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Annual Report and Accounts 2012/13
Annual Report and Accounts 2012/13
Contents
02 Who we are
16 Quality Account
03 Facts about The Royal Marsden
18 Statement on quality from the Chief Executive
04 Chairman and Chief Executive statement
20 Priorities for improvement
06 What we do
55 Statements of assurance from the Board
06 Research
61 Review of quality performance
07 Diagnosis
74
08 Treatment and care
78 Our workforce
10 Education and regulation
82 Statement of approach to staff engagement
11 Our staff
85 Governance and membership
15 Charity
88 Our Board of Directors
91
Sustainability/climate change report
The work of the Board
94 The Management Executive
95 Regulatory Ratings Report
96 Directors’ Report
97 Remuneration report
99 Financial Review for the year ended
31 March 2013
102 Annual Accounts for the year ended
31 March 2013
1
The Royal Marsden NHS Foundation Trust
Who we are
The Royal Marsden NHS Foundation Trust is a
world-leading cancer centre specialising in cancer
diagnosis, treatment, research and education.
Our academic partnership with The Institute
of Cancer Research (ICR) makes us the largest
comprehensive cancer centre in Europe with a
combined staff of 4,300. Through this partnership,
we undertake ground-breaking research into new
cancer drug therapies and treatments.
We have two hospitals: one in Chelsea, London, and
another in Sutton, Surrey. Also in Surrey, we have
a Chemotherapy Medical Daycare Unit at Kingston
Hospital and an academic partnership with the
Mount Vernon Cancer Centre. This partnership
enhances our research programmes and our
contribution to the NHS in finding new and better
ways to treat patients diagnosed with cancer.
We also provide Sutton and Merton Community
Services. Since April 2011 The Royal Marsden
has managed a range of community services, and
together we are ensuring that treatment and care
is of the highest quality and seamless between
hospital and home environments.
The Royal Marsden was founded in 1851 by William
Marsden. His vision was to create a pioneering
cancer hospital dedicated to excellence in the study,
treatment and care of people with cancer.
Today we continue to build on this legacy,
constantly raising standards to improve the lives
of the 50,000 cancer patients from across the UK
and abroad that we see each year.
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Annual Report and Accounts 2012/13
Facts about
The Royal Marsden
The Royal Marsden was the first hospital in the
world dedicated to cancer when it opened in 1851.
Its founder, William Marsden, had a vision to
create a pioneering cancer hospital dedicated to
the treatment and care of people with cancer and
research into the underlying causes of cancer.
1. This year, we celebrated nine years as an
NHS Foundation Trust. We were one of the
first hospitals to be awarded this status in
April 2004.
2. The Royal Marsden has been rated as one of
the top performing trusts in the country in the
2012 Picker Inpatient and Outpatient Surveys.
For the fifth year in a row The Royal Marsden
has been rated as excellent by the Patient
Environment Action Team (PEAT) following
an inspection. The PEAT scored the Trust as
“excellent” for overall hospital environment,
levels of privacy and dignity given to patients,
and quality of food. The Trust’s levels of
cleanliness and infection prevention and
control rates were also rated as “excellent”.
3. We have a Medical Day Unit at Kingston
Hospital. The William Rous Unit was created
in partnership with Kingston Hospital and
Macmillan Cancer Support, and aims to
provide the very best in cancer treatment to
patients closer to their homes.
4. We have academic partnerships with The
Institute of Cancer Research (ICR) and Mount
Vernon Cancer Centre. These relationships
strengthen our ‘bench-to-bedside’ approach,
enabling the research and development of
new cancer drugs and new imaging and
radiotherapy techniques. They also allow us
to combine our expert teams of scientists and
clinicians to give the best care to our patients.
6. Our Drug Development Unit, rated
“outstanding” by Cancer Research UK, has
had major breakthroughs in the treatment
of advanced melanoma and prostate cancer.
Thirty phase 1 drug trials have taken place
in the hospital this year. The Royal Marsden
also has the largest paediatric inpatient drug
development programme in the UK.
7. We are a technology and research hub for part
of the Cancer Research UK Stratified Medicine
Programme. This is a ground-breaking
national project which aims to establish a
world-class NHS genetic testing service in the
UK. This means that as and when new targeted
treatments become available, doctors will
have access to the tests they need to help them
decide which drugs are best for their patients.
8. We opened our new £18.2 million Centre
for Molecular Pathology (CMP) in Sutton
in November 2012. The CMP is a state-ofthe-art facility dedicated to the research of
personalised cancer treatment, bringing
together clinicians, geneticists, pathologists
and scientists from The Royal Marsden and
the ICR under one roof for the first time and
accelerating our work to improve treatment
and a cure for patients with cancer.
9. In the past year, The Royal Marsden School
has educated over 700 nurses and allied health
professionals across the UK.
10. The Royal Marsden, along with 16 other
NHS Trusts across west and south London,
and the ICR, is part of the London Cancer
Alliance (LCA). The LCA aims to develop
more integrated pathways of care for patients,
set the direction for improvements in patient
experience and outcomes and develop common
data sets to assess our performance.
5. The Royal Marsden took over responsibility
for providing Sutton and Merton Community
Services in April 2011. These services include
health visiting, specialist community nursing,
outpatient physiotherapy, podiatry, a falls
service and children’s physiotherapy, all in the
Sutton and Merton area.
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The Royal Marsden NHS Foundation Trust
Chairman and Chief
Executive joint statement
The Royal Marsden has a vital role in
championing change and improvement in cancer
care through research and innovation, education
and leading-edge practice. Together with The
Institute of Cancer Research (ICR), we form the
largest comprehensive cancer centre in Europe,
offering expert treatment supported by highquality research. Since 2011, The Royal Marsden
has also been responsible for providing
community services in Sutton and Merton. This
has helped us to find better ways of providing care
between hospital and home to ensure patients
receive the highest standards of treatment and the
best possible patient experience.
During the year, we continued our work on
precision medicine, tailoring treatment plans to
individual needs. This is a core focus of our benchto-bedside principle, ensuring that our patients
receive the treatment and care which is most
appropriate to them and maximising the clinical
translation of our research.
An example of this is the opening of the Centre
for Molecular Pathology on our Sutton site to
accelerate our work in finding better ways of
diagnosing and treating cancer. The centre
was opened by Professor Dame Sally Davies,
Chief Medical Officer for England, in November
2012 and brings clinicians, pathologists and
scientists together under one roof for the first
time to advance cancer research and treatment.
Working side by side, experts will be able to better
understand each patient’s individual tumour type
and develop personalised and effective treatment
plans, making our vision of personalised medicine
a reality and speeding up the research and
treatment development process.
We will be opening a new clinical research facility
in 2013, the West Wing, which will provide a
dedicated space and a central facility for the
treatment of patients in clinical trials, increasing
the opportunities for translating early phase
studies conducted in our Drug Development
Unit into later phase research. It will enable the
transition of early research findings into large
scale trials, which is integral to our work for the
National Institute for Health Research (NIHR) as a
Biomedical Research Centre.
Following the installation of CyberKnife
technology in 2012, The Royal Marsden is
leading a new study on the benefits of CyberKnife
treatment for patients and for the NHS. The
Prostate Advances in Comparative Evidence
study, an international, multicentre, randomised
study, will compare CyberKnife stereotactic body
radiotherapy with manual laparoscopic/robotic
surgery and conventionally fractionated intensitymodulated radiation therapy for the treatment
of localised prostate cancer. This will enable
clinicians and patients to make informed decisions
about their treatment based on the highest level of
clinical evidence.
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Annual Report and Accounts 2012/13
We have continued to form new partnerships
and continue with existing ones in order to
benefit patient care and maximise efficiency
across the cancer pathway. In summer 2012
The Royal Marsden signed up to the London
Cancer Alliance (LCA), along with 16 other NHS
Trusts across west and south London. The LCA
aims to develop more integrated pathways of care
for patients, set the direction for improvements
in patient experience and outcomes and develop
common data sets to assess our performance.
We aim to deliver cancer treatment and care in
a new way, improving access to screening and
diagnostics and increasing the number of patients
enrolled in clinical trials.
This will ensure we can irradiate variation and
improve the standard of care all patients receive
cross a population of five million in west and
south London.
Over the last year we have renovated four of the
wards on our Chelsea site to ensure we provide
the highest level of comfort alongside the latest in
clinical facilities. In October, we were delighted to
welcome the Secretary of State for Health, Jeremy
Hunt, to one of those wards – Ellis Ward – that
re-opened in summer 2012 as a state-of-the-art
facility following an extensive refurbishment
and modernisation programme. Our Palliative
Care ward, Horder, was officially opened by
HRH Princess Alexandra in September 2012 after
a £3 million renovation. Wiltshaw and Burdett
Coutts wards also re-opened in January 2013
after a period of renovation. Both the Ellis Ward
and Horder Ward renovations were funded by
The Royal Marsden Cancer Charity. We would
like to thank the charity and all our supporters for
the difference they make to the life and work of
The Royal Marsden, and to the quality of service
and environment we are able to provide.
Finally, we would like to thank the staff at
The Royal Marsden for their exceptional
commitment and professionalism, which is
commented on by so many of our patients. It is
the pursuit of excellence, which permeates the
organisation and allows us to provide out patients
with the best cancer care available anywhere
in the world.
R. Ian Molson
Chairman
Cally Palmer CBE
Chief Executive
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The Royal Marsden NHS Foundation Trust
What we do
Research
The Royal Marsden and The Institute of Cancer
Research (ICR) form the largest comprehensive
cancer centre in Europe and, together, are at the
forefront of moving cancer research and treatment
from bench to bedside.
A new age in the treatment of
advanced melanoma
Two drugs trialled at The Royal Marsden were
approved by the National Institute for Health
and Clinical Excellence (NICE) late last year as
recommended treatment options for metastatic
melanoma, the most aggressive form of skin
cancer. Zelboraf (vemurafenib) and Yervoy
(ipilimumab) work very differently. Vemurafenib
blocks the effects of a cancer-causing mutated
gene, BRAF. Fifty percent of patients with
metastatic melanoma will have this mutation
in their cancer, which drives the cancer’s
development. The other drug recommended for
treatment, ipilimumab, works by harnessing the
power of the body’s own immune system to fight
cancer. The results of these two trials represent
the biggest ever breakthrough in the treatment of
advanced melanoma for more than 30 years.
Landmark research into tumour variation
Patients with advanced kidney cancer at
The Royal Marsden have taken part in a
breakthrough study, published in the New England
Journal of Medicine, which suggests that taking
a sample from just one part of a tumour may
not give a full picture of its ‘genetic landscape’.
In the first-ever genome-wide analysis of the
genetic variation between regions of the same
kidney tumour, scientists from Cancer Research
UK led by Professor Charles Swanton, analysed
samples from patients of Dr James Larkin at
The Royal Marsden. They found that about two
thirds of gene faults were not shared across other
biopsies from the same tumour. The research,
which was the second most highly cited scientific
paper of 2012, revealed that there were more
differences than similarities between biopsies from
the same tumour at the genetic level.
$10 million boost for prostate research
Professor Johann de Bono, Head of the Drug
Development Unit, is collaborating with other
leading prostate cancer researchers in a $10m
global effort to drive the development of
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personalised treatment for this disease. In April
2012, Stand Up to Cancer, the Prostate Cancer
Foundation and the American Association for
Cancer Research announced the formation of a
‘Dream Team’, drawn from five leading prostate
cancer clinical research centres in London and the
USA. The team also includes Dr Gerhardt Attard
from The Royal Marsden and the ICR. Over three
years, the team will drive the development of
personalised treatment by scanning the genomes
of patients with advanced metastatic cancer.
They will look for gene alterations that are more
common in patients who respond to therapies,
as well as alterations in patients who develop
resistance to the drugs. The aim is to identify a
panel of biological markers that doctors can use
to deliver precise treatments to their prostate
cancer patients.
Translational Genetics Laboratory
The Translational Genetics Laboratory is a
key component of a groundbreaking initiative,
called the Mainstreaming Cancer Genetics
programme, led by Professor Nazneen Rahman
that will provide testing to investigate how the
genetic make-up of an individual affects why
they develop cancer and what treatment will be
most appropriate for them. The Royal Marsden
Cancer Charity is providing £1.16 million to
set-up the cutting-edge clinical sequencing
infrastructure of the Translational Genetics
Laboratory and to pilot the new test in patients at
The Royal Marsden. By 2014, Professor Rahman,
Head of the Cancer Genetics Clinical Unit at
The Royal Marsden and Head of the Division of
Genetics and Epidemiology at the ICR, hopes to
offer genetic testing to ovarian and breast cancer
patients at The Royal Marsden. Once established,
the lab will also provide genetic testing to many
other patients at The Royal Marsden and at other
hospitals. The ultimate aim of the Mainstreaming
Cancer Genetics programme is for genetic testing
to be available for any cancer patient as a matter
of course.
The Royal Marsden leads international
CyberKnife trial
The Royal Marsden is leading a new study on the
benefits of CyberKnife treatment. The Prostate
Advances in Comparative Evidence (PACE)
study, an international, multicentre, randomised
study, will compare CyberKnife stereotactic body
radiotherapy (SBRT) with manual laparoscopic/
robotic surgery and conventionally fractionated
intensity-modulated radiation therapy (IMRT)
for the treatment of localised prostate cancer.
Annual Report and Accounts 2012/13
The current accepted standards of treatment are
surgery and radiotherapy; the PACE study aims to
establish if CyberKnife is equivalent to, or better
than, this in the treatment of prostate cancer and
the impact on the patient’s quality of life. This will
enable clinicians and patients to make informed
decisions about their treatment based on the
highest level of clinical evidence.
Diagnosis
New anticancer drug for prostate cancer goes
through successful clinical development
CMP – groundbreaking facility now open
Professor Johann de Bono has led an international
Phase III clinical trial that has led to another novel
oral treatment for advanced prostate cancer called
enzalutamide. This novel agent is an androgen
receptor signalling inhibitor with superior antitumour activity to previously available antiandrogens. The trial resulted in a significant
improvement in overall survival and quality of life
in patients with advanced prostate cancer and led
to the approval of this agent by the US Food and
Drug Administration.
A new research facility for the Sutton site
A new clinical research facility has been
approved for The Royal Marsden at Sutton,
funded by The Royal Marsden Cancer Charity.
The £2.6 million project will provide a dedicated
space and a central facility for the treatment of
patients in clinical trials, in particular increasing
the opportunities for translating early phase
studies conducted within the Drug Development
Unit into later phase research. The new unit will
enable the transition of early research findings
into large scales trials, which is integral to the
National Institute for Health Research (NIHR)
Biomedical Research Centre’s strategy. The
facility will increase the amount of research at
The Royal Marsden and improve efficiency. The
unit, to be located in the West Wing of the hospital,
will be open by the end of 2013.
Early diagnosis is vital in achieving better
outcomes for cancer patients. We have a
specialist team and expert diagnostic services
at our Rapid Diagnostic and Assessment Centres
and comprehensive scanning facilities in both
Chelsea and Sutton.
The Centre for Molecular Pathology (CMP),
a world-class research facility that will
revolutionise how we diagnose and treat cancer,
was officially opened by Professor Dame Sally
Davies, Chief Medical Officer for England, in
November 2012. It brings together clinicians,
geneticists, pathologists and scientists under
one roof for the first time to advance cancer
research and treatment. This will dramatically
speed up the research and treatment development
process. Working side by side, experts will be
able to better understand each patient’s individual
tumour type and develop personalised treatment
plans faster than ever before, making our vision
of personalised medicine a reality. The centre
was born out of the unique relationship between
The Royal Marsden and the ICR. Together, they
form the only Biomedical Research Centre (BRC)
specialising in cancer in the UK. BRC status
was awarded by the NIHR in 2006 and renewed
in 2011. Professor Mitch Dowsett, Professor of
Biomedical Endocrinology at The Royal Marsden,
has been appointed Head of the CMP.
Consultants honoured with professorships
The research of Chris Nutting, Consultant
Clinical Oncologist in the Head and Neck Unit
at The Royal Marsden, has been honoured by
The Institute of Cancer Research Credentials
Committee, which conferred the title of Professor
after considerable deliberation and extensive
soundings from international experts. The
committee also honoured the work of the ICR’s
Kevin Harrington, an Honorary Consultant at
The Royal Marsden, also awarding him the title
of Professor.
7
The Royal Marsden NHS Foundation Trust
Treatment and care
Partnership, leadership and influence
We pride ourselves on our excellent standards of
care for all our patients. By working together and
using joint expertise, we and our partners can
ensure patients receive the best personalised care.
The Royal Marsden signs up to the London
Cancer Alliance
Last summer The Royal Marsden signed up to
the London Cancer Alliance (LCA), along with 16
other NHS Trusts across west and south London,
and the ICR. The LCA aims to develop more
integrated pathways of care for patients, set the
direction for improvements in patient experience
and outcomes and develop common data sets to
assess our performance. It aims to deliver cancer
treatment and care in a new way, improve access
to screening and diagnostics and increase the
number of patients enrolled in clinical trials to
improve cancer care across London and our local
health communities.
After leading the LCA through the design and
formation of its management structure and
service plan, Cally Palmer, Chief Executive of
The Royal Marsden stepped down from her
role as Chief Executive Project Lead for the
LCA, and handed over to two Independent
Chairs, Dr Neil Goodwin CBE and Dame Gill
Morgan. Dr Shelley Dolan, Chief Nurse at
The Royal Marsden was appointed as Associate
Clinical Director, supporting Professor Arnie
Purushotham, Director of King’s Health Partners
Integrated Cancer Centre, as Clinical Director,
in addition to her principal role as Chief Nurse
at The Royal Marsden.
Secretary of State visits The Royal Marsden
Staff and patients met the Secretary of State
for Health, Jeremy Hunt, when he visited
The Royal Marsden’s Chelsea site in October
2012. Together with senior colleagues from the
Department of Health, including Professor Sir Mike
Richards, National Clinical Director for Cancer,
Mr Hunt took part in two round-table events,
discussing ‘Improving patient care and experience’
and ‘Early diagnosis and improving survival’.
Senior consultants and nursing staff took part in
the discussions, which were chaired by Dr Shelley
Dolan, Chief Nurse, and Professor Martin Gore,
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Medical Director, respectively. Mr Hunt also toured
the newly refurbished Ellis Ward, speaking with
patients and staff. He was particularly interested
in the food served at The Royal Marsden, which
has won several awards and is renowned for its
high standard.
A welcoming facility for the newly
refurbished Ellis Ward
Ellis Ward re-opened in summer 2012 at our
Chelsea site following an extensive refurbishment
and modernisation programme. The ward now
contains 14 beds, with two single rooms and
three four-bedded bay areas. The refurbishment of
the unit includes modernised bathroom facilities
next to the bedded bays, and en-suites for the
single rooms. Each bedside has also had a new
patient entertainment system installed. The
refurbishment of the ward, for women with breast,
gynaecological, gastrointestinal or genitourinary
cancers, was made possible due to a generous
donation from Jimmy Thomas, whose late wife,
Alma, was treated at the hospital. The redesign
has been based on Alma’s wishes, who wanted
every patient staying on the ward to enjoy the
‘highest levels of comfort’.
Royal opening for refurbished Horder Ward
The refurbished Horder Ward was officially opened
by HRH Princess Alexandra in September 2012
after a £3 million renovation. The refurbishment,
which was funded by The Royal Marsden Cancer
Charity, turned the ward into a modern palliative
care environment with enhanced en-suite single
rooms, consultation rooms and a day room
for patients and their visitors, all set in light,
airy surroundings.
Renovated wards open
Wiltshaw and Burdett Coutts wards re-opened
in January 2013 after a period of renovation.
As part of the considerable development and
renovation of the Chelsea site over the past few
years, the opening of Wiltshaw Ward in particular
was a significant milestone in the final stages of
whole site redevelopment. Wiltshaw Ward will be
predominantly used for Private Care alongside
the Granard House development which was
completed in 2011.
Annual Report and Accounts 2012/13
Palliative care team receives
European recognition
The Palliative Care service at The Royal Marsden
received Europe-wide accreditation for its
groundbreaking work. The European Society for
Medical Oncology (ESMO) Designated Centers
of Integrated Oncology and Palliative Care
accreditation programme recognises cancer
centres that achieve a high standard of integration
between medical oncology and palliative care.
This is the second time that The Royal Marsden
has been awarded this accreditation, which
is valid for three years. Anna-Marie Stevens,
Macmillan Nurse Consultant in Palliative Care at
The Royal Marsden, said: “We are incredibly proud
of our palliative care service and the support and
care we give to patients and their families. This
reaccreditation recognises the comprehensive and
multidisciplinary approach to the care we provide.”
New PET CT facility opens at Sutton
We have enhanced our scanning capability on
the Sutton site, with two new PET CT scanners
installed in a new facility. There are now three
MRI, two CT and three PET/CT machines on
the Sutton site. This is part of a wider project
increasing scanning capacity across the
whole Trust. Work is currently underway on a
redeveloped scanning unit on the Chelsea site,
expected to be completed in 2014.
Royal Marsden nurses present study
at symposium
Two Clinical Nurse Specialists (CNSs) from
The Royal Marsden presented their research
work at the 2012 San Antonio Breast Cancer
Symposium in the USA – a first for the Trust.
Melissa Warren and Diane Mackie, CNSs in
secondary (metastatic) breast cancer, presented
their study – entitled ‘The complexity of non faceto-face work with patients affected by metastatic
breast cancer and their carers, the “hidden
consultations” of the clinical nurse specialist’
– at the prestigious annual symposium, held in
San Antonio, Texas, in December. The needs
of women with metastatic breast cancer can be
complex and the role of the CNS is important in
their care. Having contact with someone who
has specialist knowledge and understanding of
a patient’s treatment and care can help reduce a
patient’s anxieties and help them to cope with the
complications of having metastatic breast cancer.
The study looked at the complexity of patient
interaction via telephone, which is not a formally
recognised part of a CNS’s role, compared
with face-to-face contact. It has highlighted the
importance of telephone contact between CNSs,
patients and their carers, and that this work needs
to be formally identified.
Health Services Research – beyond the bedside
Considerable work has been carried out this year
in the area of Health Services Research, which
aims to develop service innovation and research
programmes that improve patient-centred care
in relation to Living with and Beyond Cancer.
Natalie Doyle, Dr Isabel White and Dr Theresa
Wiseman are members of the Department of
Health/Macmillan Consequences of Cancer and
Treatment Collaborative (CCAT) and as a Trust
we have also been successful in being part of
the Prostate Cancer UK A Survivorship Action
Partnership (ASAP) network to offer expertise for
improving prostate cancer survivorship care and
support. The Trust has implemented the Holistic
Needs Assessment (HNA) for patients in all cancer
services and has been awarded funding for pilot
site status to test and redesign care pathways to
support transition and care in the community. Dr
Natalie Pattison has also been leading trust-wide
research into how we can identify at-risk patients
and map this flexibly against staffing, exploring
cost-savings, patient-focused outcomes, mortality/
morbidity and patient acuity.
The Royal Marsden to join partners in
Academic Health Science Networks
Academic Health Science Networks (AHSNs) were
introduced by the Department of Health in 2011 to
spread innovation in healthcare, and bring together
local NHS providers, higher education institutions
and industry to improve the adoption and spread of
innovation. It is important that The Royal Marsden
is part of the AHSN initiative to help accelerate
the roll out of innovation in cancer care to a wider
population. Research and education funding may
only be available in the future through the AHSNs
and the development of networks and a more
integrated approach to the development of care will
be essential in improving efficiency longer term.
The Royal Marsden is delighted to be a member of
both the Imperial College Health Partners AHSN
and South London AHSN.
9
The Royal Marsden NHS Foundation Trust
Education and regulation
Another ‘excellent’ year
For the fifth year in a row The Royal Marsden was
rated as excellent by PEAT (Patient Environment
Assessment Team), a national organisation,
following an annual inspection. The NHS Health
and Social Care Information Centre announced
that the Trust scored an “excellent” rating for the
overall hospital environment. This included the
levels of privacy and dignity given to patients, and
the quality of food. The centre also commented
that the Trust’s levels of cleanliness and infection
prevention and control procedures and rates were
also “excellent”.
GP education programme success continues
Now in its fourth year, The Royal Marsden’s GP
Education series of quarterly one-day seminars
and online learning opportunities continues to be a
success, contributing directly to GPs’ professional
knowledge on cancer diagnosis and treatment.
To ensure our Education Days remain relevant
and engaging for GPs, we have developed more
interactive, case-led sessions to help us further
understand the problems faced in primary care
and allow us to offer expert secondary care advice.
The Royal Marsden has held 15 GP Education
Days since September 2009, covering most
tumour types, with almost 100 GPs attending each
session. Speakers focus on screening, diagnosis
and treatment. In line with government objectives,
we are helping to build relationships between
primary and secondary care by educating GPs
on the value of prevention and early diagnosis
– recognising cancer signs and symptoms and
referring patients at the right time. We also
produce video highlights of each GP Education
Day, which are made available to all GPs via
www.doctors.net.uk, while a quarterly e-bulletin
informs GPs of the latest news and general
information on specific cancers.
10
The Royal Marsden joins with local hospitals
to identify best value
The Royal Marsden joined together with Chelsea
and Westminster and Royal Brompton & Harefield
hospitals and the Institute of Cancer Research as
the Fulham Road Collaborative (FCC) to establish
a joint contract for its Soft Facilities Management
services including catering, portering and
cleaning. This was awarded to ISS Mediclean
following a competitive tendering process to
identify best value for money and best quality
of service. The project is a great example of how
healthcare organisations can work together to
make the best use of resources while maintaining
excellent standards of care for patients. The
FCC were highly commended at the National
Government Opportunities (GO) Excellence
in Public Procurement Awards for their work
on project.
The Friends and Family Test
The Royal Marsden is proud to provide worldleading cancer care to our patients but we also
want to know what we can do to make the
experiences of patients even better. This is why
it’s so pleasing to see the positive start made on
the Friends and Family Test. The Friends and
Family Test is designed to enable comparison
between hospitals throughout the NHS quickly
and easily. The Royal Marsden has made a
successful start to this new government initiative
which gives patients the opportunity to rate their
care. Since February, all inpatients have been
asked to fill in a short questionnaire when they are
discharged including the question “How likely are
you to recommend our ward to friends and family
if they needed similar care or treatment?” Every
month the results will be reported online and
made available for patients, so they can compare
hospitals and identify the trusts which provide
the highest quality of care. We can also compare
wards within the hospital, as well as the Trust as a
whole. In the first two months, The Royal Marsden
scored 4.9 out of 5 overall, with seven wards
achieving a score of 5/5 mark consistently.
Annual Report and Accounts 2012/13
Our staff
Thanks to the commitment and expertise of our
staff, we have built an international reputation for
delivering the highest quality cancer care. Staff
were rewarded for their hard work and dedication
at the annual Staff Awards Ceremony, held at the
Tower of London in November 2012.
The winners of the 2012 Staff Achievement
Awards were:
Pursuing Excellence
Dawn Smith, Nursery Manager
Ensuring Quality
Individual: Paulina Markovic, Quality Manager
Team: Pathology Quality Leads
Driving Efficiency
Individual: Claudine Sustarich (nee Cleaver),
Service Improvement Manager
Team: Physiotherapy – outpatients,
Sutton and Merton Community Services
Breaking Boundaries
Individual: Emilda Thompson,
Senior Research Nurse
Team: Professor Mitch Dowsett and team,
Academic Biochemistry
Developing Potential
Dr Khin Thway, Consultant Histopathologist
Anything’s Possible
Individual: Tina Shaughnessy,
Senior Staff Nurse, IV Team
Team: PATCH team – specialist palliative care,
Oak Centre for Children and Young People
Working Together
Individual: Lisa Ogden, Specialist Speech
and Language Therapist
Team: Dr Julia Chisholm, Consultant Paediatric
Oncologist, and Amber Conley, Matron, Oak
Centre for Children and Young People
Outstanding Contribution
Individual: Bernadette Knight, Staff Support
Facilitator, Psychological Support
Team: Lung unit research team, research nurses
and clinical trial co-ordinators
Unsung Hero/Heroine
Patricia Stanley, Welfare Rights Advisor
Outstanding Leadership
Caroline Blackburn, Specialist Nurse, Dietetics
11
The Royal Marsden NHS Foundation Trust
Other notable individual achievements
Many Royal Marsden staff are members of
national and international research committees
and academic groups. Several have been
recognised for their contribution to cancer research
and treatment. Key achievements are listed below:
Mr Bill Allum was elected President of the
Association of Upper Gastrointestinal Surgeons
of Great Britain and Ireland (AUGIS) and Chair of
the National Cancer Intelligence Network Upper GI
Clinical Reference Group.
Dr Liz Bancroft was awarded a PhD in Nursing
from the University of Nottingham. Her
thesis concerned the factors affecting interest
and uptake of genetic testing for prostate
cancer susceptibility.
Dr Craig Carr was awarded an MBA with
Distinction by the University of Oxford and
commended by the Dean of the Said Business
School for outstanding academic achievement
within his class. He is now collaborating with
academics from the University of Oxford and the
London Business School to assess the interactions
of health policy, professional culture and
management on operational efficiency and health
economics of care provision.
Professor David Cunningham was awarded
grants from The Peter Stebbings Memorial
Charity, The Robert McAlpine Foundation, The
Friends of the Royal Marsden and The Leukaemia
and Lymphoma Research, as well as from Celgene
Corporation, AstraZeneca and Glaxo SmithKline
to support ongoing novel research in the fields
of gastrointestinal cancer and lymphoma. The
Richard Steevens Scholarship (Irish Health
Service Executive) also awarded funding towards
a clinical research fellow post within Professor
Cunningham’s unit. Presented results from
Professor Cunningham’s research unit have been
awarded the Bradley Stuart Beller Merit Award at
the ASCO annual meeting (Chicago, June 2012)
and a merit award at the ASCO GI symposium
(San Francisco, January 2013).
Professor David Dearnaley received a five year
grant from Cancer Research UK for the PROMPTS
trial (A Prospective Randomised phase III study
of Observation versus screening MRI and Preemptive Treatment in castrate resistant prostate
cancer patients with Spinal metastasis) and
published preliminary safety results from the
CHHiP randomised controlled trial in The Lancet.
He was also re-elected as a National Institute for
Health Research Senior Investigator.
12
Professor Johann de Bono published two phase III
studies in the New England Journal of Medicine,
both involving new drugs in prostate cancer,
enzalutamide and abiraterone. He was also
appointed the overall scientific programme chair
of ESMO (European Society of Medical Oncology)
2014. His Experimental Cancer Medicine Centre
five year grant renewal program was awarded a
double outstanding grade from Cancer Research
UK and the Department of Health.
Professors Nandita deSouza and Martin Leach
and Dr Dow-Mu Koh were awarded a Cancer
Research UK Cancer Imaging Centre grant, joining
only three other centres in the UK (UCL/KCL,
Cambridge/Manchester, Oxford) in this area.
Professor Ros Eeles was elected to a Fellowship
of The Academy of Medical Sciences. Her
research has found genetic variants in breast
cancer predisposition genes which are also
associated with prostate cancer which has led
to an international screening study in over 60
centres. Professor Eeles was also invited to give
a prestigious lecture at The INSERM agency in
Lyon, France.
Dr Louise Fearfield was an invited plenary
speaker at the British Association of Dermatologist
annual meeting on the cutaneous toxicities
associated with the newer targeted therapies in
cancer. She has subsequently published an article
in the British Journal of Dermatology on the
management of Vemurafenib associated toxicities
in patients with metastatic malignant melanoma.
Professor Martin Gore was the invited guest
lecturer at the annual meeting of the British
Association of Dermatologists. He spoke about
new drugs in melanoma treatment.
Mr Gerald Gui delivered the Inaugural Tony
Gabriel Memorial Lecture at the Annual Sessions
of the College of Surgeons of Sri Lanka and
was awarded an Honorary Fellowship for his
contribution to education and breast cancer
services to the people of Sri Lanka.
Dr Robert Huddart had a paper on chemoradiotherapy for patients with bladder cancer
published in the New England Journal of
Medicine and was awarded a grant from Cancer
Research UK for a trial of adaptive radiotherapy
in bladder cancer and salvage chemotherapy in
testicular cancer.
Annual Report and Accounts 2012/13
Professor Stan Kaye was part of the team to win
the American Association for Cancer Research
Team Service Award, awarded to the Institute
of Cancer Research/The Royal Marsden Cancer
Therapeutics Unit and Drug Development Unit
– the first time a non-American team has won
the award – for achievements in drug discovery/
development. The award was presented to
Professor Stan Kaye, Professor Johann de Bono
and Dr Udai Banerji from The Royal Marsden and
Professor Paul Workman and his team from ICR.
Dr Vincent Khoo and his Clinical Research Trials
Team were awarded the INC Research Recognition
Award as the best performance site for clinical
trials from an international field of cancer centres.
Dr Khoo also serves on the Scientific Committees
for the European Cancer Organisation (ECCO)
and European Society for Radiotherapy and
Oncology (ESTRO).
Dr Dow-Mu Koh received the Outstanding
Teacher Award at the International Society
for Magnetic Resonance in Medicine Annual
Meeting in Australia. He also received the Editor’s
Recognition Award for reviewing with Special
Distinction in recognition of outstanding service
as a reviewer of scientific manuscripts submitted
for publication in Radiology, the journal of the
Radiological Society of North America, was
appointed to the Editorial Board of Radiology as
Associate Editor and to the European Society for
Magnetic Resonance in Medicine and Biology
School of MRI Steering Committee.
Dr Donna Lancaster has been elected as a
member of the IBFM Experimental Therapies
Committee for Childhood Leukaemia as well as
the Novel Agents Group for Childhood Cancer and
Leukaemia.
Dr James Larkin has been appointed Chair of the
National Cancer Research Institute Renal Cancer
Clinical Studies Group. The group has a remit
to develop portfolios of trials for renal cancer or
treatment approaches, including overseeing the
portfolio of existing studies and considering new
research questions.
Dr Mary O’Brien was reappointed as chair of
the European Organisation for Research and
Treatment of Cancer lung group for a second term
of three years.
Dr Natalie Pattison was awarded
a Florence Nightingale Research Scholarship for
training in ethnographic research methods. She
was also appointed to the editorial board of
European Journal of Cancer Care.
Professor Andy Pearson was elected President
of Advances of Neuroblastoma Research,
the international forum for discussion and
presentation of clinical and translational biological
research in neuroblastoma.
Dr Sanjay Popat was elected as Chairman of
the British Thoracic Oncology Group (BTOG),
Chairman of the Advanced Diseases Sub-Group
of the National Cancer Research Institute (NCRI)
Lung Cancer Clinical Studies Group, and has been
appointed to sit on the International Rare Cancers
initiative for Thymoma as European Organization
for Research and Treatment of Cancer (EORTC)
representative. He has also been a Clinical Expert
Advisor to NICE.
Professor Nazneen Rahman received funding
from Cancer Research UK to pursue the Clinical
Translation of the breast cancer predisposition
genes that her group have discovered, a Strategic
Award from Wellcome Trust to develop the
Mainstreaming Cancer Genetics Programme
and a prestigious Senior Investigator Award from
Wellcome Trust to support continuing research
into the genetic factors associated with developing
childhood cancer. She has been the lead author on
an article in Nature reporting mutations in a gene
called PPM1D which is linked to an increased risk
of breast and ovarian cancer. She also published
in Nature Genetics reporting the findings from the
largest genome wide association study of Wilms
tumour which identified genetic susceptibility loci
for the tumour.
Dr Sheela Rao was awarded a Clinical Trials
Awards and Advisory Committee grant to
conduct an international multi-centre trial in
advanced anal cancer for which she is the chief
investigator. The study will be coordinated by
The Royal Marsden GI trials unit. Dr Rao has also
been awarded a grant from Glaxo SmithKline to
conduct research in oesophago-gastric cancer
and has been appointed to the national NCRN
anorectal subgroup.
Miss Jennifer Rusby was invited to lecture to
audiences in Aarhus, Denmark and Washington
DC on nipple-sparing mastectomy.
13
The Royal Marsden NHS Foundation Trust
Dr Bhuey Sharma started a novel annual Royal
Marsden anatomical-functional imaging course
for medical/clinical/surgical oncologists and
was invited to submit a paper on 120 years of
multimodality multi-parametric imaging for Nature
Reviews Clinical Oncology.
Dr Isabel White and Dr Theresa Wiseman
received funding from Prostate Cancer UK to
pilot a new community care pathway for men
with prostate cancer. This will compliment
existing funding from Macmillan to develop
supportive services following treatment. They
were also invited, with Amanda Baxter, Ann
Muls and Dr Jervoise Andreyev, to become part
of Prostate Cancer UK ASAP (A Survivorship
Action Partnership).
Dr Robin Wilson was elected President of the
European Society of Breast Cancer Specialists,
acting chair of the Department of Health
Advisory Committee on Breast Cancer Screening
and appointed as a visiting Professor in the
Department of Applied Visual Science at the
University of Loughborough.
Professor John Yarnold was re-appointed Senior
Investigator to the National Institute of Health
Research, and appointed Co-Scientific Chair
of the European Cancer Congress to be held in
Amsterdam in September 2013. He was also
invited to deliver a plenary lecture at the San
Antonio International Breast Symposium, Texas,
in December 2012.
Several Royal Marsden staff members have also
been involved in the London Cancer Alliance:
Dr Julia Chisholm and Louise Soanes
Chairs, children and young people pathway
Natalie Doyle
Joint chair, survivorship pathway
Mr Satvinder Mudan
Chair, hepatobiliary pathway
Miss Nicky Roche
Interim chair, breast pathway group
(October 2011 – January 2013.)
Dr Alex Taylor
Chair, gynaecological cancer pathway
14
New roles within The Royal Marsden
Dr Liz Bishop
Divisional Director, Cancer Services and Research
and Development
Dr Claire Dearden
Head of Haemato-oncology Department
Dr James Larkin
Chair, Committee for Clinical Research
Mr Satvinder Mudan
Divisional Medical Director, Private Care
Professor Chris Nutting and
Professor Kevin Harrington
Joint Heads, ICR Division of Radiotherapy
and Imaging
Dr Mike Potter
Divisional Medical Director, Cancer Services
Jonathan Spencer
Divisional Director, Clinical Services
Dr Naureen Starling
Associate Director of Clinical Research
& Development
Annual Report and Accounts 2012/13
The Royal Marsden
Cancer Charity
The Royal Marsden Cancer Charity raises
money to help The Royal Marsden provide world
class diagnosis, treatment and care for cancer
patients and supports the hospital’s pioneering
work in cancer research. By supporting
The Royal Marsden in this way we aim to make
life better for people with cancer everywhere
and strive for a future without it.
Ten10 – a decade of innovation
CyberKnife, Critical Care Unit, Oak Centre for
Children and Young People, Centre for Molecular
Pathology, the da Vinci S robot – all funded by
The Royal Marsden Cancer Charity over the
last 10 years and all critically important to our
patients. We have raised £100 million over the
last ten years, and in order to carry on with this
groundbreaking work over the next ten years, we
need to raise another £100 million. To support
this, The Royal Marsden Cancer Charity launched
a new campaign in January, ten10 – a decade of
innovation, to run throughout 2013. Our President,
HRH The Duke of Cambridge, helped launch
the campaign, by starring in a specially made
film. The campaign will celebrate a different
project or facility every month and highlight the
impact they have had on cancer treatment both
at The Royal Marsden and across the country.
Visit www.royalmarsden.org/ten10
to find out more.
The Marsden March
Over 4,000 people took part in the third Marsden
March in March 2013, the annual charity walk
between our Chelsea and Sutton hospitals.
Participants included supporters, patients, staff and
celebrities who came together to take on cancer.
Centre for Molecular Pathology
The Centre for Molecular Pathology (CMP) is a
world-class research facility that will revolutionise
how we diagnose and treat cancer. It opened
in November 2012. The centre brings together
clinicians, geneticists, pathologists and scientists
from The Royal Marsden and The Institute of
Cancer Research (ICR). Working side by side,
they will be able to better understand different
tumour types and the most effective way to treat
them, leading to the development of personalised
treatment plans faster than ever before. With the
help of supporters, The Royal Marsden Cancer
Charity contributed £2.3 million towards building
the CMP, which has been developed in partnership
with the ICR.
Charity funds ward refurbishments
Ellis and Horder wards both reopened this year
after renovations funded by The Royal Marsden
Cancer Charity.
Ellis Ward was the beneficiary of a gift from
Jimmy Thomas, whose wife Alma was treated at
The Royal Marsden before her death in 2008. He
said: “My wife’s treatment at The Royal Marsden
was excellent and the staff were superb, but we
both felt the environment of the ward did not match
up to the standard of care. I am thrilled with the
look of the new ward.”
HRH Princess Alexandra officially opened
Horder Ward in September 2012 and met charity
supporters and donors including actor Nathanial
Parker, donor and charity Trustee Catherine
Armitage, donor and member of the Ethics
Committee Dr Michael Harding along with donor
Annie Gallon and supporter Dr Fui Mee Quek.
It was a fantastic event that raised over £1 million.
The Royal Marsden Cancer Charity would like to
thank everyone that helped to make the 2013 event
such a great success. The next Marsden March
will take place on Sunday 16 March 2014.
15
The Royal Marsden NHS Foundation Trust
Quality Account
What is a Quality Account?
All NHS hospitals or trusts have to publish their annual financial accounts. Since 2009 as part of
the movement across the NHS to be open and transparent about the quality of services provided
to the public, all NHS hospitals must publish a Quality Account. The public and patients can also
view quality across NHS organisations by viewing the Quality Accounts on the NHS Choices
website: www.nhs.uk
The dual functions of a Quality Account are to:
1. Summarise performance and improvements against the quality priorities and objectives we
set ourselves for 2012/13
2. Outline the quality priorities and objectives we set ourselves going forward for 2013/14.
Review of 12/13
Quality Information
Look Back
16
Set out priorities
Quality Improvement 13/14
Look Forward
Annual Report and Accounts 2012/13
Firstly, we have detailed how we performed in 2012/13 against the priorities and objectives we set
ourselves under the following categories:
Safe care
Effective care
Patient experience
Where we have not met the priorities and objectives that we set ourselves, we have explained why, and
outlined the plans we have put in place to ensure improvements are made in the future.
Secondly, we have outlined our quality priorities and objectives for 2013/14 under the same categories.
We have detailed how we decided upon the priorities and objectives we have set ourselves, and how we
will achieve and measure our performance. The regulated Statements of Assurance are also included in
this part of the report.
The Quality Account is an important document for the Board, which is accountable for the quality of
the service provided by the Trust and can be used in the scrutiny and leadership of the Trust. Frontline
staff can use the Quality Account compare or benchmark their care with other Trusts or, if comparable
information doesn’t exist, with their own performance over time, to help improve their service.
For patients, carers and the public the Quality Account should be a document that is easy to read and
understand, and highlights key areas of safety and effective care delivered in a caring and empathetic
way. It should also show how a Trust is concentrating on continuously improving its care. As the public
get used to reading the Quality Account it may also help patients with choice. It is important to remember
that some parts of the Quality Account are compulsory and can be difficult to read – they are about
important areas such as the time it has taken to get from an appointment with a GP to first receiving
treatment – generally they are presented as numbers in a table at the end of this Quality Account. If there
are any areas of the Quality Account that are difficult to read or understand or you would like any help
with the content, please contact us via our Patient Advice and Liaison Service (PALS) on 0800 783 7176
or online at www.royalmarsden.nhs.uk
The Quality Account is divided into four sections:
Part 1
A statement on quality from the Chief Executive (CE)
Part 2
Performance against priorities for quality improvement 2012/13 and statements of assurance
Part 3
Outline of quality priorities 2013/14 and an explanation of who the Trust has involved in
determining the priorities including statements from key stakeholders such as Healthwatch
(replacing Local Involvement Networks), Health and Wellbeing Boards and the Commissioners
of Services. It is important to note that with the new architecture of the NHS The Royal Marsden
will work more closely in 2013/14 with the two Clinical Commissioning Groups in Sutton
and Merton to ensure that going forward the Quality Account reflects their needs
Part 4
Review of quality performance
17
The Royal Marsden NHS Foundation Trust
Part one
Introduction to The Royal Marsden
NHS Foundation Trust and a statement
on quality by the Chief Executive
The quality of patient and family care is at the
centre of everything we do at The Royal Marsden.
The Royal Marsden NHS Foundation Trust is the
largest comprehensive cancer centre in Europe
and together with its academic partner the
Institute of Cancer Research (ICR) is responsible
for the largest research programme in cancer
in the UK.
This year has been another excellent year for
the Trust as we have continued to achieve high
ratings from our two major regulators, Monitor
and the Care Quality Commission (CQC). This
commitment to meet the challenges of delivering
quality whilst delivering efficiency cost savings
of around seven per cent a year underpins our
corporate objectives for 2012/13:
1. Improve patient safety and clinical effectiveness
2. Improve patient experience
3. Deliver excellence in teaching and research
4. Ensure financial and environmental
sustainability.
Our commitment to quality improvement is
evidenced by the following achievements in
April 2012 – March 2013:
National Patient Safety Agency Annual Patient
Environment Action Team (PEAT) Assessment
The PEAT inspection rated the Trust as “excellent”
overall. The inspection, which was performed at
both sites and included external inspectors and
patients, looked at the following areas: cleanliness
of the patient environment (wards, rooms, waiting
and reception areas), infection prevention and
control, safety and security, hospital food, and the
privacy and dignity afforded to patients.
The annual staff survey
A growing body of evidence has shown a clear
correlation between a satisfied workforce and high
quality patient care. The national staff survey
identifies the extent to which staff feel motivated
and engaged with their work and willingness
of staff to recommend the Trust as a place of
work/and for patients to receive treatment. How
members of staff rate the care that their employer
organisation provides can be a meaningful
indicator of the quality of care and a helpful
measure of improvement over time. The Trust
has traditionally performed very well with this
measure. The 2012/13 staff survey results showed
that 87% (421/488) of our staff who responded to
the NHS survey agreed or strongly agreed that if a
friend or relative needed treatment, they would be
happy with the standard of care provided by the
Trust. This is an increase on 2011/12, when survey
results were 84% (408/485). The national average
for this measure is 63%.
Customer Service Excellence Standard
The Customer Service Excellence (CSE)
standard replaced the Charter Mark in 2008
and is a standard achieved by public services
that are “efficient, effective, excellent, equitable
and empowering – with the citizen always
and everywhere at the heart of public services
provision” (CSE 2008).
The CSE tests, in-depth, those areas that research
has indicated are a priority for customers,
with particular focus on delivery, timeliness,
information, professionalism and staff attitude.
Emphasis is also placed on developing customer
insight, understanding the user’s experience and
robust (reliable) measures of service satisfaction.
18
Annual Report and Accounts 2012/13
The Royal Marsden was the first hospital to
be awarded the Customer Service Excellence
standard, in 2008. To maintain the award the
Trust needs to be assessed regularly and received
its last assessment on 14 December 2012. The
Trust was found to be compliant and therefore
retained the award.
Same-sex accommodation
Since April 2011 we have been able to declare
compliance and have met all the standards set by
the Government to provide accommodation for
patients that is not shared with the opposite sex.
A modern healthcare environment
Finally, 2012 has seen the completion of
several phases of a substantial capital building
programme which is ensuring that patients
and their families experience care in the most
appropriate, modern and technically sophisticated
environment.
In autumn 2012 the Centre for Molecular Pathology
opened at Sutton. This is the first centre for
molecular biology dedicated to cancer in the NHS.
This is a very exciting development as it will
bring together scientists and doctors in the same
environment, working together to develop new
medicines and treatments that will be targeted to
the unique genetic codes of each individual. These
new targeted medicines and treatments will ensure
that cancer patients all over the world benefit more
rapidly from accurate cancer treatments.
This is the fourth year that we have published
a Quality Account and we are very grateful for
the feedback we received on last year’s Quality
Account from patients, carers, the public through
Healthwatch (from 1 April 2013 Healthwatch
replaced the Local Involvement Networks), Health
and Wellbeing Boards and our commissioners
and governors. As you will see from this Quality
Account, 2012/13 has been another busy year
for The Royal Marsden NHS Foundation Trust.
The Trust has continued to improve its services
for patients and families, achieving key targets
despite the economic challenges to the NHS. We
are also committed to doing everything we can
to improve the environment and care further in
2013/14. I would like to thank all patients, carers,
staff, LINks, HWB, governors and commissioners
who have contributed to this Quality Account
for 2012/13.
I can confirm on behalf of the Board of
The Royal Marsden NHS Foundation Trust that
to the best of my knowledge, the information
presented in this Quality Account is accurate and
fairly represents the range of services we provide.
Cally Palmer CBE
Chief Executive
19 June 2013
Integrated Care
During 2012/13 the Trust has been very involved
in the leadership and shaping of one of the two
new integrated cancer systems across London:
The London Cancer Alliance (LCA). The aim of
the LCA is to improve cancer outcomes, safety of
care and the experience of care across two thirds
of London (4.8 million people). The Royal Marsden
has led and hosted the LCA this year.
This is also the second year of our integration
with Sutton and Merton Community Services.
Work continues on improving patient pathways,
ensuring that people with long term conditions
have improvements in their care and an improved
patient experience. We have also focused on
ensuring that our partnerships with the multiagency safeguarding hubs in both Sutton and
Merton are robust and effective in ensuring
that children are afforded the best joined up
care between health, social care and many
other agencies.
19
The Royal Marsden NHS Foundation Trust
Part two
Performance against priorities for quality improvement 2012/13 and statements for assurance
Introduction
The table below summarises the specific priorities and targets we set ourselves for Safe care, Effective
care and Patient experience for 2012/13 in the hospital.
Safe care
Priority 1
Priority 2
Priority 3
*Reduction in Healthcare
Associated Infections
(MRSA bacteraemia and
Clostridium difficile infections)
*Rate of patient safety incidents
and percentage resulting in
severe harm or death (in
2011/12 the number of deaths
from serious incidents per 100
admissions was 0.013; the
number of severe harms from
incidents per 100 admissions
was 0.021)
*Percentage of admitted
patients risk assessed for
Venous thromboembolism
Less than one
MRSA bacteraemia
Reduction in the rate of patient
safety incidents per 100
admissions and the proportion
that have resulted in severe
harm or death
95% of patients to have a
completed VTE risk assessment
Less than 16
C. difficile infections
(Report in Quality Account the
number of C. difficile infections
per 100,000 bed days)
Effective care
Priority 4
Priority 5
Priority 6
Priority 7
Reduction in
community acquired
grade 3 and 4
pressure ulcers
Increase the number
of patients that die
in their preferred
place of death (The
National Primary Care
Snapshot Audit in End
of Life Care (2009)
found that the number
of patients achieving
their preferred place of
death is 42%)
Increase the numbers
of patients who
have been offered
an Holistic Needs
Assessment
*Avoidance
of emergency
re-admissions to
hospital within
28 days of discharge
Reduce the incidence
of severe community
acquired pressure
ulcers (grade 3 and 4)
Achieve more than
42% of patients dying
in their preferred place
of death
Increase in the
proportion of
designated patients
who will be offered
a Holistic Needs
Assessment by the end
of 2012/13
Reduction in the
number of avoidable
re-admissions to
hospital within
28 days of discharge
20
Annual Report and Accounts 2012/13
Patient experience
Priority 8
Priority 9
Priority 10
Reduction in chemotherapy
waiting times and improvement
in patient experience related to
waiting times
*Ensure that we are responding
to in-patients’ personal needs
*Percentage of staff who would
recommend The Royal Marsden
to friends or family needing care
Reduction in chemotherapy
waiting times at Sutton and
Chelsea and improvement in
the patient experience related
to waiting times
Improvement in responses to
five questions (from the CQC
national survey) as monitored
through the Inpatient Frequent
Feedback Surveys
To maintain or increase the
staff survey result to this
specific question in the survey
Safe care for children
Priority 11
Percentage of babies who receive the new birth visit up to day 14
90% to be achieved
* mandatory priority
21
The Royal Marsden NHS Foundation Trust
Priority 1
Reduce the incidence of Healthcare Associated Infections (HCAIs)
Target
To reduce the number of Clostridium difficile Infections (CDI) to 16 in 2012/13 or less and maintain
a very low incidence of Meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia.
Patients with cancer are more vulnerable to infection and if an infection is sustained, they are more
likely to develop serious complications from it. We therefore see reducing the incidence of HCAIs as an
essential safety and quality priority. This priority was selected in 2009/10 and remained an important
priority in 2012/13.
What did we do in 2012/13?
–– We have maintained a high proportion of single rooms, making it easier to isolate infected patients
earlier. Almost half the patient accommodation on each site is in single rooms
–– Weekly audits against the criteria of the Care Quality Commission Hygiene Code continue across
almost all clinical areas of the Trust, including diagnostic and outpatient areas. These are carried out
by Sisters/Charge Nurses, Clinical Nurse Specialists, senior Allied Health Professionals and Matrons.
These visits serve multiple purposes, allowing senior professionals to view good practice that they can
take back to their own areas as well as providing an independent check on cleanliness, practice and
staff knowledge
–– Synbiotix (live web-based database) is available for all staff to view via the Trust intranet, showing the
results of Hygiene Code visits, hand hygiene and other audits, and daily checks and clinical indicators.
Performance is closely monitored and highlighted by regular emails from the Infection Prevention and
Control Team. Synbiotix also shows the results of equivalent audits of community services
–– Hydrogen peroxide vapour (HPV) decontamination of patient rooms where the occupant has had an
infection that may pose a risk to the next person to use the room is available across both hospitals.
Priority is given to rooms that have been occupied by patients with symptomatic Clostridium difficile
infection because this is the most effective way to destroy Clostridium difficile spores and minimise
the risk to other patients
–– Infection prevention and control is included in the induction programme and there is update training,
which is mandatory for all new and existing staff
–– Each ward and unit has clinical link nurses for infection prevention and control acting as clinical
champions and the Infection Prevention and Control Team hold monthly meetings for all ‘link’ staff. These
meetings include an educational session and allow staff to discuss infection prevention and control issues
–– The Royal Marsden Infection Prevention and Control Team hosted a national study day in July 2012 on
combating HCAIs, including sessions on antimicrobial resistance, water safety and the importance of
the environment in infection prevention. Almost 100 delegates from across the South East attended and
feedback on the event was very positive
–– All Trust Infection Prevention and Control policies are reviewed annually
–– Mattress audit and evaluation has been undertaken and any faulty mattresses replaced to assist in
the prevention of infection
–– Disinfectant and sporicidal wipes have been standardised across the Trust for cleaning equipment,
especially commodes
–– Advance weekly notification is provided to all wards before admission of patients previously identified
as infected or colonised with MRSA or another organism of concern, and of patients with no recorded
MRSA screen within the previous month. Outpatient departments and medical day units are notified
of patients with appointments who have previously been identified with MRSA, Clostridium difficile or
respiratory infections and provided with recommendations for management
22
Annual Report and Accounts 2012/13
–– Air testing and review of water test results where required during commissioning of new builds
–– Filtration of the air supply and careful monitoring (and filtration where necessary) of the water supply
to the wards where severely immuno-compromised bone marrow transplant patients are cared for.
How did we perform in 2012/13?
Table 1 below shows the numbers of two important health care associated infections (HCAIs): meticillin
resistant Staphylococcus aureus bacteraemia (MRSAb) and Clostridium difficile (CDI) over recent
years. These infections are monitored nationally through the Health Protection Agency (HPA) with all
hospitals submitting their information to the HPA website monthly. On 1 April 2013 HPA became Public
Health England.
Table 1: Number of cases of infections that are attributable to The Royal Marsden
Infection
Number
attributable
2009/10
Number
attributable
2010/11
Number
attributable
2011/12
Number
attributable
2012/13
Royal
Marsden
annual
objective
2012/13
MRSA
bacteraemia
1
2
1
0
≤1
C. difficile
39
34
18
15
≤16
The graph below shows the number of Clostridium difficile infections from April 2012 to March 2013.
Trust objective
Trust cumulative total
Sutton cumulative total
Trust month total
Chelsea cumulative total
18
16
14
12
10
8
6
4
3
2
0
April
2012
May
2012
June
2012
July
2012
Aug
2012
Sept
2012
Oct
2012
Nov
2012
Dec
2012
Jan
2013
Feb
2013
March
2013
23
The Royal Marsden NHS Foundation Trust
We have worked exceptionally hard to achieve the set objective of less than 16 cases of Clostridium
difficile infection in 2012/13, and had no cases of MRSA bacteraemia throughout the year; the target for
MRSA bacteraemia was less than or equal to one case, which was a very challenging target to achieve.
The Trust continues to commit to reducing the incidence of HCAIs still further in 2013/14.
What actions are we planning to improve our performance?
For Clostridium difficile we aim to reduce our target from 16 to 11 for 2013/14 and reduce the number
of infections by antibiotic resistant organisms, including MRSA but particularly multi-resistant gram
negative organisms.
We will aim to achieve the following:
1. Ensure that infection prevention is taken into account in all refurbishments, new builds, service
developments and other capital projects across the Trust
2. Consolidate and expand the programme of inspections and audits, including Hygiene Code
inspections; hand hygiene, Saving Lives and Essential Steps audits; local daily checks and clinical
indicators across the Trust, including Sutton and Merton Community Services
3. Facilitate access to the Synbiotix system and database for all staff across the Trust, including
Sutton and Merton Community Services, for the recording and transparent display of all the above
performance indicators
4. Review the arrangements for the deployment and operation of the hydrogen peroxide vapour (HPV)
environmental decontamination equipment to ensure that it is used as effectively as possible and
that priority is given to those areas where it will be most beneficial, particularly rooms that have been
occupied by symptomatic patients with Clostridium difficile infection
5. Review teaching for all clinical staff (doctors, nurses and rehabilitation therapists) on the importance
of optimal infection prevention and control practices to ensure that it is fit for purpose, provides staff
with the information, knowledge and skills necessary to minimise the risk of infection and meets the
requirements of the Hygiene Code
6. Host a third study day in 2013 at The Royal Marsden on combating HCAIs, with the particular
emphasis on the growing threat of multi-drug resistant gram negative organisms
7. Provide a proactive and responsive infection prevention service to all areas of the Trust, with
particular emphasis on increasing awareness of the service in community staff
8. Review the costs and benefits of pre-surgical decolonisation for all patients to reduce the risk of post
operative wound infection with a view to introducing universal preoperative decolonisation
9. Undertake a detailed retrospective analysis of the antibiotic profiles on those patients who acquired
Clostridium difficile in hospital to see if there are ways in which we need to revise our antibiotic usage.
How will improvement be measured and monitored?
Improvements will be monitored by the monthly Infection Prevention and Control Team meeting. This
is a multidisciplinary meeting chaired by the Chief Nurse, who is the Director of Infection Prevention
and Control for the Trust. Bacteraemia caused by both meticillin-resistant and meticillin-sensitive
Staphylococcus aureus (MRSA and MSSA), vancomycin-resistant enterococci (VRE) and Escherichia coli
will be reported externally to the new Public Health England, as will all confirmed Clostridium difficile
infections. Numbers of selected infections will be monitored internally to the Board in the Trust Board
Scorecard and published in the quarterly Integrated Governance Reports. Reduction in HCAIs remains
a priority for 2013/14 to prevent further harm to patients.
24
Annual Report and Accounts 2012/13
Priority 2
To reduce the rate of patient safety incidents that have resulted in severe harm or death
Target
Reduction in the rate of patient safety incidents per 100 admissions and the proportion that have
resulted in severe harm or death.
In 2011/12 the number of deaths from serious incidents per 100 admissions was 0.013; the number
of severe harms from incidents was 0.021.
What did we do in 2012/13?
–– We strengthened the use of the World Health Organisation (WHO) Surgical Safety Checklist
to promote the safety of patients in the pre, peri and post operative period
–– We invested in new digital assisted defibrillators throughout the Trust to be used in the event
of cardiac arrest
–– We strengthened the use of the national venous thromboembolism prevention and treatment
algorithims across the Trust
–– We continued to work on preventing medication errors and falls.
How did we perform in 2012/13?
Patient safety incidents resulting in severe harm or death
This year is the first time that this indicator has been required to be included within the Quality Report
alongside comparative data provided, where possible, from the Health and Social Care Information Centre.
The National Reporting and Learning Service (NRLS) was established in 2003. The system enables patient
safety incident reports to be submitted to a national database on a voluntary basis designed to promote
learning. It is mandatory for NHS trusts in England to report all serious patient safety incidents to the Care
Quality Commission as part of the Care Quality Commission registration process.
The Trust reports all patient safety incidents reported on Datix to the NRLS. Prior to NRLS producing their
six monthly reports, the Trust re-submits all patient safety incidents which captures changes made as a
result of investigations. The NRLS does not update its previously reported figures so these changes may not
be reported by the NRLS and the data held by the Trust may not be the same as that reported by the NRLS.
Rate of reported patient safety incidents (Severe harm or Death), per 100 admissions – 0.008
Number of patient safety incidents (Severe harm or Death) – 4
Total patient safety incidents – 2978
Patient safety incidents (Severe harm or Death) as % of all patient safety incidents – 0.13%
What actions are we planning to improve our performance?
–– To increase the use of the Team Simulation for Emergency situations to other clinical teams
–– Introduce the use of the new National Early Warning System which will be audited throughout 2013/14
–– Investigate the use of VitalPac systems to ensure clinical teams intervene early when patients deteriorate.
How will improvements be measured and monitored?
–– Through the specialist Morbidity and Mortality meetings
–– Clinical Audit
–– National mandatory audits
–– Utstein cardiac arrest audit.
25
The Royal Marsden NHS Foundation Trust
Priority 3
Reduction in venous thromboembolism (VTE) events/clot formation
Target
All appropriate patients will have venous thromboembolism (VTE) assessment within 24 hours of
admission and receive prophylaxis; to undertake a root cause analysis on all confirmed VTE.
VTE is a collective term for deep venous thrombosis and pulmonary embolism. A deep vein thrombosis
is a blood clot that forms in a deep vein (usually in the leg) and sometimes a clot breaks off and travels
to the arteries of the lung where it will cause a pulmonary embolism. VTE can be avoided by giving
preventative treatment (prophylaxis) to patients at risk. Patients with cancer are at greater risk of
developing VTE therefore this continues to be a safety priority for us.
What did we do in 2012/13?
The multidisciplinary VTE Steering Board is now well established and VTE risk assessment for all
appropriate patients is embedded into clinical practice in the hospital. All elective inpatients are sent
information leaflets in advance of their admission to inform them of what they can do to help prevent
clot formation. Furthermore, posters and patient information leaflets are available in the clinical areas
or from Patient Advice and Liaison Service (PALS).
More specifically the steering group has directed the following actions:
–– Ensure that every confirmed diagnosis of a VTE undergoes a root cause analysis to determine the
underlying cause of the VTE and if any other preventative action could be taken. The consultant in
charge of the patient is contacted if there are any concerns about care
–– Performance manage the compliance with risk assessment; detailed performance reports are sent
out to appropriate staff daily. Appropriate prophylaxis prescriptions are monitored monthly
–– Implementation of the new prescription drug chart which incorporates VTE risk assessment and
24 hour reassessment. The drug chart also contains information on prescribing for the junior doctors
–– The day units are developing alert cards for patients and providing stockings for patients who may
have a reduction in energy levels. The alert cards instruct patients to apply the stockings if their
activity levels reduce when on their chemotherapy
–– Updating of the VTE Patient Information booklet in line with NICE guidance published in June 2012.
26
Annual Report and Accounts 2012/13
How did we perform in 2012/13?
We have achieved the NHS Commissioning for Quality and Innovation (CQUIN) target of 95%
compliance for ensuring all of our patients are appropriately assessed for risk of VTE in 2012/13.
Furthermore we have reached the 95% level of appropriate prophylaxis being prescribed to prevent VTE.
VTE
Q1
Q2
Q3
Q4
Quarter target
95%
95%
95%
95%
Prophylaxis prescribed
96%
96%
96%
96%
The graph below demonstrates the percentage of patients who had a risk assessment completed.
VTE risk assessment compliance April 2011 to March 2013
Level of assessment achieved
Trust target
95
90
85
March 2013
Feb 2013
Jan 2013
Dec 2012
Nov 2012
Oct 2012
Sept 2012
Aug 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sept 2011
Aug 2011
July 2011
June 2011
May 2011
80
April 2011
Percentage of patients assessed
100
27
The Royal Marsden NHS Foundation Trust
What actions are we planning to improve our performance?
–– Regular audit of a new prescription drug chart, checking documentation of patient weights and
feeding back to Ward Sisters, Matrons and Pharmacy
–– Daily score cards will be sent to VTE leads to check on progress
–– Monthly compliance checking of appropriate mechanical prophylaxis
–– Weekly compliance checking VTE reassessment within 24 hours
–– All hospital acquired thrombosis will be reviewed by consultants who will check for recurring themes
–– Emphasis will be placed on weight appropriate prescribing to ensure we are compliant with the
CQUIN targets
–– Two random cases of hospital acquired thrombosis will be audited monthly, checking for appropriate
treatment dose
–– Monthly VTE Steering Group meetings have been scheduled
–– VTE reporting will take place regularly to the Junior Doctors Forum
–– VTE presentation at each Junior Doctors Induction
–– Ongoing audit of patient information and support received in the Outpatient departments
–– Developing alert cards and anti-thrombolic stockings for patients in day care.
How will improvement be measured and monitored?
VTE incidents and performance with assessment and prevention procedures will be monitored by the
VTE Steering Board. Performance will also be monitored at the Key Performance/CQUIN Steering
Board and through the monthly Board scorecard. The Trust has achieved its targets, however this will
continue to be included as a priority for 2013/14 because “Quality Accounts: reporting arrangements for
2012/13” (DoH, January 2013) and the “NHS Outcomes Framework 2012/13” suggest this remains an
important indicator of improvement in protecting patients from avoidable harm. In 2013/14 the actions
described above will be ongoing and embedded into practice. This will be demonstrated by ongoing
monitoring and audit of compliance.
28
Annual Report and Accounts 2012/13
Priority 4
Reduction of pressure ulcers
Target
To reduce the incidence of severe community acquired category 3 and 4 avoidable pressure ulcers.
Pressure ulcers are a good indicator of quality of care; their prevention requires assessment and good
skin care and adequate hydration and nutrition. Some patients with long term conditions are at high
risk of developing pressure ulcers because they have fragile skin, can have reduced nutrition and some
medications can increase the risk. A rising incidence of pressure ulcers across many patients can be
an early indication of deteriorating standards and therefore must be monitored closely. During 2012/13
guidance was made available from NHS London on pressure ulcers in relation to being avoidable or
unavoidable and all factors must be taken into account when deciphering the cause of the pressure ulcer.
What did we do in 2012/13?
Since 2011 all serious pressure ulcers (category 3 and 4) have been reported as serious incidents
nationally. All pressure ulcers in the hospital and the community are reported on Datix our online
incident reporting system and all serious pressure ulcers are investigated using root cause analysis.
Monthly category 3 and 4 pressure ulcer incident panel meetings are chaired by the Assistant Chief
Nurse (Operations). These are multidisciplinary team meetings with representation from both community
and hospital teams. These meetings have created great learning opportunities and a venue for sharing
best practice. There is also a pressure ulcer working group, chaired by the Clinical Nurse Director for
Adult Community Services which is tasked to take forward the recommendations of the incident panel
meetings and this is overseen by the Pressure Ulcer Strategy Group chaired by the Assistant Chief
Nurse (Operations).
More specifically the pressure ulcer group has directed the following actions:
–– Updating the pressure ulcer risk assessment and prevention policy to include hospital and
community settings
–– Mapped the pressure ulcer pathway
–– Introducing systems to ensure holistic assessment of patients occurs at the outset of care and
that good practice is shared amongst all
–– Developed patient and carer information leaflets on pressure ulcer prevention and care
–– Completed a knowledge and skills gap analysis and developed appropriate learning and
development days
–– Ensuring that pressure ulcer prevention and management is part of mandatory training
–– Ensuring that all staff are familiar with appropriate documentation for assessing and monitoring
pressure areas as well as treating pressure ulcers.
From October 2010, all category 3 and 4 pressure ulcers have been classified as a Serious Incident (SI)
and have been reported to the Clinical Quality and Review Group and the Integrated Governance and
Risk Management committee. This process has been hugely beneficial within community services so
that we can easily establish the root cause to why a pressure ulcer developed and determine whether
the pressure ulcer was avoidable or unavoidable.
Investigation panels attended by representatives from the relevant district nurse teams have been held
for each of these incidents to give clinical oversight and to ensure that sufficient organisational learning
takes place.
29
The Royal Marsden NHS Foundation Trust
How did we perform in 2012/13?
There are a larger number of pressure ulcers in the community. Pressure damage in the community
is more challenging to prevent because the environment is much harder to control: many people are
looked after in the community by formal and informal carers that the Trust has no responsibility for,
many patients are frail/elderly and the home environment is less easy to control. The Trust is however
committed to reducing pressure ulcers in the community setting. The table below shows the number
of community acquired category 3 and 4 pressure ulcers.
2012/13
Number of community acquired pressure ulcers
Category 3
39
Category 4
7
The chart below outlines the number of pressure ulcers (category 3-4) that were acquired within the
community setting during the period April 2011 to March 2013.
Community acquired category 3 and 4 pressure ulcers April 2011 to March 2013
Category 3
Category 4
8
7
Number of pressure ulcers
6
5
4
3
2
1
30
March 2013
Feb 2013
Jan 2013
Dec 2012
Nov 2012
Oct 2012
Sept 2012
Aug 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sept 2011
Aug 2011
July 2011
June 2011
May 2011
April 2011
0
Annual Report and Accounts 2012/13
What actions are we planning to improve our performance?
A large programme of work has been commenced by community services to address pressure ulcer
prevention strategies. All category 3 and 4 incidents are investigated and presented at a panel to identify
root causes and to learn from incidents to improve care for patients. From this the following pieces of
work have started:
–– Training programmes for internal staff are now mandatory on pressure ulcer prevention and
management. A skills gap workshop for registered nurses has been undertaken to identify areas
where we need to invest more training
–– Training and education for local authority staff (formal carers) has been set up and delivered
–– A programme has been delivered to care homes as part of a CQUIN target for staff on pressure ulcer
prevention, nutrition, continence, falls and diabetes. The training was well evaluated
–– Re-design and re-launch of leaflets for patients and both paid and unpaid carers on skin care and
prevention strategies. These are routinely given to patients on admission to the service
–– Work commenced on joint care planning with local authority staff that provide care to patients known
to the District Nursing teams
–– Investment in workforce to assist Tissue Viability Nurses to support District Nursing teams in pressure
ulcer prevention and management strategies including the development of registers of patients at risk
of pressure ulcer development
–– A CQUIN this year has also focussed on pressure ulcer prevention and management with investment
for an extra Tissue Viability Nurse to support the project
–– Developing care plans and pathways
–– Equipment update training days have taken place and continue
–– The Pressure Ulcer Prevention and Management policy has been reviewed and updated to reflect
any changes in documentation and processes
–– Audits of pressure ulcer returns to enforce prevention strategies
–– Developing and rolling out checklist to ensure all assessments completed in a timely manner
–– To review wound photography guidelines to ensure they are fit for purpose
–– Adults at risk policy revised to incorporate pressure ulcer management
–– Shared learning for teams
–– The pressure ulcer panel continues monthly and clarity gained on whether the pressure ulcer
was avoidable or unavoidable.
How will improvement be measured and monitored?
Pressure ulcers will continue to be monitored by the Pressure Ulcer Working Group which is chaired by
the Clinical Nurse Director for Adult Community Services, with serious pressure ulcers being reported
in the monthly Quality Account presented to the Board. All category 3 and 4 pressure ulcers will be
overseen by the Trust Integrated Governance and Risk Management Committee. Reducing pressure
ulcers in the community setting will remain a quality priority for 2013/14; hospital acquired pressure
ulcers will continue to be tracked as described but will not form part of the 2013/14 quality account.
The actions described above will continue through 2013/14 to ensure we reduce the number of avoidable
community acquired pressure ulcers.
31
The Royal Marsden NHS Foundation Trust
Priority 5
To increase the proportion of patients that die in their preferred place of death.
Target
To achieve more than 42% of patients dying in their preferred place of death.
To increase the numbers of patients dying in their preferred place of death where previously indicated
and recorded on Coordinate my Care (CMC) to over 42% as reported in The National Primary Care
Snapshot Audit in End of Life Care (2009). Coordinate my Care is a communication clinical service that
coordinates of end of life care for patients who receive multiple services and care from multiple providers,
allowing patients to have choice and improved quality of end of life care. There is a central database in
London that is hosted by The Royal Marsden.
What did we do in 2012/13?
–– 17/26 (65.4%) patients known to The Royal Marsden who were entered onto Coordinate my Care
by staff of The Royal Marsden NHS Foundation Trust achieved their preferred place of death
–– 20/26 (76.9%) patients known to The Royal Marsden who were entered onto Coordinate my Care
by staff of The Royal Marsden achieved their preferred place of death or died at home.
How did we perform in 2012/13?
–– Of the nine patients who didn’t achieve their documented preferred place of death:
–– three died at home
–– three died in a hospice
–– two died in hospital, one due to no bed being available in the hospice
–– one had stated ‘other’ as ‘preferred place of death’ with no further documentation to identify
where that might be.
32
Annual Report and Accounts 2012/13
What actions are we planning to improve our performance?
–– Education
–– Palliative care teaching on biannual Royal Marsden hosted south west/north west Core Medical
Training regional teaching to include emphasis on end of life care planning
–– Palliative care in-house study days to include advance care planning
–– Nursing education on identifying progression of the dying phase
–– Close working between palliative care and oncology teams
–– Involvement of Hospital2Home team when patients are being officially discharged from hospital with
no further follow up appointments scheduled
–– Use of the weekly Palliative Care multidisciplinary team meeting to ensure that preferred place of care
and death is being addressed for patients known to the Palliative Care Team
–– Roll out of Coordinate my Care across London with associated education programme which will:
–– Highlight the importance of addressing preferences for end of life care
–– Improve documentation between different healthcare providers to ensure smooth transfer of accurate,
up to date information on end of life care preferences.
How will improvement be measured and monitored?
–– Weekly review of outcomes for preferred place of care and death for patients referred to the
Hospital2Home service
–– Weekly reporting on ‘preferred place of death’ from the Coordinate my Care team. This information
is then disseminated to lead clinician and lead end of life commissioner within each Clinical
Commissioning Group.
33
The Royal Marsden NHS Foundation Trust
Priority 6
To increase the number of patients who are offered an Holistic Needs Assessment
Target
To achieve an increase in the number of designated patients who will undergo Holistic Needs
Assessment by the end of 2012/13.
A holistic needs assessment (HNA) is a process of gathering information from the patient and/or carer
in order to inform discussion and develop a deeper understanding of what the person living with and
beyond cancer knows, understands and needs.
A Holistic Needs Assessment is not a one-off exercise, but is the basis of assessment and care planning
from diagnosis onwards.
What did we do in 2012/13?
–– The Nurse Consultant for Living With and Beyond Cancer undertook a service evaluation to identify
the number of Clinical Nurse Specialists offering Holistic Needs Assessments to patients, and to
identify a consistent framework for Holistic Needs Assessment
–– In July 2012 the London Cancer Alliance Interim Clinical Board agreed that a Holistic Needs
Assessment must be offered within two weeks of a cancer diagnosis and offered again when primary
treatment has been completed, whether the treatment is surgery, radiotherapy or chemotherapy
–– The Trust has been accepted as a Macmillan e-HNA pilot site and work is underway for this bringing
the Holistic Needs Assessment to patients via electronic tablets
–– A policy around the purpose and usage of Holistic Needs Assessment is in development.
How did we perform in 2012/13?
–– By the end of the first quarter Clinical Nurse Specialists offered 249 patients the Holistic Needs
Assessment form to complete and 112 (45%) were returned
–– Within the second quarter Clinical Nurse Specialists offered 275 patients the Holistic Needs
Assessment form to complete and 103 (38%) were returned
–– Within the third quarter Clinical Nurse Specialists offered 231 patients the Holistic Needs
Assessment form to complete and 30 (13%) were returned
–– Within the fourth quarter Clinical Nurse Specialists offered 280 patients the Holistic Needs
Assessment form to complete and 113 (40%) were returned
–– Throughout the year 1035 holistic assessment needs forms were offered to patients and 358 (35%)
were returned.
34
Annual Report and Accounts 2012/13
The table below shows which units and how many patients were offered a Holistic Needs Assessment to
complete and how many chose to return the form.
Unit
HNA offered
HNA returned
Breast
322
86
Gastrointestinal
69
58
Gynaecology
26
13
Head and Neck
50
11
Lymphoma
28
3
Late Effects
407
174
Lung
86
3
Melanoma
21
1
Palliative Care
14*
3
Urology
9
6
Total 2012/13
1035
358 (35%)
* it was agreed that palliative care would not give out anymore forms as patients should be offered a Holistic Needs Assessment at the time
of diagnosis and at the end of primary treatment.
What actions are we planning to improve our performance?
–– Continue to encourage the use of the Holistic Needs Assessment across all clinical teams
–– Agreeing Holistic Needs Assessment (HNA) service plans with clinical teams and supporting
their implementation
–– Encouraging the use of approved HNA and care planning templates using the intranet
–– Providing training and support for staff in implementing HNAs
–– Present Trust wide HNA results to all MDTs
–– Improve the response rate for completion of HNA forms.
How will improvement be measured and monitored?
–– Assisting with gathering data to meet the London Cancer Alliance metric
–– Within The Royal Marsden each clinical team or service will be asked to collect their own data, either
by individual Clinical Nurse Specialist or by team. To be agreed by Divisional Clinical Nurse Directors
with input from the Nurse Consultant for Living With and Beyond Cancer
–– The numbers of completed Holistic Needs Assessments per clinical team will be monitored by the
performance team monthly
–– Overall completion rates will be presented by clinical speciality in the Quality Account quarterly.
35
The Royal Marsden NHS Foundation Trust
Priority 7
Avoidance of emergency readmissions to hospital within 28 days of discharge
Target
To achieve a reduction in the number of avoidable readmissions to hospital within 28 days
of discharge.
What did we do in 2012/13?
Together with the South West London Acute Commissioning Unit we undertook an external audit
of all readmissions over a 12 month period.
The results were presented at the Clinical Quality Review Group (CQRG)
How did we perform in 2012/13?
The chart below shows the percentage of patients that were readmitted within 28 days from April 2012
to March 2013.
Reported percentage of emergency readmissions
Percentage of eligible admissions resulting in an eligible readmission
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
April
2012
36
May
2012
June
2012
July
2012
Aug
2012
Sept
2012
Oct
2012
Nov
2012
Dec
2012
Jan
2013
Feb
2013
March
2013
Annual Report and Accounts 2012/13
The table below shows the number of patients that were readmitted within 28 days from April 2012
to March 2013.
Month
Number of patients readmitted within 28 days
April 2012
11
May 2012
10
June 2012
14
July 2012
22
August 2012
14
September 2012
13
October 2012
13
November 2012
11
December 2012
8
January 2013
9
February 2013
11
March 2013
9
What actions are we planning to improve our performance?
–– Continuous review and evaluation of clinical care especially using the Enhanced Recovery
Programme (ERP)
–– Monthly prospective audit to monitor rates.
37
The Royal Marsden NHS Foundation Trust
Priority 8
Reduction in chemotherapy waiting times and improvement in patient experience related to
waiting times
Target
Reduction in chemotherapy waiting times at Sutton and Chelsea and improvement in the patient
experience related to waiting times.
What did we do in 2012/13?
Reduction of chemotherapy waiting times
The management of chemotherapy waiting times is a particular challenge for the organisation because
of the complexity of checking it is safe to proceed to chemotherapy. Chemotherapy needs to be prepared
in an aseptic unit (where staff are gowned and gloved to prepare chemotherapy). Furthermore several
checking procedures have to be undertaken. In addition, the data below also include patients who are
on clinical trials. Some chemotherapy research studies need up to four hours preparation time once goahead for treatment has been confirmed.
The Trust is working hard at reducing the chemotherapy waiting times and improving the patient
experience by the following:
–– Introduction of a new appointment system at Chelsea site to improve treatment appointments and
reduce waiting times
–– Planned introduction of scheduling system at Sutton from March 2013
–– Improvements in pre-prescribing of chemotherapy to give pharmacy time to prepare chemotherapy
in advance of the visit
–– Production of a new patient information leaflet to inform patients about the process of
chemotherapy production
–– Improved communication between the staff and patients to keep them informed about their wait.
38
Annual Report and Accounts 2012/13
How did we perform in 2012/13?
Patients are asked to give their feedback in real time. As they leave the outpatients department
volunteers ask patients to give their responses on hand held devices to a variety of questions about their
appointment. During 2012/13 between 30 and 90 patients have responded each month.
In response to the question How do you feel about how long, from your stated appointment time you had to
wait for your treatment to start? The chart below show that across the Trust during 2012/13 on average
64% of patients waited about the right length of time for their treatment to start.
Waiting time to start of treatment
Could have been a lot sooner
Could have been sooner
About right
100
90
80
70
50
40
30
20
10
March 2013
Feb 2013
Jan 2013
Dec 2012
Nov 2012
Oct 2012
Sept 2012
Aug 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
0
Oct 2011
Percentage
60
39
The Royal Marsden NHS Foundation Trust
In response to the question Were you told how long you would have to wait? the chart below shows that
on average 18% (140) of patients did not have to wait, 30% (241) were not told how long they would have
to wait and 44% (336) were told and the wait was shorter or about as long as they had been told. Eight
per cent (66) found that the wait was longer than they were told.
Were you told how long you would wait?
Don’t know
Not told
Yes and wait was longer
Yes and wait was shorter
Yes and wait was as long as told
No did not have to wait
100
90
80
70
Percentage
60
50
40
30
20
10
40
March 2013
Feb 2013
Jan 2013
Dec 2012
Nov 2012
Oct 2012
Sept 2012
Aug 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
0
Annual Report and Accounts 2012/13
In response to the question Were you told why you would have to wait? the chart below shows that on
average 56% (371) of patients were told why they would have to wait and 29% (191) were not told but
did not mind.
Were you told why you would have to wait?
No, would have liked reason
Yes
No and didn’t mind
100
90
80
70
Percentage
60
50
40
30
20
10
March 2013
Feb 2013
Jan 2013
Dec 2012
Nov 2012
Oct 2012
Sept 2012
Aug 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
0
What actions are we planning to improve our performance?
–– New information leaflets explaining the visit for treatment have been produced
–– Waiting time information for display on the Medical Day Unit has been implemented
–– Announcements being made every 30 minutes in the outpatients department
–– Staff are speaking with individual patients when delays to appointments occur.
41
The Royal Marsden NHS Foundation Trust
Priority 9
Ensure that we are responding to inpatients’ personal needs
Target
To improve in the responses to five questions related to “Improving responsiveness to personal needs
of patients”. These five questions are taken from the national inpatient survey which is reported by the
Care Quality Commission.
Delivery of personalised medicine is one of the Trust’s strategic priorities. It is therefore important that
we understand the patient experience when they attend outpatient departments, day units and inpatient
areas. In May 2009 we started using frequent feedback hand-held devices in our day units and outpatient
areas and the matrons are responsible for developing action plans in response to recurrent concerns.
In 2012 these started being used in the inpatient areas.
What did we do in 2012/13?
The Patient Experience Feedback Group chaired by the Chief Nurse has overseen the following actions:
–– Development of the real time feedback to the inpatient areas; the questionnaire has been developed
and agreed with the Patient Feedback Steering Group and the volunteers have been trained to deliver
the questionnaire
–– Development of the real time feedback plan for the Oak Centre for Children and Young People
including Focus Groups for selected age groups
–– Commencement of new scheduling system unit to formalise the scheduling of day unit appointments
in an effort to reduce waiting times for chemotherapy.
42
Annual Report and Accounts 2012/13
How did we perform in 2012/13?
Inpatient Survey 2012 CQUIN data
The NHS Commissioning for Quality and Innovation (CQUIN) groups together five questions from
the annual national inpatient survey that indicate how trusts perform in “Improving responsiveness to
personal needs of patients”. The following five questions are below and the table shows how the scores
have improved over the last three years.
Q32 Were you involved as much as you wanted to be in decisions about your care and treatment?
Q34 Did you find someone on the hospital staff to talk to about your worries and fears?
Q36 Were you given enough privacy when discussing your condition or treatment?
Q56 Did a member of staff tell you about medication side effects to watch for when you went home?
Q62 Did hospital staff tell you who to contact if you were worried about your condition or treatment
after you left hospital?
The Patient Experience CQUIN results for The Royal Marsden are as follows:
Year
Q32
Q34
Q36
Q56
Q62
Overall CQUIN score
2012
86.8
76
92.2
73
93
84.2
2011
83.4
75.7
91.6
70.4
92.8
82.8
2010
82.3
74.6
90
68.4
94.5
82
What actions are we planning to improve our performance?
The Trust will continue to develop the nurse handover structure to ensure that discharge planning is
discussed and agreed with the patient. Furthermore, it is proposed that patients are provided with a copy
of their discharge summary when they leave the hospital.
How will improvement be measured and monitored?
The inpatient experience will be measured by the frequent feedback survey that has commenced in the
inpatient areas and by the annual national inpatient survey. This will continue to remain important for
the Trust and will continue to be part of the Quality Account for 2012/13; the NHS Operating Framework
for 2012/13 includes an organisation’s responsiveness to patients needs as key indication of the quality of
the patient experience.
43
The Royal Marsden NHS Foundation Trust
Priority 10
Monitoring of the percentage of staff who would recommend The Royal Marsden to friends
and family
Target
To maintain or increase the staff survey result to this specific question in the annual national
staff survey.
The national staff survey is conducted annually. In 2011/12 the Trust survey showed that when asked
to consider the following statement If a friend of relative needed treatment, I would be happy with the
standard of care provided by this Trust 84% (408/485) of staff would recommend The Royal Marsden
to friends and family.
What did we do in 2012/13?
We continued to work with staff to improve services for patients through the year and have held focus
groups with staff to discuss ways in which services could be provided better. We shared outcomes of
patient surveys and our monitoring reports with staff.
The Trust took part in the national early implementer scheme to introduce the Prime Minister’s question
to all inpatients. The ‘friends and family’ test was in place from January 2013 in all inpatient areas. All
patients when they are discharged are asked to answer the ‘friends and family’ question and place their
response in a confidential box. The first results show that across 18 wards during the month of February
2013 of patients that were discharged 106 responded with a score of 4.9/5.0.
How did we perform in 2012/13?
Staff in this year’s survey have been asked to consider the following statement:
If a friend or relative needed treatment I would be happy with the standard of care provided by this
organisation 87% (421/488) of staff would recommend The Royal Marsden to friends and family.
This is an increase of three per cent from last year’s result.
Table 1: Numbers of staff responding to question in national staff survey
Agreed or strongly agreed
Neither agree nor disagree
Disagreed or
strongly disagreed
2012
421 (87%)
51 (10%)
13 (3%)
2011
408 (84%)
55 (11%)
19 (4%)
What actions are we planning to improve our performance?
–– Encourage staff feedback on how our patient services could be improved
–– Continue to promote quality monitoring reports and other information on our performance to staff
–– Continue to feedback on the ‘friends and family’ test responses to staff.
How will improvement be measured and monitored?
–– Through the annual staff survey responses.
44
Annual Report and Accounts 2012/13
Priority 11
Safe care for children
Target
New Baby Review: The percentage of babies who receive the new birth visit up to day 14 after birth.
90% to be achieved.
The New Birth Visit is part of the Healthy Child Programme – the universal clinical and public health
programme for children and families from pregnancy to 19 years of age. The Healthy Child Programme,
led by health visitors and their teams, offers every child a schedule of health and development reviews,
screening tests, immunisations, health promotion guidance and support for parents tailored to their
needs, with additional support when needed and at key times. There is strong evidence supporting
delivery of all aspects of the Healthy Child Programme, which is based on Health for All Children, the
recommendations of the National Screening Committee, guidance from the National Institute of Health
and Clinical Excellence and a review of health-led parenting programmes by the University of Warwick.
This universal service visit from health visitors provides the Healthy Child Programme to ensure
a healthy start for children and family and support for parents and access to a range of community
services/resources. This child health surveillance, health promotion and parenting support elements of
the Healthy Child Programme for pregnancy and the first five years of life.
The New Baby Review is a face-to-face review by 14 days with mother and father and includes advice
and support on:
–– Infant feeding
–– Promoting sensitive parenting
–– Promoting development
–– Assessing maternal mental health
–– Sudden Infant Death support
–– Keeping safe – accident prevention advice.
If parents wish or there are professional concerns:
–– An assessment of baby’s growth
–– On-going review and monitoring of the baby’s health
–– Safeguarding.
Health Visitors regard this review as a priority together with safeguarding and we are continually
reviewing how we address those families not visited within the timescale. Reasons for this include
mother and baby staying with relatives outside the area for an initial period of time and babies being
born in the area who are resident in other areas. However, there are still a number that we can aim to
visit within the timescale.
45
The Royal Marsden NHS Foundation Trust
Table 1: Percentage of visits undertaken within 14 days after birth (those who live in the borough
of Sutton): Target 90% monthly.
Sutton borough
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Number (percentage) of
children receiving new-birth
visit by 14 days of age
163 (92.6%)
193 (91.9%)
221 (94%)
213 (94.2%)
184 (94.4%)
166 (93.3%)
200 (90.5%)
202 (94.8%)
186 (92.1%)
172 (93.0%)
178 (95.2%)
159 (95.8%)
Number of children reaching
14 days of age in period
176
210
235
226
195
178
221
213
202
185
187
166
Table 2: Percentage of visits undertaken within 14 days after birth (those who live in the borough
of Merton): Target 90% monthly.
Merton borough
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Number (percentage) of
children receiving new-birth
visit by 14 days of age
217 (90.4%)
208 (92.4%)
212 (92.6%)
236 (92.2%)
236 (90.4%)
209 (92.5%)
249 (90.2%)
228 (91.9%)
214 (90.3%)
208 (94.5%)
211 (92.1%)
195 (91.5%)
Number of children reaching
14 days of age in period
240
225
229
256
261
226
276
248
217
220
229
213
46
Annual Report and Accounts 2012/13
Table 3: Percentage of visits undertaken within 14 days after birth (those who are registered with
a GP in Sutton and Merton): Target 90% monthly.
Sutton and Merton PCT
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Number (percentage) of
children receiving new-birth
visit by 14 days of age
403 (91.4%)
414 (91.6%)
454 (92.7%)
470 (93.4%)
437 (91.8%)
464 (93.1%)
452 (90.1%)
417 (93.2%)
396 (91.2%)
396 (94.1%)
403 (93.5%)
372 (92.5%)
Number of children reaching
14 days of age in period
441
452
490
503
476
423
515
485
457
421
431
402
47
The Royal Marsden NHS Foundation Trust
Part three
Outline of Quality Improvements in 2013/14
The Department of Health and Monitor issued ‘Quality Accounts: reporting requirements for 2011/12
and planned changes for 2012/13’ in February 2012. The proposed changes followed consideration
by the National Quality Board as to how Quality Accounts should be strengthened through the
introduction of mandatory reporting against a small, core set of quality indicators. Monitor will consult
on these requirements as part of its consultation on the Annual Reporting Manual for NHS Foundation
Trusts 2012/13. From 2011/12, all acute Trusts will be required to have limited assurance work
performed on their Quality Accounts. Given the likely changes, we chose to include the proposed core
set of quality indicators proposed for requirements from 2012/13. Some of the indicators are not very
relevant to us e.g. ambulance response times, therefore these have been excluded
However, we also felt it was important to consult with our members and governors to incorporate their
views about “quality” into the Quality Account.
The process for agreeing the priorities for quality improvement were as follows:
October 2012
–– Key milestones and timetable outlined at the Patient Experience Feedback group were agreed.
Members of the Patient experience feedback group were: Sutton LINks, Sutton Health and Wellbeing
Board, Patients and Carers, Governors, Matrons from acute Trust and Community.
November 2012
–– Review of first draft of the annual quality account 2012/13 priorities and progress to date
–– Member’s event to discuss progress with developing and selection of quality priorities.
December 2012
–– Agreed on process for selecting quality priorities.
January 2013 – Review of progress
–– Review second draft of annual quality account 2012/13.
February 2013 – Engagement
–– Final draft of annual Quality Account 2012/13
–– Senior Nurse and Therapies committee reviewed priorities
–– Member’s event to discuss progress with developing and selection of quality priorities
–– Council of Governor’s meeting assisted in the selection of priorities
48
Annual Report and Accounts 2012/13
–– Patient Experience Feedback group selected final quality improvement priorities
–– Chief Nurse to discuss and agree measurable targets alongside relevant Trust staff
–– Engagement and refinement – final draft to Patient and Carer Advisory Group, Council of Governors,
Local Involvement Networks, Commissioner and the Health and Wellbeing Board; to comment and
provide a statement about the annual Quality Account.
March 2013 – Engagement
–– Patient Experience Feedback group finalised quality improvement priorities and targets for 2013/14
–– Chief Nurse informed Board of progress to date and obtained approval of quality improvement
priorities and targets for 2013/14
–– Draft to external stakeholders for comments and statements
–– Draft to Trust staff for comments.
April and May 2013 – Engagement and refinement
–– Progress against 2012/13 targets to be added to final draft of annual quality account
–– Copy to Marketing and Communications Department
–– To external auditors for review
–– Final copy to designer via marketing and communications team.
May and June 2013 – Submission and publication
–– Reviewed at Trust’s Audit committee
–– Trust’s Annual Report submitted to Monitor by 31 May 2013
–– Trust publishes annual Quality Account on NHS Choices website and own website and submitted
copy to Department of Health by 30 June 2013.
49
The Royal Marsden NHS Foundation Trust
The quality priorities for 2013/14
The quality priorities and targets for 2013/14 are displayed in the table below. The priorities marked
with * were mandatory quality indicators in 2012/13 and are expected to remain mandatory for 2013/14.
There are three new (^) quality priorities for 2013/14.
Table 1: Quality priorities and targets for 2013/14
Safe care
Priority 1
Priority 2
Priority 3
*Reduction in Healthcare
Associated Infections (MRSA
bacteraemia and Clostridium
difficile infections) Applies
to Acute beds at The Royal
Marsden and patients of
Sutton and Merton Community
Services (SMCS)
*Rate of patient safety incidents
and percentage resulting
in severe harm or death (in
2012/13 the number of deaths
from serious incidents per 100
admissions was 0; the number
of severe harms from incidents
per 100 admissions was 0.012)
Applies to acute beds and SMCS
*Percentage of admitted
patients risk assessed for
Venous thromboembolism
Less than one MRSA
bacteraemia
Reduction in the rate of patient
safety incidents per 100
admissions and the proportion
that have resulted in severe
harm or death
Maintain above 95% the
number of patients who have a
completed VTE risk assessment
Less than 11 C. Difficile
infections
(Report in Quality Account the
number of C. difficile infections
per 100,000 bed days)
Effective care
Priority 4
Priority 5
Priority 6
Priority 7
Reduction in
community acquired
grade 3 and 4 pressure
ulcers: applies to SMCS
Increase the number
of patients that die
in their preferred
place of death (The
National Primary Care
Snapshot Audit in End
of Life Care (2009)
found that the number
of patients achieving
their preferred place of
death is 42%) Applies
to acute and SMCS
Increase the numbers
of patients who have
an Holistic Needs
Assessment
*Avoidance
of emergency
re-admissions to
hospital within
28 days of discharge.
Reduce the incidence
of severe community
acquired pressure
ulcers (grade 3 and 4)
Achieve more than
42% of patients dying
in their preferred place
of death.
Increase the proportion
of designated patients
who will be offered
a Holistic Needs
Assessment by the
end of 2013/14
Reduction in the
number of avoidable
re-admissions
to hospital within
28 days of discharge
50
Annual Report and Accounts 2012/13
Patient experience
Priority 8
Priority 9
Priority 10
Reduction in chemotherapy
waiting times and improvement
in patient experience related to
waiting times
*Ensure that we are responding
to in-patients’ personal needs
*Percentage of staff who would
recommend The Royal Marsden
to friends or family needing care*
Reduction in chemotherapy
waiting times at Sutton and
Chelsea and improvement in
the patient experience related to
waiting times
Improvement in responses
to five questions (in the CQC
national survey described
above) as monitored through
the Inpatient Frequent
Feedback Surveys
Introduce a Patient Experience
survey for SMCS
To maintain or increase the
staff survey result to this
specific question in the survey.
To achieve a baseline
measurement and if possible
benchmark with other
community services
Patient experience
Priority 11
Priority 12
^Improve communication, particularly when
patients arrive for first appointments
^Reduce the length of time a patient waits for
medicines or equipment at the point of discharge
Increase or maintain the high percentage of
positive comments in dedicated patient feedback
Increase or maintain the high percentage of
positive comments in dedicated patient feedback
Childrens services
Priority 13
^The uptake of immunisation working in partnership with primary care
Increase the percentage of children receiving pre-school immunisations in partnership with GPs
(*) mandatory priority
(^) new quality priorities
51
The Royal Marsden NHS Foundation Trust
The table below summarises the quality objectives and priorities of the Trust for the last four years.
Community services are detailed from 2011/12 onwards.
Safety
2009/10
2010/11
2011/12
2012/13
Incidence of healthcare
associated infections
Reduction of
healthcare associated
infections
Reduction of
healthcare associated
infections
*Reduction in
Healthcare Associated
Infections
Reduction in
medication errors
Reduction in
medication incidents
Reduction in
medication incidents
*Rate of patient
safety incidents and
percentage resulting in
severe harm or death
Incidence of falls
Reduction in falls
Reduction in falls.
(hospital services)
A 15% increase
in number of falls
screens compared
to 2010/11 (SMCS)
Assessment,
monitoring and
treatment of venous
thromboembolism
Reduction in venous
thromboembolism
(blood clots)
Compliance with
national health
visiting targets: new
birth visits (SMCS)
Safeguarding children
priorities – compliance
with national guidance
and training (SMCS)
52
*Percentage of
admitted patients risk
assessed for venous
thromboembolism
Annual Report and Accounts 2012/13
Effective care
2009/10
2010/11
2011/12
2012/13
Mortality rate, hospital
standardised mortality
ratio (HSMR)
Reduction in the
hospital standardised
mortality ratio (HSMR)
Reduction in the
hospital standardised
mortality ratio (HSMR)
Reduction in the
hospital standardised
mortality ratio (HSMR)
Incidence of
hospital acquired
pressure ulcers
Reduction in
the incidence of
hospital acquired
pressure ulcers
Reduction in
the incidence of
hospital acquired
pressure ulcers
(hospital services)
Reduction in
community acquired
grade 3 and 4
pressure ulcers
Reduction in pressure
ulcers especially
grades 3 and 4 (SMCS)
Achieve more than
42% of patients dying
in their preferred
place of death
Effective length of stay
Reduced length of stay
Reduced length of stay
Increase the numbers
of patients who
have been offered
an Holistic Needs
Assessment
*Reducing the
number of emergency
re-admissions to
hospital within
28 days of discharge
53
The Royal Marsden NHS Foundation Trust
Patient experience
2009/10
2010/11
2011/12
2012/13
Patients in pain
To be in top 20% of
trusts for key areas
on the national
inpatient survey
To be in top 20%
of trusts for key
areas of national
inpatient survey
*Improve or maintain
a high score in
relation to responding
to inpatients’
personal needs in
the national survey
Patients treated with
dignity and respect
To be in top 20% of
trusts for key areas
on the national
outpatient survey
To be in top 20%
of trusts for key
areas of national
outpatient survey
Patients given
enough information
on discharge
Roll out of the real
time patient feedback
throughout the Trust
Roll out of the real
time patient feedback
throughout the Trust
New initiatives to
improve the patient
experience in 2011/12.
1) To reduce
chemotherapy
waiting times,
Reduction in
chemotherapy
waiting times and
improvement in patient
experience related
to waiting times
2) To improve the
patient experience of
hospital transport,
3) To improve
communication at
every part of the
patient journey
*Percentage of staff
who would recommend
The Royal Marsden
to friends or family
needing care
54
Annual Report and Accounts 2012/13
Statements of assurance from the Board
Review of services
During 2012/13 The Royal Marsden NHS Foundation Trust provided and/or sub-contracted
comprehensive cancer services.
The Royal Marsden NHS Foundation Trust has reviewed all the data available to them on the quality
of care in 100% of these services.
The income generated by the NHS services reviewed in 2012/13 represents all of the total income
generated from the provision of NHS services by The Royal Marsden NHS Foundation Trust for 2012/13.
The data reviewed in part three of this Quality Account covers the three dimensions of quality: patient
safety, clinical effectiveness and patient experience. In all areas the data has been available to review
the service.
Participation in clinical audits
National clinical audits and national confidential enquiries are tools that NHS organisations
use to assess the quality of services provided, against the best available evidence based
guidance and standards.
At The Royal Marsden we undertake many clinical audits. We participate in all the national cancer
audits which are applicable to the organisation. This allows us to benchmark against other hospitals in
England and sometimes across the world. We also have a comprehensive programme of local clinical
audits which clinical staff including consultants, junior doctors, nurses and allied health professionals
conduct regularly to improve local areas of care.
During 2012/13 11 national clinical audits and three national confidential enquiries covered NHS
services that The Royal Marsden provides.
National confidential enquiries
These are “inspections” that are carried out nationally to investigate areas of care where there may have
been problems nationally or where the patients may be particularly vulnerable. All hospitals are asked to
take part in them so that all care across England can be monitored.
During 2012/13 The Royal Marsden participated in all 11 of the national clinical audits and three
national confidential enquiries in which it was eligible to participate (Table 1). Many of the national
audits undertaken by other hospitals cannot be undertaken at The Royal Marsden because we only have
patients with cancer.
The national clinical audits and national confidential enquiries that The Royal Marsden participated
in, and for which data collection was completed for the period 2012/13, are listed below alongside the
number of cases submitted to each audit or enquiry as a percentage of the number of registered cases
required by the terms of that audit or enquiry (Table 1 and 3).
55
The Royal Marsden NHS Foundation Trust
Table 1: National clinical audits The Royal Marsden participated in 2012/13
No
National Clinical Audits
Participated
Cases submitted (%)
1
National Comparative Audit of Blood
Transfusion: Blood sampling and labelling
Yes
100%
2
National Oesophago-Gastric
cancer audit (NOGCA)
Yes
100% input of those
diagnosed at the Trust
3
The National Bowel Cancer
Audit (NBOCAP)
Yes
100% input of those
diagnosed at the Trust
4
Lung Cancer (National Lung Cancer Audit)
Yes
Note: Tertiary Trust
Standards do not apply as
most patients are not “first
seen” at tertiary trusts
5
Head and Neck Cancer (DAHNO)
Yes
100%
6
Intensive Care National Audit &
Research Centre (ICNARC) Case
Mix Programme (CMP)
Yes
100%
Other National Audits
7
The Association of Breast Surgery (ABS)
& NHS Breast Screening Programme
Yes
100%
8
Breast Cancer Clinical
Yes
100%
Outcome Measures (BCCOM) Project
9
National Health Service Cancer
Screening Programme (NHSCSP)
Audit of Invasive Cervical Cancer
Yes
Ongoing data-collection
for quarterly submission.
100% input of those
treated at the Trust
10
Royal College of Radiologists (RCR) National
Re-audit of Radiotherapy in the Treatment
of Malignant Spinal Cord Compression
Yes
100%
11
The British Association of Urological
Surgeons (BAUS) Nephrectomy audit
Yes
100%
56
Annual Report and Accounts 2012/13
The reports of 13 national clinical audits were reviewed by The Royal Marsden in period 2012/13.
The Royal Marsden will take the following actions to improve the quality of healthcare provided.
Table 2: National clinical audits published reports and actions taken in 2012/13
No
National Clinical Audit reports
published in 2012/13
Description of actions
1
National Lung cancer Audit Report 2011
None. Treatment practice exceeds
national standards. (Diagnosis is not
undertaken at The Royal Marsden)
2
National Head & Neck Cancer
Audit 2011: 7th Annual Report
Recommendations reviewed
3
National Oesophago-Gastric
Cancer Audit Report 2012
Recommendations reviewed
4
National Bowel Cancer Audit Report 2012
Recommendations reviewed
5
2011 Audit of the medical use of red cells
Report reviewed
6
2012 Audit of blood sampling and labelling
Report reviewed
7
NHSCSP Audit of invasive cervical
cancer National report 2007-2011
Report disseminated
NHS Breast Screening Programme
& ABS An audit of screen detected
breast cancers for the year of screening
April 2010 to March 2011
Report disseminated
8
NCIN (National Cancer Intelligence
Network) Recurrent and Metastatic
Breast Cancer Data Collection
Project, Pilot report, March 2012
Recommendations reviewed
9
Findings of the UK national audit
evaluating image-guided or image assisted
liver biopsy. Part I. Procedural aspects,
diagnostic adequacy, and accuracy
Report disseminated
10
Findings of the UK national audit evaluating
image-guided or image assisted liver biopsy.
Part II. Minor and major complications
and procedure-related mortality 2009/10
Report disseminated
11
RCR Summary Report of the Results
of the Royal College of Radiologists’
National Breast Radiotherapy Audit
Reviewed by members
12
RCR National Oesophago-Gastric
Cancer Audit – 2012 Annual Report
Report disseminated
13
BAUS section of oncology
Report disseminated
Analyses of Nephrectomy dataset
1 January – 31 December 2011, June 2012
57
The Royal Marsden NHS Foundation Trust
Table 3: National confidential enquiries The Royal Marsden eligible to participate in
No
National Confidential Enquiry into Patient
Outcome and Death (NCEPOD) studies
Participated
% cases submitted
1
Alcohol related liver disease
Yes
100%
2
Subarachnoid haemorrhage
Yes
100%
3
Tracheostomy care (pilot)
Yes
100%
The reports of two national confidential enquiries report were reviewed by The Royal Marsden in
2012/13. The Royal Marsden intends to take the following actions to continue to improve the quality
of healthcare provided.
Table 4: National Confidential Enquiries reports published in 2012/13 and actions
No
National Confidential Enquiry into Patient
Outcome and Death (NCEPOD) studies
Description of actions (local)
1
Bariatric Surgery: Too Lean
a Service? (2012)
Not applicable. Bariatric surgery for weight loss
2
Cardiac Arrest Procedures:
Time to Intervene? (2012)
Recommendations reviewed
The reports of 88 local clinical audits and local action plans to improve the quality and outcomes of
patient care were reviewed by The Royal Marsden in 2012/13.
Participation in clinical research
The Royal Marsden, The Institute of Cancer Research and Mount Vernon Cancer Centre form the largest
centre for cancer research in Europe. This is important because it means that our patients and our staff
are always aware of the latest research in treatments, medicines and therapies that make such a major
difference to outcomes and the experience of care. If you would like to find out more about our research
work please go on to our website on www.royalmarsden.nhs.uk
The number of patients receiving NHS services provided or subcontracted by The Royal Marsden in
2012/13 that were recruited during that period to participate in research approved by a research ethics
committee was 7,274 patients into 307 different trials.
Revalidation of doctors
Revalidation began in December 2012. The Trust has been preparing for this for some time and reported
good progress on the Organisational Readiness Self-Assessment (ORSA) as at March 2012, with a
delivery plan to ensure the four outstanding items are in place by the end of 2012. Of these four key
tasks two have been fully implemented, with the others updated to reflect recent changes. The process
to ensure doctors provide information from their work at other organisations in their appraisal portfolio
has been revised based on further guidance and is being implemented in a consistent manner with
neighbouring trusts. The policy for the reskilling, rehabilitation and remediation of doctors has been
updated based on recent guidance and is progressing through the implementation stage. An electronic
system to support revalidation has been procured and is now being rolled out. The appraisal system has
been enhanced and is tightly monitored with the rates of completed appraisals improving. The Trust’s
Responsible Officer has been revalidated and other doctors will begin to be revalidated from May 2013.
The Trust’s progress to a ‘revalidation ready’ state is managed through clear governance arrangements
and has been reported and discussed at all levels and relevant forums including the Trust Board.
58
Annual Report and Accounts 2012/13
Use of the CQUIN payment framework
The Commissioning Quality and Innovation (CQUIN) payment framework is a method that the NHS
introduced in 2009/10 to reward hospitals and other NHS services for taking quality and innovative
patient care initiatives seriously. If hospitals did not achieve their CQUIN targets then, in 2010/11, 1.5%
of a hospital’s income was removed and, in 2011/12, 2.5%. In challenging financial times for the NHS it
is important that quality initiatives are linked to a financial lever to ensure that the front line staff and
the Board are able to prioritise quality care. For a list of the CQUIN targets for 2012/13 and then 2013/14
please go on to the CQUIN page on our website via www.royalmarsden.nhs.uk or contact us via the
Head of Quality Assurance on 020 7808 2702 and we can post details out to you.
A proportion of The Royal Marsden NHS Foundation Trust’s income in 2012/13 was conditional
on achieving quality improvement and innovation goals agreed between The Royal Marsden NHS
Foundation Trust and any person or commissioning PCT they entered into a contract, agreement
or arrangement with for the provision of NHS services, through the Commissioning for Quality and
Innovation payment framework.
In 2012/13 The Royal Marsden achieved 100% of its CQUIN target which is £3 million.
In 2011/12 The Royal Marsden achieved 93% of its CQUIN target which is £1.7 million.
In 2012/13 Sutton and Merton Community Services achieved 86.7% of its CQUIN target which is £712,474.
In 2011/12 Sutton and Merton Community Services achieved 90% of its CQUIN target which is £418,000.
Further details of agreed goals for 2012/13 and for the following 12 month period are available online at:
http://www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id+3275
Or at The Royal Marsden website: www.royalmarsden.nhs.uk
What others say about the provider
Statements from the Care Quality Commission (CQC)
The Royal Marsden NHS Foundation Trust is required to register with the Care Quality Commission and
its current registration status is “registered with no conditions”.
The Care Quality Commission has not taken enforcement action against The Royal Marsden NHS
Foundation Trust during 2012/13.
The Royal Marsden NHS Foundation Trust has not participated in any special reviews or investigations
by the CQC during the reporting period, 2012/13.
Data quality
Good quality information is very important in underpinning the effective delivery of the best patient care.
The Royal Marsden NHS Foundation Trust submitted records during 2012/13 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest published data.
The percentage of records in the published data, which included the patient’s valid NHS number, was
98.7% for admitted patient care, 98.8% for outpatient care, and none for accident and emergency care
(specialist cancer trust without an accident and emergency).
The percentage of records that included the patient’s valid General Practitioner Registration Code was
98.9% for admitted patient care, 98.9% for outpatient care and none for accident and emergency.
59
The Royal Marsden NHS Foundation Trust
Data quality – England and Wales
% completeness
NHS number
GP practice
2010/11
2011/12
2012/13
2010/11
2011/12
2012/13
Inpatient & Day cases
98.6
98.6
98.7
99.0
99.0
98.9
Outpatients
98.6
98.8
98.8
98.9
99.1
98.9
Although Data Quality at The Royal Marsden is very good the Trust strives for continual improvement.
The Royal Marsden NHS Foundation Trust implements the following actions to improve data quality:
1. A dedicated data quality team are responsible for running routine validation checks and reports to
identify errors and inconsistencies in data entry
2. In 2013 Trust wide monthly communications started promoting the importance of accurate
information and data collection centrally for all Trust staff
3. Trust wide audits of data quality involving key information points are conducted annually.
Information Governance Toolkit attainment levels
The Royal Marsden score for 2012/13 for Information Quality and Records Management assessed
using the Information Governance Toolkit was 88%. This marks an improvement on the interim
submission score in October 2012 of 86%. Furthermore, the Trust scored a minimum of Level 2 on all 45
requirements. Our final position is: satisfactory (Green). The Information Governance Toolkit is available
on the Connecting for Health website (www.igt.connectingforhealth.nhs.uk).
Clinical coding error rate
The Royal Marsden NHS Foundation Trust was not to subject the Payment by Results clinical coding
audit during the reporting period by the Audit Commission.
Clinical coding
Coding Errors
Primary Diagnosis Errors
Primary Procedure Code Errors
Secondary Diagnosis Errors
Second Procedure Code Errors
2009/10
2010/11*
2011/12**
2012/13**
5.0%
2.5%
3.5%
8.0%
35.7%
2.1%
12.4%
4.7%
7.2%
1.9%
2.9%
5.1%
12.8%
8.4%
26.4%
8.8%
* The Trust was not eligible for an Audit Commission Clinical Coding Audit in 2010/11; these figures are therefore based on an audit
commissioned by The Royal Marsden in November 2010.
** These figures are draft pending the final report from the Audit Commission for the 2012/13 audit.
60
Annual Report and Accounts 2012/13
Part four
Review of quality performance (previous year’s performance)
National targets
National
target
2012/13
2012/13
performance
Q1
2012/13
performance
Q2
2012/13
performance
Q3
2012/13
performance
Q4
2012/13
performance
Cancer waiting
times targets
All urgent GP referrals
seen within 14 days
93%
95.3%
98.0%
99.0%
97.6%
97.5%
All referrals for
breast symptoms
seen within 14 days
93%
93.0%
89.2%
96.3%
97.1%
94.7%
Treatment within 31
days of decision to
treat for first treatment
96%
98.8%
99.5%
99.2%
99.3%
99.2%
Subsequent surgical
treatment started
within 31 days of
decision to treat
94%
96.2%
96.1%
96.8%
98.2%
96.8%
Subsequent drug
treatment started
within 31 days of
decision to treat
98%
99.5%
99.8%
100%
100%
99.8%
Subsequent
radiotherapy treatment
started within 31 days
of decision to treat
94%
95.6%
96.4%
98.8%
99.3%
97.6%
Treatment started
within 62 days of
urgent GP referrals*
85%
86.6%
86.1%
87.3%
83.3%
85.9%
Treatment started
within 62 days
of recall date for
urgent screening
centre referrals
90%
94.4%
90.6%*
95.7%
92.5%
93.2%
* Figures include agreed reallocations between Trusts
61
The Royal Marsden NHS Foundation Trust
NHS 18 week targets
Target/ Priority
National
target
2012/13
2010/11
%
achieved
2011/12
%
achieved
2012/13
%
achieved
National
target
2013/14
Patients requiring admission
who waited <18 weeks from
referral to treatment (not
national targets since 2010)
90%
94.90%
94.8%
96.0%
90%
Patients not requiring
admission who waited
<18 weeks from referral
to treatment (not national
targets since 2010)
95%
98.40%
98.8%
98.6%
95%
Access targets
National target
2010/11
% achieved
2011/12
% achieved
2012/13
% achieved Q1
2012/13
% achieved Q2
2012/13
% achieved Q3
2012/13
% achieved Q4
National target
2013/14
Target/ Priority
Operations cancelled
by the Trust at
the last minute
Less
than
5%
0.3%
0.3%
0.16%
0.15%
0.36%
0.22%
Less
than
5%
Last minute
cancelled operations
not subsequently
performed within
one month
0%
0%
0%
0%
0%
0%
0%
0%
The Royal Marsden NHS Foundation Trust met all key performance waiting times and access targets
in 2011/12 and 2012/13.
62
Annual Report and Accounts 2012/13
Appendix 1
Quality Indicators where national data is available from
the Health and Social Care Information Centre (HSCIC)
The Trust considers this data is as described as taken from the Health and Social Care Information Centre.
The Trust has taken actions to improve the percentage and so the quality of its services (see priorities
for each indicator in Part 2 for further information).
The tables below shows how the trust compares against other trusts and shows the highest and lowest
national scores.
Quality Indicators
A. The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information centre with regard to the rate per 100,000 bed days of
cases of C. difficile infection reported within the trust amongst patients (Trust Priority 1).
Period
The
Royal
Marsden
National
highest (all
acute and
specialist
trusts)
National
lowest (all
acute and
specialist
trusts)
Average
acute
trusts
England
national
April 2011 – March 2012
30
51.6
*0
-
21.8
April 2010 – March 2011
56.6
71.8
*0
29.6
* The Trust is advised that the zero recorded here may be due to missing data reported to the centre.
B. The data made available to the National Health Service trust or NHS foundation
trust by the Health and Social Care Information Centre Incidents reported within
the trust during the reporting period and the number and percentage of such patient
safety incidents that resulted in severe harm or death (Trust Priority 2).
Percentage
Period
The
Royal
Marsden
National
highest (all
specialist
trusts)
National
lowest (all
specialist
trusts)
Average
specialist
trusts
October 2011 – March 2012
0.1
2.9
0
0.6
April 2011 – September 2011
0.3
4.6
0
0.3
63
The Royal Marsden NHS Foundation Trust
Number
Period
The
Royal
Marsden
National
highest by %
(all specialist
trusts)
National
lowest by %
(all specialist
trusts)
Average
specialist
trusts
October 2011 – March 2012
2
6
*0
4.4
April 2011 – September 2011
5
11
*0
2.1
* The Trust is advised that the zero recorded here may be due to missing data reported to the centre.
C. The data made available to the National Health Service trust or NHS foundation trust by the Health
and Social Care Information Centre with regard to the percentage of patients who were admitted
to hospital and who were risk assessed for venous thromboembolism during the reporting period
(Trust Priority 3).
Period
The
Royal
Marsden
National
highest (all
acute and
specialist
trusts)
National
lowest (all
acute and
specialist
trusts)
Average
acute
trusts
England
national
Q3 2012/13
97
100
84.6
-*
94.1
Q2 2012/13
97
100
80.9
-*
93.8
* The Trust is advised that the zero recorded here may be due to missing data reported to the centre.
64
Annual Report and Accounts 2012/13
D. The data made available to the National Health Service trust or NHS foundation trust by the Health
and Social Care Information Centre with regard to the percentage of patients aged – i) 0-14; and
ii) 15 or over, readmitted to a hospital which forms part of the Trust within 28 days of being discharged
from a hospital which forms part of the Trust during the reporting period (Trust Priority 7).
Period
The
Royal
Marsden
National
highest
(all trusts)
National
lowest (all
trusts)
Average
specialist
trusts
England
national
2010/11 standardised
to persons 2006/07
7.94
17.33
*0
9.52
11.42
2009/10 standardised
to persons 2006/07
6.7
22.09
*0
9.45
11.16
* The Trust is advised that the zero recorded here may be due to missing data reported to the centre.
E. The data made available to the National Health Service trust or NHS foundation trust by the Health
and Social Care Information Centre with regards to the trust’s responsiveness to the personal needs
of its patients during the reporting period (Trust Priority 9).
Period
The
Royal
Marsden
National
highest
(all trusts)
National
lowest (all
trusts)
Average
specialist
trusts
England
national
2011/12
82.8
85
56.5
*-
67.4
2010/11
82
82.6
56.7
*-
67.3
* The Trust is advised that the zero recorded here may be due to missing data reported to the centre.
F. The data made available to the National Health Service trust or NHS foundation trust by the Health
and Social Care Information Centre with regard to the percentage of staff employed by, or under
contract to, the trust during the reporting period who would recommend the trust as a provider of
care to their family or friends (Trust Priority 10).
Period
The
Royal
Marsden
National
highest (all
specialist
trusts)
National
lowest (all
specialist
trusts)
Average
acute
trusts
England
national
2012
87
94
62
65
63
2011
85
96
66
65
60
65
The Royal Marsden NHS Foundation Trust
Appendix 2
Statements from
key stakeholders
Statement from Patient and Carer Advisory
Committee on the Quality Account
Robert Francis QC, in his letter to the Secretary
of State submitting his final report of the Mid
Staffordshire NHS Foundation Trust Public
Inquiry, described a Trust that did not listen
sufficiently to its patients and staff. The report
made several recommendations surrounding
openness and transparency. Robert Francis also
wrote about the need to develop and share ever
improving means of measuring and understanding
of performance of hospitals.
The Royal Marsden’s Quality Account for the
period 2012/13 is the fourth report published by
the Trust. This Quality Account demonstrates
that the Trust remains focussed on listening to its
patient, carer and staff community. It continues to
strive to improve the quality of care and its services
within the framework of its regulators. The
document also makes clear The Royal Marsden’s
commitment to be an organisation that does
measure and understand its performance, meeting
we believe, a vital recommendation of the Francis
Public Inquiry. Importantly, the Quality Account
sets out detailed quality priorities and targets for
the period 2013/14.
The Patient and Carer Advisory Committee
commend this Quality Account.
Charles McGregor
Chairman of Patient and Carer Advisory Group
Statement from the Council of Governors
on the Quality Account 2012/13
The Council of Governors routinely reviews
information prepared for inclusion in the
Quality Account and has discussed the chosen
priority quality issues at each of the Council of
Governors meetings.
A sub-group of the Council of Governors, the
Patient Experience and Quality Account Group,
has also reviewed feedback from patients,
including from the frequent feedback surveys,
and has influenced the questions used in these
surveys, to reflect patients’ interests.
Governors agreed the process for developing and
selecting priorities for quality improvement and
have met with patient, carer and public members
at two Members’ Events, in July and November
2012. At these meetings, round table discussions
were held to obtain members’ views on current
and future areas relating to patient safety, clinical
effectiveness and patient experience. The results
were then formulated into priority topics for
inclusion in the forthcoming Quality Account
and submitted to the full Council of Governors
for approval.
Dr Carol Joseph, Public Governor for Kensington
and Chelsea served as the representative from
the Patient Experience and Quality Account
Group, which was responsible for monitoring the
development of the Quality Account throughout
the year.
The Royal Marsden strives to improve the
presentation of data each year to make the Quality
Account, now in its fourth year of publication,
more succinct, interesting, and readable by
the general public as well as by healthcare
professionals. This year the Group of Governors
have seen a considerable improvement in the
layout of the information, making it easier to read
and digest.
Based on their involvement and the feedback they
have received from members and other patients
and carers, Governors endorse the key priorities
for improvement as set out in the Quality Account.
Dr Carol Joseph
Public Governor for Kensington and Chelsea
66
Annual Report and Accounts 2012/13
Statement from NHS South West
London on the Quality Account
The Quality Account shows and reflects the
huge amount of effort and commitment from
all in the organisation to improve the quality
of services in an already highly performing trust.
It should give great assurance to all who use
The Royal Marsden.
Dr Tony Brzezicki
Chair of The Royal Marsden Clinical Quality
Review Group
Healthwatch Central West London response
to The Royal Marsden NHS Foundation
Trust Quality Account 2012/13
Healthwatch Central West London (CWL)
welcomes the opportunity to comment on
The Royal Marsden NHS Foundation Trust’s
Quality Account (QA) 2012/13.
Prior to the commencement of Healthwatch (April
2013), K&C LINk Cancer sub group had ongoing correspondence with The Royal Marsden
throughout 2012/13 with RMFT represented on the
cancer sub-group.
We would like to commend the Trust for their work
on VTE risk assessment; however we would also
like the Trust to further outline whether or not they
intend on implementing thrombosis alert cards for
outpatient and day patients.
Healthwatch CWL would like clarity about how
the Trust intends on monitoring the use of Holistic
Needs assessment (HNA) as there is a seemingly
low compliance rate of 38%. There does not seem
to be a plan outlined to clarify what the trust will
be implementing to review the leaflet, its ease of
use, accessibility nor whether it addresses low and
no literacy issues.
Whilst we commend the trust for consistently
low readmission figures, the figure for July 2012
(22) shows a significant increase upon previous
months, we would like the trust to explain further
what remedial process was put into place to
alleviate this from recurring.
Healthwatch CWL would like to suggest that the
new patient experience leaflets outlined in priority
8 for patient experience are co-produced between
the Trust and patients.
Healthwatch CWL very much looks forward
to continuing our strong working relationship
with The Royal Marsden NHS Foundation
Trust in 2013/14, particularly engaging with
patients and members to take part in the new
PLACE assessments.
Note: For further information on this statement please contact
Melanie Christodoulou, Interim coordinator, Healthwatch CWL on
email: [email protected] or call 020 8968 7049
67
The Royal Marsden NHS Foundation Trust
Statement from Sutton Health and Wellbeing Board on the Quality Account
Page number*
Comment(s)
24 second bullet point
“across almost all”: can you clarify use of “almost” (or express as a
percentage) explaining why those areas which are not audited are not part
of the scheme.
34
Is the target sufficiently stretching when performance has substantially
achieved it?
36/37
With the low response rates for some conditions have you undertaken any
work to try to understand why? Is it that the process could be more sensitive
to patient needs / is the form too off-putting or complicated? Are staff at
some locations using better techniques to get better responses? Are some
conditions ‘naturally’ more likely to generate a response?
The quarterly response rate figures deteriorate quite significantly in quarter
3 of 2012/13 (and were below target). Some explanation or comment on this
would be helpful.
It would be helpful for the narrative to make some comment on these figures.
Particularly in light of the comments above the actions planned are
expressed in too general a fashion.
38
This section would benefit from more narrative explanation particularly of
the high and low months of July and December and some comment on what
might be done to rectify.
42
The fact that a full third of patients were not told how long they would have
to wait is concerning. As well as the other planned actions could you also
consider offering indicative waiting times so that people would at least have
some guide.
44/45
The fact that just under and just over a quarter of patients could not find
someone to talk to about worries and fears (Q34) and were told about side
effects (Q56) is concerning. Further narrative explaining what is being done
to improve these areas would be helpful.
52
Targets for some priorities need to be expressed more robustly e.g. Priority 5
should set a new target value (see also point above re p.34) as a percent not
simply to improve on the value set last year. See also Priorities 6 and 7.
62
Is it possible to provide some explanation and comments on improvement
actions in relation to the significant increase in errors between 2010/11
and 2011/12 for ‘primary procedure code errors’ and ‘second procedure
code errors’.
Councillor Mary Burstow
Chair Sutton Health and Wellbeing Board
*Sutton Health and Wellbeing Board commented on a draft of the Quality Accounts dated 25 March 2013.
The page numbers have been adjusted to correlate with this final version.
68
Annual Report and Accounts 2012/13
Response from Merton Clinical Commissioning
Group to The Royal Marsden NHS
Foundation Trust Quality Account
Merton Clinical Commissioning Group reviewed
the Quality Account from The Royal Marsden
NHS Foundation Trust at its Clinical Quality
Meeting on 12 April 2013. Merton CCG is the
host commissioner for the Sutton and Merton
Community Services and commissions this
community contract on behalf of Sutton CCG and
the London Boroughs of Sutton and Merton and
Public Health & the NHS England.
Merton CCG recognises that the quality account
covers both the acute hospital and community
services, however we will comment solely on
the community services aspect of the report.
We recognise that much of the content of the
quality account is mandated by the Department
of Health and we regret that this makes some of
the document rather technical and therefore less
accessible to the lay reader. In terms of clinical
care, the CCG was pleased to see the focus both
on the very young and the elderly, with schemes
relating to preventing pressure ulcers, choice
of place of death and improving support to
mothers after birth. We also welcome the focus
on improved immunisation and vaccination take
up rates for 2013/14.
Within the CCG, our GPs are very keen for the
local district nursing teams and other allied
health professionals to work with them in a closer
and more responsive and integrated way than
has been the case over the last two years. To
this end, we have asked The Royal Marsden to
present their development plans for the community
service to the CCG for discussion. We will be
monitoring progress in achieving the targets
set out in this quality account – as well as more
general improvement goals – closely over the
forthcoming year.
Jenny Kay
Director of Quality
Eleanor Brown
Chief Officer
69
The Royal Marsden NHS Foundation Trust
Appendix 3
Statement of Director’s
responsibilities in respect
of the Quality Account
The Directors are required under the Health
Act 2009 and the NHS (Quality Accounts)
Regulations 2010 to prepare Quality Accounts for
each financial year. Monitor has issued guidance
to NHS Foundation Trust Boards on the form
and content of annual quality reports (which
incorporate the above legal requirements) and on
the arrangements that Foundation Trust Boards
should put in place to support the data quality for
the preparation of the Quality Account.
In preparing this Quality Report directors have
taken steps to satisfy themselves that the content
of the Quality Report meets the requirements set
out in the NHS Foundation Trust Annual Reporting
Manual 2012/13.
The quality of the Quality Report is consistent
with internal and external sources of
information including:
–– Board minutes and papers for the period
April 2012 to May 2013
–– Papers relating to quality reported to the Board
over the period April 2012 to May 2013
–– Feedback from the commissioners dated
25 April 2013
–– Feedback from the Governors through the
Council of Governors throughout the year
dated 15 April 2013
–– Feedback from Healthwatch Central West
London (during 2012/13 known was Kensington
and Chelsea Local Involvement Network)
dated 15 April 2013
–– The Trust’s complaints report published
under regulation 18 of the Local Authority
Social Services and NHS Regulations 2009,
dated 24 April 2013
–– The 2012 national in-patient survey results
–– The 2012 national staff survey
–– The Head of Internal Audit’s annual opinion
over the Trust’s control environment dated
29 May 2013
70
–– CQC quality and risk profiles throughout
April 2012 to March 2013
–– The Quality Report presents a balanced picture
of The Royal Marsden NHS Foundations Trust’s
performance over the period covered
–– The performance information reported in the
Quality Report is reliable and accurate
–– There are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality Report, and
these controls are subject to review to confirm
that they are working effectively in practice
–– The data underpinning the measures of
performance reported in the Quality Report
is robust and reliable, conforms to specified
data quality standards and prescribed
definitions is subject to appropriate scrutiny
and review; and the Quality Report has been
prepared in accordance with Monitor’s annual
reporting guidance (which incorporates the
Quality Accounts regulations) published at
www.monitor-nhsft.gov.uk/annual reporting
manual as well as the standards to support
data quality for the preparation of the Quality
Report (available at www.monitor-nhsft.gov.uk/
annualreporting manual).
The directors confirm to the best of their knowledge
and belief they have complied with the above
requirements in preparing the Quality Report.
By order of the Board
Mr R. Ian Molson
Chairman
19 June 2013
Cally Palmer CBE
Chief Executive
19 June 2013
Annual Report and Accounts 2012/13
Appendix 4
Independent
Assurance Report
Independent Auditor’s Report to the Council
of Governors of The Royal Marsden NHS
Foundation Trust on the Quality Report
We have been engaged by the Council of
Governors of The Royal Marsden NHS
Foundation Trust to perform an independent
assurance engagement in respect of
The Royal Marsden NHS Foundation Trust’s
Quality Report for the year ended 31 March 2013
(the “Quality Report”) and certain performance
indicators contained therein.
This report, including the conclusion, has been
prepared solely for the Council of Governors of
The Royal Marsden NHS Foundation Trust as
a body, to assist the Council of Governors in
reporting The Royal Marsden NHS Foundation
Trust’s quality agenda, performance and activities.
We permit the disclosure of this report within the
Annual Report for the year ended 31 March 2013,
to enable the Council of Governors to demonstrate
they have discharged their governance
responsibilities by commissioning an independent
assurance report in connection with the indicators.
To the fullest extent permitted by law, we do not
accept or assume responsibility to anyone other
than the Council of Governors as a body and
The Royal Marsden NHS Foundation Trust for our
work or this report save where terms are expressly
agreed and with our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March 2013
subject to limited assurance consist of the national
priority indicators as mandated by Monitor:
–– Clostridium difficile;
–– Maximum 62 day waiting time from urgent GP
referral to treatment for all cancers.
We refer to these national priority indicators
collectively as the “indicators”.
Respective responsibilities of the Directors
and auditors
The Directors are responsible for the content and
the preparation of the Quality Report in accordance
with the criteria set out in the NHS Foundation
Trust Annual Reporting Manual issued by Monitor.
Our responsibility is to form a conclusion, based
on limited assurance procedures, on whether
anything has come to our attention that causes us
to believe that:
–– the Quality Report is not prepared in all material
respects in line with the criteria set out in the
NHS Foundation Trust Annual Reporting Manual;
–– the Quality Report is not consistent in all
material respects with the sources specified in
the guidance; and
71
The Royal Marsden NHS Foundation Trust
–– the indicators in the Quality Report identified as
having been the subject of limited assurance in
the Quality Report are not reasonably stated in
all material respects in accordance with the NHS
Foundation Trust Annual Reporting Manual and
the six dimensions of data quality set out in the
Detailed Guidance for External Assurance on
Quality Reports.
We read the Quality Report and consider whether
it addresses the content requirements of the NHS
Foundation Trust Annual Reporting Manual, and
consider the implications for our report if we
become aware of any material omissions.
We read the other information contained in
the Quality Report and consider whether it is
materially inconsistent with the documents
specified within the detailed guidance. We
consider the implications for our report if we
become aware of any apparent misstatements or
material inconsistencies with those documents
(collectively the “documents”). Our responsibilities
do not extend to any other information.
We are in compliance with the applicable
independence and competency requirements of
the Institute of Chartered Accountants in England
and Wales (ICAEW) Code of Ethics. Our team
comprised assurance practitioners and relevant
subject matter experts.
72
Assurance work performed
We conducted this limited assurance engagement
in accordance with International Standard
on Assurance Engagements 3000 (Revised) –
“Assurance Engagements other than Audits or
Reviews of Historical Financial Information”
issued by the International Auditing and
Assurance Standards Board (“ISAE 3000”).
Our limited assurance procedures included:
–– Evaluating the design and implementation of the
key processes and controls for managing and
reporting the indicators
–– Making enquiries of management
–– Testing key management controls
–– Limited testing, on a selective basis, of the
data used to calculate the indicator back to
supporting documentation
–– Comparing the content requirements of the
NHS Foundation Trust Annual Reporting Manual
to the categories reported in the Quality Report
–– Reading the documents.
A limited assurance engagement is smaller in
scope than a reasonable assurance engagement.
The nature, timing and extent of procedures
for gathering sufficient appropriate evidence
are deliberately limited relative to a reasonable
assurance engagement.
Annual Report and Accounts 2012/13
Limitations
Conclusion
Non-financial performance information is
subject to more inherent limitations than
financial information, given the characteristics
of the subject matter and the methods used for
determining such information.
Based on the results of our procedures, nothing
has come to our attention that causes us to believe
that, for the year ended 31 March 2013:
The absence of a significant body of established
practice on which to draw allows for the selection
of different but acceptable measurement
techniques which can result in materially different
measurements and can impact comparability. The
precision of different measurement techniques may
also vary. Furthermore, the nature and methods
used to determine such information, as well as the
measurement criteria and the precision thereof, may
change over time. It is important to read the Quality
Report in the context of the criteria set out in the
NHS Foundation Trust Annual Reporting Manual.
The scope of our assurance work has not included
governance over quality or non-mandated
indicators which have been determined locally by
The Royal Marsden NHS Foundation Trust.
–– the Quality Report is not prepared in all material
respects in line with the criteria set out in the
NHS Foundation Trust Annual Reporting Manual;
–– the Quality Report is not consistent in all
material respects with the sources specified
in the guidance; and
–– the indicators in the Quality Report
subject to limited assurance have not been
reasonably stated in all material respects in
accordance with the NHS Foundation Trust
Annual Reporting Manual.
Deloitte LLP
Chartered Accountants
St Albans
20 June 2013
73
The Royal Marsden NHS Foundation Trust
Sustainability/climate change report
Sustainability is an integral part of delivering high quality healthcare efficiently and
The Royal Marsden continues to be committed to conducting all aspects of its activities
with due consideration to the wider financial, social and environment impacts.
Adaptation to climate change will pose a challenge to both service delivery and infrastructure
in the future. It is therefore appropriate that the Trust considers it when planning how we will best
serve patients in the future.
Carbon and energy management
The Trust’s Carbon Management Plan continues to provide the framework for our environmental agenda
for the last and coming years up to 2015/16 with its goal of achieving 26% carbon savings on a 2010/11
baseline year of 13,350 tonnes of CO2.
The chart below shows the Trust’s carbon reduction progress against its target Carbon Management
Plan and shows that we are on programme due to better energy monitoring and control, fine tuning of
our BMS system and optimisation of plant room pumps which has also resulted in savings.
Carbon progress against target
BAU
Target emissions
Carbon plan emisssions
Actual emmissions
18
16
Per 1,000 tonnes CO 2
14
12
10
8
6
4
2
0
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
Further Carbon Management Plan projects that are in progress at the moment that will result in further
carbon emission saving in the financial year 2013/14 are:
–– The Combined Heat and Power Plant at our Sutton site which is due to go on line by the end of April
2013 which will save in the region of 4,168 tonnes of carbon emissions
–– Upgrade of interior and external lighting at the Sutton site which completed at the end of March 2013
with an estimated saving of 400 tonnes of carbon emissions.
Both these schemes will also produce a substantial monetary saving on energy costs which will be
reinvested in patient care through better environmental facilities.
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Annual Report and Accounts 2012/13
Good Corporate Citizen
The Trust registered with the Good Corporate Citizen (GCC) assessment model during 2012/13 which
allows organisations to score themselves against a range of questions to assess progress on sustainable
development. The assessment was divided into six sections with the Trust’s score against each section
shown in the table below.
This gave the Trust an average score of 50% however as demonstrated by the table the Trust is ahead of
time in most sections.
Travel
46%
Procurement
7%
Facilities
management
48%
Workforce
70%
Community
engagement
57%
Buildings
70%
2012
2015
2020
Governance
The Trust has a Sustainable Development Management Plan which we continue to implement and
update through the Carbon Management Programme Board to ensure that we fulfil our commitment
to conducting all aspects of our activities with due consideration to sustainability whilst providing an
excellent quality of patient care.
Travel and transport
The Trust continues to promote healthy travel to work for its staff through walking and cycling and is at
present going for Stage 3 of the London NHS Cycling Scheme. It also promotes a car sharing scheme for
staff which helps to reduce carbon emissions on staff travelling to work.
The Trust also continues to encourage the use of its extensive video conferencing equipment in an
effort to reduce its need to travel between hospital sites.
The Trust has also just taken delivery of its first electrically powered vehicle for use in the
Estates Department.
75
The Royal Marsden NHS Foundation Trust
Sustainability Performance Summary
The figures in the table 1 below are based upon the Trust’s Carbon Footprint data and shows comparison
between data for the years 2011/12 and 2012/13 as determined under the Trust’s Carbon Management
Plan using the Green house Gas Protocol. Table 2 shows performance against key growth metrics.
Table 1: Summary of performance (water, gas, electricity and waste) April 2012/13
Area
Data
2011/12
Data
2012/13
Cost (£)
2011/12
Cost (£)
2012/13
tonnes
tonnes
£
£
1210
1078
353,760
319,733
High temperature
disposal waste
weight
173
166
152,590
149,645
Non burn
treaement
(alternative
treatment
plant) disposal
waste weight
155
171
60,970
66,938
Landfill disposal
waste weight
290
15
33,030
5,000
7
5
3,360
1,150
585
720
103,810
97,000
22,486,095 kWh
25,803,221 kWh
£592,421
£838,304
17.257,791 kWh
18,766,643 kWh
£1,717,892
£1,812,100
77,771 m3
94,858m3
£126,830
£2,650,404
13,573tCO2
14,582tCO2
Waste Minimisation & Management
Total waste
weight
Waste electrical
& electronic
equipment
(WEEE) weight
Waste recovery/
recycling volume
Finite resources
Gas
Electricity
Water
Green House Gas Emissions
Electricity &
Gas Scope 1 & 2
CO2 Emissions
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Annual Report and Accounts 2012/13
Table 2: Performance against key growth metrics
2010/11
2011/12
2012/13
12,886
13,573
14,582
7.4%
5.3%
7.4%
£257,887,000
£311,587,000
£320,203,000
4.40%
20.80%
2.8%
4.997
4.356
4.55
57,939
57,955
61,840
% increase in Area
5.4%
0.0%
6.7%
Tonnes of CO2 Emissions per m2 Building Area
0.222
0.234
0.238
334,984
349,845
367,585
0.038
0.039
0.040
Tonnes of CO2 Emissions
% increase in emissions over previous year
Trusts Yearly Revenue (£)
% increase in Revenue
Tonnes of CO2 Emissions per £100k of revenue
Trusts Building Area m2
Patient Attendances
Tonnes of CO2 Emissions per patient attendance.
Whilst the Trust and its partners are committed to sustainability, it is not just about achieving carbon
reduction targets – it goes beyond just measuring carbon.
A sustainable health and care system is achieved by delivering high quality care and improved public
health without exhausting natural resources or causing severe ecological damage. This can more easily
be achieved by ‘engaging’ with all concerned parties which the Trust will seek to enhance.
The Trust, in line with business as usual, has increased its carbon emissions, however the area of the
Trust, due mainly to the construction of a new Centre for Molecular Pathology has increased by 6.7%,
with revenue increasing by 2.8% and patient attendances by 5.1%.
Waste recycling continues to increase with waste to landfill reducing to our target of zero to landfill.
Future direction
The coming financial year will provide us with an excellent opportunity to further embed sustainability
into the Trust as we hope to embark on a further large capital development at the Sutton hospital site
which will allow the possibility of low or zero carbon technologies to be included at the very beginning
of the project.
We anticipate seeing good environmental and financial returns from a number of initiatives which are
being planned at present which include;
–– The installation of a Combined Heat & Power Engine at our Chelsea site which will supply electricity
and heat at a reduced cost, reduce our carbon emissions and allow the removal of very old inefficient
steam boilers
–– Replacement of inefficient interior lighting with energy saving LED lamps through an LED Lighting
Project at the Chelsea site which will give an estimated saving of 125 tonnes of carbon emissions.
† All figures shown in this report are accurate at time of writing.
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The Royal Marsden NHS Foundation Trust
Our workforce
The Trust employed 3,783 staff as at 31
March 2013. The breakdown by staff group
is detailed below.
Clinical
Assistants
8%
Physicists,
Biomedical
Scientist
4%
Pharmacists
& Technicians
4%
Nursing
33%
The HR function provides a comprehensive
service across the full range of specialist areas.
All departments have key performance indicators
and performance is monitored to ensure the best
fir and contribution to the business. Considerable
work has continued over the last year to further
modernise and improve the quality of several key
services within the HR function.
AHP
12%
Ancillary
6%
Medical
10%
Our people are our most important resource. The
Trust has monitored performance against plan for
key human resources (HR) performance indicators
on a monthly basis. Key indicators have included
turnover, vacancy levels, sickness and agency
spend. A comprehensive balance scorecard is in
place which measures additional indicators such
as total remuneration costs, human capital ROI,
skill mix, e.g. ratio of nursing and clinical staff
as a percentage of total staff, productivity and
staff engagement. There continues to be good
performance against all indicators.
Admin
& Clerical
23%
Recruitment
As part of the Resourcing Strategy, the number
of assessment centres has increased through a
planned programme. This approach strengthens
the selection process and supports the hiring
of high calibre staff through more robust
assessment methods.
Some routine elements of the recruitment
process have been outsourced which has allowed
the recruitment team to provide more focus on
elements relating to patient safety such as
pre-employment checks.
The new online recruitment management
system has been well received by managers and
applicants and further benefits of the system will
be realised over the next year.
Employee relations
The department has supported an increased
number of organisational change programmes this
year resulting from new ways of working and the
introduction of new technologies.
People management policies have been shortened
and made simpler where possible, recognising
we need responsive processes that support
service needs.
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Annual Report and Accounts 2012/13
Staff benefits
The Annual Staff Survey
The Trust recognises the need to value and reward
its people appropriately and continues to offer a
range of staff benefits. Online reward statements
are available where staff can see the breakdown
of all benefits in addition to pay. These include an
on-site nursery, childcare vouchers, emergency
childcare cover and holiday play schemes.
The national staff survey identifies the extent to
which staff feel motivated and engaged with their
work as well as areas that the Trust can focus on
to improve staff experience.
Workforce information
A number of new initiatives have been introduced
this year. These include electronic HR forms which
will support a reduction in overpayments and a
new managers integrated workforce report which
will give managers the information they need to
help manage their staff in one report.
Our new Human Resources and Organisational
Development Service (HROD)
The 2012 survey showed that the overall
engagement of Trust staff is better then average,
scoring 3.95 out of 5. In addition 83% of staff feel
satisfied with the care they deliver, an increase
from 77% last year.
How members of staff rate the care that the
organisation provides can be a meaningful
indicator of the quality of care and a helpful
measure of improvement over time. The 2012/13
staff survey results showed that the Trust staff
scored 4.1 out of 5 that they would recommend
the Trust as a place of treatment.
While we have improved our services over recent
years we believe that a different type of service is
now necessary so that we can more proactively
support and respond to business needs. We asked
our stakeholders what they need from an HROD
service and worked with them during 2012/13 to
develop our new HROD service model. Our new
model was launched in April 2013.
Key to the new HROD Service is an HR Business
Unit with HR Business Partners. The HR Business
Unit works closely with senior leaders in the
divisions. They act as strategic partners, creating
and delivering value added workforce interventions
that support patient care, business objectives and
workforce productivity. The HR Business Unit
works with a team of specialist HR practitioners
and the HR services manager who oversees all
transactional services. The HR Services Team
delivers services for recruitment, temporary
staffing, workforce information and training
administration. A team of HR Services Advisers
answer all new enquiries into the service, acting
as a single reference point for managers.
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The Royal Marsden NHS Foundation Trust
Summary of performance
NHS Staff Survey
Overall performance in many aspects of the staff survey continues to be positive. The staff survey
format has changed slightly this year with fewer key findings measured. The majority of scores (24/28)
are either average or better than average in comparison to acute specialist Trusts, with 10 out of the 28
findings being better then average at The Royal Marsden. The overall score for staff engagement was
3.95 (out of five).
Table 1 – Response rate
2011/12
Response rate
2012/13
Trust
National
average
Trust
National
average
57
54
58
52
Table 2 – Top 5 ranking scores
2011/12
2012/13
Trust
National
average
Acute
specialist
average
Trust
National
average
Acute
specialist
average
Key finding 6
Percentage of staff receiving
job relevant training,
learning or development
in the last 12 months
83
78
77
85
81
81
Key finding 15
Fairness and effectiveness
of incident reporting
procedures
3.7
3.45
3.53
3.68
3.5
3.60
Key finding 14
Percentage of staff reporting
errors, near misses or
incidents witnessed
in the last month
98
96
96
96
90
92
Key finding 4
Effective team working
3.86
3.72
3.73
3.87
4
3.77
Key finding 9
Support from immediate
managers
3.84
3.84
3.64
3.78
3.85
3.69
The top five ranking scores show that the staff feel supported by their line managers and that they are
an integral part of an effective team.
The Trust staff continue to put patient care at the centre and report incidences to ensure they can
be managed and care improved.
Staff development needs have continued to be met and relevant learning accessed consistently.
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Annual Report and Accounts 2012/13
Table 3 – Bottom 5 ranking scores
2011/12
2012/13
Trust
National
average
Acute
specialist
average
Trust
National
average
Acute
specialist
average
Key finding 5
Percentage of staff
working extra hours
72
65
67
78
70
72
Key finding 19
Percentage of staff
experiencing harassment,
bullying or abuse from
staff in last 12 months
11
15
14
24
23
23
Key finding 7
Percentage of staff appraised
in the last 12 months
81
80
81
74
83
83
8
13
10
10
12
8
83
79
83
75
72
76
Key finding 28
Percentage of
staff experiencing
discrimination at work
in the last 12 months.
Key finding 10
Percentage of staff receiving
health and safety training
in the last 12 months
For key findings 5, 7 and 10 the change is statistically significant in comparison to last years results.
The 24% percent of staff experiencing harassment, bullying or abuse from staff in last 12 months is a
concern and does not reflect the number of complaints received that are investigated. Work will continue
to promote the Trust mechanisms to support people feeling bullied and harassed including the promotion
of the workplace adviser service, occupational health and the staff support facilitators.
It is also disappointing that staff are still working additional hours despite recent promotion of work life
balance initiatives including flexible working options. However, the majority of staff are working no more
then five additional hours per week.
The staff receiving equality and diversity training over past 12 months has increased by almost 20% in
comparison to 2011. This increase could have influenced the perception of experiencing discrimination.
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The Royal Marsden NHS Foundation Trust
Statement of approach
to staff engagement
The Royal Marsden recognises the importance
and value of having an engaged workforce and
uses a number of mechanisms to ensure staff
engagement and involvement.
Staff are represented on the Trust’s Council of
Governors by Staff Governors, representing
doctors, nurses, other clinical staff and non-clinical
staff. Following a review of the membership of
the Council of Governors in 2012, it is intended
to increase the number of Staff Governors
on the Council in 2013 to ensure appropriate
representation and reflect the size of the workforce.
The Trust’s Consultative Committee meets on a
bi-monthly basis to discuss and receive updates
on the work and performance of the Trust and
issues of concern to union members. Staff side
and other staff representatives sit on the Equality
and Diversity Committee. Staff representatives
continue to meet through the quarterly
Employment Partnership groups. These groups
are the custodians of the Trust’s Employment
Partnership principles, which represent the local
values for the Trust and reflect the principles of the
NHS Constitution and the NHS Staff Pledges. Staff
side and other representatives have been involved
in focus groups and action planning in response to
the staff survey findings.
Occupational Health
The Occupational Health Department (OHD) has
continued its commitment to providing a service
that contributes towards a safe environment
and promotes health and well-being at work.
This commitment is supported by operating
procedures which comply with legislation, policy
and good practice.
The OHD has been working towards accreditation
by the Quality Strategy Standards as part of
the Black Review to establish standards for all
providers of occupational health services which
are designed to improve the quality of OH services.
The occupational health departments works
in closely with other teams within the hospital
including staff support services, infection control
and health and safety.
Activity
–– 24,701 appointments were undertaken by the
OHD of which 9,534 were undertaken for staff
working on The Royal Marsden NHS Foundation
Trust contract
–– The seasonal influenza vaccination programme
is offered to all staff to protect patients staff and
their families
–– Monthly health promotion topics are displayed
on notice boards and on the intranet to
encourage staff to take steps to improve
their health
–– Formal counselling and support services
continue to be available to all staff on request,
via the OHD
–– The Cognitive Behavioural Therapy (CBT)
workshops have continued with an increase in
the number of sessions following the success of
the initial pilot. The workshops are designed to
support self management of normal stressors
and develop resilience but also to enable a more
positive approach towards those employees with
mental health problems requiring additional
support at work
–– Attendance management referrals are a core
OHD activity. Case conferences have increased
to help managers to deal effectively with complex
sickness absence issues
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Annual Report and Accounts 2012/13
–– Self referral for sickness absence is available for
staff who are concerned about their attendance
and want to seek advice on how they might
improve their attendance
–– Fast track physiotherapy is provided for staff
to facilitate appropriate effective intervention for
musculo-skeletal conditions
–– Free travel vaccines are provided for all staff
travelling abroad
–– Travel vaccines are offered to the wider
community at competitive rates.
The OHD continues to take an active role in
promoting the health and well being of all the staff
employed by The Royal Marsden NHS Foundation
Trust. New services are developed where a need
is identified to provide the proactive support to
reduce sickness absence and maintain attendance.
Equality reporting
The Royal Marsden NHS Foundation Trust
believes in providing equality in our services, in
treating people fairly with respect and dignity
and in valuing diversity both as a provider of
cancer health services and as an employer.
Our equality and diversity aims are to:
–– Provide the best healthcare services we can that
are accessible and are delivered in a way that
respects the differing needs of the individual
–– Employ staff who are motivated because they
feel valued for the contributions they make and
the diversity they bring to the Trust, who are well
trained and who reflect at all levels the diversity
of the population the Trust serves
–– Embed our equality and diversity values
into our policies and procedures and our
everyday practice
–– Regularly monitor and report on our Equality
Objectives, on patient and staff information and
on Equality Impact Assessments to evaluate
how we are doing and set goals and actions
in response
–– Ensure that all services procured for the Trust
either directly or indirectly and all staff working
on behalf of the Trust, understand and support
the Trust’s commitment to promoting equality
and diversity in everything we do.
The Equality and Diversity Committee approved
the 2013 Equality Information which is available
on our website. This information is part of our
public commitment to meeting the equality
duties placed on us by legislation and is
updated annually.
The information includes a Workforce Equality
Profile report, a Patient Equality Profile report and
an equality profile of our staff survey findings.
We use this information to inform our decision
making and action planning for equality, diversity
and inclusion.
Our Equality Objectives were developed in the
light of the findings from our Equality Information
and were published in April for the four year
period, April 2012 – March 2016.
A critical part of our Equality Objectives is
ensuring that we continue to undertake equality
analysis for our services and policies and for
any organisational change in order to highlight
potential inequality or discrimination within the
functions of our organisation. Summaries of our
Equality Impact Assessments are published on
our website.
We held an equality week in June and through
this we launched the national Personal Fair and
Diverse Champions campaign and ran round
table sessions with our lesbian, gay, bisexual and
transsexual staff. We also employed the EW Group
to help us explore issues raised through our staff
survey for staff from black and minority ethnic
backgrounds and staff with disabilities and to
raise awareness of these with managers within
the Trust.
This year, as a Stonewall Diversity Champion,
we made a first submission to their Workplace
Equality Index where we were commended for
the progress made to supporting lesbian, gay
and bisexual staff in the workplace.
The Trust is committed to the Disability Two
Ticks symbol and operates a guaranteed
interview scheme to make sure that full and
fair consideration is given to applications from
candidates with disabilities. Our Managing
Absence Policies ensure that where staff become
disabled in the course if employment, we take
active steps and make reasonable adjustments to
enable staff to remain employed. All of our people
management policies apply equally to staff with
and without disabilities.
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The Royal Marsden NHS Foundation Trust
We have reviewed the Equality and Diversity
Committee and Operational Group, to look at
their purpose, responsibilities, membership and
achievements. As a result of this review, two
new Groups will be established – a Diversity
and Inclusion Steering Group and a Stakeholder
Reference Group. The Steering Group will be
responsible for providing the strategic leadership
for driving the equality, diversity and inclusion
agenda across the Trust for patient care and
service development and employment opportunity.
The Stakeholder Reference Group will provide
feedback to the Steering Group from patients
and other service users, staff, trade unions, other
stakeholders and groups that represent people who
share a protected equality characteristic, in order
to inform our priorities and action plans.
Education
The Trust continues with its strong commitment
to the education, training and development of its
staff. We ensure that staff are able to keep upto-date professionally, in order to perform their
roles safely and further develop their knowledge
and skills.
The professional development of clinical staff is
supported with a significant investment for all staff
groups to access external conferences, workshops
and courses as well as internal programmes.
A full range of Continuing Professional
Development (CPD) activities have continued
over the year. These include workshops, journal
clubs, study sessions, use of competency
workbooks, and participation and presentation
of papers and posters in multiple national and
international conferences.
We give support in undertaking some form of
post-graduate education for clinical professional
continues, including a post-graduate Certificate,
Diploma module, Masters course or dissertation
for a PhD.
The Trust also continues to play a key role as a
lead provider of education and training in cancer
and nursing. The Royal Marsden School was one
of a very few education providers in London this
year to gain 100% in NHS London CPD Contract
Performance Monitoring for provision of CPD.
84
Some key activities during the year have included:
–– Dementia education has been a priority during
the year in line with national policy. The Trust
engaged with an NHS London Dementia
Train the Trainer programme equipping eight
members of staff to deliver this training which
is now being rolled out to all clinical staff
–– The Sage and Thyme model of communication
training which enables staff to communicate
effectively with patients, families and carers
who are concerned or distressed is being rolled
out across the organisation. This is intended
to enable staff to recognise psychological
distress, avoid causing psychological harm,
communicate honestly and compassionately and
know when they have reached the boundary of
their competence
–– In response to the pan-London results of
the Cancer Patient Experience Survey in
which patients had rated the way information
was given to them as ‘poor’ or less than
‘excellent’ The Royal Marsden School ran a
study day for Clinical Nurse Specialists and
Senior Allied Health Professionals (AHPs) on
‘information giving’
–– The Trust’s commitment to work-based
learning has been strengthened this year by the
establishment of three new Practice Educators
covering Medicines Management, School
Nursing and Heath Visiting
–– Physics and Radiotherapy ran an IntensityModulated Radiation Therapy (IMRT) Clinical
Practice Teaching Course attended by 120
delegates from all over the country in order to
assist achievement of government targets of 24%
inverse planned IMRT in the treatment of all
radical cancer patients
–– The Royal Marsden School has been involved
in a pan-London programme, sponsored by
Macmillan, to educate staff working in general
settings (District General Hospitals and the
Community) about cancer
–– The Trust has worked with the London
Deanery to meet the Department of Health
targets to increase the numbers of Health
Visitors trained in 2012/13 by doubling the
number of clinical placements for Health Visiting
Students in the community division of the Trust.
Annual Report and Accounts 2012/13
Governance
and membership
After nine years as an NHS Foundation Trust
The Royal Marsden continues to maintain and
develop strong governance arrangements through
the Council of Governors and Trust Board.
The Foundation Trust
Led by the Board of Directors, the Trust is
accountable to the communities it serves via the
Council of Governors who represent the Trust’s
members and the wider public. With the support
and input from Governors, the Trust is able to
meet the needs of its stakeholders and deliver
the Trust’s strategy. The Board of Directors is
responsible for the day-to-day management and
performance of the Trust.
Composition of the Council of Governors
At 31 March 2013 there were 32 seats on the
Council of Governors comprising 21 elected Patient
and Carer, Public, and Staff Governors and 11
appointed Nominated Governors as shown in table
1. The table shows details of their terms of office,
attendance at meetings of the Council of Governors
and the Annual General Meeting in 2012/13.
During the year the Governors approved a process
to reconfigure the composition of the Council
which comes into effect during 2013/14.
The role of the Council of Governors
As set out in the Trust’s constitution, the main
duties of the Council are to:
1. appoint or remove the Chairman and other NonExecutive Directors
2. approve the appointment of the Chief Executive
3. decide the remuneration, allowances and
other terms and conditions of office of the
Non-Executive Directors
4. appoint or remove the Trust’s financial auditor
5. be consulted on the development of the forward
business plans of the Trust and any significant
changes to the healthcare provided by the Trust.
Executive Directors routinely attend the Council of
Governors meetings and Reverend Dame Canon
Sarah Mullally, Non-Executive Director, continued
her role as designated link with the Council.
Through this position, she attended Council
meetings and acted as an additional conduit
between the Council and the Board. This enabled
members of the Board, in particular the NonExecutive Directors, to better understand the views
of Governors and members. Governors are invited
to attend meetings of the Board which held in
public, where they can observe the Non-Executive
Directors carrying out their roles.
Elections and appointments to the Council
of Governors
All Governors hold terms of office for a period of
three years and are eligible for re-election or reappointment to serve a maximum of nine years.
In accordance with the Model Rules for Elections,
elections were held in the following subconstituency classes with respective nominees
and turnout rates as below:
Table 1
Constituency
Nominations
Election
turnout (%)
Patient
South West
London
8
33
Patient
East
Elmbridge
and Mid
Surrey
2
43
Membership
Who can become members of
The Royal Marsden?
Anyone aged 16 years old or over and
lives in England can become a member of
The Royal Marsden. The membership is split into
three constituencies: Patient and Carer, Public, and
Staff, as defined below:
Patient and Carer membership
The Patient and Carer constituency is subdivided
into the four geographical areas of South West
London, Greater London, East Elmbridge and
Mid Surrey, and Elsewhere in England. Anyone
living in these areas who has been a patient at
the Trust within the last five years can become a
Member of the relevant Patient constituency. The
Carer sub-constituency is open to individuals who
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The Royal Marsden NHS Foundation Trust
class themselves as Carers of patients that have
attended the Trust within the last five years and
live in England.
As part of the Trust’s Membership Strategy,
recruitment and engagement activities over the
past year included:
Anyone who has been a patient within the last five
years, aged 16-25 years, can become a member of
the Paediatric and Adolescent sub-constituency.
–– maintaining links with the Trust’s
volunteer service
Public membership
The Public constituency comprises individuals
who live within the three geographical areas of the
Royal Borough of Kensington and Chelsea, London
Boroughs of Sutton and Merton, and Elsewhere
in England.
Staff membership
The Staff constituency comprises individuals
who are employed by the Trust, hold an honorary
contract with the Trust or hold a joint contract
with the Trust and The Institute of Cancer
Research. Staff automatically become members
upon joining the Trust unless they choose to opt
out. The constituency is divided into four staff
groups: Doctor, Nurse, Other Clinical and Other Non-Clinical.
Membership overview
Over the past year membership numbers have
increased from 7,815 to 9,506 and exceeded
the target.
At 31st March 2013 the Trust had 9,506 members,
comprising:
Staff
3,364
Public
4,540
–– utilising marketing tools across both sites to
promote membership and engagement initiatives
across hospital sites
–– supporting Governors to have an active presence
on the hospital sites to meet patients and the
public to discuss membership
–– encouraging existing members to recruit members
–– maintaining the connection with staff who have
left the Trust by transferring their membership
to the public constituency
–– promoting Membership and the work of the
Council to members and the wider public
through RM magazine
–– Two members’ events were held to engage on the
process of the Trust’s Quality Account; provide
tours of new facilities; and updates on the
Trust’s developments.
Contact us
The Foundation Trust Office continues to be the
central point of contact for all Members and the
public who wish to make contact with Governors.
Post
Foundation Trust Office
The Royal Marsden NHS Foundation Trust
Fulham Road
London
SW3 6JJ
Email
[email protected]
Telephone
020 7808 2844 or freephone 0800 587 7673
Patient and carer
1,602
86
The Register of Governors’ interests is held at
the Foundation Trust Office and members of the
public can gain access to this by contacting the
Foundation Trust Office.
Annual Report and Accounts 2012/13
Terms of office and attendance by Governors at meetings of the Council of Governors 2012/13
Governor
Constituency / Organisation
Term of office
End of current term
Meetings attended
total meetings = 5
Miss Stacey Munns
Paediatric and Adolescent
First
June 2014
0
Mrs. Anita Gray
South West London
Third
June 2014
4
Mrs Raelene Salter
South West London
First
June 2012
0 (out of 1)
Mr. Edward Crocker
South West London
Second
June 2015
5
Ms Fiona Stewart
South West London
First
June 2014
5
Mrs. Liz Coyne
South West London
First
June 2015
3 (out of 4)
Dr. James Laxton
East Elmbridge & Mid Surrey
Third
April 2013
5
Mr. Christopher Pelley
East Elmbridge & Mid Surrey
Second
June 2012
1 (out of 1 )
Mr. Simon Spevack
East Elmbridge & Mid Surrey
First
June 2015
3 (out of 4 )
Mrs. Hilary Bateson
Greater London
Second
April 2013
3
Dr. Geoff Harding*
Greater London
Second
April 2013
3
Ms. Vikki Orvice
Elsewhere in England
First
April 2013
3
Mrs. Sally Mason
Elsewhere in England
Third
April 2013
5
Mrs. Lesley-Ann Gooden
Carer
First
April 2013
3
Mr. John Preston
Carer
First
April 2013
2
Mr. John Howard
Carer
First
July 2013
5
Dr Carol Joseph
Kensington and Chelsea
First
June 2014
5
Mr. Anthony Hazeldine
Sutton and Merton
Third
April 2013
5
Mrs Ann Curtis
Elsewhere in England
Second
January 2015
3
Professor Ian Smith
Doctor
Third
April 2013
3
Ms. Lorraine Hyde
Nurse
Second
April 2013
4
Ms. Nina Kite
Other Clinical
First
April 2013
2 (out of 4)
Ms. Kim Andrews
Non Clinical
First
April 2013
3
Mrs Cathy Scivier
Institute of Cancer Research
First
January 2015
4
Dr Chris Elliott
Primary Care Referrer
Second
October 2013
0
Ms. Alison Hill
South West London Cancer Network
First
March 2013
1 (out of 3)
Vacant
West London Cancer Network
n/a
n/a
n/a
Cllr. Robert Freeman
London Borough of Kensington & Chelsea
First
July 2014
4
Dr Martyn Wake
Sutton and Merton PCT
Third
April 2013
0
Vacant
Croydon PCT
n/a
n/a
n/a
Ms. Mable Wu
Kensington and Chelsea PCT
First
July 2012
0 (out of 3)
Vacant
Surrey PCT
Second
October 2013
n/a
Vacant
University Partner
n/a
n/a
n/a
Kate Law
Cancer Research UK (Charity)
First
December 2014
2
Patient Governors
Carer Governors
Public Governors
Staff Governors
Nominated Governors
* Lead Governor appointed for the Council of Governors
Expenses of Governors
The Trust’s expenses policy ensures Governors are appropriately reimbursed for reasonable expenses
incurred in fulfilling their roles. A total expense incurred by the Council of Governors during the year
was £629.90.
87
The Royal Marsden NHS Foundation Trust
Governance
Our board of Directors
The Board of Directors comprises five Executive
Directors, including the Chief Executive and
seven Non-Executive Directors, including the
Chairman. The role of the Board is to provide
effective leadership and set the strategic aims
and vision for the Trust. It is responsible for
ensuring the Trust’s management delivers the
strategy whilst complying with its constitution,
and statutory and regulatory requirements.
The description below of each Director’s
background demonstrates the balance,
completeness and relevance of the skills,
knowledge and expertise that each of the Directors
bring to the Trust. The table on page 93 shows
details of their attendance at meetings and
committees during 2012/13.
Key
R
Member of Remuneration and Terms of
Service Committee
A
Member of Audit and Finance Committee
I
Member of Investment Committee
E
Member of Equality and Diversity Committee
ICR
Member of the Board of Trustees of
The Institute of Cancer Research
QAR
Member of Quality, Assurance and
Risk Committee
88
Mr R Ian Molson
Chairman R ICR (alternate)
QAR I
Ian Molson was appointed Chairman in December
2010. From 1999 to 2004, he was Deputy
Chairman of the Board and Chairman of the
Executive Committee of Molson Inc, a Canadian
public corporation founded in 1786. Between 1977
and 1997, he was employed by Credit Suisse First
Boston, one of the leading investment banking
and securities firms in the world. From 1993 to
1997, he served as co-Head of their Investment
Banking Department in Europe, a position which
encompassed all corporate finance, corporate
advisory, mergers and acquisitions businesses
in Europe, Russia, Africa and the Middle East.
He graduated from Harvard University (AB
Honours) in 1977. Ian is also Chairman of
The Royal Marsden Cancer Charity.
Executive Directors
Miss Cally Palmer
CBE Chief Executive
ICR QAR I
Cally Palmer became Chief Executive of
The Royal Marsden in 1998 and a Trustee of
The Institute of Cancer Research (ICR). Previously,
Cally was Deputy Chief Executive and Director of
Services at the Royal Free Hampstead NHS Trust.
Cally is an MSc graduate in management from the
London Business School, which she gained with
distinction in 1995, and a member of the Institute
of Health Services Management. Cally was
awarded a CBE in 2006 for her contribution
to the NHS.
Dr Shelley Dolan
Chief Nurse
A QAR
Shelley Dolan was appointed to the role of Chief
Nurse at The Royal Marsden NHS Foundation
Trust in June 2007. She was promoted to Chief
Nurse from her position as the first Nurse
Consultant in Critical Care in the UK, a role she
took up at The Royal Marsden in 2000. Shelley
has worked clinically in the field of intensive
care for over 20 years and is a trained Intensive
Care and Cancer Nurse who achieved her MSc in
Cancer Care in 1996 and Doctorate in 2011. She
is also the Vice Chair of the Board of the MHRA
Annual Report and Accounts 2012/13
(DH). In December 2012 Shelley was appointed
as the Associate Clinical Director of the London
Cancer Alliance; and is also on the Membership
Council for the South London and North West
London Local Education Training Boards. Shelley
is a member of the European Oncology Nursing
Society and the International Nurses in Cancer
Care and lectures extensively nationally and
internationally. Her research is in the areas of early
detection of sepsis, acute and critical care of the
cancer patient, patient involvement and experience
of care. Shelley took adoption leave from 1 October
2011 to May 2012.
Dr Liz Bishop
Interim Chief Nurse
A QAR (1 October 2011 – 30 April 2012)
Liz Bishop was appointed Interim Chief Nurse with
effect from 1 October 2011 to cover Shelley Dolan’s
adoption leave. Previously she was Divisional
Director and Divisional Nurse Director for Cancer
Services at The Royal Marsden between January
2009 and October 2011. She has worked in the
NHS since 1982, obtaining a BSc in Nursing, an
MSc in Advanced Clinical Practice and completed
her Doctorate in Clinical Practice in 2009. She has
worked in a variety of clinical settings including
surgery, haematology and oncology, as a Nurse
Consultant and in a range of clinical and general
management roles. From May 2012 she took the
role of Divisional Director for Cancer Services/
Research and Development.
Mr Alan Goldsman
Director of Finance
I A QAR
Alan Goldsman was appointed in 2002 from
Guy’s and St Thomas’ NHS Trust where he was
Deputy Director of Finance. Prior to this, Alan’s
career included four years in senior finance
roles with the health service in New Zealand
and a further four years in the construction
industry and in commercial banking. Alan is a
qualified accountant and has an MSc in Health
Management from City University.
Professor Martin Gore
Medical Director
QAR
Professor Martin Gore qualified in medicine
at St Bartholomew’s Hospital, London in 1974.
He trained in General Internal Medicine for
five years and then was appointed as a Clinical
Scientist at the Ludwig Institute of Cancer
Research (1981-1984). In 1984, he joined the
training programme at The Royal Marsden and
was appointed Consultant Cancer Physician to
The Royal Marsden and Senior Lecturer at the
ICR in 1988 and Professor of Cancer Medicine at
The Institute of Cancer Research in 2002. He is
co-Patron of The Rarer Cancers Foundation and a
Medical Advisor to the Kidney Cancer Association
in the US.
His previous appointments included Chair of
Department of Health’s Gene Therapy Advisory
Committee, President of the UK Melanoma Study
Group, Chair of the NCRI Melanoma Clinical
Studies Group and he was on the Council of the
International Gynecologic Cancer Society and the
Program Committee of the American Society of
Clinical Oncology. He has served on the editorial
boards of several journals, published over 350
articles and edited eight textbooks.
Mr David Probert
Chief Operating Officer
E QAR
David Probert joined The Royal Marsden in
October 2007 as its first Chief Operating Officer.
Having completed his MBA in 1998, David has
worked in a mixture of community and acute
settings including a period of time spent with
the world renowned Institute of Healthcare
Improvement in Boston, USA.
Following his time in the US, David joined Guy’s
and St Thomas’ NHS Trust as a Deputy General
Manager, being promoted to General Manager in
2003. He joined The Royal Marsden having held
the position of Divisional General Manager/Deputy
Divisional Director at Guy’s and St Thomas’
NHS Foundation Trust for almost four years,
looking after a mixture of surgical, specialist and
chronic services.
89
The Royal Marsden NHS Foundation Trust
Non-Executive Directors
The Reverend Canon Dame Sarah Mullally*
Senior Independent Director
A E QAR
The Reverend Canon Dame Sarah Mullally was
Chief Nursing Officer for England/Director of
Patient Experience until September 2004 and
Assistant Curate at Battersea Fields Benefice,
London until September 2006. Following six
years as Rector for the Church of England Team
Ministry in Sutton she became Canon of Salisbury
Cathedral in September 2012. Dame Sarah is the
designated Link Non-Executive Director with the
Council of Governors and was Chair of the Equality
& Diversity Committee until December 2012. She
was appointed Senior Independent Director in
November 2008 and was Acting Chairman from
1-30 November 2010. She stood down as a NonExecutive Director from 31 March 2013.
Mr Gregory Andrews FCA*
A
Greg Andrews joined The Royal Marsden as a
Non-Executive Director on 1 April 2008. He is
Chair of The Royal Marsden’s Audit and Finance
Committee. He spent most of his career in financial
services and held a number of positions at Merrill
Lynch, including that of a Managing Director in the
Wealth Management Division. Since leaving the
City, he has served as Chief Operating Officer of
New Philanthropy Capital from 2002 to 2006 and
as a strategic consultant in financial restructuring
and change management.
Mr Colin Clark*
RA
Colin Clark joined The Royal Marsden as a
Non-Executive Director on 1 May 2005. He has
over 30 years experience in the investment
management industry. Colin previously worked
with Mercury Asset Management and Merrill
Lynch Investment Managers.
Sir John Craven*
R QAR
Sir John Craven joined The Royal Marsden as
a Non-Executive Director on 1 April 2008. He
had a long career in banking culminating in
membership of the Board of Managing Directors of
the Deutsche Bank in Germany. He served as chief
executive and Chairman of Morgan Grenfell from
1989 to 1996 and before that was Vice Chairman of
SG Warburg. After his retirement from banking he
served as non-executive Chairman of Lonmin plc
90
for several years. At an earlier stage in his career
he served as non-executive director of a number
of companies, including Reuters (of which he was
the Senior Independent Director), Societe Generale
de Surveillance and Ducatti SpA. He was also
Chairman of Fleming Family and Partners limited,
an independent privately owned investment house.
He holds both British and Canadian nationality
and was knighted for his services to banking and
to the City.
Professor Alan Ashworth FRS
QAR ICR
Professor Ashworth joined The Royal Marsden
as a Non-Executive Director on 17 January 2011.
He is Chief Executive of The Institute of Cancer
Research, where he is responsible for a major
programme of cancer research which extends from
basic laboratory science through translational
research to clinical implementation. He is a
Professor of Molecular Biology and a Fellow of The
Royal Society.
Mr Richard Turnor*
R QAR A
Richard Turnor joined The Royal Marsden as a
Non-Executive Director on 1 January 2009. He was
a partner with the international law firm Allen &
Overy LLP from 1985 to 2009 where he headed
the Commercial Trust and Partnership Group. In
2010, he established Maurice Turnor Gardner LLP,
an independent firm practising in association with
Allen & Overy LLP from which he continues to
advise professional firms and fund managers on
structuring and constitutional issues including
international structure, disputes, mergers, demergers and governance issues.
* The Non-Executive Directors which the Board considers to
be independent
Members of the public can gain access
to the Register of Directors’ Interests through
the Corporate Affairs Office by emailing [email protected].
Significant commitments of the Trust Chairman
R. Ian Molson is a director of the following
organisations: Alphatec Spine Inc., Cayzer
Continuation PCC Ltd, Central European
Petroleum Ltd (Deputy Chairman), Healthpoint
Capital LLC and Lennox Investment Management.
He is no longer a Director of Maggie’s Oxford
Campaign Board.
Annual Report and Accounts 2012/13
Governance
The work of the Board
The Royal Marsden NHS Foundation Trust’s
Standing Financial Instructions Policy sets out
the powers reserved for the Board of Directors
and the Scheme of Delegation sets out its other
responsibilities.
Decisions taken by the Board include the following:
–– regulations and control
–– appointment and dismissal of committees
–– strategy, business plans and budgets
–– policy determination
–– appointment of internal auditors
–– receipt and approval of the Trust’s Annual
Report and Accounts
–– monitoring and continuous appraisal of the
affairs of the Trust.
Decisions delegated to management include policy
implementation and operational management. The
Trust’s Management Executive (ME) meets every
six to eight weeks. ME has two sub-committees,
the Performance Review Group, which looks at key
performance issues, and the Financial Strategy
Group (formerly the Quality and Efficiency Group)
monitors the financial position and drives quality
initiatives across the Trust through efficient
service and working arrangements.
Board of Directors’ balance, completeness
and appropriateness
The Board is satisfied that its current composition
and balance between skills, knowledge and
experience is complete and appropriate to the
requirements of the Trust.
Performance evaluation of the Board of
Directors, its Committees and its Directors
The Chairman is generally appraised annually
through a three stage process led by the Senior
Independent Director. This takes into account
the views of the Board, the Council of Governors
and The Royal Marsden Cancer Charity Trustees.
The Senior Independent Director formally reports
the outcome of these discussions to the Trust
Board and Council of Governors. The Chairman
completed his second year in office at the end
of 2012 and, at the time of writing, the appraisal
process is in progress.
The Chairman conducts an annual appraisal
of Non-Executive Directors. This information
is an important part of the consideration when
an individual is seeking re-appointment. The
Chairman also conducts the Chief Executive’s
appraisal, following discussion with the NonExecutive Directors.
The Chief Executive evaluates the performance of
each Executive Director to ensure continued high
standards of performance and effectiveness, which
is discussed at the Remuneration Committee.
Committees of the Board of Directors
The Audit and Finance Committee
The Audit and Finance Committee is formally
constituted as a sub-committee of the Trust
Board and its main purpose is to independently
contribute to the Board’s overall process for
ensuring that an effective internal control system
is maintained. In particular, the Committee has the
following key objectives:
–– providing confidence in the objectivity and
fairness of financial reporting
–– providing assurance about the adequacy of
internal control
–– safeguarding of assets
–– reducing the risk of illegal or improper acts
–– reinforcing the importance, independence and
effectiveness of internal and external audit.
91
The Royal Marsden NHS Foundation Trust
The Nominations Committee
Remuneration Committee
The Council of Governors has responsibility for
approving the appointment or re-appointment of
the Chairman and other Non-Executive Directors,
as recommended by the Nominations Committee.
The Remuneration Committee met once during
2012/13. Disclosures of the remuneration paid to
members of the Board are provided in the accounts.
Please also refer to the remuneration report.
Membership of the Nominations Committee
comprises:
The Equality and Diversity Committee
–– Chairman (or Vice Chair/Senior
Independent Director)
–– three Non-Executive Directors
–– one Executive Director
–– three Council of Governor representatives
to include one Elected Governor,
–– one Stakeholder Governor and one
Staff Governor.
Within the above membership, those attending
particular meetings will vary according to the
business of the meeting, i.e. a Non-Executive Director
would not attend when his/her reappointment is
under discussion. Where remuneration is discussed,
only Council Governors attend.
There was one meeting of the Nominations
Committee during 2012/13. Having agreed
the process, job description and person
specification that ensured the Board maintained
its completeness and balance, the committee
recommended the appointment of Dame Nancy
Hallett as a Non-Executive Director to replace
Reverend Dame Canon Sarah Mullally when
her term expired at the end of the year. The
Council of Governors unanimously approved
the appointment.
Non-Executive Director appointments are for
a term of three years. The removal of a nonexecutive director requires the approval of threequarters of members of the Council of Governors.
Details of the criteria for disqualification from
holding the office of a director can be found in the
Trust’s constitution.
The Quality, Assurance and Risk Committee
The Quality, Assurance and Risk Committee
supports the Trust Board in developing an
integrated approach to governance by ensuring
robust systems to monitor achievements against
objectives. A key focus of the Committee is patient
safety, including infection control.
92
Following a review of the governance
arrangements for equality and diversity in Autumn
2012. A new Equality, Diversity and Inclusion
steering group was formatted under the leadership
of the Director of Workforce and Corporate Affairs.
This will report to the Integrated Governance
and Risk Management Committee and Workforce
Strategy Group, driving the equality, diversity and
inclusion agenda across the Trust for patient care,
service development and employment opportunity.
A new Stakeholder Reference Group will provide
input and feedback to the Steering Group from
patients and service users, staff, trade unions, and
other stakeholders and interest groups.
NHS Foundation Trust Code of Governance –
compliance statement
The Royal Marsden has governance policies
and procedures which support the main and
supporting principles of the NHS Foundation
Trust Code of Governance, which was updated in
April 2010. The Trust Board considers that it was
compliant with the provisions of the Code with the
following exception:
Balance and independence of the Board
of Directors
The Royal Marsden does not comply with the
provision that requires at least half the Board,
excluding the Chairman, comprising NonExecutive Directors determined by the Board to
be independent. This is because one of its NonExecutive Directors, Professor Alan Ashworth, is
not considered to be independent as he is the Chief
Executive of the Trust’s academic partner, The
Institute of Cancer Research.
Annual Report and Accounts 2012/13
Terms of office and attendance at meetings of the Board Directors, Audit and Finance and
Remuneration Committees 2012/13
Name
Role
Board of Directors
Meetings attended
Term of office
End of
current term
Total meetings = 7
R Ian Molson
Chairman (from 1 December 2010)
7
First
30.11.13
Gregory Andrews
Non-Executive Director
7
Second
31.3.14
Liz Bishop
Interim Chief Nurse (covering
Adoption Leave to May 2012)
1 (out of 1)
Colin Clark
Non-Executive Director
5
Third
30.4.14
Sir John Craven
Non-Executive Director
7
Second
31.3.14 (to be
confirmed annually
in March from 2012)
Reverend Canon Dame
Sarah Mullally
Senior Independent Director
7
Third
31.3.13 (standing
down)
Professor Alan Ashworth
Non-Executive Director
6
First
16.1.14
Richard Turnor
Non-Executive Director
7
Second
31.12.14
Cally Palmer
Chief Executive
7
Shelley Dolan
Chief Nurse (from May 2012)
6 (out of 6)
Alan Goldsman
Director of Finance
7
Professor Martin Gore
Medical Director
7
David Probert
Chief Operating Officer
7
Audit and Finance Committee
Total meetings= 4
Gregory Andrews
Chairman of Committee /
Non-Executive Director
4
Liz Bishop
Divisional Director of Cancer
Services/Research and Development
(from May 2012) and Interim
Chief Nurse (until May 2012)
4
Colin Clark
Non-Executive Director
2
Shelley Dolan
Chief Nurse
4
Alan Goldsman
Director of Finance
4
Reverend Dame Canon
Sarah Mullally
Non-Executive Director
4
Richard Turnor
Non-Executive Director
4
Remuneration Committee
Total meetings =1
Sir John Craven
Chairman of Committee /
Non-Executive Director
1
R. Ian Molson
Chairman of the Trust
1
Cally Palmer
Chief Executive
1
Colin Clark
Non-Executive Director
1
Richard Turnor
Non-Executive Director
1
93
The Royal Marsden NHS Foundation Trust
Governance
The Management Executive
Cally Palmer
Chief Executive
Dr. Liz Bishop
Divisional Director of Cancer
Services/Research and
Development (from May 2012)
and Interim Chief Nurse
(October 2011 – April 2012)
Nicky Browne
Director of Performance and
Strategy Implementation
Gary Burkill
Head of Facilities
Anne Carey
Project Director (Strategic
Planning) (to August 2012)
Mick Carey
Assistant Director of Projects
(Estates)
Professor David Cunningham
Director of Clinical Research
and Development (from
October 2012)
Dr. Shelley Dolan
Chief Nurse (returned from
Adoption Leave, May 2012)
94
Adam Doyle
Divisional Director, Sutton
and Merton Community
Services (to September 2012),
Director of Private Care (from
September 2012)
Alan Goldsman
Director of Finance
Professor Martin Gore
Medical Director
Ian Haig
Divisional Director of Clinical
Services (to January 2013)
Kerensa Heffron
Director of Business and Private
Practice (on maternity leave from
September 2012)
Professor Stephen Johnston
Director of Clinical R&D
(to September 2012)
David Probert
Chief Operating Officer
Jon Reed
Director of ICT (to June 2012)
Rachael Reeve
Director of Marketing and
Communications
Colin Rickard
Director of Capital Projects
Jonathan Spencer
Divisional Director of Clinical
Services (from January 2013)
Deborah Tarrant
Director of Workforce and
Corporate Affairs
Sunil Vyas
Deputy Director of Projects,
Director of Project and Estates
(from January 2013)
Sarah Wright
Interim Divisional Director,
Sutton and Merton Community
Services (from September 2012)
Annual Report and Accounts 2012/13
Regulatory Ratings Report
Monitor uses a risk-based framework to guide the intensity of its monitoring and indicate any concerns
which may cause a breach of the terms of the Trust’s authorisation. This covers three areas:
–– Financial Risk Rating
–– Governance Risk Rating
–– Mandatory Services
Financial risk is based on indicators including delivery of plan, operating margin, return on assets
and liquidity to provide a weighted metric rated 1 (highest risk) to 5.
Governance risk is derived from factors including performance against national targets and indicators,
and Care Quality Commission registration and ongoing performance against registration requirements.
The metrics are graduated using green (lowest risk), amber-green, amber-red, and red (highest risk)
The mandatory services rating assesses the provision of mandatory goods and services set out in
the terms of authorisation and is measured on a similar scale to the governance risk rating.
The tables below set out the Trust’s quarterly performance in 2011/12 and 2012/13 against its
annual plan.
Financial
Risk Rating
Annual Plan
2011/12
Q1
2011/12
Q2
2011/12
Q3
2011/12
Q4
2011/12
3
3
3
3
3
Annual Plan
2012/13
Q1
2012/13
Q2
2012/13
Q3
2012/13
Q4
2012/13
4
4
4
4
4
Governance
Risk Rating
Mandatory
Services
Rating
Financial
Risk Rating
Governance
Risk Rating
Mandatory
Services
Rating
There have been no deviations from the plan in year and no requirements for intervention by Monitor.
95
The Royal Marsden NHS Foundation Trust
Directors’ Report
The Directors present their report and audited
financial statements for the year to 31 March
2013. The names of the individuals who were
directors of the NHS Foundation Trust during the
year are reported on page 88.
Principle activities
The Trust’s principle activity is the provision of
healthcare services to patients.
Disclosure of information to auditors
As far as each of the Directors are aware, there
is no relevant audit information of which the
auditors are unaware. Each Director has taken all
the steps a Director ought to have taken to make
themselves aware of any relevant audit information
and to establish that the auditors are aware of
such information.
Auditors
–– Chairman’s and Chief Executive’s statement
on pages 4 to 5
The Trust’s appointed external auditors are
Deloitte LLP. The auditors provide audit services
comprising carrying out the statutory audit of the
Trust’s annual accounts and the use of resources
work as mandated by the Healthcare Commission,
and a review of the Quality Accounts. The
cost of this services in 2012/13 was £82,000
(2011/12 £80,000).
–– The Financial Review on pages 99 to 101.
Cost allocation and charging requirements
In addition to this, other information relevant to the
NHS Foundation Trust’s activities are set out in
the other sections of this document.
The Trust has complied with the cost allocation
and charging requirement set out in HM Treasury
and office of Public Sector Information Guidance.
Post balance sheet events
Going Concern
There have been no significant events since the
balance sheet date that have had a material impact
on the NHS Foundation Trust.
The Directors have a reasonable expectation that
the NHS Foundation Trust has adequate resources
to continue in operational existence for the
foreseeable future. For this reason, they continue
to adopt the going concern basis in preparing
the accounts.
Business review
The NHS Foundation Trust’s activities are
reviewed in:
Political and charitable donations
The NHS Foundation Trust has not made any
political or charitable donations this year or in
previous years.
Public sector payment policy
The Trust aims to pay its non-NHS trade creditors
in accordance with the CBI prompt payment code
and government accounting rules. The target is to
pay non NHS trade creditors within thirty days of
receipt of goods or a valid invoices (whichever is
the later) unless other payment terms have been
agreed with the supplier. The Trust also aims to
pay local community suppliers within ten days.
96
Annual Report and Accounts 2012/13
Remuneration report
The Royal Marsden NHS Foundation Trust’s
Remuneration Report describes how the
Trust applies the principles of good corporate
governance in relation to Directors’ remuneration
as required by the Companies Act 2006,
Regulation 11 and Schedule 8 of the Large and
Medium-Sized Companies and Groups (Accounts
and Reports) Regulations 2008 and elements of
the NHS Foundation Trust Code of Governance.
The Remuneration report summarises the
Trust’s remuneration policy and its application
in connection with the Executive Directors and
members of the Management Executive. Details
of the Executive Directors’ remuneration and
pension benefits are set out in the tables within the
Account on page 125. This information has been
subject to audit.
Remuneration Committee
The Remuneration Committee is a sub-committee
of the Trust Board chaired by Sir John Craven,
a Non-Executive Director, with membership
comprising the Trust Chairman, R. Ian Molson,
Colin Clark and Richard Turnor, Non-Executive
Directors. Two meetings were held during this
financial year, attendance at which is shown on
page 87.
The Chief Executive is in attendance to provide
information on Directors. The Director of
Workforce & Corporate Affairs provides general
support and prepares review of general pay and
reward intelligence including comparative data
on Directors’ salaries and NHS guidance on pay
and terms and conditions as requested. Neither
these individuals nor any other executive or senior
manager participated in any discussion relating to
their own remuneration.
Remuneration policy
The Royal Marsden is committed to the
overarching principles of value for money and
high performance. The Trust must attract and
retain a high calibre senior management team
and workforce in order to ensure it maintains
its excellent standards of clinical outcomes and
patient care, functions efficiently and is well
positioned to deliver the business strategy. In
making decisions on remuneration, the Committee
considers the responsibilities and requirements
of the role, time in the role, marketability of the
individual, market rates, the external economic
environment and the performance of the Trust.
The comparative data used to determine market
rates includes high-performing NHS foundation
trusts in London and elsewhere. Reference
is normally made to Incomes Data Services
reports. This is the second year of a two-year pay
freeze set for NHS staff and has been applied at
The Royal Marsden.
Performance of Directors is assessed through
regular appraisal against predetermined objectives.
Non-Executive Directors’ remuneration
Proposals for the remuneration of Non-Executive
Directors are developed by the Nominations
Committee (details of which are set out on
page 92) for approval by the Council of Governors.
Only Governors attend the Nominations
Committee meetings where remuneration is
discussed, with support from the Director of
Workforce & Corporate Affairs. Remuneration
was last reviewed in January 2010 and a position
statement presented to the Council of Governors
in February 2010. In view of the economic climate,
it was not felt appropriate to recommend an
increase in the remuneration of Non-Executive
Directors, although the Committee wished to
record its view that remuneration rates should be
increased in due course, in order to recognise the
significant responsibilities of directors in NHS
foundation trusts and to attract individuals with
the necessary experience and ability to make an
important contribution to The Royal Marsden’s
strategy, business and general corporate affairs.
The Nominations Committee and Council of
Governors did however agree that the Senior
Independent Director should have a higher rate of
remuneration because of the substantial additional
responsibilities attached to the position and
given that this was a relatively new role and one
established since the last remuneration review.
None of the Non-Executive Directors are
employees of the Trust. They receive no benefits
or entitlements other than fees and are not
entitled to any termination payments. The Trust
does not make any contribution to the pensions
arrangements of Non-Executive Directors.
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The Royal Marsden NHS Foundation Trust
Off payroll engagements
Table 1: For off-payroll engagements at a cost of over £58,200 per annum that were in place as
of 31 January 2012
Number in place on 31 January 2012
12
Of which
Number that have since come onto the Organisation’s payroll
1
Of which
Number that have since been re-negotiated/re-engaged to include to include contractual
clauses allowing the (department) to seek assurance as to their tax obligations
1
Number that have not been successfully re-negotiated, and therefore continue without
contractual clauses allowing the (department) to seek assurance as to their tax obligations
3
No. that have come to an end
7
Total
12
Table 2: For all new off-payroll engagements between 23 August 2012 and 31 March 2013, for
more than £220 per day and more than 6 months
Number of new engagements
9
Of which
Number of new engagements which include contractual clauses giving the department the
right to request assurance in relation to income tax and National Insurance obligations
0
Of which
Number for whom assurance has been accepted and received
0
Number for whom assurance has been accepted and not received
0
Number that have been terminated as a result of assurance not being received
0
Total
9
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Annual Report and Accounts 2012/13
Financial Review for the
year ended 31 March 2013
In its ninth year as an NHS Foundation Trust
The Royal Marsden has maintained its excellent
track record of financial performance. The Trust
has met, and in most cases, exceeded its financial
and performance plans for the year.
The accounts show that the Trust generated a
deficit of £3.8m after accounting for the impact
of a technical accounting loss of £14.6m from the
valuation of its estate, and donations for capital
schemes of £8.5m; which under new accounting
rules these are now recorded as income.
The ‘underlying’ surplus after excluding these
changes for valuations and for depreciation on
donated assets is £6.3m; £1.3m more than the
planned surplus of £5m. This result is due to a
combination of factors including strong income
performance, the continued delivery of the
Trust’s efficiency programme, and good financial
discipline and control.
The surplus will be applied to capital development,
in particular to schemes that will enhance services
to patients on both the Chelsea and Sutton sites.
The Trust continues to maintain a strong balance
sheet and cash position. At 31 March 2013 the
Trust held cash deposits of £14.3m, a reduction of
£8.1m from the previous year end. This reduction
reflects capital expenditure of £31m and payment
of the Department of Health Dividend of £4.2m;
funded by increased net cash flow from operations
of £18.6m and from charitable donations towards
capital projects of £8.5m.
Efficiency
In a challenging economic environment the Trust
has continued to deliver its efficiency targets
in 2012/13. This programme of efficiency has
delivered improvements in order to meet NHS tariff
reductions, to support the local health economy
and to provide a surplus of £6.3m for development.
The efficiency programme is comprised of
initiatives which will increase private income with
less, or no, increase in costs and those which
reduce costs with less, or no, reduction in income.
Financing and Investment
The Trust has an authorised Prudential Borrowing
Limit of £57.6m, which excludes a working capital
facility of £21.6m. Because the Trust has maintained
healthy cash flow it has not needed to either borrow
or use its working capital facility to date.
In 2011/12, the Trust Board approved a five-year
capital programme for 2011 – 2016 totalling £121m.
This programme will, for the most part, provide
new assets that are considered ‘protected’ for
the NHS under the Foundation Trust Terms of
Authorisation. During the year the Trust spent
£27.8m of which £8.5m was financed by charitable
donations, with the remainder being funded by
operating surpluses and free cash.
In light of the capital development in the year, a
professional valuation firm completed a valuation
of the Chelsea and Sutton sites as at 31 March
2013. As a result fixed asset values were reduced
by £14.9m; £0.3m related to land and was charged
to the revaluation reserve and the remaining
£14.6m was charged to expenditure since there
was no balance sheet reserve available.
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The Royal Marsden NHS Foundation Trust
Income and Expenditure
Relationships with key stakeholders
In 2012/13 our overall income was £321.4m
(£311.6m in 2011/12). The increase of £9.8m
comprises increases in NHS patient income of
£11.2m and Private Patient income of £8.7m, partly
offset by a reduction in research and charitable
income of £11.8m. However, charitable income will
fluctuate year-on-year due to the scale of capital
schemes funded.
On 1 April 2011 the Trust acquired Sutton and
Merton Community Services following a process
of selection and due and careful enquiry by Sutton
and Merton Primary Care Trust and NHS London,
as part of a process called ‘externalisation’. The
Trust Board conducted its own due diligence
including taking advice from professional advisors.
The Foundation Trust receives the majority of its
patient care income from Primary Care Trusts.
Patient referrals are centred on the Trust’s sites
in London, Sutton and Kingston, but extend from
this local base to cover all of England and beyond,
particularly for referrals for rare cancers.
NHS patient income is supplemented by income
to provide infrastructure and support for research
and development activity and from private patient
income. The margin delivered on our private
patient income remains a vital source of support
for NHS services to patients.
The Health and Social Care Act 2012 introduced a
new requirement that a Foundation Trust’s income
from the provision of goods and services for the
purposes of the health service in England must
be no greater than its income from the provision
of goods and services for any other purpose. The
Trust has met this requirement. In reaching this
assessment the Trust has considered whether an
exchange of goods and services has occurred,
and whether income relates to activities required
under the Act.
The Trust’s overall operating expenditure was
£320.7m (£300.1m in 2011/12) an increase of
£20.1m. The increase is mostly due to staff costs
(£7.4m), drug costs (£5.8m), and £6.9m of other
operating expenses.
100
During the year the Trust has continued to develop
its relationships with its stakeholders including
South West London Acute Commissioning Unit,
Sutton and Merton PCT, Kingston Hospital
NHS Trust and St Georges Healthcare Trust. Its
contracts with Primary Care Trusts are governed
by the legally binding contract introduced as part
of the Foundation Trust reforms. Over the year
the Trust has delivered increased activity for
NHS patients.
The Trust’s relationship with The Institute for
Cancer Research and the Mount Vernon Cancer
Centre to develop a new academic and research
partnership continue to grow stronger with the aim
of increased collaboration and joint working on
trials and research.
Annual Report and Accounts 2012/13
Managing risks
Principle risks and future developments
Finance
The following are regarded as the principle areas
of risk and future development for the Trust:
Over the full year the Trust has consistently
maintained a financial risk rating of four in line
with its plan (where five is the lowest risk and
one is the highest). This means that the Trust
is considered, by Monitor – the Independent
Regulator of NHS Foundation Trusts, to be
medium risk in financial terms. This risk rating
incorporates the key financial performance
indicators for the Trust.
Governance
The Trust is rated green on its governance
arrangements covering compliance with the terms
of authorisation and meeting NHS standards
and targets for performance. The rating is
based on performance throughout the year and
on self-certification; where the Trust Board
has confirmed that all core national healthcare
targets and standard have been met, and that
plans are in place to ensure that they will be met
going forward.
–– The continuation of a deflator for NHS patient
income, slower growth in NHS funding and the
impact of the new commissioning bodies
–– In order to meet its ongoing capital equipping
and development plans the Trust is planning
to increase its surplus, and to reduce financial
risk in order to achieve a financial risk rating
of four. This must be delivered at a time of
economic challenge
–– The Trust has continued to be fully engaged in
the Pan London Cancer Services Review and
with the Better Value, Better Services review
being undertaken in south west London on
behalf of NHS London. It is important that the
Trust’s development strategies can be delivered
within the future direction set out in this policy.
Quality Board statement
The Trust Board has declared that it is satisfied
with its arrangements and will continue to keep in
place arrangements for the purpose of monitoring
and continually improving the quality of healthcare
provided to its patients
Mandatory services
The Trust is rated on its provision of mandatory
services in conjunction with the Healthcare
Commission. The Trust has continued to maintain
its ‘green’ rating from Monitor.
Counter Fraud
The Trust has a counter-fraud officer in place
that proactively reviews the Trust’s counter-fraud
arrangements and follows up on any incidents
reported. There is also a whistle-blowing
procedure in place and available to all staff; all
matters raised are dealt with in confidence.
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The Royal Marsden NHS Foundation Trust
Annual Accounts for the
year ended 31 March 2013
In preparing the accounts, the Accounting Officer
is required to comply with the requirements of the
NHS Foundation Trust Annual Reporting Manual
and in particular to:
Foreword to the accounts
The Royal Marsden NHS Foundation Trust
– observe the Accounts Direction issued by
Monitor, including the relevant accounting and
disclosure requirements, and apply suitable
accounting policies on a consistent basis;
These accounts for the year ended 31 March
2013 have been prepared by The Royal Marsden
NHS Foundation Trust in accordance with
paragraphs 24 and 25 of Schedule 7 to National
Health Service Act 2006.
Cally Palmer CBE
Chief Executive
29 May 2013
Statement of Chief Executive’s
responsibilities as Accounting Officer of
The Royal Marsden NHS Foundation Trust
The National Health Service Act 2006 states
that the Chief Executive is the Accounting
Officer of the NHS Foundation Trust.
The relevant responsibilities of Accounting
Officer, including their responsibility for the
propriety and regularity of the public finances
for which they are answerable, and for the
keeping of proper records, are set out in the
NHS Foundation Trust Accounting Officer
Memorandum issued by the Independent
Regulator of NHS Foundation Trusts (“Monitor”).
Under the National Health Service Act 2006,
Monitor has directed The Royal Marsden
NHS Foundation Trust to prepare for each
financial year a statement of accounts in the
form and on the basis set out in the Accounts
Direction. The accounts are prepared on an
accruals basis and must give a true and fair
view of the state of affairs of The Royal Marsden
NHS Foundation Trust and of its income and
expenditure, total recognised gains and losses and
cash flows for the financial year.
102
– make judgements and estimates on a
reasonable basis;
– state whether applicable accounting standards
as set out in the NHS Foundation Trust Annual
Reporting Manual have been followed, and
disclose and explain any material departures
in the financial statements; and
– prepare the financial statements on a going
concern basis.
The Accounting Officer is responsible for keeping
proper accounting records which disclose with
reasonable accuracy at any time the financial
position of the NHS Foundation Trust and to
enable her to ensure that the accounts comply
with requirements outlined in the above
mentioned Act. The Accounting Officer is also
responsible for safeguarding the assets of the
NHS Foundation Trust and hence for taking
reasonable steps for the prevention and detection
of fraud and other irregularities.
To the best of my knowledge and belief, I have
properly discharged the responsibilities set out
in Monitor’s NHS Foundation Trust Accounting
Officer Memorandum.
Cally Palmer CBE
Chief Executive
29 May 2013
Annual Report and Accounts 2012/13
Annual Governance Statement 2012/13
The Royal Marsden NHS Foundation Trust
1. Scope of responsibilities
As Accounting Officer, I have responsibility for
maintaining a sound system of internal control that
supports the achievement of The Royal Marsden
NHS Foundation Trust’s policies, aims and
objectives, whilst safeguarding the public funds
and departmental assets for which I am personally
responsible, in accordance with the responsibilities
assigned to me. I am also responsible for ensuring
that The Royal Marsden NHS Foundation Trust is
administered prudently and economically and that
resources are applied efficiently and effectively.
I also acknowledge my responsibilities as set
out in the NHS Foundation Trust Accounting
Officer Memorandum.
2. The purpose of the system of internal control
The system of internal control is designed
to manage risk to a reasonable level rather
than to eliminate all risk of failure to achieve
policies, aims and objectives; it can therefore
only provide reasonable and not absolute
assurance of effectiveness. The system of
internal control is based on an ongoing process
designed to identify and prioritise the risks to the
achievement of the policies, aims and objectives
of The Royal Marsden NHS Foundation Trust,
to evaluate the likelihood of those risks being
realised and the impact should they be realised,
and to manage them efficiently, effectively
and economically.
The system of internal control has been in place in
The Royal Marsden NHS Foundation Trust for the
year ended 31 March 2013 and up to the date of
approval of the annual reports and accounts.
A Board Assurance Framework has been
established and used within the Trust for the
last six years which is designed to meet the
requirements of the 2012/13 Annual Governance
Statement and provide reasonable assurance that
there is an effective system of internal control to
manage the principal risks as identified by the
NHS Foundation Trust.
The controls and assurances noted within the
Framework have been in existence for some time
and continue to be in place.
3. Capacity to handle risk
The NHS Foundation Trust’s Board of Directors
provides leadership and commitment for
establishing effective risk management systems
across the organisation. The Chairman of
the Quality, Assurance & Risk Committee
is a Non-Executive Director with senior health
service experience, and membership includes other
Non-Executive and Executive Directors. As a subgroup of the Board, the Committee is responsible
for approving the strategic management of risk and
monitoring the implementation of risk management
arrangements within the NHS Foundation Trust.
The Chief Nurse is identified as the Executive
Director with responsibility for risk management.
Responsibility for implementing risk management
is delegated to a range of staff across the
organisation. Their roles and responsibilities
for risk management are clearly defined and
can be found in the overarching Trust risk
management policy.
Risk management training is provided for every
member of staff at induction and is part of the
annual mandatory training programme. The Head
of Risk Management is responsible for providing
advice and expertise to all staff. Specific ongoing
training is determined via the appraisal and
personal development planning process at an
individual level and by training needs analysis
against key risk areas at a strategic level.
Guidance for staff is provided through training
programmes and information is available in the
Risk Management Policy. This is supported by
the Accident/Incident & Patient Safety Incident
Reporting Policy Including Serious Incidents
Requiring Investigation, which supports a learning
culture within the organisation. Any incident of
any severity including near miss is reported on the
Trust wide datix system. More serious incidents
require a panel and the results of the root cause
analysis including best practice recommendations
are fed back through all the relevant clinical
bodies in the Trust through from the Board
Quality Assurance and Risk committee through
the Medical Advisory Committee, the Nursing,
Rehabilitation and Radiography committee,
the Matrons, Sisters and Staff Nurses Forums,
Junior doctors forums. All policies relating to risk
management are easily accessible and available
to staff on the hospital intranet policy section with
supporting information available under the risk
management department section. This year the
Trust undertook the NHSLA Level 3 assessment
for the first time and passed.
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The Royal Marsden NHS Foundation Trust
4. The risk and control framework
The Risk Management Policy has been approved
by the Board and is reviewed on an annual
basis. It defines the process for the systematic
identification and control of risks. It clearly
defines accountability structures, roles and
responsibilities. The policy details the process
for risk identification and evaluation using a
standardised risk assessment matrix and sets
out the levels of authority for the management of
identified risk. During 2012/13 there were no Never
Events at the Trust. (This refers to Never Events
as described in the NHS Never Events Policy
Framework published in October 2012).
Risk management is firmly embedded into the
activity of the organisation and operational
responsibility for risk identification and control
is delegated to individual Directors and Senior
Managers who have functional responsibility
within their areas of management.
The policy has been disseminated throughout
the NHS Foundation Trust and communicated to
key stakeholders.
The Assurance Framework was originally adopted
by the Board for 2003/04 in line with Department
of Health guidelines and was revised and further
developed in 2007/08 to incorporate, for example,
the Healthcare Commission Standards for Better
Health Domains. The Assurance Framework maps
out the NHS Foundation Trust’s objectives, key
risks to achieving the objectives, and the controls
and assurance mechanisms in place to mitigate
the risks. The NHS Foundation Trust in 2012
again updated the Board Assurance Framework
following national guidance and continues to
monitor the assurances it receives against those
expected within the Framework and review
progress on the action plans drawn up to close
the gaps in both controls and assurance. The
NHS Foundation Trust is fully compliant with the
core Standards for Better Health.
The NHS Foundation Trust is committed to
having an effective structure for patient and public
stakeholder involvement at all levels within the
organisation and as an NHS Foundation Trust is
provided with strategic direction by the Council
of Governors.
104
The NHS Foundation Trust has implemented a
Patient and Public Involvement Strategy. The Trust
Integrated Governance and Risk management
Committee has at least two patient / carer
representatives on it as core members. The Patient
and Carer Advisory Group acts as the focus for all
local patient involvement initiatives often working
alongside the Governors.
The Board reviewed the systems and procedures
for securing personal data, including patient data
in transit and were satisfied that these have been
and remain compliant with relevant information
governance guidance and the Data Protection
Act 1998. A new programme highlighting the
risks surrounding sensitive information has been
initiated to reinforce awareness amongst staff.
Encryption devices have been supplied to relevant
members of staff and internal audit reviews
into data and IT systems security have been
carried out during the year, the recommendations
of which have been, or are in the process of
being, implemented.
The Royal Marsden NHS Foundation Trust score
for 2012/13 for Information Quality and Records
Management assessed using the Information
Governance Toolkit was 88%. The Trust scored
a minimum of Level 2 on all 45 requirements and
therefore achieved a satisfactory (Green) score.
The Information Governance Toolkit is available
on the Connecting for Health website (www.igt.
connectingforhealth.nhs.uk).
The Foundation Trust is fully compliant with the
requirements of registration with the Care Quality
Commission (CQC). The Trust has unconditional
registration with the CQC. To ensure that
the Trust’s Board, Council of Governors,
Management Executive and front line staff can
regularly review performance against the CQC’s
Essential Standards of Quality and Safety (2010)
the Trust publishes a portfolio of quality and
performance documents:
– A nnual Quality Account
– Monthly Quality Account
– Integrated Governance Monitoring Report.
Annual Report and Accounts 2012/13
The Integrated Governance Monitoring Report
includes details on compliance with key
performance indicators from the Essential
Standards of Quality and Safety. The 28 outcomes
are grouped into six areas:
– Involvement and information
– Personalised care, treatment and support
– Safeguarding and safety
– Suitability of staffing
– Quality and management
– Suitability of management.
As an employer with staff entitled to membership
of the NHS Pension Scheme, control measures
are in place to ensure all employer obligations
contained within the Scheme regulations are
complied with. This includes ensuring that
deductions from salary, employer’s contributions
and payments into the Scheme are in accordance
with the Scheme rules, and that member
Pension Scheme records are accurately updated
in accordance with the timescales detailed in
the Regulations.
Control measures are in place to ensure that all the
organisation’s obligations under equality, diversity
and human rights legislation are complied with.
The Foundation Trust has undertaken risk
assessments and Carbon Reduction Delivery
Plans are in place in accordance with emergency
preparedness and civil contingency requirements,
as based on UKCIP 2009 weather projects, to
ensure that this organisation’s obligations under
the Climate Change Act and the Adaptation
Reporting requirements are complied with.
The Foundation Trust is involved, through
Borough Resilience Forums and Regional
Emergency Planning Network Groups, in extensive
multi agency risk reduction and planning work.
This is in accordance with the Civil Contingencies
act and against the National, Regional and
Borough Risk Registers. Risk assessments have
been carried out against emergency preparedness
and civil contingency requirements.
The systematic identification, analysis and control
of risks are a key organisational responsibility.
A culture of ownership and responsibility for risk
management/patient safety is fostered throughout
the organisation and all managers and clinicians
undertake risk management as one of their
fundamental duties.
The Trust’s procedures for reporting and
investigating accidents, non-clinical incidents,
near misses and patient safety incidents aim to
support active learning and to ensure that the
lessons learnt from these events are embedded
into the organisation’s culture and practices.
Learning from incidents is an essential part of
integrated governance and risk management
within the Trust and also a requirement of the
Trust Risk Management Policy.
Risk management and incident reporting
processes identify risks of all levels of severity
throughout the organisation. These processes
feed into the divisional risk registers which are
reviewed on an ongoing basis. Risks that score
above 12 are included on the Trust risk register
which is reviewed quarterly by the Trust Board.
Current high-level clinical risks include issues
with (1) junior doctor support, and (2) the resilience
of clinical IT systems.
1. There are national problems associated with
junior doctor recruitment and core trainee
availability. Robust processes are in place led
by the Medical Director and Chief Operating
Officer to ensure there is high quality cover
by Consultant or Associate Consultants. The
Trust has also invested in the training and
development of Advanced Nurse Practitioners
who are working within surgical teams.
This innovation has been well evaluated by
patients/families/medical and nursing teams
2. The Trust has a very high quality
clinical IT system that was designed by
The Royal Marsden around the requirements
of a specialist cancer hospital. Although the
product is still excellent the underpinning
IT architecture is now dated and unable to
be renewed. The IT teams have dedicated
support to the system and are releasing
more functionality to ensure stability until
a new systems wide development can be
resourced. The Medical Director/ Chief Nurse
and Director of IT are currently investigating
alternative international systems used
in cancer care particularly in the US.
The above risks have associated high-level
action plans which are updated quarterly with
the risk scores being adjusted as the level of risk
is reduced. These risks are reviewed quarterly by
the Trust Board.
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The Royal Marsden NHS Foundation Trust
5. Review of economy, efficiency and
effectiveness of the use of resources
The NHS Foundation Trust has established
arrangements for managing its financial and
other resources which demonstrate that value
for money is being managed and achieved. The
NHS Foundation Trust:
– Achieved its financial plan and efficiency targets
in 2012/13 and has an ongoing plan to improve
organisational efficiency. This is managed by
the NHS Foundation Trust’s Board of Directors.
The Audit and Finance Committee reviews
performance against the efficiency programme
on a regular basis. The Performance Review
Group chaired by the Chief Operating Officer
meets every two months and reviews the
financial performance of each division including
the delivery of the efficiency programme
– Reviewed key processes, such as the levels
of pre-ordering of chemotherapy drugs by
clinicians, to improve the efficiency of the service
– Is working on several initiatives with shared
services with other NHS Foundation Trusts across
a range of clinical and non-clinical functions
– Is developing its benchmarking capability and
gathering the evidence to be able to demonstrate
differences between services and organisations
– Continued to identify potential productivity
gains to be obtained from new workforce
contract arrangements and internal workforce
planning systems
– Internal Audit undertake audits each year which
include the review of efficiency and use of
resources across an range of expenditure types.
6. Annual Quality Report
The directors are required under the Health Act
2009 and the National Health Service (Quality
Accounts) Regulations 2010 to prepare Quality
Accounts for each financial year. Monitor has
issued guidance to NHS foundation trust boards
on the form and content of annual Quality Reports
which incorporate the above legal requirements in
the NHS Foundation Trust Annual Reporting Manual.
The Board of Directors of The Royal Marsden
NHS Foundation Trust is assured that the Quality
Report presents a balanced view and that there
are appropriate controls in place to ensure the
accuracy of data. The Quality Report is discussed
throughout the year at monthly Trust Board
meetings and at the Quality, Assurance and Risk
sub committee of the Board.
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The Quality Account is authored by the
Chief Nurse with input from a wide range of
stakeholders throughout the year including:
– The Foundation Trust Board
– The Council of Governors
– The Management Executive
– The Patient and Carer Advisory Group
– Frontline staff
– The Trust Consultative Committee
– Local Involvement Networks (LINks)
– South West London Acute Commissioners Unit.
All the improvement priorities since 2009/10
have been identified and endorsed by members
of the stakeholder groups (above). Members of the
stakeholder groups have also reviewed progress
on achievements over the last two years and
ensured that the Trust has realistic but stretching
improvement targets. In 2012/13 for the first time
Merton Clinical Commissioning Group has been
invited to review and add its critique and support
to targets for the Sutton and Merton Community
Services. On 29 November 2012 the Trust held
a patient and public involvement event which
over 70 people attended to ensure that priorities
for 2012/13 were coherent with all stakeholders.
The data presented in the Quality Account is
generated by either the Information Team or
external bodies such as the Health Protection
Agency or Dr Foster Limited who are independent
of the operational and clinical teams in the Trust.
Finally, the Trust’s external auditors undertook
sample data testing of Clostridium difficile cases,
cancer treatments started within 62 days of urgent
GP referral and Serious Incident reporting.
7. Review of effectiveness
As Accounting Officer, I have responsibility
for reviewing the effectiveness of the system of
internal control. My review is informed by the
work of internal auditors, clinical auditors and the
executive managers and clinical leads within the
NHS Foundation Trust who have responsibility for
the development and maintenance of the internal
control framework. I have drawn on the content of
the quality report attached to this annual report
and other performance information available to
me. My review is also informed by comments
made by the external auditors in their management
letter and other reports.
Annual Report and Accounts 2012/13
I have been advised on the implications of the
result of my review of the effectiveness of the
system of internal control by the Board, Audit
and Finance Committee and Quality, Assurance
and Risk Committee, and Clinical Governance
Committee, and a plan to address weaknesses and
ensure continuous improvement of the system is
in place.
The Assurance Framework provides me with
evidence that the effectiveness of controls to
manage risks to the organisation achieving its
principal objectives have been reviewed.
My review is also informed by:
– Assessment of financial reports submitted
to Monitor, the Independent Regulator of
NHS Foundation Trusts
– Opinions and reports made by external auditors
– Opinions and reports made by internal auditors
– Opinions and reports made by clinical auditors
– Achievement of the Customer Service
Excellence standard
– Unannounced CQC Inspections
– N HSLA Level 3 attainment
– N HS London Annual Emergency Planning
Assurance Process
The process that has been applied in maintaining
and reviewing the effectiveness of the system of
internal control has been reviewed by:
– The Board; through consideration of key
objectives and the management of principal
risks to those objectives within the
Assurance Framework
– The Integrated Governance and
Risk Management Committee; by reviewing
all policies relating to governance and risk
management and monitoring the implementation
of arrangements within the Trust
– The Audit and Finance Committee; by reviewing
and monitoring the opinions and reports
provided by both internal and external audit
– The Quality, Assurance and Risk Management
Committee; by implementing and reviewing
clinical governance and risk management
arrangements and receiving reports from all
operational risk committees
– External assessments of services.
8. Conclusion
As Accounting Officer and based on the review
process detailed above, I am assured that there
are no significant internal control issues.
– ISO 9001 compliance for Radiotherapy
and Chemotherapy
– Clinical Pathology Accreditation (CPA) held for
designated pathology services
– Quarterly Integrated Governance
Monitoring Reports
Cally Palmer CBE
Chief Executive
29 May 2013
– Infection Control Annual Report
– Clinical audit reports and action plans
– Investigation reports and action plans following
serious and significant incidents
– Departmental and clinical risk assessments and
action plans
– National Health Service Litigation Assessment
Level 3 attainment
– Results of the national patient surveys
– Results of the National Staff Survey.
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The Royal Marsden NHS Foundation Trust
Independent Auditor’s Report to the Board
of Governors and Board of Directors of
The Royal Marsden NHS Foundation Trust
We have audited the financial statements of
The Royal Marsden NHS Foundation Trust for
the year ended 31 March 2013 which comprise
the Statement of Comprehensive Income, the
Statement of Financial Position, the Statement
of Changes in Taxpayers Equity and the
Statement of Cash Flows and the related notes
1 to 22. The financial reporting framework
that has been applied in their preparation is
applicable law and the accounting policies
directed by Monitor – Independent Regulator
of NHS Foundation Trusts.
This report is made solely to the Board of
Governors and Board of Directors (“the Boards”)
of The Royal Marsden NHS Foundation Trust, as a
body, in accordance with paragraph 4 of Schedule
10 of the National Health Service Act 2006. Our
audit work has been undertaken so that we might
state to the Boards those matters we are required
to state to them in an auditor’s report and for no
other purpose. To the fullest extent permitted by
law, we do not accept or assume responsibility to
anyone other than the Trust and the Boards as a
body, for our audit work, for this report, or for the
opinions we have formed.
108
Respective responsibilities of the accounting
officer and auditor
As explained more fully in the Accounting Officer’s
Responsibilities Statement, the Accounting Officer
is responsible for the preparation of the financial
statements and for being satisfied that they give
a true and fair view. Our responsibility is to audit
and express an opinion on the financial statements
in accordance with applicable law, the Audit Code
of NHS Foundation Trusts and International
Standards on Auditing (UK and Ireland). Those
standards require us to comply with the Auditing
Practices Board’s Ethical Standards for Auditors.
The directors are responsible for the maintenance
and integrity of the corporate and financial
information included on the company’s
website. Legislation in the United Kingdom
governing the preparation and dissemination of
financial information differs from legislation in
other jurisdictions.
Scope of the audit of the financial statements
An audit involves obtaining evidence about
the amounts and disclosures in the financial
statements sufficient to give reasonable assurance
that the financial statements are free from material
misstatement, whether caused by fraud or error.
This includes an assessment of: whether the
accounting policies are appropriate to the Trust’s
circumstances and have been consistently applied
and adequately disclosed; the reasonableness
of significant accounting estimates made by the
Accounting Officer; and the overall presentation of
the financial statements. In addition, we read all
the financial and non-financial information in the
annual report to identify material inconsistencies
with the audited financial statements. If we
become aware of any apparent material
misstatements or inconsistencies we consider
the implications for our report.
Annual Report and Accounts 2012/13
Opinion on financial statements
Certificate
In our opinion the financial statements:
We certify that we have completed the audit of
the accounts in accordance with the requirements
of Chapter 5 of Part 2 of the National Health
Service Act 2006 and the Audit Code for
NHS Foundation Trusts.
– give a true and fair view of the state of the
Trust’s affairs as at 31 March 2013 and of its
income and expenditure for the year then ended;
– have been properly prepared in accordance
with the accounting policies directed
by Monitor – Independent Regulator of
NHS Foundation Trusts; and
– have been prepared in accordance with the
requirements of the National Health Service
Act 2006.
Opinion on other matter prescribed by the
National Health Service Act 2006
In our opinion:
Heather Bygrave FCA, BA (Hons)
Senior Statutory Auditor
29 May 2013
For and on behalf of Deloitte LLP
Chartered Accountants and Statutory Auditor
St. Albans, United Kingdom
– the information given in the Directors’ Report
for the financial year for which the financial
statements are prepared is consistent with the
financial statements.
Matters on which we are required to report
by exception
We have nothing to report in respect of the
following matters where the Audit Code for
NHS Foundation Trusts requires us to report to
you if, in our opinion:
– the Annual Governance Statement does not
meet the disclosure requirements set out in the
NHS Foundation Trust Annual Reporting Manual,
is misleading or inconsistent with information of
which we are aware from our audit. We are not
required to consider, nor have we considered,
whether the Annual Governance Statement
addresses all risks and controls or that risks are
satisfactorily addressed by internal controls;
– proper practices have not been observed in the
compilation of the financial statements; or
– the NHS foundation trust has not made proper
arrangements for securing economy, efficiency
and effectiveness in its use of resources.
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The Royal Marsden NHS Foundation Trust
Statement of comprehensive income for the year ended 31 March 2013
Note
2012/13
2011/12
£000
£000
Income from activities
3
247,026
226,056
Other operating income
3
74,331
85,530
Operating expenses
4
(320,717)
(300,617)
640
10,969
35
149
Public Dividend Capital dividends payable
(4,516)
(4,216)
Net finance costs
(4,481)
(4,067)
(Deficit)/surplus for the year
(3,841)
6,902
(315)
54
(4,156)
6,956
2012/13
2011/12
£000
£000
(3,841)
6,902
(8,532)
(19,362)
4,065
3,611
Operating surplus
Finance costs
Finance income
7
Other comprehensive (losses)/income
Revaluation and impairment gains on land
9
Total comprehensive income and expense
for the year
Surplus for the year pre impairment
and adjustments relating to capital
charitable donations
(Deficit)/surplus for the year
Donated capital income
9
Depreciation on donated assets
Impairment
4
14,620
13,374
Loss on disposal
4
19
26
6,331
4,551
Surplus for the year pre impairment
110
Annual Report and Accounts 2012/13
Statement of financial position as at 31 March 2013
Note
31 March 2013
31 March 2012
£000
£000
Non-current assets
Intangible assets
8
483
227
Tangible assets
9
218,393
216,463
218,876
216,690
Total non-current assets
Current assets
Inventories
10
4,895
4,416
Trade and other receivables
11
34,881
32,662
Cash and cash equivalents
14
14,287
22,397
54,063
59,475
Total current assets
Current liabilities
Trade and other payables
12
(30,592)
(35,822)
Provisions
12
-
(11)
Other liabilities
12
(20,706)
(14,686)
Tax payable
12
(3,924)
(3,772)
(55,222)
(54,291)
-
(1)
-
(1)
217,717
221,873
101,350
101,350
12,850
13,165
Income and expenditure reserve
103,517
107,358
Total taxpayers’ equity
217,717
221,873
Total current liabilities
Non-current liabilities
Provisions
13
Total non-current liabilities
Total assets employed
Financed by taxpayers’ equity
Public Dividend Capital
Revaluation reserve
Cally Palmer CBE
Chief Executive
29 May 2013
Alan Goldsman
Director of Finance
29 May 2013
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The Royal Marsden NHS Foundation Trust
Statement of changes to taxpayers’ equity for the year ended 31 March 2013
Total
taxpayers’
equity
Public
Dividend
Capital
Revaluation
reserve
Income and
expenditure
reserve
£000
£000
£000
£000
214,917
101,349
13,110
100,458
6,902
-
-
6,902
54
-
54
-
Public Dividend Capital received
-
-
-
-
Other transfer between reserves
-
1
1
(2)
Taxpayers’ equity at 31 March 2012
221,873
101,350
13,165
107,358
Taxpayers’ equity at 1 April 2012
221,873
101,350
13,165
107,358
Taxpayers’ equity at 1 April 2011
Surplus for the year
Revaluation losses and impairment
losses on property, plant and equipment
Deficit for the year
Revaluation losses on property, plant
and equipment
(3,841)
(315)
Public Dividend Capital received
-
Other transfer between reserves
-
Taxpayers’ equity at 31 March 2013
112
(3,841)
217,717
(315)
101,350
12,850
103,517
Annual Report and Accounts 2012/13
Cash flow statement for the year ended 31 March 2013
2012/13
2011/12
£000
£000
27,079
26,259
35
149
(31,024)
(41,075)
-
2
(30,989)
(40,924)
-
-
Public Dividend Capital dividends paid
(4,200)
(4,091)
Net cash generated from financing activities
(4,200)
(4,091)
Decrease in cash and cash equivalents
(8,110)
(18,756)
Cash and cash equivalents at 1 April
22,397
41,153
Cash and cash equivalents at 31 March
14,287
22,397
Note
Cash flows from operating activities
Net cash generated from operations
14.1
Cash flows used in investing activities
Interest received
Purchase of property, plant and equipment
Proceeds from sale of property,
plant and equipment
Net cash generated from investing activities
Cash flow from financing activities
Public Dividend Capital received
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The Royal Marsden NHS Foundation Trust
1. Accounting Policies
Monitor has directed that the financial
statements of NHS foundation trusts shall meet
the accounting requirements of the Foundation
Trust Annual Reporting Manual which shall be
agreed with Treasury. Consequently, the following
financial statements have been prepared in
accordance with the NHS Foundation Trust Annual
Reporting Manual 2012/13 issued by Monitor.
The accounting policies contained in that manual
follow International Financial Reporting Standards
(IFRS) and HM Treasury’s Financial Reporting
Manual to the extent that they are meaningful
and appropriate to NHS foundation trusts. The
accounting policies have been applied consistently
in dealing with items considered material in
relation to the accounts.
Accounting convention
These accounts have been prepared under the
historical cost convention modified to account for
the revaluation of property, plant and equipment,
intangible assets, inventories and certain financial
assets and financial liabilities.
An estimate of the value of partially completed
patient episodes is included in Accrued Income.
This estimate has been derived by assessing the
patient episodes that span both sides of the year
end, and estimating the unbilled value of these
episodes by pro-rating the number of days spent
as an inpatient pre and post year-end.
1.2 Expenditure on employee benefits
Short term employee benefits
Salaries, wages and employment-related payments
are recognised in the period in which the service
is received from employees. The cost of annual
leave entitlement earned but not taken by
employees at end of period is recognised in the
financial statements to the extent that employees
are permitted to carry forward leave into the
following period.
Long term employee benefits
The policy for accounting for pension costs and
liabilities is described in section 1.18. Employers
pension cost contributions are charged to
operating expenses as and when they become due.
1.1 Income recognition
1.3 Expenditure on other goods and services
Income in respect of services provided is
recognised when, and to the extent that
performance occurs and is measured at the fair
value of the consideration receivable. The main
source of income for the NHS Foundation Trust
is contracts with commissioners in respect of
healthcare services. Where income is received
for a specific activity which is to be delivered
in the following financial year, that income is
deferred. Income from sale of non-current assets
is recognised only when all material conditions of
sale have been met, and is measured as the sums
due under the sale contract.
Expenditure on goods and services is recognised
when, and to the extent that they have been
received, and is measured at the fair value of those
goods and services. Expenditure is not recognised
in operating expenses where it results in the
creation of non-current assets such as property,
plant and equipment.
Monitor’s guidance states that there should be no
netting off of income and expenditure. There are a
number of employees of the NHS Foundation Trust
that perform work for other organisations, who in
turn reimburse the NHS Foundation Trust for this
work. The accounts show the income and expense
from these arrangements under the headings
‘Other income’ and ‘Staff costs’ respectively.
114
Monitor’s guidance states that there should be no
netting off of income and expenditure. There are a
number of employees of the NHS Foundation Trust
that perform work for other organisations, who in
turn reimburse the NHS Foundation Trust for this
work. The accounts show the income and expense
from these arrangements under the headings
‘Other income’ and ‘Staff costs’ respectively.
Annual Report and Accounts 2012/13
1.4 Property, plant and equipment
Recognition
Property, plant and equipment is capitalised where:
– it is held for use in delivering services or for
administrative purposes
– it is probable that future economic benefits
will flow to, or service potential be provided to,
the Trust
– it is expected to be used for more than one
financial year
– the cost of the item can be measured reliably
– individually they have a cost of at least £5,000, or
– collectively they have a cost of at least £5,000,
where the assets are functionally interdependent,
they had broadly simultaneous purchase dates,
are anticipated to have simultaneous disposal
dates and are under single managerial control, or
– they form part of the initial setting-up cost of a
new building or refurbishment of a ward or unit,
irrespective of their individual or collective cost.
Where a large asset, for example a building,
includes a number of components with
significantly different asset lives e.g. plant and
equipment, then these components are treated as
separate assets and depreciated over their own
useful economic lives.
Valuation
All property, plant and equipment assets are
measured initially at cost, representing the costs
directly attributable to acquiring or constructing
the assets and bringing it to the location and
condition necessary for it to be capable of
operating in the manner intended by management.
In accordance with NHS Foundation Trust Annual
Reporting Manual 2012/13, all land and buildings
are revalued every five years with an interim
valuation in the third year. A land and buildings
valuation was undertaken as at 31 March 2013.
This valuation forms the basis of the land and
buildings values on the balance sheet as at 31
March 2013.
Valuations are carried out by professionally
qualified valuers in accordance with the Royal
Institute of Chartered Surveyors (RICS) Appraisal
and Valuation Manual.
Valuations are carried out primarily on the basis
of Modern Equivalent asset value (MEV) for
specialised operational property and fair value for
non-specialised operational property.
Assets in the course of construction are valued at
cost and are valued by professional valuers as part
of the five or three-yearly valuation, on completion.
Operational equipment is valued at net current
replacement cost. Equipment surplus to
requirements is valued at net recoverable amount.
Subsequent Expenditure
Subsequent expenditure relating to an item of
property, plant and equipment is recognised as
an increase in the carrying amount of the asset
when it is probable that additional future economic
benefits or service potential deriving from the cost
incurred to replace a component of such item will
flow to the enterprise and the cost of the item can
be determined reliably. Where a component of an
asset is replaced, the cost of the replacement is
capitalised if it meets the criteria for recognition
above. The carrying amount of the part replaced
is de-recognised. Other expenditure that does
not generate future economic benefits or service
potential, such as repairs and maintenance, is
charged to the Statement of Comprehensive
Income in the period in which it is incurred.
Depreciation
Items of property, plant and equipment are
depreciated over their remaining useful economic
lives in a manner consistent with the consumption
of economic or service delivery benefits. Freehold
land is considered to have an infinite life and is
not depreciated.
Assets in the course of construction are not
depreciated until the asset is brought into use.
Buildings and dwellings are depreciated
on their current value over the estimated
remaining life of the asset as advised by the
NHS Foundation Trust’s professional valuer (576 years). Leaseholds are depreciated over the
primary lease term.
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The Royal Marsden NHS Foundation Trust
Equipment is depreciated on cost, including
historic indexation, evenly over the estimated
remaining life of the asset. These are estimated
as follows:
Plant and machinery
5-15 years
Transport equipment
7 years
Information technology
5-8 years
Furniture and fittings
10 years
Revaluation gains and losses
Revaluation gains are recognised in the
revaluation reserve, except where, and to the
extent that, they reverse a revaluation decrease
that has previously been recognised in operating
expenses, in which case they are recognised in
operating income.
Revaluation losses are charged to the revaluation
reserve to the extent that there is an available
balance for the asset concerned, and thereafter
are charged to operating expenses.
Gains and losses recognised in the revaluation
reserve are reported in the Statement of
Comprehensive Income as an item of ‘other
comprehensive income’.
Impairments
In accordance with the NHS Foundation Trust
Annual Reporting Manual 2012/13, impairments
that are due to a loss of economic benefits or
service potential in the asset are charged to
operating expenses. A compensating transfer
is made from the revaluation reserve to the
income and expenditure reserve of an amount
equal to the lower of (i) the impairment charged
to operating expenses; and (ii) the balance in the
revaluation reserve attributable to that asset before
the impairment.
116
An impairment arising from a loss of economic
benefit or service potential is reversed when, and
to the extent that, the circumstances that gave rise
to the loss is reversed. Reversals are recognised
in operating income to the extent that the asset
is restored to the carrying amount it would have
had if the impairment had never been recognised.
Any remaining reversal is recognised in the
revaluation reserve. Where, at the time of the
original impairment, a transfer was made from the
revaluation reserve to the income and expenditure
reserve, an amount is transferred back to the
revaluation reserve when the impairment reversal
is recognised.
Other impairments are treated as revaluation
losses. Reversals of ‘other impairments’ are treated
as revaluation gains.
Donated assets
Donated fixed assets are capitalised at their
fair value on receipt. The donation is credited
to income at the same time, unless a donor has
imposed a condition that the future economic
benefits embodied in the grant are to be consumed
in a manner specified by the donor, in which case,
the donation is deferred within liabilities and is
carried forward to future financial years to the
extent that the condition has not been met.
The donated assets are subsequently accounted
for in the same manner as other items of property,
plant and equipment.
1.5 Intangible fixed assets
Recognition
Intangible assets are non-monetary assets
without physical substance which are capable
of being sold separately from the rest of the
NHS Foundation Trust’s business or which arise
from the contractual or other legal rights. They
are recognised only where it is probable that
future economic benefits will flow to, or service
potential be provided to, the NHS Foundation Trust
and where the cost of the asset can be measured
reliably. Where internally generated assets are
held for service potential, this involves a direct
contribution to the delivery of service to the public.
Annual Report and Accounts 2012/13
Software
Recognition
Software which is integral to the operation of
hardware e.g. an operating system, is capitalised
as part of the relevant item of property, plant and
equipment. Software which is not integral to the
operation of hardware e.g. application software,
is capitalised as an intangible asset.
Financial assets and financial liabilities which
arise from contracts for the purchase or sale of
non-financial items (such as goods or services),
which are entered into in accordance with the
NHS Foundation Trust’s normal purchase, sale or
usage requirements, are recognised when, and to
the extent which, performance occurs i.e. when
receipt or delivery of the goods or services is made.
Measurement
Intangible assets are recognised initially at cost,
comprising all directly attributable costs needed
to create, produce and prepare the asset to the
point that it is capable of operating in the manner
intended by management.
Subsequently intangible assets are measured
at fair value. Revaluation gains and losses and
impairments are treated in the same manner as
for property, plant and equipment.
Amortisation
Intangible assets are amortised over their
expected useful life in a manner consistent
with the consumption of economic or service
delivery benefits.
1.6 Inventories
Inventories are valued at the lower of cost and net
realisable value.
1.7 Financial Instruments and
Financial Liabilities
Financial instruments are defined as contracts
that give rise to a financial asset of one entity and
a financial liability or equity instrument of another
entity. The NHS Foundation Trust will commonly
have the following financial assets and liabilities:
trade debtors (but not prepayments), current asset
investments, cash at bank and in hand, trade
creditors (but not deferred income), finance lease
obligations, loans, provisions.
Financial assets or financial liabilities in respect
of assets acquired or disposed of through
finance leases are recognised and measured in
accordance with the accounting policy for leases
described below.
Regular way purchases or sales are recognised
and de-recognised, as applicable, using the
trade date.
All other financial assets and financial liabilities
are recognised when the NHS Foundation Trust
becomes a party to the contractual provisions of
the instrument.
De-recognition
All financial assets are de-recognised when
the rights to receive cash flows from the assets
have expired or the NHS Foundation Trust has
transferred substantially all of the risk and
rewards of ownership.
Financial liabilities are de-recognised when the
obligation is discharged, cancelled or expires.
Classification and measurement
Financial assets are classified into the following
specified categories:
– financial assets ‘at fair value through income
and expenditure’ or
– ‘loans and receivables’.
Financial liabilities are classified as either:
– financial liabilities ‘at fair value through income
and expenditure’ or
– ‘other financial liabilities’.
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The Royal Marsden NHS Foundation Trust
Loans and receivables
Determination of fair value
Loans and receivables are non-derivative financial
assets with fixed or determinable payments with
are not quoted in an active market. They are
included in current assets.
For financial assets and financial liabilities carried
at fair value, the carrying amounts are determined
from quoted market prices/independent appraisals/
discounted cash flow analysis.
The NHS Foundation Trust’s loans and receivables
comprise: cash at bank and in hand, NHS debtors,
accrued income and ‘other debtors’.
Impairment of financial assets
Loans and receivables are recognised initially
at fair value, net of transactions costs, and are
measured subsequently at amortised cost, using
the effective interest method. The effective interest
rate is the rate that discounts exactly estimated
future cash receipts through the expected life
of the financial asset or, when appropriate, a
shorter period, to the net carrying amount of the
financial asset.
Interest on loans and receivables is calculated
using the effective interest method and credited
to the Statement of Comprehensive Income except
for short-term receivables when the recognition of
interest would be immaterial.
Other financial liabilities
All ‘other’ financial liabilities are recognised
initially at fair value, net of transaction costs
incurred, and measured subsequently at amortised
cost using the effective interest method. The
effective interest rate is the rate that discounts
exactly estimated future cash payments through
the expected life of the financial liability or, when
appropriate, a shorter period, to the net carrying
amount of the financial liability.
They are included in current liabilities except for
amounts payable more than 12 months after the
balance sheet date, which are classified as longterm liabilities.
Interest on financial liabilities carried at amortised
cost is calculated using the effective interest
method and charged to Finance Costs. Interest in
financial liabilities taken out to finance property,
plant and equipment or intangible assets is not
capitalised as part of the costs of those assets.
118
At the balance sheet date, the
NHS Foundation Trust assesses whether any
financial assets, other than those held at ‘fair value
through income and expenditure’ is impaired.
Financial assets are impaired and impairment
losses are recognised if, and only if, there is
objective evidence of impairment as a result of
one or more events which occurred after the initial
recognition of the asset and which has an impact
on the estimated future cash flows of the asset.
For financial assets carried at amortised cost,
the amount of the impairment loss is measured
as the difference between the asset’s carrying
amount and the present value of the revised future
cash flows discounted at the asset’s original
effective interest rate. The loss is recognised in
the Statement of Comprehensive Income and
the carrying amount of the asset is reduced
through the use of an allowance account/bad
debt provision.
Provision for impairment of receivables
The NHS Foundation Trust provides for the
impairment of its receivables based on the age and
type of each debt. The percentages applied reflect
an assessment of the recoverability of each class
of debt. During 2012/13 the method was reviewed
and the percentages amended based on historical
recovery and write off levels. Provisions are
charged to operating expenditure.
1.8 Cash, bank and overdrafts
Cash, bank and overdraft balances are recorded
at the current values of these balances in the
NHS Foundation Trust’s cash book. Overdrafts
are disclosed within creditors. Interest earned on
bank accounts and interest charged on overdrafts
is recorded as, respectively, ‘finance income’ and
‘finance expenses’ in the periods to which they
relate. Bank charges are recorded as operating
expenditure in the periods to which they relate.
Annual Report and Accounts 2012/13
1.9 Leases
Non-clinical risk pooling
Finance leases
The NHS Foundation Trust participates in the
Property Expenses Scheme and the Liabilities
to Third Parties Scheme. Both are risk pooling
schemes under which the NHS Foundation Trust
pays an annual contribution to the NHS Litigation
Authority and in return receives assistance
with the costs of claims arising. The annual
membership contributions, and any excesses
payable in respect of particular claims are charged
to operating expenses when the liability arises.
Where substantially all risks and rewards of
ownership of a leased asset are borne by the
NHS Foundation Trust, the asset is recorded
as a property, plant and equipment and a
corresponding liability is recorded. The value
at which both are recognised is the lower of the
fair value of the asset or the present value of the
minimum lease payments, discounted using the
interest rate implicit in the lease. The implicit
interest rate is that which produces a constant
periodic rate of interest on the outstanding liability.
Operating leases
Other leases are regarded as operating leases and
the rentals are charged to operating expenses on
a straight-line basis over the term of the lease.
Operating lease incentives received are added
to the lease rentals and charged to operating
expenses over the life of the lease, even if
payments are not made on such a basis.
1.10 Provisions
The NHS Foundation Trust recognises a provision
where it has a present legal or constructive
obligation of uncertain timing or amount; for which
it is probable that there will be a future outflow of
cash or other resources; and a reliable estimate can
be made of the amount. The amount recognised
in the Statement of Financial Position is the best
estimate of the resources required to settle the
obligation. Where the effect of the time value of
money is significant, the estimated risk-adjusted
cash flows are discounted using HM Treasury’s
discount rate of 2.2% in real terms, except for early
retirement provisions and injury benefit provisions
which both use the HM Treasury’s pension
discount rate of 2.9% in real terms.
Clinical negligence costs
The NHS Litigation Authority (NHSLA)
operates a risk pooling scheme under which
the NHS Foundation Trust pays an annual
contribution to the NHSLA which in return
settles all clinical negligence claims. Although
the NHSLA is administratively responsible for all
clinical negligence cases the legal liability remains
with the NHS Foundation Trust. The total value
of clinical negligence provisions carried by the
NHSLA on behalf of the NHS Foundation Trust is
disclosed at note 13 but is not recognised in the
NHS Foundation Trust’s accounts.
Other insurance
The NHS Foundation Trust holds commercial
insurance for a range of risks in excess of those
covered by the Non-clinical risk pooling scheme.
This includes cover for property damage, business
interruption and increased costs of working.
1.11 Contingencies
Contingent assets are assets arising from past
events whose existence will only be confirmed
by one or more future events not wholly within
the entity’s control. These are not recognised
as assets, but are disclosed in note 16 where an
inflow of economic benefits is probable.
Contingent liabilities are not recognised, but are
disclosed in note 16, unless the probability of a
transfer of economic benefits is remote. Contingent
liabilities are defined as:
– possible obligations arising from past events
whose existence will be confirmed only by the
occurrence of one or more uncertain future
events not wholly within the entity’s control or
– present obligations arising from past events
but for which it is not probable that a transfer
of economic benefits will arise or for which the
amount of the obligation cannot be measured
with sufficient reliability.
1.12 Public dividend capital
Public dividend capital (PDC) is a type of public
sector equity finance based on the excess of
assets over liabilities at the time of establishment
of the predecessor NHS trust. HM Treasury has
determined that PDC is not a financial instrument
within the meaning of IAS32.
A charge, reflecting the cost of capital utilised by
the NHS Foundation Trust, is payable as public
dividend capital dividend. The charge is calculated
at the rate set by HM Treasury (currently
3.5%) on the average relevant net assets of the
NHS Foundation Trust during the financial year.
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The Royal Marsden NHS Foundation Trust
Relevant net assets are calculated as the value of
all assets less the value of all liabilities, except
for (i) donated assets, (ii) net cash balances held
with the Government Banking Services and (iii)
any PDC dividend balance receivable or payable.
In accordance with the requirements laid down
by the Department of Health (as the issuer of
PDC), the dividend for the year is calculated on
the actual average relevant net assets as set out in
the ‘pre-audit’ version of the annual accounts. The
dividend thus calculated is not revised should any
adjustment to net assets occur as a result the audit
of the annual accounts.
1.13 Value added tax
Most of the activities of the NHS Foundation Trust
are outside the scope of VAT and, in general,
output tax does not apply and input tax on
purchases is not recoverable. Irrecoverable VAT
is charged to the relevant expenditure category or
included in the capitalised purchase cost of fixed
assets. Where output tax is charged or input VAT
is recoverable, the amounts are stated net of VAT.
1.14 Corporation Tax
Health service bodies, including Foundation Trusts
are exempt from tax on their principal health
care income.
The NHS Foundation Trust has determined that
there is no corporation tax liability due for 2012/13.
1.15 Foreign exchange
The functional and presentational currencies of the
trust are sterling.
1.16 Third party assets
Assets belonging to third parties (such as money
held on behalf of patients) are not recognised in
the accounts since the NHS Foundation Trust
has no beneficial interest in them. However, they
are disclosed in a separate note to accounts in
accordance with the requirement of HM Treasury’s
Financial Reporting Manual.
1.17 Pension costs
Past and present employees are covered by the
provisions of the NHS Pensions Scheme. The
scheme is an unfunded, defined benefit scheme
that covers NHS employers, General Practices
and other bodies, allowed under the direction of
the Secretary of State, in England and Wales. The
scheme is not designed to be run in a way that
would enable NHS bodies to identify their share
120
of the underlying scheme assets and liabilities.
Therefore, the scheme is accounted for as if it were
a defined contribution scheme.
Employers’ pension cost contributions are
charged to operating expenses as and when they
become due.
Additional pension liabilities arising from early
retirements are not funded by the scheme, except
where the retirement is due to ill-health. The full
amount of the liability for the additional costs is
charged to operating expenses at the time the
Trust commits itself to the retirement, regardless
of the method of payment.
1.18 Key areas of estimation and judgement
The key areas of estimation and judgement used
in the preparation of the accounts have been
disclosed within other sections of the accounting
policy notes. These include provisions for
impairment of receivables, estimates of partially
complete patient episodes, valuation of land
and buildings, and depreciation rates applied to
property, plant and equipment.
1.19 Losses and special payments
Losses and special payments are items that
Parliament would not have contemplated when
it agreed funds for the health service or passed
legislation. By their nature they are items that
ideally should not arise. They are therefore subject
to special control procedures compared with the
generality of payments. They are divided into
different categories, which govern the way that
individual cases are handled. Losses and special
payments are charged to the relevant functional
headings in expenditure on an accruals basis,
including losses which would have been made
good through insurance cover had NHS trusts
not been bearing their own risks (with insurance
premiums then being included as normal
revenue expenditure).
The losses and special payments note, note
17.2, is compiled directly from the losses and
compensations register which reports on an
accrual basis with the exception of provisions
for future losses.
Annual Report and Accounts 2012/13
2. Segmental analysis
Income
Surplus before interest and dividends
Assets
2012/13
2011/12
£000
£000
321,357
311,586
640
10,969
217,717
221,873
The Trust has only one segment of business which is the provision of healthcare. The segment has been
identified with reference to how the Trust is organised and the way in which the chief operating decision
maker (determined to be the Board of Directors) runs the Trust.
The geographical and regulatory environment and the nature of services provided are consistent across
the organisation and are therefore presented in one segment. The necessary information to develop
detailed income and expenditure for each product and service provided by the Trust is currently not
discretely available and the cost to develop this information would be excessive.
Significant amounts of income are received from transactions with the Department of Health and
other NHS bodies, but none of these amounts to over 10% of total income. Disclosure of all material
transactions with related parties is included in note 18 to these financial statements. There are no
other parties that account for more than 10% of total income.
3. Operating income
3.1 Income from activities by source
2012/13
2011/12
£000
£000
601
878
181,184
168,516
696
38
Other NHS
3,450
4,105
Local Authority
1,280
1,375
59,815
51,144
247,026
226,056
Mandatory healthcare
Strategic Health Authority
Primary Care Trusts
Department of Health
Non-mandatory healthcare
Private care
The above analysis classifies income from activities arising into mandatory and non-mandatory services
as set out in the Trust’s Terms of Authorisation.
121
The Royal Marsden NHS Foundation Trust
3.2 Analysis of income from activities by type
Elective income
Non-elective income
Outpatient income
Other types of activity income
Private patient income
2012/13
2011/12
£000
£000
36,292
35,773
8,233
8,135
20,971
20,623
121,715
110,381
59,815
51,144
247,026
226,056
The Health and Social Care Act 2012 repealed the statutory limitation on private patient income;
therefore the private patient cap is no longer disclosed.
3.3 Other operating income
2012/13
2011/12
£000
£000
25,000
30,083
6,456
6,117
25,049
31,790
Non-patient care services to other bodies
3,979
2,894
Services provided to associated charities
1,706
1,634
3,325
3,441
544
552
Catering
1,150
1,104
Other
7,122
7,915
74,331
85,530
Research and development
Education and training
Charitable and other contributions to expenditure
Other income includes:
Salaries and wages recharged
to other organisations
Car parking
122
Annual Report and Accounts 2012/13
4. Operating expenses
4.1 Analysis of operating expenses
2012/13
2011/12
£000
£000
180,118
172,744
Executive Directors’ costs
827
982
Non-Executive Directors’ costs
128
129
Drug costs
46,870
41,045
Supplies and services – clinical
27,677
31,293
Supplies and services – general
5,278
4,876
Establishment
3,069
2,590
Transport
2,756
2,488
Premises
11,420
8,173
(345)
(373)
Depreciation and amortisation
11,002
10,179
Property, plant and equipment impairment
14,620
13,374
Audit services – statutory audit
81
77
Audit services – other external
-
3
1,037
975
Loss on disposal of fixed assets
19
26
Other services from NHS Foundation Trusts
29
-
9
3
5,793
3,538
10,329
8,495
320,717
300,617
Staff costs
Bad debts
Clinical negligence
Other services from NHS Trusts
Other services from other NHS bodies
Other operating expenses
The Trusts property assets have been impaired by £14,620,000. This is necessary for two reasons:
Firstly, the assets are valued under the Modern Equivalent Asset Value method in accordance with the
accounting policy set out in note 1.4. This basis of valuation incorporates the latest building cost indices
and seeks to establish what assets would cost should they be replaced with assets in an equivalent state
of repair at an alternative location. Since standard building cost indices are applied, and across London
these have decreased over the last year, an impairment is required.
Secondly, the Trust has a significant capital expenditure programme taking place on its established
estate in Sutton and Chelsea. This capital programme is based on the requirement to continue to provide
high quality care in the existing locations. Because the capital programme exceeds the values implied by
the Modern Equivalent Asset Valuation an impairment is recognised in the accounts.
This is a technical accounting adjustment and does not require any payment of cash.
123
The Royal Marsden NHS Foundation Trust
4.2 Operating leases
Operating lease rentals include:
Minimum lease payments
2012/13
2011/12
£000
£000
Plant and machinery
208
635
Buildings
692
593
900
1,228
2012/13
2011/12
£000
£000
-
452
19
85
1,190
1,474
387
56
1,491
1,207
-
-
3,087
3,274
Operating lease commitments include:
Minimum lease payments
Total commitments on leases expiring
Not later than one year
Building
Other
Between one and five years
Building
Other
After more than five years
Building
Other
124
Annual Report and Accounts 2012/13
4.3 Salary and pension entitlements of senior managers
Short term benefits
Name
Title
Other long term benefits
Salary
Other
remuneration
Real increase
in pension
at age 60
(bands of
£5,000)
(bands of
£5,000)
(bands of
£2,500)
£000
£000
40-45
Total accrued
pension at age
60 at 31 March
(bands of
£5,000)
Cash
equivalent
transfer value
at 31 March
Real increase
in cash
equivalent
transfer value
£000
£000
£000
£000
-
-
-
-
-
2012/13
Mr R.I. Molson
Chairman
Mr C Clark
Non Executive Director
10-15
-
-
-
-
-
Rev Dame S. Mullally
Non Executive Director
15-20
-
-
-
-
-
Sir J. Craven
Non Executive Director
10-15
-
-
-
-
-
Mr R. Turnor
Non Executive Director
10-15
-
-
-
-
-
Mr G. Andrews
Non Executive Director
10-15
-
-
-
-
-
Prof A. Ashworth
Non Executive Director
10-15
-
-
-
-
-
Miss C. Palmer CBE
Chief Executive
220-225
-
n/a
n/a
n/a
n/a
Mr A. Goldsman
Director of Finance
145-150
-
2.5-5
30-35
617
88
Prof M. Gore
Medical Director
10-15
155-160
0-2.5
70-75
n/a
n/a
Dr S. Dolan
Chief Nurse
115-120
-
0-2.5
35-40
783
41
Dr E. Bishop
Acting Chief Nurse
Appointed 01/10/11
Acting Chief Nurse
5-10
-
0-2.5
25-30
462
38
Mr D. Probert
Chief Operating Officer
120-125
-
0-2.5
20-25
277
27
40-45
-
-
-
-
-
2011/12
Mr R.I. Molson
Chairman
Mr C Clark
Non Executive Director
10-15
-
-
-
-
-
Rev Dame S. Mullally
Non Executive Director
15-20
-
-
-
-
-
Sir J. Craven
Non Executive Director
10-15
-
-
-
-
-
Mr R. Turnor
Non Executive Director
10-15
-
-
-
-
-
Mr G. Andrews
Non Executive Director
10-15
-
-
-
-
-
Prof A. Ashworth
Non Executive Director
10-15
-
-
-
-
-
Miss C. Palmer CBE
Chief Executive
220-225
-
2.5-5
85-90
1,764
161
Mr A. Goldsman
Director of Finance
135-140
-
2.5-5
25-30
530
99
Prof M. Gore
Medical Director
10-15
155-160
2.5-5
70-75
n/a
n/a
Dr S. Dolan
Chief Nurse
95-100
-
2.5-5
35-40
743
128
Dr E. Bishop
Acting Chief Nurse
Appointed 01/10/11
Acting Chief Nurse
65-70
0
2.5-5
n/a
424
n/a
Mr D. Probert
Chief Operating Officer
120-125
-
2.5-5
20-25
251
84
A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme
benefits accrued by a member at a particular point in time. The benefits valued are the member’s
accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment
made by a pension scheme, or arrangement to secure pension benefits in another pension scheme, or
arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their
former scheme. The pension figures shown relate to the benefits that the individual has accrued as a
consequence of their total membership of the pension scheme, not just their service in a senior capacity
to which the disclosure applies. The CETV figures include the value of any pension benefits in another
scheme or arrangement which the individual has transferred to the NHS pension scheme. They also
include any additional pension benefit accrued to the member as a result of their purchasing additional
years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and
framework prescribed by the Institute and Faculty of Actuaries.
125
The Royal Marsden NHS Foundation Trust
5. Employee expenses and numbers
5.1 Employee expenses
2012/13
2011/12
£000
£000
144,007
138,753
Social security costs
12,411
11,757
Employer contributions to NHS Pensions Agency
16,304
15,653
8,223
7,563
180,945
173,726
Salaries and wages
Agency Staff
5.2 Average number of persons employed (full time equivalent)
Permanently
employed
number
Temporary
and contract
staff number
2012/13
total
number
2011/12
total
number
Medical and dental
346
346
347
Administration and estates
841
841
803
Healthcare assistants and
other support staff
272
272
256
1,115
1,115
1,100
784
784
782
413
413
432
413
3,771
3,720
Nursing, midwifery and
health visiting staff
Scientific, therapeutic
and technical staff
Bank and agency staff
3,358
126
Annual Report and Accounts 2012/13
5.3 Median Pay
The Trust is required to disclose the relationship between the remuneration of the highest-paid director
in the Trust and the median remuneration of the Trust’s workforce. The mid-point of the banded
remuneration of the highest-paid director in the Trust in the financial year 2012/13 was £222,500
(2011/12 £222,500). This was 6.7 (2011/12 6.7) times the median remuneration of the workforce, which
was £33,452 (2011/12 £33,150). The median has been calculated to include London-weighting, as the
highest paid director is London-based.
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as
severance payments. It does not include employer pension contributions and the cash equivalent transfer
value of pensions.
5.4 Retirement due to ill-health
During 2012/13 there was one early retirement from the Trust agreed on the grounds of ill-health
(2011/12 two). The estimated additional pension liability of this ill-health retirement will be £9,183
(2011/12 £259,589). The cost of ill-health retirements is borne by the NHS Pensions Agency.
5.5 Staff exit packages
Exit package cost
< £10,000
£10,000 – £25,000
£25,001 – £50,000
Number of
compulsory
redundancies
Number of
other
departures
agreed
Total number
of exit
packages by
cost band
7
22
29
(15)
(15)
8
11
(8)
(8)
4
10
(1)
(1)
3
6
£50,001 – £100,000
3
1
4
£100,001 – £150,000
-
1
1
19
36
55
454
539
993
Total number of exit packages by type
Total resource cost (£000)
Of the 55 departures agreed, 31 were under a Mutually Agreed Redundancy Scheme. Prior year
comparatives are provided in brackets.
127
The Royal Marsden NHS Foundation Trust
6. Profit/(loss) on disposal of plant, property and equipment
2012/13
2011/12
£000
£000
Profit on disposal of buildings
Loss on disposal of plant and equipment
(19)
(25)
Loss on disposal of transport equipment
(1)
Profit on disposal of fixtures and fittings
(19)
(26)
2012/13
2011/12
£000
£000
35
149
35
149
7. Financing income
Interest receivable
128
Annual Report and Accounts 2012/13
8. Intangible assets
Software licences
£000
Cost at 1 April 2012
309
Additions purchased
298
Disposals
-
Cost at 31 March 2013
607
Accumulated depreciation at 1 April 2012
(82)
Provided during the year
(42)
Disposals
Depreciation at 31 March 2013
(124)
Net book value at 31 March 2013
Purchased
Donated
483
483
Cost at 1 April 2011
133
Additions purchased
176
Disposals
-
Cost at 31 March 2012
309
Accumulated depreciation at 1 April 2011
(59)
Provided during the year
(23)
Disposals
Depreciation at 31 March 2012
(82)
Net book value at 31 March 2012
Purchased
Donated
227
227
129
The Royal Marsden NHS Foundation Trust
9. Property, plant and equipment
9.1 Property, plant and equipment at the balance sheet date comprise the following elements:
Cost at 1 April 2012
Land
Buildings
excluding
dwellings
Assets
under
construction
Plant
and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
24,535
121,882
28,139
61,332
58
15,546
2,025
253,517
Additions purchased
Additions donated
Reclassifications
Revaluation
32,051
(315)
19,310
19,310
8,532
8,532
(42,854)
24,220
Depreciation at 1 April 2012
Provided during the year
Revaluation
4,815
367
0
(19,119)
(5,311)
(38)
(3,174)
(283)
(8,806)
61,642
20
17,187
2,109
253,434
(184)
(28,570)
(47)
(7,594)
(659)
(37,054)
(4,254)
(4,613)
(3)
(1,914)
(176)
(10,960)
135,129
13,127
4,185
4,185
Disposals
Depreciation at 31 March 2013
0
(18,804)
Disposals
Cost at 31 March 2013
5,621
5,293
38
3,174
283
8,788
-
(253)
-
(27,890)
(12)
(6,334)
(552)
(35,041)
Net book value at 31 March 2013
24,220
134,876
13,127
33,752
8
10,853
1,557
218,393
Cost at 1 April 2011
24,481
105,339
31,311
52,681
137
13,419
1,517
228,885
Additions purchased
-
-
22,592
-
-
-
-
22,592
Additions donated
-
-
19,361
-
-
-
-
19,361
Reclassifications
-
33,697
(45,125)
8,785
-
2,135
508
-
54
(17,154)
-
-
-
-
-
(17,100)
-
-
-
(134)
(79)
(8)
-
(221)
24,535
121,882
28,139
61,332
58
15,546
2,025
253,517
Depreciation at 1 April 2011
-
(72)
-
(24,378)
(91)
(5,814)
(514)
(30,869)
Provided during the year
-
(3,892)
-
(4,323)
(8)
(1,788)
(145)
(10,156)
Revaluation
-
3,780
-
-
-
-
-
3,780
Disposals
-
-
-
131
52
8
-
191
Depreciation at 31 March 2012
-
(184)
-
(28,570)
(47)
(7,594)
(659)
(37,054)
24,535
121,698
28,139
32,762
11
7,952
1,366
216,463
Revaluation
Disposals
Cost at 31 March 2012
Net book value at 31 March 2012
None of the land or buildings were held under finance leases or hire purchase contracts at 31 March 2013
or 31 March 2012.
130
Annual Report and Accounts 2012/13
9.2 Property, plant and equipment by funding source
Purchased
Land
Buildings
excluding
dwellings
Assets
under
construction
Plant
and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
24,220
83,511
5,584
22,131
8
9,029
659
145,142
51,365
7,543
11,621
1,824
898
73,251
Donated
Net book value at 31 March 2013
24,220
134,876
13,127
33,752
8
10,853
1,557
218,393
Purchased
24,535
75,043
16,609
20,012
10
6,177
513
142,899
-
46,655
11,530
12,750
1
1,775
853
73,564
24,535
121,698
28,139
32,762
11
7,952
1,366
216,463
Land
Buildings
excluding
dwellings
Assets
under
construction
Plant
and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
24,220
131,051
Donated
Net book value at 31 March 2012
9.3 Property, plant and equipment by status
Protected
Unprotected
155,271
3,825
13,127
33,752
8
10,853
1,557
63,122
Net book value at 31 March 2013
24,220
134,876
13,127
33,752
8
10,853
1,557
218,393
Protected
24,535
116,507
-
-
-
-
-
141,042
-
5,191
34,460
31,398
11
7,398
1,232
79,690
24,535
121,698
34,460
31,398
11
7,398
1,232
220,732
Unprotected
Net book value at 31 March 2012
9.4 The net book value of land, buildings and dwellings comprises:
Freehold
31 March 2013
31 March 2012
£000
£000
159,096
146,233
159,096
146,233
131
The Royal Marsden NHS Foundation Trust
10. Inventories
2012/13
2011/12
£000
£000
4,895
4,416
4,895
4,416
2012/13
2011/12
£000
£000
7,642
9,720
(3,402)
(3,865)
Prepayments
2,029
1,874
Accrued income
9,881
8,321
18,731
16,612
34,881
32,662
2012/13
2011/12
£000
£000
At 1 April
3,865
4,302
(Decrease)/increase in provision
(345)
(373)
Amount utilised
(118)
(64)
At 31 March
3,402
3,865
Raw materials and consumables
11. Trade receivables and other receivables
11.1 Current
NHS trade receivables
Provision for impaired receivables
Other receivables
11.2 Provision for impairment of receivables
132
Annual Report and Accounts 2012/13
11.3 Analysis of impaired trade and other receivables
2012/13
2011/12
£000
£000
Up to three months
305
537
In three to six months
427
804
2,670
2,524
3,402
3,865
17,617
16,578
In three to six months
1,193
1,171
Over six months
1,720
627
20,530
18,376
Ageing of impaired receivables
Over six months
Ageing of non-impaired receivables past their due date
Up to three months
133
The Royal Marsden NHS Foundation Trust
12. Current liabilities
2012/13
2011/12
£000
£000
Trade and other payables
17,015
19,695
Accruals
13,577
16,127
-
11
3,924
3,772
20,706
14,686
55,222
54,291
Provisions
Tax payables
Other liabilities
13. Provisions for liabilities and charges
Pensions
relating to
other staff
Other
Total
£000
£000
£000
23
-
23
(11)
-
(11)
Released to operating expenses during the year
-
-
-
Provided in year
-
-
-
At 31 March 2012
12
-
12
At 1 April 2012
12
12
(12)
(12)
At 1 April 2011
Utilised during the year
Utilised during the year
Released to operating expenses during the year
-
Provided in year
At 31 March 2013
-
-
-
-
-
-
Expected timing of cash flows
Less than one year
Between one and five years
134
Annual Report and Accounts 2012/13
Clinical negligence
£2,511,033 is included in the provisions of the NHS Litigation Authority at 31 March 2013 in respect
of clinical negligence liabilities of the Trust (31 March 2012 £2,863,116).
Pensions
Provision for the pre-1995 pension related costs on early retirements have been accounted for by
the Trust.
14. Notes to the cash flow statement
14.1 Reconciliation of operating surplus to net cash flow from operating activities
2012/13
2011/12
£000
£000
640
10,969
Depreciation and amortisation
11,002
10,179
Impairment
14,620
13,374
Increase in inventories
(479)
(198)
Increase in receivables
(2,534)
(11,418)
(Decrease)/increase in trade and other payables
(2,195)
4,996
6,018
(1,658)
(12)
(11)
19
26
27,079
26,259
2012/13
2011/12
£000
£000
Decrease in cash in the period
(8,110)
(18,756)
Net funds at 1 April
22,397
41,153
Net funds at 31 March
14,287
22,397
Total operating surplus
Non-cash income and expense
Increase/(decrease) in other liabilities
Decrease in provisions
Other non-cash movements
Net cash inflow from activities
14.2 Reconciliation of net cash flow to movement in net funds
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The Royal Marsden NHS Foundation Trust
14.3 Analysis of changes in net funds/(debt)
At 31 March
2013
Changes in
cash in year
At 1 April
2012
£000
£000
£000
14,001
(7,448)
21,449
286
(662)
948
14,287
(8,110)
22,397
Government Banking Service cash at bank
Commercial cash at bank and in hand
Cash and cash equivalents
15. Capital commitments
Commitments under capital expenditure contracts at the balance sheet date were £1,775,104 (2011/12
£4,454,908). A further £482,921 (2011/12 £3,587,680) capital expenditure is committed to be funded by
The Royal Marsden Cancer Charity.
16. Contingencies
There are no contingent liabilities at the balance sheet date.
17. Financial performance targets
17.1 Public dividend capital
The Trust is required to pay an annual dividend of 3.5% of its forecast average relevant net assets.
The actual dividend rate is the dividend paid figure in the cash flow statement, £4,200,000 (2011/12
£4,091,000), divided by the average of relevant opening and closing net assets, £128,042,309 (2011/12
£120,462,000), expressed as a percentage. This gives an actual dividend rate for 2012/13 of 3.3%
(2011/12 3.5%).
17.2 Losses and special payments
There were 1,612 cases of losses and special payments (2011/12 299) totalling £120,986
(2011/12 £69,354). These payments are the cash payments made in the year and are not calculated
on an accruals basis.
There were no clinical negligence, fraud, personal injury, compensation under legal obligation or
fruitless payment cases where the net payment exceeded £100,000 (2011/12 nil).
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Annual Report and Accounts 2012/13
17.3 Prudential borrowing limit
The Trust is required to comply and remain within the prudential borrowing limit set by Monitor.
This is made up of two elements.
– the maximum cumulative amount of long-term borrowing. This is set by reference to the five ratio
tests set out in Monitor’s Prudential Borrowing Code. The financial risk rating set under Monitor’s
Compliance Framework determines one of the ratios and therefore can impact on the long-term
borrowing limit
– the amount of any working capital facility approved by Monitor.
2012/13
2011/12
£000
£000
Maximum cumulative long term borrowing
57,600
57,600
Working capital facility
21,600
21,600
Prudential borrowing limit set by Monitor
79,200
79,200
-
-
Actual borrowing in year
The Trust’s dividend cover ratio for the year was 3.9 compared to a minimum dividend cover ratio
required of 1 (3.6 for the year ended 31 March 2012).
18. Related party transactions
The Royal Marsden NHS Foundation Trust is a public benefit corporation and has been authorised
pursuant to Section 6 of the Health and Social Care (Community Health and Standards) Act 2003.
During the year none of the Board Members or members of the senior management team or parties
related to them has undertaken any material transactions with the Trust.
During the year the Trust has had a significant number of material transactions with the following
NHS bodies:
– N HS Primary Care Trusts
– N HS Foundation Trusts
– N HS Strategic Health Authorities
– N HS Trusts
– N HS Pension Scheme
– N HS Blood and Transplant.
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The Royal Marsden NHS Foundation Trust
The Trust has entered into the following material transactions with related parties:
Income
2012/13
£000
Sutton and Merton PCT
62,171
Croydon PCT
29,398
Surrey PCT
23,236
Department of Health
17,778
West Sussex PCT
8,241
Kingston PCT
7,344
Hampshire PCT
6,520
London Strategic Health Authority
6,103
Wandsworth PCT
5,911
East of England Specialised Commissioning Group
5,168
Richmond and Twickenham PCT
5,034
Kensington and Chelsea PCT
3,821
South West Specialist Commissioning Group
3,558
Epsom and St Hellier NHS Trust
3,319
Guy’s and St. Thomas’ NHS Foundation Trust
3,074
Eastern and Coastal Kent PCT
2,725
Westminster PCT
2,515
Hounslow PCT
2,438
198,354
Expenditure
2012/13
£000
NHS Pension Scheme
16,312
HM Revenue and Customs
12,411
Sutton and Merton PCT
5,961
NHS Blood and Transplant
3,606
38,290
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Annual Report and Accounts 2012/13
Payables
31 March 2013
£000
HM Revenue and Customs
3,924
NHS Pension Scheme
2,238
6,162
The Trust has had a number of transactions with Government departments and other central and local
Government bodies. These include transactions with the Royal Borough of Kensington and Chelsea and
the London Borough of Sutton relating to business rates.
19. Financial instruments
IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating
or changing the risks an entity faces in undertaking its activities. The Trust does not have any complex
financial instruments and does not hold or issue financial instruments for speculative trading purposes.
Because of the continuing service provider relationship the Trust has with Primary Care Trusts and
the way those Primary Care Trusts are financed, the Trust is not exposed to the degree of financial risk
faced by business entities.
Also financial instruments play a much more limited role in creating or changing risk than would be
typical of the listed companies to which IFRS 7 mainly applies. The Trust has limited powers to borrow
or invest surplus funds and financial assets and liabilities are generated by day-to-day operational
activities rather than being held to change the risks facing the Trust in undertaking its activities.
The Trust’s financial instruments comprise loans, finance lease obligations, provisions, cash at bank
and in hand and various items, such as trade debtors and trade creditors, that arise directly from its
operations. The main purpose of these financial instruments is to raise finance for the Trust’s operations.
19.1 Categories of financial instruments
2012/13
2011/12
£000
£000
54,063
53,185
55,222
35,822
Financial assets
Loans and receivables (including cash)
Financial liabilities
Other financial liabilities (amortised cost)
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The Royal Marsden NHS Foundation Trust
19.2 Fair values
31 March 2013
Book value
31 March 2013
Fair value
31 March 2012
Book value
31 March 2012
Fair value
£000
£000
£000
£000
-
-
12
12
Financial liabilities
Provision under contract
As allowed by IFRS 7, short term trade debtors and creditors measured at amortised cost may be
excluded from the above disclosure as their book values reasonably approximate their fair values.
19.3 Liquidity and interest risk tables
Less than
1 year
Total
£000
£000
32,851
32,851
14,287
14,287
Gross financial assets at 31 March 2013
47,138
47,138
Non-interest bearing
30,788
30,788
22,397
22,397
53,185
53,185
Weighted
av. interest
rate %
Financial assets
Non-interest bearing
Variable interest rate instrument
Variable interest rate instrument
Gross financial assets at 31 March 2012
0.25%
0.25%
20. Third party assets
The NHS Foundation Trust held nil cash at bank and negligible cash in hand at 31 March 2013
(31 March 2012 – nil) which relates to monies held by the NHS Foundation Trust on behalf of patients.
21. Events after the reporting period
There have been no material events after the reporting period.
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Annual Report and Accounts 2012/13
22. Adoption of new and revised standards
At the date of authorisation of these financial statements, the following standards and interpretations
which have not been applied in these financial statements were in issue but not yet effective (and in
some cases had not yet been adopted by the EU):
IAS 12
(December 2010)
Income taxes
IFRS 7
(December 2011)
Offsetting financial assets and liabilities (disclosure)
IFRS 9
(October 2010)
Financial liabilities
IFRS 9
(November 2009)
Financial assets
IFRS 10
(May 2011)
Consolidated financial statements
IFRS 11
(May 2011)
Joint arrangements
IFRS 12
(May 2011)
Disclosure of interests in other entities
IFRS 13
(May 2011)
Fair value measurement
IAS 1
(June 2011)
Presentation of financial statements
IAS 27
(May 2011)
Separate financial statements
IAS 28
(May 2011)
Associates and joint ventures
IAS 19
(June 2011)
Employee benefits
IAS 32
(December 2011)
Offsetting financial assets and liabilities (presentation)
The Trust does not expect that the adoption of these standards and interpretations in future periods will
have a material impact on the financial statements of the Trust.
141
The Royal Marsden NHS Foundation Trust
Life demands excellence.
At The Royal Marsden, we deal with cancer every
day so we understand how valuable life is. And
when people entrust their lives to us, they have
the right to demand the very best.
That’s why the pursuit of excellence lies at
the heart of everything we do. No matter what
we achieve, we’re always striving to do more.
No matter how much we exceed expectations,
we believe we can exceed them still further.
We will never stop looking for ways to improve
the lives of people affected by cancer. This attitude
defines us all, and is an inseparable part of the
way we work. It’s The Royal Marsden way.
You can visit, write to or call The Royal
Marsden using the following details:
Chelsea, London
The Royal Marsden
Fulham Road
London SW3 6JJ
Tel 020 7352 8171
Sutton, Surrey
The Royal Marsden
Downs Road, Sutton
Surrey SM2 5PT
Tel 020 8642 6011
www.royalmarsden.nhs.uk
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Annual Report and Accounts 2012/13