Download Annual report and accounts 2012-13

Moorfields Eye Hospital
NHS Foundation Trust
Annual Report and
Accounts 2012/13
Moorfields Eye Hospital NHS Foundation Trust
Annual Report and Accounts 2012/13
Moorfields Eye Hospital
NHS Foundation Trust
Annual Report and
Accounts 2012/13
Presented to Parliament pursuant to Schedule 7,
paragraph 25(4) of the National Health Service Act 2006
2 3
Contents
Section 1
Chairman’s foreword
5
Section 2
Welcome to Moorfields
7
Who we are 7
What we do
7
Where we work
9
Section 3
Directors’ report
11
Directors during 2012/13
11
The strategic context
11
⎯– Our Vision of Excellence
11
⎯– Priorities for the year
13
⎯– Responding to the Francis inquiry
15
⎯– A new centre of excellence
17
Clinical care 18
⎯– Clinical developments
18
⎯– Improving the patient experience
19
⎯– Patient safety
21
⎯– Clinical effectiveness
23
⎯– Enhanced infrastructure support and new equipment
24
Research and development
25
⎯– A new strategy for research and development
25
⎯– National Institute for Health Research biomedical research centre
26
⎯– UCL Partners
26
⎯– Research activity this year
27
Education, teaching and training
28
⎯– Undergraduate medical training
28
⎯– Post-graduate medical training
28
⎯– Developing our non-medical staff
29
⎯– Sharing our expertise
31
Working with patients and partners
31
⎯– Listening to our patients
32
⎯– New communication initiatives
33
⎯– Social and community initiatives
33
⎯– Charitable support
34
⎯– Events and visits
35
Working with our staff
36
⎯– Staff engagement
36
⎯– Developing, supporting and rewarding our staff
37
⎯– Learning and development
38
Looking ahead
38
Section 4
Section 5
Section 6
Operational and financial review
41
Patient activity
41
Commissioning arrangements
42
Business continuity
42
Commercial divisions
43
⎯– Moorfields Pharmaceuticals
43
⎯– Moorfields Private
44
⎯– Moorfields Eye Hospital Dubai
44
Financial report
45
⎯– Income
46
⎯– Expenditure
47
⎯– Statement of financial position
47
⎯– Statement of cash flows
47
⎯– Borrowing
48
– External audit services
48
– Counter-fraud arrangements
49
– Accounting policies and other declarations
49
– Financial outlook for 2013/14
49
Governance arrangements
51
Membership council
51
⎯– Composition of the membership council 2012/13
52
⎯– Register of interests for the membership council
53
Our membership
53
⎯– Representing our membership
54
⎯– Elections
54
Board of directors
55
⎯– Composition of the board of directors 2012/13
55
⎯– Committees of the board
56
⎯– Managing risk
59
⎯– Performance assessment
61
⎯– Register of interests for the board of directors
61
Statement of compliance with the NHS foundation trust code of governance
61
Remuneration report
63
APPENDICES
65
1 Quality report
67
2 Staff survey
97
3 Sustainability report
99
4 Equality and diversity report
103
5 Annual accounts
105
5
1
Chairman’s foreword
I am pleased to introduce the 2012/13 annual report and accounts for Moorfields Eye Hospital NHS
Foundation Trust.
As usual, Moorfields has achieved much over the past 12 months, although the year was not
without its challenges. In particular, the publication of the second Francis report in early 2013 gave
us all pause for thought, and an opportunity to review whether we are focusing enough on the
issue that matters most – the quality of the care that we provide to our patients.
We believe that we are, but have nonetheless identified several areas where improvements could
be made and are working to implement these, sometimes using new ideas, sometimes building
on existing activities. We had, for example, already introduced a regular quality of services and
patient experience report to the board to complement those covering operational and financial
matters, and will continue to enhance this to ensure that we are getting as full as possible a
picture on this crucial topic.
Patient attendances rose again this year, with people being seen both at our main hospital in
London’s City Road and, increasingly, in our various satellite locations. Our satellite network model
is becoming more established and stronger, providing care in a number of areas from expert
consultant participation in eye services run by other organisations, to community eye clinics and
centres offering both outpatient and surgical services.
To support the growing numbers of patients choosing to come to Moorfields, we introduced several
new treatments and services, as well as new ways of working, and several new senior clinical posts.
These include five new consultant posts in a range of sub-specialties and supporting satellite services
as well as those at our main City Road hospital, a new senior nurse at St George’s, two new matron
roles covering our satellites in north-west London, and a new lead nurse for education and research.
We have also continued with our programme of refurbishment of service areas and completed an
upgrade at our unit at St Ann’s Hospital in Tottenham, ensuring that our patients can enjoy a much
higher standard of accommodation than was previously the case.
We made an important decision about the long-term future of our main central London hospital,
following detailed deliberations and analysis throughout the year. Our decision to focus all our
efforts on a location in the King’s Cross/Euston area is, we believe, the best way to meet our
aspiration – together with our research partners at the UCL Institute of Ophthalmology – to create
a fully integrated and flexible modern facility, bringing together patient-focused eye research,
education and healthcare in a truly coherent way. There is a lot more work to do before this
becomes a reality, but our decision is an important milestone and an exciting opportunity to assure
our future as one of the world’s leading eye centres.
Financially, we had a satisfactory year, slightly exceeding our planned surplus of £4 million. This is
important; as an NHS foundation trust, we can reinvest our surpluses in services and facilities for
6 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
patients, and many of the developments described in this report – as well as our ambitious plans
for the future – are possible in large part thanks to our strong financial performance in recent
years. Our commercial divisions – Moorfields Pharmaceuticals, Moorfields Private and, increasingly,
Moorfields Eye Hospital Dubai – make an important contribution to our financial health and all
performed well again this year, despite the challenging financial climate.
Donations to our affiliated charities also provide vital financial support, and I am very grateful to
everyone involved in our fundraising activities for their continued support, both now and in the
future, when philanthropic giving will be increasingly important. We also recognise the generosity of
all those who give to the hospital’s affiliated charities.
Our operational performance was strong, and we achieved all the national targets that matter
most to patients, as well as ensuring compliance with all the standards set by the Care Quality
Commission (CQC) and others. Our biggest operational challenge remains to reduce the amount of
time that patients wait once they arrive for appointments in our clinics and to improve our surgical
pathways. We have made progress here, especially in our A&E department, and in those areas with
large and growing demand, such as glaucoma outpatients, but we have to get much better. The
radical new way of working that we tested in the glaucoma outpatient clinics held in our eye centre
at St George’s Hospital in Tooting has the potential to enable dramatic improvements in waiting
times in future.
Continuing to improve our services while responding to the growth in demand is a key challenge
both for our board and our foundation trust governors. In the latter group, I am pleased formally
to welcome Ron Wallace to our membership council, representing residents of Bedfordshire and
Hertfordshire. I would also like to take this opportunity to thank non-executive director Lesley Potter
and director of IT Mike Andersson, both of whom left Moorfields this year. Both joined Moorfields
five years ago at a challenging point in our history and made important contributions to the much
stronger position in which we find ourselves now. In Lesley’s place, I am delighted to welcome
Sumita Sinha, whose background in architecture and teaching, as well as her experience as a
Moorfields patient, will be invaluable as we develop our plans for our new centre of excellence.
Finally, I must thank all our staff. I say it every year, but they genuinely are our greatest asset and
their continued commitment will be crucial to ensuring that Moorfields remains where it should be –
at the forefront of eye treatment, research and education in the best interests of our patients.
Rudy Markham, chairman
7
2
Welcome to Moorfields
2.1 Who we are
Moorfields Eye Hospital NHS Foundation Trust is the leading provider of eye health services in
the UK and a world-class centre of excellence for ophthalmic research and education. We have a
reputation, developed over two centuries, for providing the highest quality of ophthalmic care. Our
1,800 staff are committed to sustaining and building on our pioneering legacy and ensuring we
remain at the cutting edge of developments in ophthalmology.
We were one of the first NHS organisations to become a foundation trust in 2004 and are founder
members of UCL Partners, one of the UK’s first academic health science centres. With our partners
at the UCL Institute of Ophthalmology, we are members of Vision 2020, an organisation committed
to raising public awareness of blindness and vision impairment as major public health issues.
Moorfields is registered without conditions with the Care Quality Commission (CQC), the
independent regulator of health and social care in England.
2.2 What we do
Our mission is to be the leading international centre in the care and treatment of people with eye
disorders, driven by excellence in research and education. This is supported by a set of values, which
build on those in the NHS constitution, but also reflect Moorfields’ particular philosophy:
We strive to give people the best possible visual health so that they can live their lives to the full
We put patients at the centre of everything we do by treating everyone with respect and
compassion
We undertake to use our resources effectively and efficiently to provide high-quality care
We seek to build on our pioneering legacy by leading innovations in eye health
We recognise the worth of our staff by providing rewarding careers and supporting personal and
professional development
We aim to provide seamless care through professional teamworking and strong, innovative
partnerships
We are committed to acting responsibly and being held accountable for all we do
8 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Our main focus is the treatment and care of NHS patients with a wide range of eye problems, from
common complaints to rare conditions that require treatment not available elsewhere in the UK.
Our patient services are sub-divided into four clinical directorates, following a restructure which
came formally into force on 1 April 2012. The restructure aims to ensure that senior clinicians have
greater authority and more responsibility to make decisions about the management of patient care.
Our new directorates are responsible for patient care as follows.
Outpatient and diagnostic services
The outpatient and diagnostic services directorate comprises all outpatient services at City Road,
clinical support services, our specialist A&E department, the clinical sub-specialties focused on
paediatric and emergency care and chronic disease management, and a new general ophthalmology
service. The directorate is also responsible for our joint working arrangements with Barts Health and
Great Ormond Street Hospital for Children.
Surgical services
The surgical services directorate comprises all elements of the surgical pathway at City Road, as well
as the theatre and recovery staffing and facilities at the majority of our satellites. It also includes the
medical secretariat and the records library, and the clinical sub-specialties focused principally on the
surgical pathway.
Moorfields South
Moorfields South centres on our district hub at St George’s hospital in Tooting and encompasses
responsibility for the management of all our other satellite locations in south-west London.
Moorfields North
Moorfields North covers our three district hubs to the north of the river (Bedford, Ealing and
Northwick Park hospitals) and the satellite locations that support them, along with the smaller
satellite sites that make up Moorfields East (Barking, Harlow, Homerton, Mile End and St Ann’s).
Our unique patient case-mix and the number of people we treat mean that our clinicians have
expertise in discrete ophthalmic sub-specialties as listed below
Clinical service
What it does
Accident and emergency
Treats urgent eye problems
Adnexal
For treatments for the accessories or anatomical parts attached to the
eyeball, such as the eyelids, extraocular muscles, orbit and tear glands
Cataract
A common eye condition, in which the lens becomes progressively
opaque, resulting in blurred vision
External disease and corneal
For conditions related to the outside of the eyeball, including the
cornea, iris and sclera (the tough outer layer of the eye)
General ophthalmology
(formerly primary care)
Treatment for general eye problems, including those that might need
referral to one of our more specialist services
Glaucoma
For treatments for the signs and symptoms of this common condition,
including increased pressure in the eyeball, which can cause gradual
loss of sight if left untreated
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Clinical service
What it does
Medical retina
Provides medical treatments for conditions at the back of the eye,
using drugs, eye drops or lasers, and including diabetic screening and
age-related macular degeneration (AMD), an increasingly common
eye condition, especially among older people, in which central vision
gradually worsens
Ocular oncology
Treats cancers of the eye; provided by Barts Health NHS Trust
Paediatrics
Services for children’s eye conditions, including those provided jointly
with Great Ormond Street Hospital for Children NHS Foundation Trust
and others
Refractive
For the treatment of refractive errors using precision lasers
Strabismus and neuroophthlamology
Treats squints and visual problems related to the nervous system
Vitreo-retinal
Provides treatments for conditions at the back of the eye that require
surgical interventions, including retinal detachments
We also have service directors for anaesthetics and for theatres, providing clinical leadership in these
important areas.
In addition, we provide a range of specialist clinical support services, including:
Electrodiagnostics
Eye bank, which stores tissue for transplantation
Medical imaging
Ocular prosthetics
Orthoptics
Optometry, including medical contact lens, refraction, low-vision aid and spectacle dispensing
services
Pathology (provided by the UCL Institute of Ophthalmology)
Pharmacy
Radiology and ultrasound
We are a postgraduate teaching centre and a national centre for ophthalmic research involving, with
the UCL Institute of Ophthalmology, one of the largest ophthalmic research programmes in the world.
We also manage three commercial divisions: Moorfields Private, Moorfields Pharmaceuticals and
Moorfields Eye Hospital Dubai.
2.3 Where we work
We treat people at our main hospital in London’s City Road and in several other locations in and
around the capital, which enables us to provide expert treatment closer to patients’ homes. These
satellite services are organised into four main categories as set out below.
District hubs
Co-located with general hospital services, our district hubs provide comprehensive outpatient and
diagnostic care as well as more complex eye surgery and will increasingly serve as local centres
9
10
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
for eye research and multidisciplinary ophthalmic education. Moorfields runs district hubs in the
following locations:
Bedford hospital
Ealing hospital
Northwick Park hospital, Harrow
St George’s hospital, Tooting
Local surgical centres
These centres provide more complex outpatient and diagnostic services alongside day-case surgery
for the local area and can be found in the following locations:
Mile End hospital, Whitechapel
Potters Bar community hospital
Queen Mary’s hospital, Roehampton
St Ann’s hospital, Tottenham
Community-based outpatient clinics
These clinics focus predominantly on outpatient and diagnostic services in community-based
locations closer to patients’ homes. Moorfields runs such clinics in the following locations:
Barking community hospital
Bedford enhanced services centre (North Wing)
Bridge Lane health centre, Battersea
Loxford polyclinic, Redbridge
Teddington Memorial hospital
Partnerships and networks
In this model, Moorfields offers medical and professional support and joint working to eye
services managed by other organisations. We have partnership arrangements with the following
organisations:
Croydon Health Services NHS Trust, based in Croydon university hospital
Homerton University Hospital NHS Foundation Trust, based in Homerton hospital in Hackney
The Princess Alexandra NHS Trust, based in Princess Alexandra hospital in Harlow
West Hertfordshire Hospitals NHS Trust, based in Watford general hospital
Harrow Health Ltd, a company formed by local GPs, based in the Visioncare eye medical centre
in Wealdstone
Direct Local Health (DLH), a local practice-based commissioning group, based in Boots Opticians
in the Harlequin shopping centre in Watford
We also provide clinical leadership to various diabetic retinopathy screening services and to networks
across London that deal with retinopathy of prematurity, an eye condition that affects premature
babies.
3
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Directors’ report
3.1 Directors during 2012/13
Job title
Name
Chairman
Rudy Markham
Chief executive
John Pelly
Non-executive directors
Deborah Harris-Ugbomah
Sir Roger Jackling
Professor Phil Luthert
Andrew Nebel
Lesley Potter
Stephen Williams
Medical director
Mr Declan Flanagan
Chief operating officer
Ruth Russell
Finance director
Charles Nall
Director of research and development
Professor Peng Tee Khaw
Director of nursing and allied health
professions
Tracy Luckett
The following directors, who are formally associate directors, also attend board meetings, but do
not have voting rights:
Job title
Name
Comments
Director of information technology
Mike Andersson
Until 21 March 2013
Director of strategy and business development
Rob Elek
Director of human resources
Sally Storey
Director of corporate governance
Ian Tombleson
From 14 May 2012
3.2 The strategic context
Our Vision of Excellence
Our Vision of Excellence, a 10-year strategy for Moorfields published in September 2010, provides
the framework for our annual planning processes. During 2012/13, we reviewed the high-level
aspirations of the strategy in light of changes to the wider healthcare environment and our success
or otherwise to date in implementing our plans. The publication of the Francis report toward the
end of the year also presented us with a further opportunity to ensure that the strategy is focused
on what is most important: the quality of what we do and the patients we treat.
12 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
The main conclusion of this high-level review was that our initial themes continue to represent
the appropriate strategic direction for the organisation, but that the underpinning actions require
updating as there are some gaps between where we are and where we need to be. A first draft of a
refreshed strategy document has been produced, which will be further refined during 2013/14, and
reflected in our strategic priorities for future years.
Our strategy remains aligned with the main thrust of the Health and Social Care Act 2012; namely,
to place patients at the heart of all we do, focus on improving further clinical safety and outcomes,
and continue to lead the way in providing more ophthalmic care in community and primary care
settings. The lifting of the private patient cap, set out in the act, will also enable further income
growth opportunities.
– Vision
The strategy sets out a vision of where we want to be by 2020:
Providing a comprehensive range of eye care services, operating through a network of centres
linked to a state-of-the-art facility in London
Shaping the development and delivery of the eye health agenda nationally
Known for providing the highest standards of patient experience, outcomes and safety across all
of our sites
At the forefront of international research with our partners
Maintaining our leading role in the training and education of eye care clinicians
To achieve this vision, our strategy identifies a range of objectives under four strategic themes,
which are supported by five enabling themes. All nine of these themes are interlinked, interdependent and mutually supportive.
– Strategic themes
What we do: how Moorfields’ service portfolio will change
Moorfields will remain the leading provider of specialist ophthalmic care nationally, but should
also aim to become a leader in community-based eye services. We will also continue to be at the
forefront of research and education in ophthalmology.
Where we work: how our geographical reach will develop
Moorfields will provide services through a structured network of facilities across London and
the south east, supported by a state-of-the art centre in London, which will be the focus for our
most specialist and complex clinical services.
Our reputation and quality: how we will ensure quality is the defining characteristic
of all we do
Wherever patients use our services, Moorfields will be the safest place to have ophthalmic
treatment, the provider with the best outcomes for routine and specialist treatments, and be
known for offering an excellent patient experience. We want Moorfields to provide training set
apart by its high quality, and research that continues to be world leading.
Our role and influence: the part we will play as the market leader in eye care
We will seek to retain our autonomy and identity, and use our knowledge, skills and experience
to help shape, rather than simply respond to, the ophthalmic agenda.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – Enabling themes
Improving our estate and facilities: we will redevelop our facilities to provide a central
London hospital and local services in accommodation that is fit for the 21st century and provides
a consistently excellent patient environment.
Increasing our productivity and efficiency: we will develop and implement a programme
to maximise productivity and efficiency in all our clinical and non-clinical services.
Developing our workforce: we will ensure we have the right workforce, skills and capacity
to implement our clinical model and strategy.
Developing our leadership and organisational design: we will ensure we have the
leadership, culture and organisational design we need to implement the strategy.
Improving our IT and information: we will put in place the IT and information so that we
understand what we do and how well we do it, and maximise the potential of technology to
reduce our cost base and improve the care we give.
Priorities for the year
Our 2012/13 annual plan expressed our business plans through a series of priority areas and
objectives that are clearly linked to the strategic and enabling themes within Our Vision of
Excellence, enabling the annual plan to become the implementation vehicle for the strategy. These
priority areas did not include issues that had become business as usual.
Our priorities for 2012/13 were as follows:
– What we do: how our portfolio will change
Target our business development activities to ensure that we make the largest impact where it
matters most, to us and our stakeholders
Build on our successful biomedical research centre application and ensure that we continue to
lead the world in eye-related research
Develop and commence implementation of a comprehensive education, learning and
development strategy for medical, nursing, optometrist, other professional and non-clinical staff
Maximise our returns from Moorfields Private by commencing the implementation of our private
patient strategy
Establish an organisation for specialist pharmaceutical products through collaboration with
leading London hospitals
– Where we work: how our geographical reach will develop
Provide the right sub-specialty services closer to patients’ homes in line with our strategy and
with the quality, innovation, productivity and prevention (QIPP) agenda, within a financially
sustainable model of care
Further develop our international presence
13
14 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
– Our quality and reputation: how we will ensure quality is the
defining characteristic of all we do
Ensure that we are fully prepared to implement medical revalidation arrangements when agreed
and use revalidation and our new clinical management structure to enhance our clinical quality
management systems and culture
Embed existing outcome measures into performance management, and further develop
meaningful and relevant outcome measures
Ensure we use the most effective and efficient clinical technologies by exploring and, where
appropriate, trialling developments including Femto-assisted phaco and flexible theatre solutions
Further improve the patient experience
Ensure that we are able to respond to the implications of the Health and Social Care Act 2012 in
relation to its governance and regulatory requirements
– Our role and influence: the part we play as the market leader in eye
care
Further raise our profile and ability to influence key decision-makers to build support for strategic
developments and key projects, by developing effective two-way external communications with
key individuals and organisations
Develop and strengthen our overall brand identity to ensure quality and consistency across all our
service locations
Modernise our website by making it more relevant and accessible to patients, GPs and other
stakeholders
– Improving our estate and facilities
Commence the next phase of planning for our future facilities requirements, following the
appointment of an appropriately resourced project team
Continue to progress the pre-campaign phase, ahead of initiating the private phase of the
fundraising campaign to support the City Road redevelopment project
Improve the environment and increase capacity for the new A&E clinical pathways
Upgrade the patient and staff environment at our district hubs, focusing on Ealing and St
George’s
Ensure that our City Road hospital can provide operational services safely until our new facilities
are completed
– Increasing our productivity and efficiency
Continue to achieve service and cost improvements
Further assess and exploit the use of digital technology to improve quality, services, productivity
or costs
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – Developing our workforce
Establish and implement revised staffing profiles in identified target areas to enhance the patient
experience and provide an optimal service and cost balance
Develop a strategy for nursing and allied health professionals that extends and enhances their
role and capacity in healthcare provision
– Developing our leadership and organisational design
Improve clinical engagement, connect responsibilities and authorities at service and satellite level,
and integrate operational, nursing and clinical management by successfully embedding the new
clinical management structure
Improve the development, retention and progression of our high potential talent through the
implementation of talent management processes
Refresh our internal communications and engagement strategy to ensure that all our staff can be
fully involved in what we do
– Improving our IT and information
Complete the development of OpenEyes, including a structured roll-out of the clinical system
across all sub-specialties and locations
Agree and commence implementation of plans to enable the operation of clinical and other
areas without paper
Identify and commence implementation of a system that provides unified and consistent access
to ophthalmology medical images, irrespective of the user’s location or the equipment on which
images were captured
Develop and implement an ICT infrastructure that, for the foreseeable future, can support the
provision of care at all required locations and meet the needs of all users
Support the effective management of the organisation by implementing a new HR and payroll
system and preparing for the implementation of a new finance system
For each of our priorities, we agreed objectives and action plans and monitored progress against
them through quarterly reports to the board throughout 2012/13.
Our performance across all the priorities has generally been good, with significant achievements
being made across a broad and ambitious range of objectives. This annual report, including the
quality report at appendix 1, contains many examples of the progress we made against these
priorities. Areas in which we have made less progress than we would have liked remain priorities for
2013/14 as set out in section 3.8 below.
Responding to the Francis inquiry
In common with all NHS organisations, Moorfields has sought to learn from the findings of the
second Francis report into the circumstances leading to the very poor care at Stafford Hospital,
which was published in February 2013. Our response and action plan is structured around five key
themes raised in the report itself, with sub-themes and action plans for each as summarised below.
We have sought to ensure that each sub-theme and the associated action plans are consistent with
and in the spirit of the Francis report, easy to understand, proportionate in relation to Moorfields,
and achievable, consisting of a combination of current and new initiatives.
15
16 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
– Putting the patient first
Progress with the transformation programme – our transformation programme is in its early
stages, but is gradually gaining momentum, and is designed to ensure that everything we do is
viewed through the eyes of patients (see page 19 for more information)
Listen to patients and carers and address the issues raised through patient feedback – we have
a range of ways of receiving feedback from patients (see pages 32 to 33), but we need to
review these to ensure they are properly joined up and systematically addressed; we also need to
improve genuine engagement with patients, which will be a feature of our emerging patient and
public involvement strategy
– Organisational culture and values
The trust and trust board – the board will continue with its constructive, self-critical analysis as
part of its self-evaluation processes
Reinforcing clarity of values and principles – we will use the changes agreed nationally to
Agenda for Change to improve the quality and coverage of staff appraisal, an important part of
this theme
Listening organisation – although we have a range of mechanisms to enable staff to provide
feedback and raise concerns, these need reinforcement and enhancement; the findings of the
most recent staff survey (see appendix 2) will be helpful in this regard, as will our plans to make
senior managers more accessible to staff across the trust
Connecting staff up and down the organisation – we will continue to build on our new clinical
management structure, in particular the roles of the new service directors, to ensure that
front-line staff and services fully understand the aspirations of senior clinical and managerial
leaders
Compassion among front-line staff – this is a major component of our new nursing strategy (see
page 29) for which a more detailed action plan is already being developed
– Standards of behaviour
Evaluation of customer care programme – this programme, which focuses on front-line staff
behaviours and how they communicate and engage with patients has been running for more
than a year and is now being evaluated to identify whether further action is required
Candour, openness and transparency – we will review our ‘being open’ policy to ensure that it is
working as intended to ensure that patients are properly notified of serious incidents relating to
their care
– Governance
The role of the quality and safety committee – the committee (see section 5.3) will consider its
oversight and scrutiny remit
Enhancing the role of governors – this is a new requirement resulting from the Health and Social
Care Act 2012 and will assist us in ensuring that the trust board is held to account and that the
membership council is able to represent the public interest
Internal and external peer review – we will learn from our successful patient safety walkabout
programme (see page 22) and consider what form of peer review would be appropriate to assess
the quality of our services and systems
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Measuring ophthalmic clinical outcomes – this will continue as a priority in our quality accounts
(see appendix 1)
Review of care out of hours – although no specific concerns have been raised about patient
safety out of hours, we will review our arrangements to ensure clinical staff cover and
supervision is adequate at all times
Review of follow-up care – following the completion of a review of glaucoma patients who were
at risk of not receiving adequate follow-up care after their initial diagnosis and treatment, we
will now undertake a comprehensive review of all patients to ensure that no one else is at risk of
being ‘lost to follow-up’
Working with partner organisations – we will undertake a review of our arrangements to ensure
that concerns raised by patients being treated by more than one organisation are adequately
addressed in partnership
– Provision of information
Enhanced reporting of quality – we will continue to improve our reporting of quality
performance both at corporate and directorate level
Telling staff about patient safety and experience – we will further develop our internal electronic
information systems to introduce an electronic incident management and reporting system as
well as new ways to make accessible information about patient experience and about where
things go wrong
A new centre of excellence
Throughout the year, we continued to consider the options for replacing our ageing buildings at
our main hospital in London’s City Road, focusing on two main choices: rebuilding the hospital in its
existing location, or relocating, with our academic partners at the UCL Institute of Ophthalmology,
to a site in the Euston/King’s Cross area. Following detailed analysis, with support from clinical
planning experts and cost consultants, the trust board agreed in March 2013 that our long-term
interests would be best served by moving.
Relocation to a new site in the King’s Cross/Euston area is considered the best option for our
aspiration to create a fully integrated and flexible modern facility, enabling us to bring together
patient-focused eye research, education and healthcare in a truly coherent way. In so doing, we hope
to attract the world’s best ophthalmic scientists, educators and clinicians and significantly enhance
our capacity and capability to undertake leading research to ensure that scientific breakthroughs are
translated to treatments for patients as quickly as possible – at the same time as providing the highest
quality clinical care in a modern, supportive environment for patients and staff.
Work during 2012/13 showed that we would be unlikely to meet these aims were we to rebuild on
the City Road site, in part because the fundamental redesign and expansion required by the Institute
of Ophthalmology to realise their ambitions could not be easily accommodated at City Road. In
addition, any redevelopment of City Road would need to take place alongside the continued
provision of all existing services, which would require us to identify and pay for a significant amount
of decant accommodation, which would be both costly and enormously disruptive for patients,
visitors and staff, and take longer to achieve.
While the decision to relocate is an important milestone, it is only the start of a longer process,
which we expect to take around six years to complete. This will be an ambitious project, the overall
cost of which we expect to be in the region of £320 million. The cost will be funded through a
variety of sources, including borrowing, the proceeds from the sale of the City Road site, and a
major fundraising campaign, jointly with UCL, which will raise around 25% of the money we need.
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18 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
3.3 Clinical care
Clinical developments
– Expanded emergency nurse practitioner service
We significantly expanded our emergency nurse practitioner (ENP) service in our A&E department
during 2012/13 to cover evenings and weekends, in addition to normal weekday working. ENPs see,
treat and discharge patients who attend with a variety of conditions, without the need to consult
medical staff. Expanding the service will ultimately enable ENPs to treat around a third of our A&E
department’s patients, compared to the 17% who were treated this way previously. ENPs offer a high
quality service that is well received by patients, and relieve pressure on A&E doctors, enabling them to
focus on other patients with more complex needs. The initiative is an example of our commitment to
the development of a wide range of extended roles and autonomous practice for nurses.
– New treatment for keratoconus
We started a new collagen cross linking (CXL) service during 2012/13 for patients with keratoconus,
who are usually in their 20s. Keratoconus is a non-inflammatory eye condition in which the normally
dome-shaped cornea progressively thins, causing a cone-like bulge to develop and impairing the
ability of the eye to focus properly, causing poor vision. CXL can stop the disease getting worse, by
strengthening the structures within the cornea that link to each other and keep the cornea from
bulging outwards. It is a simple treatment, which takes around 30 minutes in total, and is effective
in around 90% of cases. Importantly, it delays the need for corneal transplants and makes contact
lenses easier to fit and more tolerable to wear.
We plan to develop the service further in 2013/14 by training nurses to perform the procedure and
establishing an early keratoconus clinic, led by optometrists, to deal with pre- and post-operative
monitoring.
– New micro-surgery treatment
Towards the end of the year, we introduced a new micro-surgery treatment, known as trabectome,
at our satellite centre in St George’s Hospital, Tooting. The new procedure, which results in faster
surgery and healing times for patients undergoing cataract surgery for glaucoma, has been widely
used in the USA, but Moorfields is one of the first to introduce it in the UK. A trabectome procedure
is carried out under local anaesthetic and takes between 10 and 15 minutes to perform. It involves
the surgeon making a small incision in the affected eye, and tissue being very precisely removed
by an electrical pulse. The eye is then washed out with saline to remove debris. The surgery is
only mildly invasive and can delay the need for more major surgery, as well as reducing the need
for frequent daily doses of eye drops, the use of which can be unpleasant and is often disliked by
patients. As well as providing a better experience for patients, the new procedure could also save
the NHS money over time, by reducing both drug use for glaucoma treatment and the need for
more major operations such as trabeculectomy.
– One of the country’s first consultant orthoptists
A new consultant orthoptist started work at Moorfields in September 2012. One of the first such
posts in the UK, this new role will develop and expand our orthoptic service across all our locations,
as well as oversee the treatment of adults and children with lazy eyes, squints or double vision, who
can be treated effectively by allied health professionals rather than by doctors.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – Developments in children’s services
We worked with colleagues at Great Ormond Street Hospital to create a new joint paediatric
and adult consultant post for corneal and external diseases in order to enhance clinical care,
research and education in this field. As well as running paediatric anterior segment clinics and
paediatric corneal surgery at both hospitals, the new post holder will also contribute to the adult
corneal service. This will ensure a sufficient surgical caseload to maintain standards of safety and
competence, as well as facilitating the translation of skills and techniques developed in adult
practice into children’s services. The case-mix provided by working across two specialist hospitals
also provides great potential for developing an outstanding clinical service, as well as an important
resource for future research. The new post is currently being advertised.
Also in children’s services, one of our consultants now runs a weekly joint paediatric glaucoma
surgical clinic at Great Ormond Street.
– Enhanced support for uveitis patients
We now have a formal partnership with University Hospitals Bristol for inflammation and
immunotherapy via our National Institute for Health Research biomedical research centre (see
page 26). In 2012/13, we extended this to establish a formal alliance with the medical eye unit at
Guy’s and St Thomas’ NHS Foundation Trust (GSTT) to provide continuity of care for patients with
sight-threatening uveitis, many of whom suffer from associated non-ocular diseases and from the
complications of systemic treatment. To support the new alliance, we invested in a new training
programme in ophthalmology and in extra consultant sessions to allow Moorfields staff to support
weekly uveitis clinics at GSTT.
– Maintaining high quality radiology support
In February 2013, we completed a review of our radiology service, undertaken in light of increasing
costs and the need to continue to provide a high standard of clinical care and patient experience
in this important support service. The review concluded that we should continue to provide our
existing radiology service onsite at our City Road Hospital, replace the CT scanner in 2016/17 and
appoint permanently to the posts of superintendent radiographer and radiographer. This option was
the only one that preserves the existing service at the same time as maintaining standards of clinical
quality – including keeping the number of outpatient appointments for each patient to a minimum
– and was also the most cost efficient, with further potential for income generation.
Improving the patient experience
– Transforming how we work
Between August and November 2012, we experimented with an entirely new way of working in
some glaucoma outpatient clinics in our satellite location at St George’s Hospital in Tooting.
Supported by Vanguard Consulting, a team of specialists in service transformation, we started
work on a change programme, the core principle of which is to provide services designed to deliver
only that which is of value to the patient – rather than running services for the benefit of the
organisation. An important measure of success for this programme is to reduce the total length of
the whole appointment, by minimising the amount of time spent doing things that are of no value
to the patient. For example, a patient who spends two and a half hours in a glaucoma outpatient
clinic will typically spend only a third of that time doing something of value, such as tests, or talking
to the consultant. The rest of the time, they are simply waiting.
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20 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
To date, around 1,500 patients have been involved in this project and, although journey times varied
considerably during the experiment clinics, the average journey time was reduced from 103.4 to
66.7 minutes, a reduction of about 36 minutes. Perhaps more importantly, the percentage of the
patient’s journey that added value increased from 33% to 73% in the experiment clinics.
The project is now being extended across the whole glaucoma pathway at our St George’s satellite
and will then expand to cover all eye services at St George’s.
– Reducing waiting times in outpatient clinics
Waiting times continue to be a major cause of complaint from our patients and work went on
throughout the year to improve these, in addition to the transformation project (see above). New
profiles for all glaucoma and medical retina clinics were agreed and uploaded to our patient administration system during 2012/13, and all are due to be live by the end of May 2013. Getting clinic
profiles right is vital to shortening waiting times as it ensures that the right numbers of the right
kinds of healthcare professionals are available to treat the number of patients expected for each
clinic session. For those that have already gone live, 20% have demonstrated a significant reduction
in the average patient journey time, but we need to do more work to ensure the other 80% also
register improvements in future.
– Better processes for surgical patients
We know that many patients spend too long in hospital and have a variable patient experience
when they come to us for an operation. A lot of work took place during 2012/13 to improve patient
journey times on the day of surgery, focusing predominantly on the cataract service – although
similar work was underway by the end of the year with our adnexal, medical retina, corneal and
glaucoma surgical teams. Initiatives included ordering lists in advance to ensure that they started on
time, and that patient arrivals can be staggered where appropriate. The average journey time on the
cataract test lists has reduced from four hours and 56 minutes, to four hours and two minutes, with
an average journey time on the best of the test lists of three hours and 35 minutes.
Our drive to improve the efficiency of our operating theatres has also included publishing data
on list start times by service and theatre, including the reasons for late starts. Over the period in
question, this initiative has resulted in an increase in the percentage of lists starting within 15
minutes of their scheduled start time from 40% to 59%. We aim to improve this figure to 90% by
the end of 2013/14.
At Mile End, St George’s and Northwick Park, we identified additional surgical capacity to help
reduce waiting times and increase the number of local people to whom we can offer surgery in
those locations. This, in turn, frees up capacity at our busy central London hospital so that we
can treat more people more quickly there. In a similar vein, we undertook an outpatient mapping
exercise to identify further opportunities to move patients’ treatment closer to where they live and
relieve pressure on the City Road hospital.
– New integrated patient support service
In December 2012, we launched a new integrated patient support service, bringing together our
eye clinic liaison officers (ECLOs), nurse counsellors and certificate of visual impairment (CVI) team
into a coherent unit providing psychological and emotional support and professional counselling
for patients at any stage as their sight worsens. Integrating the team in this way allows patients
to move between the different components of the service seamlessly, according to the nature of
the support that they require. The new full time nurse counsellor’s post and the ECLO post based
in North West London (shared between our satellite centres at Northwick Park and Ealing) were
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 funded by charitable grants secured with the support of Moorfields Eye Charity, the Friends of
Moorfields and Action for Blind People, a charity affiliated to the Royal National Institute of Blind
People (RNIB).
– Award-winning team
Staff from our macular clinic collected the clinical service of the year award at the Macular Disease
Society’s 25th anniversary awards for excellence in September 2012. Four specialists within the
service were nominated by patients grateful for the exceptional level of care they received.
– Improved facilities
We completed refurbishments to house our vitreo-retinal emergency and ultrasound services,
co-locating these with other parts of the surgical pathway and freeing up space to expand
the orthoptics department in the main hospital. We also completed a refurbishment of our
ocular prosthetics department. Work is now underway to refurbish and expand our specialist
A&E department, for which demand continues to rise. This expansion is possible following the
completion of an upgrade in our private patient wing to accommodate a new observation bay
for patients admitted to A&E who need to remain in hospital overnight. In our satellite locations,
we successfully refurbished our specialist eye unit at St Ann’s Hospital in Tottenham, consolidating
services in one area.
We have made steady progress throughout the year against our backlog maintenance programme,
although some works will need to be carried over to the new financial year. On a lighter note, we
were also delighted that charity BlindArt agreed to the donation of their entire collection of tactile
art to the main City Road hospital. This unique collection was formally unveiled on World Sight Day
in October 2012 at an event arranged by our new arts committee.
We received the findings of the 2011/12 annual patient environment action team (PEAT) inspection
in June 2012. These gave us an ‘excellent’ score for food and ‘good’ scores for environment and
privacy and dignity. PEAT inspections have now been replaced by patient-led assessments of the care
environment (PLACE). The new system will assess hospitals across a range of environmental aspects
against common guidelines, based on a visual assessment. In common with PEAT, assessments will
offer a non-technical view of the buildings and non-clinical services provided across all hospitals,
hospices and independent treatment centres providing NHS-funded care. The assessment process
will be led by our patients and supported by designated staff groups who will be available on the
day of the assessment. We expect our first assessment using the new process to take place early in
2013/14.
– Better information
During 2012/13, we installed an additional 12 information screens across our locations and services.
These screens provide our patients with regular, high quality information about journey times, and
are also used to reinforce health promotion campaigns such as flu vaccination, and to advertise and
encourage participation in service developments.
Patient safety
– New initiatives
Several initiatives contributed to an enhanced culture of patient safety. These included a
strengthened system for investigating serious incidents, with greater consultant and senior trainee
involvement, and the creation of a new quality and safety board report, which incorporates clinical
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22 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
outcome measures and is being shared with the World Association of Eye Hospitals (WAEH) to
provide true benchmarks with other specialist ophthalmic institutions.
We revised and formalised a robust patient safety walkabout process and completed visits to our
four largest satellite centres during 2012/13. During these visits, staff from the quality and safety
team and an executive director met with local senior staff and presented and discussed a thorough
review of all safety, including an analysis of both notable practice and areas of concern. Each visit
also included a tour of the department and, where possible, conversations with local staff and
patients. These visits have resulted in several important actions, including resolving problems with
the water supply at our centre in Ealing Hospital and the development of a process to prioritise case
notes for distribution from the main hospital to satellites.
We continued to use our locally developed modified global trigger tool (mGTT) to measure risk
and low-level adverse events and allow comparison of the quality of care between sites. One
improvement implemented as a result of this process has been the introduction of a combined
children’s vision clinic led by orthoptists and optometrists at our centre in Ealing Hospital, which has
significantly improved patient journey times and efficiency.
– Medical revalidation
Medical revalidation is a new process, introduced during 2012, through which all doctors who are
licensed with the General Medical Council (GMC) will regularly demonstrate that they are up to date
and fit to practise. Revalidation builds on existing processes, strengthening them to meet the needs
of regulation and to ensure greater consistency. It is based on a local evaluation of doctors’ practice
through appraisal, strengthened by a range of support information, including 360 degree appraisals
by colleagues, and feedback from patients.
Moorfields was part of the London Deanery’s revalidation pilot project in 2011, an experience that
put us in good stead to ensure that we met the national requirement to have revalidation fully
in place by the end of 2012. Solid preparation meant that we were rated green for readiness in
the national organisational readiness self-assessment (ORSA) audit in June 2012, and submitted a
complete list of doctors to be revalidated to the GMC.
We have trained 27 of our consultants to an approved GMC revalidation standard to conduct
appraisals of other colleagues, and 22 as facilitators to discuss the findings of the 360 degree
appraisal reports and identify any development needs. By 31 March 2013, 10 of our senior doctors
had been successfully revalidated as planned, and a further 20 have almost completed the collection
and collation of the required evidence in line with our plans for 2013/14.
– Infection control
Moorfields has a strong track record on infection control, with no recorded cases of MRSA
bloodstream infection or Clostridium difficile to date. To reduce the risk of infection, we undertake
fortnightly environmental cleanliness inspections and weekly hand hygiene audits, the results of
which are reported monthly to the chief executive and quarterly to the board. Remedial action
is then taken to address any areas of concern. Our average score for 2012/13 stands at 98%
compliance for cleanliness and 97% compliance for hand hygiene.
In addition to MRSA screening, mandatory surveillance of bloodstream infections and C-diff, we also
monitor infection rates for two infections that are more relevant to ophthalmology, to ensure that
they are promptly recognised, investigated and managed.
Adenovirus, a community-acquired infection, is a severe conjunctivitis that also commonly involves
the cornea. Variable numbers of patients attend Moorfields for treatment, and we monitor the
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 number who develop adenovirus having attended Moorfields up to three weeks prior to diagnosis
with a non-infective eye condition. For 2012/13, the percentage of possible hospital-acquired cases
of adenovirus among all adenovirus cases was 2.9%, compared to 4.6% the previous year.
We also monitor for endophthalmitis, an inflammation or infection of the inside of the eye
diagnosed within six weeks of surgery or of any procedure involving the inside of the eye. We
have established benchmarks for endophthalmitis after both cataract surgery and AMD intravitreal
injections, based on the best available international evidence and historic trust data. During
2012/13, our rate for endophthalmitis infection post-cataract extraction was 0.29 per 1,000 cases
against a benchmark of 0.83 cases per 1,000 procedures. For endophthalmitis infection post-AMD
intravitreal injection, our rate was 0.35 per 1,000 cases, compared to a benchmark infection rate of
0.5 per 1,000 procedures, and a slight increase on the previous year’s rate of 0.3 per 1,000 cases.
Clinical effectiveness
– Patient reported outcome measure for ophthalmology
Patient reported outcome measures (PROMs) assess the quality of care offered to NHS patients from
the patient perspective. During 2012/13, we developed a PROM for ophthalmology and tested it with
50 patients who had attended a general ophthalmology clinic at our main hospital more than once.
The patient reported eye symptom score (PRESS) is a simple questionnaire completed by the patient
at consecutive visits in which they are asked to ‘score’ their symptoms to provide an indication of
the quality of care provided from their perspective. Our pilot demonstrated that the questionnaire
was easy to use and that the majority of patients reported less serious or fewer symptoms at the
second visit compared to the first. We also repeated the test at our centre in Ealing Hospital, where
it was combined with a clinician reported outcome score for the same patients.
Work is now underway to analyse and compare results from patients and clinicians in order to
validate the tool and check whether there is any correlation between patients feeling better and a
clinician’s assessment that their treatment has worked. Once this work is complete, we intend to
introduce the PRESS for regular use at all sites where we run general ophthalmology clinics. Other
PROM projects are also underway to identify practical and suitable measures for ophthalmology.
– Clinical outcome indicators
We also now have three key clinical outcome indicators for each of our clinical sub-specialties,
allowing us to benchmark and monitor performance so that improvements can be made as
necessary. Although our performance against these standards generally demonstrates excellent
outcomes, the process for capturing the data remains slow and labour intensive which reduces the
frequency with which information can be reported.
The following results are especially encouraging:
Post-operative refractive outcomes, which demonstrate how accurately and reliably we are
able to achieve the planned spectacle prescription following cataract surgery in general and
for very short-sighted people in particular compare favourably with published external national
and international benchmarks; this predictability means that patients are much less reliant on
spectacles following cataract surgery
Glaucoma surgical success rates in excess of 90% at one year post-surgery are significantly
better than previously published outcomes (85%)
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24 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Posterior capsule rupture rates, the most robust predictor of poor outcomes following cataract
surgery, compares favourably with national and international benchmarks
Post-operative endophthalmitis, the most serious complication of cataract surgery, was
significantly lower at 0.03% than in previous years, and also compares favourably with the best
published national and international benchmarks
Surveys undertaken during the year in the glaucoma and adnexal services by patients, GPs,
optometrists and commissioners support the key outcomes currently identified. Those deemed
especially important are the retention of vision, the ability to drive, and the outcome of surgical
procedures.
Details of our performance against the agreed clinical outcome indicators are included in our quality
report at appendix 1.
Enhanced infrastructure support and new equipment
– A state-of-the-art electronic patient record for ophthalmology
OpenEyes is a collaborative effort led by Moorfields to create a state-of-the-art electronic patient
record (EPR). Ultimately, the system should replace the vast majority of paper records, allowing
clinicians to have access to good quality and comprehensive information about their patients in the
right place at the right time, and enabling them to provide better patient care.
OpenEyes is an open source project. This means that the software is available free of charge in most
cases, which encourages other eye specialists and units to contribute ideas and code and means
that everyone can make use of the best ideas, speeding up future developments. For example,
ophthalmologists in Cardiff co-developed a glaucoma module, while those in Fife worked on
cataracts and others in Maidstone concentrated on injections for age-related macular degeneration.
New functionality added during 2012/13 means that OpenEyes now handles all clinical correspondence, electronic prescribing and the recording of notes relating to surgical procedures, as well as
activity relating to surgical bookings, theatre diaries and surgical waiting lists. We also launched a
new module for cataract surgeons, and made good progress on the development of further clinical
modules for medical retina and glaucoma. A prioritised plan for future clinical modules was agreed
during the year. As with all new systems, there have been some teething problems, but the OpenEyes
team worked closely with the clinicians and support staff who use the new system to identify the
lessons learned for future releases, fix any problems and make improvements in response to feedback.
The potential to adapt OpenEyes for use in other clinical specialties was demonstrated in January 2013
when members of our team won first prize at the third NHS Hack Day. Using the OpenEyes framework,
our team worked with two cardiologists to create a suite of events to support the entire patient journey
from admission with myocardial infarction, through cardiac catheterisation, to discharge.
The system is also attracting interest from commercial partners, which has the potential to generate
new income that can be reinvested in services for all our patients in future.
– Upgraded optical coherence tomography machines
We completed a £200,000 programme to replace and upgrade all of our optical coherence
tomography (OCT) equipment. OCTs provide high-resolution cross-section images of the inside of
the eyeball to assist in the diagnosis and treatment of a range of conditions. Our in-house electrobiomedical engineering (EBME) medical devices management team was shortlisted in the best
project team category of the Building Better Healthcare 2012 awards for their work on this complex
project with commercial partners Topcon.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – New femtosecond laser
In August we took delivery of one of the first femtosecond lasers in the UK. This machine is
designed to perform key steps in cataract surgery, including corneal incisions, capsulotomy and lens
fragmentation and provides several theoretical advantages over standard lens surgery, including
improved patient safety, better visual outcomes and potentially improved efficiency. Given the
high cost of this equipment, Moorfields is currently evaluating its use with private patients before
deciding whether to invest in it for future NHS use. In parallel, we hope to secure funding for
a randomised controlled trial to enable us to establish the safety and efficacy of this technique
compared with standard lens surgery.
– IT and telecommunications
We completed an IT and informatics strategy during 2012/13 and have started the implementation of a plan to improve our IT infrastructure, which was identified as a priority as part of the
strategy development process. Work is also underway to improve our telecommunications systems
and practices, following several problems with the existing network during 2012/13, which also
identified a range of associated problems with current practice.
3.4 Research and development
Along with our academic partners at the UCL Institute of Ophthalmology, Moorfields is recognised
as a world-class centre of excellence in eye research. Together, we form one of the largest
ophthalmic institutions in the world, with 48 professors and principal investigators (PIs), and a large
and diverse patient population. In research, we are more productive than any other eye institution,
publishing some 200 papers in 2012/13, while our joint research portfolio includes 264 open
projects, including a large number of National Institute for Health Research high-priority projects.
As well as headline-grabbing pioneering research, our staff work on many projects to ensure that
patients receive effective support to deal with their eye conditions. A small sample of these projects
is covered in the section below on research activity this year.
A new strategy for research and development
Our research and development team was further boosted this year by the appointment of a
deputy director who is providing new focus on this vital part of our work. A key early piece of
work was the completion of a joint strategy for research and development with the UCL Institute
of Ophthalmology. This document, prepared collaboratively by both institutions, and with wide
external consultation, lays out a joint strategic path for future research and development activity
across our two organisations to ensure our continued pre-eminence in the field, and maintain the
beneficial impact that our research activity has on patients up to 2020 and beyond.
The strategy sets out a clear direction to allow us to continue as a world-leading organisation in
eye-disorder prevention and treatment, as well as enabling us to remain agile enough to respond to
new developments and opportunities. It plans to achieve this by:
Conducting fundamental research and rapidly translating it by focusing on high-patient-impact
research programmes, while also strengthening our fundamental research base
Attracting, training and developing premier research talent, to drive research output, discovery
and innovation in new treatments
Developing an integrated culture to foster an inspirational environment for collaborative research
to boost innovation
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26 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Heading some of the largest, world-leading partnerships with other institutions and with
industry, to bring complementary skills to bear on some of the toughest research questions
The strategy identifies three main areas – glaucoma, diabetic retinopathy and age-related macular
degeneration – on which to focus research activity, but also highlights essential scientific platforms
such as stem cell therapy and genetics that will underpin this activity and require further development.
National Institute for Health Research biomedical research centre
We remain one of only 11 sites nationally to be awarded National Institute for Health Research (NIHR)
biomedical research centre (BRC) status for translational research, which helps us to attract extra funding
to support our research programmes and to fast-track exciting new developments to benefit patients
more rapidly.
The applied clinical trials unit investigating vision and eyes (ACTIVE) is located within our BRC. ACTIVE’s
remit is to increase clinical trial activity in ophthalmology, and develop a methodological hub for all
aspects of the design, conduct and reporting of trials in collaboration with other clinical trials units
(CTUs). It helps research teams throughout the country carry out clinical trials safely and to a high
scientific standard, offering a range of services to help ensure the results are accurate and credible. The
unit links with the ophthalmic statistics group which aims to raise the standards of statistics in ophthalmic
research, and is formally linked with the Cochrane eyes and vision group and the newly established UCL
clinical trials unit.
The predominantly academic focus of CTUs is complemented under the NIHR umbrella by clinical
research facilities (CRFs). We appointed a new head of clinical research operations in January
2013 to lead our CRF, following the award of an additional £5 million by the NIHR in 2011/12 to
create additional capacity for early phase and first-in-human clinical research. Building on previous
successful and ground-breaking trials in which Moorfields patients have participated, the CRF will
enable us to accelerate the transfer of breakthroughs in experimental medicine into treatment trials
to benefit patients with eye diseases.
UCL Partners
We are a founding member of UCL Partners, which was designated as one of the UK’s first
academic health science centres in March 2009. The partnership aims to provide tangible
patient and population health gain locally, nationally and globally through new models of care,
enhanced multi-professional education and medical advances. Moorfields’ director of research and
development, Professor Peng Tee Khaw, is the programme director for the eyes and vision theme
of the partnership, which aims to drive forward translational research programmes targeting the
blinding diseases that pose the greatest burden to patients and society, and to increase our capacity
and support for high-quality research programmes.
During 2012/13, UCLP applied to become an academic health science network, alongside its
existing role as an academic health science centre. The proposal to create AHSNs emerged from the
Department of Health’s paper Innovation, Health and Wealth, published in December 2011, which
recognised that innovation in the NHS is often slow to be adopted. AHSNs across the country will
be responsible for delivering proven innovation into practice at scale, both to improve patient and
population health outcomes, and to create wealth. UCL Partners AHSN will span a wide range of
organisations, collaborating to achieve measurable health gain for a population of six million people
across North East and North West London, as well as Hertfordshire, Bedfordshire and Essex.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Research activity this year
– Degenerative eye disease
Scientists from our biomedical research centre showed for the first time that transplanting lightsensitive photoreceptors into the eyes of visually impaired mice can restore their vision. The research,
published in scientific journal Nature in April 2012, suggested that transplanting photoreceptors
– the light-sensitive nerve centres that line the back of the eye – could form the basis of a new
treatment to restore sight in people with degenerative eye diseases.
– Diabetic macular edema
The results of a further trial on the use of bevacizumab (Avastin) injections to treat diabetic macular
edema (DME) were also published in April 2012 in the Archives of Ophthalmology, a peer-reviewed
journal. The results, from the second phase of the bevacizumab or laser therapy (BOLT) trial, showed
improvement to the sight of patients with DME, which causes distortion to central vision and can
lead to blindness, following treatment with a course of injections rather than laser therapy. This is
important as anti-VEGF drugs such as bevacizumab are not only cheaper, but are also proving to
have a longer-lasting effect than previous treatments.
– Inflammatory eye disease
Our biomedical research centre joined forces with University Hospitals Bristol and the University
of Bristol to enter into a consortium agreement with the National Eye Institute of the American
National Institutes of Health. The consortium, formally launched during a visit by the Americans to
Moorfields in May 2012, aims to combine transatlantic research excellence to achieve advances in
treating inflammatory eye diseases.
– Glaucoma
In October 2012, we were awarded £1.7 million by the National Institute for Health Research health
technology assessment (NIHR HTA) programme to assess whether laser treatment for glaucoma could
provide patients with a better quality of life than traditional eye drops if laser was the first form of
treatment offered. The laser in glaucoma and ocular hypertension (LIGHT) study will involve more than
700 patients who have been newly diagnosed with glaucoma and have received no prior treatment
for the condition. It is a joint project between Moorfields and the UCL PRIMENT clinical trials unit.
– Age-related macular degeneration
We entered into a new collaboration with medical device company SalutarisMD Ltd in January 2013
to improve treatments for age-related macular degeneration (AMD). Three of our doctors will work
with the SalutarisMD team to establish phase 1 clinical trials of a novel medical device which enables
retinal specialists to administer high-precision localised radiation therapy to the back of a patient’s
eyes to stem vision loss caused by wet AMD. If successful, the device could offer several advantages:
it will enable treatment to be administered in a non-invasive way, without the need for complex
expensive equipment, and it can be used in a normal clinical setting, which could be important in
the development of better, more cost-effective protocols in the longer term. The device has already
been trialled in a very small group of patients in the USA, with positive results.
– Diabetic retinopathy
In February 2013, we were named as one of 11 centres across Europe participating in a clinical
trial to evaluate a new therapeutic treatment using eye drops to treat the early stages of diabetic
retinopathy – an eye disease that occurs in people with diabetes. Small blood vessel damage has been
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28 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
the main focus of investigation and therapy for the condition for some time, but there is growing
evidence to suggest that retinal neuro-degeneration plays an important part in the onset of the disease
and this trial will look at whether that aspect can be modified. The trial is an important step in the
development of a new, non-invasive treatment for a devastating complication of diabetes, given early
in the disease. It is also hoped that the findings of the research will pave the way for new screening
systems to allow the diagnosis of diabetic retinopathy at earlier stages in the disease.
3.5 Education, teaching and training
Moorfields provides ophthalmic training and education for eye doctors at all levels, including
undergraduate medical students, post-graduate specialty registrars and fellows, and academic
clinical fellows and lecturers. Regular courses in various specialist areas are run at the main hospital
in London’s City Road, many of them in association with the UCL Institute of Ophthalmology. We
also welcome doctors from around the world to observe our renowned treatment of eye diseases
and injuries.
Undergraduate medical training
Moorfields provides undergraduate teaching in ophthalmology to around 1,250 medical students
from Barts and The London School of Medicine and Dentistry, University College London (UCL) and
St George’s, University of London. We have dedicated, ring-fenced service increment for teaching
(SIFT) funding, which enables us to provide teaching fellows and consultants with protected time
for teaching and to encourage continued professional development for post-graduates in medical
education. At present, seven of our staff are undertaking degree courses in medical education.
Our medical students attended a variety of conferences during 2012/13, with many of them
preparing poster presentations on projects in which they had been involved. They were also
heavily involved in our patient days on specific eye conditions, which bring together patients, staff,
healthcare professionals and charities to share experiences and learn from one another.
Two of our teaching fellows were recognised by medical schools during 2012/13. Kam Balaggan
won an award for excellence in student education from Barts and The London and Moloy Dey won
an excellence in medical education award from UCL.
Feedback from students from Barts and The London received during 2012/13 was very positive.
Among year 4 students, 90% rated their overall experience as ‘very good’ or ‘excellent’, while all
students taking student selected components (SSCs – optional modules within the undergraduate
medical syllabus) rated the improvement in their skills as ‘good’, ‘very good’ or ‘excellent’ following
teaching at Moorfields.
Post-graduate medical training
UCL Partners, of which we are a major part, is now the lead provider responsible for organising
post-graduate ophthalmic training across the whole of North London, following a competitive
process during 2012/13.
Overall satisfaction rates in the 2012 General Medical Council (GMC) training survey were again
very high for Moorfields, and we were rated as a positive outlier – meaning that we were much
better than average – for access to educational resources. Trainees from across London also perform
very well in national exams. For example, in the part 2 Fellow of the Royal College of Ophthalmologists (FRCOphth) exam, the pass rate for London trainees was 63% in the oral exam and 100% in
the written exam, compared to a national pass rate of 51% and 84% respectively.
We run an innovative training programme in clinical leadership and management for trainee ophthalmologists. These combine seminars in major skills areas with participation in and leadership of
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 quality, innovation, productivity and prevention (QIPP) projects. The QIPP element involves fledgling
leaders working with a consultant or senior colleague mentor to lead a multidisciplinary team to
complete a project that leads to service change or improvement. Their learning is mapped against
the national medical leadership competency framework and allows them to put their knowledge
and skills into real-life NHS practice to achieve a change for the better for patients and the trust.
We also continue to host and develop the London Deanery ophthalmic simulation programme and
have recently expanded participation, both internally and across the South East. There are now more
than 150 active users and we have been able to train up several associate simulation trainers who
are also regularly involved in the training course. Thirty medical students completed our tailored
course for simulation training during 2012/13.
The programme received two awards over the year from the Deanery’s simulation and technologyenhanced learning initiative (STeLI) in the educational excellence academic activity and productivity
categories. We also received a further award from STeLI for capacity and capability funding, which
we are using to ensure we have the latest software and hardware simulation packages available
for our trainees. With the charitable support of the Special Trustees of Moorfields Eye Hospital, we
now head up the International Forum of Ophthalmic Simulation, a multinational and multicentre
collaboration developing ophthalmic virtual reality training programmes and validating them
through research. This work has repeatedly resulted in national and international recognition for us
as leaders in this field.
Developing our non-medical staff
– New nursing strategy
We launched our new nursing strategy during 2012/13. Called Focusing on the Future, the strategy
provides a clear vision for nurses and associated support staff such as healthcare assistants and
technicians. It sets out four strategic objectives to support our target of becoming a centre of
excellence in the training and development of ophthalmic nurses, and of ensuring those nurses
place patients at the heart of all they do:
To develop a nursing workforce that is fit to provide ophthalmic care in the 21st century
To educate nurses and support workers to offer the best clinical care, and become a respected
provider of ophthalmic nurse education, with national recognition
To develop and retain the best clinical leaders of the future, equipping them with the skills and
competencies to act as ambassadors for the organisation
To provide evidence-based, safe care with dignity and compassion
The strategy was launched at our annual nursing conference, which took place in January 2013 and
attracted around 200 nurses from across Moorfields.
– Nursing and allied health professional education and research
We appointed a lead nurse for education and research – a new role – during 2012/13 to bring all
nurse education and training in-house. This might also offer the potential to generate income by
offering courses to external students.
Our optometry department runs a range of courses to allow our specialist optometrists to work at
an advanced level. These include training in gonioscopy (used to diagnose and monitor conditions
associated with glaucoma), referral refinement and therapeutics. During 2012/13, 43 of our
optometrists gained a professional certificate in glaucoma, while 13 others received diplomas in
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30 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
therapeutics and independent prescribing and one was awarded a diploma in rehabilitation of visual
impairment.
Research is an important component in developing non-medical staff, and Moorfields continues
to promote the role of nursing and allied health professional research. With support from City
University London, we continue to participate in and lead on ophthalmic nursing research. Our
optometrists are also active in research and are currently participating in a wide range of projects.
These include investigating changes in corneal biomechanics following collagen cross-linking in
keratoconus, the value of eccentric viewing training in macular disease, and the evaluation of
iris and ciliary body lesions with anterior segment optical coherence tomography (OCT) versus
ultrasound B scan.
We play an active role in the production of the International Journal of Ophthalmic Practice, a
peer-reviewed journal for ophthalmic nurses, orthoptists and allied professionals. Our lead nurse
for education and research is one of the consultant editors for the journal, which is published every
other month. Several other Moorfields’ nurses also write articles and day-in-the-life features. This
year, these included a piece about the experience of learning to use a slit lamp by a staff nurse in
A&E, and about research by one of our ward sisters into the pain levels suffered by patients who
have undergone retinal surgery.
Many of our nurses, optometrists and orthoptists speak at conferences internationally, nationally
and locally to promote our research projects and new nursing initiatives such as the intravitreal
injection project (see below).
– New roles for non-medical staff
We continue to enable non-medical staff to learn new skills and take on responsibilities previously
within the remit only of doctors. This ensures that everyone’s professional expertise is used to the
best effect and provides improvements to patient care. Three of our senior nurses are now qualified
to administer intravitreal injections to patients with wet age-related macular degeneration – a
service previously provided only by medical staff – with three more in training. In addition, six of our
nurses are trained to treat posterior capsular opacification, a common side-effect of cataract surgery,
using a specialist piece of equipment, known as an Nd:Yag laser.
This procedure is also performed by two trained optometrists who additionally provide YAG
peripheral laser iridotomy and selective laser trabulectomy to treat glaucoma. During 2012/13, we
introduced extended roles for optometrists in our anterior uveitis and adnexal clinics and supported
13 more optometrists to undertake a non-medical prescribing course. This enables them to
prescribe medicines for patients safely and effectively, and brings the total number of optometrist
non-medical prescribers to 18. Using nurses and optometrists in this way allows us to release
medical staff to undertake more complex procedures and means that we can treat patients more
quickly.
– Highlighting the work of ophthalmic photographers
In March 2013, our ophthalmic photographers marked the national Healthcare Science Week with a
social media campaign to highlight their work. Ophthalmic photographers play a vital role in patient
care at Moorfields, where they are responsible for taking images of the front and back of patients’
eyes. Their work contributes to the diagnosis of a wide range of eye conditions.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Sharing our expertise
Many of Moorfields’ expert staff get involved in conferences and seminars in the UK and around
the world, talking about innovations in ophthalmic treatments and discussing the outputs of their
research.
– Association for Research and Vision in Ophthalmology
Professor Khaw, our director of research and development, is currently the president of the
Association for Research in Vision and Ophthalmology (ARVO), the largest such organisation in
the world. ARVO includes more than 12,500 eye and vision researchers from over 80 countries
and encourages and assists research, training, publication and knowledge-sharing in vision and
ophthalmology.
– International Glaucoma Symposium
In January 2013, consultant ophthalmologist Keith Barton welcomed around 300 glaucoma
specialists to the sixth annual Moorfields International Glaucoma Symposium. The two-day
meeting was also simultaneously webcast to a further 300 delegates at five centres in Europe and
the Middle East, with expert speakers presenting on a range of topics. Other similar events this
year organised by Moorfields staff included the UK Paediatric Glaucoma Society meeting and a
diabetic retinopathy conference.
– Preventable sight loss indicator
Several of our expert staff made important contributions to the first preventable sight loss indicator
as part of the national public health outcomes framework. Two Moorfields’ consultants, our head
statistician and other support staff are part of a national group working with the government to
improve the measurement, interpretation and collection of the incidence of certifiable blindness,
partial sightedness and the numbers of people who have lost their sight due to the three biggest
causes of preventable sight loss in England: macular degeneration, diabetic retinopathy and
glaucoma. Local interpretation of information gathered by the group will be used to help plan,
commission and provide services.
– Supporting training in West Africa
Moorfields Lions Korle Bu Trust, the charity established by Moorfields to oversee the establishment
of a new eye centre and surgical training programme based in Accra, Ghana, was awarded
£242,000 in October 2012 by the Government’s health partnership scheme. The funding will enable
a team of clinicians and nurses from Moorfields to volunteer to teach and offer practical assistance
to clinicians in Ghana to increase their surgical skills, improve and establish community eye clinics
and train other healthcare professionals. The health partnership scheme, which is managed by the
Tropical Health and Education Trust (THET), also benefits the volunteers as they return to the NHS
with increased knowledge, better leadership skills and an improved ability to deal with complex
situations under pressure.
3.6 Working with patients and partners
Moorfields works with a wide range of groups and individuals, including patients, other healthcare
organisations, academic partners, foundation trust members and charities. We engage with them in a
variety of ways both face-to-face and in writing, whether via traditional publications or digital media.
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32 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
A new external communications and engagement strategy was approved by trust board in July 2012
and is now being implemented. This includes work to raise our profile further, especially among
audiences who are not reached by existing activity, to contribute to increased patient referrals
and charitable donations and the recruitment and retention of high-calibre staff. It also covers the
roll-out of a piece of work completed in the previous financial year to create a new visual identity
and key messages, which are now in use across all publications and key corporate documents.
Listening to our patients
We use a range of mechanisms to find out what our patients think of our services and to make
improvements in response. These include comment cards, feedback posted on NHS Choices, other
websites or via social media sites, a patient narrative programme and surveys. We also held patient
focus groups in the summer of 2012 to inform the development of a new patient and public
involvement strategy to encourage wider engagement.
– National surveys
Our specialist A&E department performed well in the national A&E survey published in December
2012 by the Care Quality Commission (CQC). We were rated as performing especially well
compared to others on care and treatment, the provision of information, and for doctors and
nurses listening to what patients had to say. We did less well in explaining the side effects of new
medications and on our staff considering patients’ home and family situations before discharging
them.
In July 2012, we received the results of our trust-wide day-care survey of patients who underwent
surgery in March 2012. These showed that 99% of respondents felt that their admission process
was very or fairly well organised, 98% felt that our doctors and nurses worked well together, and
98% rated their overall care as good, very good, or excellent.
Our next day-care and outpatient surveys are currently underway and are due to report at the end
of May 2013.
– Minute cards and the Friends and Family test
During 2012/13, we introduced new ‘Moorfields Minute’ cards to replace our patient experience
tracker (PET) programme, which came to an end in May 2012. While useful in providing real-time
patient experience information in a way that was relatively simple to use, we wanted to explore
the use of alternative methods which will generate higher response rates and provide more useful
information.
The new minute cards, so named because they take only a minute to complete, are proving a simple
and effective way of understanding patient satisfaction with our services by asking patients how
likely they are to recommend Moorfields to a friend or relative on a scale of one to 10 and, if they
wish, to give us their reasons. Scores are calculated by subtracting the number of ‘detractors’ (those
who would not recommend us) from the number of ‘promoters’ (those who would) and can be
used as a benchmark against future progress, or as a comparator between clinics or wards. Scores
for the first seven months were broadly positive, ranging from 74 to 80.
We also piloted the national Friends and Family test – which was launched on 1 April 2013 and is
very similar to our minute cards – in A&E, our observation bay and our two inpatient areas between
January and March 2013. Our scores to date have been consistently high. Of the 1,462 Moorfields’
patients who responded in March 2013, 1,222 (83.5%) said they would be ‘extremely likely’ to
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 recommend us to their friends or family, while only 10 respondents said they were unlikely or not at
all likely to recommend us.
– Formal complaints
The formal complaints process also remains vital in identifying trends and areas for improvement. In
2012/13, Moorfields received a total of 291 complaints, compared with 263 in 2011/12. Although
this is a significant increase, it needs to be viewed in the context of a rise in total attendances. There
is no evidence of any one particular issue causing the increase.
The main causes of complaint were waiting times in clinics, including a lack of information about
why delays were occurring, being lost to follow-up (people who should have had a further
appointment), staff attitude and difficulties in getting through to the hospital by telephone. We
received 58 complaints about clinical care, which represents about 20% of the total.
Complaints information is provided to the trust board on a quarterly basis, along with information
about other activity undertaken by our patient advice and liaison service (PALS).
New communication initiatives
In Focus, our regular publication for foundation trust members was relaunched in the autumn
of 2012. Using the new visual identity, the refreshed magazine contains more information and is
additionally circulated to staff, patients and other key stakeholders.
We also started work to redevelop our website, informed by focus groups of staff and patients and
an online survey to ensure that the new site is easy to navigate and that its structure reflects what
users want and need. The site is now being built and is due to be launched in the first quarter of
2013/14. Content for the new site is being developed in tandem and will include a phased plan for
further enhancements once the new site is live.
To support better relationships with local GPs and the emerging clinical commissioning groups, we
created a GP liaison manager post as part of our business development team. The new post-holder
joined us towards the end of 2012 and is now working on a range of initiatives to support GP
colleagues, including an ophthalmic education tool and a comprehensive referral guide.
Social and community initiatives
Many patients, carers and clinicians took part in a survey during the spring of 2012 to provide
suggestions for research priorities related to sight loss and vision over the next 10 years. Part of
a national project, the Sight Loss and Vision Priority Setting Partnership, the aim is to identify the
unanswered questions about the prevention, diagnosis and treatment of a number of different sight
loss and eye conditions from the perspective of patients/service users and eye health professionals
and then prioritise those which both groups agree are the most important. Moorfields consultant
Richard Wormald and biomedical research centre manager Karen Bonstein are on the partnership’s
steering group to represent Moorfields.
Our nurse-led health promotion team continued its rolling programme of health promotion
sessions at the City Road site. The sessions, which included promoting heart and arthritis care and
smoking cessation, were very well received by patients, visitors and staff. To arrange these events,
the team worked closely with local community health colleagues from NHS Islington and NHS City
and Hackney and with national charities, including Diabetes UK, Arthritis Care and Help the Aged.
In September 2012, we worked alongside several eye health charities to offer information during
National Eye Health Week. The collective aim was to raise awareness of eye health issues and to
encourage patients to ensure that they have regular eye tests so that problems can be diagnosed early.
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We attend meetings with the Islington health and wellbeing committee as required and liaise with
Islington Local Involvement Network (LINk). In addition, Moorfields’ director of nursing and allied
health professions represents the trust on both the Islington safeguarding children board and the
Islington safeguarding adults partnership to ensure that Moorfields protects these vulnerable groups
as well as possible and in line with national guidance.
Charitable support
– Our charities
All charities affiliated to Moorfields are independently constituted charities, registered with the
Charity Commission.
Moorfields Eye Charity (charity number 1140679) raises funds above and beyond those normally
provided by the NHS to enable us to continue to provide the highest quality care for our patients
and their families and help ensure we remain a world-class centre of excellence for eye research
and education. In October 2012, Moorfields Eye Charity was shortlisted in the charity of the
year category in the Association of Optometrists’ awards, which recognise the highest levels of
achievement in UK optics. The charity was shortlisted for using initiative to promote the importance
of optometry and raising awareness and funds to enhance the provision of sustainable eye care.
Two other charitable organisations also provide dedicated support for our work. The Special Trustees
of Moorfields Eye Hospital (charity number 228064) is a grant-giving body, which primarily supports
leading-edge research carried out at the hospital and with our research partners at the UCL Institute
of Ophthalmology, alongside a range of other high-profile projects. The Friends of Moorfields Eye
Hospital (charity number 228637) is an active and dedicated body of voluntary fundraisers, whose
main aim is to provide extra services and equipment for patients and their visitors. The charity is
assisted by more than 100 volunteers, who complement existing services and staff.
Funds donated to our affiliated charities come from a variety of sources, including gifts left by
people in their wills, donations from grateful patients and their families, charitable trusts, companies
and philanthropists. Events, collections and other fundraising activities also make an important
contribution. Together, these donations enable our charities to fund a wide range of important
research projects and to improve our services and facilities.
– Projects supported in 2012/13
A range of projects was supported during the year, including:
Various research projects, including studies to investigate the feasibility of retinal repair for the
treatment of Stargardt’s macular degeneration, the development of a surgical cell therapy for
age-related macular degeneration, and investigating the mechanism of disease for a form of
retinitis pigmentosa
Key posts, including a full-time nurse counsellor as part of our new integrated support service
and a research nurse for our clinical trials unit
Supporting efforts to tackle avoidable blindness and visual impairment across West Africa
through the construction of a new eye centre and surgical training facility at Ghana’s largest
teaching hospital and primary tertiary referral centre, which is under construction and due for
completion later in 2013
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 In addition, the Friends started celebrations to mark their 50th anniversary in the first part of 2013
by awarding grants and focusing fundraising activity on three special projects: £70,000 to support
the costs of an eye clinic liaison officer (ECLO) for our Northwick Park and Ealing satellite centres for
three years; £80,000 over three years to support the development of an arts programme, including
special events, improved artworks and occasional music; and £8,000 to support a programme
to increase the employment of visually impaired people at Moorfields through the provision of
specialist technology and improved advertising.
The celebrations will also include social events and fundraising activities, which got underway in
March 2013 with a successful ‘Moorfields’s Got Talent’ competition to showcase some of our staff’s
singing, comedic and musical abilities. Further events are planned for the remainder of the year,
including a river boat cruise on the Thames.
– Fundraising for the future
Over the next few years, philanthropy will need to play a key role if we are to realise our ambitious
plans to build a fully integrated centre for eye research, education and healthcare in the King’s
Cross/Euston area, along with the UCL Institute of Ophthalmology. We expect fundraising to
generate about 25% of the £320 million total cost of the new facility and to contribute significantly
to the enhancement of our research capabilities by attracting and retaining the best researchers
from around the world, increasing our research capacity and output and ensuring that scientific
breakthroughs are translated to treatments for patients as quickly as possible. For more information
about the new hospital project, please see section 3.2.
New partnerships
We were accredited to provide community eye services for the people of Hertfordshire in September
2012, following a successful tender process under the ‘any qualified provider’ system. This means
that, since October 2012, GPs throughout Hertfordshire have been able to refer to Moorfields
any of their patients who need a general ophthalmology or glaucoma consultation. Our service is
provided in our satellite locations in Potters Bar, Northwick Park and Bedford, but could be extended
to other sites nearer to patients’ homes in due course.
In south London, we continued to work closely with Croydon University Hospital NHS Trust to
support the provision of ophthalmic services locally. The community general ophthalmology service
for NHS Harrow was extended to include a glaucoma and cataract pathway on a pilot basis.
In early 2013, our specialist reading centre was awarded the contract to provide a retinal grading
service over the next two years for a trial looking into the link between nutrition and vision. The
central retinal enrichment supplement trial (CREST), led by the Waterford Institute of Technology
in Ireland and funded by the European Research Council, is examining the role of nutritional
supplements in visual performance and the prevention of AMD. This was the first occasion on which
Moorfields has been required to submit a competitive tender for a reading centre service, in line
with European procurement regulations, and to win it was a significant achievement.
Events and visits
We ran several successful patient days throughout the year, bringing together patients, staff,
healthcare professionals and charities to share experiences and learn from one another. This year,
events covered retina, glaucoma, diabetic retinopathy, thyroid eye disease and birdshot uveitis.
We also hosted a visit by representatives from Kyoto University and Canon Inc in January 2013,
reciprocating a visit to Kyoto in September 2012 at which the productive and high profile
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36 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
collaboration between these two organisations was demonstrated. Of particular interest to
Moorfields is Canon’s next generation adaptive optics retinal imaging device and the possibility of
Canon selecting us as a European site for testing the prototype.
The President of Malta, Dr George Abela, visited Moorfields in November 2012, as part of a short
trip to London. In common with other specialist hospitals, Moorfields treats patients from Malta
under the national treatment abroad scheme, so Dr Abela was keen to visit us and find out more
about our work and how we look after his compatriots. At the end of the reception, Dr Abela
presented a cheque to the chair of Moorfields Eye Charity, John Hooper, as a small token of thanks
for the work we undertake on behalf of the Maltese people.
In May 2012, we welcomed a delegation of American and British blind war veterans as part of
an initiative called Project Gemini. Members of the US Blinded Veterans Association met up with
colleagues from Blind Veterans UK (formerly known as St Dunstan’s) and listened to talks on a
number of exciting developments in regenerating damaged and diseased nerve cells, and new stem
cell transplantation and drug delivery discoveries which may in the future lead to people with loss of
vision having it restored.
In September 2012, we opened up our children’s eye centre for one morning during London Open
House weekend, an annual celebration of the capital’s diverse architecture. The children’s centre is
recognised by architects as a good example of an innovative healthcare building and several visitors
commented that they did not feel like they were in a hospital at all.
3.7 Working with our staff
Moorfields employs around 1,800 staff across a variety of professional disciplines at our main
hospital base in London’s City Road and at our various satellite facilities in and around the capital. Of
these, almost 89% have been in post for more than a year, a good indication of workforce stability.
Our annual rolling staff turnover rate was 6.5%. Recorded sickness absence across the year was
3.2%, against a target threshold of 4%. Moorfields is currently compliant with the requirements of
the European Working Time Directive.
We started a new piece of work during 2012/13 to increase the number of staff with visual
impairments we employ at Moorfields. This work, supported by a grant from the Friends of
Moorfields, will include widening access to work experience opportunities to those with visual
impairments and passing all new suitable vacancies to Blind in Business, a specialist charity, and
the Royal National Institute of Blind People (RNIB) to widen access to substantive posts within the
organisation. It is disappointing that this has not, to date, resulted in any such individuals being
employed, but two visually-impaired graduates are joining us in May 2013 for work experience. We
have also recently started using a new dedicated jobs board for people with a disability, and we are
working with the charities to understand and overcome barriers to recruitment.
Staff engagement
We are keen to engage with our staff, and our annual staff survey (see appendix 2) shows that
our staff feel positive about working for us. Many teams and departments hold local departmental
meetings to enable two-way communications between staff and line managers. The chief executive
hosts open meetings every other month, to which all staff are invited, and the chief executive and
other directors visit our satellite locations on a regular basis to ensure that staff based away from
the main hospital are kept informed of developments and have an opportunity to raise any issues or
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 concerns. Since May 2012, the chief executive has also circulated a personal newsletter to all staff
once a week, providing updates on key developments, achievements and other items of note from
across the trust.
We re-launched our weekly staff update in May 2012 to bring it into line with the new visual
identity and complement the weekly chief executive newsletter. The new e-bulletin is circulated to
all staff and provides a quick overview of news, developments, operational information and useful
dates, with links to further information on the intranet for those who want to find out more. All
staff also have access to In Focus magazine, which we relaunched during 2012/13 to cover a wider
range of topics in a more lively and engaging format. In Focus, which is also sent to foundation trust
members and made available in public areas around the trust, incorporates information previously
published in a stand-alone staff magazine, Review. It is available both as a hard copy publication
and as an e-zine, which can be viewed via our intranet.
Our four staff governors are becoming more active and now have a dedicated presence on
our intranet. They host regular drop-in sessions or walkabouts to gather views from other staff
and regularly attend membership council and trust board meetings. We also have a joint staff
consultative committee, which enables face-to-face contact between management, staff governors
and representatives from all trades unions whose members work in the trust.
The national staff survey is a further useful mechanism for engaging with staff and receiving
feedback from them. Action plans are developed based on the outcomes of the survey and details
are shared with all staff through our regular communications channels. Findings from the most
recent staff survey are included at appendix 2.
Our improving working lives (IWL) group, which includes staff governors, managers and clinicians,
supports staff in achieving a good balance in their working lives by promoting and developing a
wide range of benefits and hosting regular events. The group runs open days to inform colleagues
about various staff benefits and visits our larger satellite locations, where members talk to staff,
gather suggestions for change or improvements and look for areas of good practice.
Developing, supporting and rewarding our staff
During 2012/13, we ran a small campaign to raise awareness among staff of our whistleblowing
policy, which was updated towards the end of the previous financial year. The policy is intended to
enable all employees, including agency, volunteers and locum staff, to raise concerns or disclose
information about suspected malpractice safely. The campaign included posters around the trust
and flyers attached to payslips, as well as a new section on the intranet with a quick reference guide
and a link to the policy itself. Further internal campaigns during the year included a week devoted
to information governance issues and another focusing on sustainability. The creation of a new post
dedicated to staff communications will enable us to run more of these sorts of campaigns in future,
and enhance the range of benefits available to staff.
Our employee assistance programme, open to staff and their immediate family members, provides
confidential counselling, information and signposting services, designed to assist staff with personal
or work-related issues that might be affecting their health and wellbeing. Staff can also access
occupational health support via a service provided by Barts Health NHS Trust. The team runs an
on-site service at our main hospital in City Road two days a week and can be accessed at other
times via telephone or at The Royal London Hospital in Whitechapel. At the same time, our staff
benevolent fund is available to all permanent staff who are experiencing severe financial difficulty or
who need self-development in areas that fall outside the scope of learning and development funded
by the trust. The fund is financed by the Special Trustees of Moorfields Eye Hospital.
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We also provide a range of other benefits to our staff, ranging from sabbatical leave opportunities
to free contact lens and VDU eye examination clinics. Since February 2013, staff have had access
to a discounted corporate membership scheme at a gym and swimming pool local to the main City
Road hospital.
Our fourth annual Moorfields’ Stars ceremony took place in February 2013. The stars awards
recognise and reward staff for academic achievement and long service, as well as those named
as employees of the month over the previous 12 months. There are also several special awards
for which staff nominate their colleagues and teams, for which we received a record number of
nominations this year. These special awards recognise an outstanding individual, the team of the
year, innovation in patient care, research or education, and improvements to the patient experience.
This year, we introduced a new category to reward excellence in patient care. We also gave stars
awards to staff who were recognised nationally or internationally by other organisations during
2012, and those nominated by the public via the national NHS Heroes awards.
Learning and development
All staff at Moorfields have access to a range of learning and development courses and materials,
including health and safety training. These are provided by both the trust and the joint library
of ophthalmology, which is run in conjunction with our colleagues at the UCL Institute of
Ophthalmology and offers a range of courses and access to many journals and other helpful
resources.
Our programmes include traditional taught courses and online learning via My Learning Centre,
our bespoke learning portal, which lists the training considered essential for staff to perform their
jobs safely and effectively. The list is reviewed regularly by our multidisciplinary mandatory training
group. This group has also developed a range of flexible approaches to training by introducing
online assessment for some topics, grouping several mandatory subjects into single or half days to
make better use of staff time and implementing a system through which managers can identify
online, by subject, which of their staff are up to date and which are not. Individual staff can also
use this system to check their own compliance status. The mandatory training group also reviews
compliance data on a regular basis to identify problems and address them as necessary.
This year, we invested in a bespoke development programme for all our new clinical directors and
also held the first of a series of induction events for new service directors. At the same time, our
dedicated team of IT trainers focused much of their activity on ensuring that all staff are up to date
with our clinical systems, which is essential for patient safety. We also streamlined and simplified our
appraisals process to make conversations easier between managers and their staff.
3.8 Looking ahead
Our annual plan for 2013/14 continues to use the strategic and enabling themes of Our Vision
of Excellence as the framework for the year’s strategic priorities. The work to refresh the strategy
that started in late 2012/13 (see section 3.2 above) proposed the merger of the workforce and
leadership/ organisational development enabling themes into a single theme – our people – which
results in four strategic and four enabling themes as set out below.
What we do: how our portfolio will change:
Business development – create further growth in a sustainable manner
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Commercial business development – use the opportunities available with the changes to the
private patient cap to exploit the brand and our expertise to generate new areas of business
Research and development – implement our joint R&D strategy to ensure that we maintain our
world-leading status and maximise translational research opportunities and income generation
Education – focus effort on developing the components of an education strategy that produce
the most impact in 2013/14, and then go on to shape the wider strategic issues
Where we work: how our geographical reach will develop
NHS service development – respond to the requirements of our patients and commissioners, and
rebalance NHS activity in line with our strategic direction, optimising our capacity and efficiency
International business – continue to develop our international business through profitable
expansion of our activities in the UAE and exploration of other opportunities as they arise
Our quality and reputation: how we will ensure quality is the
defining characteristic of all we do
Quality – continue to maintain high standards of clinical quality, and demonstrate our excellence
by providing our clinicians, patients, commissioners and other stakeholders with regular,
up-to-date information on the success of most of our interventions
Patient experience – maintain our commitment to continuously improving our patients’
experience, focusing on the areas that they tell us are important
Our role and influence: the part we play as the market leader in
eye care:
Communications – implement the external communications and engagement strategy to
improve our specialist standing, public profile and brand recognition so that we are known for
being the ‘best’
Influencing – enhance our ability to capture and track existing activity, and develop supportive
new relationships in key areas
Improving our estate and facilities
New hospital project – continue with the planning for the replacement of the City Road hospital,
to provide an improved patient experience, by finalising the location for the new hospital and
completing the business case for investment
Satellite locations – further refine our networked model, and ensure that our satellites are able to
provide our rebalanced clinical activities
Increasing our productivity and efficiency
Transformation – change the way we work to provide the most effective and efficient services
Technology – lead the field in the translation of medical technology research into clinical practice,
ensuring that we deliver services in the most efficient manner
Efficiencies – deliver the financial efficiencies and income growth required to maintain our
financial risk rating and planned surplus levels
39
40
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Our people: recruiting, retaining, developing and rewarding the
best staff
Clinical leadership – engage all staff fully in the implementation of our vision and support them,
through development, technology, and clear incentives including reward to provide the highest
quality of care for our patients, and to be as productive as they can be
Staff engagement – develop and implement an internal, two-way communications strategy, and
a well-being strategy, to provide an engaged workforce, that hears consistent messages about
efficiencies, our strategy, and our new hospital, and is sufficiently informed to contribute to the
debate
Improving our IT and information
OpenEyes – continue to develop and implement our bespoke electronic patient record (EPR) and
maximise its impact internally and across the ophthalmic world
IT infrastructure – modernise our IT systems and infrastructure to support the provision of clinical
services
The priority areas set out above do not include significant issues that have become well embedded
in our day-to-day operational delivery and reporting. In addition, they might need to be amended
following the completion of our work to refresh Our Vision of Excellence to align our annual plan
with our longer-term strategy. For each of our priorities, we have agreed objectives and action plans,
and we will monitor progress against them throughout 2013/14.
41
4
Operational and financial review
Moorfields achieved strong operational performance across a wide range of measures during
2012/13. Targets for infection control, waiting times, clinical effectiveness and cancelled operations
were all met. Specifically, our A&E performance remains robust – 99.3% of our patients were
admitted, transferred or discharged within four hours of their arrival in the department, against a
national target of 95%. Against our internal target of admitting, transferring or discharging 80%
of patients within three hours, we also performed well, scoring almost 82%. For full details of our
compliance with national priorities and core standards, please see section 4 in our quality report at
appendix 1.
Financially, we also performed well, generating a surplus of £4.2 million, which was £0.2 million
better than planned. This surplus enabled us to achieve a financial risk rating of four with our
regulator, Monitor, by the end of the year. Further details of our financial performance are contained
in our financial report at section 4.5.
4.1 Patient activity
Moorfields provides care in a variety of settings, either via contracts with commissioners, where
we charge directly for our activity or through partnerships where another party charges the
commissioner for the work we provide. For example, we provide the ophthalmology service at
Bedford hospital, but do not directly charge the local commissioners; similarly, we have a number
of joint medical appointments providing support to the ophthalmology service at the Princess
Alexandra Hospital in Harlow where we charge the hospital for the work our consultants undertake.
We are also increasingly providing services closer to patients’ homes under the community services
contract.
The total NHS care provided by Moorfields grew across all settings in 2012/13 as shown in the table
below. As our Bedford satellite successfully moved the provision of around 125 intravitreal injections
per month from a theatre to an outpatient setting in June 2012, the activity figures for 2011/12
have been adjusted accordingly to allow a like-for-like comparison with this year’s figures.
The figures below cover all activity where we are clinically responsible for an entire service, not just
those for which we are directly contracted, but exclude non-chargeable activity. The figures also
include around 10,000 laser treatments and 13,500 intravitreal injections, which are provided in a
variety of settings and are classified either as outpatient or inpatient activity according to the local
service model.
42 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Activity
2012/13
2011/12*
% change
415,209
403,797
+ 2.8%
A&E attendances
82,435
79,767
+ 3.9%
Total inpatient and day-case admissions
31,180
30,520
+ 2.2%
Total outpatient attendances
* Figures different to those stated in annual report and accounts 2011/12 as final figures (‘freeze’
position) not available at time of going to press; figures for 2012/13 are also likely to change slightly
once frozen for the same reason.
4.2 Commissioning arrangements
Moorfields undertook £99 million of contracted clinical activity in 2012/13 for commissioners from
across the UK. Of this, £97.7 million relates to our contracts with more than 80 former primary care
trusts (PCTs) and £1.3 million relates to referrals outside contract (non-contracted activity).
Our NHS income (referred to in section 4.5 as £111.4 million) includes this contracted activity, but
also includes other items, principally activity at Bedford that is not under our main acute contract,
some non-contract high cost drugs, and amounts we have billed where the number of patients we
have seen have been in excess of those planned for in our contract.
Our largest contracts are with London primary care trusts from across the North West London,
South West London, North East London and North Central clusters, and with Hertfordshire primary
care trust, as set out in the pie chart below. Together, these clusters account for 85% of our total
contracted activity.
Contracts 2012/13
Other 15%
North and East
Central London
40%
Hertfordshire 6%
South East
London 7%
South West
London 14%
North West
London 18%
Contract activity 2012/13 – breakdown between commissioners
4.3 Business continuity
Our business continuity plan aims to improve our capacity to manage disruptions to operations
and reduce any impact on stakeholders, damage to our reputation, and financial losses. This is
a statutory duty under the Civil Contingencies Act 2004 and was reinforced in 2008 by interim
guidance from the Department of Health on business continuity planning. Our plan includes the
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 procedures for responding to an externally-declared major incident as required by NHS guidance on
emergency planning published in 2005.
Strong business continuity arrangements were especially important during 2012, when London
hosted the Olympic and Paralympic Games which had the potential to impact heavily on the
provision of normal services. Our general approach was one of ‘business as usual’, but we prepared
thoroughly ahead of the games to ensure that services continued to run as smoothly as possible.
We planned for an increase in staff numbers in A&E with a contingency to move in more staff if
required, and put in place measures to ensure that all requests for annual leave during the games
period were co-ordinated to guarantee sufficient cover for all services and departments.
During the games themselves, a multidisciplinary team met on a daily basis to check that everything
was running smoothly and to identify and resolve any problems as quickly as possible.
Having a robust business continuity plan also proved useful in preparing for strikes in 2012/13 by
the public sector union Unite and by the British Medical Association, which represents doctors.
4.4 Commercial divisions
Moorfields has three commercial divisions – Moorfields Pharmaceuticals, Moorfields Private and
Moorfields Eye Hospital Dubai. These units exist entirely to augment and support the care we
provide to NHS patients by generating income from outside the NHS, which can then be reinvested
in services for all our patients. For example, in a normal year, the financial contribution from our
commercial divisions pays for more than half of our capital expenditure requirements, which include
new equipment and improvements to buildings. This means that NHS funds can be freed up to
spend on other items.
Despite the difficult financial climate, our three commercial divisions returned a joint surplus of
£3.64 million in 2012/13. For the future, the lifting of the private patient cap, which limited the
amount of income we were allowed to make from private patient activities, provides us with
an opportunity to grow our commercial activities, without impacting on our NHS activity, which
remains our main focus.
Moorfields Pharmaceuticals
Moorfields Pharmaceuticals, our specialist pharmaceutical manufacturing arm, makes a
comprehensive range of niche, unlicensed ophthalmic medicines that are often not available
anywhere else in the UK. These products are used to treat the special clinical needs of patients
both at Moorfields and across the UK. Moorfields Pharmaceuticals also has a growing portfolio
of licensed ophthalmic products and acts as a contract manufacturer for third parties producing
licensed products and clinical trials supplies.
The division recorded growth of 7.5% and exceeded its profit target due to very strong performance
in contract management. It missed its sales budget target by £0.4 million. Sales revenues were
down in part due to the tough trading climate, but were also the result of a fire in an external
product testing facility which temporarily affected production towards the end of the year. On a
positive note, the division launched new products during the year, including Emustil and Lubristil
gel, which are licensed products for dry eyes and are now selling well to optometrists and opticians,
including those in retail outlets.
In November 2012, the Medicines and Healthcare Products Regulatory Agency (MHRA) carried out
a good manufacturing practice (GMP) inspection of Moorfields Pharmaceuticals. The outcome of
43
44 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
the inspection was positive, evidencing the very high standards that are required for manufacturing
sterile pharmaceutical products.
We also continued to explore opportunities to collaborate with other leading London NHS trusts to
benefit our patients and create commercial opportunities.
Moorfields Private
Moorfields Private in London enjoyed another successful year in 2012/13, making a net contribution
of £2.8 million, marginally below its budget target, but representing a 10% increase in contribution
on 2011/12.
The unit has ward and refractive laser facilities in a discrete area of the main City Road hospital,
and outpatient and diagnostic consultation rooms in the John Saunders Suite and Arthur Steele
Unit adjacent to the site. There are further outpatient consulting rooms at Upper Wimpole Street in
London’s West End.
This year saw the appointment of several new consultants and a new managing director, who has
significant expertise in both the NHS and the private healthcare sectors.
During 2012/13, the management team worked to identify new premises to enable the integration
of its outpatient consulting and refractive laser services in the John Saunders Suite and Arthur Steele
Unit into one location. This would improve the overall environment in which services are provided
and which fee-paying customers expect, as well as provide additional capacity to accommodate new
consultants. Discussions also started to launch a private patient service at Moorfields’ larger satellite
centres at Northwick Park and Bedford, in order to gain increased market share and boost financial
returns. Cumberlege Ward was extensively refurbished during 2012/13, providing much improved
facilities for those who require an overnight stay following surgery.
Reviews are now underway of the patient enquiry line and practice administration arrangements,
with a view to ensuring that as many enquiries as possible result in new appointments being
made, and improving the efficiency and quality in the management of private practice. The reviews
continue and change will be introduced in the early part of 2013/14.
Moorfields Eye Hospital Dubai
Moorfields Eye Hospital Dubai (MEHD) officially celebrated its fifth anniversary in 2012/13, and also
welcomed a new managing director and medical director. There are now seven consultants and
a specialty doctor permanently based in MEHD, covering all the major ophthalmic sub-specialties,
with an eighth consultant specialising in paediatric ophthalmology due to join the team in the first
quarter of 2013/14. The medical staff are supported by a strong team of nurses, optometrists and
an orthoptist, as well as multi-lingual administrative staff.
Together, the team provides a high standard of ophthalmic care to patients from a wide catchment
area. Since opening its doors to patients in 2007, MEHD has treated more than 27,000 patients
from more than 90 countries, and is now widely regarded as the place to go for eye care in Dubai.
It has also become a reference for UK health organisations as a successful NHS overseas healthcare
operation.
Alongside negotiations to ensure our continuing presence in Dubai, we are also looking at
establishing a surgical facility in Abu Dhabi. We look after the eye care needs of the patients of the
Imperial College London Diabetes Centre (ICLDC) in Abu Dhabi and Al Ain, but do not currently
have access to surgical facilities. We are exploring options for these.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 In addition, we are working to expand our training and education activities, as well as to collaborate
with Government and other agencies to undertake appropriate ophthalmic research in the United
Arab Emirates.
4.5 Financial report
Moorfields’ financial surplus for the year was £4.2 million, £0.2 million better than planned. The
surplus enabled us to maintain a financial risk rating of four at the end of the year (where one is the
worst and five is the best rating).
As an NHS foundation trust, we can keep this modest surplus to re-invest in services for our NHS
patients. Our financial strategy has identified scenarios to ensure that we maintain an appropriate
financial risk rating so that we can support potential borrowing as part of the funding arrangements
for our new central London hospital (see section 3.2).
Our cost improvement programme (CIP) has achieved £3 million in efficiencies at the same time as
maintaining the quality of our services. As part of our CIP assurance process during the year, the
medical director and the director of nursing and allied health professions were required to scrutinise
and approve proposed savings schemes against a range of quality standards before they were
agreed. Savings have been generated from a range of initiatives, including new income sources,
savings on drugs, procuring supplies at better prices, and savings on rent.
In order to create larger-scale efficiencies than are achievable through a traditional CIP, we have
adopted a transformational approach. Led by a team of specialist consultants, our transformation
programme has been piloted during 2012/13. In the coming year, we will review the results of the
pilot to determine how best to take this work forward. For more information about the transformation project, please see section 3.3.
The table below presents a high-level comparison between 2012/13 and 2011/12; segmental
information for the year is given at note 2 to the accompanying accounts.
2012/13
Actual
2011/12
Actual
– NHS income
111.4
107.8
– Private
19.5
17.9
Total income from activities
130.9
125.7
– Moorfields Pharmaceuticals
9.4
8.1
– Non-clinical income
17.8
17.2
Total other operating income
27.2
25.3
Total income
158.1
151.0
All figures in £million
Income
Income from activities
Other operating income
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46 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2012/13
Actual
2011/12
Actual
Pay costs
86.4
81.0
Non-pay costs
59.8
57.0
Depreciation and amortisation
5.5
5.1
Total expenditure
151.7
143.1
Operating surplus
6.4
7.9
Interest and dividends
2.2
2.1
Net surplus
4.2
5.8
All figures in £million
Expenditure
Income
Our total income grew by 4.7% to £158.1 million from £151.0 million last year. The principal
growth areas were NHS income (£3.6 million), private and overseas income (1.6 million), and drug
sales (£1.3 million), with the balance made up of other non-clinical income sources (£0.6 million).
NHS clinical income is paid for at prices generally set by the Department of Health (DH). Although
prices fell compared with the previous year, reflecting the Government’s requirement for increased
NHS efficiency, activity increases meant that our income from NHS activities grew by £3.6 million
(3.3%), from £107.8 million in 2011/12 to £111.4 million in 2012/13. Strong growth in outpatient
and non-elective income, the increased use of Lucentis in the treatment of wet age-related macular
degeneration (AMD) and income from activities where prices are not set centrally by the DH were
higher than expected. These activities include patient treatments as well as reimbursement for
certain drugs deemed to be ‘expensive’ under the relevant DH rules. Conversely, income for planned
surgical procedures fell during the year, mainly due to price reductions set by the DH.
Income from our private and overseas patient activities in London and Dubai rose to £19.5 million,
compared with £17.9 million in 2011/12, with income near expectations for both locations.
Moorfields Pharmaceuticals made sales of £9.4 million to other organisations during the year, an
increase compared with 2011/12 (£8.1 million).
Non-clinical income arises from activities including research and development, education and
training, charitable income and other income. Total non-clinical income rose by £0.6 million (3.5%)
to £17.8 million from £17.2 million in the previous year.
The Health and Social Care Act 2012 requires that our income from the provision of goods and
services for the purposes of the health services in England must be greater than our income from the
provision of goods and services for any other purpose. During 2012/13, we met this requirement. Our
principal source of income from other purposes is through our commercial divisions, and we do not
assess these as adversely impacting on our provision of NHS healthcare. The divisions exist entirely to
augment and support the care we provide to NHS patients by generating income from outside the
NHS which can then be reinvested in services for all our patients.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Expenditure
Expenditure grew by £8.6 million (6%) to £151.7 million from £143.1 million last year, following
agreed investments and growth in our core NHS clinical services. Pay costs of £86.4 million rose by
£5.4 million (6.7%) from £81.0 million in 2011/12, an increase due mainly to the higher number
of staff required to treat increased numbers of patients, combined with investments made in our
staffing base during the year. Note 5 within the annual accounts provides further details.
Non-pay costs increased by £2.8 million or 4.9%, from £57.0 million last year to £59.8 million
during the year. The main components of non-pay expenditure are shown in the table below:
Expenses type
All figures in £million
2012/13
Actual
2011/12
Actual
Drug costs
17.9
15.4
Clinical supplies and services
11.9
11.9
Establishment
4.1
3.0
Transport
2.3
2.0
Premises
12.2
13.1
Other
11.4
11.6
Total
59.8
57.0
Drug costs rose, primarily due to the high-cost drugs used for the treatment of age-related macular
degeneration (AMD). Costs of clinical supplies increased during the year, mainly due to increased
clinical activity, but offset by savings in this area. Premises costs fell, largely because of service level
agreements negotiated during the year and some reclassification of expenditure between cost types.
Expenditure classed as ‘other’ remained relatively static between years.
Statement of financial position
The balance sheet totals fell by £1.8 million from £82.7 million to £80.9 million, principally reflecting
the surplus of £4.2 million, offset by asset value impairments of £6 million. Non-current assets
decreased by £4.4 million to £76.9 million from £81.3 million due mainly to impairment of assets
which were affected by an accounting adjustment to the remaining life we estimate our assets to
have, as recommended by our property valuers.
Current assets increased by £2.5 million, from £34.3 million to £36.8 million during the year as
trade and other receivables increased along with cash holdings. Cash holdings were £20.6 million
(2011/12: £18.5 million) and financial assets were nil (2011/12: £0.8 million), totalling £20.6 million
(2011/12: £19.3 million).
Current liabilities increased to £27.9 million (2011/12: £23.3 million) due to normal variations in
the timing of payments to suppliers. Non-current liabilities fell to £4.9 million from £9.6 million,
principally due to repayment of borrowings. Taxpayers’ equity fell in the year as a result of the
surplus, offset by the reduction in the value of our non-current assets.
Statement of cash flows
As noted above, the strong operating surplus was offset by slower collections from debtors, and
higher payments on capital infrastructure to trade creditors and to loan creditors. The net result was
a cash inflow of £2.1 million in year, compared with a cash inflow of £0.2 million in 2011/12, as
cash and cash equivalents rose from £18.5 million in 2011/12 to £20.6 million in 2012/13.
47
48 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Borrowing
Since attaining foundation trust status, Moorfields has taken out long-term loans from the
foundation trust financing facility as well as entering certain long-term leasing arrangements
(finance leases). No further loans were taken out during 2012/13. Given very low returns on bank
deposits and a good cash position, borrowings and finance leasings of £4.5 million and £1.5 million
respectively were repaid in 2012/13, leaving outstanding borrowings of £4.8 million.
External audit services
Moorfields employs the services of Deloitte LLP as external auditor. The type of services and costs are
detailed below.
2012/13
£000
2011/12
£000
Statutory audit services
76
76
Other
0
10
VAT
68
147
Deloitte’s work on VAT delivered total recoveries of £0.2 million in 2012/13.
The trust and Deloitte have safeguards in place to avoid the possibility that the external auditors’
objectivity and independence could be compromised. The audit committee reviews the annual
report from the external auditors on the actions they take to comply with professional and
regulatory requirements and best practice designed to ensure their independence from the trust.
The audit committee also reviews the statutory audit, tax and other services provided by Deloitte,
and compliance with the trust’s policy, which prescribes in detail the types of services which the
external auditors can and cannot provide:
External audit services
Other audit services – work which regulators require the auditors to undertake, such as on behalf
of the Care Quality Commission
Tax services – all significant tax consulting work is put out to tender, except where the auditors
are best placed to do this, such as in relation to value added tax
Internal audit – the external auditors may not perform internal audit assignments
General consulting – the external auditors may not tender for such engagements
All engagements with the external auditors over a specified amount require the advance approval of
the chair of the audit committee. The policy is regularly reviewed and, where necessary, amended in
the light of internal developments, external requirements and best practice.
So far as the directors are aware, there is no relevant audit information of which the auditors are
unaware and the directors have taken all of the steps that they ought to have taken as directors in
order to make themselves aware of any relevant audit information and to establish that the auditors
are aware of that information.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Counter-fraud arrangements
Moorfields has established a counter-fraud policy and response plan to minimise the risk of fraud
or corruption, together with a code of conduct and a whistle-blowing policy to be followed in
the event of any suspected wrong-doing being reported. The policies and related materials are
available on the intranet and counter-fraud information is prominently displayed on our premises.
The trust’s local counter-fraud specialist (LCFS) reports to the director of finance and performs
a programme of work designed to provide assurance to the board in regard to fraud and
corruption. The LCFS attends audit committee meetings to present the programme and the results
of counter-fraud work. The LCFS also gives regular fraud awareness sessions for Moorfields’ staff
and investigates concerns reported by staff; if these are substantiated, the trust takes appropriate
criminal, civil or disciplinary measures.
Accounting policies and other declarations
The accounting policies for the trust are set out in note 1 of the notes to the accounts in the annual
accounts section at appendix 5.
Moorfields Eye Hospital NHS Foundation Trust has complied with the cost allocation and charging
requirements set out in HM Treasury and Office of Public Sector information guidance.
Moorfields’ policy is to pay our suppliers in accordance with the contractual terms agreed with or
applying to the supplier. We largely complied with that policy during the year. We did not pay any
interest under the Late Payment of Commercial Debts (Interest) Act 1998.
After making enquiries, the directors have a reasonable expectation that the 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.
Financial outlook for 2013/14
Subject to the completion of commissioning negotiations for 2013/14, we are budgeting for a
surplus of £4 million on income of £166 million. This is expected to achieve a financial risk rating of
three from Monitor, the same as was planned for last year. Patient care prices and efficiency targets
for our NHS activities are worse than the Government’s announced 4% efficiencies target at 7.7%,
so we have set ourselves a challenging efficiency agenda to compensate for the above-average
reduction in the price we are paid for our NHS activities. We expect that meeting our cost
improvement target will be challenging. We want to avoid redundancies, so for the remainder of
the year and for future years, we will be looking at new ways of working and of making the most of
opportunities for expansion and more efficient ways of working.
49
50
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
51
5
Governance arrangements
Moorfields Eye Hospital NHS Foundation Trust is authorised to operate as a public benefit
corporation under the National Health Service Act 2006. The trust is led by the board of directors,
which is accountable to the board of governors, known at Moorfields as the membership council.
The responsibilities of both are laid out in the trust’s constitution, which is a key component of the
terms of authorisation. The roles and responsibilities of each are described in the following sections
of the report.
5.1 Membership council
The membership council has a duty under the NHS Act 2006 to represent the interests of
foundation trust members and stakeholders to the board of directors and the management of the
trust. The membership council includes elected and nominated governors as shown in the table
below and has decision-making powers defined by statute. These powers are described in our
constitution and are mainly concerned with the appointment, removal and remuneration of the
chairman and non-executive directors; the appointment and removal of our external auditors; the
provision of views on our annual plan; and scrutiny of our annual accounts and the quality account.
The council met five times during 2012/13 to discuss a wide range of subjects, including quality and
safety, the patient experience, Moorfields’ business agenda and our service and strategic plans.
The council has two formal sub-committees – a remuneration committee for non-executive
directors, and a nominations committee for the appointment of non-executive directors, including
the chairman of the board. The remuneration committee reviewed the remuneration of the
chairman and non-executives during the year and its recommendations were ratified by the
membership council.
The nominations committee met during 2012/13 in relation to the appointment of a new
non-executive director to replace Lesley Potter, who stood down at the end of March 2013.
Its recommendation to make an appointment was agreed by the membership council.
Executive and non-executive directors routinely attend membership council meetings, and
non-executive directors are linked to one or more of the public and patient constituencies. This
provides a direct link for governors to a member of the board, and acts as a bridge between the
two bodies. Governors receive the minutes and agenda of the board of directors’ public meetings
and are actively encouraged to attend the meetings. A summary of the board’s business agenda is
included as a standing item on the council’s agenda.
52 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Composition of the membership council 2012/13
Elected governors
Representing
Other responsibilities
Jane Colebourn
Public: Bedfordshire and
Hertfordshire
Non-executive director nomination committee
Ron Wallace (from
October 2012)
Public: Bedfordshire and
Hertfordshire
Bill Tidmas
Public: North East London and Essex Vice chair
Chair, non-executive director remuneration
committee (from November 2012)
Non-executive director nomination committee
Chair, membership development group
Patient environment action team
Istvan F Selmevzi
Public: North East London and Essex Non-executive director remuneration
committee
Paul Murphy
Public: North Central London
Non-executive director remuneration
committee
Non-executive director nomination committee
Catering forum
Patient experience committee
Narayanan Sisupalan
Public: North Central London
Non-executive director remuneration
committee
Nigel Liddell (until
January 2013)
Public: North West London
Non-executive director nomination committee
Brian Watkins
Public: North West London
Non-executive director remuneration
committee
Patricia Davies (until
January 2013)
Public: South East London
Suryanarayanan
Naga Subramanian
Public: South East London
Quality and safety committee
Non-executive director nomination committee
Andrew Hill
Public: South West London
Chair, non-executive director nomination
committee (until November 2012)
Chair, non-executive director remuneration
committee (until November 2012)
Simon Mansfield
(until January 2013)
Public: South West London
Brenda Faulkner
Patient
Patient experience committee
Equality and diversity committee
Non-executive director nomination committee
Arts committee
Robert Jones
Patient
Chair, non-executive director nomination
committee (from November 2012)
Employment of visually impaired staff working
group
Jill Wakefield
Patient
Quality and safety committee
Alexandra Edwards
Staff – City Road class
Improving working lives group
Catering forum
Eilis Kennedy
Staff – City Road class
Improving working lives group
Catering forum
Colin Carter
Staff – satellite class
Improving working lives group
Mary Masih
Staff – satellite class
Improving working lives group
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Nominated governors
Represented organisation
Cllr Robert Khan
London Borough of Islington
Tracey Riddell (until June 2012), David Newbold (from July
to October 2012) and Louise Stalker (from November 2012)
Royal National Institute of Blind People (RNIB)
Valerie Greatorex
International Glaucoma Association
Professor Peter Mobbs
University College London
John Lawrenson
City University
Vacant
Primary care trust/commissioners
Elected governors normally hold their positions for three years. Nominated governors are proposed
by their host organisation and hold the position until a new nomination is made, or they are
otherwise notified.
A record is kept of the number of meetings attended by individual governors and is available on
request – please see contact details below.
Register of interests for the membership council
The register of interests of individual governors on the membership council is available to the
public on request in writing to the director of corporate governance, Moorfields Eye Hospital NHS
Foundation Trust, 162 City Road, London EC1V 2PD, by email to [email protected] or
telephone 020 7566 2490.
5.2 Our membership
Moorfields continues to grow its membership and we currently have more than 18,000 members,
an increase of more than 9,500 since our authorisation as an NHS foundation trust in 2004 and
about an 11% increase since 31 March 2012. In the past year, the largest growth has occurred
in our patient constituency, with an increase of more than a third. There has been a slight, but
insignificant decrease in the public constituencies and a marginal increase in staff members.
Membership numbers in each public constituency reflect to some degree the size of the satellite
service provision in the area. For example, North West London has the greatest number of members
because it includes two of our largest satellite facilities. As new satellites emerge, we will carry out
further membership recruitment drives.
A successful membership week was held in July 2012, during which governors spent time at our
main hospital in London’s City Road and at several of our satellite locations, recruiting new members
and gathering feedback from patients. Additional recruitment drives also took place at several
of our satellite locations during the year. Feedback from the governors is passed to the patient
experience committee as well as to the membership council so that learning and improvement can
take place. A programme for similar membership drives is planned throughout 2013/14.
All members are invited to our annual general meeting (AGM), with seats allocated on a first-come,
first-served basis. Last year’s AGM, held on 18 July 2012, attracted more than 250 members.
The break-down of our membership between constituencies is as follows:
53
54 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Constituency
Number of members
Patient constituency
9,062
Bedfordshire and Hertfordshire public constituency
537
North Central London public constituency
1,557
North East London and Essex public constituency
1,910
North West London public constituency
2,145
South East London public constituency
449
South West London public constituency
891
Staff constituency – City Road and satellite
1,720
Affiliate
52
TOTAL
18,323
Representing our membership
Members are represented by elected patient, public and staff governors on the membership council
(see above), which meets at least five times a year. Governors participate in a range of activities,
such as membership development and engagement, reviewing quality initiatives, and attending
recruitment panels for executive director appointments. They are also represented on the quality and
safety, and patient experience committees.
We draw our public membership from six geographic constituencies, set out in the table above.
Any member of the public who lives in one of these areas and is aged 14 years or over can join as a
public member. Any patient aged 14 years or over can join the wider patient constituency. All staff
are automatically registered as members, but they can opt out if they wish.
Elections
A by-election was held in October 2012 for a new governor to represent members of the
Bedfordshire and Hertfordshire constituency. This by-election was called as no one put themselves
forward as a nominee for the previous ballot held in March 2012, which meant that this
constituency was without a representative for the first part of 2012/13. Ron Wallace was duly
elected to represent the constituency.
Further elections were held in March 2013 for four further public constituencies and three staff
representatives, where governors had come to the end of their terms of office, as set out below. The
successful candidates start their terms of office from 1 April 2013.
Constituency
Number of seats
Successful candidate(s)
Bedfordshire and Hertfordshire
1
Jane Colebourn
North Central London
1
Mir Habibur Rahman
North West London
1
Simon Mansfield (uncontested)
South West London
1
Patricia Davies (uncontested)
Staff – City Road
2
Alexandra Edwards and Eilis Kennedy
(both uncontested)
Staff – satellite
1
Mary Masih (uncontested)
Full details of the composition of the membership council from 1 April 2013 and of the election
results are posted on our website at www.moorfields.nhs.uk.
All elections are held in accordance with the election rules set out in the constitution. This has been
confirmed by the returning officer for the elections held during 2012/13.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Members who want to contact their representative governor or a member of the board may do so
through the director of corporate governance, Moorfields Eye Hospital NHS Foundation Trust, 162
City Road, London, EC1V 2PD, or by email to [email protected]
5.3 Board of directors
The board of directors holds overall accountability for the organisation and is responsible for strategic
direction and the high-level allocation of resources. It delegates decision-making for the operational
running of the trust to the chief executive.
Non-executive directors and the chairman are appointed by the nominations committee of the
membership council initially for a period of three years, which may be extended for a further three years
following review by the nominations committee of the membership council and agreement by the full
council. Our constitution also allows for the UCL Institute of Ophthalmology to have a representative on
the trust board, which means that this non-executive appointment is not subject to the usual selection
processes. Executive directors are appointed by the nominations committee of the board of directors.
Composition of the board of directors 2012/13
This was the first full year in which we operated with a slightly revised board structure. This revision,
which came into force in March 2012, provides for two new directors, one executive and one nonexecutive, in order to ensure that the skills of the board are strengthened as the trust implements
its 10-year strategy, especially in view of the plan to rebuild our main central London hospital (see
section 3.2).
Date and length
of appointment
Board member
Position
Rudy Markham (9)
Chair
(Background – finance director)
Chair
Deborah Harris-Ugbomah (11)
Non-executive
(Background – chartered accountant)
Chair
Sir Roger Jackling (11)
Non-executive
(Background – civil service)
Vice
Professor Phil Luthert (10)
Non-executive
director
of the Institute of Ophthalmology
Chair of quality and safety committee
1 February 2006
(Background – ophthalmic pathologist and research
scientist)
Director
Andrew Nebel (10)
Non-executive
(Background – marketing and communications director)
Chair
1 April 2008 for three
years; renewed on
1 April 2011
Lesley Potter (8)
Non-executive
director
1 April 2008 for three
years; renewed on
1 April 2011
Stephen Williams (10)
Non-executive
director
15 March 2012 for
three years
John Pelly (11)
Chief
Declan Flanagan (11)
Medical
Professor Peng Tee Khaw (11)
Director
of remuneration and nomination
committees
director
of audit committee
1 January 2008 for
three years; renewed
on 1 January 2011
director
1 April 2008 for three
chair and senior
years; renewed on
independent director (non-executive)
1 April 2011
Chair of strategy and investment committee
director
of new hospital committee
(Background – communications and public relations
consultant)
(Background – lawyer)
executive
(Background – accountant and health service
management)
director
(Background – ophthalmic surgeon)
(Background – ophthalmic surgeon and clinician scientist)
1 April 2008 for three
years; renewed on
1 April 2011
of research and
development
55
56 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Date and length
of appointment
Board member
Position
Tracy Luckett (11)
Director
of nursing and allied health professions
Charles Nall (11)
Director
of finance
Ruth Russell (11)
Chief
(Background – registered nurse)
(Background – finance and corporate services
management)
operating officer
(Background – qualified nurse and health service
management)
All board meetings were held in public and the bracketed numbers in the table above refer to the
number of public board meetings directors attended during 2012/13 out of a possible 11. The
board can also hold a confidential meeting each month if required. The board of directors believes
that it has the appropriate balance and completeness in its composition to meet the requirements of
an NHS foundation trust.
Committees of the board
– Audit committee
The audit committee comprises three non-executive directors. Andrew Nebel replaced Lesley Potter
on the audit committee at the end of 2012/13, following Lesley’s decision to stand down as a
non-executive director at the end of March 2013. The directors have satisfied themselves that all the
members of the committee are competent in financial matters. The chair has recent and relevant
financial experience and is also the chair of the Association of Audit and Financial Non-Executive
Directors (AFNED). The committee’s meetings are attended, by invitation, by the chief executive,
finance director, director of corporate governance, the internal auditors, the local counter-fraud
specialist, the external auditors and others as required.
The audit committee assists the board in fulfilling its oversight responsibilities in respect of the
integrity of the trust’s accounts, risk management and internal control arrangements, compliance
with legal and regulatory requirements, the performance, qualifications and independence of the
external auditors and the performance of the internal audit function.
Management supplies the audit committee with all the information necessary for the performance
of its duties. The internal auditors, the local counter-fraud specialist and the external auditors have
direct access to the audit committee separately from management.
During 2012/13, the audit committee met as follows:
Date
Present
22 May 2012
Deborah Harris-Ugbomah, Roger Jackling, Lesley Potter
13 September 2012
Deborah Harris-Ugbomah, Roger Jackling, Lesley Potter
17 October 2012
Deborah Harris-Ugbomah, Roger Jackling, Lesley Potter
6 December 2012
Deborah Harris-Ugbomah, Roger Jackling
11 March 2013
Deborah Harris-Ugbomah, Roger Jackling, Andrew Nebel
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – New hospital committee
The new hospital committee is a new committee of the trust board, formed during 2012/13. It
has six principal roles relating to the development and construction of a new facility to replace
the existing City Road campus: to provide assurance that all aspects of the project have been
appropriately managed by the project board; to scrutinise and challenge the key decisions of the
project board; to ensure that the project is affordable within the envelope set by the financial
strategy approved by the strategy and investment committee and represents value for money; to
endorse the overall project programme; to work collaboratively with the strategy and investment
committee to ensure that business requirements and cases are jointly approved by both committees
and that we comply with Monitor and other relevant investment guidance; and to provide assurance
that project risks are appropriately recorded and mitigated by the project board.
The committee’s core membership comprises two non-executive directors and the chief executive,
with an open invitation to all other non-executives to attend. The director of strategy and business
development, finance director, director of nursing and allied health professions and a medical
professional also attend the meetings, with other directors and senior managers invited to attend as
appropriate.
During 2012/13, the new hospital committee met as follows:
Date
Present
8 October 2012
Rob Elek (on behalf of John Pelly), Andrew Nebel, Stephen Williams
6 February 2013
Andrew Nebel, John Pelly, Stephen Williams
21 February 2013
Andrew Nebel, John Pelly
7 March 2013
Andrew Nebel, John Pelly
– Nominations committee
The nominations committee deals with the appointment of executive and other director positions
and is established when required. The committee is chaired by the trust’s chairman and comprises all
non-executive directors and the chief executive.
During 2012/13, the nominations committee met as follows:
Date
Present
24 May 2012
Deborah Harris-Ugbomah, Roger Jackling, Phil Luthert, Andrew Nebel, Rudy
Markham, John Pelly, Lesley Potter, Stephen Williams
23 August 2012
Deborah Harris-Ugbomah, Andrew Nebel, John Pelly
17 August 2012
Deborah Harris-Ugbomah, Roger Jackling, Phil Luthert, Andrew Nebel, Rudy
Markham, John Pelly, Lesley Potter
24 January 2013
Deborah Harris-Ugbomah, Roger Jackling, Andrew Nebel, Rudy Markham, John Pelly,
Lesley Potter, Stephen Williams
11 March 2013
Deborah Harris-Ugbomah, Roger Jackling, Phil Luthert, Andrew Nebel, John Pelly
57
58 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
– Remuneration committee
The remuneration committee is responsible for setting the pay and terms of employment of
executive directors and other board-level posts, as well as taking an overview of performance
reward in the trust. The committee is chaired by the trust’s chairman and comprises all
non-executive directors. The committee’s decisions are informed by benchmarking information
derived from published reward research, such as the IDS NHS Boardroom Pay Report, and surveys of
other trusts’ remuneration for similar posts.
During 2012/13, the remuneration committee met as follows:
Date
Present
24 May 2012
Deborah Harris-Ugbomah, Roger Jackling, Phil Luthert, Andrew Nebel, Lesley Potter,
Stephen Williams
23 August 2012
Deborah Harris-Ugbomah, Roger Jackling, Andrew Nebel
17 October 2012
Deborah Harris-Ugbomah, Roger Jackling, Andrew Nebel, Rudy Markham, Lesley
Potter
24 January 2013
Deborah Harris-Ugbomah, Roger Jackling, Andrew Nebel, Rudy Markham, Lesley
Potter, Stephen Williams
The chief executive and the director of human resources attend meetings of the remuneration
committee in an advisory capacity.
– Strategy and investment committee
This committee conducts independent and objective reviews of strategic direction and investment policies,
and has specific responsibilities in relation to risk. The committee is chaired by a non-executive director,
with a second non-executive director, the chief executive, the finance director, the medical director and the
director of strategy and business development as members.
During 2012/13, the strategy and investment committee met as follows:
Date
Present
14 June 2012
Rob Elek, Declan Flanagan, Deborah Harris-Ugbomah, Charles Nall, Roger Jackling,
Andrew Nebel, John Pelly
27 June 2012
Rob Elek, Declan Flanagan, Roger Jackling, Charles Nall, Andrew Nebel, John Pelly
23 August 2012
Rob Elek, Deborah Harris-Ugbomah, Roger Jackling, Charles Nall, Andrew Nebel, John
Pelly
11 October 2012
Rob Elek, Deborah Harris-Ugbomah, Roger Jackling, Charles Nall, Andrew Nebel
6 December 2012
Rob Elek, Deborah Harris-Ugbomah, Roger Jackling, Charles Nall, Andrew Nebel
10 January 2013
Rob Elek, Declan Flanagan, Deborah Harris-Ugbomah, Roger Jackling, Charles Nall,
Andrew Nebel, John Pelly
7 March 2013
Rob Elek, Declan Flanagan, Roger Jackling, Charles Nall, Andrew Nebel, John Pelly
– Quality and safety committee
The quality and safety committee provides independent and objective review of all aspects of quality
and safety at Moorfields. It also has specific responsibility for ensuring that risks relating to quality
and safety are scrutinised. The committee is chaired by a non-executive director and its membership
also includes two non-executive directors, the chief executive, the chief operating officer, the
director of nursing and allied health professions, the medical director, the clinical director of quality
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 and safety and the director of corporate governance. Two governors from the membership council
are also invited to attend.
During 2012/13, the quality and safety committee met as follows:
Date
Present
1 May 2012
Rob Elek, Declan Flanagan, Deborah Harris-Ugbomah, Charles Nall, Roger Jackling,
Andrew Nebel, John Pelly
11 July 2012
Declan Flanagan, Tracy Luckett, Phil Luthert, John Pelly, Lesley Potter, Ruth Russell, Ian
Tombleson
10 August 2012
Declan Flanagan, Melanie Hingorani, Tracy Luckett, Phil Luthert, John Pelly, Ian
Tombleson, Stephen Williams
17 October 2012
Melanie Hingorani, Tracy Luckett, Phil Luthert, John Pelly, Lesley Potter, Ian Tombleson,
Stephen Williams
11 December 2012
Declan Flanagan, Phil Luthert, John Pelly, Ruth Russell, Ian Tombleson
8 March 2013
Declan Flanagan, Melanie Hingorani, Tracy Luckett, Phil Luthert, John Pelly, Lesley
Potter, Ian Tombleson
Managing risk
The chief executive has overall responsibility for risk management, which is managed through
the trust management board and the management executive team, as well as the groups and
committees that report to them. Individual directors have specific accountabilities for different
categories of risk. This is explained further in the annual governance statement, included in the
annual accounts at appendix 5.
– Risk management standards
Moorfields was accredited at level 3 for the NHS Litigation Authority’s risk management standards
following an assessment completed in December 2011. This is the highest level possible and means
that Moorfields has demonstrated that our risk management processes are solid and well controlled.
It is also financially beneficial, as contributions to the NHSLA’s clinical negligence and risk pooling
schemes, which provide insurance against claims for negligence, are lower for trusts at level 3. Work
has continued throughout 2012/13 to ensure that systems are in place to maintain compliance with
the level 3 standard.
– Registration with the Care Quality Commission (CQC)
The Care Quality Commission (CQC) is the independent regulator for all health and social care services in
England, and has responsibility for licensing providers of such services and for ensuring that they meet a
wide range of essential quality and safety standards. In order to be licensed, providers must demonstrate
that they meet these standards, and are then subject to periodic assessments of their continuing
compliance with them. At Moorfields we have separate CQC registrations for each of the sites from
which we provide surgical services, eight in all.
During 2012/13, our satellite unit at St Ann’s Hospital in Tottenham was assessed as being fully
compliant against six of the essential standards of quality and safety for which it was assessed during an
unannounced CQC inspection in August 2012. The CQC also undertook an unannounced inspection of
our main City Road hospital in February 2013. Again, we were found to be compliant with all six of the
standards against which we were assessed during this inspection.
59
60 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
– Monitor risk ratings
Monitor, the independent regulator for NHS foundation trusts, assesses trusts on a quarterly basis
on three key performance measures:
Financial risk rating, rated 1 to 5, where 1 represents the highest and 5 the lowest risk
Governance risk rating, rated red, amber or green
Mandatory services, rated as red, amber or green
Moorfields’ performance against these measures in 2012/13 is set out below, alongside data for
2011/12 for comparative purposes.
2012/13
2011/12
Annual plan
3
3
Quarter 1
4
4
Quarter 2
4
4
Financial risk rating
Quarter 3
4
4
Quarter 4
4
5
Governance risk rating
Annual plan
Green
Green
Quarter 1
Green
Green
Quarter 2
Green
Green
Quarter 3
Green
Green
Quarter 4
Green
Green
Annual plan
Green
Green
Quarter 1
Green
Green
Mandatory services
Quarter 2
Green
Green
Quarter 3
Green
Green
Quarter 4
Green
Green
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 – Serious incidents involving data loss or confidentiality breach
We reported one serious incident involving personal data in 2012/13 as follows:
Date of incident
Nature of incident
Nature of data involved
Number
of people
potentially
affected
20 September 2012
Loss of patient letters
Clinical information
19
Notification steps: Report sent to NHS North Central London and to NHS London
Further action on information risk: Action plan developed with 10 recommendations
The table below represents a summary of other personal data related incidents in 2012/13:
Category
Nature of incident
Total
I
Loss/theft of inadequately protected electronic equipment, devices or paper
documents from secured NHS premises
2
II
Loss/theft of inadequately protected electronic equipment, devices or paper
documents from outside secured NHS premises
0
III
Insecure disposal of inadequately protected electronic equipment, devices or paper
documents
10
IV
Unauthorised disclosure
26
V
Other
10
Performance assessment
The chief executive evaluates the performance of each of the executive and other directors who report
directly to him, while the chairman carries this out for the chief executive and the non-executive
directors. The vice chairman/senior independent director leads the evaluation of the chairman of the
board of directors. .
Register of interests for the board of directors
The register of interests of individual directors is available to the public on request in writing to the
director of corporate governance, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road,
London EC1V 2PD, by email to [email protected] or telephone 020 7566 2490. There
were no significant conflicting commitments of the chairman.
5.4 Statement of compliance with the NHS foundation trust code of
governance
The board of directors and the membership council are committed to the principles of good
corporate governance as detailed in the NHS foundation trust code of governance. The code of
governance was published in September 2006 and a revised version of the code came into effect
from 1 April 2010. The trust’s constitution is up to date with the requirements of the code.
61
62
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
63
6
Remuneration report
Performance is judged initially by the chief executive for the executive directors and by the chairman
for the chief executive against objectives agreed for the year. The chief executive’s recommendations
are subsequently discussed by the remuneration committee, which agrees on the necessary action.
Details of the remuneration committee can be found in section 5.3 above.
Remuneration is not split into different elements. The committee is always mindful of the national
NHS pay uplift for staff and the system within which staff are remunerated when considering
each individual, but the final determination of the pay level to any particular individual is based on
performance assessment.
All contracts are open ended. All trust directors are on three-months’ notice with the exception of
the chief executive, who is on six-months’ notice. There are no termination payments built into the
contracts and there are no contractual provisions for early retirement beyond that required by the
law. In certain circumstances, an individual may benefit from the provisions of the NHS pension
scheme. The trust does not provide any non-cash benefits within the remuneration package.
Details of senior managers’ pay and pension entitlements can be found in note 4.2.3 of the notes to
the accounts in the annual accounts section.
Acting on the recommendations of the Hutton review of fair pay and the reporting requirements of
HM Treasury, the trust makes the following declarations:
The median remuneration of staff employed at the trust during the 2012/13 financial year
was £33,150 (2011/12: £33,154). The calculation is based on full-time equivalent staff of the
reporting entity at the reporting period end date on an annualised basis.
The mid-point of the banded remuneration of the highest paid director of the trust during the
same period was £157,500 (2011/12: £157,500) – only those directors whose remuneration the
trust is directly able to determine are included in this calculation
The ratio of the two amounts is 4.75:1 (2011/12: 4.75:1) – that is, the mid-point of the banded
remuneration of the highest paid director of the trust was 4.75 times that of the median
remuneration for all staff employed at the trust..
No payments for compensation for loss of office were made during 2012/13.
As required by section 156(1) of the Health and Social Care Act 2012, I declare that the total
out-of-pocket expenses paid to governors of the trust in 2012/13 were £2,305 (2011/12: £1,338),
and that the total out-of-pocket expenses paid in 2012/13 to the directors shown in note 4.2.3 to
the financial accounts were £4,415 (2011/12: £3,135).
John Pelly, chief executive
64
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
65
Appendices
Quality report
Staff survey
Sustainability report
Equality and diversity report
Annual accounts
66 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Appendix 1
Quality report 2012/13
1 Chief executive’s statement on quality
The issue of quality across the NHS was brought into sharp focus this year with the publication of
Sir Robert Francis QC’s report into the poor standards of care at Stafford Hospital in February 2013.
Although we are confident that failures on that scale could not happen here at Moorfields, we have
robustly reviewed the findings of the report to identify areas where improvements could be made
or where we might build on existing activity to ensure that patients are always truly at the centre
of everything we do. Further details of our response to the Francis report can be found in section
3.2 of our annual report and accounts for 2012/13 and will form an important part of our strategic
priorities for 2013/14.
Quality is central to our 10-year strategy, Our Vision of Excellence, where it is listed as one of four
strategic themes. Specifically for 2012/13, we had four priorities as part of this strategic theme,
covering medical revalidation arrangements, the embedding of outcome measures into performance
management, the use of effective and efficient clinical technologies, and improvements to the
patient experience.
Progress against the specific quality themes of clinical effectiveness, patient safety and the patient
experience are described in section 2 below. For 2013/14, we intend to build on this progress and
on current initiatives to ensure that quality continues to underpin all of our activity.
National targets remain a helpful framework for delivering quality, and we are especially pleased
that, once again, we successfully met or exceeded the national targets that matter most to
patients. Specifically, we maintained our strong performance for the 18-week referral-to-treatment
targets, the four-hour target in A&E and infection control measures. In addition, we are registered
without conditions with the Care Quality Commission and received positive feedback from CQC
inspections of our main hospital in London’s City Road and of our satellite unit at St Ann’s Hospital
in Tottenham.
We continue to work closely with our board and membership council, which includes patient representatives, in developing quality initiatives for the future. Increasingly, we are also interacting directly
with patients through an enhanced programme of patient information days and via a wide range
of feedback systems. We also introduced a new monthly board report specifically looking at quality
and safety and incorporating clinical outcome measures.
We work alongside our commissioning partners and with the Islington health and wellbeing
committee to ensure our plans reflect those issues of greatest importance to the wider community.
To the best of my knowledge, the information included in this quality report is accurate.
John Pelly, chief executive
67
68 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2 Progress against priorities for improvement during 2012/13
For 2012/13, Moorfields identified six quality improvement priorities as set out below. These
priorities were identified in consultation with patients, staff and governors and approved by the
trust board.
2.1 Patient experience – improving outpatient waiting times
Objective: To ensure that improvements achieved to date in outpatient journey times (the time
between the patient’s appointment time and when they leave the hospital) are maintained, and that
they apply to all glaucoma and medical retina clinics.
In addition, to develop and implement an operational plan to extend the remit of the outpatient
improvement project to cover other ophthalmic specialties beyond glaucoma and medical retina.
The work of the outpatient improvement team will also be integrated into the trust’s longer
term plans and linked to the corporate priorities for the coming year through the transformational change programme, workforce redesign and the relocation of service provision in line with
geographical demand and financial sustainability.
Progress in 2012/13:
The profiles of all clinics within the glaucoma and medical retina services were agreed with key
clinicians, uploaded onto the patient administration system and implemented by the end of
March 2013, with all the new profiles set to go live by the end of May.
Approximately 20% of the re-profiled clinics demonstrated a significant reduction in the average
patient journey time. The level of improvement is detailed in the table below:
Service/type of appointment
Glaucoma
Medical retina
% of clinics
demonstrating
significant
improvement
Benchmark
average patient
journey time
Average improvement
Number
of minutes
% of original
journey time
new
23%
2hrs 21mins
24 mins
13%
follow up
39%
1hr 38 mins
19 mins
17%
new
0%
1hr 59 mins
Nil
N/A
follow up
15%
1hr 43 mins
Nil
N/A
It is important to note that we did not achieve a significant reduction in the patient journey
times in 80% of the re-profiled clinics. This is because having introduced the new profiles we
were unable to manage the clinics strictly in line with these schedules, and profiles continued
to be overbooked in line with the level of demand on these two services. We believe that the
transformational change programme referenced below and other initiatives focused on new
ways of working and controlling demand, will be key to our ability to use the new profiles to
deliver improved journey times and a better patient experience.
A bespoke electronic rota solution designed to link doctors’ leave to outpatient clinic capacity
went live in the glaucoma service in February 2013.
A new process for the requesting and authorisation of medical staff leave was agreed with
service directors and clinical directors and launched on 1 March 2013.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 During 2012/13, the trust completed the installation of 12 additional information screens across
Moorfields’ sites and services. These screens provide our patients with regular, high quality
information about journey times, but they have also been used to reinforce health promotion
campaigns such as flu vaccination and to advertise and facilitate service developments such as
asking patients to express an interest in repatriating their care to a Moorfields site closer to home.
During 2012/13, the trust employed Vanguard Consulting to help us to plan and implement
a transformational change programme, the core principle of which is to provide services that
are designed to deliver only that which is of value to the patient. One of the key performance
measures for the programme in the outpatient setting is the patient’s journey time and the
amount of non-value added time included in the outpatient journey. The programme has begun
by focusing on the glaucoma pathway at St George’s and to date some 1,500 patients have
been involved in the experimental work. By recording the amount of time that patients spent
waiting and undertaking value activities during the baseline and experiment clinics, the team at
St George’s was able to demonstrate the progress made by the experiments towards eliminating
non-value time. In the baseline clinics, patients spent an average of 67% of their clinic visit in
non-value activities, i.e. waiting. In the experiment clinics, patients spent an average of only 27%
of their clinic visit on non-value activities. The team is working to improve these results further as
the transformation programme progresses at St George’s.
2.2 Patient experience – improving the cataract surgical pathway
Objective: To deliver the productive operating theatre programme (T-POT), and to ensure that
further improvements in surgical journey times (the time between when the patient is asked to
arrive at the hospital and when they are discharged home), are achieved via the completion of the
service improvement work for the pilot areas. The work programme for 2012/13 will include the
comprehensive introduction of staggered arrival times with a robust link to the order of theatre lists,
pre-dispensing dilation drops and the provision of pre-packed post-operative medication. During the
second half of the year the programme will move on to roll out this service improvement work to
other cataract pathways
Progress in 2011/12:
Productive operating theatre programme (T-POT)
Initially, T-POT focused on theatre list start times, theatre utilisation and cancellations on the day
of surgery. Performance data on these indicators is now regularly published in theatres. Through
the improvement work undertaken to date, the number of lists starting on time has increased
from 40% in June 2012 to 59% in March 2013 and cancellations on the day of surgery have
reduced from 12% to 7% as a result of this initiative.
A review of all surgical capacity has been undertaken with a focus on repatriating surgical
activity in line with care closer to home and the trust’s strategic intention to optimise the use of
its satellite locations.
Surgical journey times
The average cataract journey time on pilot lists has reduced during 2012/13 from four hours and
56 minutes to four hours and two minutes, with an average journey time across the best of the
pilot lists of three hours and 35 minutes.
All cataract lists are now ordered in advance, which allows patient arrival times to be staggered
where appropriate.
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70 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
The initial improvement work on the pilot lists found that pre-dispensing of dilation drops and
pre-prescribing of post-operative medication reduced the patient’s length of stay. However,
our original methodology required significant administrative support from medical staff, which
in turn led to inconsistency and variations in performance. In consultation with the clinical
champion for this project a pre-operative dilation pellet was introduced which has subsequently
been shown to improve the patient experience and to reduce both the patient preparation and
nursing time. Pharmacists have also started dispensing take-home medicines on the wards and
we believe that this will have a positive impact on the post-operative length of stay.
The improvements implemented on the pilot cataract pathways are now in the process of being
rolled out to other services, and pilots have commenced in the adnexal, medical retina, cornea
and glaucoma services.
A clinical lead from theatres has also been appointed who is responsible for leading both of the
programmes outlined above and securing the engagement of his clinical colleagues.
2.3 Patient experience – improving the environment
Objective: To continue to improve the quality of the patient environment in the outpatient setting,
specifically through the delivery of the following key investment schemes:
The City Road A&E refurbishment and expansion project (work to have commenced on site by
the end of 2012/13)
The redevelopment of Victoria Ward at City Road to accommodate the ultrasound service and
the vitreo-retinal emergency clinic
The refurbishment and expansion of the orthoptics department at City Road
The refurbishment of the ocular prosthetics department at City Road
The completion of the Moorfields at Ealing redevelopment project
The completion of the design and planning phase for Moorfields at St George’s Hospital
redevelopment project
Progress in 2012/13:
Work began on the City Road A&E refurbishment project on 18 February 2013. The observation
bay has been relocated to increase the footprint of the A&E department and to provide
dedicated space for the new emergency nurse practitioner (ENP) pathway. At the same time the
department will be redecorated and the environment improved with new flooring, lighting and
furnishings. Facilities will also be improved for children and patients who could possibly represent
an infection control risk to others. This programme of work is expected to take approximately 32
weeks, with an anticipated completion date during quarter 3 of 2013/14.
The redevelopment of Victoria Ward at City Road to accommodate the ultrasound service and to
create a new centre for retinal emergencies was successfully completed this year.
Following the relocation of the ultrasound service to its new home on Victoria Ward, the
refurbishment and expansion of the orthoptics department began at the end of February 2013,
and is due for completion in the spring.
The refurbishment of the ocular prosthetics department at City Road was successfully completed
this year.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 The Moorfields at Ealing redevelopment project and the Moorfields at St George’s hospital
redevelopment project have not made the progress anticipated this year. Relevant Moorfields
staff, including clinical and executive directors, have been actively engaged in negotiations
with the respective host hospitals to develop and agree mutually acceptable plans for these
developments, and both of these projects will remain priorities for the trust during 2013/14.
2.4 Clinical effectiveness – expansion of clinical outcome and
performance indicator programme
Objective: To report routinely on at least two clinical outcome indicators for each major
subspecialty service across the trust, to develop an array of meaningful clinical outcome indicators
for two services with input from stakeholders, including users, and to develop a consistent
outcomes and performance dashboard for all four clinical directorates.
Progress in 2012/13: All services have identified and agreed three key clinical outcome indicators
(“core outcomes”), and during the year data has been collected and analysed by a combination
of electronic data capture, prospective data collection and retrospective analysis of case notes. The
trust’s performance against these standards generally demonstrates excellent clinical care, with
many services achieving results well above standard. All results are detailed in an annex at the end
of the quality report, but of particular note are the following:
The results for biometry predictability, which demonstrate how accurately and reliably we are able
to achieve the planned postoperative spectacle prescription, both for all cataract surgery patients
and also for those with high short sight where the outcomes are more difficult to predict.
The very low rates of failure in drainage surgery for glaucoma, both for the more common
procedure (trabeculectomy), and the very specialist procedure performed in more complex cases
(tube drainage).
The excellent results of all lid surgery – surgery for in-turning and out-turning lids and drooping
eyelids.
The very low rates of serious complications of squint (strabismus) surgery.
The low rates of serious infection (endophthalmitis) after procedures.
The use of the WHO surgical safety checklist and the venous thromboembolism assessment are
outcomes that measure process rather than the direct results of clinical care. We did not achieve
100% against these indicators during 2012/13, but it is hoped that the planned observational audit
of practice in theatres will help to improve this performance.
The process of collecting outcome data remains time and labour intensive and as a result reporting
is only possible annually for some outcomes.
Surveys have been undertaken in the glaucoma and adnexal services, with input received from
patients and other stakeholders, including GPs, optometrists and commissioners. The results of
these surveys have supported the key outcomes currently identified, with those deemed particularly
important being the retention of vision, the ability to drive, and the outcome of surgical procedures.
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72 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2.5 Patient safety – site and service safety review: revision of patient
safety walkabouts in combination with structured case note
review procedure to cover all areas
Objective: To revitalise the patient safety walkabout process with a timetabled plan of walkabouts,
and to combine this with a structured case note review procedure designed to spot the signs of
things going wrong – the modified global trigger tool (mGTT) – to create a consistent safety review
tool across all trust sites and services.
Progress in 2012/13: The trust has developed a revised, formalised and robust patient safety
walkabout process and recently completed a pilot in which the four major district hubs were visited.
Staff from the quality and safety team and one of the trust’s executive directors met with local
senior staff and presented and discussed a thorough review of all safety, patient experience and
clinical effectiveness data, including an analysis of both notable practice and areas of concern.
Each visit also included a physical tour of the department and, where possible, visiting staff met
with local staff and patients. Agreed and achievable improvement action plans were developed and
the delivery of those plans monitored. Several important actions have been completed, including
resolution of water supply issues in Ealing and the development of a process for prioritising case
note provision from City Road to the satellite sites.
The process also allows other issues, which the visits themselves could not realistically be expected
to resolve, to be escalated appropriately within the organisation.
The trust also continued to use its locally developed mGTT to provide a structured case note review
audit which measures risk and low-level adverse events and allows comparison of quality of care
between sites. Changes implemented using the mGTT include the introduction of a combined
children’s vision clinic (orthoptic and optometric led) in Ealing, which has significantly improved
patient journey times and efficiency. Not every site and service has completed an mGTT audit during
the year and work continues to complete these.
2.6 Patient experience and clinical effectiveness – developing patient
reported outcome measures (PROMS)
Objective: To create and pilot a PROM for ophthalmology.
Progress in 2012/13: The development of bespoke PROMs takes some time to allow for
appropriate input and direction from patients and users, piloting and validation. During the year,
an easy to use PROM, known as the PRESS (patient reported eye symptom score), was developed
for use in general ophthalmology clinics. Once developed, a successful pilot was run involving 50
patients who had attended a general ophthalmology clinic at City Road more than once. The pilot
demonstrated that the tool was easy to use and the results showed that the majority of patients
reported significantly better symptom scores at the second visit compared to the first. The pilot
has been repeated at the trust’s satellite service in Ealing Hospital, where it was combined with
a clinician reported outcome score for the same patients. Work is now underway to analyse and
compare results from patients and clinicians for the purposes of validating the tool. Several other
PROMs projects are currently underway to identify which are practical and suitable for use in other
areas of ophthalmology.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 3 Performance against key indicators for 2012/13
Each of the indicators listed below was selected to provide comparable data over time to
demonstrate compliance with those agreed corporate objectives for 2012/13 relating to the quality
agenda. Some indicators were new for 2012/13 and the trust’s rationale for changing or selecting
new key indicators is as set out in its 2011/12 quality report.
The trust’s achievement against each of the indicators in the table below has been assessed using a
RAG (red, amber, green) rating; a green rating indicates that the indicator has been fully achieved,
an amber rating indicates partial achievement, and a red rating indicates little or no progress.
Indicator
Source
2011/12
result
2012/13
target
2012/13
result
Patient experience
Composite indicator consisting
of five questions from the trust’s
bespoke day-care survey
Picker
day-care
survey
73%*
81%
Results not yet available
% of patients who spent less than
four hours waiting in A&E
Internal
performance
monitoring
99.1%
95%
(national
target)
99.3%
% of patients who spent less than
three hours in A&E
Internal
performance
monitoring
N/A – new
indicator
80%
81.7%
% reduction in average patient
journey time for cataract surgery
patients
Internal
performance
monitoring
4hrs 56
mins
30%
reduction
in average
journey time
on pilot lists
(reduce from
4hrs 56mins
to 3hrs
30mins).
Complete the clinic re-profiling
exercise in all medical retina and
glaucoma clinics across all MEH
sites
Internal
performance
monitoring
Pilot clinics
x5
% overall compliance with
equipment hygiene standards
(cleaning of slit lamp)
Internal
performance
monitoring
N/A – new
indicator
% overall compliance with hand
hygiene standards
Internal
performance
monitoring
96%
Number of reportable MRSA
bacteraemia cases
Internal
performance
monitoring
0
0
0
Number of reportable Clostridium
difficile cases
Internal
performance
monitoring
0
0
0
Incidence of endophthalmitis per
1,000 cataract cases
Internal
performance
monitoring
0.48
<0.83
18% reduction in average
journey time on pilot
lists (reduced from 4hrs
56mins to 4hrs and
4mins)
99
Clinic re-profiling
additional
exercise complete
clinics across
the two
relevant
services on
all sites
Patient safety
90%
91.5%
95%
97%
(increased
from 90% in
2011/12
0.29
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74 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2011/12
result
2012/13
target
Internal
performance
monitoring
0.30**
<0.5
Internal
performance
monitoring
N/A – new
indicator
Combination
walkabout
and mGTT
completed
and reported
to clinical
governance
meeting in
line with
published
programme
% implementation of NICE
guidance
Internal
performance
monitoring
100%
100%
Posterior capsule rupture rate for
cataract surgery
Internal
performance
monitoring
1.34%
Development of performance
dashboards for the four new
clinical directorates including
all relevant clinical outcome
indicators, and regular reporting
via the performance management
framework
Internal
performance
monitoring
N/A – new
indicator
As per
indicator
Trust-wide clinical
quality and safety
performance report
in use. Directorate
dashboard in draft to be
piloted.
Comprehensive clinical outcome
metrics in place for two specialty
services
Internal
performance
monitoring
N/A – new
indicator
As per
indicator
Outcome surveys
completed and outcome
measures agreed for
glaucoma and adnexal;
awaiting the launch of
relevant clinical modules
in OpenEyes to start
collecting results
Indicator
Source
Incidence of endophthalmitis per
1,000 intravitreal injections for the
treatment of AMD***
Site and service safety review:
patient safety walkabout and
casenote review
2012/13
result
0.35
Walkabout process
devised and completed
in the four district hubs;
mGTT audits regularly
performed but not
achieved in all major
sites/services
Clinical effectiveness
<1.8%
100%
0.80%
*2011/12 performance against this indicator was not included in the trust’s 2011/12 quality report
as the information was not available at the time of going to press.
**Last year 0.33 was reported as the rolling average as opposed to the overall figure for the year
which would have been 0.30.
***AMD is age-related macular degeneration which is a condition which usually affects older adults
and results in a loss of vision in the centre of the visual field (the macula) because of damage to the
retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness and visual impairment
in older adults (>50 years). Macular degeneration can make it difficult or impossible to read or
recognise faces, although enough peripheral vision remains to allow other activities of daily life.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 4 Performance against national performance measures
Moorfields reports compliance with the requirements of the Monitor compliance framework, the
NHS operating framework and the relevant indicators in the NHS outcomes framework to every
meeting of the trust board as part of a monthly performance report. The report demonstrates
progress against key quality indicators, as set out in the table below.
In relation to the Clostridium difficile data, the 28 readmissions indicators, and the patient safety
indicator (which are the NHS outcomes areas applicable to the trust), Moorfields Eye Hospital NHS
Foundation Trust provides the following analysis with actions to improve the quality of its services:
Clostridium difficile: there were no cases so no further comparison or actions are required.
28-day readmissions: there were eight emergency readmissions within 28 days of discharge after
inpatient admission. This equates to 1.3% of discharges following inpatient admissions. This is a
significantly lower figure compared to the national average of 11.4% in 2010/11.
Patient safety incidents: the benchmarking data for a specialist peer group indicates that
Moorfields has good reporting rates for its overall numbers which have increased from 2011/12.
A bigger number is an indicator that reporting rates are higher (on the basis that most incidents
are not leading to harm). The trust is below average for its rates per 100 admissions (although
it is noted that the method of calculation is different for Moorfields) – within the range of the
lowest and highest performers, the trust compares at the lower end of the range (performance
for 2012/13 was better than 2011/12). The trust believes that better comparative ophthalmic
benchmarks need to be found in order to obtain meaningful comparisons. The trust intends
to continue to improve its overall reporting rate; part of supporting that will be by introducing
electronic incident reporting, which will also help comparative analysis and learning from the
themes that have arisen and any links to complaints, PALS and patient experience data. Under
the current manual system, this data is being used to improve aspects of care, treatment, service
delivery or the patient experience as issues are determined – this action has been specifically
confirmed in the trust’s response to the Francis report.
The data for these and other national reportable indicators for two years is set out below:
Target
2012/13
MRSA – meeting the
MRSA objective
0
0
0
N/A
N/A
N/A
Clostridium difficile
year-on-year reduction
0
0
0
N/A
N/A
N/A
Screening all elective
inpatients for MRSA
100%
100%
100%
N/A
N/A
N/A
Screening all emergency
inpatients for MRSA by
2011
100%
100%
100%
N/A
N/A
N/A
Risk assessment of
hospital-related venous
thromboembolism (VTE)
100%
90%
96.1%
93.9%
100%
78%
Description of target
Performance Average
2012/13
2012/13
Highest
Lowest
performing performing
trust 2012/13 trust 2012/13
Performance
2011/12
Infection control
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76 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Target
2012/13
Two-week wait from
urgent GP referral for
suspected cancer to first
outpatient appointment
100%
93%
100%
N/A
N/A
N/A
Four-hour maximum
wait in A&E from arrival
to admission, transfer or
discharge
99.2%
95%
99.3%
(3rd
nationally
for acute
providers)
95.9%
100%
88.3%
18-week standard from
point of referral to
treatment for admitted
patients
92%
90%
91.1%
92.2%
100%
78.5%
18-week standard
from point of referral
to treatment for
non-admitted patients
97%
95%
96.0%
97.5%
100%
86.5%
18-week standard from
point of referral to
treatment for patients
awaiting treatment
N/A – new
measure for
2012/13
92%
92.0%
94.3%
99.6%
73.2%
6-week diagnostic test
waiting time
N/A – new
measure for
2012/13
99%
100%
98.9%
100%
100%
100%
95.1%
(full year)
100%
(Q4)
25%
(Q4)
Numbers
826
N/A
1137
722
1720
36
Rate per 100 admissions
2.6
N/A
3.7
7.5
24.9
1.4
7
N/A
8
3.4
0
26
0.9%
N/A
0.7%
0.5%
0
1.8%
Description of target
Performance Average
2012/13
2012/13
Highest
Lowest
performing performing
trust 2012/13 trust 2012/13
Performance
2011/12
Waiting times (1)
100%
82.4%
Cancelled operations
All patients who have
operations cancelled
for non-clinical reasons
to be offered another
binding date within 28
days, or the patient’s
treatment to be funded
at the time and hospital
of the patient’s choice.
Patient safety incidents (2)
Numbers resulting in
severe harm or death
Severe harm or death
incidents as a % of total
incidents
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Performance
2011/12
Target
2012/13
0
0
0
28-day emergency
readmission rate
(over 16 years old)
N/A
N/A
28-day emergency
readmission rate
(0 to 15 years old)
N/A
Full
compliance
Description of target
Performance Average
2012/13
2012/13
Highest
Lowest
performing performing
trust 2012/13 trust 2012/13
Other (3)
Mixed-sex
accommodation
breaches
Certification against
compliance with the
requirement regarding
access to health care
for people with learning
disabilities
0.2 per
1,000
N/A
N/A
1.3%
11.4%
(2010/11
N/A
N/A
N/A
0%
10.0%
(2010/11)
N/A
N/A
Full
compliance
Full
compliance
N/A
N/A
N/A
(1) Only one of the new national cancer waiting times targets was relevant this year to Moorfields
due to our low activity levels in this area.
(2) This year is the first time that this indicator has been required to be included within the quality
report. 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 (CQC) as part of its registration process. To avoid
duplication of reporting, all incidents, including those relating to severe harm or death are reported
to the NRLS. The NRLS then report the serious incidents to the CQC.
As there is not a nationally established and regulated approach to reporting and categorising patient
safety incidents, trusts may apply different approaches and guidance to reporting, categorisation
and validation of patient safety incidents. The approach taken to determine the classification of
each incident, such as those ‘resulting in severe harm or death’, often relies on clinical judgement.
This judgement differs between professionals. In addition, the classification of the impact of an
incident may be subject to a potentially lengthy investigation which may result in the classification
being changed. This change may not be reported externally and the data held by a trust may not be
the same as that held by the NRLS. Therefore the differences between the data reported by different
trusts may not be comparable.
Specific things to note from this data are as follows:
The benchmarking dataset is the acute specialist NRLS data.
For 2012/13:
–– This is the first year of introduction of the patient safety indicator so no target has been set.
–– The rate per 100 admissions for Moorfields is calculated by dividing the total number of
incidents by the total number of inpatient and outpatient admissions and deriving a rate per
100 admissions.
–– In relation to the number of incidents recorded as severe harm or death, following year end a
limited number of clarifications are made which means this may not be the final figure.
–– The national data is derived from six months of NRLS data for a group of specialist trusts
(April – September 2012), as a full year of data was not available.
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78 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
It should be noted that there is a huge variety in reporting between specialist acute organisations
and that is unsurprising given the very different work that they do. More work is required to find
a peer group that may provide better comparative data.
3) An indicator relating to trusts’ responsiveness to personal needs is not relevant to this
organisation because it relates to the inpatient survey which this organisation does not participate in
(because of its small number of inpatients and the nature of the ophthalmic care we offer).
5 Priorities for 2013/14
The development of the trust’s quality report was led by the chief operating officer in close liaison
with the clinical director of quality and safety, the director of nursing and allied health professions,
the medical director and the director of corporate governance.
The trust management board (TMB) has had an overview of the trust’s quality priorities during the
year. These fall into the three areas of patient safety, patient experience and clinical effectiveness.
Development of the quality report was reviewed by the quality and safety committee half way
through the year and was finalised as a balanced representation of the trust’s priority areas across
patient safety, patient experience and clinical effectiveness. The membership council has also
scrutinised and fed its views into the development of the quality account which was agreed by the
trust board on 23 May.
Progress against the trust’s quality priorities has been overseen by TMB and scrutinised by the trust
board, the quality and safety committee, and the membership council.
The quality priorities for 2013/14 are consistent with the trust’s agreed strategic priorities. Several
stakeholders have been consulted during the development of the quality priorities, including
clinicians, governors (some of whom are patients), commissioners, the quality and safety committee,
Healthwatch, and Islington’s health and wellbeing scrutiny committee. The quality priorities have
been included in the annual plan and have been approved by the trust board.
5.1 Patient experience – transformational change programme –
designing services to deliver only what is of value to patients
Objective: To extend the transformation programme to include all subspecialties at St George’s and
make decisions on subsequent roll-out to further sites and services.
Rationale for inclusion: As described in section 2.1 above, the results of the programme at St
George’s so far demonstrate that the systems thinking approach advocated by Vanguard Consulting
makes tangible improvements to the value of outpatient visits. In order to see the full benefits of
this approach, it needs in the first instance to be extended beyond outpatient clinics to encompass
the referral and surgical stages of the glaucoma pathway, prior to starting work in the other subspecialties at St George’s.
How we will monitor, measure and report on progress: :
A suite of measures will be developed to monitor the progress of the programme at St George’s.
These measures will be derived from the operating principles for the programme, which are listed
below:
1. Only do work that is valuable to the patient
2. “Single piece flow” – minimise handovers between staff
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 3. “Set up clean” (i.e. with all staff and equipment ready on time) and “finish clean” (i.e. patients
leave with all tests done and all the information they need, and clinic staff leave a tidy clinical
environment with all administrative tasks completed)
4. Patients see the right person with the right skills and additional expertise is available to be
“pulled in” as and when necessary
5. We will learn, make change and decisions based on data
6. Challenge existing rules, regulations and practices
7. Design against demand
8. Always have the right measures of capability
Progress and performance against the agreed measures will be monitored and measured by the
multidisciplinary team involved in the transformation programme at St George’s and during monthly
directorate performance review meetings. Performance against the measures will also be reported
to the trust board as part of the new quality and safety report.
5.2 Patient experience – improving patient information and
communication
Objective:
To improve how we communicate with our patients, specifically about waiting times and delays
in the outpatient clinics.
To make it easier for patients to contact the right person when they need to change or confirm
appointments.
To improve the quality of the discharge information we give to patients, with an emphasis on
medication side effects.
Rationale for inclusion: Patient feedback obtained from surveys, complaints and PALS enquiries
tell us that we need to improve how we communicate with our patients. In particular, we need to
concentrate on keeping them informed about delays during their visit and to make it easier for them
to contact somebody who can help with enquires, such as appointment queries. Patients would
also like to receive more robust information about how to manage their eye conditions following
discharge after a surgical procedure.
How we will monitor, measure and report on progress : We will monitor improvement through
monthly reviews of the number of complaints and PALS enquiries relevant to this objective, and
this will be reported and reviewed at the patient experience committee. We will also use the results
from the day care survey to assess our performance on the quality and robustness of our discharge
processes, including information on medication side effects.
5.3 Patient experience – improving the surgical pathway
Objective:
To complete year two of T-POT, including participation in the Foundation Trust Network theatre
benchmarking exercise and rolling out the programme beyond City Road to all Moorfields sites
undertaking surgical activity.
To roll out the surgical pathway improvements to all ophthalmic specialties.
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As part of the planning exercise for Moorfields’ new central London hospital and in line with the
trust’s objective to provide care as close to the patient’s home as possible and to optimise the use
of our satellite network, operational management staff will work with patients and senior clinical
colleagues to repatriate surgical work away from City Road to existing and, where appropriate,
new satellite locations.
In line with the trust’s transformational programme, to review and redesign the current patient
pathway for all ophthalmic services at City Road – this will involve process mapping the current
pathway and working with clinicians, nursing staff and patients to develop the optimum
patient pathway.
To develop and formalise a standard operating procedure for theatres.
Rationale for inclusion: We need to ensure that our surgical pathway at City Road is lean and
patient-focused in order to improve the patient experience and to ensure that we use resources
efficiently and effectively in order to support the delivery of high-quality clinical care.
The development of a standard operating procedure will assist in supporting the delivery of this
objective by providing clear and robust processes.
How we will monitor, measure and report on progress : Progress on the delivery of these
initiatives will be monitored via the regular monthly performance review meetings with the surgical
services directorate.
We will also monitor improvement through monthly reviews of the amount of complaints, PALS
enquiries and patient feedback relevant to these objectives, for example the number of complaints
mentioning unacceptably long surgical journey times.
5.4 Patient experience – improving the environment
Objective:
The successful completion of the City Road A&E project as outlined above.
The successful completion of the project to expand and refurbish the orthoptics department.
The completion of the Moorfields at Ealing redevelopment project.
Significant progress on the Moorfields at St George’s hospital redevelopment project.
Rationale for inclusion: We need to ensure that the environment in which patients are seen and
treated is of a sufficiently high standard to support the delivery of high-quality clinical care. We face
several challenges in achieving this objective, predominantly due to the age of the estate at the
main hospital in City Road and at some of our satellite facilities. We also need to ensure that, during
the upgrade of any of our facilities, we can continue to deliver services with as little disruption and
inconvenience as possible.
All projects listed under this objective are co-ordinated and managed by multidisciplinary steering
groups, all of which include patient representatives.
How we will monitor, measure and report on progress : The progress of these major capital
projects is monitored by the trust’s capital planning group and, in turn, by the trust board. The
quality of the patient experience before, during and after project implementation is monitored using
a variety of patient feedback mechanisms, including patient surveys, complaints, comment cards
and Moorfields minute cards.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 5.5 Clinical effectiveness – expansion of clinical outcome and
performance indicator programme
Objective:
To continue to report and publish routinely on at least three clinical outcome indicators for each
major sub-specialty across the trust; to review standards for achievement against national and
international benchmarks and medical literature; to include results in regular quality reports (see
below) and on the new website.
To expand the number of services reporting on outcomes developed with input from
stakeholders, including patients.
To integrate the routine collection of clinical outcome data into the relevant module of the
trust’s new electronic patient record system (OpenEyes) so that, as each goes live, we aim to
allow as much automated generation of results for as many important outcomes as possible
for each service.
Rationale for inclusion: The aim of developing a programme of routine outcome measurement
is to allow patients, commissioners, referrers and other professionals to see up-to-date, accurate
information about the safety of care provided by Moorfields. Outcomes must be relevant and
widely recognised as important and meaningful to clinicians, stakeholders and patients and should
avoid excessive use of clinical staff time to generate the results. Ideally, this information should be
generated automatically from routine clinical data entry.
How we will monitor, measure and report on progress : The trust will continue to collect
information from patients, users, commissioners and clinical staff on which outcomes to measure
in the remaining services, as well as incorporating information from the medical literature, major
eye units internationally and bodies such as the Royal College of Ophthalmologists. Services will be
asked to agree additional outcomes based on this information, and the clinical modules in OpenEyes
(the trust’s new electronic patient record) will be created to allow these outcomes to be collected
without the need for additional audit data fields or pages. Results will be published via the quality
reporting systems below and on the new website.
5.6 Patient safety – roll-out of patient safety walkabout and case note
review procedures to cover all areas
Objective:
To present the safety walkabout pilot and its results widely, and to develop a process to ensure
that it can be continued across all sites and areas possibly in combination with other current
internal visits and inspections, to minimise disruption and repetition.
To ensure the regular use of mGTT audits in all sites and services; the audits will be prioritised
and staff supported to ensure at least one is undertaken annually per major site and service.
Rationale for inclusion: Patient safety walkabouts and regular site visits, with reviews of local
quality and safety data, are important in allowing two-way communication between very senior
management staff, clinical staff, and patients, ensuring that safety and quality issues are highlighted
and acted upon at the highest level in the organisation. Regular reviews of case notes are a
proactive way of identifying and changing poor practice before it reaches the level of a serious
patient safety incident. Both of these are particularly important for Moorfields with its many satellite
locations.
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The walkabout programme is extremely useful and now that the pilot has been successfully
completed, the process will be reviewed to ensure optimum efficiency and effectiveness.
Consideration will be given to including non-executive directors and governors in this process
alongside other senior trust staff.
How we will monitor, measure and report on progress : The implementation of the patient
safety walkabouts and mGTT audits programme will be monitored and measured against the implementation plan via the new directorate performance dashboards (see below). The dashboards will
be reviewed at all directorate performance review meetings.
5.7 Patient experience and clinical effectiveness – developing PROMS
tools
Objective:
To complete the validation of the general ophthalmology PROM, make any further adjustments
to the tool as necessary, and to introduce the PROM for regular use in Moorfields sites providing
general ophthalmology clinics.
To continue our work in developing PROMs for cataract surgery and paediatric ophthalmology,
to support the work being undertaken in research for a glaucoma PROM and to begin to utilise
these tools once development work is completed.
Rationale for inclusion: Information on clinical outcomes is important in an overall assessment
of the quality of care provided, but the use of PROMs provides a key measure of whether the care
that we deliver benefits the patients in relation to their quality of life. In the absence of nationally
approved ophthalmic PROMs, and as a leader in ophthalmic care, Moorfields should take a lead in
the development and use of these tools in ophthalmology.
How we will monitor, measure and report on progress : The introduction of PROMs in general
ophthalmology, cataract surgery, paediatric ophthalmology and glaucoma will be monitored via the
quality and safety report to the board. Patient scores will also be monitored in this way as well as via
the directorate performance dashboards and the patient experience committee.
5.8 Patient safety and clinical effectiveness – developing regular
quality reporting
Objective:
To develop further the process of quality and safety reporting so that it incorporates an “at a
glance” overview of all quality performance indicators, and provides an appropriate level of
detail, analysis and explanation .
To continue to develop and roll out the directorate performance and quality dashboard.
Rationale for inclusion: The new clinical quality and safety performance report provides a
complete overview and assurance mechanism for all aspects of clinical quality and safety across the
three domains of patient safety, patient experience and clinical effectiveness. It does not, however,
provide some of the richer, detailed information on items such as patient complaints and the patient
experience that are necessary to facilitate learning from such feedback.
The use of the new-style report will continue, but it will be supplemented by regular, more
detailed reports which will cover each of quality domains in turn. These supplementary reports
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 will contain narrative and detail, and they will focus on learning, achieving actions for change and
agreeing measurements which will demonstrate improvement. The development of the directorate
performance and quality dashboards will continue to mirror the measures included in the trust-wide
quality and safety report.
How we will monitor, measure and report on progress : The clinical quality and safety
performance report will be generated at least twice yearly with quarterly detailed reports on patient
safety, clinical effectiveness and patient experience. The directorate performance and quality
dashboards will be in use in all directorates and monitored via the routine performance review
framework.
6 Key indicators for 2013/14
We have made some changes to our key indicators for 2013/14 as set out in the table below. These
changes can be summarised as follows:
The trust continues to receive adverse feedback from patients about how we communicate
with them, whether it is keeping them informed about delays during their hospital visit, ease
of access in contacting the correct person to assist with an enquiry, or the quality of discharge
advice given after surgery. We have invested significantly in customer care training for all frontline
staff in order to improve how we communicate with patients and we have also improved our
telecommunications facility, as well as improving the discharge advice that we give to patients. To
evaluate the effectiveness of these interventions, the trust has introduced a new indicator focused
on the number of complaints received from patients about these issues throughout the year.
The trust has performed consistently well against the national requirement for patients to spend
four hours or less in the A&E from arrival to admission, transfer or discharge, with a performance
of 99.3% in 2012/13 against a 95% target. At the beginning of the year we decided to set
ourselves an additional internal performance target of a maximum journey time of three hours
for A&E patients and this intention was included in our 2011/12 quality report. During 2012/13,
we achieved this new standard for 81.7% of patients against our internal target of 80% and
as a result, our key indicator in relation to the emergency pathway for 2013/14 will be the
three-hour standard. We will of course continue to report our performance against the national
requirement in section 4 of the quality report.
One of the trust’s key quality improvement priorities for both 2012/13 and 2013/14 is to
optimise the efficiency of our operating theatres via the implementation of the productive
theatre programme (T-POT) and to continue the service improvement programme focused on
the surgical pathway and designed to reduce patient journey times and improve the patient
experience. In line with this objective we have introduced two new indicators for 2013/14; the
first is focused on the percentage of operating lists on the City Road site that start on time, and
the second requires the development of a standard operating procedure for our theatres.
The indicator focused on the completion of the clinic re-profiling exercise in the glaucoma and
medical retina services has been removed as that piece of work was successfully completed
during 2012/13. The emphasis on patient journey times in outpatients remains however, and
is reflected in a new indicator that focuses on the progress of the transformational change
programme described earlier in this report.
The indicator focused on the development of clinical outcome measures in two specialty
services has been removed as this piece of work was successfully completed during 2012/13. An
indicator has been added to focus on the production of this information via OpenEyes, the trust’s
new bespoke electronic patient record.
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An indicator has been added which focuses on the trust’s 2013/14 objective to develop patient
reported outcome measures (PROMs) relevant to ophthalmology patients.
Indicator
Source
2011/12
result
2012/13
result
2013/14
target
Patient experience
Composite indicator consisting
of five questions from the trust’s
bespoke day-care survey
Picker
day-care
survey
73%
Results not TBC in line with 2012/13
yet available results
20% decrease in the number of
complaints about communicating
the reasons for delays, and/or
accessing the most appropriate
person to deal with appointments
Internal
performance
monitoring
N/A – new
indicator
65
complaints
% of patients whose journey time
through the A&E department was
three hours or less
Internal
performance
monitoring
N/A – new
indicator
81.7%
% reduction in average patient
journey time for cataract surgery
patients at City Road
Internal
performance
monitoring
4hrs 56
mins
18%
reduction 4hrs 4mins
% increase in all City Road theatre
lists starting on time
Internal
performance
monitoring
N/A – new
indicator
59%
Development of a standard
operating procedure for operating
theatres
Internal
performance
monitoring
N/A – new
indicator
N/A – new
indicator
As per indicator
Progress on the transformation
programme
Internal
performance
monitoring
N/A – new
indicator
N/A – new
indicator
Staff in all subspecialty
clinics at St George’s
to have been involved
in a ‘systems thinking’
intervention to improve
their service. The focus
in all clinics will be
delivering increased
value as defined by
patients.
Internal
performance
monitoring
N/A – new
indicator
91.5%
<52 complaints
>80%
30% reduction 3hrs 30mins
90%
Patient safety
% overall compliance with
equipment hygiene standards
(cleaning of slit lamp)
90%
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 2011/12
result
2012/13
result
Internal
performance
monitoring
96%
97%
Number of reportable MRSA
bacteraemia cases
Internal
performance
monitoring
0
0
0
Number of reportable Clostridium
difficile cases
Internal
performance
monitoring
0
0
0
Incidence of presumed infective
endophthalmitis per 1,000 cataract
cases
Internal
performance
monitoring
0.48
0.29
<0.8
Incidence of presumed infective
endophthalmitis per 1,000
intravitreal injections for AMD
Internal
performance
monitoring
0.30
0.35
<0.5
Site and service safety review:
Patient safety walkabout and use
of mGTT
Internal
performance
monitoring
N/A – new
indicator
N/A – new
indicator
% implementation of NICE
guidance
Internal
performance
monitoring
100%
100%
100%
Posterior capsule rupture rate for
cataract surgery
Internal
performance
monitoring
1.34%
0.8%
<1.5% (reduced from
1.8% in 2012/13)
Comprehensive clinical outcome
indicators in place via OpenEyes
Internal
performance
monitoring
N/A – new
indicator
N/A – new
indicator
Outcome metrics
generated electronically
for all clinical specialty
modules in live use on
OpenEyes
Developing quality reporting –
overview and detail
Internal
performance
monitoring
N/A – new
indicator
Corporate
clinical
quality
and safety
report in
use and
regularly
presented
to the trust
board
Trust-wide clinical
quality and safety
performance report
published at least twice
a year, supplemented
with detailed reports
on clinical effectiveness,
patient safety, and the
patient experience
Developing PROMs
Internal
performance
monitoring
N/A – new
indicator
N/A – new
indicator
General ophthalmology
PROM validated and
in regular use in all
relevant clinics
Indicator
Source
% overall compliance with hand
hygiene standards
2013/14
target
95%
20 mGTT audits to be
conducted during the
year, the new walkabout
process to be agreed and
in regular use.
Clinical effectiveness
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7 Statements of assurance
Review of services
Moorfields Eye Hospital NHS Foundation Trust provides ophthalmic NHS services covering a range of
sub-specialties. We regularly review all healthcare services that we provide. During 2013/14, we will
continue with our rolling programme of reviewing the quality of care and delivery of services.
The income generated by the NHS services under review represents all of the total income generated
from the provision of NHS services by Moorfields for 2012/13.
Participation in clinical audits and national confidential inquiries
During 2012/13, one on-going national clinical audit was undertaken by Moorfields Eye Hospital
NHS Foundation Trust, and two national confidential enquiry reports were reviewed.
Due to the single speciality nature of the hospital, most national audits are not relevant to the trust.
The trust therefore attempts to audit against standards and guidelines set by the Royal College of
Ophthalmologists (RCOphth). During 2012/13, 133 clinical audits were registered on the trust’s
clinical audit webtool (CLAW) database, of which 18 audits were completed as a result of RCOphth
recommended standards.
With regards to national confidential enquiries (NCEs), two reports produced in 2012/13 were
reviewed. Moorfields Eye Hospital NHS Foundation Trust participated in the development of and
demonstrated compliance with one of these NCEs (cardiac arrest procedures). The second NCE
reviewed was not relevant to the trust and the trust was not able to participate in its development.
The national clinical audits, Royal College standards and NCEs that Moorfields Eye Hospital NHS
Foundation Trust was eligible to participate in during 2012/13 were as follow:
National audits
UK ocular tissue transplant audit – NHS Blood and Transplant
Fifth national audit project of the Royal College of Anaesthetists and Association of Anaesthetists
of Great Britain and Ireland
Royal College of Ophthalmology audits
Modified global trigger tool, City Road/glaucoma
Modified global trigger tool, Ealing/strabismus
Modified global trigger tool, City Road/medical retina
Retinopathy of prematurity, Ealing
Activity and outcomes in a vitreoretinal clinic
Cataract surgery outcomes and patient satisfaction
Modified global trigger tool, City Road/paediatrics
Cataract surgery in trainees
Modified global trigger tool, Ealing/paediatrics
Intraoperative floppy iris syndrome in patients on oral doxazosin
A retrospective evaluation of optometrist-performed YAG and Argon pre-treated LASER
procedures
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Modified global trigger tool, Mile End/primary care
Audit on investigations for retinal vein occlusions
Prospective audit for screening of premature babies for retinopathy of prematurity
Outcomes of glaucoma referrals across Europe – the UK component
Provision of eye services to children with sensorineural hearing impairment
Activity and waiting times in a day-case cataract service
National confidential enquiries
Cardiac arrest procedures – Moorfields participated in the study and the trust’s processes and
procedures comply with the recommendations
Bariatric surgery – Moorfields did not participate in the study and thus the recommendations are
not applicable to the trust
Between April 2012 and March 2013, Moorfields Eye Hospital NHS Foundation Trust clinical audit
department has had 133 audits registered on the clinical audit web tool (CLAW), of which 18 audits
have demonstrated the implementation of the audit cycle. Audit reports and action plans have been
submitted and approved by the clinical audit and assessment committee, ensuring that audit activity
is adhered to as identified in the trust clinical audit annual report.
As part of the process for each completed audit report, action plans are generated to improve the
quality of healthcare provided. Examples of some of the actions submitted include:
Review all policies and ensure they are updated in line with current practice
Ensure that all key findings from audit reports are disseminated and shared with all relevant staff
for discussion at service meetings/nursing meetings encouraging best practice
Ensure all audit criteria and standards used for audit are reviewed and discussed at the clinical
audit and assessment committee meetings
Summary of trust mandatory audit findings to be included on the trust intranet and in the
communication brief
Re-audit to be encouraged to ensure that we continuously monitor and evaluate clinical practice
Action plans are monitored by the clinical audit department.
Participation in clinical research
The number of patients receiving relevant health services provided or sub-contracted by Moorfields
Eye Hospital NHS Foundation Trust in 2012/13 that were recruited during that period to participate
in research approved by a research ethics committee was 4,852.
Use of the commissioning for quality and innovation (CQUIN)
framework
The CQUIN payment framework enables commissioners to reward providers by linking a proportion
of the providers’ income to the achievement of local quality improvement goals. Some CQUINs are
national requirements but others are developed locally in discussion with the commissioners. For
2012/13, the trust had eight CQUIN requirements, and 2.5%, or £2.3 million, of Moorfields Eye
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88 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Hospital NHS Foundation Trust’s income was conditional on achieving quality improvement and
innovation goals agreed between Moorfields Eye Hospital NHS Foundation Trust and NHS Islington
through the CQUIN framework; the total for 2011/12 was 1.5%, or £1.2 million.
Registration with the Care Quality Commission
Moorfields Eye Hospital NHS Foundation Trust is required to be registered with the Care Quality
Commission (CQC) and is currently registered without conditions. The CQC has not taken any
enforcement action against Moorfields Eye Hospital NHS Foundation Trust in 2012/13.
In August 2012, St Ann’s, one of the trust’s satellites, received an unannounced inspection against
six essential standards of quality and safety and was found to be compliant against all of them.
In February 2013, the trust’s main City Road site received an unannounced inspection against six
essential standards of quality and safety and was also found to be fully compliant.
Moorfields Eye Hospital NHS Foundation Trust has not participated in any special reviews or investigations by the CQC during the reporting period.
Quality of data
Moorfields Eye Hospital 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 percentages of records in the published data which included the patient’s valid NHS
number were; 98.4% for admitted care; 98.0% for outpatient care and 92.7% for accident
and emergency care. The percentages of valid data which included the patient’s valid general
practitioner registration code were: 100% for admitted care; 100% for outpatient care; and 100%
for accident and emergency care.
The information governance assessment received a grading of level 2 with a “satisfactory” score.
The toolkit overall score was 75%.
Moorfields Eye Hospital NHS Foundation Trust was not subject to the payment by results clinical
coding audit during 2012/13.
Moorfields Eye Hospital NHS Foundation Trust will be taking the following actions to improve data
quality during 2013/14:
Complete a review of the data quality policy to ensure that responsibilities of staff of all grades
and disciplines with regard to data quality are clearly defined
Launch the revised policy to ensure that staff are aware of their responsibilities
An external review of data quality will be undertaken
Raise awareness of data quality requirements and increase monitoring of frontline staff to ensure
that they are checking and recording changes to patient information
Data quality procedures to be produced and made available to all staff involved in data entry on
all trust systems
Review of data held within the trust’s data warehouse
Review patient administration system (PAS) training currently available
Executive leads have been nominated for each of the above actions and the information governance
committee will monitor progress against agreed timescales.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 8 Statement of support from partner organisations
Our quality report for 2012/13 has been shared with our membership council as well as with
colleagues at our host clinical commission group (NHS Islington), the London Borough of
Islington’s health and wellbeing scrutiny committee and Islington’s Healthwatch. The CCG
commented as follows:
NHS Islington CCG is responsible for the commissioning of health services from Whittington Health
and Moorfields Eye Hospital acute/specialist trusts and Camden and Islington Foundation Trust for
mental health services, on behalf of the population of Islington.
NHS Islington CCG welcomes the opportunity to provide this statement about Moorfields’ quality
account. We confirm that we have reviewed the information contained within the account
and checked this against data sources where this is available to us as part of existing contract/
performance monitoring discussions and is accurate in relation to the services provided.
We have taken particular account of the identified priorities for improvement for Moorfields and
how this work will enable real focus on improving the quality and safety of health services for the
population they serve.
We have reviewed the content of the account and confirm that this complies with the prescribed
information, form and content as set out by the Department of Health. We believe that the account
represents a fair, representative and balanced overview of the quality of care at Moorfields. We have
discussed the development of this quality account with Moorfields over the year and have been able
to contribute our views on consultation and content.
This account has been reviewed within NHS Islington CCG and by colleagues in NHS North and East
London Commissioning Support Unit.
Overall, we welcome the vision described within the quality account, agree on the priority areas
and will continue to work with Moorfields to continually improve the quality of services provided to
patients.
9 Statement of directors’ responsibilities in respect of the 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) and on the arrangements that
foundation trust boards should put in place to support the data quality for the preparation of the
quality report.
In preparing the quality report, directors are required to take steps to satisfy themselves that
The content of the quality report meets the requirements set out in the NHS Foundation Trust
Annual Reporting Manual 2012/13;
The content of the quality report is not inconsistent with internal and external sources of
information including:
–– Board minutes and papers for the period April 2012 to May 2013
–– Papers relating to quality reported to the board over the period April 2012 to May 2013
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90 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
–– Feedback from the commissioners dated 28 May 2013
–– Feedback from governors provided in May 2013
–– The trust’s complaints report published under regulation 18 of the Local Authority Social
Services and NHS Complaints Regulations 2009, dated 19 July 2012;
–– The national outpatient survey of November 2011 and A&E survey of September 2012
–– The 2012 national staff survey
–– The head of internal audit’s annual opinion over the trust’s control environment dated 31
March 2013
–– CQC quality and risk profile dated 31 March 2013
The quality report presents a balanced picture of the NHS foundation trust’s performance over
the period covered
The performance information reported in the quality report is reliable and accurate
There are proper internal controls over the collection and reporting of the measures of
performance included in the quality report, and these controls are subject to review to confirm
that they are working effectively in practice
The data underpinning the measures of performance reported in the quality report is robust
and reliable, conforms to specified data quality standards and prescribed 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/annualreportingmanual) as well as the standards to
support data quality for the preparation of the quality report available at: www.monitor-nhsft.
gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275
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,
Rudy Markham, chairman
31 May 2013
John Pelly, chief executive
31 May 2013
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 10Further information
Further information about this quality account can be obtained from the director of corporate
governance at Moorfields Eye Hospital NHS Foundation Trust. This report will be available on the
NHS Choices website from June 2013.
11Independent auditor’s report to the council of governors of
Moorfields Eye Hospital NHS Foundation Trust on the quality
report
We have been engaged by the council of governors of Moorfields Eye Hospital NHS Foundation
Trust to perform an independent assurance engagement in respect of Moorfields Eye Hospital NHS
Foundation Trust’s quality report for the year ended 31 March 2013 (the “quality report”) and
certain performance indicators contained therein.
This report, including the conclusion, has been prepared solely for the council of governors of
Moorfields Eye Hospital NHS Foundation Trust as a body, to assist the council of governors in reporting
Moorfields Eye Hospital NHS Foundation Trust’s quality agenda, performance and activities. We permit
the disclosure of this report within the annual report for the year ended 31 March 2013, to enable
the council of governors to demonstrate they have discharged their governance responsibilities by
commissioning an independent assurance report in connection with the indicators. To the fullest
extent permitted by law, we do not accept or assume responsibility to anyone other than the council
of governors as a body and Moorfields Eye Hospital NHS Foundation Trust for our work or this report
save where terms are expressly agreed and with our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March 2013 subject to limited assurance consist of the national
priority indicators as mandated by Monitor:
C. Difficile
Emergency readmissions within 28 days of discharge from hospital
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
statement of directors’ responsibilities in respect of the quality report; and
the indicators in the quality report identified as having been the subject of limited assurance in
the quality report are not reasonably stated in all material respects in accordance with the NHS
Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the
Detailed Guidance for External Assurance on Quality Reports.
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92 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
We read the quality report and consider whether it addresses the content requirements of the NHS
Foundation Trust Annual Reporting Manual, and consider the implications for our report if we
become aware of any material omissions.
We read the other information contained in the quality report and consider whether it is materially
inconsistent with the documents specified within the detailed guidance. We consider the
implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively the “documents”). Our responsibilities do not extend to
any other information.
We are in compliance with the applicable independence and competency requirements of the
Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team
comprised assurance practitioners and relevant subject matter experts.
Assurance work performed
We conducted this limited assurance engagement in accordance with International Standard on
Assurance Engagements 3000 (Revised) – “Assurance Engagements other than Audits or Reviews
of Historical Financial Information” issued by the International Auditing and Assurance Standards
Board (“ISAE 3000”). Our limited assurance procedures included:
Evaluating the design and implementation of the key processes and controls for managing and
reporting the indicators
Making enquiries of management
Testing key management controls
Limited testing, on a selective basis, of the data used to calculate the indicator back to
supporting documentation
Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to
the categories reported in the quality report
Reading the documents
A limited assurance engagement is smaller in scope than a reasonable assurance engagement.
The nature, timing and extent of procedures for gathering sufficient appropriate evidence are
deliberately limited relative to a reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent limitations than financial
information, given the characteristics of the subject matter and the methods used for determining
such information.
The absence of a significant body of established practice on which to draw allows for the selection
of different but acceptable measurement techniques which can result in materially different
measurements and can impact comparability. The precision of different measurement techniques
may also vary. Furthermore, the nature and methods used to determine such information, as well as
the measurement criteria and the precision thereof, may change over time. It is important to read
the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting
Manual.
The scope of our assurance work has not included governance over quality or non-mandated
indicators which have been determined locally by Moorfields Eye Hospital NHS Foundation Trust.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Conclusion
Based on the results of our procedures, nothing has come to our attention that causes us to believe
that, for the year ended 31 March 2013:
the quality report is not prepared in all material respects in line with the criteria set out in the
NHS Foundation Trust Annual Reporting Manual;
the quality report is not consistent in all material respects with the sources specified in the
statement of directors’ responsibilities in respect of the quality report; 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
31 May 2013
93
94 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Annex to the quality report – core outcomes
Speciality
Metric
Standard
Moorfields
Performance
2012/13
Cataract
Posterior capsular
rupture rate (PCR)
% phaco
operations
complicated by PCR
<1.8%
0.80%
Cataract
Endophthalmitis
after cataract
surgery
% phaco
operations with
postoperative
endophthalmitis
<0.08%
0.03%
Cataract
Biometry accuracy
in cataract surgery
% postoperative
refraction +/- 1D
of that planned in
those undergoing
phaco
>85%
97.60%
Cataract
Biometry accuracy
in high myopes
having catract
surgery
% postoperative
refraction +/- 1D
of that planned
in high myopes
undergoing phaco
>50%
90.60%
Glaucoma
Trabeculectomy (glaucoma
drainage surgery)
failure
% failed trabeculectomies at 12
months post-op
≥15%
80.2%
Glaucoma
PCR in glaucoma
patients
% phaco surgery
complicated by
PCR in those with
glaucoma
<National
2.15%
ophthalmic dataset
Glaucoma
Glaucoma tube
drainage
% drainage tube
failure after 1 year
<10%
5.20%
Medical retina
Endophthalmitis
after injections
for macular
degeneration
% suspected
infective endophthalmitis after
intravitreal Lucentis
for wet AMD
<0.05%
0.04%
Medical retina
Visual
improvement
after injections
for macular
degeneration
Visual acuity (VA)
improvement: %
gaining ≥ 15 letters
at 12 months.
>20%
30.50%
Medical retina
Visual loss
after injections
for macular
degeneration
VA loss: % losing
<15 letters at 12
months
>80%
85.70%
Medical retina
Time from referral
to assessment
of proliferative
diabetic
retinopathy
% patients referred 80%
from screening with
R3 attending clinic
within 4wks
Vitreo retinal
Success of primary % cases with
retinal detachment attached retina
(RD) surgery
3 months after
primary RD
operation
>75%
90.3%
80%
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Speciality
Metric
Standard
Moorfields
Performance
2012/13
81%
Vitreo retinal
Success of macular % cases with
hole surgery
macular hole closed
3 months after
primary macular
hole surgery
>80%
Vitreo retinal
PCR in cataract
surgery in
vitrectomised eyes
% phaco surgery
complicated by
PCR in those with
previous vitrectomy
<National
4%
ophthalmic dataset
Neuroophthalmology and
strabismus
Serious
complications of
strabismus surgery
% serious
intra-op or postop
complications in
strabismus surgery
<2.2%
0.30%
Neuroophthalmology and
strabismus
Premature
baby eye (ROP)
screening
compliance
% adherence to
ROP screening
guidelines
99%
100%
Neuroophthalmology and
strabismus
Success of probing
for congenital tear
duct blockage
% success rate
lacrimal probing in
young children
>85%
85.70%
External disease
Endothelial
keratoplasty (also
known as DSAEK)
corneal graft
failure rate
% failure DSAEK
graft by 1 year
≤12%
11%
External disease
PCR in cataract
surgery in
vitrectomised eye
% failure primary
PK graft by 1 year
UK Transplant
Service
16%
External disease
PCR in cataract
surgery in
vitrectomised eye
% failure DALK
graft by 1 year
UK Transplant
Service
11%
Refractive
Accuracy LASIK
% +/- 0.5D planned >85%
(laser for refractive after LASIK in
error) in short sight myopia up to --6D
88.80%
Refractive
Loss of vision after
LASIK
% losing 2 or more
lines of vision after
LASIK
<1%
0%
Refractive
Good vision
without lenses
after LASIK
% uncorrected
visual acuity > 6/12
after LASIK
≥90%
97.80%
Adnexal
Ptosis surgery
failure
% patients
undergoing primary
ptosis procedure
requiring further
ptosis procedure
<15%
3%
Adnexal
Entropion surgery
success
% patients
undergoing primary
entropion repair
who require further
procedure in 1 year
>95%
100%
Adnexal
Ectropion surgery
success
% patients
undergoing primary
ectropion repair
who require further
procedure in 1 year
>80%
100%
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96 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Speciality
Metric
Standard
Moorfields
Performance
2012/13
A&E
Unplanned reattendances
% unplanned adult
re-attendance at
A&E within 7 days
<5%
0.10%
A&E
Rate adherence
to NICE transient
ischaemic attack
(TIA) guidelines
% patients with
TIA or “mini
stroke” attending
A&E whose
management
complied with NICE
guidance
100%
100%
A&E
Nurse-led care in
A&E
% patients
attending adult
A&E managed by
nurse-led pathway
15%
21%
A&E
Treatment acute
glaucoma
% patients
with acute
glaucoma whose
management
complied with
protocol
98%
94.70%
A&E
Use of WHO
surgical safety
checklist
100%
% patients
undergoing theatre
procedure in whom
WHO checklist used
appropriately
94%
Anaesthetic
Venous thromboembolism (VTE)
prevention
% eligible patients
100%
undergoing theatre
procedures who
received correct VTE
prophylaxis
92%
Anaesthetic
Post-op pain score
completion
% patients in
recovery who had
post-op pain score
completed
75%
80%
Anaesthetic
On-the-day
transfers
Patients
unexpectedly
transferred to
another hospital
No standard
0.97%
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Appendix 2
National staff survey
The national staff survey is a useful mechanism for engaging with staff and receiving feedback from
them. Action plans are developed based on the outcomes of the survey and details are shared with
all staff through our regular communications channels. The main responsibility for ensuring action is
taken in response to feedback from the survey lies with the trust management board.
1 Summary of performance
In the most recent survey, 44% of our staff responded, a slight drop from the 47% response rate in
the previous year, and below the national average for acute specialist trusts
Positive findings:
Staff reported levels of motivation at work well above the national average and equal to the best
national score
88% reported that they are satisfied with the quality of work and care they provide; this is
significantly higher than the national average of 82%
Staff report high levels of staff engagement, better than last year and above the national average
Levels of work-related stress and work pressure are lower than last year, and significantly lower
than the national average
Significantly more staff say they feel able to contribute towards improvements at work, up from
62% to 71%
The proportion of staff recommending Moorfields as an attractive place in which to work or
receive treatment increased, and is above the national average
Staff perceptions about the fairness and effectiveness of incident reporting procedures improved,
and are again above the national average
Areas of concern:
The proportion of staff reporting that they have experienced discrimination from patients or
relatives has increased from 15% to 17%
5% of staff experienced physical violence from other staff compared to a national average of 2%
27% of staff reported that they have experienced harassment, bullying or abuse from patients or
relatives in the past 12 months compared to a national average of 21%
There has been a decrease to 83% in the number of staff who said they reported errors, near
misses or incidents they witnessed, compared to a national average of 92%
The number of staff who reported they had an appraisal in the past 12 months was down, and
there was a decrease in the number of staff attending mandatory training such as equality and
diversity and health and safety training
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98 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2 Top four ranking scores for 2012/13
2012/13 score
Moorfields
Trust improvement/
deterioration
2011/12 score
National average
for acute specialist
trusts
Moorfields
National average
for acute specialist
trusts
Statement 1: Percentage of staff feeling satisfied with the quality of work and patient care they are able
to deliver
88
82
88
77
No change
3.85
3.85
Improvement
67
No change
Statement 2: Staff motivation at work
4.02
3.88
Statement 3: Percentage of staff working extra hours
63
72
63
Statement 4: Percentage of staff suffering work-related stress in the last 12 months
25
32
25
27
No change
3 Bottom four ranking scores 2012/13
2012/13 score
Moorfields
Trust improvement/
deterioration
2011/12 score
National average
for acute specialist
trusts
Moorfields
National average
for acute specialist
trusts
Statement 1: Percentage of staff reporting errors, near misses or incidents witnessed in the last month
83
92
99
96
Deterioration
Statement 2: Percentage of staff experiencing physical violence from staff in the last 12 months
5
2
N/A
N/A
N/A
Statement 3: Percentage of staff experiencing discrimination at work in the 12 months
17
8
15
10
Deterioration
Statement 4: Percentage of staff experiencing harassment, bullying or abuse from patients/relatives or the
public in the last 12 months
27
21
N/A
N/A
N/A
4 Future priorities and targets – acting on staff feedback
Key actions and next steps:
Present headline findings to management executive and trust management board (completed in
March 2013)
Examine responses in detail, including by staff group where possible, analysing areas of concern,
reviewing the responses alongside some of the recommendations from the Francis report, and
drawing up an action plan
Present detailed report to management executive, trust management board and joint staff
consultative committee
Agree and publish action plan
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Appendix 3
Sustainability report
1 Introduction
NHS trusts, primary care trusts and strategic health authorities are required by the Department of
Health to produce a sustainability report in 2012/13 and beyond as part of their annual report. This
requirement does not apply to foundation trusts, which may include it at their discretion. Moorfields
recognises the importance of reporting on our sustainability objectives, so has produced a sustainability report using the guidance provided by HM Treasury and the NHS sustainability development unit.
2 Summary of performance
Moorfields is at the early stages of reviewing our sustainability performance. Our primary focus is to
reduce our energy consumption, improve asset efficiency and meet all statutory requirements such
as the Carbon Reduction Commitment (CRC) energy efficiency scheme. Measures to improve energy
efficiency include a review of the building management system (BMS) and its future replacement,
continued upgrade of the lighting with light-emitting diodes (LED), and the installation of a new
energy monitoring and targeting system to allow more accurate reporting. A new waste reporting
procedure is being implemented alongside a complete review of our waste management process.
We are also reviewing procedures to monitor and report water consumption, and will consider
reviewing the new Good Corporate Citizenship assessment tool.
Greenhouse gas emissions
Moorfields has a target to reduce carbon emissions by 10% (to 5,143 tonnes of carbon) by March
2015 from the 2008/2009 baseline level of 5,714 tonnes of carbon. We follow the guidelines of
the Greenhouse Gas Protocol, which provides the most commonly used standard methodology for
emissions reporting worldwide.
Our current target relates to direct greenhouse gas emissions from the activity of on-site gas boilers
and from the off-site generation of grid electricity respectively.
6,000
CO2 footprint (tonnes)
5,800
5,600
5,400
5,200
5,000
4,800
4,600
2008/09
2009/10
2010/11
Actual consumption
2011/12
2012/13
2013/14
2013/14
Target
We currently do not measure emissions resulting from transport or waste as the appropriate
monitoring systems are not in place for this to be undertaken.
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100 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
The total carbon emissions for the trust from April 2012 to March 2013 are expected to be 5,668
tonnes, compared with the baseline year of 5,714 tonnes, a reduction of 0.8%. Carbon emissions
for 2011/12 were 5,626 tonnes, an expected increase of 42 tonnes for this year, or 0.7%.
Several factors can be attributed to the rise in energy use, including in particular the introduction
of Saturday morning clinics and longer clinic times, greater use of the central sterile services
department (CSSD) and the installation of a new IT server room, which includes three chillers, extra
fans and a pumping system.
Waste
Our new head of facilities, who joined us in February 2013, is in the process of reviewing our waste
management process, including a review of monitoring procedures and waste audits undertaken in
2011/12 by our waste contractors for domestic waste and clinical waste.
A current breakdown of the operational waste for 2012/13 has been provided using financial
indicators. This has been compared with the previous year’s waste expenditure as an indication of
the final disposal route of Moorfields waste. More expenditure on recycling suggests that more
domestic and clinical waste is being recycled.
% Waste disposal costs
100%
90%
Other costs
80%
70%
Waste incinerated/energy from waste
60%
50%
Waste recycled/reused
40%
30%
Waste sent to landfill
20%
10%
0%
2011/12
2012/13
Use of finite resources – water
Water consumption has reduced over the last five years, although a target has yet to be established
as a part of our sustainable development management plan.
Our water consumption reduced by 1997 cubic meters in 2012/13.
Water consumption
50,000
45,000
Cubic metres
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
2008/09
2009/10
2010/11
2011/12
2007/08
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Sustainable procurement
We recognise that our procurement contributes to about 68% of our total carbon footprint (based
on 2010/11 data), but have not undertaken any recent measurement as we are joining a shared
procurement service with other trusts in 2013/14 to minimise costs and wastage.
3 Governance
The Moorfields sustainable development management plan has recently been updated and will
ensure that we continue to fulfil our commitment to conducting all aspects of our activities with
due consideration to sustainability, at the same time as providing high quality patient care. To ensure
we are meeting Environment Agency compliance requirements, we have recently undertaken an
external audit of our CRC energy efficiency scheme procedures. Our in-house communications team
also helped raise awareness by distributing useful energy saving tips and facts to staff during carbon
reduction awareness week in March 2013.
4 Good Corporate Citizen
The Good Corporate Citizenship (GCC) assessment model was updated in January 2013. Moorfields
has yet to register as it is reviewing its priorities with greater focus on energy and waste.
Please note that this report contains estimates for 2012/13 data for energy, water and waste. This
is because energy data will not be available until June 2013, and ERIC data for 2012/13 is expected
to be published in October 2013, and because waste data in tonnages is incomplete for all types of
waste; the contractors have been contacted for the information.
101
102 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Appendix 4
Equality and diversity report
Moorfields published its equality report, Focus on Inclusion, in January 2012. The report was part of
our response to the requirements of the public sector equality duty, which supports organisations
carrying out public functions to consider the needs of those that use services; in shaping policy and
the provision of services; in relation to their own employees; and in relation to local communities.
The publication of our report followed a review of equality, diversity and inclusion activity across the
trust, which considered what we do well and what we could improve.
In this report, we declared our continuing aspiration in terms of equality and diversity to be an
organisation that:
Has the confidence and respect of our patients, the community, our staff and partners
Provides high-quality ophthalmic services, including promotion of better eye care and the
prevention of eye problems, that meet the needs of different communities
Enhances our patients’ quality of life through a more holistic approach to their physical and
emotional needs
Has equality, diversity, inclusion and dignity embedded in its culture
Works with our members, our patients, their families and our partners to maximise opportunities
for community engagement so that we can continue to improve our services
Recruits, supports and retains a diverse and skilled workforce by providing training and guidance
which enables and empowers them to provide a first-class service with confidence
We stated that our equality and diversity strategy aims to provide three key components:
A service that uses its leverage to make a difference by way of positive impact to the life
opportunities and health of the local community and the patient population
A workforce committed to delivering health equality and diversity
A better place to work for all staff
In March 2012, Moorfields published three-year objectives setting out how the organisation would
both continue to meet, but also improve the way in which it complied with the Equality Act’s
requirements.
These objectives are:
To create an organisation that is increasingly sensitive to equality and diversity issues when
dealing with patients, their carers and visitors to the trust
To provide high quality ophthalmic services, including promotion of better eye care and the
prevention of eye problems that better meets the needs of different communities and has a
positive impact in the communities where the trust provides services
To attract, maintain and develop a diverse workforce, ensuring the widest labour market is
accessed and the best employees are secured, taking into consideration the needs of the trust
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104 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
We identified priority actions to support each objective for the first year, primarily around improving
the quality of the data we have available about patients and staff. Completion of these monitoring
actions will help evaluate patient and workforce outcomes in order to identify any trends.
In February 2013 (one year on), Moorfields reported its progress against the objectives it had set
itself by producing an updated version of Focus on Inclusion.
Much was achieved during the first year with some interesting highlights being:
Introducing new monitoring of patients and complainants to understand the experiences of
people with different protected characteristics
Developing a new fully accessible website
Re-developing and launching a new prayer room that meets the needs of our diverse community
Increasing opportunities for patients to meet clinicians and governors, to develop their
understanding of the eye health and treatment options
Revising and reintroducing equality and diversity training for all staff
Increasing opportunities for recruits with visual impairments including a focused recruitment
campaign and making resources available for adjustments
The report from the first year’s activities concludes that the trust has demonstrated continuing
compliance against the Equality Act and that a wide range of activity in the area of equality and
diversity has taken place, with solid progress against the objectives.
A full copy of Focus on Inclusion and our equality and diversity objectives are available on our
website.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Appendix 5
Annual accounts 2012/13
1 Foreword to the accounts
The accounts for the year ended 31 March 2013 have been prepared by Moorfields Eye Hospital
NHS Foundation Trust in accordance with The National Health Service Act 2006.
John Pelly, chief executive
28 May 2013
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106 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2 Statement of the chief executive’s responsibilities as the
accounting officer of Moorfields Eye Hospital 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 the accounting officer, including his
responsibility for the propriety and regularity of the public finances for which he is answerable and
for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer
Memorandum issued by the independent regulator of NHS foundation trusts (“Monitor”).
Under the NHS Act 2006, Monitor has directed Moorfields Eye Hospital NHS Foundation Trust to
prepare for each financial year a statement of accounts in the form and on the basis set out in the
Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair
view of the state of affairs of Moorfields Eye Hospital NHS Foundation Trust and of its income and
expenditure, total recognised gains and losses and cash flows for the financial year.
In preparing the accounts, the accounting officer is required to comply with the requirements of the
NHS Foundation Trust Annual Reporting Manual, and in particular to:
Observe the Accounts Direction issued by Monitor, including the relevant accounting and
disclosure requirements and apply suitable accounting policies on a consistent basis;
Make 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 him
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.
The accounting officer is responsible for the maintenance and integrity of the corporate and financial
information included on the trust’s website. Legislation in the United Kingdom governing the
preparation and dissemination of financial information differs from legislation in other jurisdictions.
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.
John Pelly, chief executive
28 May 2013
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 3 Annual governance statement
Scope of responsibility
As accounting officer, I have responsibility for maintaining a sound system of internal control
that supports the achievement of the NHS foundation trust’s policies, aims and objectives, whilst
safeguarding the public funds and departmental assets for which I am personally responsible, in
accordance with the responsibilities assigned to me. I am also responsible for ensuring that the
NHS foundation trust is administered prudently and economically and that resources are applied
efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation
Trust Accounting Officer Memorandum.
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 Moorfields Eye Hospital NHS Foundation Trust, to evaluate the likelihood of
those risks being realised and the impact should they be realised and to manage them efficiently,
effectively and economically. The system of internal control has been in place in Moorfields Eye
Hospital NHS Foundation Trust for the year ended 31 March 2013 and up to the date of approval of
the annual report and accounts.
Within NHS foundation trusts, the system of internal control consists of a combination of strategic
documents such as standing orders and standing financial instructions and schemes of delegation;
policies and procedures to establish processes and how they operate; dedicated risk functions and
other specialist knowledge to bind the systems together and ensure they operate smoothly; and the
checks and balances through management review, board scrutiny and internal or external review.
Capacity to handle risk
The trust, through the board of directors, is required to ensure that systems of internal control
are in place. As accounting officer I have overall responsibility for risk management. I chair the
management executive and trust management board through which executive responsibility for risk
management is exercised.
The overall strategy of the trust is to maintain systematic and effective arrangements for recognising
and managing all risks within the organisation. The director of corporate governance has responsibility for the design, development and maintenance of operational risk systems, policies
and processes. The director of corporate governance chairs the risk and safety committee, which
provides additional management review of risks and supports the day-to-day risk management
processes across the organisation.
The trust continues to build upon its board assurance framework (BAF) which details the principal
risks to meeting the trust’s strategy and how they are being mitigated. The BAF is integrated with
the trust’s corporate risk register, which sets out the key risks to the organisation and how they are
being managed. The corporate risk register and BAF have been reviewed on a quarterly basis by the
management executive and board, in line with risk management policies.
Management reviews consist of a full evaluation of the status of all the risks (and any new risks),
including risk scores, understanding mitigation and, where needed, introducing further actions and
107
108 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
mitigations. Board reviews largely test assurances and challenge understanding of the overall risk
position and capacity to manage risks within the organisation.
The trust has a risk and safety department responsible for ensuring the day-to-day functioning and
co-ordination of risk systems within the organisation and for providing support to staff. Along with
the clinical governance team, the head of risk and safety manages the serious incident (SI) process,
which investigates incidents where serious patient harm has occurred or is suspected. Subsequent
learning from SI investigations is achieved through a number of mechanisms, for example as a
result of action plans resulting from investigations, feedback directly to clinical teams, trend and
comparative data analysis and through a regular series of clinical governance meetings. These
mechanisms are also used for sharing good practice; examples include improved use of the surgical
safety checklist and our new system for checking that the correct intra-ocular lens is used in cataract
surgery.
Training provides a basis of core skills for staff which cover 40 areas across the organisation. These
are prioritised into a smaller number of mandatory areas for all staff. Mandatory staff training in
relation to different aspects of risk includes risk and safety management, general health and safety,
incident reporting for managers, infection control and information governance. However, training
is tailored for specific roles and responsibilities; for example, those that work most closely with
children are required to have level 3 child protection training. Training is delivered through a variety
of mechanisms which include face-to-face and e-learning with assessment.
In common with all NHS organisations, Moorfields has sought to learn from the findings of the
second Francis report following the public inquiry into the very poor care at Stafford Hospital.
The management executive, trust management board and the trust board have all assessed the
implications of the report and are confident that failures on that scale could not happen in this
organisation. However, a detailed action plan has been produced and will be reviewed at intervals
by the trust board.
The risk and control framework
The trust has a risk management strategy and policy, and levels of accountability and responsibility
are detailed within this. The trust has risk management systems in place for recording, evaluating,
monitoring and controlling risks. The systems are comprehensive across all operational areas and
are subject to overview and scrutiny by the trust board and its committees. The control of risks is
embedded in the management roles of the executive directors and the directorate teams. Processes
for monitoring clinical activity are in place within directorates. This information forms part of the
directorates’ dashboards which contains activity, financial and quality information. Currently, these
dashboards undergo a comprehensive update on a quarterly basis and are formally reviewed at
quarterly performance meetings which also involve executive director review.
The three current most significant corporate risk areas relate to:
Maintaining high clinical standards within available financial resources: This is mainly caused by
pressures from the decreasing ophthalmology tariff and some cost growth. The trust is mitigating
this through attention to detail in contractual negotiations, continuing strategic financial
planning and robust savings plans, and through a clinical transformation programme which will
evolve over one to two years.
Replacing and maintaining the ageing estate: The trust’s main building is more than 113 years
old. Because of its age there is a need for significant and ongoing annual maintenance and the
trust has risks in relation to its backlog maintenance programme in that unexpected/unplanned
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 maintenance may be required. The trust has sufficient contingencies and insurance to mitigate
these risks. In addition, the trust is preparing to replace its current main hospital building.
Outdated information technology (IT) systems: The trust has outdated IT systems that are in the
process of being updated over a two-year period. There are no patient safety risks associated
from the current IT systems weaknesses.
Clinical audit supports the maintenance and review of clinical standards across the organisation
and the trust participates in national audits and has a local audit programme. Clinical audit and
effectiveness are monitored through a clinical audit and effectiveness committee chaired by the
clinical director of quality and safety. The clinical audit team is a central function which supports
audit activities within the service areas and directorates.
All trust-wide policies and procedures have senior owners and dates for review, and are available on
the trust’s intranet. Management oversight of the maintenance of policies and procedures rests with
the director of corporate governance.
The trust has quality governance systems in place with oversight provided by the quality and safety
committee, which is a committee of the board.
The trust has systems in place, led by the clinical governance team and operating through the
management committees, to ensure ongoing compliance with the Care Quality Commission’s (CQC)
essential standards of quality and safety. Following an unannounced inspection by the CQC in
February 2013, the trust was found to be compliant with all the essential standards of quality and
safety that were assessed. Moorfields Eye Hospital NHS Foundation Trust is therefore fully compliant
with the registration requirements of the CQC.
The general risk appetite within the organisation is to minimise avoidable risk, with timescales
varying for mitigation depending on the nature of the risks. However, the concepts relating to the
identification, monitoring and mitigation of risks continue to mature year by year. Overall clinical
and process risks within the organisation remain low. This is supported by the fact that in December
2011, the trust was assessed by the NHSLA against level 3 of their risk management standards and
was awarded a pass at this level, the highest rating for trusts, achieving a score of 47 out of 50.
The level of assessment remains in place for three years before reassessment, and during this period
there are systems in place, supported by a project manager, to ensure ongoing compliance.
Information governance
Data security is addressed through the trust’s information governance arrangements. Responsibility
for the leadership of the information governance agenda is delegated from the chief executive to
the senior information risk owner (SIRO) who is the director of corporate governance. The SIRO is
responsible for ensuring that information governance risk management systems and processes are in
place and operating effectively.
The information governance committee (IGC) is chaired by the SIRO and is responsible for
overseeing the trust’s information governance processes, systems and practice across all of its sites,
and ultimately provides the board with assurance that the trust is compliant with, and managing
any risk to that compliance, in the following areas:
Information governance management
Information security assurance
Confidentiality and data protection assurance
Clinical information assurance
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110 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Secondary use assurance
Corporate information assurance
All key areas of the trust are represented on the IGC. The IGC reports to the management executive
and has several sub-groups which cover specific areas such as corporate records, information
management and IT security.
One part of the IGC’s responsibilities is to oversee the annual information governance (IG) toolkit
assessment which has to be submitted by 31 March each year, and the outcomes of which are
reported to the Care Quality Commission. Moorfields achieved a ‘satisfactory’ (at least level 2
compliance in all 45 requirements) score of 75% for the year 2012/13 compared with a score of
80% (satisfactory) in the previous year.
The reason for this drop in overall score, apart from changes to the reporting levels within the IG
toolkit (which change annually), was the lowering of a number of the requirements around data
quality following a reportable serious incident (SI). A detailed action plan to address the issues
identified in the SI has been agreed, with executive director leads being responsible for each of the
actions and the delivery of the overall plan being co-ordinated and monitored by the information
governance committee.
An action plan has been produced with director leads, which is being co-ordinated by the IGC;
these actions include:
Completing a review of the data quality policy to ensure that responsibilities of staff, of all grades
and disciplines, with regard to data quality are clearly defined
Launching the revised policy to ensure that staff are aware of their responsibilities
Undertaking an external review of data quality
Raising awareness of data quality requirements and increasing monitoring of front-line staff to
ensure that they are checking and recording changes to patient information
Data quality procedures being produced and made available to all staff involved in data entry on
all trust systems
Reviewing data held within the trust’s data warehouse
Reviewing PAS training currently available
The toolkit also includes a requirement to undertake an annual data mapping exercise to assess all
routine data flows within the organisation and between the trust and any third parties. The output
of this exercise, which was produced with the engagement of directorates and departments, was
a revised and fully risk assessed set of data flow maps. The respective data flows and analyses have
been fed back to the directorates for improvement actions where these are required.
In terms of the wider organisation, considerable emphasis is placed on communication, awareness
raising and training so that all members of the workforce understand their responsibilities with
respect to information governance (IG), including information security. The trust achieved 95.9% of
staff trained in IG in 2011/12 and 96.3% in 2012/13, the results being very similar with an equally
high degree of promotion and emphasis being placed on this important agenda over both years.
Stakeholder involvement in risk management
Trust governors, who include patient, public, staff and nominated (stakeholder) governors, are
involved in a number of groups and committees across the organisation. These groups have responsibilities in supporting the identification and management of risks. Non-executive directors,
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 governors and patients attend and support the work of the patient experience committee which has
responsibility for improving key aspects of the patient experience identified through patient surveys
and other sources of patient feedback.
Other routes whereby stakeholders can feed in risks and issues to the organisation include:
Patients and the public
Patient advice and liaison service (PALS)
Formal complaints processes
Specific patient groups
The trust’s annual general meeting
The national patient survey programme
Local involvement networks (now Healthwatch in 2013/14)
Staff
The annual staff survey
Chief executive’s briefing sessions
Responding to the chief executive’s newsletter
Health partners
Primary care trust (PCT) (clinical commissioning group (CCG) from 1 April 2013) engagement
through the clinical quality review group meeting (CQRG) provides a regular forum for the
discussion of issues and risks and a regular formal review of the corporate risk register with a
focus on quality performance
Islington borough council through their health and wellbeing scrutiny committee
As an employer with staff entitled to membership of the NHS pension scheme, control measures
are in place to ensure that all employer obligations contained within the scheme’s 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 trust has an equality and diversity
steering group which meets twice a year and reports to the board, which provides oversight of
the management of the equality and diversity requirements across the organisation. An equality,
diversity and human rights management group manages the implementation of the legal and
operational requirements for equality, diversity and human rights. This is chaired by the director
of corporate governance and is led in conjunction with the director of human resources and the
director of nursing and allied health professions. Equality impact assessments are integrated into the
development of all strategies, policies and procedures.
The trust has undertaken risk assessments and carbon reduction delivery plans are in place in
accordance with emergency preparedness and civil contingency requirements, as based on UKCIP
2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act
and the Adaption Reporting requirements are complied with.
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112 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Review of economy, efficiency and effectiveness of the use
of resources
The trust has an annual programme of internal audit which is prepared taking into consideration the
views of management and the audit committee. The audit committee monitors progress against the
audit programme and addresses any improvement actions identified. The management executive,
trust management board and trust board review the trust’s financial position and savings programme
monthly and further scrutiny is undertaken by the audit committee as required.
In the case of internal audit, the two main reviews cover the trust’s financial management, i.e. financial
controls and processes, financial stewardship, financial throughput of central systems and interdependencies with operational systems, the use and understanding of financial targets; and financial
reporting, i.e. scrutiny of finances at an operational level, empowering staff to manage budgets and
be held accountable for them, information and analysis supplied to the board and its committees.
Both reviews were able to give the highest of three possible levels of assurance (i.e. adequate, requires
improvement, inadequate) regarding the trust’s systems of financial management and reporting. A
more detailed discussion of trust performance and key performance indicators can be found in the
main text of the annual report.
Financial data generated and relied upon by the trust is subject to a number of tests as to accuracy
and the extent to which internal controls can be relied upon. Assurance is given regarding these
controls through a system of internal audit, the outcome of which is described above and is principally
concerned with how the information is generated and used internally.
The accuracy of clinical coding is subject to an annual audit; for 2012/13 the trust was not subject to a
risked based payment by results audit. The accuracy of data more broadly is subject to scrutiny by the
information management group via bi-monthly reports which include data completeness reports for
national and contractual targets.
Annual quality report
The directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended) to prepare quality accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual
quality reports which incorporate the above legal requirements in the NHS Foundation Trust Annual
Reporting Manual.
The development of the trust’s quality report is led by the chief operating officer and co-ordinated
by the director of corporate governance in close liaison with the clinical director of quality and
safety, the director of nursing and allied health professions and the medical director.
The trust management board has had an overview of the trust’s quality priorities during the year which
fall into the three areas of patient safety, patient experience and clinical effectiveness. Development
of the quality report was reviewed half way through the year by the quality and safety committee and
was finalised as a balanced representation of the trust’s priority areas across patient safety, patient
experience and clinical effectiveness. The membership council has also scrutinised and fed its views
into the development of the quality account which was agreed by the trust board on 23 May.
The quality priorities for 2013/14 are consistent with the trust’s agreed strategic priorities. A number
of stakeholders have been consulted during the development of the quality priorities, including
clinicians, governors (some of whom are patients), commissioners, the quality and safety committee,
Healthwatch and Islington’s health and wellbeing scrutiny committee. The quality priorities have
been included in the annual plan and have been approved by the trust board.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Review of effectiveness
As accounting officer, I have responsibility for reviewing the effectiveness of the system of internal
control. My review of the effectiveness of the system of internal control is informed by the work of
the internal auditors, clinical audit and the executive managers and clinical leads within the NHS
foundation trust who have responsibility for the development and maintenance of the internal
control framework. I have drawn on the content of the quality report attached to this annual report
and other performance information available to me. My review is also informed by comments made
by the external auditors in their management letter and other reports. I have been advised on the
implications of the results of my review of the effectiveness of the system of internal control by the
board, the audit committee and the quality and safety committee and a plan to address weaknesses
and ensure continuous improvement of the system is in place.
My review of the effectiveness of the systems of internal control is informed by executive directors
and managers within the organisation.
The process that has been applied in maintaining and reviewing the effectiveness of the system of
internal controls has involved:
The trust board, working with an integrated programme of business, ensuring that the key
compliance and regulatory requirements are reported and reviewed and that key risks are
considered.
The audit committee providing the board with independent and objective review of the
financial controls within the trust. There has been a programme of internal audit to review the
systems, controls and processes and the outcomes of these reports have been reviewed by the
audit committee. This work has included identifying and testing the effectiveness of the risk
management and assurance processes that take place.
The activities of a number of management committees, which provide the additional
mechanisms for the internal controls within the organisation, particularly the clinical governance
committee, the risk and safety committee and the information governance committee.
Internal financial controls are implemented through finance systems and automated processes,
physical measures, and manual processes, all governed by the standing financial instructions and
reported through the audit committee.
Conclusion
To conclude, there are no significant control issues identified, but areas where improvements are in
progress are indicated in the text above.
The opinion of the head of internal audit is included here:
The head of internal audit opinion is that substantial assurance can be given that there is generally
a sound system of internal control which is designed to meet your objectives and that generally
controls are being consistently applied in all the core areas reviewed.
John Pelly, chief executive
28 May 2013
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114 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
4 Independent auditor’s report to the board of governors and
board of directors of Moorfields Eye Hospital NHS Foundation
Trust
We have audited the financial statements of Moorfields Eye Hospital NHS Foundation Trust for
the year ended 31 March 2013 which comprise the statement of comprehensive income, the
statement of financial position, the statement of changes in taxpayers’ equity, the statement of cash
flows and the related notes 1 to 24. 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
Moorfields Eye Hospital NHS Foundation Trust, as a body, in accordance with paragraph 4 of
Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that
we might state to the boards those matters we are required to state to them in an auditor’s report
and for no other purpose. To the fullest extent permitted by law, we do not accept or assume
responsibility to anyone other than the trust and the boards as a body, for our audit work, for this
report, or for the opinions we have formed.
Respective responsibilities of the accounting officer and auditor
As explained more fully in the accounting officer’s responsibilities statement, the accounting officer
is responsible for the preparation of the financial statements and for being satisfied that they give a
true and fair view. Our responsibility is to audit and express an opinion on the financial statements
in accordance with applicable law, the audit code of NHS Foundation Trusts and International
Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing
Practices Board’s ethical standards for auditors.
Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in the financial statements
sufficient to give reasonable assurance that the financial statements are free from material
misstatement, whether caused by fraud or error. This includes an assessment of: whether the
accounting policies are appropriate to the trust’s circumstances and have been consistently applied
and adequately disclosed; the reasonableness of significant accounting estimates made by the
accounting officer; and the overall presentation of the financial statements. In addition, we read all
the financial and non-financial information in the annual report to identify material inconsistencies
with the audited financial statements. If we become aware of any apparent material misstatements
or inconsistencies we consider the implications for our report.
Opinion on financial statements
In our opinion the financial statements:
Give a true and fair view of the state of the trust’s affairs as at 31 March 2013 and of its income
and expenditure for the year then ended;
Have been properly prepared in accordance with the accounting policies directed by Monitor, the
independent regulator of NHS foundation trusts; and
Have been prepared in accordance with the requirements of the National Health Service Act 2006
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Opinion on other matters prescribed by the National Health Service
Act 2006
In our opinion:
The part of the directors’ remuneration report to be audited has been properly prepared in
accordance with the National Health Service Act 2006; and
The information given in the directors’ report for the financial year for which the financial
statements are prepared is consistent with the financial statements
Matters on which we are required to report by exception
We have nothing to report in respect of the following matters where the audit code for NHS
Foundation Trusts requires us to report to you if, in our opinion:
The annual governance statement does not meet the disclosure requirements set out in the NHS
Foundation Trust Annual Reporting Manual, is misleading or inconsistent with information of
which we are aware from our audit. We are not required to consider, nor have we considered,
whether the annual governance statement addresses all risks and controls or that risks are
satisfactorily addressed by internal controls;
Proper practices have not been observed in the compilation of the financial statements; or
The NHS foundation trust has not made proper arrangements for securing economy, efficiency
and effectiveness in its use of resources
Certificate
We certify that we have completed the audit of the accounts in accordance with the requirements
of chapter 5 of part 2 of the National Health Service Act 2006 and the audit code for NHS
Foundation Trusts.
Craig Wisdom, senior statutory auditor
For and on behalf of Deloitte LLP
Chartered accountants and statutory auditor
St Albans, UK
29 May 2013
115
116 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
5 Statement of comprehensive income
Income from activities
Note
31 March
2013
£’000s
31 March
2012
£’000s
2, 3.1–3.2
130,872
125,670
27,202
25,315
158,074
150,985
(151,665)
(143,128)
6,409
7,857
Other operating income
2, 3.3
Total income
Operating expenses
4–5
OPERATING SURPLUS
Finance income
6
52
52
Finance expense – financial liabilities
6
(446)
(505)
Finance expense – unwinding of discount on provisions
14
(5)
(5)
Public dividend capital dividends paid
19
(1,761)
(1,634)
4,248
5,764
(6,037)
3,137
(1,789)
8,901
SURPLUS FOR THE YEAR
Other comprehensive income
Revaluation (losses)/gains on property, plant and equipment
TOTAL COMPREHENSIVE INCOME FOR THE YEAR
All income and expenditure is derived from continuing operations.
Notes 1 to 24 form part of these accounts.
15
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 6 Statement of financial position
31 March 2013
£’000s
Note
1 April 2012
£’000s
NON-CURRENT ASSETS
7
2,179
794
8
74,724
80,337
10
–
153
76,903
81,283
9
3,205
3,252
Trade and other receivables
10
13,007
11,662
Other financial assets
11
Intangible assets
Property, plant and equipment
Trade and other receivables
TOTAL NON-CURRENT ASSETS
CURRENT ASSETS
Inventories
–
852
Cash and cash equivalents
20,609
18,527
TOTAL CURRENT ASSETS
36,821
34,294
CURRENT LIABILITIES
Trade and other liabilities
12
(26,871)
(21,255)
Borrowings
12
(447)
(1,721)
Provisions
14
(608)
(333)
(27,926)
(23,309)
85,798
92,268
TOTAL CURRENT LIABILITIES
TOTAL ASSETS LESS CURRENT LIABILITIES
NON-CURRENT LIABILITIES
Trade and other liabilities
12
(396)
(311)
Borrowings
12
(4,323)
(9,070)
Provisions
14
(151)
(171)
TOTAL NON-CURRENT LIABILITIES
(4,870)
(9,551)
TOTAL ASSETS EMPLOYED
80,928
82,716
FINANCED BY:
TAXPAYERS’ EQUITY
Public dividend capital
18
31,279
31,279
Revaluation reserve
15
3,743
9,912
Income and expenditure reserve
15
45,907
41,527
80,928
82,716
TOTAL TAXPAYERS’ EQUITY
The financial statements on pages 105 to 154 were approved by the board and signed on their
behalf by:
John Pelly, chief executive
28 May 2013
117
118 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
7 Statement of changes in taxpayers’ equity
Public
dividend
capital
£’000s
Revaluation
reserve
£’000s
Income and
expenditure
reserve
£’000s
Total
£’000s
31,279
9,912
41,527
82,717
Surplus for year
–
–
4,248
4,248
Revaluation losses on property, plant and
equipment
–
(6,037)
–
(6,037)
Other transfers between reserves
–
(132)
132
–
31,279
3,743
45,907
80,928
Public
dividend
capital
£’000s
Revaluation
reserve
£’000s
Income and
expenditure
reserve
£’000s
Total
£’000s
31,279
7,138
35,400
73,817
Surplus for year
–
–
5,764
5,764
Revaluation gains on property, plant and
equipment
–
3,137
–
3,137
Other transfers between reserves
–
(363)
363
–
31,279
9,912
41,527
82,717
At 1 April 2012
At 31 March 2013
At 1 April 2011
At 31 March 2012
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 8 Statement of cash flows
Operating surplus
2013
£’000s
2012
£’000s
6,409
7,857
5,462
5,118
330
987
(956)
(2,283)
47
(147)
5,425
981
41
28
256
(278)
17,014
12,262
52
52
852
(173)
(1,582)
(195)
Non-cash income and expense:
Depreciation and amortisation
Impairments
(Increase) in trade and other receivables
Decrease/(increase) in inventories
Increase in trade and other payables
Increase in other liabilities
Increase/(decrease) in provisions
NET CASH GENERATED FROM OPERATIONS
Cash flows from investing activities
Interest received
Purchase of financial assets
Purchase of intangible assets
Purchase of property, plant and equipment
(5,745)
(7,967)
Net cash used in investing activities
(6,423)
(8,284)
Loans repaid
(4,470)
(800)
Capital element of finance lease rental payments
(1,551)
(862)
(376)
(405)
(41)
(105)
Cash flows from financing activities
Interest paid
Interest element of finance leases
PDC dividend paid
(2,070)
(1,593)
Net cash used in financing activities
(8,508)
(3,767)
2,083
212
Cash and cash equivalents at 1 April
18,527
18,315
Cash and cash equivalents at 31 March
20,609
18,527
INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS
119
120 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
9 Notes to the accounts
1 Accounting policies and other information
Monitor has directed that the financial statements of NHS foundation trusts shall meet the
accounting requirements of the NHS Foundation Trusts Annual Reporting Manual (“FT ARM”),
which shall be agreed with HM Treasury. Consequently, the following financial statements have
been prepared in accordance with the FT ARM 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 (FReM) to the extent that they are meaningful and appropriate to NHS
foundation trusts. The accounting policies have been applied consistently in dealing with items
considered material in relation to the accounts.
1.1 Accounting convention
These accounts have been prepared under the historical cost convention modified to account for the
revaluation of property, plant and equipment and intangible assets.
NHS foundation trusts, in compliance with HM Treasury’s Financial Reporting Manual, are not
required to comply with the international accounting standard 33 requirements to report “earnings
per share” or historical cost profits and losses.
After making enquiries, 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.
1.2 Income
Income in respect of services provided is recognised when, and to the extent that, performance
occurs and is measured at the fair value of the consideration receivable. The main source of income
for the trust is contracts with commissioners in respect of healthcare services. Income is recognised
in the period in which services are provided. Where income is received for a specific activity which is
to be delivered in the following financial year, that income is deferred.
With regard to partially completed spells, if the trust can demonstrate that it is certain to receive
the income for a treatment or spell once the patient is admitted and treatment begins then the
income for that treatment or spell can start to be recognised at the time of admission and treatment
starting. Costs of treatment are then expensed as incurred. Income relating to those spells which are
partially completed at the financial year end should be apportioned across the financial years on a
pro rata basis. This basis may be the expected or actual length of stay or may be based on the costs
incurred over the length of the treatment. It is for the trust to establish a suitable pro rata basis, and
where material, disclose this in the accounting policy note.
Income from the sale of non-current assets is recognised only when all material conditions of sale
have been met, and is measured as the sums due under the sale contract.
1.3 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 the end of the period is recognised in the financial statements to the extent that
employees are permitted to carry forward leave into the following period.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Pension costs
Past and present employees are covered by the provisions of the NHS pension 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. It is not possible for the
NHS foundation trust to identify its share of the underlying scheme liabilities. Therefore, the scheme
is accounted for as 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 the operating expenses at the time the
trust commits itself to the retirement, regardless of the method of payment.
1.4 Expenditure on other goods and services
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 recognised in
operating expenses except where it results in the creation of a non-current asset such as property,
plant and equipment.
1.5 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;
Individual items have a cost of at least £5,000; or
Items form a group of assets which individually have a cost of more than £250, collectively have
a cost of at least £5,000, are functionally interdependent, have broadly simultaneous purchase
dates, are anticipated to have simultaneous disposal dates and are under single managerial
control; or
Items form part of the initial set-up cost of a new building or refurbishment of a ward or
operational 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 asset and bringing it to the location and condition
necessary for it to be capable of operating in the manner intended by management.
The carrying values of tangible fixed assets are reviewed for impairment in periods if events or
changes in circumstances indicate the carrying value may not be recoverable. The costs arising from
financing the construction of the fixed asset are not capitalised but are charged to the income and
expenditure account in the year to which they relate.
121
122 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
Significant land and buildings are revalued to current value using independent professional
valuations in accordance with international accounting standard 16 every five years. Annual desktop
valuations are also carried out. Full valuations were carried out on properties at 162 City Road, the
Richard Desmond Children’s Eye Centre (RDCEC) and pharmacy manufacturing unit during the year
ended 31 March 2013 with an effective date of 1 April 2013. A desktop valuation was carried out
on trust property at Northwick Park during the year ended 31 March 2013 with an effective date of
1 April 2013. The valuation was carried out by Gerald Eve, an external firm of chartered surveyors,
with the basis of valuation being modern equivalent asset.
Assets in the course of construction are valued at cost and are valued by independent professional
valuers as part of the annual or five-yearly valuations, or when they are brought into use.
Operational equipment is valued at historic cost. Equipment surplus to requirements is valued at its
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 subsequent expenditure enhances an asset beyond its original specification, the directly
attributable cost is added to the asset’s carrying value.
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 additional 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 plant and equipment are depreciated over their remaining useful economic lives on a
straight-line basis, which varies from five to 15 years.
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, installations and fittings are depreciated over the estimated remaining life of the asset as
assessed by the NHS foundation trust’s independent professional valuers. Leaseholds are depreciated
over the primary lease term.
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’.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Impairments
In accordance with the FT ARM, 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.
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.
De-recognition
Assets intended for disposal are reclassified as ‘held for sale’ once all of the following criteria are met:
The asset is available for immediate sale in its present condition subject only to terms which are
usual and customary for such sales;
The sale must be highly probable, ie:
–– Management are committed to a plan to sell the asset;
–– An active programme has begun to find a buyer and complete the sale;
–– The asset is being actively marketed at a reasonable price;
–– The sale is expected to be completed within 12 months of the date of classification as ‘held
for sale’; and
–– The actions needed to complete the plan indicate it is unlikely that the plan will be dropped
or significant changes made to it.
Following reclassification, the assets are measured at the lower of their existing carrying amount
and their ‘fair value less costs to sell’. Depreciation ceases to be charged and the assets are not
revalued, except where the ‘fair value less selling costs’ falls below the carrying amount. Assets are
de-recognised when all material sale contract conditions have been met.
Property, plant and equipment which is to be scrapped or demolished does not qualify for
recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s economic
life is adjusted. The asset is de-recognised when scrapping or demolition occurs.
Donated assets
Donated and grant funded property, plant and equipment assets are capitalised at their fair value on
receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a
condition that the future economic benefits embodied in the grant are to be consumed in a manner
specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried
forward to future financial years to the extent that the condition has not yet been met.
The donated and grant-funded assets are subsequently accounted for in the same manner as other
items of property, plant and equipment.
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1.6 Intangible assets
Recognition
Intangible assets are non-monetary assets without physical substance which are capable of being
sold separately from the rest of the trust’s business or which arise from contractual or other legal
rights.
They are recognised only where it is probable that future economic benefits will flow to, or service
potential be provided to, the trust for more than one year; where the cost of the asset can be
measured reliably; and where that cost is at least £5,000.
Software
Software which is integral to the operation of hardware e.g. an operating system, is capitalised as
part of the relevant item of property, plant and equipment. Software which is not integral to the
operation of hardware e.g. application software, is capitalised as an intangible asset.
Purchased computer software licences are capitalised as intangible fixed assets where expenditure of
at least £5,000 is incurred and amortised over the shorter of the term of the licence and their useful
economic lives.
Costs relating to internally generated software are capitalised as intangible fixed assets and
amortised over the anticipated useful economic life of the resulting software.
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.
Intangible fixed assets held for operational use are valued at historical cost and are amortised over
the estimated life of the asset on a straight-line basis. The carrying value of intangible assets is
reviewed for impairment at the end of the first full year following acquisition and in other periods if
events or changes in circumstances indicate the carrying value may not be fully recoverable.
Revaluations gains and losses and impairments are treated in the same manner as for property, plant
and equipment.
Intangible assets held for sale are measured at the lower of their carrying amount or ‘fair value less
costs to sell’.
1.7 Government grants
Government grants are grants from Government bodies other than income from primary care trusts
or NHS trusts for the provision of services. Where the Government grant is used to fund revenue
expenditure it is taken to the statement of comprehensive income to match that expenditure.
Where the grant is used to fund capital expenditure it is also taken to the statement of
comprehensive income in full, unless conditions are specified at the time of the grant which require
a certain usage profile over the life of the asset thus obtained.
1.8 Inventories
Inventories are valued at the lower of cost and net realisable value. The cost of inventories is
measured using the weighted average cost method within the pharmacy department, and the
first-in, first-out (FIFO) method for all other balances.
Work-in-progress comprises goods in intermediate stages of production.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Where an inventory is found to be obsolete or expired, the carrying value of that inventory is
immediately recognised as an expense.
1.9 Financial instruments and financial liabilities
Recognition
Financial assets and financial liabilities which arise from contracts for the purchase or sale of
non-financial items (such as goods or services), which are entered into in accordance with the
trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which,
performance occurs, i.e. when receipt or delivery of the goods or services is made.
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.
All other financial assets and financial liabilities are recognised when the 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 trust has transferred substantially all of the risks and rewards of ownership.
Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
Classification and measurement
Financial assets are categorised as loans and receivables, or ‘available-for-sale financial assets’.
Financial liabilities are classified as ‘other financial liabilities’.
Loans and receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments which
are not quoted in an active market. They are included in current assets.
The trust’s loans and receivables comprise: current investments, cash and cash equivalents, NHS
debtors, accrued income and ‘other debtors’.
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 where agreements with counterparties specify otherwise.
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
statement of financial position date, which are classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using the effective interest
method and charged to finance costs. Interest on financial liabilities taken out to finance property,
plant and equipment or intangible assets is not capitalised as part of the cost of those assets.
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Impairment of financial assets
At the statement of financial position date, the trust assesses whether any financial assets, other
than those held at ‘fair value through income and expenditure’ are impaired. Financial assets
are impaired and impairment losses are recognised if, and only if, there is objective evidence of
impairment as a result of one or more events which occurred after the initial recognition of the 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 directly.
1.10 Research and development
Expenditure on research is not capitalised. Expenditure on development is capitalised only where all
of the following can be demonstrated:
The project is technically feasible to the point of completion and will result in an intangible asset
for sale or use;
The trust intends to complete the asset and sell or use it;
The trust has the ability to sell or use the asset;
How the intangible asset will generate probable future economic or service delivery benefits
e.g. the presence of a market for it or its output, or where it is to be used for internal use, the
usefulness of the asset;
Adequate financial, technical and other resources are available to the trust to complete the
development and sell or use the asset; and
The trust can measure reliably the expenses attributable to the asset during development.
Expenditure so deferred is limited to the value of future benefits expected and is amortised
through the statement of comprehensive income on a systematic basis over the period expected
to benefit from the project. It is revalued on the basis of current cost. Expenditure which does not
meet the criteria for capitalisation is treated as an operating cost in the year in which it is incurred.
Where possible, NHS foundation trusts disclose the total amount of research and development
expenditure charged in the income and expenditure account separately. However, where research
and development activity cannot be separated from patient care activity it cannot be identified and
is therefore not separately disclosed.
Fixed assets acquired for use in a specific research and development project are amortised over the
life of that project.
1.11 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 the discount rates published and mandated by HM Treasury, except for early
retirement provisions and injury benefit provisions which both use the HM Treasury’s pension
discount rate of 2.9% (2011/12: 2.9%) in real terms.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 1.12 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 14 but is
not recognised in the NHS foundation trust’s accounts.
1.13 Non-clinical risk pooling
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 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.
1.14 Contingencies
Contingent assets (that is, assets arising from past events whose existence will only be confirmed by
one or more future events not wholly within the entity’s control) are not recognised as assets, but
would be disclosed as a note to the accounts where an inflow of economic benefits is probable. The
trust has no such assets as at 31 March 2013 or for reported prior years.
Contingent liabilities are not recognised, but would be disclosed as a note to the accounts, 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.
The trust has no such assets as at 31 March 2013 or for reported prior years.
1.15 Pension costs
Past and present employees are covered by the provisions of the NHS Pensions scheme. Details of
the benefits payable under these provisions can be found on the NHS Pensions website at www.
nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS
employers, general practices and other bodies, allowed under the direction of the Secretary of
State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS
bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is
accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating
in the scheme is taken as equal to the contributions payable to the scheme for the accounting
period.
The scheme is subject to a full actuarial valuation every four years by the Government actuary (until
2004, based on a five-year valuation cycle) and an accounting valuation every year.
The purpose of this valuation is to assess the level of liability in respect of the benefits due under
the scheme (taking into account its recent demographic experience), and to recommend the
contribution rates to be paid by employers and scheme members. The latest published valuation,
which determined current contribution rates, covered the period from 1 April 1999 to 31 March
2004.
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128 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of
£3.3 billion against the notional assets as at 31 March 2004. However, after taking into account the
changes in the benefit and contribution structure effective from 1 April 2008, the scheme actuary
reported that employer contributions could continue at the existing rate of 14% of pensionable
pay, and that the scheme operates on a sound financial basis. On advice from the scheme actuary,
scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities.
Up to 31 March 2008, the vast majority of employees paid contributions at the rate of 6% of
pensionable pay. From 1 April 2008, employees’ contributions are on a tiered scale from 5% up to
10.9% of their pensionable pay depending on total earnings.
Scheme provisions as at 31 March 2008
The scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th of the best
of the last three years’ pensionable pay for each year of service. A lump sum normally equivalent to
three years’ pension is payable on retirement.
Scheme provisions from 1 April 2008
The scheme is a final salary scheme and is split into two pension ‘sections’:
The “1995 section”, which has an annual pension based on the 1/80th of the best of the last
three years’ service and a lump sum normally equivalent to three years’ pension for staff with
pensionable service pre-April 2008 and less than a five-year gap in service.
The “2008 section” which has an annual pension based on 1/60th of the best three out of the
last 10 years’ pensionable pay for each year of service; no lump sum is payable on retirement
General
Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act
1971, and are based on changes in retail prices in the 12 months ending 30 September in the
previous calendar year. This was based on consumer prices with effect from 1 April 2012.
Early payment of a pension, with enhancement, is available to members of the scheme who are
permanently incapable of fulfilling their duties effectively through mental or physical infirmity.
A death gratuity is payable for death in service or after retirement, the terms of which differ
depending on the section to which the member belonged.
For early retirements other than those due to ill health, the additional pension liabilities are not
funded by the scheme. The full amount of the liability for the additional costs is charged to the
income and expenditure account at the time the trust commits itself to the retirement, regardless of
the method of payment.
The scheme provides the opportunity to members to increase their benefits through money
purchase additional voluntary contributions provided by an approved panel of life companies. Under
the arrangement, employees can make additional contributions to enhance their pension benefits.
The benefits payable relate directly to the value of the investments made.
Scheme members have the option to transfer their pension between the NHS pension scheme and
another scheme when they move into or out of NHS employment.
Where a scheme member ceases NHS employment with more than two years’ service they can
preserve their accrued NHS pension for payment when they reach the scheme’s retirement age.
Where a scheme member is made redundant they may be entitled to early receipt of their pension
plus enhancement, at the employer’s cost.
Further details of both schemes, including the changes made in 2008, can be found on the NHS
Pensions website at www.nhsbsa.nhs.uk/pensions.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 1.16 Value added tax (VAT)
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.
1.17 Foreign exchange
The functional and presentational currencies of the trust are sterling, with the exception of the
branch office in Moorfields Dubai. The functional currency of Moorfields Dubai is United Arab
Emirates dirhams and the presentational currency is sterling.
A transaction which is denominated in a foreign currency is translated into the functional currency
at the spot exchange rate on the date of the transaction. Where the trust has assets or liabilities
denominated in a foreign currency at the statement of financial position date:
Monetary items (other than financial instruments measured at ‘fair value through income and
expenditure’) are translated at the spot exchange rate on 31 March;
Non-monetary assets and liabilities measured at historical cost are translated using the spot
exchange rate at the date of the transaction; and
Non-monetary assets and liabilities measured at fair value are translated using the spot exchange
rate at the date the fair value was determined.
Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the statement of financial position date) are recognised in income or expense in the period
in which they arise.
Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner
as other gains and losses on these items.
1.18 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, where
they exist they would be disclosed in a separate note to the accounts in accordance with the
requirements of HM Treasury’s Financial Reporting Manual.
1.19 Leases
Finance leases
Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS
foundation trust, the asset is recorded as property, plant and equipment and a corresponding
liability is recorded. The value at which both are recognised is the lower of the fair value of the asset
or the present value of the minimum lease payments, discounted using the interest rate implicit in
the lease.
The asset and liability are recognised at the commencement of the lease. Thereafter the asset is
accounted for as an item of property, plant and equipment.
The annual rental is split between the repayment of the liability and a finance cost so as to achieve
a constant rate of finance over the life of the lease. The annual finance cost is charged to finance
costs in the statement of comprehensive income. The lease liability is de-recognised when the
liability is discharged, cancelled or expires.
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130 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
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.
Leases of land and buildings
Where a lease is for land and buildings, the land component is separated from the building
component and the classification for each is assessed separately.
1.20 Public dividend capital
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of
assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has
determined that PDC is not a financial instrument within the meaning of IAS 32.
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.
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, excluding cash
balances held in GBS accounts that relate to a short-term working capital facility, and (iii) any PDC
dividend balance receivable or payable.
In accordance with the requirements laid down by the Department of Health (as the issuer of PDC),
the dividend for the year is calculated on the actual average relevant net assets as set out in the
‘pre-audit’ version of the annual accounts. The dividend thus calculated is not revised should any
adjustment to net assets occur as a result of the audit of the annual accounts.
1.21 Corporation tax
Corporation tax is payable on non-patient related healthcare profits over a value of £50,000.
Moorfields Eye Hospital NHS Foundation Trust has no non-patient healthcare related activities.
1.22 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).
However, the losses and special payments note is compiled directly from the losses and compensations
register which reports on an accrual basis with the exception of provisions for future losses.
1.23 Critical accounting judgements and key sources of estimation
uncertainty
In the application of the trust’s accounting policies the directors are required to make judgements,
estimates and assumptions about the carrying amounts of assets and liabilities that are not readily
apparent from other sources. The estimates and associated assumptions are based on historical
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 experience and other factors that are considered to be relevant. Actual results may differ from
these estimates.
The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to
accounting estimates are recognised in the period in which the estimate is revised if the revision
affects only that period, or in the period of the revision and future periods if the revision affects
both current and future periods.
1.24 Accounting standards issued but not yet effected
The following standards, amendments and interpretations have been issued by the International
Accounting Standards Board (IASB) and the International Financial Reporting Interpretations
Committee (IFRIC) but are not yet required to be adopted or are not yet effective:
Change published
Published by
IASB
Financial year for which the change first applies
IFRS 9 Financial instruments
Financial assets:
Financial liabilities:
November 2009
October 2010
Uncertain. Not likely to be adopted by the
EU until the IASB has finished the rest of its
financial instruments project
IFRS 10 Consolidated financial statements: May 2011
Effective date of 2013/14 but not yet
adopted by EU
IFRS 11 Joint arrangements
May 2011
Effective date of 2013/14 but not yet
adopted by EU
IFRS 12 Disclosure of interests in other
entities
May 2011
Effective date of 2013/14 but not yet
adopted by EU
IFRS 13 Fair value measurement
May 2011
Effective date of 2013/14 but not yet
adopted by EU
IAS 12 Income taxes amendment
December 2010
Effective date of 2013/14 but not yet
adopted by EU
IAS 1 Presentation of financial
statements, on other comprehensive
income (OCI)
June 2011
Effective date of 2013/14 but not yet
adopted by EU
IAS 27 Separate financial statements
May 2011
Effective date of 2013/14 but not yet
adopted by EU
IAS 28 Associates and joint ventures
May 2011
Effective date of 2013/14
IAS 19 (Revised 2011) Employee benefits
June 2011
Effective date of 2013/14 but not yet
adopted by EU
IAS 32 Financial instruments:
Presentation – Amendment
Offsetting Financial assets and liabilities:
December 2011
Effective date of 2013/14 but not yet
adopted by EU
IAS 7 Financial instruments:
Disclosures – Amendment
Offsetting Financial assets and liabilities:
December 2011
Effective date of 2013/14 but not yet
adopted by EU
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132 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
2 Segmental analysis
The trust has four reportable segments – Moorfields Private, Moorfields Dubai, Moorfields
Pharmaceuticals, and NHS activity
2012/13
NHS
£’000s
Moorfields
Private
£’000s
Moorfields
Dubai
£’000s
Moorfields
Pharmaceuticals
£’000s
Intra-trust
elimination
£’000s
Total
£’000s
113,461
11,645
5,766
835
(835)
130,872
Income by segment
Income from activities
Other operating income
Operating and other
expenditure
Surplus for the year
2011/12
15,954
1,820
–
9,428
–
27,202
129,415
13,465
5,766
10,263
(835)
158,074
(129,616)
(10,624)
(5,370)
(9,051)
835
(153,826)
(201)
2,841
396
1,212
–
4,248
NHS
£’000s
Moorfields
Private
£’000s
Moorfields
Dubai
£’000s
Moorfields
Pharmaceuticals
£’000s
Intra-trust
elimination
£’000s
Total
£’000s
108,903
11,911
4,856
998
(998)
125,670
15,996
1,180
–
8,139
–
25,315
124,899
13,091
4,856
9,137
(998)
150,985
(122,968)
(10,453)
(4,594)
(8,204)
998
(145,221)
1,931
2,638
262
933
–
5,764
Income by segment
Income from activities
Other operating income
Operating and other
expenditure
Surplus for the year
Where possible, income and expenditure has been directly attributed to each of the four segments.
No segment information on the statement of financial position is presented routinely to
management and is not disclosed here. Where balances were not directly attributable to segments,
the following allocation bases were used for material items:
Pharmacy: proportion of issues to each segment
Estates and central overheads: floor space occupied by each segment
Theatres: activity levels attributable to each segment
Stores and supplies: proportion of orders made by each segment
Information technology and personnel: headcount
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 3 Income
3.1 Income from activities by type
2012/13
£’000s
2011/12
£’000s
26,442
28,774
4,501
4,085
44,460
37,991
7,685
8,043
Total income at tariff
83,088
78,893
Non-tariff NHS income
28,553
28,830
Private patient income
19,231
17,947
130,872
125,670
2012/13
£’000s
2011/12
£’000s
375
339
6,346
4,379
103,705
95,615
_
6,272
19,231
17,947
237
178
Elective income
Non-elective income
Outpatient income
A&E income
3.2 Income from activities by source
NHS foundation trusts
NHS trusts
Primary care trusts
Other NHS
Non NHS:
–– Total private patients activity
–– Overseas patients (non-reciprocal)
978
940
130,872
125,670
2012/13
£’000s
2011/12
£’000s
10,013
7,040
3,875
3,288
768
2,854
Pharmaceutical drugs sales
9,427
7,970
Other income
3,119
4,163
27,202
25,315
–– Other
3.3 Other operating income
Research and development
Education and training
Charitable and other contributions to expenditure
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134 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
3.4 Income from the provision of goods and services
2012/13
£’000s
133,541
NHS income
22,834
Non-NHS income
1,699
Other income
158,074
14.60%
Ratio of ‘Non-NHS income’ to ‘income from the provision of goods and services’
Private patient income is equal to the aggregate of services delivered to private patients through
Moorfields Private, Moorfields Dubai, and sales apportionment within Moorfields Pharmaceuticals.
The statutory limitation on private patient income in section 44 of the NHS Act 2006 was repealed
with effect from 1 October 2012 by the Health and Social Care Act 2012. The financial statements
disclosures that were provided previously are no longer required.
Section 43(2A) of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) requires
that the income from the provision of goods and services for the purposes of the health service in
England must be greater than its income from the provision of goods and services for any other
purposes.
Moorfields Eye Hospital NHS Foundation Trust has met this requirement in 2011/12 and 2012/13.
3.5 Income by protected and non-protected services
Protected income
Non-protected income
2012/13
£’000s
2011/12
£’000s
113,461
108,903
44,613
42,082
158,074
150,985
Protected services are those that are required for the mandatory provision of healthcare services.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 4 Operating expenses
4.1 Operating expenses comprise:
2012/13
£’000s
2011/12
£’000s
301
1,098
2,495
4,183
Services from other NHS bodies
202
424
Purchase of healthcare from non-NHS bodies
872
–
1,049
892
Services from NHS foundation trusts
Services from NHS trusts
Employee expenses – executive directors
100
72
Employee expenses – staff
85,497
80,049
Drug costs
17,947
15,449
Supplies and services – clinical (excluding drug costs)
11,865
11,914
Employee expenses – non-executive directors
940
889
Establishment
4,053
2,953
Transport
2,283
1,976
Premises
12,156
13,053
1,510
1,459
(74)
64
5,328
5,008
Amortisation on intangible assets
133
110
Impairments of property, plant and equipment
Supplies and services – general
Lease rental
Increase in bad debt provision
Depreciation on property, plant and equipment
330
987
Audit services – statutory audit
83
76
Audit services – taxation
68
147
–
10
Clinical negligence insurance premium
628
903
Legal fees
263
224
Training, courses and conferences
623
462
3,012
727
151,665
143,128
Audit services – other
Other
135
136 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
4.2 Operating lease rentals
4.2.1 Operating expenses include:
2012/13
£’000s
2011/12
£’000s
1,510
1,459
1,510
1,459
2012/13
£’000s
2011/12
£’000s
Within one year
1,505
1,449
Between one and five years
1,399
1,756
After five years
1,500
1,398
4,403
4,603
Other operating lease rentals
4.2.2 Total future lease payments:
At the balance sheet date, the trust had outstanding commitments for future
minimum lease payments under non-cancellable operating leases, which fall
due as follows:
4.2.3 Salary and pension entitlements of the board of directors
(a) Remuneration – 2012/13
2012/13
Executive salary
(bands of £5,000)
£’000s
Clinical/research
salary
(bands of £5,000)
£’000s
Total
entitlement
£’000s
Mr J Pelly – chief executive
155 – 160
–
155 – 160
Mr C Nall – finance director
120 – 125
–
120 – 125
Mr D Flanagan – medical director(3)
35 – 40
95 – 100
135 – 140
Prof P Khaw – research director
30 – 35
185 – 190
215 – 220
Ms T Luckett – director of nursing and
allied health professions
85 – 90
–
85 – 90
Ms R Russell – chief operating officer(1)
105 – 110
–
105 – 110
Mr R Markham – chairman(2)
30 – 35
–
30 – 35
Prof P Luthert – non-executive director
15 – 20
–
15 – 20
Ms D Harris-Ugbomah – non-executive director
15 – 20
–
15 – 20
Sir R Jackling – non-executive director
20 – 25
–
20 – 25
Mr A Nebel – non-executive director
15 – 20
–
15 – 20
Ms L Potter – non-executive director
10 –15
–
10 – 15
Mr S Williams – non-executive director(4)
10 – 15
–
10 – 15
Name and title
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Remuneration – 2011/12
2011/12
Executive salary
(bands of £5,000)
£’000s
Clinical/research
salary
(bands of £5,000)
£’000s
Total
entitlement
£’000s
Mr J Pelly – chief executive
155 – 160
–
155 – 160
Mr C Nall – finance director
120 – 125
–
120 – 125
Mr D Flanagan – medical director(3)
30 –35
125 – 130
155 – 160
Prof P Khaw – research director
30 –35
185 – 190
215 – 220
Ms T Luckett – director of nursing and
allied health professions(1)
80 – 85
–
80 – 85
Ms R Russell – chief operating officer(1)
0–5
–
0–5
Mr R Markham – chairman(2)
35 – 40
–
35 – 40
Prof P Luthert – non-executive director
15 – 20
–
15 – 20
Ms D Harris-Ugbomah – non-executive director
15 – 20
–
15 – 20
Sir R Jackling – non-executive director
15 – 20
–
15 – 20
Mr A Nebel – non-executive director
10 – 15
–
10 – 15
Ms L Potter – non-executive director
10 – 15
–
10 – 15
0–5
–
0–5
Name and title
Mr S Williams – non-executive director(4)
(1) The chief operating and nursing officer post carried executive director status. Ms R Russell covered the post on an interim basis until 27
May 2010. Subsequently the board created the roles of chief operating officer and director of nursing and allied health professions on 27
January 2011. The latter post carried executive director status from this date. The chief operating officer’s post carried executive director status
from 15 March 2012.
(2) Mr R Markham waived his remuneration in 2011/12 and 2012/13, and requested that this be donated for use within Moorfields Eye
Hospital charities.
(3) Mr D Flanagan ceased employment with Moorfields Eye Hospital on 6 March 2012, and re-commenced employment with Moorfields Eye
Hospital on 19 March 2012 on revised terms and conditions.
(4) Mr S Williams commenced 15 March 2012.
137
138 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
(b) Pension benefits
Value of
automatic lump
sums at
31 March 2013
(bands of £2,500)
£’000s
Real increase in
year in the value
of automatic lump
sums
(bands of £2,500)
£’000s
Cash equivalent
transfer value at
31 March 2013
(bands of £1,000)
£’000s
Real increase in
cash equivalent
transfer value in
2012/13
(bands of £1,000)
£’000s
Mr J Pelly – chief executive
120.0 – 122.5
7.5 – 10.0
Nil
N/A
Mr C Nall – finance director
Nil
Nil
59 – 60
25 – 26
Ms T Luckett – director of
nursing and allied health
professions
82.5 – 85.0
5.0 – 7.5
456 – 457
45 – 46
102.5 – 105.0
7.5 – 10.0
618 – 619
69 – 70
Name and title
Ms R Russell – chief
operating officer
Prof P Khaw is not a member of the NHS pension scheme.
Mr D Flanagan ceased to be a member of the NHS pension scheme during 2011/12.
Mr J Pelly remains a member of the NHS pension scheme but during 2012/13 reached the age at which scheme transfers are no longer
possible, therefore the cash equivalent transfer value is now nil.
Non-executive directors do not receive pensionable remuneration.
A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accumulated by a member at
a particular point in time. The benefits valued are the member’s accumulated benefits and any contingent spouse’s pension payable from the
scheme.
CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
The real Increase in CETV reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension
due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or
arrangement) and uses common market valuation factors for the start and end of the period.
The value of trust contributions to the NHS pension scheme in 2012/13 in respect of executive directors was £94,515 (2011/12: £96,902).
4.2.4 Hutton disclosure
Government bodies are required to disclose the ratio of remuneration received by the highest paid
director of the trust to the median remuneration of all staff at the trust.
Two directors receive remuneration for clinical or research activities, and this has been excluded from
the assessment of executive remuneration. Therefore, for the purposes of this disclosure, the trust
has used the total remuneration of the chief executive as the highest paid director.
The median remuneration of all staff as at 31 March 2013 at the trust was £33,146 (2011/12:
£33,154). The remuneration of the highest paid director was £157,500 (2011/12: £157,500)
[mid-point of declared remuneration in note 4.2.3]. The required ratio was therefore 4.75:1
(2011/12: 4.75:1).
4.2.5 Expenses paid to executive directors and governors
Total out-of-pocket expenses paid to governors of the trust in 2012/13 were £2,305 (2011/12
£1,338).
Total out-of-pocket expenses paid to the directors shown in note 4.2.3 in 2012/13 were £4,415
(2011/12 £3,135).
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 5 Employee expenses and costs
5.1 Employee expenses
Total
2012/13
£’000s
Permanently
employed
2012/13
£’000s
Other
2012/13
£’000s
2011/12
£’000s
Salaries and wages
66,766
66,766
–
62,759
Social security costs
5,662
5,662
–
5,338
Employer contributions to NHSPA
6,896
6,896
–
6,495
302
302
7,422
–
7,422
6,447
87,048
79,626
7,422
81,039
Total
2012/13
Number
Permanently
employed
2012/13
Number
Other
2012/13
Number
2011/12
Number
Medical
329
329
–
257
Administration and estates
582
582
–
562
77
77
–
63
338
338
–
370
Scientific, therapeutic and technical staff
271
271
–
245
Agency staff
156
–
156
135
1,752
1,596
156
1,633
2012/13
£’000s
2011/12
£’000s
30
26
30
26
Termination benefits
Agency staff
5.2 Average number of employees
Healthcare assistants and other support staff
Nursing, midwifery and health visiting staff
Total
5.3 Employee benefits
Various employee taxable benefits in kind
5.4 Retirements due to ill-health
During 2012/13, there were no early retirements on ill-health grounds (2011/12: nil), at a cost of
£nil (2011/12: nil). This information has been supplied by the NHS Pensions Agency.
139
140 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
6 Interest
6.1 Finance income
2012/13
£’000s
2011/12
£’000s
49
44
3
8
52
52
2012/13
£’000s
2011/12
£’000s
394
400
52
105
446
505
Interest on loans and receivables
Interest on held-to-maturity financial assets
Total
6.2 Finance expense – financial liabilities
Loans from Foundation Trust Financing Facility
Finance leases
Total
7 Intangible assets
Gross cost at 1 April 2012
Additions – purchased
Gross cost at 31 March 2013
Licences and
trademarks
£’000s
Information
technology
(internally
generated)
expenditure
£’000s
Development
expenditure
£’000s
Total
£’000s
1,198
–
425
1,623
560
927
95
1,582
1,758
927
520
3,204
Amortisation at 1 April 2012
432
–
397
829
Provided during the year
124
52
20
196
Accumulated amortisation at
31 March 2013
556
52
417
1,025
763
–
28
791
2
–
–
2
766
–
28
794
1,199
875
103
2,177
Net book value
– Purchased at 31 March 2012
– Donated at 31 March 2012
– Total at 31 March 2012
– Purchased at 31 March 2013
– Donated at 31 March 2013
– Total at 31 March 2013
2
–
–
2
1,201
875
103
2,179
During the course of the year the costs of an internally-developed patient records management system
(OpenEyes) were capitalised. These costs are shown in note 7 as ‘information technology (internally
generated)’.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 8 Property, plant and equipment
8.1 Tangible fixed assets at the balance sheet date comprise the
following elements:
Land
£000
Cost or valuation at 1 April 2012 11,300
Plant and Transport Information
Buildings machinery equipment technology
£000
£000
£000
£000
62,686
26,934
5
8,842
Furniture
and
fittings
£000
Total
£000
1,060 110,827
Additions purchased
–
2,685
2,366
–
627
206
5,884
Additions donated
–
–
136
–
–
–
136
390
(6,427)
–
–
–
– (6,037)
11,690
58,944
29,436
5
9,469
1,266 110,810
Depreciation at 1 April 2012
–
6,196
16,631
5
7,123
535 30,491
Provided during the year
–
2,013
2,261
1
859
132
5,265
Impairment recognised in
operating expenses
–
330
–
–
–
–
330
Accumulated depreciation
at 31 March 2013
–
8,539
18,892
5
7,982
667 36,086
376 64,603
Gains/(losses) on revaluation
At 31 March 2013
11,300
42,845
8,363
1
1,718
––Finance lease at 31 March
2012
––Purchased at 31 March 2012
–
–
894
–
–
––Donated at 31 March 2012
–
13,645
1,046
–
1
148 14,840
Total at 31 March 2012
11,300
56,490
10,303
1
1,719
524 80,337
––Purchased at 31 March 2013
11,690
38,404
8,949
–
1,487
482 61,012
–
–
656
–
–
–
12,001
940
–
–
117 14,840
11,690
50,405
10,544
–
1,487
599 74,724
––Finance lease at 31 March 2013
––Donated at 31 March 2013
Total at 31 March 2013
–
894
–
656
During the course of 2011/12, building work at the trust’s satellite site at Northwick Park was completed and fully
transferred from ‘assets under construction’ to ‘buildings’. Where the trust has received donated assets or funds to
purchase assets, no conditions attach to those donations beyond a requirement to purchase the specified assets.
8.2 Analysis of protected and unprotected tangible fixed assets
Land
£000
Plant and Transport Information
Buildings machinery equipment technology
£000
£000
£000
£000
Furniture
and
fittings
£000
Total
£000
Net book value
––Protected assets at
31 March 2013
––Unprotected assets at
31 March 2013
Total at 31 March 2013
10,620
43,643
–
–
–
–
54,263
1,070
6,762
10,544
–
1,487
599
20,462
11,690
50,405
10,544
–
1,487
599
74,724
Protected assets are those that are required for the mandatory provision of healthcare services.
141
142 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
9 Inventories
Raw materials and consumables
31 March
2013
£’000s
31 March
2012
£’000s
380
421
29
68
Finished goods
2,796
2,763
TOTAL
3,206
3,252
Work in progress
The value of inventories recognised in expenses during 2012/13 was £30,689,000 (2010/11:
£27,906,000).
10 Receivables
10.1 Trade receivables
31 March
2013
£’000s
31 March
2012
£’000s
9,423
7,822
Current:
NHS debtors
(3,652)
(3,846)
Other prepayments and accrued income
2,069
1,963
Other debtors
5,167
5,724
13,007
11,662
–
153
13,007
11,815
Provision for irrecoverable debts
Sub total
Non-current:
NHS debtors
TOTAL
10.2 Provision for impaired receivables
31 March
2013
£’000s
31 March
2012
£’000s
Balance at 1 April
3,846
3,840
Increase in provision for debtors impairment
3,653
3,846
Debtors written off during year as uncollectable
Unused provision reversed
Balance at 31 March
(120)
(58)
(3,726)
(3,782)
3,652
3,846
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 10.3 Analysis of impaired debtors
31 March
2013
£’000s
31 March
2012
£’000s
304
1,548
Ageing of doubtful debtors
Up to three months
719
929
Over six months
2,628
1,368
Total
3,652
3,846
31 March
2013
£’000s
31 March
2012
£’000s
Up to three months
537
1,180
Three to six months
297
273
Over six months
497
20
1,331
1,472
In three to six months
Ageing of non-provided debtors past their due date
Total
The provision for impaired receivables is determined initially within operating segments, i.e. NHS,
Non-NHS, Moorfields Pharmaceuticals, Moorfields Private, and Moorfields Dubai.
The provision for impaired receivables is inherently uncertain, as debts known with certainty to be
irrecoverable are written off rather than provided for.
Assessments are made of the overall level of disputed debt, the overall level of aged debt, and
factors specific to individual debtors where appropriate. A combination of these factors is used to
arrive at an opinion as to the recoverability of debts and the provisions therein.
11 Other financial assets
31 March
2013
£’000s
31 March
2012
£’000s
852
679
Additions
–
173
Disposals
(852)
–
–
852
Held to maturity investments
Balance at 1 April
Balance at 31 March
143
144 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
12 Trade and other liabilities
12.1 Trade and other liabilities are made up of:
31 March
2013
£’000s
31 March
2012
£’000s
1,989
2,472
Amounts falling due within one year:
NHS creditors
Tax and social security costs
2,705
2,494
Receipts in advance
3,808
2,861
202
1,266
Other creditors
8,830
7,695
Accruals
6,762
1,774
–
74
2,573
2,618
26,871
21,255
Other trade payables
396
311
Sub total
396
311
27,267
21,566
Capital creditors
PDC payable
Deferred income
Sub total
Amounts falling due after more than one year:
TOTAL
The Better Payment Practice Code requires the trust to aim to pay all undisputed invoices by the due
date or within 30 days of receipt of goods or a valid invoice, whichever is later. The trust achieves
this aim for all but a small number of cases, and works with staff and suppliers throughout the year
to minimise this number.
12.2 Borrowings are made up of:
31 March
2013
£’000s
31 March
2012
£’000s
447
800
–
921
447
1,721
4,323
8,442
–
628
Amounts falling due within one year:
Loans
Obligations under finance leases
Amounts falling due after more than one year:
Loans
Obligations under finance leases
TOTAL
4,323
9,070
4,770
10,791
All outstanding finance leases were settled in full prior to the end of 2012/13.
The trust repaid two loans from the Foundation Trust Financing Facility during 2012/13 (see note
12.3).
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 12.3 Loans
31 March
2013
£’000s
31 March
2012
£’000s
447
800
Amounts falling due:
In one year or less
Between one and two years
447
800
Between two and five years
957
1,889
Over five years
2,918
5,753
TOTAL
4,770
9,242
– wholly repayable within five years
1,852
3,490
– wholly repayable after five years, by instalments
2,918
5,753
4,770
9,242
of which:
The trust has one loan from the Foundation Trust Financing Facility of £4,769,880. The trust is
paying the loan in three tranches. Tranche A of the loan is for £1,159,262, with an interest rate of
4.5%. Tranche B of this loan is for £362,269 with an interest rate of 4.45%. Tranche C of this loan
is for £3,248,348, with an interest rate of 4.4%. Capital of £447,160 is being repaid in instalments
each year and the loan will be redeemed in 2031.
Payments are fixed in value for the duration of the loan and the tranches within it.
The trust repaid two loans from the Foundation Trust Financing Facility during 2012/13, prior to
their full term:
£3,200,000: The trust was paying this loan in two tranches. Tranche A of this loan was for
£640,000, with an interest rate of 4.65%. Tranche B of this loan was for £2,560,000 with an
interest rate of 4.6%. Outstanding capital of £3,200,000 was fully repaid in December 2012.
£646,620: The trust was paying this loan in one tranche, with an interest rate of 5.05%.
Outstanding capital of £646,620 was fully repaid in December 2012.
13 Finance lease obligations
31 March
2013
£’000s
31 March
2012
£’000s
– within one year
–
981
Amounts falling due:
– between one and five years
–
682
– later than five years
–
–
Sub total
–
1,663
Finance charges allocated to future periods
–
(114)
Net obligations
–
1,549
All outstanding finance leases were settled in full prior to the end of 2012/13.
145
146 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
14 Provisions for liabilities
Pensions
relating
to former
directors
£’000s
Pensions
relating to
other staff
£’000s
Other
£’000s
Total
£’000s
85
108
311
504
Arising during the year
–
–
585
585
Utilised during the year
(12)
(11)
(311)
(334)
Unwinding of discount
2
3
–
5
At 1 April 2012
–
–
–
0
At 31 March 2013
75
99
585
759
At 1 April 2011
94
115
573
782
Reversed during the year
Arising during the year
–
–
425
425
Utilised during the year
(11)
(11)
(339)
(361)
Unwinding of discount
2
3
–
5
Reversed during the year
–
–
(347)
(347)
85
108
311
504
Within one year
12
11
585
608
Between one and five years
48
46
–
94
After five years
15
42
–
57
At 31 March 2013
75
99
585
760
At 31 March 2012
Expected timing of cashflows:
Pensions provisions relate to pre-1995 pension-related costs on early retirements.
‘Other’ opening balance 2011/12 refers to a HMRC provision for VAT claims for current and prior
years. This provision was extended and then subsequently settled in-year.
‘Other’ opening balance 2012/13 refers to a £68k provision under the carbon reduction
commitment, and £243k for an additional staff payment made in 2012/13 and relating to service in
2011/12.
‘Other’ closing balance 2012/13 refers to a £585k general provision for administrative and clerical pay.
£1,301,930 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, £582,000).
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 15 Movements on reserves
Movements on reserves in the year comprised the following:
At 1 April 2012
Transfer from the income and expenditure account
Revaluation gains on property, plant and equipment
Revaluation
reserve
£’000s
Income and
expenditure
reserve
£’000s
Total
£’000s
9,912
41,527
51,439
–
4,248
4,248
(6,037)
–
(6,037)
Other transfers between reserves
(132)
132
–
At 31 March 2013
3,743
45,907
49,650
At 1 April 2011
7,138
35,400
42,538
–
5,765
5,765
Transfer from the income and expenditure account
Revaluation (losses) on property, plant and equipment
3,137
–
3,137
Other transfers between reserves
(363)
363
–
At 31 March 2012
9,912
41,527
51,439
At 31 March
2012
£’000s
Cash
changes
in year
£’000s
At 31 March
2013
£’000s
16 Analysis of changes in net debt
1,573
2,443
4,016
16,954
(362)
16,592
(800)
353
(447)
Debt due after one year
(8,442)
4,119
(4,323)
Finance leases
(1,549)
1,549
–
Commercial cash at bank and in hand
Government Banking Service cash at bank
Debt due within one year
Other financial assets
852
(852)
–
8,588
7,250
15,838
147
148 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
17 Capital commitments
Commitments under capital expenditure contracts as at 31 March 2012 were £1,444,000 (2011/12:
£1,342,000).
2012/13
£’000s
2011/12
£’000s
Authorised
1,199
1,199
Authorised and committed
1,444
1,342
2,643
3,333
2012/13
£’000s
2011/12
£’000s
18 Movement in public dividend capital
Public dividend capital as at 1 April
31,279
31,279
Public dividend capital as at 31 March
31,279
31,279
2012/13
£’000s
2011/12
£’000s
6,009
7,398
(1,761)
(1,634)
current asset investments
(6,037)
3,137
Net increase in taxpayers' equity
(1,788)
8,901
Opening taxpayers' equity
82,717
73,816
Closing taxpayers' equity
80,928
82,717
19 Movement in taxpayers’ equity
Surplus for the financial year
Public capital dividends payable
Surplus/(deficit) on revaluations of fixed assets and
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 149
20 Financial performance
20.1 Public dividend capital dividend
The trust is required to make a public dividend capital dividend at a rate of 3.5% of average relevant
net assets.
In 2012/13 average relevant net assets totalled £50,307,000 (2011/12: £46,743,000) and a dividend
of £1,761,000 was calculated (2011/12: £1,634,000).
20.2 Performance against prudential borrowing limit
The NHS foundation trust is required to comply and remain within a prudential borrowing limit. This
is made up of two elements:
1. 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.
2. The amount of any working capital facility approved by Monitor.
Further information on the NHS foundation trust prudential borrowing code and compliance
framework can be found on the website of Monitor, the independent regulator of foundation trusts.
The trust had a prudential borrowing limit of £26,300,000 in 2012/13 (2011/12: £27,300,000). The
trust has not drawn down further borrowings in 2012/13 (2011/12: £nil). Total borrowings are shown
in note 12.2.
Performance against the approved prudential borrowing limit (PBL) ratios is shown below:
Financial ratios 2012/13
Actual ratios
Approved PBL ratios
Minimum dividend cover
6.48
>1x
Minimum interest cover
25.44
>3x
Minimum debt service cover
6.27
>2x
Maximum debt service to revenue
1.2%
>2.5%
Financial ratios 2011/12
Actual ratios
Approved PBL ratios
Minimum dividend cover
7.63
>1x
Minimum interest cover
24.52
>3x
Minimum debt service cover
5.86
>2x
Maximum debt service to revenue
1.4%
>2.5%
The trust has an approved working capital facility of £6,000,000 (2011/12: £6,000,000).
150 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
21 Related party transactions
Moorfields Eye Hospital NHS Foundation Trust is a public benefit corporation established under the
Health and Social Care (Community Health and Standards) Act 2003.
During the year none of the board members or members of the key management staff, or parties
related to them, has undertaken any material transactions with Moorfields Eye Hospital NHS
Foundation Trust other than their employment remuneration where applicable.
The Department of Health is regarded as a related party. During the year Moorfields Eye Hospital
NHS Foundation Trust has had a significant number of material transactions with the department,
and with other entities for which the department is regarded as the parent company.
The trust has also had a significant number of material transactions with the Friends of Moorfields,
Special Trustees of Moorfields Eye Hospital, and the Moorfields Eye Charity (which combined with
the Moorfields Eye Hospital Development Fund in March 2011). These charities work closely with
the trust and should be regarded as related parties.
This year, the Friends of Moorfields directly paid £94,229 (restated 2011/12 - £95,715) to
Moorfields Eye Hospital in income/donations. The Friends also made commitments of over
£246,000 to support the hospital. This is in addition to the work of their team of volunteers,
estimated at £100,000 per annum.
Debtors were nil (2011/12: nil). There was no in-year expenditure or year-end creditor. The
2011/12 balances have been restated following an internal review, which revealed that the
income/donations received from the Friends in that year and preceding years back to 2008 had
been under-valued. The Friends also pay directly for a number of items for Moorfields, including a
three-year art In hospital grant, medical equipment, fish tanks, flower boxes, children’s distraction
toys, magazines, etc.
Income/donations for the year from Special Trustees of Moorfields Eye Hospital was £498,760
(2011/12: £587,262), whilst debtors were £522,111 (2011/12: £253,845). There was no in-year
expenditure or year-end creditor.
Income/donations for the year from Moorfields Eye Charity was £391,311 (2011/12: £253,981), whilst
debtors were £28,950 (2011/12: £24,261). There was no in-year expenditure or year-end creditor.
The table on page 151 shows significant related parties (individually > 1% of revenue), their
relationship to the trust, and the nature of the transactions entered into. There were no individually
significant transactions to report.
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 Total
revenue
£’000s
Total
expenditure
£’000s
Nature of relationship
to the trust
Islington PCT
7,559
0
Patients of NHS body treated by the trust
Ealing PCT
7,315
0
Patients of NHS body treated by the trust
Department of Health
6,456
0
Patients of NHS body treated by the trust
Hertfordshire PCT
6,330
7
Patients of NHS body treated by the trust
Wandsworth PCT
5,854
6
Patients of NHS body treated by the trust
Harrow PCT
5,755
0
Patients of NHS body treated by the trust
City and Hackney Teaching PCT
5,621
0
Patients of NHS body treated by the trust
Bedford Hospital NHS Trust
5,387
866
Haringey Teaching PCT
4,484
0
Patients of NHS body treated by the trust
Sutton and Merton PCT
4,321
0
Patients of NHS body treated by the trust
Tower Hamlets PCT
4,130
146
Patients of NHS body treated by the trust
Enfield PCT
3,879
0
Patients of NHS body treated by the trust
London Strategic Health Authority
3,621
26
Patients of NHS body treated by the trust
Newham PCT
3,540
0
Patients of NHS body treated by the trust
Barnet PCT
3,418
0
Patients of NHS body treated by the trust
Redbridge PCT
3,304
195
Patients of NHS body treated by the trust
Brent Teaching PCT
3,147
0
Patients of NHS body treated by the trust
Barking and Dagenham PCT
2,266
115
Patients of NHS body treated by the trust
Waltham Forest PCT
2,213
0
Patients of NHS body treated by the trust
Havering PCT
2,169
0
Patients of NHS body treated by the trust
Surrey PCT
2,169
0
Patients of NHS body treated by the trust
Croydon PCT
2,116
0
Patients of NHS body treated by the trust
Camden PCT
2,083
0
Patients of NHS body treated by the trust
Lambeth PCT
1,802
0
Patients of NHS body treated by the trust
Richmond and Twickenham PCT
1,602
0
Patients of NHS body treated by the trust
Hounslow PCT
1,494
17
Patients of NHS body treated by the trust
Hampshire PCT
1,410
0
Patients of NHS body treated by the trust
Barts Health NHS Trust
1,088
248
Patients of NHS body treated by the trust
69
1,790
Patients of NHS body treated by the trust
(income)/costs of operating satellite site at
NHS body (expenditure)
NHS pension scheme
0
6,796
Employer pension contributions
National insurance fund
0
5,662
Employer NI contributions
Name of related party
St George’s Healthcare NHS Trust
Patients of NHS body treated by the trust
(income)/costs of operating satellite site at
NHS body (expenditure)
151
152 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
22 Financial instruments
IFRS7 financial instruments disclosures, 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.
Because of the continuing service-provider relationship that the foundation trust has with primary
care trusts and their successor bodies, and the way those bodies are financed, the foundation
trust is not exposed to the degree of financial risk faced by other 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 IFRS7 mainly applies.
The foundation trust has power to borrow in accordance with the prudential borrowing code
issued by the independent regulator for foundation trusts. Surplus funds may also be invested in
accordance with the investment policy as approved by the trust board. Financial assets and liabilities
generated by day-to-day operational activities are not held to change the risks facing the foundation
trust in undertaking its activities.
Liquidity risk
A large proportion of the foundation trust’s net operating costs are incurred under annual service
agreements with primary care trusts and their successor bodies, which are financed from resources
voted annually by Parliament. Capital expenditure has been financed from internal funds and
donations. In addition, the Foundation Trust Financing Facility has been set up to provide a source
of capital funding for foundation trusts, and has funds allocated to it for this purpose from the
Treasury. Moorfields Eye Hospital NHS Foundation Trust is not therefore exposed to significant
liquidity risks.
Market risk
The foundation trust has a branch in Dubai, with transactions conducted in pounds sterling and
United Arab Emirates dirhams. The branch accounts are consolidated into the overall trust accounts,
converted using spot and average exchange rates as appropriate, with exchange gains or losses
reported as expenses as and when they occur. Due to the size of the operation, and the fact that
the majority of cost and income are denoted in local currency, the trust has limited exposure to
currency exchange fluctuations.
The trust is not exposed to changes in interest rates as all borrowings are at fixed rates.
22.1 Financial assets by category
31 March
2013
£’000s
31 March
2012
£’000s
10,330
9,242
–
852
Cash and cash equivalents
20,609
18,527
TOTAL
30,939
29,232
Trade and other receivables
Other financial assets
Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13 22.2 Financial liabilities by category
31 March
2013
£’000s
31 March
2012
£’000s
4,770
9,242
–
1,549
Trade and other payables
20,488
16,013
Provisions under contract
174
193
25,432
26,997
Borrowings excluding finance lease liabilities
Obligations under finance leases
TOTAL
22.3 Fair values of financial assets at 31 March 2013
Set out below is a comparison, by category, of book values and fair values of the trust’s financial
assets and liabilities at 31 March 2013.
Book value
At 31 March
2013
£’000s
Fair value
At 31 March
2013
£’000s
Creditors over one year
(396)
(396)
Provisions under contract
(152)
(152)
Note a
Loans
(4,323)
(4,323)
Note b
TOTAL
(4,871)
(4,871
Basis of fair
valuation
Financial liabilities
a) Fair value is not significantly different from book value since, in the calculation of book value, the
expected cash flows have been discounted by the Treasury discount rate of 2.9% in real terms.
b) These are loans from the Foundation Trust Financing Facility where it is expected that the book
value will equal fair value.
153
154 Moorfields Eye Hospital NHS Foundation Trust – Annual Report and Accounts 2012/13
23 Intra-Government and other balances
NHS foundation trusts
English NHS trusts
Department of Health
Debtors:
amounts
falling due
within one
year
2012/13
£’000s
Debtors:
amounts
falling due
within one
year
2011/12
£’000s
Creditors:
amounts
falling due
within one
year
2012/13
£’000s
Creditors:
amounts
falling due
within one
year
2011/12
£’000s
362
264
70
318
1,900
1,815
1,585
1,973
235
–
91
74
–
–
1
26
7,149
5,725
127
64
–
–
–
–
12
18
115
91
9,658
7,822
1,989
2,546
Debtors:
amounts
falling due
after one
year
2012/13
£’000s
Debtors:
amounts
falling due
after one
year
2011/12
£’000s
Creditors:
amounts
falling due
after one
year
2012/13
£’000s
Creditors:
amounts
falling due
after one
year
2011/12
£’000s
English primary care trusts
–
153
–
–
TOTAL
–
153
–
–
English strategic health authorities
English primary care trusts
RAB special health authorities
Other whole of Government accounts bodies
TOTAL
24 Losses and special payments
There were 235 cases of losses and special payments (2011/12: 276 cases) totalling
£164,000 (2011/12: £172,000) approved during 2012/13.
There were no payments for clinical negligence, fraud, personal injury, compensation
under legal obligation or fruitless journey where the net payment exceeded £100,000
(2011/12: nil cases).
Moorfields Eye Hospital NHS Foundation Trust
162 City Road, London EC1V 2PD
Tel: 020 7253 3411
www.moorfields.nhs.uk
Published by Moorfields communications team
Design: Fountainhead Creative Consultants
© July 2013, Moorfields Eye Hospital NHS Foundation Trust