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PROFILE OF LANCASHIRE TEACHING HOSPITALS NHS
FOUNDATION TRUST
1. OVERVIEW
Lancashire Teaching Hospitals NHS Foundation Trust was established on 1 April 2005, as a
public benefit corporation authorised under the Health and Social Care (Community Health
and Standards) Act 2003.
The Trust’s services are based on two hospital sites – Chorley and South Ribble Hospital
and Royal Preston Hospital. It also provides care from a Neuro-Rehabilitation Unit based on
the site of the former Sharoe Green Hospital in Preston and Broadoaks Child Development
Centre in Leyland.
The hospitals provide care to a local population of 390,000 and specialist health services to a
wider population of 1.5 million across Lancashire and Cumbria. As one of the largest NHS
providers in the region the Trust employs around 6,000 staff.
2. RANGE OF SERVICES
The following services are provided:

24 hour accident and emergency facilities on both hospital sites

Intensive, high dependency and coronary care units

General medicine, including elderly care

General surgery and urology

Child health

Ear, nose and throat surgery

Orthopaedics (bone and joint conditions)

Maternity services

Gynaecology (women’s diseases)

Anaesthetics

Oral and maxillo-facial surgery (mouth and jaw conditions)

Ophthalmology (eye diseases)

Support services for diagnosis and treatment such as pathology, x-ray, physiotherapy,
occupational therapy and specialist nurses
People in Cumbria and Lancashire also access the following specialist services:

Neurosurgery and neurology (brain surgery and nervous system diseases)

Oncology (radiotherapy and chemotherapy) and complex cancer surgery

Renal (kidney diseases)

Burns and plastic surgery

Disablement services such as artificial limbs and wheelchairs
3. ACTIVITY
The information below gives an indication of the high levels of activity during 2006/07.
During the year the Trust has over performed against all the activity targets. Improvements
have also been made in day case rates and lengths of stay for both elective and non-elective
patients.
Elective in-patients
Day cases
Total Electives
Non-elective in-patients
Total IP/DC
New outpatients
Follow up outpatients
Total Outpatients
A&E attendances – total
Births**
Regular Day/Night Attenders**
Actual
Plan
Difference
16325
37476
53801
52154
105955
98549
238081
336630
115545
4495
69898
16186
36018
52204
50713
102917
92745
224410
317155
113263
4021
68004
139
1458
1597
1441
3038
5804
13671
19475
2282
474
1894
** NB : Planned levels for birth and regular day/night attendances (renal and oncology services) are 2005/06
out-turn
4. WORKFORCE PROFILE
Staff in post for the five years up to 31 March 2007 were as follows:
LANCASHIRE TEACHING HOSPITALS
STAFF IN POST (HEADCOUNT) 2002 - 2007
7000
6000
5000
4000
3000
2000
1000
0
Ancillary
A&C Senior
Managers
M&D
N&M
AHP/HCA/P&T
Works & Maint.
Total
2002
528
1222
475
2302
828
82
5437
2003
506
1253
469
2363
835
88
5514
2004
507
1298
473
2469
948
85
5780
2005
477
1329
486
2522
944
74
5832
2006
494
1332
490
2524
962
87
5889
2007
475
1298
519
2571
995
104
5962
5. FINANCE
The Trust’s total income of £291.4 million was an increase of 9% on 2005/06 mainly as a
result of increased activity to achieve waiting times targets and service developments. The
Trust had a successful year in 2006/07 delivering a surplus of £1.84 million.
The Trust’s future financial plans include further benefit from the Payment by Results system
resulting in an expected increase on the 2006/07 surplus. The Trust will continue to ensure
cost effective services are delivered to the population it serves.
In 2007/08 the Trust plans further capital investment to support its service development
strategy. The main areas include:

Further expansion in education facilities

The implementation of the Picture Archiving and Communication System (PACS), which
updates the Trust’s x-ray films to digital technology thus improving storage and retrieval

Implementation of a new decontamination process to comply with national standards

Continuing a programme of substantial upgrades to theatres, wards and medical
equipment
6. PERFORMANCE TARGETS, NEW FACILITIES AND FUTURE DEVELOPMENTS
Performance Targets
The Trust’s achievement of key targets for 2006/07 included:

100% of patients with an urgent cancer referral being seen within 14 days;

98% of patients attending Accident and Emergency waited less than four hours from
arrival to admission, transfer or discharge.

No patient waited over 20 weeks for an inpatient or day case surgery appointment at 31
March 2007;

100% compliance when operations were cancelled for non-clinical reasons and
alternative dates were provided within 28 days;

No patient waited over 2 weeks for an appointment in Rapid Access Chest Pain Clinics.

The Trust was rated as excellent in its use of resources, fully complied with core targets
and health care standards and was identified as fair overall for quality of services. The
reasons for falling below excellent for quality of services resulted from the failure to
achieve the trajectory for heart disease and stroke management.
New Facilities and Future Developments
Capital expenditure for the year was £10.5 million in 2006/07 and £29 million in 2007/08.
Some of the new facilities within the Trust are summarised below:

A major multi-million pound expansion of orthopaedic services at Chorley and South
Ribble to provide around 3,200 extra operations a year, in addition to the 6,000
orthopaedic procedures already undertaken at the Trust.

The introduction of a Cardiac Catheter Laboratory at Royal Preston Hospital to undertake
life saving heart procedures to either diagnose or treat serious heart conditions.

The opening of a hi-tech laparoscopic operating theatre at Chorley and South Ribble
Hospital, allowing state-of-the-art keyhole surgery to be undertaken.

A park and ride scheme for staff to ease congestion and free up parking spaces for
patients and visitors at Royal Preston Hospital.

A specialist treatment centre for sufferers of neuromuscular conditions, providing patients
with access to regular intravenous treatments, detailed assessments and specialist
nursing care.

A hair and beauty salon for cancer patients at Royal Preston Hospital, where they can
receive relaxation treatments and consult with a hair specialist.

Development of a Picture Archiving and Communication System (PACS), which became
operational in April 2007, meaning that the Trust will no longer be using conventional xray films and all patient x-ray images from this date will be viewable electronically, which
will have major benefits for patient care.
Work is underway on the following developments:

A PETCT scanner (which produces three dimensional images to either detect disease or
find out how it was spread) at Royal Preston Hospital to help save the lives of cancer
patients across the region and ensure appropriate treatment is carried out.

A multi-million pound modernisation scheme to improve the wards at Royal Preston
Hospital is underway. The Medical Assessment Unit will be relocated following a major
programme of refurbishment. Two further wards will also be redesigned and upgraded in
2007/08.

A major expansion of the Trust’s education and training facilities.

Improved parking facilities at Chorley and South Ribble Hospital and Royal Preston
Hospital. This includes the introduction of ‘real-time signage’ and car park barriers and
signage at the sites and a new one-way system at Royal Preston Hospital.
The following medical advances have been made to ensure better patient services:

Completion of the transfer of cancer services from the Christie Hospital in South
Manchester and introduction of a new facility to prepare chemotherapy drugs.

Centralisation of cancer surgery for gynaecology and urology resulting in better patient
care.

Introduction of a technique for diagnosing lung diseases, often caused by asbestos.

Lancashire Teaching Hospitals is the only place in the UK to use a special type of
technology to undertake biopsies.

Launch of a dedicated service for children’s surgery with a ‘one-stop’ outpatient and preoperative assessment clinic.

Joint initiative with Royal Blackburn Hospital to treat and save lives of premature and sick
babies across the county by providing a dedicated neonatal transfer service and new
equipment for the care of neonates has been provided.

Completion of new pre-operative assessment units on both hospital sites.

Launch of a service in conjunction with Macmillan Cancer Support to provide anyone
affected by cancer with in-depth information and help and support them with practical and
emotional issues.

Introduction of a patient information film in the Accident and Emergency Department at
Chorley and South Ribble Hospital.
Business Reform Programme
In response to the requirement to redesign the Trust’s services and to take full advantage of
the opportunities offered as a Foundation Trust, which depends upon cultural change and
new ways of working, a business reform programme has commenced involving 20
‘champions’ and 300 staff. This will enable change to be initiated and driven throughout the
organisation by involvement of staff at all levels. The work includes issues related to:






Productivity and efficiency of Directorates
Quality and configuration of services, focusing on the patient’s pathway
Designation of beds
Ability to compete with the private sector
Relationship management
Marketing/promotion of services – publicising achievements
The process has initially concentrated on about six projects and the pace of change will be
incremental. The work will complement existing initiatives in place such as clinical and
financial benchmarking, which are already in place to monitor Directorate performance.
Undergraduate and Postgraduate Medical Training
The Trust has passed the half way point of its development for the training of medical
students from the University of Manchester with a total of 180 students on site and the target
of 240 students will be reached by 2009.
Construction of the new Education Centre has commenced and is due for completion in
January 2008. The building will house additional seminar rooms, a large lecture theatre, a
large clinical skills unit, a simulation unit, accommodation for the resuscitation team, a
student common room and office accommodation for most of the Undergraduate team.
Representatives from the Manchester Medical School, following a recent visit, praised the
standard of education being provided for the medical students. This represents a major
achievement on the part of all Trust staff and especially the Undergraduate Team who do so
much to support the students and ensure that the standards of training and the environment
in which it is offered is of the highest quality.
For Postgraduate education, an extensive, high quality Foundation House Officer
Programme is in place, under the leadership of a Foundation Programme Director, one of the
Trust’s Consultants, aided by a high quality administrative team. A visit by representatives
from the Deanery, University of Manchester, in April 2006 resulted in many aspects of the
training programmes being complimented. Progress has been made in introducing a Trust
supervision policy to assist in the delivery of appropriate training for medical staff, which
reinforces the importance of safe clinical care.
The Trust also hosts a very successful GP registrar training programme. This will expand to
take 27 trainees each year and rapidly start to contribute to the expansion and replacement
of the local GP workforce.
7. MANAGEMENT ARRANGEMENTS
The Trust benefits from a strong and experienced Board of Directors supported by effective
Directors and Clinical Leaders throughout the organisation.
Current Trust Board Structure
Chair
Non-Executive Directors
(7)
Executive Directors
(5)
Collectively, existing Board Members possess a wide range of knowledge, skills and
experience that will enable them to exploit the potential benefits of Foundation status to the
full. The Non-Executive Directors bring considerable experience of involvement in a wide
range of organisations outside the health sector, including academic, commercial and
charitable organisations and Local Government.
As part of the Trust’s organisational development strategy, a Board level development
programme is ensuring that Board Members are aware of their responsibilities in managing a
regulated service, and that Non Executive Directors remain aware of their responsibilities in
respect of the following key areas as outlined in the ‘Review of the Effectiveness of NonExecutive Directors’ by Derek Higgs published in January 2003:
Strategy:
Non-Executive Directors should constructively
contribute to the development of strategy.
challenge
and
Performance:
Non-Executive Directors should scrutinise the performance of
management in meeting agreed goals and objectives and monitor the
reporting of performance.
Risk:
Non-Executive Directors should satisfy themselves that financial
information is accurate and that financial controls and systems of risk
management are robust and defensible.
People:
Non-Executive Directors are responsible for determining appropriate
levels of remuneration of Executive Directors and have a prime role in
appointing, and where necessary removing, senior management and
in succession planning.
Trust Executive Team
The current responsibilities of the Trust’s Executive Team are set out below:
(a)
Chief Executive
Executive leadership of Trust, ensuring
strong performance and positive
relationships. Management of Executive
Directors. Developing and maintaining
strategic directions and policies.
(b)
Nursing Director
Leadership of the Nursing Profession,
Strategic Management of Nursing,
Clinical Governance, Quality Assurance,
Patient and Public Involvement, and Risk
Management.
(c)
Medical Director
Leadership of Medical Profession,
Management of Medical Issues,
Research and Development, Medical
Education, Clinical Governance,
Professional Support Services.
(d)
Finance Director
Responsible for Financial Management,
Financial Strategy, Audit Probity,
Negotiation with Commissioners, and
IM&T.
(e)
Chief Operating Officer
Responsible for Standards for Better
Health, Performance and Waiting List
Management, development of Cancer
Services, Data Quality, Call Centre and
Site Management.
(f)
Director of Business Development
Responsible for Marketing and
Modernisation of Service Provision,
Business Planning, Modernisation,
Booked Admissions, Patient Choice
through engagement with Stakeholders,
Health Records.
(g)
Workforce Director
Overall responsibility for Workforce
Development including Human Resource
Management, Education, Training and
Development, Improving Working Lives,
and Staff Involvement.
(h)
Director of Facilities and Services
Responsible for Estates and Non-Clinical
Support Services, and Controls
Assurance.
Trust Management Team
The Trust Management Team, comprising Executive and Clinical Directors, has successfully
established the organisation from a merger of two large predecessor organisations with very
different cultures and approaches. Whilst the Team has always been clear that the strategic
goal is for integration of clinical services across the hospital sites, clinical teams have been
given the space and time to achieve this in ways that are sensitive to their particular
circumstances.
Chief Executive
Finance Director
Medical Director
Director of Business Development
Director of Facilities and Service
Nursing Director
Chief Operating Officer
Workforce Director
Clinical Directorate Structure
(Individual Clinical Directorates are detailed under the following Service Categories)
CLINICAL SUPPORT
SERVICES
ACUTE SERVICES
SPECIALIST SERVICES


Imaging
Pathology




Oncology Services
Plastic Surgery

Professional Support
Services (including,
Dietetics, Disablement
Services, Medical
Illustration, Pharmacy,
Physiotherapy,
Occupational Therapy,
Sterile Services, Speech
and Language Therapy)

Accident and Emergency
Anaesthetics (including
Theatres, Critical Care Day
Case Services)
Child Health

Neurosciences (Including
Neurology and
Neurosurgery)
Head and Neck (Including
ENT, Ophthalmology, and
Oral Surgery)
Medicine
Orthopaedics and
Rheumatology
Surgery
Women’s Health

Renal Services





8. GOVERNANCE ARRANGEMENTS
The Trust has established the following arrangements for its NHS Foundation Trust
Governing Council:
GOVERNING COUNCIL
CHAIR
STAFF
1
1
1
1
1
1
Doctors or Dentists
Other Health Professionals
Nurse or midwife (Chorley)
Nurse or midwife (Preston)
Non-clinical (Chorley)
Non-clinical (Preston)
Elected
by staff
members
PRIMARY CARE TRUSTS
1
Elected
by public
members
Local Residents
(14)
Local and Regional Patients
(+ Carers)
(6)
Primary Care Trusts
LOCAL AUTHORITY
1
1
1
1
Preston City
Chorley Borough
South Ribble Borough
Lancashire County
EDUCATION
1
University representative
NHS
Foundation
Trust
decides
with
partners
OTHER ORGANISATIONS
Community
1
1
1
1
Total 20
Council for Voluntary Services
Trust volunteer
Race Equality Council
Lancashire Care Trust
Total 16
Governors have a very important role in ensuring the link between the members of the NHS
Foundation Trust, the wider community and those who run the Trust. They are required to
devote a substantial amount of time to NHS Foundation Trust work and attend at least three
Governing Council meetings each year, as well as the Annual Members’ Meeting, and may
also be expected to attend meetings because of the need to conduct urgent business.
Governors will also attend other events and sub-committees based on their areas of interest.
Terms of office will normally be for three years. Governors will be eligible for re-election at
the end of that period but cannot hold office for more than six consecutive years.
The Trust has a development programme to assist Governors to develop effective ways of
keeping in touch with members so that they can listen to ideas and opinions and feed these
back to the Governing Council.
The Governing Council:







acts as a source of ideas about how the NHS Foundation Trust can provide its services
in ways that meet the needs of patients, members and the wider community.
makes sure that the NHS Foundation Trust operates in a way that follows NHS principles
and values
receives the Trust’s Annual Accounts, Auditor’s Report and the Annual Report from the
Board of Directors.
appoints the Chair and Non-Executive Directors of the Trust’s Board of Directors
is consulted by the Board of Directors on the development of future plans for the Trust
reviews the success of the Trust in meeting its objectives for the provision of high quality
services.
ensures that members are kept informed and updated on the Trust’s developments and
the work of the Governing Council.
9. ORGANISATIONAL DEVELOPMENT
A priority for the Trust is to embed a programme of leadership development for key clinical
and managerial staff to support higher levels of autonomy and delegated responsibility within
Clinical Directorates, and to support the Trust’s business planning and partnership agenda.
Creating a strong, clinically led, and devolved management structure is an important aspect
of Organisational Development for the Trust. This provides a key platform for system and
management development that is needed for the Trust to operate as an NHS Foundation
Trust.
The overall philosophy guiding this strategy is that an NHS Foundation Trust is not just a
legal body, but a form of organisation which requires a strategy for development, and an
underpinning Organisational Development philosophy, which enables this organisation to
develop and prosper.
It is particularly important for the Trust to further enhance the management capacity and
management capabilities within the organisation consistent with a commitment to delivering
all aspects of management at the highest level. The Trust is anxious to extend this
Leadership and Development Programme to include Members of the Board of Governors, as
part of their development.
In addition to the above, the Trust recognises that the move to Foundation Trust status
demands the development of a range of new core business skills and management
processes within the Trust. The primary focus of the development of the Trust to operate as
a Foundation Trust is as follows:

Strategies to ensure that the Trust remains responsive to the needs and requirements
of patients, relatives and carers;

Enhanced business planning and business development strategies suitable for
operating within a commercial environment;

Development of effective arrangements for working in partnership with other NHS
bodies across the local health economy and Strategic Health Authority, in order to
develop appropriate and co-ordinated service provision.

Greater involvement and dialogue with key Stakeholders, particularly those on the
Governing Council. It will be important for the Trust to adjust to the new governance
arrangements and spend a greater proportion of their time responding to, and working
in partnership with, its major Stakeholders;

Strategies for engaging potential business partners, particularly the finance community
in support of any borrowing and potential Joint Venture ambitions;

Market analysis, analysis of “customer” behaviour, ‘’customer’’ liaison, and business
development opportunities linked to the choice agenda;

Integration of the SWOT methodology into business planning at all levels within the
organisation and the clear linkage of this to corporate business strategy;

Development of internal financial management processes in response to Payment by
Results and the move away from a largely fixed budgetary control environment into one
which is more dynamic, that demands a flexible cost base and a more developed
understanding of the cost drivers and their relationship to activity, than has hitherto
been the case;

Development of a business strategy related to handling of risk, and the consideration of
risk management issues at all stages in the business and management processes;

Increasingly sophisticated development and use of activity trend analysis and
modelling techniques and the explicit integration of this into the management process;

Increased focus on internal performance management processes;

The increasing focus on Clinical Directorates being the core “Business Unit” within the
Trust with clearly identified responsibilities related to ongoing business management
and viability.
Emphasis on these aspects of the Trust’s business will form an increasingly important aspect
of the Trust’s Management Development Programme. Business strategy, development, and
management within the Foundation Trust context will also be integrated into the corporate
governance structure of the Trust.