Annual report 2010/11 - East Cheshire NHS Trust

Annual Report& SummaryFinancialStatements2010/20111

WelcomeWelcome from our chairman and chief executiveThis annual report outlines the successes and challengesfaced by East Cheshire NHS Trust during 2010/11. It alsorepresents a landmark in the provision of health services bythe trust as on 1 April 2011 community services previouslyprovided by the primary care trust were transferred toEast Cheshire NHS Trust with the ambition of improvingpatient care in future.Central to all the trust's objectives is to place the patient atthe centre of what we do and to ensure the continueddelivery of safe quality services to people when they needus. We have delivered further reductions in infection duringthe year and patient surveys continue to demonstrate highlevels of satisfaction from the users of our services. Indeed,during the year, trust staff have won national awards forthe care they provide.The skills and commitment of staff are fundamental inachieving our desire to provide quality services and our thanksgo to all staff who have worked for the trust during the year.This commitment was especially demonstrated duringDecember and January when the trust was under significantpressure in dealing with increased emergency admissionsduring the H1N1 outbreak. It is reassuring that the planningwork we undertake for such events proved successful duringthis period.satisfaction survey recently published and we look forward toimproving staff communication further.In line with many organisations the achievement of thefinancial duties was a major challenge and our thanks go toall the staff who were actively engaged in maximisingproductivity and reducing waste to allow this to take placeto generate savings of circa £6m.In the last six months of the year the trust worked with thecommunity services provider to integrate both organisations.The signing of the business transfer agreement on 31 March2011 was a major achievement and allows services to beredesigned reducing waste and duplication in the carepathways for patients. This work during 2011/12 will formthe bedrock for future service provision which will enable thetrust to make an application to the Secretary of State in 2012to become a foundation trust from 1 April 2013.We hope you find this report helpful and informative and ifyou want to gain further insight into our work you maywish to visit our website www.eastcheshire.nhs.ukLynn McGill, ChairmanJohn Wilbraham, Chief Executive4Recognising the importance of the contribution made bystaff we undertook a listening exercise giving the staff theopportunity to share their thoughts and suggestimprovements we could make. The project entitled “YourVoice” has led to a number changes within the organisation.It is also encouraging to note the improvement in the staff5

The trust’smissionTo be the hospitalwhere you wouldchoose to be treated.The trust’s objectives 2010 /11‘‘ ,,Kindness and understanding of any fears I may havehad. The whole breast screening department is apleasant place to be for a necessary procedure.PATIENTSINNOVATIONTHE FUTUREBREAST SCREENING• To continuously improve quality, safety and thepatient experience.• Achieve same sex accommodation requirements.• Reduce hospital acquired infections in line withnational targets.• Act on areas identified for improvement fromnational patient surveys.• Achievement of NHS Litigation Authority Level 2.• Achieve quality strategy performance measures.STAFF• To support and develop staff to enable them toachieve their best.• Implement the second stage of our organisationaldevelopment strategy.• Act on areas identified for improvement fromstaff surveys.• Deliver NHS Constitution staff pledges.• Achieve workforce key performance indicators.• To encourage staff to be innovative when deliveringand planning services.• Develop skills and provide opportunities for ourstaff to innovate.• Recognise and reward innovation by our staff.• Include innovation in our executive and clinical leadportfolios.• Utilise new technologies to enable innovation.COMMUNITY AND ENVIRONMENT• To contribute to our local community and beconsiderate of the environment.• Involve patients and carers in shaping services.• Implement plans for carbon reduction.• Implement plans for reducing waste.• Promote public health awareness includinginitiatives eg. no smoking.• To work with our partners to provide an integratedhealth service for our local population.• Continued development of integrated service models.• Appoint to joint posts across the health economy.• Increase engagement with commissioning andcommunity partners.• Further develop our collaborative partnerships forbreast services.MONEY• To achieve financial sustainability.• To deliver planned activity within agreedexpenditure budgets.• Achieve Auditors’ Local Evaluation Level three.• Deliver the required Cost ImprovementProgramme (CIP).• Achievement of NHS Performance Framework‘performing’ standard.67

Non-executive DirectorsNon-executive DirectorsFull details of meetings andcommittees on which our Directorsserve can be found under the‘About us’ section of our website:www.eastcheshire.nhs.ukTrust Board members have todeclare any interests that may berelevant to the business of thetrust.The register of interests can befound at www.eastcheshire.nhs.ukKathy CowellChairman(until 31 October2010)Lynn McGillChairman fromNovember 2010previouslyNon-executiveDirector/ DeputyChairman (until31 October 2010)Executive DirectorsStewart FraserNon-executiveDirectorDavid CooreyNon-executiveDirectorTony CoombsNon-executiveDirectorExecutive DirectorsNeil MasomNon-executiveDirectorOther DirectorsJohn WilbrahamChief ExecutiveVal AherneDeputy ChiefExecutiveDr Robert SteadMedical DirectorStuart NorthDirector ofFinance(until 30September 2010)Neil CookFinance Director(from 4 October2010)Bernie SalisburyDirector ofNursing andPatient CareStandards(until 14 October2010)Kath SeniorDirector ofNursing,Performanceand Quality(from 18 October2010)Sally CampbellDirector ofHumanResources andWorkforceJulie GreenDirector ofCorporateAffairs andGovernance(from 1 February2011)1011

The trustAll Clinical BusinessUnits are supportedin their activities bythe corporateservices division ofthe trust.East Cheshire NHS TrustEast Cheshire NHS Trust was established in 2002 andprovides a wide range of acute health services to thepopulation of eastern Cheshire and the borders of theneighbouring areas of Stockport, High Peak and NorthStaffordshire. The population catchment area isapproximately 200,000. The trust consists of three hospitalsin Macclesfield, Congleton and Knutsford, in Cheshire and anumber of outpatient facilities throughout the local area.built Rehabilitation Unit. We also provide a number ofhospital services in partnership with other local trusts andprivate providers.East Cheshire NHS Trust provides a full range of generalacute secondary care hospital services through a ClinicalBusiness Unit Structure. These are Outpatients, Surgical,Medical and Women’s and Children’s services.The trust has a 24 hour Emergency and Trauma Departmentwith inpatient services provided from three sites. The trustalso benefits from a state of the art Antenatal Department,Cancer Resource Centre, and day surgery facilities and newlyAll Clinical Business Units are supported in their activitiesby the corporate services division of the trust whichencompasses specialist areas such as HR, finance, governance,communications and engagement and estates functions.2009/10 2010/ 11Macclesfield District General Hospital 388 inpatient beds 392 inpatient bedsCongleton War Memorial Hospital 28 beds 28 bedsKnutsford District Community Hospital 18 beds 18 beds until September2010. Temporarily closedafter September 2010.Trust income £115,877k £118,610kFull details can be found on page 71 Finance income analysis.Trust employees 2,139 2,103Volunteers 297 273Outpatient attendees 193,910 191,779Emergency Department attendees 53,023 53,257Emergency admissions 21,452 22,433Planned admissions 16,043 15,245Births 1,911 2,018Home births 38 451213

Outpatients ServiceMedical Business UnitCancerServicesNeurosurgeryRheumatologyOutpatientServicesEmergencyMedicineAcuteMedicineOlderPeoplePharmacyBed ManagementDischarge Co-ordinationPalliativeCareNeurologyAdultPhysiotherapyNursingEmergencyCareRespiratoryOlder PeopleServicesHaematologyVascularAudiologyBookingand CapacityNursingStaffGastroenterologyStrokeServicesDermatologyAdult OTDataQualityMinor InjuryUnitDiabetesIntermediateCareDialysisNephrologySALTEEGCase NoteLibraryBookingandReceptionCardiologyAcuteMedicineClinicalCodingChooseand BookEndocrinology18 WeekMedicalSecretaries1617

Women’s and Chidren’s Business Unituntil February 2011New Community Business Unitfrom February 2011Special CareBaby UnitAntenatalServicesIntrapartumCareCommunity/Inpatient WardGynaecologyServicesPaediatricSurgeryCommunityPaediatricsChildren’sWardChildren’sOutpatientsSafeguardingChildrenHospital@ HomeSpecialityNursesDuring the last quarter of 2010, East Cheshire NHS Trustbegan the integration process with Cheshire EastCommunity Health (CECH), the community provider arm ofCentral and Eastern Cheshire Primary Care Trust (CECPCT).During this time the Clinical Business Units underwent areview in order to ensure the very best pathway of care forthe patients at the trust. The Women’s and Children’sBusiness Unit was disestablished, the services of which arenow delivered out of other business units (from 1 February2011). Obstetrics and Gynaecology Services were moved tothe Surgical Business Unit and Community Paediatrics wasmoved to the Community Business Unit. This allowed forthe community pathway to be integrated into the trust inApril 2011.PlannedCareAdultCommunityNursing EastAdultCommunityNursing CentralChildrenand FamiliesCommunityPaediatricsChildren’sWardChildren’sOutpatientsSafeguardingChildrenAcuteServicesUrgent CareCenter/CentralCheshire GPOut of HoursEasternCheshire GPOut of HoursSpecialistServicesHospital@ HomeIntermediateCareSpecialistNursingAdministrationManagerAllied HealthProfessionalServices1819

The year’sachievementsQIPP is a nationalprogrammesupported by the NHSNorthwest which isseen as the majorvehicle to plan forand deliver thesavings required bythe NHS.QIPPSETTING THE STANDARDQuality, Innovation, Prevention, Productivity (QIPP) isembedded in everything that the NHS delivers. Thestandards that the trust have achieved during 2010/11meet the requirements of the QIPP agenda.Our achievements in 2010/11{Q} {I} {P} {Pr} indicates how these achievements relateto QIPP.QUALITYQThe trust was delighted to welcome the followingconsultants and senior clinical staff to the teamduring 2010/11:• Dr Rubina Japanwala, Consultant Ortho-geriatrician• Dr Maryam Shahbaz-Samavi, Consultant Rheumatologist• Dr Lynsey Taylor, Consultant Dermatologist• Dr Martin Muller, Consultant Radiologist• Dr Sara Nausheen, Consultant Obstetrician andGynaecologist• Dr Iram Rabbani, Resident Consultant Obstetrician andGynaecologist• Dr Joe Kabyemela, Resident Consultant Obstetrician andGynaecologist• Advanced Respiratory Practitioners• Brian Green, Head of Professional Practice.QIn May 2010 the IIP Recognition Award Panelconfirmed the trust’s status as an Investor in People.IIP is regarded as the leading people managementbenchmark of business improvement.QThe Learning Disabilities Group were awarded therunner up prize in the National Guardian PublicServices Awards in the category of Partnership Working in2010.QKathy Cowell, the former trust Chairman, wasnominated for the Outstanding Non ExecutiveDirector Award at the NHS North West Leadership Academyannual conference. Kathy was one of three finalists at theevent.QThe Stroke Team have improved the key performanceindicators within stroke care. The service deliveredduring the year reached the averages of over 90% eachmonth for the 14 indicators that are monitored (forexample direct access to an acute stroke bed, CT scan within24 hours of stroke). Other improvements that have beenmade include delivering thrombolysis as a nine to fiveservice, and the introduction of group therapy sessions onthe ward including a breakfast club.QQAwards and recognitionThe East Cheshire NHS Trust Endoscopy and TreatmentUnit (ETU) was successful in achieving GastrointestinalEndoscopy Joint Advisory Group (JAG) accreditation. JAG isresponsible for setting standards for all aspects ofgastrointestinal endoscopy in the UK. The underpinningrationale of JAG includes emphasis on education andtraining, the significance of Nurse Endoscopists within theworkforce and the overall quality of endoscopy units.QThe Supervisors of Midwives Team (Grace Hopps,Lynda Moorcroft, Lorraine Perry, Heather Millward,Amanda Lucas, Michelle Moran, Beverley Walsh and ElaineAlston) from the Maternity Department at East CheshireNHS Trust, were shortlisted for the ‘Excellence in SupervisionAward’ at the prestigious British Journal of MidwiferyAwards in November 2010. The Midwifery Team at EastCheshire NHS Trust offers an integrated service whichprovides continuity of care and support to all womenthroughout their pregnancy. The team provides care acrossthe whole pregnancy continuum working both in theQWithin the regional Advancing Quality programmethe trust achieved third best performing for Acutehospital and community with the flexibility to work wherewomen need them to be.Myocardial Infarction; was awarded most improved in theNorth West for pneumonia; and is on track to achieve allother measures. The Advancing Quality programmepromotes best practice care for the above conditions.QSally Campbell, Director of HR and OrganisationalDevelopment, won two awards in 2010/11: the NHSNorth West HR Role Model and HR Director of the Year inDec 2010.2021

IA new surgical procedure which could transform thelives of breast cancer patients was unveiled atMacclesfield District General Hospital in July 2010. The newtechnique, called Lipomodelling, uses liposuction to extractthe excess fat from the stomach and thighs. The fat is thencentrifuged to separate out the fat cells ready forreinjection. This technique allows breast cancer patients tohave the contour irregularities caused by surgery to becorrected using natural fatty tissue from their ownabdomen or thigh. Macclesfield District General Hospital isone of the first hospitals in the Cheshire and Stockport areato offer this operation.PREVENTIONPEast Cheshire NHS Trust (ECT) and Cheshire EastCommunity Health (CECH) have worked jointly to bethe lead provider of Intermediate Bed Based Services (IBBS).The aim of the IBBS is to avoid unnecessary hospitaladmissions and support early discharge from an acutehospital bed. The development of an integrated electronicbed bureau for all community intermediate service beds hasenabled patients to be fast tracked to the most appropriateavailable bed. It has also enabled patient throughput tocommunity support at home to be more clearly managed.PIn 2010/11 the provision of social services andintermediate care services out of hours was extended.A night response team to reduce avoidable admissions wasestablished and additional intermediate care beds in thecommunity have been purchased on a temporary agreement.26PA Pre-conception and Recurrent Miscarriage Service isnow available at Macclesfield District GeneralHospital which aims to help women in planning for a futurepregnancy. The service aims to optimise maternal health togive the best chance of a successful birth. Women areinvestigated to identify possible causes for recurrentmiscarriages and provided with counselling and informationregarding pre-conception.PA preconception clinic has been established duringthe year in order to maximise health outcomes forwomen with co morbidities who may be consideringpregnancy.PA day case area has been developed on the EgertonUnit (formerly the Emergency Floor). This is a smallbut comfortable area where patients requiring treatment orinvestigations can be managed without the need to beadmitted to an inpatient bed.PService improvement work within the operatingtheatres has facilitated new ways of working tomaximise efficiencies within existing resource.PRODUCTIVITYPrDuring summer 2010 two new integrated posts acrossEast Cheshire NHS Trust and Cheshire East CommunityHealth were appointed to Children’s Services to ensureseamless care for children and families moving in and out ofacute and community settings. The children’s servicemanager and advanced paediatric nurse practitioner andmatron have worked across acute and community servicesdeveloping integrated services and care pathways for theindividual child or family.PrThe working day and week has been extended in theOutpatient Department, Physiotherapy Departmentand Audiology Department at Macclesfield District GeneralHospital. This is to give patients a greater choice ofappointments to suit them.PrChanges to the administrative teams have beenimplemented leading to a more team based approachto medical secretarial support.PrThe productive ward initiative helps staff across theacute sector to significantly increase their time spenton direct patient care. Antenatal patients are benefitingfrom a service redesign programme centred on theproductive ward. The Experience Based Design approachwas used to find out how patients’ experience of using theservice made them feel. Patients were asked how they feltat each stage of their care. Repeat surveys and audits aftersix months provide evidence that patients are feelinghappier, safer and less worried, and that clinic waiting timeshave decreased. This has led to a reduction in informalverbal complaints by 50%, and a 4.4% reduction in patientsnot attending appointments. A total of 13 changes wereimplemented including:a.the provision of a patient information leaflet;b.information boards in patient and staff areas; andc. more frequent delivery of blood results.Plans are in place to introduce the productive ward onto thematernity ward in 2011/12.PrThe trust has achieved the Public Service Agreement(PSA) targets in relation to smoking at delivery, breastfeeding initiation and full health and social needs assessmentwhich all require completion by 12 weeks of pregnancy.PrThe trust has introduced the Resident ConsultantModel for obstetric staffing on a two year trial. Thismodel increases the consultant presence on the labour wardand an increase in a consultant delivered service rather thana consultant led service. Monday to Friday, nine to five thereis always a consultant based on the labour ward. In additionthere is a consultant on call 24 hours per day, seven days perweek. This reduces time waiting for specialist care when it isrequired by patients and increases medical expertise andlearning outcomes for all medical staff.PrThe trust has undertaken a review in GynaecologyServices to explore the opportunity for revisingcurrent practices in light of technological advances. TheGynaecology Service at the trust began a service reviewduring the year of new operating equipment, which willprovide the following patient benefits:• Reduced operating time• An increase in day case surgery thus reducing the need forgeneral anaesthetic• Reduced recovery time for patients• Less requirement for inpatient stay so that they can gohome to recover the same day.PrThe Emergency Floor area has been re-named theEgerton Unit after a local dignitary Lord Egerton whoopened Macclesfield Infirmary in the 1800’s. The unit hascontinued to develop to improve efficiency and quality ofcare. Staffing has been reconfigured to enable staff to workmore effectively. New technology has been implementedwith ambulance screens installed to alert staff of emergencyarrivals and an automated drug cabinet improves stockcontrol and security.27

The trust’sperformancePerformance against national standards28Monthlyperformance chartscan be found in thetrust Board paperson our websitewww.eastcheshire.nhs.ukThe trust is measured on its performance against theDepartment of Health NHS Performance Framework whichprovides a dynamic assessment of the performance of NHSproviders that are not yet NHS Foundation Trusts.The assessments are across four key domains oforganisational function; finance, quality of service,operational standards and targets and quality and safety.Performance is assessed quarterly. The trust is categorisedas ‘Performing’ out of the following categories:• Performing• Performance under review• Underperforming.Our performance standards include:• 97.3% of Emergency Department patients treated ordischarged in four hours (target no less than 95%). Thecontinues to be one of the best performing acute trustsnationally with regard to the four hour EmergencyDepartment standard.• Three cases of MRSA (target no more than 4).• 45 cases of Clostridium Difficile (target of no morethan 63).• Median standards: 12.3 weeks for the year (target lessthan 11.1 weeks) admitted referral to treatment and4.3 weeks for the year (target less than 6.6 weeks nonadmitted patients treated in 18 weeks).• 95th Percentile standards: 22.2 weeks for the year(target less than 27.7 weeks) admitted referral totreatment and 17.3 weeks for the year (target less than18.3 weeks) non admitted patients treated in 18 weeks.• 98% urgently referred suspected cancers seen within14 days of referral (target not less than 93%).• 97.3 (target not less than 93%) of patients seen within14 days for referral of breast symptoms.• 99.6% (target not less than 96%) urgently referredsuspected cancers treated within 31 days of diagnosis.• 78.6% of patients receiving Thrombolysis within 60minutes of call . (target not less than 68%).• 4.4% (target less than 3.5%) in delayed transfers of care.• Reduction of pregnant smokers at time of giving birth to13.5% (target no more than 15%).• 94.6% achievement of CT scan within 24 hours ofadmission for Stroke patients (in year target 80%).• 82.6% of stroke patients having 90% of hospital stay ina dedicated stroke ward (target 80%).• 89.2% of cancer patients receiving treatment within62 days of GP referral (target 85%).• 6.1% of cancelled operations not readmitted within28 days (target less than 5%).29

Registration under the Health and Social CareAct 2008 (Regulated Activity) Regulations 2009and the Care Quality Commission (Registration)Regulations 2009In April 2010 all NHS health care providers were requiredby law to register with the Care Quality Commission anddeclare compliance against 28 regulations. 16 regulationsrelated to quality and safety of care received by patients.Any area of non-compliance had to be declared and anaction plan put in place which would be reviewed by theCare Quality Commission. Registration could be issued with‘no condition’ or ‘with conditions’.East Cheshire NHS Trust successfully registered with theCare Quality Commission declaring full compliance with allof the regulations. The trust registration was granted withno condition attached to it and retained this positionthroughout 2010/11. As part of the regulations the trust isrequired to notify the Care Quality Commission of anychanges to service. During 2010/11 the trust has made threenotifications to the Care Quality Commission in relation to:• The integration of East Cheshire NHS Trust and CheshireEast Community Health in April 2011.• Change in the provision of Nuclear Medicine Service fromEast Cheshire NHS Trust to Stockport Foundation Trust viaService Level Agreement from 17 May 2010.• Tatton Ward located at Knutsford Community and DistrictHospital, was temporarily closed from September 2010.The closure was a proactive move on behalf of the trust,due to difficulties in recruiting sufficient clinical staff cover.Incident reporting statisticsComparative reporting rate, per 100 admissions,for 30 acute organisations from 1 April 2010 to30 September 201012.0010.008.006.004.002.000.00Reported incidents per 100 admissionsIt is a Care Quality Commission (CQC) requirement that allpatient safety incidents are reported to the National PatientSafety Agency (NPSA).The data published by the National Patient Safety Agency isbased on six months worth of data submitted by the trustfrom April to September 2010.East Cheshire NHS Trust is classified by the NPSA as a smallacute. There are 30 trusts in this cluster group (East CheshireNHS Trust being amongst that 30). If the small acute trustsare placed in order, to be in the top 25% of reporters in thecluster group the trust must be placed at position 23 orhigher on the graph.East Cheshire NHS Trust is, based on the latest data released,at position 21 on the graph (6.41 incidents/100 admissions).The trust is therefore 0.2 incidents/100 admissions awayfrom being in the top 25% of reporters in their clustergroup. This data shows that the trust has to marginallyincrease its reporting to become one of the top 25% ofreporters.The following chart identifies where East Cheshire NHS Trustwas (position wise) on the graphs for the reports used forthis analysis and also indicates where (percentage wise) thetrust was based on that position.Period for reports Position on graph % Area of(in cluster group) reportingApril – September 16 Mid 50%2008October 2008 – 3 Lower 25%March 2009April – September 7 Lower 25%2009 (higher end)October 2009 – 12 Mid 50%March 2010April – September 21 Mid 50%2010 (higher end)KEY: East Cheshire NHS Trust reporting rate = 6.41incidents reported per 100 admissions.3031

Freedom of information requestsThe Freedom of Information Act (2000) came into effect forall public authorities in January 2005. Since then, allrequests for information have had to be answered inaccordance with the Freedom of Information (FOI) Act 2000or the Environmental Information Regulations 2004 (EIR).The Freedom of Information Act provides the general publicwith a general right of access to recorded information heldby East Cheshire NHS Trust, subject to certain conditionsand exemptions.During 2010/11 the trust received 193 requests frommembers of the public in relation to a number of differentareas. For example: funding, staff, clinical services and more.All responses to requests were completed in the requiredtime frame of 20 working days.The trust remains committed to promoting a culture ofopenness and accountability to enable the public to havea greater understanding of how the trust carry out duties,how decisions are made and how public money is spent.A full list of freedom of information responses can be foundat www.eastcheshire.nhs.ukPersonal data related incidents 2010/11It is essential that all incidents relating to actual or potentialbreaches in confidentiality involving personal identifiableinformation, including data loss, are reported appropriatelythrough the information governance assurance framework.East Cheshire NHS Trust has risk assessment policies andprocedures in place to assess the severity of such incidentsand to take any necessary action to address the risk.The following table provides details of externally reportedincidents for 2010/11.Summary of other personal data relatedincidents in 2010-2011Category Nature of Incident TotalLoss of inadequately protectedI electronic equipment, devices or 0paper documents from securedNHS premises.Loss of inadequately protectedII electronic equipment, devices or 0paper documents from outsidesecured NHS premises.Insecure disposal of inadequatelyIII protected electronic equipment, 1devices or paper documents.*IV Unauthorised disclosure 0Serious Untoward IncidentsEast Cheshire NHS Trust has a duty to report SeriousUntoward Incidents (SUI) to the Strategic Health Authorityvia the Strategic Executive Information System (StEIS) andthe Primary Care Trust (PCT).Month Number2010/11 of reports CategoryMarch 0April 0May 0June 0July 0August 0September 2 • Delayed diagnosis• Intrapartum deathOctober 2 • Suboptimal care of thedeteriorating patient• Surgical errorNovember 1 • Unexpected deathDecember 3 • Unexpected death• Grade 3 pressure soreJanuary 8 • Sub optimal care• Delayed diagnosis• Missed diagnosis• Grade 3 pressure sore (x4)• Grade 3/4 pressure soreFebruary 5 • Grade 3 pressure sore (x2)• Information Governance• Adult protection• Unexpected deathMarch 4 • Grade 3 pressure sore (x3)• Ward closureTotal 2532V Other 0*Note: Although the level three incident detailed above wasclassed as level 3 by the risk assessment criteria from theDepartment of Health under their policy, due to the low risknature of the data involved it was not investigated by theInformation Commissioners Office (ICO).The role of the SHA and Commissioning PCT is to ensureincidents are properly investigated, that action is taken toimprove clinical quality and that lessons are learnt in orderto minimise the risk of similar incidents occurring in thefuture. The NHS North West revised SUI protocol sets outthe requirements for reporting and examples of incidentsto report.Note: From December 2010 the trust was required to reportall Grade 3 and 4 pressure sores on StEIS.Each incident was thoroughly investigated using a rootcause analysis approach endorsed bt the National PatientSafety Agency (NPSA) and any lessons learnt will be used toinfluence future practice to reduce the likelihood ofrecurrence.33

Emergency preparednessPatient safety and governance‘‘ ,,I could not ask for better, all staff treated my childand myself with respect and concern. I believe theydo an excellent job that is much needed.PAEDIATRIC DIABETESRisk management34The trust has continued to demonstrate, throughoperational activity and audits, that it is well placed to dealwith a variety of emergencies. During 2010/11 East CheshireNHS Trust has led on and participated in numerousresilience activities, these have included:• Undertaking leadership in emergencies training formembers of the Executive Director Team.• Participating in two internal exercises and one externalmulti-agency exercise.• Implemented robust escalation plans to enable theexpansion of the Intensive Care Unit (ICU) to counter thedemand of seasonal Influenza whilst dealing with adversewinter weather conditions.• Practical training and testing of our Chemical, Biological,Radiological and Nuclear (CBRN) response capabilities.The trust has also scored 86% and 92% on external auditsfor emergency preparedness and business continuity,respectively. This has ensured that we fulfil our legalrequirements under the Civil Contingencies Act and moreimportantly ensures that East Cheshire NHS Trust meets itsvision to be the “hospital of choice”.The trust commitment to patient safety and ensuring arobust governance framework is in place and monitoringcontinued through 2010/11. During the year furtherdevelopments were made in relation to the review andmonitoring of NICE (National Institute for ClinicalExcellence) guidance and National Confidential Enquiryreports to ensure ongoing learning and development isimplemented to provide safe care.The trust has also dedicated time to improving adultprotection and now works more closely and collaborativelywith Social Services to ensure concerns which are raised aredealt with quickly and effectively to support patientsand staff.During 2010/11 the trust remained below the nationalbenchmark of 100 for Hospital Standardised Mortality Ratio(provided by Dr Foster Intelligence) and has participated ina national mortality study known as: Preventable Incidents,Survival and Mortality Study (PRISM). The results for thestudy are due to be published to participating trusts inJune 2011.A figure of 100 means results are directly in line withexpectations. A higher figure means a higher mortality rateat the hospital. A lower figure means a low mortality rate.The safety of patients continues to be a high priority for thetrust. The trust works to achieve this by having a strong riskmanagement culture and structure in place to identify andreduce risks and therefore harm to our patients.The trusts risk management processes are supported by anannual Risk Management Strategy, which once again wasratified by the Trust Board in March 2010 for the year2010/11. This continues to demonstrate the board’scommitment to providing care in a safe environment.Through a process of continued review and development ofour risk management structure a reorganisation of thetrusts corporate and business unit risk registers has beencompleted. A standardised format has been implemented toensure the seamless escalation of risks up to the corporaterisk register and Board Assurance Framework. This meansthat the Executive Directors and the Trust Board are fullyaware of all significant risks to patients and theorganisation and the actions being taken to reduce orresolve these. This process also allows lessons to be learntacross all areas of the trust therefore improving patientsafety on a broader scale.35

Quality AccountCustomer careLessons learnt and changes to trust servicesPublic websitesThe trust produces an annual quality account. The qualityaccount details priorities for improvement and reviewsquality performance in 2010/11. The full quality account canbe viewed on the trust website at www.eastcheshire.nhs.ukInfection prevention and controlThe effective prevention and control of infection is anessential part of maintaining and promoting patient safetyand has the highest priority at all levels in the trust. Patientsmust be given confidence that everyone involved in theircare will be vigilant in preventing infection. Continualmonitoring of both the environment and our proceduresensures the highest standards are achieved.Customer care is a crucial element of patient satisfaction.Every time the trust has contact with customers there is theopportunity to retain and improve the trust’s reputationand increase the likelihood of patients and their familieschoosing East Cheshire NHS Trust for treatment in the future.Over 2,500 compliments relating to the hospital, patientcare, procedures and staff were received in 2010/11.The trust has an open an honest approach to dealing withcomplaints and ensures that they are investigatedthoroughly and fairly to establish the facts. The feedbackreceived from customers ensures that the trust is able toimprove the services delivered.The aim of our Customer Care Department is to focus onthe complainants needs, and use negative feedback,positively to improve services.• The number of complaints received in 2010/11 was 156.• The number of Patient Advice and Liaison Service (PALS)issues received in 2010/11 was 935.• The number of complaints referred to Health ServiceOmbudsman was two.As a result of complaints made to the trust, lessons havebeen learnt examples of which are:• Letter amended to inform all patients to report tocustomer care reception where on arrival to the hospital,they will then be clerked in and directed to theappropriate ward or department.• Chairs removed from outpatients corridors to protectpatients’ privacy and dignity.• Amendments made to the patient information leaflet forpatients attending for an MRI scan.• Amendments made to home birth information, so thatpatients fully understand the circumstances for homebirths and why this not to be possible for some parents.• Raise awareness of communication when undertakingcare of woman in labour.• Appropriate action taken to prevent and manage patientsat risk of falls.• Ensure the patient receives adequate pain relief in atimely manner.• Visiting hours on the Maternity Unit have been changed.• The visitors policy now reflects why flowers are notallowed on the hospital wards.This can be found at www.eastcheshire.nhs.uk/policiesNHS ChoicesNHS Choices is a public website on which patients andvisitors may publically post comments, concerns andcompliments. The trust monitors this site and responds to allcomments posted.31 comments have been received through NHS Choiceswebsite during 2010/11. These feature both complaints andcompliments. Examples of some of these are detailed below.• “Compliment that staff had professional approach andpatient was impressed when they treated urinaryretention problem. Front line staff are world class.”• “Compliment that staff were great and attended topatient quickly and effectively. Also, follow upappointment was first class. NHS is a wonderful serviceeven if it does have some failings”• “Compliment about all aspects of maternity care “MumsnetA review of postings for the past year showed eightpostings on the site relating to Macclesfield District GeneralHospital. In response to a mum querying what thematernity care would be like at Macclesfield, a number ofcomments were made:• Macclesfield is “much friendlier, nicer atmosphere.”• One person’s second baby was born at Macclesfield,“she couldn’t praise them highly enough, from labour todelivery to ward after care.”• “I had a really positive experience at Macclesfield.”3637

The people whowork hereWe undertook acomprehensive staffengagement andlistening exercise.Our staffDuring 2010/11 we continued to pursue our OrganisationalDevelopment (OD) Plan, to understand, develop, andtransform the culture of the trust; in other words“changing the way we do things”. We undertook acomprehensive staff engagement and listening exercise aspart of the “Your Voice” culture change programme, to helpus learn more about how we can improve the working livesof staff, and continue to improve the quality andsustainability of the services they provide duringincreasingly challenging times.The trust will continue to deliver actions that resulted fromthis stage of the OD plan through 2011/12, ensuring theysupport the ongoing delivery of high quality patient care –and link to the wider development of the trust, and supportour transformation to a successful integrated health carefoundation trust.Learning and developmentThe trust continues to be committed to a culture of lifelonglearning, and to ensuring that staff are safe to practise, thatthey maximise their potential, and are able to provideexcellent services to patients.During 2010 we improved the appraisal process, andsupported managers with effective appraisal training, todeliver a better quality of appraisal. This resulted inincreasing numbers of staff having an appraisal, producinga personal development plan, and feeling that the processhad made a positive difference.We have begun to develop our relationships with localeducation providers to support staff development duringchallenging times. The trust has also signed up todeveloping a consistent approach to mandatory trainingwith other health organisations across the North West – toensure that staff across the region are appropriately skilledto provide high quality services to patients.Management and leadership development will be a focusfor 2011/12, particularly supporting the development ofleaders from clinical professions. The trust is also planningto increase the use of e-learning and other innovative andcosts effective ways to deliver training and development.Relationships with the unionsIn preparation for becoming an integrated organisation inApril 2011, the acute and community divisions integratedthe Joint Consultative and Negotiation Committee (JCNC)meeting and Partnership Forum (Community) to becomeone forum bringing together staff side representatives fromboth organisations. The new format has been exceptionallywell received and is working well with a new staff side chairfrom the Community Services Business Unit and a new LocalNegotiation Committee (LNC) chair from the acute division.3839

STAFF AWARDSCategories and winnersThe trust is extremely proud of its staff and allthe hard work they do everyday. To celebratetheir achievements and say thank you EastCheshire NHS Trust held its third Annual StaffAwards on Friday 22 October 2010 atTatton Park, Knutsford, supported by sponsorsHill Dickinson, The Emerson Foundation,Harvest Housing and PriceWaterhouseCoopers.The awards were established to celebrate theexcellent work done by our staff, and are asuperb way of letting individuals and teamsknow that their hard work throughout the yearis very much appreciated.Doctorof the Year:Dr KatinaMarinakiNurse / Midwifeof the Year:Amanda LucusRegisteredProfessionalof the Year:Debra RowarthTeam of the Year:Stroke TeamQuality andDignity Award:Hayley ReadingPatients Choice Award:Cancer Resource TeamPatient andPublicInvolvementAward:Emily BeardThere were over 300 nominations. This year’snominees came from throughout the trust.Whether they are a physiotherapist or a doctor,or working in finance or catering; they all haveone thing in common; they go the extra mile tomake tangible improvements to the servicesthe trust provide and the lives of those whouse the services. Winners were presented witha certificate of achievement and a plaque tocommemorate their success.Managerof the Year:Paul BuckleyEducatorof the Year:Elaine AlstonPatient SafetyAward:Lyn BaileyColleagueof the Year:Rosemary DunnChampionsExtra MileAward:Janet EdwardsAdministratorof the Year:Pam BostockYour VoiceAward:Barry BridgeChairman’sAward:Rick Newcombe4041

Other awards and recognitionBritish Journal of Midwifery – National Midwife of the yearaward - Elaine Alston Practice Development Midwife andLabour Ward Co ordinator. Elaine has been described as aninspirational role model for midwives and works to supportexcellence in clinical practice and a safe service for mothersand babies.Royal College of Midwives – National Midwifery Team ofthe year - Sally Sharpley, Louise Yusef, Barbara Arrowsmithand Heather Millward Their winning project focused onmodernising maternity care at the trust, leading to aone-to-one care in labour rate of over 97%, a reducedlength of stay with a revised postnatal care pathway and arevamped parent education programme.UNICEF BFI stage 2 – The Maternity Unit staff undertook theUNICEF Baby Friendly Initiative UK award stage 2 assessmentin December and achieved a 100% success rate. The teamwere particularly complimented on their positive attitudetowards helping mothers to breastfeed and their hard workin improving practice since the previous assessment.Patient Passport – The ‘Patient passport’, developed withcolleagues at the David Lewis, Rossendale Trust, EastCheshire Advocacy and Cheshire and Wirral Partnership toease the path to medical treatment for people with learningdisabilities, was shortlisted for the Guardian Public Servicespartnership award in November 2010. The aim of the patientpassport is to improve the care and services available forpeople with learning disabilities. The new patient passportwas effectively used on the 9 December 2010 when anumber of students from Park Lane School came to visitMacclesfield District General Hospital. Starting at A&E, thegroup went on a guided tour of the areas they might visit inhospital. Showing their patient passports allowed trust staffto support their needs and enabled the students to practisewhat would happen on a real visit to a hospital.Staff wellbeingThe trust is in the second year of delivering an EmployeeWellbeing Strategy, which aims to support improvements instaff health and morale, and the associated increases inemployee productivity.Staff sickness and absenceOur trust target for sickness absence for the year is less than4.5%, which we achieved during 2010/11.The table below details the sickness absence percentagerate each month for the calendar year January toDecember 2010. Although these figures show seasonaldifferences (mainly during the winter months), the overalltrend is that sickness absence has continued to fall for thelast three years.Month% sicknessabsence rateJanuary 5.45February 4.60March 4.56April 4.08May 4.25June 4.03July 4.45August 4.42September 4.47During 2010 we promoted the message of staff health andwellbeing through a number of events, initiatives andregular publications focused on the key wellbeing objectivesto improve; physical and mental wellbeing, organisationalwellbeing and good people management, and economicand social wellbeing (with advice on retirement, pensionsand financial planning).October 4.30November 4.63December 5.54Total(12 month average) 4.46In 2011 we will continue to deliver this strategy, with aparticular focus on improving the way that absence fromwork is managed.4243

Staff sickness absence2010-11 2009-10Number NumberDays lost (long term) 0 0Days lost (short term) 17,258 17,750Total days lost 17,258 17,750Total staff years 1,749 1,739Average working days lost 10 10Total staff employed inperiod (headcount) 0 0Total staff employed in periodwith no absence (headcount) 0 0Percentage staff withno sick leave 0.00% 0.00%The data for 2010-11 refers to the calender year 2010, asmandated by the Department of Health.During 2010 sickness absence was included on all businessunit performance reports, along with other key workforceperformance indicators. Continued efforts from managers,supported by Human Resources and Occupational Health,helped to support staff in reducing their sickness absence toa level which is better than the North West NHS average.‘‘ ,,Staff surveyAll the staff from the surgeon to nurses and eventhe cleaners were lovely. They couldn't do enoughfor me. Nothing was too much trouble. I am verysatisfied with my treatment and my wholeexperience of the hospital is positive.All staff at the trust were asked to participate in the 2010NHS staff survey – which collected views and opinions acrossa wide range of issues including; health and wellbeing,training and development, staff engagement, equality anddiversity, and job satisfaction.The results for East Cheshire NHS Trust improvedsignificantly from the previous year’s survey.When compared to other NHS acute trusts, East Cheshirestaff reported a higher overall level of staff engagement,more staff receiving health and safety training, and a higherlevel of overall job satisfaction. More staff at East Cheshiresaid they’d had a well structured appraisal, with a personaldevelopment plan, in the last 12 months. More staff alsoreported having equality and diversity training.BREAST RECONSTRUCTIONStaff also felt there could be improvements in the qualityof work and patient care they are able to deliver.The trust will continue to pursue the staff engagementagenda, with further analysis and action following theseresults. The survey findings from Cheshire East CommunityHealth will also be included, to inform a consistent overallapproach to improving safety, wellbeing and staffsatisfaction – delivering staff pledges of the NHSConstitution and improving the working lives of staff in2011 and beyond.The results highlighted a number of areas for improvement.A higher proportion of staff at East Cheshire continue toreport working extra hours in comparison to other acutetrusts, with higher than average feelings of work pressure,and pressure to attend work when feeling unwell.44 45

The communitywe serveInvolving the communityNational adult inpatient survey 2010East Cheshire NHS Trust was reviewed by 460 patients outof a sample of 817 patients who had been treated as aninpatient at the trust during summer 2010.The trust was in the top 20% of trusts for 13 out ofa possible 64 areas including:• Privacy when being examined or treated in A&E• Time on waiting list before admission• Choice of admission dates• Admission date not changed by hospital• Same sex accommodation while staying in hospital• Posters informing patients and visitors to washtheir hands• Quality of hospital food• Enough nurses on duty• Privacy when discussing treatment• Staff helping to control pain• Being treated with dignity and respect• Posters and leaflets available showing how to complain.Areas where the trust saw the largest increase in scoresinclude:• Patients being able to use same sex bathrooms• Posters and leaflets available explaining how to complain• Potential side effects of medication being explained• Patients being asked to give views on the quality oftheir care• Doctors hand washing• Explanations of what would be done during operationsand an explanation of how it had gone afterwards andreceiving copies of letters sent between hospital and GP.‘‘ ,,I was given an appointment within a week.The staff were friendly, helpful and professional.Very pleased with the NHS - did not expect such agood service.RADIOLOGY4647

National maternity survey 2010This survey was last carried out in 2007 and the 2010 resultsshow an improvement in the scores for the majority ofquestions where a comparison is possible.The figures below show the overall ratings for the differentstages of maternity care, ie antenatal, labour, postnatal andat home:2007 2010 All* 2010Antenatal care duringpregnancy(excellent / v good / good) 98% 98% 91%Care received duringlabour and birth(excellent / v good / good) 96% 93% 93%Treated with care andunderstanding in hospitalafter birth of baby(always / sometimes) 97% 95% 92%Care received at homefollowing the birth(excellent / v good / good) 88% 90% 87%* Average from all trusts whose surveys were undertaken byQuality Health. This represents 25% of all acute trusts.In the benchmarking, the trust was in the top 20% of trustsfor the following:• Being able to move around and choose comfortableposition in labour.• Skin to skin contact with baby shortly after the birth.• Partner or companion during labour and delivery madewelcome by staff.• Feeling that the length of stay in hospital after the birthwas appropriate.The trust was in the lowest 20% for one area – the reasonsfor having a screening test for Down’s syndrome beingclearly explained.National cancer survey 2010East Cheshire NHS Trust was in the highest performing 20%of trusts for 32 out of a possible 55 areas. In particular thetrust achieved the highest scores of all trusts for thefollowing three areas:• First appointment no more than 4 weeks after referral• Admission date not changed by hospital• Patient given written information about operation.The ‘Deciding the best treatment for you’ section of thesurvey was also a strong performing area with all areas inthis section achieving ratings in the highest performing 20%of trusts.The trust was not in the lowest 20% of trusts for any areas.Local feedbackA wide variety of patient feedback work has been carriedout across all areas of the trust covering a range of subjectsincluding bowel cancer, radiology, breast screening,patients’ experience of theatre, Endoscopy and TreatmentUnit, consent, day case surgery, breast reconstruction,paediatric diabetes, Hospital at Home, antenatalphysiotherapy, colposcopy, stroke services, emergencydepartment, pharmacy, acute rehab team, inflammatorybowel disease, audiology, haematology, Macmillan NursingService, dermatology, customer care and chaplaincy.Some examples of service feedback and improvementsinclude:Paediatric audiology – Not all patients felt they hadadequate information before they attended for theirappointment, especially those attending with olderchildren. In response to this the trust will ensure that allnew patients receive a full information pack in relation towhat to expect on the day and also other general hospitalinformation. There has also been a literature review toensure that the information provided is suitable for olderchildren attending for appointments.Paediatric diabetes – Some of the comments reflected thefact that the respondents felt that the ward staff had onlybasic knowledge on diabetes and that there was a lack ofconfidence in the wards ability to manage insulin pumps.The team has run a series of training sessions on insulinpumps and will continue to programme this into the wardteaching schedule. A diabetes folder has been assembled tohelp consolidate ward staff knowledge and to help supportgeneral diabetes knowledge and emergency advice givento patients.Pharmacy – Following a pharmacy survey looking at whypatients may fail to take their medication properly it wasdiscovered that only 44% of patients said they ‘definitely’received clear and easy to understand information abouteach medication before it was prescribed and that only 19%said that a member of staff definitely checked if they hadany problems that might make it difficult for them to taketheir medication. In response to this the new pharmacyward based teams have been developed ensuring that moredischarges will be completed at ward level and pharmacystaff will counsel patients on their medications directly.Physiotherapy – Pregnant women were asked their viewson the trust’s idea to develop an antenatal physiotherapyDVD that could be given to all pregnant women at theirbooking appointment. The feedback to this idea wasextremely positive with many benefits highlighted especiallybeing able to re-watch and keep for reference, being ableto watch at a time that is convenient and being able tovisualise the exercises and techniques. Following thisfeedback the trust has now produced the DVD.In all surveys patients routinely rate the trust highly in termsof being treated with dignity and respect.48

Monthly auditsIn order to demonstrate its commitment to regular patientfeedback the trust undertakes monthly audits across allwards looking at cleanliness, provision of same sexaccommodation, communication and quality of care.On average 89% of patients stated that the nurses ‘always’washed or cleaned their hands between touching patientsand 80% of patients stated that doctors ‘always’ washed orcleaned their hands between touching patients. Thisrepresents a 4% increase for both doctors and nurses on theprevious year. Excellent or good rating for the cleanliness ofthe ward averages at 98%.On average 93% of patients said that they are nursed insame sex accommodation when first admitted to thehospital and this figure rises to 97% following moves toother wards.94% of patients ‘always’ have enough privacy when beingexamined and 92% ‘always’ feel they are treated withdignity and respect.91% of patients report feeling involved in decisions abouttheir care and treatment and 94% say that they have theopportunity to talk to a doctor or nurse when needed.95% of patients rated the communication between staff aseither excellent or good and 97% rated the level of carereceived as either excellent or good.98% of patients would recommend the hospital to familyand friends.Real time patient feedbackReal time means giving feedback as close to the event aspossible, so that any action needed can be takenstraightaway. The trust implemented two methods ofgaining real time feedback over the past year.The first method trials the Heart of England system, wherematrons observe and speak to patients on the wards andinput results as they do so. This data is then translatedimmediately into results so the staff can immediately seehow they are performing in ‘real time.’The second is ‘Ward of the month’, where patients on award are interviewed and the results written up anddisseminated within 24 hours. Below are examples ofcomments made:• All commented about the helpfulness of staff - ‘The staffcan’t do enough for you’ was stated several times.(Ward 1)• ‘treated with dignity and respect – undoubtedly.’ (Ward 7)• About the food ‘absolutely excellent, very high standard’(Ward 7)• All commented on the fact that they felt they had enoughprivacy on the ward and that the staff did all they couldto help maintain their dignity. (Ward 2)Local Involvement Network (LINk)The trust has maintained its relationship with Cheshire EastLINk, the LINk chair and vice chair meeting regularly withthe trust’s Chief Executive and Chairman and the LINk chairattended Trust Board meetings. ‘Enter and view’ visits havebeen carried out in the following areas:• Aston Ward, CWMH, where improvements in décor werenoted.• Ward 10, where good levels of cleanliness and patientinvolvement were noted.• A&E, which was felt to be an ‘efficient departmentappreciated by the patients.’• Unannounced visits to several wards reviewing care ofolder people around dignity and nutrition. (At time ofpress the trust are awaiting report, visitwww.eastcheshire.nhs.uk for full details).Overall the feedback was extremely positive andsuggestions for further improvement have been acted on.The trust has also responded to LINk requests forinformation regarding care of over 80s, discharge, industrialaction, MRSA screening and national Patient Safety Alerts.LINk has been invited to comment on the Quality Accountand has attended the communications and engagementwork stream of the Integration programme.Trust staff have attended LINk liaison meetings.East Cheshire NHS Trust Health Focus GroupThis group is an organisational member of LINk, keyactivities for the group have included:• Ward of the Month interviews• Medical outliers recorded interviews• Surveys in A&E• Representation on trust’s Patient Experience Group.5051

EQUALITY AND HUMAN RIGHTSEquality and fairness for allWith the support of Five Boroughs Partnership Trust, thetrust has made considerable progress in further embeddingequality and human rights across the trust. Introducingequality as a session on the statutory and mandatorytraining programme has ensured that 90% of staff havereceived some form of training in this area. Specialisttraining has continued with the aim of ensuring staff areaware of their responsibilities under the new Equality Act2010 and to ensure our staff are equipped to deal with thediffering needs of people from the different equalitystrands. Members of the Trust Board have attended adevelopment session on equality and human rights.Reviewing how we are doingReview of the Dignity and Rights Group resulted in thedecision to disband this group and look at ways of makingequality part of the business of the trust, rather thandealing with it in a separate arena.Equality impact assessmentsOver the past year we have reviewed the impact assessmentprocess and this has led to improved training in this areaand improvements in our policies and service impactassessments. Examples of where this has made a differenceinclude:• Post death procedures policy. Partners are now detailedalongside relatives so that same sex couples are notdiscriminated against. Also, the need to take account ofthe different requirements of different faiths is nowreferred to earlier in the policy.• Making changes to our day case lists to segregate sexes• Possible identified impact on waiting times.Awards and commitments• The trust has once again successfully retained the ‘Positiveabout disability’ status, (two ticks) awarded by JobcentrePlus. The trust was commended on the standard of itsapplication.• Signing up to Stonewall‘s Diversity ChampionsProgramme last year, the trust was assessed against theworkplace equality index. The trust came 320 out of 378organisations who applied. In looking at this result interms of NHS organisations who applied, the trustperformed better than other NHS organisations whoapplied in the following areas:- Workforce monitoring and follow up- Bullying prevention- Access to training.Areas for further development are community and staffengagement and procurement.• To demonstrate commitment to the mental healthagenda, the trust signed up to the ‘Mindful Employer’scheme.• Becoming a member of the Gender Trust has been helpfulin developing the trust’s transgender policy for bothservice users and staff.• Continuous improvement of the quarterly workforcemonitoring reports enables us to have a clear pictureacross the equality strands of race, age, disability, sexualorientation, gender, religion and belief.• The trust is committed to listening to its staff,demonstrated by the ‘Your Voice’ consultation, whichshowed that our Muslim staff felt that prayer facilities inthe trust were inadequate. Following this a focus groupwas held. Issues raised included: reviewingaccommodation for prayer, putting Holy books and rosarybeads in communications boxes on wards anddepartments. And developing a patient and staff leafleton what facilities are available.Learning disabilitiesBuilding on the work undertaken during 2009/10, trust staffhave continued to work in partnership with David Lewis,Rosendale Trust, East Cheshire Advocacy and Cheshire andWirral Partnership Trust to further improve care for patientswith learning disabilities and their families. This culminatedin achieving runner up status in the partnership workingcategory in the Guardian Public Services Awards and beingnominated in the North West Positive Action Awards.5253

Key achievements over the past year:• Further embedding of the unique one page patientpassport.• More staff attending training sessions.• Awareness raising drama presentation for staff by thelearning disabilities drama group Speaking Up SpeakingOut (SUSO).• ‘Top tips’ posters developed for wards and departments.• Visits to hospital arranged for students from Park LaneSchool so that they are familiar with wards anddepartments in the hospital should they need to beadmitted.• Following the ‘Big Health Day’ conference for people withlearning disabilities and their carers, maps fromoutpatients to pharmacy have been produced usingsymbols and photographs.• More accessible information has been produced includingphotographic journeys to prepare for hospital visits.• Working on a care pathway for patients with learningdisabilities that are clear, simple and accessible to all staff.Patient health informationThe Information Standard is a nationwide scheme thatenhances the credibility and reputation of an organisationand demonstrates that patient information is reliable andevidence based.In March 2011, Information Standard assessors reviewed thetrust’s patient information processes and have made someminor suggestions which, if achieved, will enable the trustto be recommended for certification.Key achievements are:• Developing a network of ‘Information champions’ andvolunteers• Information can be made available in audio CD, brailleand translated into other languages• Leaflets are available to download from the trust’swebsite.With more than 800 patient information leaflets which arereviewed every three years, the trust is keen to ensure thatpatients receive information about their condition that istimely, accessible and up-to-date. This means that patientsand carers can make informed decisions about theirtreatment and medical conditions.Only 14 NHS trusts are currently certified members of thescheme, therefore achieving Information Standardcertification will be a great achievement for East CheshireNHS Trust.Further details can be found at www.eastcheshire.nhs.ukDignity and respectTreating patients with the dignity and respect they deserveis a key priority for the trust.Initiatives which have highlighted the trust commitment tothis are:• Raising awareness – dedicated teaching sessions withinStatutory and Mandatory training have been scheduledthroughout the year to reach new and existing staffmembers to raise awareness of the importance of dignityand respect for all.• Patient surveys during hospital visits ensure that the trustengage with customers, providing real time feedback onwhich the trust can demonstrate its commitment andmake informed changes where required.• Improving Same Sex Accommodation is a Department ofHealth requirement for all trusts.Same sex accommodationThere is a commitment across the NHS to eliminate mixedsex accommodation within hospitals.During 2010/11 East Cheshire NHS Trust has made manychanges in working practice with patients to ensurecompliance with the Department of Health guidance and tomake sure patients privacy and dignity are respected.Some of these changes have included;• Extra bathroom and toilet facilities.• Changing ward layouts.• Same sex treatment lists.• Information for patients.• Dignity awareness sessions for all staff.Trust results are reported directly to the Primary Care Trustand Strategic Health Authority on a regular basis.The trusts declaration of compliance can be found atwww.eastcheshire.nhs.ukNutritionDuring 2010/ 11 the trust has been committed to ensuringthat good nutrition for every patient is available regardlessof medical conditions. As such the trust has introduced:• The red tray scheme to assist patients. Patients whorequire help with feeding are given a red tray so that theyare easily identified to staff as requiring assistance.• Protected meal times ensure that patients are left alonewithout visitors or medical interruptions in order toensure patients are afforded the time required to eat.• Patient surveys have been carried out to ensure that theprovision of food at the trust meets patient’sexpectations. Results are good. (See PEAT scores overleaf)• New adult nutritional policies provide advice on goodnutrition care for adults. These include guidance on theuse of supplements, artificial feeding and recognisingmalnutrition through inpatient screening.• Recognised mealtime help volunteer scheme where trustvolunteers assist staff and patients at mealtimes withinward areas.5455

PEAT‘‘ ,,The National Patient Safety Agency carries out its annualPatient Environment Action Team (PEAT) survey and ratesevery hospital in England to give them an overall scorebetween ‘excellent’ and ‘unacceptable’.Two of the hospitals that are managed by the trust,Congleton War Memorial Hospital and KnutsfordCommunity Hospital, received ‘excellent’ ratings for theirfood, which includes choice, quality, quantity, presentationand cleanliness and hygiene of the kitchens. The food atMacclesfield District General Hospital was rated as ‘good’.In addition, all three hospitals received ‘good’ ratings forthe environment in which patients are treated as well as theprivacy and dignity which is given to patients.The inspection team, which included patients, staff andmembers of the public, examined the standards of thepatient environment, such as bathroom areas, décor,lighting, floors and patient access, as well as hospital food.The team also considered whether the environmentsupported privacy and dignity and looked at the separationof men and women in sleeping areas, toilets and bathrooms.From start to finish I was treated bycaring professional staff in a polite andrespectful manner.Health MattersETUHealth Matters is a series of free public lectures, givingmembers of the public the opportunity to ask prominentconsultants questions. Health Matters takes place monthlycovering a range of popular clinical areas and has been anoutstanding success in delivering key messages by seniormembers of the trust to the community that the hospitalserves.Health Matters which took place throughout the year are:Date Topic PresenterFeb-14 Q&A on General Surgery Mr BroughApr-14 Childhood coughs,colds and wheezesDr HoMay-14 Joint Replacement Surgeryin Hands and WristsMr FischerJun-14 Preconception andRecurrent MiscarriageMr DevarajJul-14 Organ Donation Dr HunterSep-14 Women's Health Mr HallOct-14 Paediatric Epilepsy Dr MarinakiNov-14 Diabetes Dr WeiComments which have been made by the public about theseevents ensure that we are providing the best educationaltopics for our population.• ‘Excellent talk - illustrating the skill of the surgeons atMacclesfield.’• ‘A fascinating talk with impressive demonstration ofsurgical intervention.’• ‘Generally informative, a very interesting and enjoyablepresentation.’• ‘A super presentation which dispelled a lot of myths.’• ‘Excellent presentation, video and leaflets.’• ‘Another excellent lecture.’• ‘Informative and compassionate.’• ‘I want to study medicine so all background knowledgeon health is helpful.’VolunteersThe trust volunteers continue to enhance and support therole of staff at the hospital. They are a positive, committedand enthusiastic group of people of various ages who makea tremendous difference to the patient experience at thehospital.Highlights of the year• The trust has welcomed several new volunteers to thetrust in many different roles and areas.• The team of volunteer meal time assistants has increased.Some of these volunteers have now undergone furthertraining, allowing them to feed patients.• Several volunteers have been trained on the PatientAdministration System (PAS) system including those onthe Customer Care Reception Desk at Macclesfield DistrictGeneral Hospital.• Volunteers have been recruited to help in the CancerResource garden. They have made a tremendousdifference to the look and feel of the garden for thebenefit of patients.• Volunteering continues to be of interest to the localcommunity. Waiting lists and regular recruitment sessionsheld at the trust ensure that everyone who is interestedgets the chance to discuss how they wish to get involved.• The team of breast feeding support volunteers hasexpanded.If you are interested in becoming a volunteer for EastCheshire NHS Trust please contact the Customer Care Teamon 01625 661449.5657

Trust support for armed forcesEast Cheshire NHS Trust has been recognised for its supportof armed forces this year by being presented with a largecommemorative print of a picture called ‘Safe Return’ byCommanding Officer Colonel Kerry Trow from 207(Manchester) Field Hospital in gratitude for the trust’sefforts in overseas missions. “207” is one of elevenTerritorial Army (TA) Field Hospitals whose role is to providemedical support to UK Forces on operations overseas.“207” ran the British Military Hospital in Iraq for part of2004 and returned in January this year from a deploymentto Afghanistan where they ran the Military Hospital inCamp Bastion.Several members of East Cheshire NHS Trust staff volunteerwith the Territorial Army Medical Services Unit includingHelen Archer, Operating Practitioner and Steve Booth,Transfusion Practitioner.Volunteers undertake a ‘tour of duty’ for which they receivetraining and preparation.Corporals Helen Archer and Steve Booth made a vitalcontribution to 207 Field Hospital’s deployment toAfghanistan earlier this year, where they helped to run theMilitary hospital at Camp Bastion. Both were involved inproviding first class care for British and US servicemen andwomen in what has been reported as the “busiest traumacentre in the world”. This support is vital to reservists andmakes operational deployment and their continuedinvolvement with the TA possible.Our volunteers experience with the 207 (Manchester) FieldHospital (Volunteers) Medical Services Unit has enabledthem to develop many skills and qualities which haveoffered benefits to the trust and our patients.Key improvements include:• Changes to the massive haemorrhage protocol for themanagement of patients experiencing massive blood lossat East Cheshire NHS Trust.• Changes to the trust’s major incident protocol, which aimsto improve the trust’s planning and response to anyincident with major consequences for health or healthservices in partnership with the emergency services, localauthorities and others.• Our volunteers have delivered a series of educationalpresentations to highlight their experiences and shareskills with the trust’s clinical staff – for example TheMidwives and Nurses Day staff conference 2011.Sustainable developmentSustainable development, in particular carbon reduction,has become an increasingly important national priority, withthe UK committed to reducing carbon by 80% by 2050.East Cheshire NHS Trusts strategy to reduce carbonemissions concentrates on the following areas:1. Energy and carbon management2. Procurement and food3. Low carbon travel, transport and access4. Water5. Waste6. Designing the built environment7. Organisational and workforce development8. Role of partnership and networks9. Governance10. FinanceDuring 2010/11 the trust built upon previous high levelactions by carrying out an independent assessment of thedistrict general hospital site including the main nucleusbuilding and all ancillary buildings. This assessment willform the baseline for the trusts improvement programme.The assessment tool used (BREEAM Healthcare XB) wasdeveloped by the Building Research Establishment on behalfof the Department of Health with the aim of enabling NHSTrusts to:• improve efficiency of their existing building portfolio• improve the indoor environment of their occupiedbuildings, with the result of increasing staff andpatients' wellbeing• reduce energy waste and, consequently, reduce utility bills• demonstrate commitment to sustainable development.Whilst the results showed that the trust performedrelatively well in terms of sustainability and environmentalperformance there were areas of weakness which meantthat certain buildings including the main nucleus and TrustHeadquarters failed to meet the minimum scorerequirement for certification.A full set of recommendations for score improvement wasalso commissioned and this will inform the trusts action planfor 2011/12.The trust also commissioned aerial thermal images to showareas of significant heat loss the findings of which wereconsistent with the above assessment.A long term lease was also agreed on a new office blockbeing built on the ‘Blue Zone’ area of the district generalhospital site. As part of that agreement the trust requiredthat the building meets the highest possible environmentalperformance standard for a new building (BREEAMExcellent) and that this is independently certified uponcompletion. The trust will take occupation of this buildingduring 2011/12 and thereby reduce carbon emissions andenergy usage still further by vacating less efficient premises.5859

The futureof the trustFrom 1 April 2011 East Cheshire NHS Trust will be anintegrated trust, having added a community servicesdivision to its portfolio of services. The trust intends tostart delivering the benefits immediately, redesigning carepathways and improving the patient experience alongsideimproving the productivity of services. Clinical redesign willbe a major strand of the transformation of the currentservices as the trust moves to becoming a high performingintegrated foundation trust in 2013.The first year of the integrated trust will build on theprevious success of both Cheshire East Community Healthand East Cheshire NHS Trust. In the first three months2011/12 the trust wishes to involve and enable staff todefine the mission, vision and values of the neworganisation which have been suggested by both Boards.East Cheshire NHS Trust continues to be a key employer andpurchaser of services in the area and as such recognises itsrole and responsibility in contributing to the health andwellbeing of Cheshire. The trust intends to developrelationships with local educational establishments andbusinesses to deliver social value from all existing resources.During 2011/12 the trust will be preparing for foundationtrust status and aim to achieve this by working with clinicalleaders to clarify the service strategy. This will involvefurther development of partnerships with GeneralPractitioners and other acute hospitals.2011/12 will be focussed on working towards thesekey outcomes:• Achieve and improve on patient outcomes and experienceyear on year.• All patients receive effective and safe care of the highestquality.• Patients are treated with dignity in an environment thataffords privacy.• Service users are involved with decisions about theirtreatment.• Improve our annual staff rating year on year.• All our staff have the skills to do the job and aresupported by education and training opportunities.• Staff deliver services in a caring, professional and friendlyway.• Staff feel engaged and confident to communicate.• Reduce our cost base by 20% within 5 years from 2009/10baseline and ensure a 1% surplus.• Achieve foundation trust status.• Achieve and improve on all local and national targets yearon year.• To have a culture of honesty, trust and integrity andcommunicate openly with patients, staff, stakeholdersand the public.• To work co-operatively and collaboratively with localhealth and social care partners to reduce delays, improveefficiency, standardise good practice and ensure a positivepatient experience.• To involve the public and other stakeholders in planningand improving our services.• As a major local employer, to contribute to thesustainability and improvement of the local communities,in particular our role in public health promotion andmaximising the social value of healthcare resources.• Clinicians form a significant part of the decision makingbodies of the trust.6061

The financialreportIntroductionIn 2010/11 the trust delivered its financial plan, andcontinued to improve its historic income and expenditureposition.To achieve this objective the trust has made progress inseveral areas. It has successfully delivered its costimprovement plan and worked with commissioners todeliver agreed contracts and support the trust’sfinancial plan.For 2011/12 the trust plans to further improve its financialstability and achieve a £250k surplus. This will be deliveredthrough a significant efficiency and productivityprogramme, whilst maintaining high quality services topatients. The 2011/12 plans also include the integration ofcommunity services and acute services.Achievements in 2010/11 are outlined below:Performance area Objective Outcome1. Income and expenditure Surplus £250k Achievedsurplus £345k2. External financing limit Managing within the cash limit agreed Achievedwith the Department of Health.within the £50k tolerance3. Capital resource limit Managing capital expenditure within the Achievedcapital resource limits agreed with theDepartment of Health.4. Capital cost absorption rate Making at least 3.5% return on the trust Achievednet relevant assets.5. Cost improvement programme Deliver identified efficiency schemes. Achievedefficiency programme £6,500k6263

IncomeExpenditureCapital programmeStatement on internal controlThe trust has delivered its 2010/11 income targets. Thetrust’s improvements in streamlining clinical process haslead to productivity gains that have supported localcommissioner sustainability plans. The following analysis ofthe trust’s position identifies where the organisation hasgenerated its income.In 2010/11 the trust spent £116m on delivering services topatients and managing the organisation. A summaryanalysis of operating expenditure is detailed below.The trust has invested £2,918k in 2010/11 to improvefacilities and equipment for patient care. Key investmentcan be summarised as follows:Capital scheme £0001. Backlog maintenance/hospital master plan 1,539The Trust Board is accountable for internal control. A fullcopy of The Statement on Internal Control 1 is included inthe 2010/11 Annual Accounts. A full copy of the Statementof Internal Control can be viewed on the trust websitehttp://www.eastcheshire.nhs.uk/About-The-Trust/Trust-Board/Annual-reports.htmlEast Cheshire NHS Trust income analysis 2010/11East Cheshire NHS Trust expenditure 2010/112. Remodelling the estate 4283. CT scanner enabling 251Fraud awareness4. ETU development 735. Pacing room 226. Health and safety 30The trust has an accredited local counter fraud specialistbased within the Internal Audit Department. The trustcomplies with the national counter fraud initiative.7. Operational equipment 2368. IT schemes 339Management costsChanges to accounting policiesThe trust has amended its accounting policies following therevaluation of the land and buildings. The estimationtechnique used for asset lives takes into account thefunctional operational life of a complete building. It isconsistent with professional guidance and standards.The trust management costs as a percentage of incomehave increased slightly from 4.1% 2009/10 to 4.3% in2010/11.Management costs 2010-11 2009-10£000 £000Management costs 5,035 4,647Primary Care TrustsNon-Patient Care Services to Other BodiesEducation and TrainingOther IncomeNHS OtherStaff Costs (permanently employed staff)Supplied and ServicesStaff Costs (locums, agency and bank staff)DepreciationClinical negligenceOtherConsultancy CostsServices from Other NHS TrustsEducation and TrainingThe trust has completed its accounts on a going concernbasis. The directors have considered the trust’s financialplans and are satisfied that this approach will continue infuture years.Income 116,002 113,2041 A copy of the Annual Accounts can be obtained from theDirector of Finance,Trust Headquarters,Ingersley Building,Victoria Road,Macclesfield,SK10 3BL.6465

Better payment practice codeExternal auditRemuneration and terms of service committeeThe Better Payment Practice Code requires the trustto aim to pay all undisputed invoices by the due date orwithin 30 days of receipt of goods or a valid invoice,whichever is later.The audit services provided in 2010/11 included the audit ofthe trust’s financial statements and other statutory activitiesincluding value for money work. These services wereprovided by the Audit Commission and the cost was £154k.The purpose of this committee is to advise the board aboutappropriate remuneration and terms of service for the chiefexecutive and other executive directors and senioremployees within the trust and the membership consists of:Better Payment Practice Code - measure of compliance 2010-11 2009-10Number £000 Number £000Total Non-NHS trade invoices paid in the year 39,883 33,812 38,926 30,352Total Non NHS trade invoices paid within target 9,409 9,935 13,241 12,100Percentage of Non-NHS trade invoices paid within target 24% 29% 34% 40%Total NHS trade invoices paid in the year 1,673 15,343 1,526 14,389Audit committeeThis committee reviews the establishment and maintenanceof an effective system of internal control and riskmanagement within the trust. The membership consists of:• Lynn McGill Non-executive Director/Deputy Chairman• Lynn McGill• Stewart Fraser• David Coorey• Tony CoombsNon-executive Director/Deputy ChairmanNon-executive DirectorNon-executive DirectorNon-executive DirectorTotal NHS trade invoices paid within target 285 3,891 196 2,099Percentage of NHS trade invoices paid within target 17% 25% 13% 15%• Stewart FraserNon-executive Director• Neil MasomNon-executive Director• David CooreyNon-executive DirectorThe Late Payment of Commercial Debts (Interest) Act 1998 2010-11 2009-10£000 £000Amounts included in finance costs from claims made under this legislation 0 5Compensation paid to cover debt recovery costs under this legislation 0 0Total 0 5• Tony Coombs• Neil MasomNon-executive DirectorNon-executive Director/Chair of Audit CommitteeMarket value of interests in landThere was no difference between the carrying amount andmarket value of interests in land reported in the accounts.Neil Cook66

Related party transactionsDuring the year none of the Department of HealthMinisters, and three trust board members, has undertakenmaterial transactions with East Cheshire NHS Trust.Details of related party transactions with individuals are asfollows:Payments Receipts Amounts Amountsto related from related owed to due fromparty party related party related party£ £ £ £Mrs L McGill, Non Executive Directoruntil 31/10/10, then Chairman- Business Director, of Veredus, Capita PLC 18,612 0 0 0Mr S Fraser, Non Executive Director- Deputy Chairman of NHS Audit North West 120,552 0 67,355 0Dr R Stead, Medical Director- Vice President of East Cheshire Hospice 0 199,389 0 15,849- Non NHS work at Spire Regency hospital 0 350 0 0The Department of Health is regarded as a related party.During the year East Cheshire NHS Trust has had asignificant number of material transactions with theDepartment, and with other entities for which theDepartment is regarded as the parent department.These entities are listed below:• Strategic Health Authorities• Primary care trusts• NHS Trusts• NHS Litigation Authority• NHS Business Services Authority68The trust has also received revenue and capital paymentsfrom a number of charitable funds, certain of the trusteesfor which are also members of the NHS Trust Board.The audited accounts of the Funds Held on Trust will bepublished separately.Independent auditors report to the directors ofEast Cheshire NHS TrustI have examined the summary financial statement for theyear ended 31 March 2011 which comprises the Statementof comprehensive income, Statement of financial position,Statement of changes in taxpayers’ equity, Statement ofcash flows and related notes.This report is made solely to the Board of Directors ofEast Cheshire NHS Trust in accordance with Part II of theAudit Commission Act 1998 and for no other purpose, as setout in paragraph 45 of the Statement of Responsibilities ofAuditors and Audited Bodies published by the AuditCommission in March 2010.Respective responsibilities of directors andauditorThe directors are responsible for preparing the AnnualReport. My responsibility is to report to you my opinion onthe consistency of the summary financial statement withinthe Annual Report with the statutory financial statements.I also read the other information contained in the AnnualReport and consider the implications for my report if Ibecome aware of any misstatements or materialinconsistencies with the summary financial statement.I conducted my work in accordance with Bulletin 2008/03“The auditor's statement on the summary financialstatement in the United Kingdom” issued by the AuditingPractices Board. My report on the statutory financialstatements describes the basis of my opinion on thosefinancial statements.OpinionIn my opinion the summary financial statement is consistentwith the statutory financial statements of East Cheshire NHSTrust for the year ended 31 March 2011.Julian FarmerOfficer of the Audit CommissionAspinall CloseMiddlebrookBoltonBL6 6QQ9 June 201169

Statement of the Chief Executives responsibilities as the accountable officer for the trustStatement of director’s responsibilities in respect of the accountsThe Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the trust.The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by theDepartment of Health.The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year.The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the stateof affairs of the trust and of the income and expenditure, recognised gains and losses and cash flows for the year.These include ensuring that:In preparing those accounts, directors are required to:• there are effective management systems in place to safeguard public funds and assets and assist in the implementation ofcorporate governance;• value for money is achieved from the resources available to the trust;• the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to theauthorities which govern them;• effective and sound financial management systems are in place; and• annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury togive a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure,recognised gains and losses and cash flows for the year.To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointmentas an Accountable Officer.• apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;• make judgements and estimates which are reasonable and prudent;• state whether applicable accounting standards have been followed, subject to any material departures disclosed andexplained in the accounts.The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any timethe financial position of the trust and to enable them to ensure that the accounts comply with requirements outlined in theabove mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the trust andhence for taking reasonable steps for the prevention and detection of fraud and other irregularities.The directors confirm to the best of their knowledge and belief they have complied with the above requirements inpreparing the accounts.By order of the BoardSignedChief Executive9 July 2011 Date Chief ExecutiveDate 9 July 20119 July 2011 Date Finance Director7071

Summary financial statements Statement of comprehensive income for the year ended 31 March 2011The summary financial statements aremerely a summary of the informationin the full accounts which are availableon request from the director of financeon 01625 661581. A nominal fee maybe charged.2010-11 2009-10£000 £000RevenueRevenue from patient care activities 106,497 102,484Other operating revenue 12,113 13,393Operating expenses (116,461) (112,830)Operating surplus/(deficit) 2,149 3,047Finance costs:Investment revenue 24 10Other gains and losses (65) 3,187Finance costs (16) (290)Surplus/(deficit) for the financial year 2,092 5,954Public dividend capital dividends payable (1,747) (2,028)Retained surplus/(deficit) for the year 345 3,926Other comprehensive incomeImpairments and reversals (360) (25,464)Gains on revaluations 3,821 1,924Receipt of donated/government granted assets 337 481Net gain/(loss) on other reserves (e.g. defined benefit pension scheme) 0 0Net gains/(losses) on available for sale financial assets 0 0Reclassification adjustments:- Transfers from donated and government grant reserves (314) (125)- On disposal of available for sale financial assets 0 0Total comprehensive income for the year 3,829 (19,258)Reported NHS financial performance positionRetained surplus/(deficit) for the year 345IFRIC 12 adjustment 0Impairments 461Reported NHS financial performance position 8067273

Statement of financial position as at 31 March 2011Statement of financial position as at 31 March 2011 (continued)31 March 31 March2011 2011£000 £000Non-current assetsProperty, plant and equipment 65,556 62,967Intangible assets 723 811Other financial assets 0 0Trade and other receivables 540 599Total non-current assets 66,819 64,377Current assetsInventories 1,200 1,211Trade and other receivables 4,608 12,610Other financial assets 0 0Other current assets 0 0Cash and cash equivalents 380 3546,188 14,175Non-current assets held for sale 0 0Total current assets 6,188 14,175Total assets 73,007 78,55231 March 31 March2011 2011£000 £000Financed by taxpayers' equity:Public dividend capital 35,897 35,897Retained earnings (805) (1,227)Revaluation reserve 16,895 13,743Donated asset reserve 2,453 2,198Government grant reserve 0 0Other reserves 0 0Total taxpayers' equity 54,440 50,611The financial statements on pages 1 to 44 were approved by theBoard on 9 June 2011 and signed on its behalf by:Signed (Chief Executive) Date 9 July 2011Current liabilitiesTrade and other payables (11,163) (14,912)Other liabilities 0 0Borrowings (316) (5,316)Other financial liabilities 0 0Provisions (720) (562)Net current assets/(liabilities) (6,011) (6,615)Total assets less current liabilities 60,808 57,762Non-current liabilitiesBorrowings (1,585) (1,901)Trade and other payables 0 0Other financial liabilities 0 0Provisions (4,783) (5,250)Other liabilities 0 0Total assets employed 54,440 50,6117475

Statement of changes in taxpayers’ equityfor the year ended 31 March 2011Public Retained Revaluation Donated Government Other Totaldividend earnings reserve asset grant reservescapital reserve reserve(PDC)£000 £000 £000 £000 £000 £000 £000Changes in taxpayers’ equity for 2010-11Balance at 1 April 2010 35,897 (1,227) 13,743 2,198 0 0 50,611Total comprehensive income for the yearRetained surplus/(deficit) for the year 0 345 0 0 0 0 345Transfers between reserves 0 77 (77) 0 0 0 0Impairments and reversals 0 0 (360) 0 0 0 (360)Net gain on revaluation of property, plant, equipment 0 0 3,589 232 0 0 3,821Net gain on revaluation of intangible assets 0 0 0 0 0 0 0Net gain on revaluation of financial assets 0 0 0 0 0 0 0Receipt of donated/government granted assets 0 0 0 337 0 0 337Net gain/loss on other reserves (e.g. definedbenefit pension scheme) 0 0 0 0 0 0 0Movements in other reserves 0 0 0 0 0 0 0Reclassification adjustments:- transfers from donated asset/government grant reserve 0 0 0 (314) 0 0 (314)- on disposal of available for sale financial assets 0 0 0 0 0 0 0Reserves eliminated on dissolution 0 0 0 0 0 0 0Originating capital for trust establishment in year 0 0 0 0 0 0 0New PDC received 0 0 0 0 0 0 0PDC repaid in year 0 0 0 0 0 0 0PDC written off 0 0 0 0 0 0 0Other movements in PDC in year 0 0 0 0 0 0 0Balance at 31 March 2011 35,897 (805) 16,895 2,453 0 0 54,4407677

Statement of changes in taxpayers’ equityfor the year ended 31 March 2010Public Retained Revaluation Donated Government Other Totaldividend earnings reserve asset grant reservescapital reserve reserve(PDC)£000 £000 £000 £000 £000 £000 £000Changes in taxpayers’ equity for 2009-10As previously stated 35,897 (5,135) 36,561 2,564 0 0 69,869Prior period adjustment 0Restated balance 35,897 (5,135) 36,561 2,564 0 0 69,869Changes in taxpayers’ equity for 2009-10Total comprehensive income for the yearRetained surplus/(deficit) for the year 0 3,926 0 0 0 0 3,926Transfers between reserves 0 0 0 0 0 0 0Impairments and reversals 0 0 (24,742) (722) 0 0 (25,464)Net gain on revaluation of property, plant, equipment 0 0 1,924 0 0 0 1,924Net gain on revaluation of intangible assets 0 0 0 0 0 0 0Net gain on revaluation of financial assets 0 0 0 0 0 0 0Receipt of donated/government granted assets 0 0 0 481 0 0 481Net gain/loss on other reserves (e.g. definedbenefit pension scheme) 0 0 0 0 0 0 0Movements in other reserves 0 0 0 0 0 0 0Reclassification adjustments:- transfers from donated asset/government grant reserve 0 0 0 (125) 0 0 (125)- on disposal of available for sale financial assets 0 0 0 0 0 0 0Reserves eliminated on dissolution 0 0 0 0 0 0 0Originating capital for trust establishment in year 0 0 0 0 0 0 0New PDC received 0 0 0 0 0 0 0PDC repaid in year 0 0 0 0 0 0 0PDC written off 0 0 0 0 0 0 0Other movements in PDC in year 0 0 0 0 0 0 0Balance at 31 March 2010 35,897 (1,227) 13,743 2,198 0 0 50,6117879

Statement of cash flows for the year ended 31 March 2011Statement of cash flows for the year ended 31 March 2011 (continued)2010-11 2009-10£000 £000Cash flows from operating activitiesOperating surplus/(deficit) 2,149 3,047Depreciation and amortisation 3,286 2,967Impairments and reversals 461 0Net foreign exchange gains/(losses) 0 0Transfer from donated asset reserve (314) (125)Transfer from government grant reserve 0 0Interest paid (84) (155)Dividends paid (1,670) (2,028)(Increase)/decrease in inventories 11 (43)(Increase)/decrease in trade and other receivables 2,573 (809)(Increase)/decrease in other current assets (75) 0Increase/(decrease) in trade and other payables (3,437) 2,651Increase/(decrease) in other current liabilities 0 (3,739)Increase/(decrease) in provisions (243) (370)Net cash inflow/(outflow) from operating activities 2,657 1,396Cash flows from investing activitiesInterest received 24 10(Payments) for property, plant and equipment (2,648) (4,758)Proceeds from disposal of plant, property and equipment 5,509 3(Payments) for intangible assets (200) (351)Proceeds from disposal of intangible assets 0 0(Payments) for investments with DH 0 0(Payments) for other investments 0 0Proceeds from disposal of investments with DH 0 0Proceeds from disposal of other financial assets 0 0Revenue rental income 0 0Net cash inflow/(outflow) from investing activities 2,685 (5,096)Net cash inflow/(outflow) before financing 5,342 (3,700)2010-11 2009-10£000 £000Cash flows from financing activitiesPublic dividend capital received 0 0Public dividend capital repaid 0 0Loans received from the DH 0 5,000Other loans received 0 0Loans repaid to the DH (5,316) (2,650)Other loans repaid 0 0Other capital receipts 0 481Capital element of finance leases and PFI 0 0Net cash inflow/(outflow) from financing (5,316) 2,831Net increase/(decrease) in cash and cash equivalents 26 (869)Cash (and) cash equivalents (and bank overdrafts)at the beginning of the financial year 354 1,223Effect of exchange rate changes on the balance of cash heldin foreign currencies 0 0Cash (and) cash equivalents (and bank overdrafts)at the end of the financial year 380 3548081

Salary and pension entitlements ofNon Executive and Executives remunerationDirectors salaries and allowances 2010/11Benefits in kind relate to the provision of lease carsor cash alternative.Miss S Campbell, Director of Human Resources andOrganisational Development is employed 1/3 byEast Cheshire NHS Trust.2010-11 2009-10Salary Other Benefits Salary Other Benefits(bands of remuneration in kind (bands of remuneration in kind£5,000) (bands of (rounded to £5,000) (bands of (rounded to£5,000) nearest £000) £5,000) nearest £000)Name and title £000 £000 £000 £000 £000 £000Mrs K Cowell, Chairman until 31/10/10 10-15 20-25Mrs L McGill, Non-Executive Director until 31/10/10then Chairman 10-15 5-10Mr A Dicken, Non-Executive Director until 30/11/09 5-10Mr D Coorey, Non-Executive Director 5-10 5-10Mrs E C Darbyshire, Non-Executive Director,until 31/10/09 0-5Mr S Fraser, Non-Executive Director 5-10 5-10Mr NA Masom, Non-Executive Director 5-10 5-10Mr A Coombs, Non-Executive Director, from 01/05/10 5-10Mr J Wilbraham, Chief Executive 125-130 120-125 5Mr N Cook, Director of Finance, from 04/10/10 55-60Mr S North, Director of Finance until 30/09/10 50-55 90-95 4Dr R Stead, Medical Director 35-40 140-145 35-40 150-155Mrs M Salisbury, Director of Nursing & Patient CareStandards, until 14/10/10 45-50 80-85 4Mrs V Aherne, Chief Operating Officer /Deputy Chief Executive 85-90 4 85-90 4Miss S Campbell, Director of Human Resources &Organisational Development (1/3) 30-35 25-30 1Ms K Senior, Interim Chief Operating Officer,until 18/10/10 then Director of Nursing andPatient Care Standards 75-8082Mrs J Green, Director of Governance and CorporateAffairs, from 01/02/11 10-1583

Salary and pension entitlements of seniormanagers – pension benefitsAs Non-Executive members do not receive pensionableremuneration, there will be no entries in respect ofpensions for Non-Executive members.Miss S Campbell, Director of Human Resources andOrganisational Development is employed 1/3 byEast Cheshire NHS TrustLump sumat age 60Total related toReal Real pension at accrued Cash Cash Realincrease in increase in age 60 at pension at equivalent equivalent increase Employer’spension lump sum 31 March 31 March transfer transfer in cash contributionat age 60 at aged 60 2011 2011 value at value at equivalent to(bands of (bands of (bands of (bands of 31 March 31 March transfer stakeholder£2,500) £2,500) £5,000) £5,000) 2011 2010 value pensionName and titles £000 £000 £000 £000 £000 £000 £000 £00Mr J Wilbraham, Chief Executive 0-2.5 0-2.5 40-45 125-130 659 720 -55Mr S North, Director of Finance until 30/09/10 30-35 100-105 635 693 -52Ms V Aherne, Chief Operating Officer /Deputy Chief Executive 0-2.5 0-2.5 30-35 91-95 541 580 -37Miss S Campbell, Director of Human Resources &Organisational Development (1/3) 0-2.5 0-2.5 5-10 25-30 124 124 -81Dr R Stead, Medical Director 0-2.5 0-2.5 70-75 210-215 1,491 1,566 -80Ms K Senior, Interim Chief Operating Officer,until 18/10/10 then Director of Nursing andPatient Care Standards 2.5-5 12.5-15 25-30 60-65 412 378 17A Cash Equivalent Transfer Value (CETV) is the actuariallyassessed capital value of the pension scheme benefits accruedby a member at a particular point in time. The benefits valuedare the member's accrued benefits and any contingentspouse's pension payable from the scheme. A CETV is apayment made by a pension scheme or arrangement to securepension benefits in another pension scheme or arrangementwhen the member leaves a scheme and chooses to transferthe benefits accrued in their former scheme. The pensionfigures shown relate to the benefits that the individual hasaccrued as a consequence of their total membership of thepension scheme, not just their service in a senior capacity towhich the disclosure applies. The CETV figures and the otherpension details include the value of any pension benefits inanother scheme or arrangement which the individual hastransferred to the NHS pension scheme. They also include anyadditional pension benefit accrued to the member as a resultof their purchasing additional years of pension service in thescheme at their own cost. CETVs are calculated within theguidelines and framework prescribed by the Institute andFaculty of Actuaries.Real Increase in CETV - This reflects the increase in CETVeffectively funded by the employer. It takes account of theincrease in accrued pension due to inflation, contributionspaid by the employee (including the value of any benefitstransferred from another scheme or arrangement) and usescommon market valuation factors for the start and end ofthe period.8485

Exit packages for staff leaving 2010/11Redundancy and other departure costs have been paidin accordance with the provisions of the NHS Scheme.Exit costs in this note are accounted for in full in the yearof departure. Where the Trust has agreed early retirements,the additional costs are met by the Trust and not the NHSpensions scheme. Ill-health retirement costs are met by theNHS pensions scheme and are not included in the table.Except for compulsory redundancies, in 2010/11 the trustemployee identified has taken an exit package throughMutually Agreed Resignation Scheme (MARS).2010-11 2009-10TotalTotalnumbernumberNumber of of exit Number of of exitExit package cost band Number of other packages Number of other packages(including any special compulsory departures by cost compulsory departures by costpayment element) redundancies agreed band redundancies agreed band£200,000 0 0 0 0 0 0Total number of exit packages by type 2 1 3 3 0 3Total resource cost (£000s) 36 100 136 52 0 528687

The glossaryChemical, Biological, Radiologicaland NuclearCheshire East Community HealthCentral and Eastern Cheshire PrimaryCare TrustCash Equivalent Transfer ValueCost Improvement ProgrammeCentral Manchester Hospitals NHSFoundation Trust(CBRN)(CECH)(CECPCT)(CETV)(CIP)(CMFT)Mutually Agreed Resignation SchemeMedical Assessment UnitMacclesfield District General HospitalNational Health ServiceNHS Litigation AuthorityNational Institute for Clinical ExcellenceNational Patient Safety AgencyOutpatients Department(MARS)(MAU)(MDGH)(NHS)(NHS LA)(NICE)(NPSA)(OD)Care Quality Commission(CQC)Patient Advice and Liaison Service(PALS)Congleton War Memorial Hospital(CWMH)Patient Administration System(PAS)Emergency Assessment Unit(EAU)Patient Environment Action Team(PEAT)Experience Based DesignEast Cheshire NHS TrustEnvironmental Information RegulationsEar Nose and ThroatFreedom of InformationFoundation TrustHealthcare Inquired InfectionsHuman ResourcesIntermediate Bed Based ServicesJoint Consultative and NegotiationCommittee(EBD)(ECT)(EIR)(ENT)(FOI)(FT)(HCIA)(HR)(IBBS)(JCNC)Preventable Incidents, Survivaland Motability StudyPublic Service AgreementQuality, Innovation, Prevention, ProductivitySurgical Assessment UnitStrategic Health AuthorityStatement on Internal ControlSame Sex AccommodationStrategic Executive Information SystemSerious Untoward IncidentsSpeaking Up Speaking Out(PRISM)(PSA)(QIPP)(SAU)(SHA)(SIC)(SSA)(StEIS)(SUI)(SUSO)Local Involvement Networks(LiNK)Territorial Army(TA)Local Negotiations Committee(LNC)8889

NotesNotes9091

If you have any questions, comments or wouldlike a copy of the Annual Report please write to:The Chief Executive,East Cheshire NHS Trust,Trust Headquarters,Ingersley Building,Macclesfield District General Hospital,Victoria Road,Macclesfield,Cheshire,SK10 3BL.www.eastcheshire.nhs.ukThe annual report is available in Braille, moon, largeprint, audiotape, CD and translation into a foreignlanguage on request from Trust Headquarters at theaddress above.Designed and produced by Printit Limited - 01625 536144.Photography by Hilary Belshaw, Henhouse Productions Limited.Cover: Printed on 300gsm Condat Silk.Inner: Printed on 160gsm Evolve 100. Made from 100% recycled material.