Plymouth Hospitals NHS Trust. Annual Accounts for the year ended 31 March 2015

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1 Plymouth Hospitals NHS Trust Annual Accounts for the year ended 31 March 2015

2 Annual Accounts of Plymouth Hospitals NHS Trust STATEMENT OF THE CHIEF EXECUTIVE'S RESPONSIBILITIES AS THE ACCOUNTABLE OFFICER OF THE TRUST The Chief Executive of the NHS Trust Development Authority has designated that the Chief Executive should be the Accountable Officer to the Trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Chief Executive of the NHS Trust Development Authority. These include ensuring that: - there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; - value for money is achieved from the resources available to the Trust; - the expenditure and income of the Trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; - effective and sound financial management systems are in place; and - annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure, recognised gains and losses and cash flows for the year. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer. Ann James Chief Executive 29 May 2015 Appendix: Annual Accounts 1

3 Annual Accounts of Plymouth Hospitals NHS Trust STATEMENT OF DIRECTORS' RESPONSIBILITIES IN RESPECT OF THE ACCOUNTS The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the Trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to: - apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; - make judgements and estimates which are reasonable and prudent; - state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts. By order of the Board 29 May 2015 Ann James Chief Executive 29 May 2015 Joe Teape Finance Director Appendix: Annual Accounts 2

4 Annual Accounts of Plymouth Hospitals NHS Trust Annual Governance Statement Scope of responsibility The Board is responsible for internal control. As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation s policies, aims and objectives. I also have responsibility for safeguarding public funds and the organisation s assets for which I am personally responsible as set out in the Accountable Officer Memorandum. Governance framework of the organisation Board composition The Trust has had a fully constituted Board for most of 2014/15. Towards the end of 2014/15, the Trust began a process to recruit two new Non-Executive Directors (NEDs) to fill vacancies created by two existing NEDs coming to the end of their tenure. Board committee structure The committees of the Trust Board comprise: Audit. Remuneration. Safety & Quality. Finance & Investment. Workforce & Organisational Development. Charitable Funds. The Terms of Reference for each committee are reviewed and approved by the Trust Board on a regular basis. Each committee is chaired by a Non-Executive Director. Committee attendance for each Non-Executive and Executive Director is summarised in the Trust s Annual Report. Board performance In 2012/13, the Board completed the Board Governance Assurance Framework (BGAF) as part of the Foundation Trust application process. This resulted in the production of a Board Development Plan to build on its strengths and address identified weaknesses. In 2013/14, a member of the NHS Leadership Academy conducted an independent review to assess the adequacy of the Board s focus on key issues of clinical and financial sustainability and performance. The Board held regular development sessions throughout 2014/15 which focused on ensuring that it had a good understanding of the environment in which we are working. These sessions did not, however, explicitly address the development of the Board s skills or incorporate a more formal assessment of its performance. The Board will need to reflect on these issues, identify its key areas of development and update its development plan early in 2015/16. Compliance with the Corporate Governance Code Corporate governance is the way in which an organisation is directed, controlled and led. It defines relationships and the delegation of roles and responsibilities of those who work within the organisation, determines the rules and procedures through which the organisation s strategic objectives are set, and provides the means of attaining those strategic objectives and monitoring performance. Most importantly, it defines where accountability lies throughout the organisation. The 3

5 Annual Accounts of Plymouth Hospitals NHS Trust Board s activities are based on the principles of good corporate governance and nationally publicised best practice. Risk assessment Strategic aims and objectives The Trust s strategic aims are set out in At the Heart of Health in the Peninsula which was published in May These are summarised in the diagram below. In 2014/15 the Trust set a series of more specific objectives under each of these strategic aims. These were approved by the Trust Board in May 2014 and are summarised below. Quality Care QC1 QC2 Care Pathway Transformation: Ensure that patients are treated in the right place and at the right time. Quality Improvement: Ensure that patients receive safe, effective, personal and timely care. Inspired People IP1 IP2 Leadership & Culture: Develop our leaders to foster a positive safety culture which puts patients at the heart of all that we do. Workforce Planning: Ensure that we have suitably trained and qualified people, in the right place and at the right time. Healthy Organisation HO1 HO2 Financial Sustainability: Deliver our annual budget and develop a plan which secures long-term financial viability. Organisational Governance: Ensure that we have effective governance systems at every level of the Trust. Innovate & Collaborate IC1 IC2 Community Partnerships: Take a proactive leadership role in transforming the local health and social care system. Innovation: Maximise our value by developing new ways of working and realising new opportunities. Key risks to the achievement of our objectives Key risks to the achievement of our objectives have been regularly reviewed and updated throughout the year. The key areas of focus have included: 4

6 Annual Accounts of Plymouth Hospitals NHS Trust Quality Care Compliance with NHS Constitutional Standards Operational resilience Follow-up backlogs Staffing levels (medical and nursing) Inspiring People Staff Morale Recruitment & Retention Staff Appraisals Mandatory Training. Healthy organisation Medium Term Financial Plan Service Line Viability Cost Improvement Plans Budget Delivery 2014/15 CCG Financial Position Innovation & Collaboration Community transformation. Progress in mitigating these risks has been reviewed by the Trust Board and its committees throughout the year. This process is described further under the section titled The risk and control framework. Data security The Trust has put an information risk management process in place led by the Trust s Senior Information Risk Owner (SIRO). Information governance related incidents are recorded on the Trust s DATIX system. A scoring system is used to categorise the severity of the incident Level 0 and Level 1 incidents are reviewed using local procedures whilst Level 2 (the most severe) incidents are reported through a national reporting tool and shared with the Information Commissioner s Office. In 2014/15 there were 5 Level 2 serious incidents. The information governance team reviews all reported incidents, works to promote good practice and ensures that we identify and act on lessons learned from these incidents. Whilst the overall severity of reported incidents remains low we have worked proactively with the Information Commissioner s Office (ICO) to review our arrangements and identify potential areas for improvement. Representatives from the ICO s good practice team conducted a risk review in July The Trust agreed to the review after a series of self-reported breaches in 2013 and The breaches typically involved disclosure of sensitive personal data to third parties by , post and fax. Human error was the most common theme in the breaches. The IG team engaged with the ICO prior to the review and promoted an online survey in tandem with posters, screen savers, face to face briefings and messages from key senior staff in the build up to the visit. The ICO identified many positive practices during the review which they publicised on their blog. They were impressed by the overwhelmingly positive attitude of staff, the mature approach to information governance training, the use of a network of information governance champions and the 5

7 Annual Accounts of Plymouth Hospitals NHS Trust use of unique fobs to pull a print job on request. The ICO identified a number of areas for improvement which included: Introducing lockable post box style cabinets/bins to hold confidential waste sacks. Reminding staff of the need to shred all confidential waste and stress that not part or whole paperwork that has contained personal data should be used as scrap paper in any location; Reminding all staff of the standard operating procedures associated with the use of fax machines. Developing a training needs analysis for staff in key information governance positions. The risk and control framework Overall 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. It involves an ongoing process designed to identify and prioritise the risks to the achievement of the Trust s objectives, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. Corporate governance framework The Trust Board is supported by its sub-committees which review in more depth the risks and assurances associated with different aspects of the Trust s responsibilities. These are the Safety & Quality Committee, the Workforce & Organisational Development Committee and the Finance & Investment Committee. Clinical leadership is central to our future success as it will help us remain focused on our primary task of delivering care. With this in mind, we have organised the Trust into a series of business units known as Service Lines. We have also established five Care Groups each of which is headed by a Clinical Director who is a member of the Trust Management Executive. Each Service Line is aligned to a Care Group. Whilst this has given us a real base on which to build we recognise that we must continue to develop this model to ensure that all services become clinically and financially sustainable. In 2014/15 we developed an Accountability Framework which more clearly describes the key roles, responsibilities and accountabilities of the various layers of governance within the Trust. Board Assurance Framework The Trust has a Risk Management Framework which has been approved by the Trust Board. The Framework sets out the key responsibilities for the management of risk and seeks to ensure that the risks to the achievement of the Trust s objectives is understood, reported and appropriately mitigated. The Board Assurance Framework (BAF) is the key strategic tool for the management of risk and assurance. The Framework enables the Board to demonstrate how it has identified and met its assurance needs in relation to the delivery of the Trust s objectives. The BAF includes: The Trust s objectives. Significant risks to the achievement of these objectives. Controls in place to manage the risks identified. Sources of assurance in relation to the controls in place to mitigate the risks. Further actions required to manage the risk down to an acceptable level. Furthermore: 6

8 Annual Accounts of Plymouth Hospitals NHS Trust Actions required to mitigate risks or improve the level of assurance are identified and incorporated within the forward work programme of the relevant committee. The Board and its committees review the framework on a monthly basis to ensure that key risks are identified and seek assurance that appropriate mitigating actions are being taken. The Audit Committee reviews aspects of the assurance framework on a regular basis to satisfy itself that appropriate systems of control are being maintained. Serious or significant risks are added to the Board Assurance Framework and actions to mitigate these risks are monitored at the relevant level of the Trust. Essential standards of quality and safety The Care Quality Commission (CQC) is the organisation which regulates and inspects health and social care services in England. All NHS hospitals are required to be registered with the CQC in order to provide services and are required to maintain specified essential standards of quality and safety in order to retain their registration. As part of its role the CQC is required to monitor the quality of services provided across the NHS and to take action where standards fall short of the essential standards. Their assessment of quality is based on a range of diverse sources of external information about each Trust which is regularly updated and reviewed. This is in addition to their own observations during periodic, planned and unannounced inspections. The CQC uses intelligent monitoring of more than 150 different indicators to identify areas of care that need to be followed up with providers and to allocate its resources to where they might be needed most. Together with local information from partners and the public, this monitoring helps them to decide when, where and what to inspect. The results of this monitoring are used to group each of the 160 acute trusts into one of six bands for inspection based on the likelihood that people may not be receiving safe, effective and high quality care - Band 1 is the highest priority and Band 6 the lowest. These bands are based on the proportion of indicators that have been identified as risk or elevated risk or if there are known serious concerns. The CQC published its latest series of intelligent monitoring reports for NHS trusts in December We have been assessed in the latest report as a Band 5 which is an improvement from our previous assessment in July 2014 as Band 4. Whilst this represents a very positive outcome, the report identifies a number of areas of elevated risk, as follows: Mortality rates for conditions normally associated with a very low rate. Diagnostics waiting times: patients waiting over 6 weeks for a diagnostic test. The proportion of patients whose operation was cancelled. NHS Trust Development Authority escalation score. Diagnostic waiting times and cancelled operations continue to be an area of focus within the regular performance report to the Trust Board whilst the NHS TDA escalation score reflects the financial position of the Trust and the wider health community rather than any specific quality issues. In terms of the risk associated with mortality rates, the Medical Director arranged for the notes for the patients whose deaths fell within the relevant diagnosis codes to be reviewed by clinicians. This identified two cases where the coding needed to be amended. The Clinical Coding Manager is now reviewing the notes for the remaining patients to determine whether the coding is appropriate or not and to ensure that we more proactively identify and address coding issues. The Trust continues to be fully registered with the CQC across all if its locations without conditions and continues to monitor compliance across all of the essential standards. We continue to monitor, review and improve the quality of care across the services that we provide. The Trust s last routine planned inspection was in April 2013 but is due to be inspected again in April We will ensure that any issues identified during this inspection are acted upon promptly and incorporated within our ongoing review of health care standards. 7

9 Annual Accounts of Plymouth Hospitals NHS Trust Quality governance The Francis, Keogh and Berwick reports reinforced the critical importance of maintaining effective quality governance arrangements. The Trust s current quality arrangements include: Oversight of the Trust s quality governance arrangements by the Safety & Quality Committee. Monthly reports are provided to the Trust Board showing the Trust s performance across a widerange of safety and quality metrics. The Audit Committee independently reviews the adequacy of evidence supporting selfassessments of compliance against essential standards. Following a self-assessment against Monitor s published good practice criteria in late 2012/13, the Trust conducted a more detailed review of its quality governance arrangements in 2013/14. This identified the need for improvements in a number of areas including: Rewrite the Quality Strategy, agree a core set of improvement priorities and ensure that these are supported by appropriate metrics and cascaded throughout the Trust. Review, revise and document all quality systems ensuring that they are properly integrated and focused on patients and their families rather than governance tasks Align quality governance functions to Care Groups and Service Lines and devolve them to the most appropriate layer to secure engagement and ownership. Improve the feedback to clinical teams by providing them with appropriate information and feedback on issues such as adverse events. Introduce a Trust-wide Quality Matters newsletter to facilitate sharing and learning Redesign the Trust Board report to provide horizontal triangulation of ward-based information. We have made good progress in this regard but still have further progress to make in ensuring that we provide meaningful, triangulated information to Care Groups and Service Lines and our risk management framework is sufficiently mature and embedded. Quality account The Trust is required to publish an annual Quality Account. This is reviewed by the Trust Board and the Safety & Quality Committee to ensure that it represents a balanced view and that there are appropriate controls in place to ensure the accuracy of data contained within it. Independent assurance on the Trust s 2014/15 Quality Account will be provided by the Trust s external auditors. Data quality The Trust has adopted a pro-active approach to data quality in 2014/15 by developing a risk-based approach to assessing the key performance data presented to the Trust Board and subjecting this to independent internal audit scrutiny to test and report on its accuracy, reliability and validity. Review of effectiveness Approach to reviewing effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework 8

10 Annual Accounts of Plymouth Hospitals NHS Trust itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review is also informed by: External audit reports. Internal audit reports. Assessments by external agencies. Care Quality Commission inspections. Internal management reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the activities of the Trust Board, its sub-committees and the Senior Management Team. Significant issues We have much to be proud of in the quality of care that we give to our patients. We continue to perform well in many areas and have reason to be proud of the incredible people who give so much of themselves to care for our patients but the current operational pressures cannot be sustained without having a further detrimental impact on our patients and staff. The most significant issues facing the Trust in 2014/15 may be summarised as follows: National performance standards: We are not meeting all of the key national performance targets. More specifically, we have faced significant pressure from a sustained increase in the volume and acuity of patients requiring urgent care which has led to an increase in medical outliers and the cancellation of a significant number of planned investigations and operations. Financial sustainability: The Trust will incur a further deficit in both 2014/15 and 2015/16 and must find a way of improving quality whilst existing within a shrinking financial envelope. Quality governance: The Trust must secure further improvements in its quality governance arrangements by fully implementing the recommendations from the comprehensive review undertaken in 2013/14. Risk management: We need to ensure that effective performance and risk management arrangements are embedded within Care Groups and Service Lines and strengthen our effectiveness in mitigating risks set out in the Board Assurance Framework. Recruitment and retention: The Trust recognises the importance of ensuring that we have the right staff, in the right place and, at the right time. We are committed to minimising vacancies against established staffing levels to ensure that our services can be appropriately maintained and delivered by experienced and skilled staff. We continue to adopt innovative approach to the recruitment of nursing and clinical staff but face challenges in recruiting and retaining staff to some key service areas and must develop a stronger plan for addressing these issues on a sustainable basis. Our detailed plans for 2015/16 are in the in process of being finalised. At this stage, however, it is fair to say that next year will be one of, if not, the most critical and challenging for the Trust in a very long time. Not only must we work even harder with our partners within the health & social care community to restore operational resilience but we must do this in the context of unprecedented financial challenges. We will continue to confront these challenges head on with great passion and commitment in 2015/16. Most importantly, we will maintain our absolute focus on doing what is right for our patients and the communities whom we serve. 9

11 Annual Accounts of Plymouth Hospitals NHS Trust Conclusion My review confirms that whilst many key components of an effective system of internal control are in place as at 31 March 2015, there is still scope for strengthening the Trust s arrangements to provide a sound basis for securing delivery of our objectives. This will continue to be a key area of focus for the Trust s leadership team throughout 2015/16. Signed (on behalf of the Trust Board) Ann James Chief Executive 10

12 Annual Accounts of Plymouth Hospitals NHS Trust INDEPENDENT AUDITOR'S REPORT TO THE DIRECTORS OF PLYMOUTH HOSPITALS NHS TRUST We have audited the financial statements of Plymouth Hospitals NHS Trust for the year ended 31 March 2015 under the Audit Commission Act The financial statements 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. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. We have also audited the information in the Remuneration Report that is subject to audit, being: the table of salaries and allowances of senior managers and related narrative notes the table of pension benefits of senior managers and related narrative notes the table of pay multiples and related narrative notes This report is made solely to the Board of Directors of Plymouth Hospitals NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust's directors and the Trust as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of Directors and auditor As explained more fully in the Statement of Directors Responsibilities in respect of the accounts, the Directors are 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 and International Standards on Auditing (UK and Ireland). Those standards also 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 directors; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report which comprises the Strategic report, the Directors report and the Finance report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. 11

13 Annual Accounts of Plymouth Hospitals NHS Trust Opinion on financial statements In our opinion the financial statements: give a true and fair view of the financial position of Plymouth Hospitals NHS Trust as at 31 March 2015 and of its expenditure and income for the year then ended; and have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. Opinion on other matters In our opinion: the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and the information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements. Matters on which we report by exception We are required to report if we refer a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have a reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency. On 29 August 2014 we referred a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 on the basis that the Trust is likely to breach its statutory break-even duty over a three year period. We report to you if: in our opinion the governance statement does not reflect compliance with the NHS Trust Development Authority's Guidance; or we issue a report in the public interest under section 8 of the Audit Commission Act We have nothing to report in these respects. Conclusion on the Trust s arrangements for securing economy, efficiency and effectiveness in the use of resources Respective responsibilities of the Trust and auditor The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements. We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission in October

14 Annual Accounts of Plymouth Hospitals NHS Trust We report if significant matters have come to our attention which prevent us from concluding that the Trust has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2014, as to whether the Trust has proper arrangements for: securing financial resilience challenging how it secures economy, efficiency and effectiveness. The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Basis for qualified conclusion In considering the Trust's arrangements for securing financial resilience, we identified the following matters: The Trust did not achieve its statutory break even objective in 2014/15, recording a deficit of 5 million. The Trust has a planned deficit of 33.3 million for 2015/16 and does not currently have a medium term financial plan which will bring the Trust back into cumulative financial balance. The actual and planned deficits are evidence of weakness in arrangements in respect of the Trust's strategic financial planning. Qualified conclusion On the basis of our work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2014, with the exception of the matters reported in the basis for qualified conclusion paragraph above, we are satisfied that in all significant respects Plymouth Hospitals NHS Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March

15 Annual Accounts of Plymouth Hospitals NHS Trust Certificate We certify that we have completed the audit of the accounts of Plymouth Hospitals NHS Trust in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Peter Barber for and on behalf of Grant Thornton UK LLP, Appointed Auditor Grant Thornton UK LLP Hartwell House Victoria Street Bristol BS1 6FT 1 June

16 Statement of Comprehensive Income for year ended 31 March NOTE 000s 000s Gross employee benefits 9.1 (257,433) (250,516) Other operating costs 7 (168,784) (162,101) Revenue from patient care activities 4 386, ,866 Other operating revenue 5 43,852 45,341 Operating surplus/(deficit) 4,600 (2,410) Investment revenue Other gains and (losses) (45) Finance costs 13 (108) (135) Surplus/(deficit) for the financial year 4,719 (2,554) Public dividend capital dividends payable (6,516) (6,241) Retained surplus/(deficit) for the year (1,797) (8,795) Other Comprehensive Income s 000s Impairments and reversals taken to the revaluation reserve 0 (413) Net gain/(loss) on revaluation of property, plant & equipment 2, Total comprehensive income for the year 315 (8,443) Financial performance for the year Retained surplus/(deficit) for the year (1,797) (8,795) Impairments (excluding IFRIC 12 impairments) (3,353) (4,251) Adjustments in respect of donated asset reserve elimination Adjusted retained (deficit) (4,989) (12,988) The notes on pages 19 to 49 form part of this account. 15

17 Statement of Financial Position as at 31 March March March 2014 NOTE 000s 000s Non-current assets: Property, plant and equipment , ,668 Intangible assets Trade and other receivables ,579 2,785 Total non-current assets 215, ,992 Current assets: Inventories 19 8,903 7,475 Trade and other receivables ,493 20,798 Cash and cash equivalents 21 1,118 1,382 Sub-total current assets 31,514 29,655 Non-current assets held for sale ,959 Total current assets 31,514 31,614 Total assets 246, ,606 Current liabilities Trade and other payables 23 (36,721) (28,499) Provisions 25 (341) (559) Capital loan from Department of Health 24 (700) (700) Total current liabilities (37,762) (29,758) Net current assets/(liabilities) (6,248) 1,856 Total assets less current liablilities 208, ,848 Non-current liabilities Provisions 25 (1,279) (1,267) Capital loan from Department of Health 24 (2,100) (2,800) Total non-current liabilities (3,379) (4,067) Total assets employed: 205, ,781 FINANCED BY: Public Dividend Capital 195, ,045 Retained earnings (527) 921 Revaluation reserve 9,926 8,163 Other reserves Total Taxpayers' Equity: 205, ,781 The notes on pages 19 to 49 form part of this account. The financial statements on pages 15 to 49 were approved by the Board on 29th May 2015 and signed on its behalf by Chief Executive: Ann James Date: 29 May

18 Statement of Changes in Taxpayers' Equity For the year ending 31 March 2015 Public Dividend capital Retained earnings Revaluation reserve Other reserves Total reserves 000s 000s 000s 000s 000s Balance at 1 April , , ,781 Changes in taxpayers equity for Retained surplus/(deficit) for the year (1,797) (1,797) Net gain / (loss) on revaluation of property, plant, equipment 2,112 2,112 Transfers between reserves 349 (349) 0 0 New temporary and permanent PDC received - cash 6,806 6,806 New temporary and termanent PDC repaid in year (3,300) (3,300) Net recognised revenue/(expense) for the year 3,506 (1,448) 1, ,821 Balance at 31 March ,551 (527) 9, ,602 Balance at 1 April ,163 9,356 8, ,342 Changes in taxpayers equity for the year ended 31 March 2014 Retained surplus/(deficit) for the year (8,795) (8,795) Net gain / (loss) on revaluation of property, plant, equipment Impairments and reversals (413) (413) Transfers between reserves 360 (360) 0 0 New temporary and permanent PDC received - cash 30,082 30,082 New temporary and permanent PDC repaid in year (9,200) (9,200) Net recognised revenue/(expense) for the year 20,882 (8,435) (8) 0 12,439 Balance at 31 March , , ,781 17

19 Statement of Cash Flows for the Year ended 31 March s 000s Cash Flows from Operating Activities Operating surplus/(deficit) 4,600 (2,410) Depreciation and amortisation 15,007 15,389 Impairments and reversals (3,353) (4,251) Donated Assets received credited to revenue but non-cash (249) (368) Interest paid (37) (50) Dividend (paid) (6,618) (6,282) (Increase) in Inventories (1,428) (391) (Increase) in Trade and Other Receivables (387) (2,053) Increase/(Decrease) in Trade and Other Payables 7,884 (4,698) Provisions utilised (253) (296) Increase/(Decrease) in movement in non cash provisions (23) 368 Net Cash Inflow/(Outflow) from Operating Activities 15,143 (5,042) Cash Flows from Investing Activities Interest Received (Payments) for Property, Plant and Equipment (20,044) (20,061) (Payments) for Intangible Assets (442) (159) Proceeds of disposal of assets held for sale (PPE) 2,235 0 Net (Outflow) from Investing Activities (18,213) (20,184) Net Cash (Outflow) before Financing (3,070) (25,226) Cash Flows from Financing Activities Gross Temporary and Permanent PDC Received 6,806 30,082 Gross Temporary and Permanent PDC Repaid (3,300) (9,200) Loans repaid to Dept of Health - Capital Investment Loans Repayment of Principal (700) (700) Net Cash Inflow/(Outflow) from Financing Activities 2,806 20,182 NET (DECREASE) IN CASH AND CASH EQUIVALENTS (264) (5,044) Cash and Cash Equivalents at Beginning of the Period 1,382 6,426 Cash and Cash Equivalents at year end 1,118 1,382 18

20 NOTES TO THE ACCOUNTS 1. Accounting Policies The Secretary of State for Health has directed that the financial statements of NHS trusts shall meet the accounting requirements of the Department of Health Group Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the DH Group Manual for Accounts issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Trust are described below. They 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, intangible assets, inventories and certain financial assets and financial liabilities. 1.2 Going concern IAS 1 requires management to assess, as part of the accounts preparation process, the Trust's ability to continue as a going concern. In the context of non-trading entities in the pubic sector, the anticipated continuation of the provision of a service in the future is normally sufficient evidence of going concern. The financial statements should be prepared on a going concern basis unless there are plans for, or no realistic alternative other than, the dissolution of the Trust without the transfer of its services to another entity. The directors consider that the contracts it has agreed with commissioning bodies and an application it intends to make to the Department of Health, supported by the NHS Trust Development Authority, for additional cash funding in 2015/16 are sufficient evidence that the Trust will continue as a going concern for the foreseeable future and the accounts have been prepared on that basis. 1.3 Charitable Funds From , the divergence from the FReM that NHS Charitable Funds are not consolidated with NHS Trusts' own returns was removed. However, the income, expenditure, assets and liabilities of the Plymouth Hospitals General Charity are not material in the context of the Trust's accounts, and consolidated accounts have not, therefore, been prepared. 1.4 Critical accounting judgements and key sources of estimation uncertainty In the application of the Trust s accounting policies, management is 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 experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. 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 Critical judgements in applying accounting policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust s accounting policies and that have the most significant effect on the amounts recognised in the financial statements. Judgement is required to assess whether or not there has been any impairment of assets over the period. In the case of land and buildings the advice of the District Valuer is sought annually. For plant and equipment an internal impairment review is completed annually. Similarly, judgement must be exercised in the assessment of provisions necessary for the impairment of debtors and for liabilities Key sources of estimation uncertainty The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year. Accruals for services received not yet invoiced are estimated on the basis of past experience. 19

21 Notes to the Accounts - 1. Accounting Policies (Continued) 1.5 Revenue Revenue 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 revenue for the trust is from commissioners for healthcare services. Revenue relating to patient care spells that are part-completed at the year end are apportioned across the financial years on the basis of length of stay at the end of the reporting period compared to expected total length of stay. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pension's Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts. 1.6 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 leave 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. Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share 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. 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 expenditure at the time the Trust commits itself to the retirement, regardless of the method of payment. 1.7 Other expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. 1.8 Property, plant and equipment Recognition Property, plant and equipment is capitalised if: 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 will be supplied to the Trust; it is expected to be used for more than one financial year; the cost of the item can be measured reliably; and the item has a cost of at least 5,000; or Collectively, a number of items have a cost of at least 5,000 and individually have a cost of more than 250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 20

22 Notes to the Accounts - 1. Accounting Policies (Continued) Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the Trust s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: Land and non-specialised buildings market value for existing use Specialised buildings depreciated replacement cost HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income. Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses. 1.9 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to the Trust, where the cost of the asset can be measured reliably, and where the cost is at least Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. 21

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