been
identified.
Nancy Hallett
Chief Executive
28 May 2012
Annual report 2011/12 87

ANNUAL ACCOUNTS
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, and
• 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.
Nancy Hallett
Chief Executive
28 May 2012
88 Annual report 2011/12

Independent Auditor’s report to the Board
of Governors and Board of Directors
of Homerton University Hospital NHS
Foundation Trust
We have audited the financial statements of Homerton
University Hospital NHS Foundation Trust for the year
ended 31 March 2012 which comprise the Statement of
Comprehensive Income, the Statement of Financial Position
the Statement of Changes in Taxpayers Equity and the
Statement of Cash Flows and the related notes 1 to 29.
The financial reporting framework that has been applied
in their preparation is applicable law and the accounting
policies directed by Monitor – 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.
The directors are responsible for the maintenance and
integrity of the corporate and financial information included
on the company’s website. Legislation in the United Kingdom
governing the preparation and dissemination of financial
information differs from legislation in other jurisdictions.
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.
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 2012 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 matter prescribed by the National
Health Service Act 2006
In our opinion:
• 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: 28 May 2012
Annual report 2011/12 89

ANNUAL ACCOUNTS
Statement of comprehensive income for the year ended 31 March 2012
Restated
2011/12 2010/11
NOTE £000 £000
Revenue
Operating income from continuing operations 3.1 243,677 190,871
Operating expenses (excluding impairments) 4.1 (234,150) (182,621)
Impairments charged to operating expenses (916) (5,172)
Operating surplus 8,611 3,078
Finance costs:
Finance income 8 145 113
Finance expenses-finance liabilities 8.1 (187) (198)
Finance expenses-unwinding of discount on provisions 17 (19) (22)
Public dividend capital dividends payable 19 (3,296) (3,491)
Total finance costs (3,357) (3,598)
Retained surplus/(deficit) for the year 5,254 (520)
Other comprehensive income
Net revaluation (losses)/gains and impairment losses on land, property, plant and equipment (2,197) 1,378
Gain on asset disposals - 14
Total comprehensive income for the year 3,057 872
The Trust reported an underlying trading surplus of £6,170,000 in 2011/12 (£4,652,000 in 2010/11) before taking into
account impairments.
Due to the Trust taking on City and Hackney community health services on 1st April 2011 and the FReM’s interpretation of
IAS 20 (Accounting for Government Grants and Disclosure of Government Assistance), certain prior year balances have been
restated. The details of this restatement can be seen at note 1.25 to the accounts.
The notes on pages 94 to 119 form part of these accounts.
90 Annual report 2011/12

Statement of financial position as at 31 March 2012
Restated Restated
31 March 2012 31 March 2011 1 April 2010
NOTE £000 £000 £000
Non-current assets
Intangible assets 9 642 742 1,120
Property, plant and equipment 10 115,121 117,617 117,494
Total non-current assets 115,763 118,359 118,614
Current assets
Inventories 12.1 1,121 1,025 887
Trade and other receivables 13.1 13,456 10,465 10,684
Other financial assets 14 - 25 23
Cash and cash equivalents 15 30,556 17,088 16,535
Total current assets 45,133 28,603 28,129
Total assets 160,896 146,962 146,743
Current liabilities
Trade and other payables 16.1 (18,185) (12,527) (10,535)
Borrowings 16.1 (257) (257) (257)
Provisions 16.1 (1,685) (638) (204)
Tax payable 16.1 (5,204) (3,996) (3,570)
Other liabilities 16.1 (5,403) (3,104) (6,300)
Total current liabilities (30,734) (20,522) (20,866)
Net current assets 14,399 8,081 7,263
Total assets less current liabilities 130,162 126,440 125,877
Non-current liabilities
Borrowings 16.1 (3,794) (4,051) (4,307)
Provisions 16.1 (641) (644) (694)
Total non current liabilities (4,435) (4,695) (5,001)
Total assets employed 125,727 121,745 120,876
Financed by taxpayers’ equity
Public dividend capital 19 84,100 83,175 83,175
Revaluation reserve 20,859 23,142 21,898
Retained earnings 20,768 15,428 15,803
Total taxpayers’ equity 125,727 121,745 120,876
The financial statements on pages 90 to 119 were approved by the Board and signed on its behalf by:
Chief Executive
28 May 2012
Annual report 2011/12 91

ANNUAL ACCOUNTS
Statement of changes in taxpayers’ equity 2011/12
Public dividend Retained Revaluation Donated asset
capital (PDC) earnings reserve reserve Total
£000 £000 £000 £000 £000
Balance at 31 March 2011 (restated) 83,175 15,428 23,142 - 121,745
Changes in taxpayers’ equity for 2011/12
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 from donated asset reserve - 86 (86) - -
New PDC received 925 - - - 925
Balance at 31 March 2012 84,100 20,768 20,859 - 125,727
Statement of changes in taxpayers’ equity 2010/11
Public dividend Retained Revaluation Donated asset
capital (PDC) earnings reserve reserve Total
£000 £000 £000 £000 £000
Balance at 31 March 2010 (restated) 83,175 12,466 21,898 2,966 120,505
Changes in taxpayers’ equity for 2010/11
Total Comprehensive income for the year:
Prior period adjustment - 3,337 - (2,966) 371
Retained deficit for the year - (520) - - (520)
Impairments and reversals - - (519) - (519)
Net gain on revaluation of tangible assets - - 1,894 - 1,894
Receipt of donated assets - - - - -
Transfer due to disposal of assets - 145 (131) - 14
Balance at 31 March 2011 (restated) 83,175 15,428 23,142 - 121,745
92 Annual report 2011/12

Statement of cash flows for the year ended 31 March 2012
Restated
2011/12 2010/11
NOTE £000 £000
Net cash inflow from operating activities 20 21,507 11,386
Cash flows from investing activities
Interest received 145 113
Payments for intangible assets (323) (34)
Payments for property, plant and equipment (5,134) (6,815)
Proceeds from disposal of plant, property and equipment - 58
Net cash outflow from investing activities (5,312) (6,678)
Net cash inflow before financing 16,195 4,708
Cash flows from financing activities
Public dividend capital received 925 -
Loans repaid to the DH (226) (226)
Other loans repaid (31) (31)
Interest repaid (187) (198)
PDC Dividend paid (3,208) (3,700)
Net cash outflow from financing (2,727) (4,155)
Net increase in cash and cash equivalents 13,468 553
Cash and cash equivalents (and bank overdrafts) at 1 April 17,088 16,535
Cash and cash equivalents (and bank overdrafts) at 31 March 30,556 17,088
Annual report 2011/12 93

ANNUAL ACCOUNTS
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 2011/12 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 & 9 Financial Instruments
• IFRS 10 Consolidated Financial Statements
• IFRS 11 Joint Arrangements
• IFRIC 12 Disclosure of Interests in Other Entities
• IFRIC 13 Fair Value Measurement
• IAS 1 Presentation of Financial Statements on Other
Comprehensive Income
• IAS 12 Income Taxes Amendment
• IAS 27 Separate Financial Statements
• IAS 28 Associates and Joint Ventures
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.
Employer’s pension cost contributions are charged to
operating expenses as and when they become due. The
cost of the scheme is equal to the contributions payable
to the scheme for the accounting period. The employer
contribution payable in 2011/12 was £13.4m (2010/11
£9.7m), and is estimated to be £13.7m in 2012/13.
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
94 Annual report 2011/12

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 sale 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 are 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. An interim 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 2012.
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 are depreciated on their current value
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
Annual report 2011/12 95

ANNUAL ACCOUNTS
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 is depreciated on current cost evenly over the
estimated UEL.
Property, Plant and Equipment which has been reclassified
as ‘Held for Sale’ ceases to be depreciated upon the
reclassification. 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 - The remaining useful life of the asset. Land is
generally not depreciated because considered to have
infinite life.
• Non-residential buildings and dwellings - average
remaining useful life of the building block in accordance
with the Independent Qualified Valuer‘s 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 sufficent 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 derecognised
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,
96 Annual report 2011/12

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
1.7.1 Recognition
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
directly 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.
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 of 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.
Annual report 2011/12 97

ANNUAL ACCOUNTS
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
1.11.1 Recognition
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 assts and current liabilities.
These financial assets and financial liabilities are recognised
initially at fair value, with transaction costs charged to
the 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 through 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 through 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
98 Annual report 2011/12

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 discount rate of 2.2% in real terms, except
for early retirement provisions and injury benefit provisions
which both use the HM Treasury’s pension discount rate of
2.9% 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
Annual report 2011/12 99

ANNUAL ACCOUNTS
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 18.
(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.
100 Annual report 2011/12

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.
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 Trust
has had a significant number of material transactions with
Government Departments and their agencies. These entities
are listed in note 23.
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 IAS27 (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 HRG price by
specialty and point of delivery of the fully coded spells in
the preceding months.
1.23 Transforming community services (TCS)
The community health services previously provided by NHS
City and Hackney transferrred to Homerton University
Hospital NHS Foundation Trust on 1 April 2011. The
transfer involved the TUPE of staff and a three year contract
was signed. The transaction did not include any transfer of
non-current assets.
This transaction represents the transfer of services between
public sector bodies which are under common control
and therefore is classified as Machinery of Government
Change. This transaction meets the definition of a Group
Reconstruction under IFRS 3 Business Combinations
and therefore falls outside the scope of that Standard.
In accordance with the FT ARM principles of merger
accounting should have been applied to this transaction.
However the Department of Health has considered the
feasibility of restating Statement of Comprehensive Income
under merger accounting for all local bodies (including
NHS foundation trusts) and considers it is impracticable to
undertake this restatement for all bodies in light of cost and
availability of information.
To meet these requirements, the Trust has only restated its
Statement of Financial Position and associated notes. In
addition the Trust has reported 12 months of combined
activity in its 2011/12 balances.
1.24 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 17)
• Estimates of partially completed patient episodes (note
1.22), and
• Depreciation rates applied to property, plant and
equipment (note 10).
Annual report 2011/12 101

ANNUAL ACCOUNTS
1.25 Restatement of balances
As per note 1.23 the Trust has restated its balances for the TCS transaction. In addition the FReM’s interpretation of IAS
20, ‘Accounting for Government Grants and Disclosure’ has resulted in the need to restate certain balances within these
accounts. The restatements are summarised as follows:
Statement of Financial Position
Closing balance
as at
31 March 2011
£000
2009/10
IAS 20
Adjustment
£000
Restated
Opening
Balance as at
1 April 2010
2010/11
In Year
movements
£000
2010/11
IAS 20
Adjustment
£000
2010/11
TCS
Transaction
£000
Restated
closing
balance as
at 31 March
2011
£000
Non-current assets 118,614 - 118,614 (255) - - 118,359
Current assets
Accrued income 3,522 - 3,522 (799) 243 2,966
Other receivables 2,722 - 2,722 220 - 31 2,973
Other current assets 21,885 - 21,885 779 - - 22,664
Total current assets 28,129 - 28,129 200 - 274 28,603
Current liabilities
Deferred income (6,671) 371 (6,300) 2,380 827 (10) (3,103)
Other payables (4,942) - (4,942) - - (264) (5,206)
Other current liabilities (9,624) - (9,624) (2,589) - - (12,213)
Total current liabilities (21,237) 371 (20,866) (209) 827 (274) (20,522)
Non-current liabilities (5,001) - (5,001) 306 - - (4,695)
Total assets employed 120,505 371 120,876 42 827 - 121,745
Taxpayers’ equity
Public dividend capital 83,175 - 83,175 - - - 83,175
Revaluation reserve 21,898 - 21,898 1,248 (4) - 23,142
Donated asset reserve 2,966 (2,966) - 1,856 (1,856) - -
Retained earnings reserve 12,466 3,337 15,803 (3,062) 2,687 - 15,428
Total taxpayers’ equity 120,505 371 120,876 42 827 - 121,745
2010/11
Position as at 31 March 2011
£000
2010/11
IAS 20 Adjustment
£000
2010/11
Restated position as at
31 March 2011 £000
Operating income and expenditure
Operating income 183,017 - 183,017
Other income 4,713 3,141 7,854
Transfer from donated asset reserve 387 (387) -
Total operating income 188,117 2,754 190,871
Other operating expenses (182,621) - (182,621)
Impairments charged to operating expenses (5,105) (67) (5,172)
Total operating expenses (187,726) (67) (187,793)
Operating surplus 391 2,687 3,078
The cashflow statement balances have been restated in note 20.1
102 Annual report 2011/12

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
3.1 Income from activities
2011/12
£000
2010/11
£000
Elective income 21,759 22,300
Non-elective income 47,272 48,185
Outpatient income 32,994 30,592
A&E Income 9,061 8,326
Other type of activity income 54,393 51,783
Community income 47,200 -
Private patient income 588 508
Other non-protected clinical income 9,890 6,893
Total income from activities 223,157 168,587
Other operating income
Research and development 504 489
Education and training 11,708 11,165
Donated assets and deferred income recognition 1,477 -
Profit on disposal (non current assets) - 58
Non-patient care services to other bodies 2,571 2,718
Other income 4,260 7,854
Total other operating income 20,520 22,284
Total operating income 243,677 190,871
Other income includes rent (£1.1m), staff recharges (£1.5m), nursery income (£0.4m), and catering income (£0.3m).
2011/12
£000
2002/03
£000
3.2 Private patient income
Private patient income 588 224
Total patient related income 223,157 83,880
Private patient income (%) 0.3% 0.3%
Section 44 of the NHS Act 2006 requires that the proportion of private patient income to the total patient related
income of NHS foundation trusts should not exceed its proportion whilst the body was an NHS Trust in 2002/03,
its base year. The Trust’s Private Patient Cap is set at 0.3% and was not exceeded during the year ended 31 March
2012.
Annual report 2011/12 103

ANNUAL ACCOUNTS
3.3 Income by source
2011/12
£000
2010/11
£000
NHS Foundation Trusts 4,113 4,315
NHS Trusts 1,059 403
Strategic Health Authorities 11,367 11,189
Primary Care Trusts 216,518 163,968
Department of Health 541 28
NHS Other 50 349
Local Authorities 3,659 2,058
Non NHS: Private Patients 588 508
Non NHS: Overseas Patients 41 156
NHS Injury Scheme (was Road Traffic Act) 830 684
Other operating income 4,911 7,213
Total 243,677 190,871
NHS Injury Scheme income is subject to a nationally prescribed provision for doubtful debts of 10.5% (2010/11
9.6%) to reflect expected rates of collection.
4. Operating expenses
2011/12
£000
2010/11
£000
Services from other NHS Foundation Trusts 266 -
Services from other NHS Trusts 558 -
Services from other NHS Bodies 1 1
Purchase of healthcare from non-NHS bodies 377 163
Directors’ costs 1,220 1,317
Non executive Directors’ costs 124 114
Staff costs 157,471 121,056
Drugs costs 11,049 10,748
Supplies and services - clinical (excluding drug costs) 14,741 11,263
Supplies and services - general 1,765 1,469
Establishment 3,054 2,399
Research and development (non salary cost) 139 149
Transport 1,780 1,294
Premises 28,647 19,897
Increase in bad debt provision 52 239
Depreciation on property, plant and equipment 5,588 5,251
Amortisation of Intangible Assets 423 512
Impairments of Property, Plant and Equipment 916 5,172
Audit fees 79 53
NHSLA insurance premium 4,683 4,236
Loss on Disposal of Plant & Equipment 2 65
Other 2,131 2,395
Total 235,066 187,793
104 Annual report 2011/12

4.1.1 Operating lease rentals
2011/12 2010/11
£000 £000
Hire of plant and machinery 370 332
Hire of building 90 103
460 435
In addition to leases whose financial values are shown above, the Trust has a lease for Mary Seacole Nursing Home
from Newlon Housing Trust for a building which have been leased for a number of years at a peppercorn rent.
4.1.2 Operating lease commitments
2011/12 2010/11
Land and buildings Other leases Total Total
£000 £000 £000 £000
Annual commitments on leases expiring:
Within 1 year 80 325 405 251
Between 1 and 5 years 187 484 671 576
Total 267 809 1,076 827
4.3 Salary and pension entitlements of senior managers
a) Remuneration
Name and title
2011/12 2011/12 2011/12 2010/11
Directors Other Salary Salary
salary remuneration (bands of (bands of
£000 £000 £5,000) £5,000)
Hallett N - Chief Executive 145-150 - 145-150 145-150
Coakley J - Medical Director 90-95 105-110 200-205 200-205
Farrar J - Director of Finance 130-135 - 130-135 130-135
Panniker A - Director of Environment (until October 2011) 55-60 - 55-60 95-100
Clements C - Director of Workforce 95-100 - 95-100 95-100
Fletcher T - Chief Operating Officer 110-115 - 110-115 110-115
Sheldon C - Chief Nurse and Director of Governance 95-100 - 95-100 75-80
Cassidy M - Chairman 40-45 - 40-45 40-45
Hay S - Non Executive Director 10-15 - 10-15 10-15
Keith M - Non Executive Director 10-15 - 10-15 10-15
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
Sorensen E - Non Executive Director (until October 2011) 5-10 - 5-10 10-15
Sir John Gieve - Non Executive Director (from November 2011) 5-10 - 5-10 n/a
Annual report 2011/12 105

ANNUAL ACCOUNTS
b) Pension benefits
Name and title Real Real Total Total Cash Cash Real Increase
increase increase accrued accrued equivalent equivalent in cash
in pension in lump sum pension at lump sum at transfer transfer equivalent
at age 60 at age 60 31 March 2011 31 March 2011 value at value at transfer
31 March 2011 31 March 2011 value
(bands of (bands of (bands of (bands of £000 £000 £000
£2500) £2500) £5000) £5000)
Hallett N
Chief Executive 0-2.5 2.5-5 65-70 195-200 1,383 1,271 84
Coakley J
Medical Director 0-2.5 2.5-5 75-80 235-240 1,675 1,558 82
Farrar J
Director of Finance 0-2.5 2.5-5 10-15 30-35 142 101 38
Panniker A
Director of Environment
(until October 2011) 0-2.5 2.5-5 10-15 30-35 194 146 44
Clements C
Director of Workforce 0-2.5 0-2.5 20-25 70-75 462 404 49
Fletcher T
Chief Operating Officer 0-2.5 0-2.5 25-30 75-80 368 290 71
Sheldon C
Chief Nurse and
Director of Governance 0-2.5 2.5-5 20-25 65-70 289 205 79
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, contributions paid by the employee (including the value of any benefits transferred from
another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period.
Real Increase in CETV for the current year may be different from the prior year. In July 2010 the Chancellor announced that
the uprating (annual increase) of public sector pensions would change from the Retail Price Index (RPI) to the Consumer
Prices Index (CPI). As a result the Government Actuaries Department undertook a review of all transfer factors.
106 Annual report 2011/12

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 banded remuneration of the highest-paid director in Homerton University Hospital NHS Foundation Trust in financial
year 2011/12 was £202,500 (2010/11 £202,500). This was 6.2 times (2010/11; 6.8 times) the median remuneration of
the workforce, which was £32,830 (2010/11; £29,939). In 2011/12, 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.
5. Staff costs and staff numbers
5.1 Staff costs
2011/12 2010/11
Permanently Other Total Total
Employed
£000 £000 £000 £000
Salaries and wages 118,772 - 118,772 88,965
Social Security costs 10,793 - 10,793 8,351
Employer contributions to NHS Pensions Agency 13,474 - 13,474 9,740
Agency/contract staff - 15,652 15,652 15,317
143,039 15,652 158,691 122,373
5.2 Average number of persons employed
2011/12 2010/11
Permanently Other Total Total
Employed
Number Number Number Number
Medical and dental 394 - 394 363
Healthcare assistants and other support staff 249 - 249 155
Nursing, midwifery and health visiting staff 1,089 - 1,089 803
Nursing, midwifery and health visiting learners 29 - 29 6
Scientific, therapeutic and technical staff 598 - 598 260
Administration and estates 664 - 664 574
Bank and agency staff - 324 324 321
Other 7 - 7 91
Total 3,030 324 3,354 2,573
Annual report 2011/12 107

ANNUAL ACCOUNTS
5.3 Employee benefits
There are no individual employee benefit costs for 2011/12 (2010/11 Nil).
5.4 Retirements due to ill-health
2011/12 2011/12 2010/11 2010/11
Number £000 Number £000
Early retirements agreed on the grounds of ill-health 1 6 1 21
5.5 Staff exit packages
Number of Number of Total number of
compulsory other departures exit packages
redundancies agreed by cost band

9. Intangible fixed assets
All Intangible fixed assets relate to software licenses.
9.1 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
Net book value
- Purchased at 1 April 2011 742
- Purchased at 31 March 2012 642
9.2 2010/11
Gross cost at 1 April 2010 4,028
Additions - purchased 134
Gross cost at 31 March 2011 4,162
Amortisation at 1 April 2010 2,908
Provided during the year 512
Amortisation at 31 March 2011 3,420
Net book value
- Purchased at 1 April 2010 1,120
- Purchased at 31 March 2011 742
Annual report 2011/12 109

ANNUAL ACCOUNTS
10. Property, plant and equipment
10.1 As at 31 March 2012
Land
£000
Buildings
excluding
dwellings
£000
Assets
under
construction
£000
Plant and
machinery
£000
Transport
equipment
£000
Information
technology
£000
Furniture
& fittings
£000
Cost or valuation at 1 April 2011 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)
Cost or valuation at 31 March 2012 26,142 88,460 1,484 21,556 75 8,321 1,317 147,355
Total
£000
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 at 31 March 2012 - 11,298 - 13,657 75 6,052 1,152 32,234
Net book value
- 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
Net book value
- Purchased at 31 March 2012 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 2011/12:
Land
£000
Buildings
excluding
dwellings
£000
Assets
under
construction
£000
Plant and
machinery
£000
Transport
equipment
£000
Information
technology
£000
Furniture
& fittings
£000
Net book value
- Protected assets at 31 March 2012 26,142 77,162 - - - - - 103,304
- Unprotected assets at
31 March 2012
- - 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
Total
£000
110 Annual report 2011/12

10.2 As at 31 March 2011 (Restated)
Land
£000
Buildings
excluding
dwellings
£000
Assets
under
construction
£000
Plant and
machinery
£000
Transport
equipment
£000
Information
technology
£000
Furniture
& fittings
£000
Cost or valuation at 1 April 2010 26,000 78,368 10,545 20,019 75 7,122 1,224 143,353
Additions - purchased - 4,204 1,453 776 - 456 20 6,909
Additions - donated - 88 - 2,229 - - 7 2,324
Other revaluations 142 1,755 - - - - - 1,897
Impairments - loss - (5,662) - - - (29) - (5,691)
Reclassifications - 9,532 (9,781) 45 - 204 - -
Disposals - - - (2,718) - - - (2,718)
Cost or valuation at 31 March 2011 26,142 88,285 2,217 20,351 75 7,753 1,251 146,074
Total
£000
Depreciation at 1 April 2010 - 5,954 - 14,502 75 4,388 940 25,859
Provided during the year - 2,593 - 1,726 - 825 107 5,251
Disposals - - - (2,653) - - (2,653)
Depreciation at 31 March 2011 - 8,547 - 13,575 75 5,213 1,047 28,457
Net book value
- Purchased at 1 April 2010 26,000 70,607 10,545 4,382 - 2,734 260 114,528
- Donated at 1 April 2010 - 1,807 - 1,135 - - 24 2,966
Total at 1 April 2010 26,000 72,414 10,545 5,517 - 2,734 284 117,494
Net book value
- Purchased at 31 March 2011 26,142 77,966 2,217 3,754 - 2,540 176 112,795
- Donated at 31 March 2011 - 1,772 - 3,022 - - 28 4,822
Total at 31 March 2011 26,142 79,738 2,217 6,776 - 2,540 204 117,617
Analysis of property, plant, and equipment
Land
£000
Buildings
excluding
dwellings
£000
Assets
under
construction
£000
Plant and
machinery
£000
Transport
equipment
£000
Information
technology
£000
Furniture
& fittings
£000
Net book value
- Protected assets at 31 March 2011 26,142 79,738 - - - - - 105,880
- Unprotected assets at 31 March 2011 - - 2,217 6,776 - 2,540 204 11,737
Total at 31 March 2011 26,142 79,738 2,217 6,776 - 2,540 204 117,617
Total
£000
Annual report 2011/12 111

ANNUAL ACCOUNTS
10.3 Assets held at market value
At 31 March 2012 the Trust held land assets at market
value for existing use of £26,142,000 (31 March 2011,
£26,142,000).
10.4 Valuation of land & buildings
The buildings have been valued as at the 31 March 2012
using a Modern Equivalent Asset basis of valuation, as
discounted for wear and tear.
Land has been revalued at the 31 March 2012 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 estaimated useful economic lives ranging
from 7 years to 60 years.
10.5 Assets held under finance leases and hire
purchase contracts at 31 March 2012
The Trust did not hold any finance leases or hire purchase
contracts during 2011/12.
10.6 Donated assets
Donated assets include £1,152,189 (£2,095,000 in
2010/11) of equipment assets donated by GE Healthcare.
We have restated the prior year figure to exclude £970,000
of donated assets that related to assets donated in
2011/12.
11. Fixed asset investments
There were no fixed asset investments held at 31 March
2012 (31 March 2011 - Nil).
12. Inventories
12.1 Inventories
2011/12 2010/11
£000 £000
Drugs 810 819
Consumables 181 124
Energy 130 82
13. Trade and other receivables
13.1 Amounts falling due within one year:
31 March 2012
£000
31 March 2011
£000
NHS receivables 5,323 4,398
Provision for impaired
(652) (619)
receivables
Prepayments 894 538
Accrued income 3,562 2,966
PDC receivable 121 209
Other receivables 4,208 2,973
Total 13,456 10,465
13.2 Analysis of the provision for impaired receivables
31 March 2012
£000
31 March 2011
£000
At 1 April 619 394
Arising during the year 52 239
Utilised during the year (19) (14)
At 31 March 652 619
By age: 31 March 2012
£000
31 March 2011
£000
Up to three months old 27 63
In three to six months old 20 11
Over six months old 605 545
Total 652 619
14. Other Financial Assets
31 March 2012
£000
31 March 2011
£000
Cost or valuation at 1 April 25 23
(Disposals) / Additions (25) 2
Cost or valuation at 31 March - 25
Total at net realisable value 1,121 1,025
12.2 Inventories recognised in expenses
31 March12 31 March11
£000 £000
Total Inventories recognised as an
expense in the period 13,331 12,893
112 Annual report 2011/12

15. Cash and cash equivalents
31 March 2012
£000
31 March 2011
£000
Balance as at 1 April 17,088 16,535
Net change in year 13,468 553
Balance at 31 March 30,556 17,088
Of which:
Commercial banks and cash in hand 73 72
Cash with the Government Banking Service 30,458 17,016
Other current investments 25 -
Total cash and cash equivalents in the
Statement of Cash Flows
30,556 17,088
16. Liabilities
16.1 (i) Current liabilities: Amounts falling due within one year
31 March 2012
£000
Restated
31 March 2011
£000
NHS payables 5,201 1,531
Trade payables - Capital 481 1,281
Loans 257 257
Other payables 7,638 5,205
Payments received on account 164 1,044
Tax payable 5,204 3,996
Accruals 4,701 3,465
Deferred income 5,403 3,104
Provisions 1,685 638
Total amounts falling due within one year 30,734 20,521
16.1 (ii) Non current liabilities: Payables due after more than one year
31 March 2012
£000
31 March 2011
£000
Provisions 641 644
Loans 3,794 4,051
4,435 4,695
16.1 (iii) Total payables 35,169 25,216
Annual report 2011/12 113

ANNUAL ACCOUNTS
16.2 Loans - payment of principal falling due:
31 March 2012
£000
31 March 2011
£000
Within one year 257 257
Between one and two years 257 257
Between two and five years 664 717
After five years 2,873 3,077
Total 4,051 4,308
Of which:
Wholly repayable within 5 years 157 1,231
Wholly repayable after 5 years, not by instalments - -
Wholly or partially repayable after 5 years by instalments 3,894 3,077
Total 4,051 4,308
16.3 Prudential borrowing limit:
Prudential Borrowing Limit set by Monitor 45,500 34,900
Working Capital Facility Limit 8,500 8,500
Total Prudential Borrowing Limit 54,000 43,400
The Trust had a Prudential Borrowing Limit (PBL) of £54m in 2011/12 (£43.4m in 2010/11). The Trust did not draw
down on its working capital facility druing the year ended 31 March 2012 or during the year ended 31 March 2011.
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:
Financial ratio
Actual ratios
2011/12
Approved
PBL
ratios
2011/12
Actual ratios
2010/11
Approved PBL
ratios 2010/11
Minimum dividend cover 3.65 1.00 3.14 1.00
Minimum interest cover 68.33 3.00 49.84 3.00
Minimum debt service cover 30.40 2.00 22.99 2.00
Maximum debt service to revenue 0.19% 2.50% 0.25% 2.50%
ii) The amount of any working capital facility approved by Monitor.
The Trust has an agreed working capital facility of £8.5m (£8.5m in 2010/11). The Trust did not draw down on its working
capital facility during the year ended 31 March 2012 or the year ended 31 March 2011.
Further information on the Prudential Borrowing Code and Compliance Framework can be found on Monitor’s website.
114 Annual report 2011/12

17. Provisions for liabilities and charges
Pensions
relating
to former
Directors
Pensions
relating to
former Staff
Clinical
negligence Redundancy Other
31 March
2011
Total
31 March
2011
Total
£000 £000 £000 £000 £000 £000 £000
At 1 April 82 607 68 - 525 1,282 898
Arising during the year - - - 132 1,452 1,584 503
Change in discount rate 3 23 - - - 26 -
Utilised during the year (6) (41) (12) - (526) (585) (39)
Reversed unused - - - - - - (102)
Unwinding of discount 2 17 - - - 19 22
At 31 March 81 606 56 132 1,451 2,326 1,282
Within one year 6 41 56 132 1,451 1,686 638
Between one and five years 22 151 - - - 173 168
After five years 53 414 - - - 467 476
Total 81 606 56 132 1,451 2,326 1,282
Pension related provisions as at 31 March 2012 included £687,000 relating to matters handled by the NHS Pensions Agency
(NHSPA). Other provisions include £119,000 relating to historic issues with our employee records system, and £127,000 of
carbon tax liabilities.
18. Clinical negligence liability
The amount provided by the NHSLA in respect of clinical negligence liabilities of the trust as at 31 March 2012 is
£29,089,314 (2010/11; £27,651,000).
19. Movement in Public Dividend Capital
2011/12
£000
2010/11
£000
Public Dividend Capital as at 1 April 83,175 83,175
New PDC received 925 -
Public Dividend Capital as at 31 March 84,100 83,175
The dividend paid for the year was £3.3m (2010/11 £3.5m). Further details on how the dividend was calculated on the basis
set out in note 1.15.
Annual report 2011/12 115

ANNUAL ACCOUNTS
20. Notes to the cash flow statement
20.1 Reconciliation of operating surplus to net cash inflow from operating activities:
2011/12
£000
Restated
2010/11
£000
Total operating surplus 8,611 3,078
Depreciation and amortisation 6,011 5,763
Impairment 916 5,172
Donated assets capitalised (1,152) (2,314)
Increase in inventories (96) (138)
(Increase)/decrease in receivables (4,690) 493
Increase in payables 6,866 2,418
Increase in provisions 1,043 384
Transforming community services adjustment - (274)
Other movements 3,999 (3,196)
Net cash inflow from operating activities 21,507 11,386
20.2 Reconciliation of net cash flow to movement in net debt
2011/12
£000
2010/11
£000
Increase in cash in the period 13,443 553
Cash outflow from increase in liquid resources 257 259
Change in net debt resulting from cash flows 13,700 812
Net debt at 1 April 12,806 11,994
Net debt at 31 March 26,506 12,806
20.3 Analysis of changes in net debt
At 1 April 2011 Cash changes Non-cash At 31 March At 31 March
in year changes in year 2012 2011
£000 £000 £000 £000 £000
GBS cash at bank 17,016 13,442 - 30,458 17,016
Commercial cash at bank and in hand 72 1 - 73 72
Debt due after one year (4,051) 257 257 (3,537) (4,050)
Debt due within one year (257) 257 (257) (257) (257)
Current asset investments - 25 - 25 -
Other financial assets 25 (25) - - 25
Total 12,805 13,957 - 26,762 12,806
21. Contractual capital commitments
There were £1.3m of commitments under capital expenditure contracts as at 31 March 2012 (31 March 2011; £Nil).
22. Contingent liabilities 2011/12 2010/11
£000 £000
Liabilities to Third Parties Scheme (LTPS) member’s contribution (14) (58)
Further details of the LTPS are in note 1.13(ii) to these accounts
116 Annual report 2011/12

23. Related party transactions
Details of related party transactions with individuals are as follows:
Payments to Income From
Name and role Related party details related party related party
£000 £000
Andrew Panniker,
Spouse Chief Executive,
Director of Environment North Middlesex Hospital NHS Trust - 7
Charlie Sheldon, Honorary Senior Lecturer, 26 50
Chief Nurse
City University
Charlie Sheldon, Honorary Visiting Reader, 2 -
Chief Nurse
London South Bank University
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 Foundation Trust 4,028 242 88 90
Barts and London NHS Trust Trust 638 4,937 320 926
NHS Litigation Authority Insurer - 4,685 - 29
NHS Pensions Agency Commissioner - 21,044 - 1,656
NHS City and Hackney Commissioner 132,167 4,354 4,190 4,853
Department of Health Commissioner 541 358 13 40
NHS Enfield Commissioner 1,958 - 52 -
NHS Haringey Commissioner 4,685 - 283 -
NHS Islington Commissioner 4,177 - - 7
London Borough of Hackney Commissioner 3,657 1,605 795 25
NHS London SHA Commissioner 11,366 - 54 -
NHS Newham Commissioner 3,701 - 762 -
NHS Redbridge Commissioner 3,143 - 109 -
South East Essex PCT Commissioner 2,493 - - 42
NHS Tower Hamlets Commissioner 30,971 - 103 2
NHS Waltham Forest Commissioner 7,152 - 447 -
NHS Croydon Commissioner 16,636 - 57 -
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.
24. Private Finance Initiative transactions
The Foundation Trust has no PFI schemes.
Annual report 2011/12 117

ANNUAL ACCOUNTS
25. 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 raise
finance for the Trust’s operations.
26.1 Financial assets
Fixed rate Floating rate Non-interest bearing Total
£000 £000 £000 £000
At 31 March 2012 25 30,531 14,139 44,695
At 31 March 2011 (Prior year) 25 17,088 9,653 26,766
Financial assets consist of cash and cash equivalents and trade and other receivables less prepayments.
26.2 Financial liabilities Fixed rate Non-interest bearing Total
£000 £000 £000
At 31 March 2012 3,275 21,302 24,577
At 31 March 2011 (Prior year) 3,500 13,716 17,216
Financial liabilities consist of current and non-current liabilities less deferred income, tax and provisions.
26.3 Financial assets and liabilities
At 31 March 2012
£000
At 31 March 2011
£000
26.3 (i) Financial assets (book and fair value)
Cash 30,531 17,088
Receivables within 1 year: 12,128 9,362
Receivables after 1 year: - Agreements with commissioners to cover provisions 311 291
Other current investments 25 25
Total 42,995 26,766
26.3 (ii) Financial liabilities (book and fair value)
Payables within 1 year (19,885) (12,265)
Provisions under contract over 1 year (641) (644)
Loans (4,051) (4,307)
Total (24,577) (17,216)
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 2.2% in real terms (2010/11; 2.2%)
118 Annual report 2011/12

27. Third party assets
The Trust held £1,288 of patients’ monies at 31 March 2012 (31 March 2011; £1,353). This amount has been excluded from
the cash at bank and in hand figure reported in the Accounts.
28. Intra-Government and other balances
Receivables: amounts
falling due within one year
Payables: amounts
falling due within one year
At March 2012 At March 2012
£000 £000
28.1 Receivable and payable balances
English NHS Foundation Trusts 174 217
English NHS Trusts 367 1,233
Department of Health 13 40
English Strategic Health Authorities 54 1
English Primary Care Trusts 7,922 4,909
Other NHS WGA bodies 33 423
Other WGA bodies 3 2
Total 8,566 6,825
28.2 Income and expenditure values for the year
Income
Year Ended March 2012
£000
Expenditure
Year Ended March 2012
£000
English NHS Foundation Trusts 4,113 790
English NHS Trusts 1,058 6,545
Department of Health 541 358
English Strategic Health Authorities 11,366 2
English Primary Care Trusts 216,518 4,346
NHS WGA bodies 11 5,594
Other WGA bodies 39 35
Total 233,646 17,670
29. Losses and special payments
Total
Number
£000
Losses 19 34
Special payments 2 9
Total 21 43
Losses have been calculated on an accruals basis but exclude provisions for future losses.
Annual report 2011/12 119

ANNUAL ACCOUNTS
120 Annual report 2011/12

Annual report 2011/12 121

ANNUAL ACCOUNTS
122 Annual report 2011/12

Homerton University Hospital
Homerton Row London E9 6SR
Tel: 020 8510 5555
www.homerton.nhs.uk

Homerton University Hospital NHS Foundation Trust Annual Report and Accounts 2011/12
Homerton University Hospital NHS Foundation Trust Annual Report and Accounts 2011/12