This is an HTML version of an attachment to the Freedom of Information request 'South London healthcare trust Chief executive salaries, wage increases and bonus's'.

QUEEN ELIZABETH HOSPITAL 
NHS TRUST 
 
 
 
 
 
 
 
 
 
 
ANNUAL REPORT & ACCOUNTS 
2008/09 
 
 
 
 
 
 
 
 
 
 

 

 
 

CONTENTS 
 
 
 

Page 
 
1.  Introduction – South London Healthcare NHS Trust   
 
                   3    
2.  Queen Elizabeth Hospital – Review of the year  
 
 
 
        4       
3.  Operating & Financial Review 
                                                                         5 
•  History and background to the Trust 
 
 
 
                   5 
• 
The 
services 
we 
provide 
      
                  6 
•  The environment in which we operate   
 
 
                   7 
•  How we are governed and managed 
 
 
 
                   7 
•  How we performed in 2008/09 
 
 
 
 
                 10  
• 
Our 
priorities 
for 
2009/10 
                      17 
• 
Financial 
report 
       
 
               22 
•  How we are addressing our environmental, social and  
     
 
community responsibilities                                                                        25 
•  Our emergency planning arrangements   
 
 
                 26 
4. 
Staffing 
Report         
                27 
5. Remuneration Report       
 
 
 
 
 
 
 
 
      
 
               31 
6. Appendices to the annual report                                                                           34 
•  Services provided at Queen Elizabeth Hospital  
 
                 34  
• 
Director 
biographies 
       
                36 
• 
Committee 
structure 
       
                39 
•  Clinical directorate structure 
 
 
 
 
     
      40 
7. Annual Accounts                                                                                                   41 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

2

INTRODUCTION – SOUTH LONDON HEALTHCARE NHS TRUST 
 
On 1 April 2009 a new NHS Trust came into existence in South London.  South London 
Healthcare NHS Trust was the product of the merger of three smaller hospital trusts.  Queen 
Mary’s Sidcup NHS Trust (QMS), Queen Elizabeth Hospital NHS Trust (QEH) and Bromley 
Hospitals NHS Trust (BHT) merged to create a single hospital on several sites.   
  
The merger took place after much discussion within the local health community about how we 
might create the best organisation for delivering top quality health services to local residents in 
the early part of the 21st century. 
  
This was a very positive development.  It offered tremendous benefits for patients, local 
residents and NHS staff.  In the months and years ahead: 
  
•  A new, larger organisation will provide the critical mass that enables the NHS to develop 
sustainable and resilient clinical services. 
•  With an income of over £400m a year the new trust will be approaching the size of 
organisations such as King’s College Hospital.  It will be a major new health organisation 
for London and beyond. 
•  It will help develop financial stability in the local health community and will enable us to 
rationalise common functions such as human resources and finance; and 
•  It will mean the NHS in south east London can develop, recruit and retain the leaders 
and the clinicians it needs to provide world class health services for local people. 
  
As soon as the new Trust was created there was evidence that talented people were positively 
seeking to join the new hospital Trust because they can see that the merger spells a bright 
future and a better way of working. 
  
South London Healthcare NHS Trust came into existence on 1 April 2009 but, of course, not 
everything changed immediately. There is a new board with a new chairman (Mr. George 
Jenkins) and a new chief executive (Dr Chris Streather).  A transitional executive management 
team was appointed and the recruitment of a permanent executive team began. 
  
Within the new Trust change will be gradual and incremental – evolutionary rather than 
revolutionary.  It will be a rolling process.  Staff, patients and local communities will all need to 
embrace and adopt new ways of working and new ways of using our local health services.   
  
Staff can be proud of the fact that all three of the former trusts have a track record of providing 
good health care for local people.  This record is reflected in support from the public and other 
stakeholders but uncertainty about the future was straining clinical services.  The new, larger, 
combined Trust will be in a far stronger position to ensure the continuing provision of the very 
best healthcare for local communities. 
  
South London Healthcare NHS Trust will be setting its sights high.  The new Trust will aim to be 
“best in class” in all it does.  It will be looking to recruit the best and the brightest people.  It will 
be defining standards of care, levels of staffing and clinical cover, governance structures and 
financial and operational targets which will place the new Trust at the forefront of patient care 
and clinical excellence. 
  
3

The people of London and beyond can look forward to a hospital trust in which they can take 
renewed pride, and which will inspire their loyalty and trust.  Our staff can look forward to 
working for a vibrant and successful health organisation that is nothing less than top class. 
 
 

QUEEN ELIZABETH HOSPITAL – REVIEW OF THE YEAR  
 
2008/09 was another extremely busy year for Queen Elizabeth Hospital in which we have 
continued to achieve most of our important short term objectives, whilst at the same time, 
working closely with colleagues in PCTs and other NHS Trusts in outer south east London to 
move forward plans for the future shape of local health care.  The Trust also undertook its share 
of the work to successfully complete the process of creating South London Healthcare NHS 
Trust.  
 
Apart from these two major pieces of work, our priorities continued to be to provide the highest 
standard of care to our patients whilst seeking to move towards financial stability. 
 
In financial terms we succeeded in achieving our planned deficit of £5.5 million. In 2007/08 the 
deficit was £3.1 million.  To achieve this position we have continued to place tight controls on 
expenditure throughout the organisation.  Much credit for this should go to our former Director of 
Finance David Wragg and his team.   
 
We have done well in meeting the majority of our targets for the year although we did not 
achieve our 18 week target for admitted patients in December 2008.  Through the hard work of 
many of our staff the backlog of cases has now been cleared and the target achieved from April 
2009.  
 
The Trust achieved a sharp reduction in MRSA cases to 6, well below the trajectory target of 16, 
which was in itself challenging. This is a tremendous achievement and reflects the hard work 
and dedication of all staff, but in particular, former Director of Nursing, Terina Riches, our 
Matrons, the infection control team and our ISS Mediclean partners.  
 
Having had 41 cases in 2004/05, we managed to reduce this to 23 cases in 2005/06 and 17 in 
2006/07 and 19 cases last year. During the past 12 months there have been a number of 
months when we have recorded no MRSA bacteraemia cases at all.  
 
Our efforts to reduce Clostridium Difficile have continued to be successful and have won praise 
from the SHA and Department of Health.  We ended the year with 58 cases recorded which was 
significantly below another challenging trajectory of 71. 
 
 
In the pages that follow, we describe more about the hospital’s achievements and challenges in 
2008/9.  
 
 
4

 
OPERATING & FINANCIAL REVIEW 
 
History and background to the Trust 
 
Queen Elizabeth Hospital NHS Trust (QEH) was formed in March 2001 when services relocated 
to a new hospital in Woolwich in the London Borough of Greenwich. QEH was developed via 
the government’s Private Finance Initiative (PFI) and is located on the site previously occupied 
by the Queen Elizabeth Military Hospital. The new 500 bed hospital was created partly by 
rebuilding and partly by refurbishing the military hospital, and now provides a range of acute 
hospital services mainly to the residents of Greenwich as well as to a natural catchment from 
our neighbouring borough of Bexley and, increasingly, from further afield.  
 
The hospital is well located in the centre of the borough with excellent road transport and bus 
service links. A total of seven bus routes serve the hospital and also link the hospital to London 
and into Kent via rail and DLR services from Woolwich Arsenal station and via the Jubilee line 
underground service into London from North Greenwich station.  
 
From 1 April 2009 the Secretary of State for Health approved the merger of Queen Elizabeth 
Hospital NHS Trust with Bromley Hospitals NHS Trust and Queen Mary’s Sidcup NHS Trust to 
form South London Healthcare NHS Trust. 
 
Population 
 
Greenwich is one of 12 inner London boroughs. It has a population of around 230,000, which is 
expected to rise by approximately 40,000 over the next 10 years – a rise of some 17%. This rise 
is principally the result of the Thames Gateway development – the largest housing development 
in Europe. Whilst a major tourist destination, with World Heritage status, the borough has 
pockets of extreme deprivation and a number of wards are amongst the 10% most deprived in 
England. 
 
More than 100 different languages are spoken in the borough and approximately 23% of the 
borough’s population are from minority ethnic groups, compared with 13% of the population of 
England as a whole. Increasingly, the highest proportion of the population in Greenwich is in the 
30 to 34 age group. This has been reflected in the increased number of births -, which have 
risen from 3,021 in 2001/02, when QEH first opened, to 4,190 in 2008/09.     
 
While the proportion of older people in the borough is decreasing, the number of very elderly 
people (85+ years of age) is rising, creating its own demands on the hospital and support 
services.  
 
The new housing developments, which form part of the Thames Gateway, will impact on the 
age profile of the borough, with residents in the new developments expected to be mainly of 
working age and proportionately fewer older people among the borough’s new entrants. 
 
QEH is also the local healthcare provider to HM Prison at Belmarsh, a maximum security jail. 
The prison population makes a particularly high demand on the Trust’s genito-urinary services. 
Telemedicine technology has been developed to provide some services to this section of the 
population. 
 
 
5

The services we provide 
 
A full range of clinical services is provided at Queen Elizabeth Hospital, providing both 
emergency and elective (planned) care to patients. The majority of these are provided by staff 
employed by QEH; however some specialities, including ophthalmology, oral surgery and ENT 
(ear, nose and throat) surgery are provided on an outpatient basis only by staff from 
neighbouring trusts. QEH also provides some services, such as urology and dermatology, to 
other local trusts. The full list of services available at QEH is set out in Appendix 1 
 
Activity Review 
 
Since it opened in 2001, demand for services at QEH has grown significantly. This 
demonstrates that we have strong backing from the community we serve and confirms our 
credibility as the local provider of choice.  
 
The tables below show that in 2008/09 the hospital remains as busy as ever.  Please note that 
the apparent drop in non-elective activity reflects a reclassification of some of that activity into 
outpatient attendances and does not represent an activity reduction.     
 
A&E Attendances 
 
2001/02 
2002/03 
2003/04 
2004/05 
2005/06 
2006/07 
2007/08 
2008/09 
 
75,149 73,638 85,223 94,298 100,831 99,700  99,534 
98,224 
  
 
Non-Elective Admissions (spells) 
(excluding obstetrics) 
 
2001/02 
2002/03 
2003/04 
2004/05 
2005/06 
2006/07 
2007/08 
2008/09 
13,355 14,854 16,584 16,879 16,882 17,669 17,757 
14,421* 
     * see note in text above 
Elective Admissions (spells) 
 
2001/02 
2002/03 
2003/04 
2004/05 
2005/06 
2006/07 
2007/08 
2008/09 
18,586 20,946 21,116 21,155 23,497 24,622 23,648 
24,369 
 
Outpatient Attendances 
 
2001/02 
2002/03 
2003/04 
2004/05 
2005/06 
2006/07 
2007/08 
2008/09 
155,000 169,808 168,234 158,221 169,560 190,077 193,502 
210,279 
 
Births 
 
2001/02 
2002/03 
2003/04 
2004/05 
2005/06 
2006/07 
2007/08 
2008/09 
3,021 3,264 3,487 3,753 3,950 4,182 4,263 
4,190 
 
6

The environment in which we operate 
 
Along with all NHS trusts, QEH operates within a financial, competitive and regulatory 
environment determined by government. This regulation includes an annual health check, by 
the Care Quality Commission (CQC) and a number of inspections and accreditations from a 
wide range of interested bodies including the medical royal colleges, deaneries, peer review 
teams (most notably those concerned with cancer care), specialty-specific bodies such as 
Clinical Pathology Accreditation (CPA), the Health & Safety Executive (HSE), the NHS Litigation 
Authority, Patient Environment Action Teams (PEAT) and many others. These are all designed 
to ensure that hospitals operate to the highest standards and, where problems are identified, 
that they are addressed. 
 
The CQC annual health check assesses hospitals on the basis of a range of performance 
measures, which come together to produce two ratings, one for quality of services and the other 
for use of resources. As with last year, QEH was rated as ‘Good’ for quality of services and 
Weak’ for use of resources based on performance during 2007/08.  We had anticipated a poor 
use of resources rating because of the financial challenges we face, and we were pleased to 
have again been assessed as ‘Good’ for the quality of our services.   
 
 
How we are governed and managed 
 
The Trust Board and its committees 

 
 
Governance of the Trust is exercised by the Trust Board and a small number of non-executive 
led Board committees, supported by a comprehensive framework of executive management. 
 
The Board comprises a non-executive Chairman, five other non-executive directors (NEDs) and 
eight executive directors (EDs), including the Chief Executive.  The previous Chairman of the 
Patients’ Forum is a Non Executive Associate Director to ensure continued patient 
representation on the Board.  The names and short biographies of Board members are set out 
in Appendix 2
 
The Chief Executive is the Trust’s Accountable Officer, accountable via the NHS Chief 
Executive to Parliament. 
 
The Board meets monthly in public to oversee the management of the entirety of the Trust’s 
business. Where confidential matters need to be discussed, the Board also meets in a closed 
session, immediately following the open meeting. Detailed minutes of all meetings are recorded 
and the minutes of public meetings are published. 
 
The Board has established four non-executive led committees to oversee particular areas of 
Trust business that the Board considers require more detailed scrutiny than the full Board can 
provide. These are: 
 
•  Audit & Assurance Committee 
•  Clinical Governance & Risk Management Committee 
•  Finance Committee 
•  Remuneration & Terms of Service Committee 
 
Minutes are taken and reported to the Board following each committee’s meeting. 
7

 
 
Outer South East London (OSEL) Joint Committee – the move towards merger 
 
  We make reference later in this report to the challenging strategic agenda faced by acute trusts 
in outer south east London.  We have recognised the need to work collectively to provide the 
best care and services to local people and better meet the requirements of the south east 
London Primary Care Trusts.   As a result three acute trusts - Queen Elizabeth, Queen Mary’s, 
Bromley Hospitals - recognised the need for new  management arrangements to enable a faster 
more transparent solution to developments aimed at improving the financial position of the 
trusts. During the year, under the auspices of the Joint Committee, a three month TUPE 
consultation process, together with stakeholder engagement was carried out by the three Trusts 
to discuss the proposal to merge.  It has recently been announced that the ‘A Picture of Health’ 
reconfiguration proposals have been approved by the Secretary of State.  The merged Trust 
can now work with its commissioners on addressing the provision of services in the local health 
economy.   . 
   
 
Trust Executive Committee 
 
The QEH Board has a Trust Executive Committee (TEC), chaired by the Chief Executive, as the 
principal decision-making body of the Trust.  TEC comprises the executive directors, clinical 
directors and the general managers of the clinical directorates. TEC meets twice each month 
and, as with the Board, detailed minutes are taken of each meeting’s discussions and decisions, 
which are subsequently reported to the Board. 
 
A number of management committees and groups have been established to support the work 
of, and report to, TEC. These include the following, some of which have their own sub-
committees: 
 
•  Clinical Governance Executive 
•  Control of Infection Committee 
•  Cancer Board 
•  Operations Executive 
•  Risk Management & NHS Standards Committee 
•  Capital Planning Group 
•  Estate & Facilities Management Group 
•  ICT Strategy Programme Board 
•  Information Governance Steering Group 
 
The Trust’s committee structure can be seen in diagrammatic form at Appendix 3.  
 
Clinical management structure 
 
The Trust has five clinical directorates, each led by a part-time clinical director (CD) and 
supported by a full-time general manager (GM), with responsibility for all aspects of the 
management of a significant part of the Trust’s business. The new clinical directorates manage 
the following services: 
 
•  Acute Medicine – acute medical specialties, elderly care, accident and emergency and 
therapies; 
8

•  Specialist Medicine – a range of medical specialties including cardiology, rheumatology, 
dermatology, as well as cancer services, critical care, genito-urinary services, imaging 
and outpatients; 
•  Surgery – general surgery, urology, trauma and orthopaedics, anaesthetics and 
theatres; 
•  Women and Children – maternity services, gynaecology and paediatrics; and 
•  Pathology – covering all the pathology disciplines. 
 
The clinical directorates have a considerable amount of autonomy, operating within a structured 
performance management framework.  Each of the clinical directorates has established its own 
management structures and arrangements to enable it to manage its affairs effectively, and 
each is supported by a member of the Finance and HR departments. 
 
The clinical directorate structure can be seen in diagrammatic form at Appendix 4. 
 
Business planning and performance management  
 
The Trust has a well established planning process that commences in the autumn of each year 
with the development and agreement by TEC and the Board of the coming year’s corporate 
objectives. These are developed by reference to the Trust’s longer-term strategic direction, the 
Department of Health’s priorities and targets, and the Trust’s own immediate priorities. Once 
agreed, these form the basis of detailed planning guidance which is provided to the clinical and 
corporate directorates and departments, together with a template and timetable for the 
submission of their plans for the year ahead. These are reviewed and refined at meetings 
between the directorates and the executive team prior to final sign-off in the spring. 
  
Performance management operates at three levels: within clinical directorates; at formal 
performance review meetings of the directorates; and by the Board. These arrangements work 
well, as evidenced by the operational and financial performance of the directorates, and the 
Trust as a whole, in recent years where the great majority of Trust and directorate plans and 
targets have been met.  The Trust has achieved extensive savings plans in recent years of 
£3.5M in 2008/09, £7.8M in 2007/08, £10.9M in 2006/7 and £4.5M in 2005/6.    
 
In parallel with these internal performance management arrangements, regular meetings 
between senior Trust personnel and those of Greenwich Teaching Primary Care Trust and 
Bexley Care Trust also take place to review performance against the respective Service Level 
Agreements, including local priorities and performance targets, and to consider and agree on 
any matters requiring action.   
 
Risk management 
 
The Trust has comprehensive and robust risk management arrangements in place that enable 
the Board to be made aware of, and scrutinise the Trust’s arrangements for managing, the risks 
facing the organisation. These include regular consideration of the content of the Assurance 
Framework (which has received a Category A rating by the Trust’s internal auditors, confirming 
that it meets the criteria laid down by the Department of Health), appropriate risk management 
policies, procedures and systems, an extensive structure of Board and executive committees 
concerned with clinical and non-clinical risk management, as well as sound anti-fraud 
arrangements and expertise. 
 
The Trust’s key long term risks are:- 
9

 
•  The Trust’s ability to implement a plan to achieve financial balance within the planned 
timescale, with expenditure being contained within income earned.  
 
•  The Trust’s requirement to standardise key Information Technology systems across its 
sites and the capacity to deploy the new national Care Records System given the 
financial position and probable impact of A Picture of Health on staff time and resources. 
The full benefits of Connecting for Health may not be realised by the Trust.  
 
•  Clinical services may suffer from less than optimum organisational arrangements until 
proposals from A Picture of Health are implemented. 
 
•  The Trust’s ability to meet national targets for waiting times and the 4 hour accident and 
emergency target may potentially affect patient care, and may damage the good 
reputation of the Trust. 
 
 
The Department of Health requires trusts to disclose serious untoward incidents 
involving data loss or confidentiality breaches in the format below 
 
Date  
Nature  
Nature  
Number of 
Grade 
Notification 
of  
of  
of  
People 
Steps 
Incident 
Incident 
data  
potentially 
involved 
affected 
February 
Fax sent to 
Names, 
 
 
Contacted and 
2009 
a wrong 
Addresses, 


informed by 
number 
Hospital 
 
telephone 
Number and 
Clinical 
Details 
Further 
The incident has been investigated and the policy for sending faxes 
action 
reviewed.   
We will continue to monitor and assess risks associated with breach of 
confidentiality. 
 
 
How we performed in 2008/09 
 
2008/09 National Targets 
 
The Trust’s performance against the national performance targets, is summarised in the 
following table. 
 
 
Trust 

Indicator 
Measure 
Target 
Position 
or 
2008/09 

 
 
 
 
A&E - 4 hour target 
% of patients waiting 4 hours or less in 
98% 
97.67% 

A&E from arrival to admission, transfer 
 
or discharge 
 
 
 
 
 
 
10

 
Trust 

Indicator 
Measure 
Target 
Position 
or 
2008/09 

18 Week  Referral to 
Data completeness of the referral to 
Between 90 
Within 
√ 
Treatment Target 
treatment data 
and 110% 
thresholds 
 
(RTT) 
 
 
 
 
 
 
90% 
 
 
By December 2008, 90% of admitted 
 
70% 

patients to be treated within 18 weeks 
 
 
 
 
95% 
 
 
By December  2008, 95% of non-
97% 
√ 
admitted patients to be treated within 18 
 
weeks 
 
 
 
 
 
 
Diagnostic Tests 
Proportion of patients receiving specific 
100% 
100% 
 
diagnostic test in 6 weeks or less 
 
 
 
 
 
 
Cancer – 2 week rule  
Proportion of patients seen within 2 
98% 
98.9% 
 
weeks of urgent GP referral for 
suspected cancer to first outpatient 
appointment 
 
 
 
 
 
 
All Cancers – 1 month  
Proportion of patients treated within 31 
98% 
100.0% 
 
days of diagnosis 
 
 
 
 
 
 
All Cancers – 2 months   Proportion of patients treated within two 
95% 
98.6% 
 
months of urgent GP referral  
 
 
 
 
 
Cancelled Operations 
Part 1 - % of elective admissions 
0.8% 
0.78% 
√ 
cancelled on the day of, or after, 
 
 
 
admission for non-clinical reasons 
 
 
 
 
 
 
 
Part 2  - % of elective admissions 
0% 
0% 
√ 
cancelled on the day of, or after 
 
admission for non-clinical reasons, 
 
where that patient is not offered a date 
 
within 28 days 
 
 
 
 
 
 
 
MRSA Bacteraemia 
To achieve the target trajectory 
16 

√ 
 
reduction in the number of incidents of 
  
MRSA bacteraemia 
 
 
 
 
 
 
Clostridium difficile 
Local target for Clostridium difficile 
71 
58 
 
infections agreed with PCTs and in 
place by March 2008,  
 
 
 
 
 
 
Delayed transfers of 
% of patients whose transfer of care 
3.5% 
1.76% 
√ 
care 
was delayed 
 
 
 
 
 
 
 
 
Number of inpatients 
% of patients waiting 26 weeks or more 
0% 
0% 
 
or day cases waiting 
for an elective admission 
longer than the 
11

 
Trust 

Indicator 
Measure 
Target 
Position 
or 
2008/09 

standard 
 
 
 
 
 
 
Number of outpatients 
% of patients waiting 13 weeks or more 
0% 
0% 
 
waiting longer than the 
for a first outpatient appointment 
standard 
following a GP referral 
 
 
 
 
 
 
Waiting times for Rapid  % of patients to RACP clinics seen 
98% 
98.7% 
 
Access Chest Pain  
within 14 days (where referral received 
 
from GP within 24 hours) 
 
 
 
Awaiting 
 
 
Waiting times for GUM 
Improvement in access to GUM clinics  confirmation 
99.2% 
√ 
clinic 
within 48 hours 
by the CQC 
 
 
 
 
 
 
Data quality on ethnic 
% of patient admissions for whom a 
85% 
93.4% 
√ 
group 
valid 2001 census coding for ethnic 
category is recorded 
 
 
 
 
 
 
Infant mortality and life 
Part 1 - reduction in the number of 
< previous 
12.7% 

expectancy at birth 
women known to be smokers at the 
year 
 
 
 
time of delivery compared to 2006/07  
 
 
 
 
>  
 
 
Part 2 - Number of mothers known to 
previous 
81.5% 
√ 
have initiated breastfeeding within 48 
year 
 
hours compared to 2005/06 
 
 
 
Action with regard to targets not met 
 
SLHT recognises that sustained delivery of the key access targets - 18 week Referral 
 to Treatment Time (RTT) target and  4-hour A&E - will be critical to its success and 
 we have developed a model for performance improvement that enables a structured 
 approach to delivery against these and all targets.   
 
18 Weeks Delivery 
 
The SLHT model for delivery is based on the successful turnaround in performance 
achieved on the QMS site during 2008/09.  The model combines performance 
management and improvement techniques that have been used successfully at Bromley 
hospitals and Queen Mary’s Sidcup. 
 
4-Hour A&E Delivery 
 
A similarly structured approach is now being applied to A&E performance improvement 
to ensure sustained achievement of the 4-hour target.   A weekly performance board has 
been established, which will provide the coordinating hub, and a dedicated project 
manager has been appointed to focus on short-term performance and sustainability, in 
particular during a period of significant change during APOH implementation.  Details of 
the approach are provided in Appendix 3.2. 
 
12

Reduction in the number of women known to be smokers at the time of delivery 
 
All women who book to deliver their babies at Queen Elizabeth are asked whether or not 
they smoke.  Those that do, are offered a referral to the Smoking Cessation Team, 
where a midwife member can work with them to give up smoking. 
 
Reducing healthcare acquired infection   
                              
We have been very pleased with our overall performance against the national targets, this year 
achieving a reduction in the number of MRSA (methicillin-resistant staphylococcus aureus) 
bacteraemia (bloodstream infections).  16 MRSA bacteraemias during 2008/9 was considered a 
challenging target set for our organisation and much lower than many other London hospitals.  
A concerted effort was made by all staff across the organisation, which culminated with the 
organisation achieving a total of 6 MRSA bacteraemias during 2008/9. Of these 6 three were 
pre 48 hours and therefore considered community acquired (1 was in a patient who travelled 
directly to Woolwich from Ireland and therefore not a local resident. The other 3 were associated 
with the hospital 1 surgical 1 medical and 1 maternity (this is the first bacteraemia we have seen 
in relation to maternity patients).  
(This figure compares against 19 MRSA bacteraemias during 2007/08). We know that the public 
see cleanliness as one of the most important priorities in their hospitals, with MRSA infection 
rates viewed as a key indicator of this.   
 
Infection control continues to have an extremely high profile within our organisation and this 
view was supported by the Healthcare Commission in their feedback to us following their 
unannounced spot-check visit in August 2008. There was only one area where action was 
required and this was in relation to the Trust not displaying the ward specific cleaning 
schedules. This requirement was instituted and cleaning schedules are now displayed on the 
ward walls and included in each patient’s bedside folder. 
 
Our work during the year has also focused on reducing other healthcare acquired infections, in 
particular Clostridium Difficile (C. Diff).   During 2008/09 the Trust is pleased to report a 
reduction in the number of cases to 58, beating its Department of Health target of no more than 
71.  
 
We have implemented and maintained a number of measures across the hospital to help 
reduce infection rates, including: 
 
°  Continued participation in the ‘Clean your Hands’ campaign; 
  
°  The availability of alcohol hand rub dispensers in all areas; the introduction of a Hand 
Hygiene Compliance Policy and regular hand hygiene audits, which have demonstrated 
an overall gradual improvement in compliance; The trust is compliant with the NPSA 
Alert published in September 2008 regarding the use and positioning of alcohol hand 
gels. We have recently removed alcohol hand gels from the main hospital corridors.  
(This was as a result of the thefts and ingestion of alcohol gel by unknown persons 
across some London Hospitals). Clear notices continue to be placed across the 
organisation reminding the need to use the gel at point of care from supplies located on 
the wards and at the patients’ bedsides. 
 
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°  Regular audits using both the Saving Lives HII audit tools and the ICNA (Infection 
Control  Nurses Association) audit tools;  
 
°  Analysis of each MRSA bacteraemia to ensure that we understand the cause, and, 
where necessary, policies and procedures are reviewed; 
 
°  Enhanced chlorine cleaning was introduced in 2007/08, and has gradually  been rolled 
out to the majority of wards;  
 
°  Antibiotic protocols were reviewed and re-issued, with every junior doctor receiving a 
pocket guide. 
 
In addition, during 2008/09 QEH successfully bid for resources from Greenwich PCT. The 
funding included monies for the: -  
 
°  Increase in Microbiology laboratory staff to support the increase in screening specimens 
 
°  Funding for the appointment for an Infection Control Data Analyst 
 
°  Funding for 5 WTE Infection Control Administrative Support 
 
Achievements during the year 
 
During the year, the Trust focused on service developments that would contribute towards the 
provision of more local services, consolidating the Trust’s position as the local hospital of 
choice. These developments were cost neutral or cost saving to commissioners. For the most 
part, our plans to develop these services looked to maximise the use of existing skills and 
resources and provide local choice for the first time. The aim has been to broaden QEH’s 
catchment base and, in time, when services are well established, to enable some work to be 
repatriated from the tertiary centres. 
 
Breast reconstruction surgery 
The Trust introduced simultaneous reconstruction surgery for women requiring mastectomy for 
breast cancer. A plastic surgeon from Guy’s and St Thomas’ supports this service, which 
provides a monthly operating list at the moment, providing the instruction and clinical 
supervision that the development of such a service requires. The development of this surgical 
technique has augmented the service so that the Breast unit at QEH can care for all women 
requiring surgery for this condition regardless of their treatment choice. The development 
provides a local choice and avoids unnecessary travel into tertiary centres for women who 
chose simultaneous breast reconstruction with mastectomy.  
 
 
 
Non invasive detection of early liver disease 
The Trust has invested in a Fibroscan machine, which optimises the quality of patient care by 
detecting early liver disease using non invasive scanning. This procedure is provided in a one-
stop clinic stetting and reduces the need to use radiological scanning and liver biopsies. The 
Fibroscan is a standalone portable machine and is used in the gastroenterology outpatient 
clinics providing, for the first time, a local non-invasive scanning service for patients with 
potential liver disease. 
 
 
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Ano rectal physiology assessments 
The Trust has invested in an anal endo-sonography machine which enables QEH to undertake 
ano rectal physiology assessments locally. This investigative method is a simple rapid and 
accurate method of screening patients to determine whether surgical repair might be 
appropriate and is also invaluable in the investigation of anal pain and sepsis. Until now the 
Trust has had to refer outside of the area for this investigation, which is inconvenient for the 
patients concerned and has a detrimental impact on 18 week pathway achievement. 
 
End of life care 
During the year, the Trust consulted on merging the management of Specialist Palliative care 
under the umbrella of Greenwich and Bexley Hospice (GBCH) and this merger has been 
successfully implemented. 
This service change has united the services previously managed separately by QEH and the 
GBCH in a ‘hub and spoke’ model under the management of GBCH, but with medical staff 
contracts remaining with QEH. The newly merged service provides a more seamless service for 
patients as well as achieving economic efficiency. The combined service will also allow for 
service developments and provide a more comprehensive range of services to meet national 
recommendations for Greenwich palliative care patients. The new service configuration also 
includes the service delivery changes necessary to meet NICE guidance on supportive and 
palliative care for adults with cancer. 
 
Clinical skills laboratory 
In April 2008, the Trust opened a new multi-disciplinary clinical skills laboratory, supported by 
SIFT funding. In Phase 1, the lab is delivering medical student skills training as set out in the 
Guy’s, King’s and St Thomas’ curriculum, Royal College of surgeons accredited base surgical 
skills course, laparoscopic gynaecology courses, MRCOG courses,  and resuscitation courses. 
This facility provides all staff with the opportunity to learn and practice clinical techniques, based 
upon the best evidence, in a non-threatening environment. It also allows both pre and post 
registration practical skills to be honed prior to attempting the chosen skill on a patient, without 
compromising patient care. The laboratory provides a range of anatomical models and 
mannequins/simulators together with audiovisual equipment and video camera facilities 
simulated consultations and team based patient scenarios. This allows effective feedback to 
participants during scenarios and addresses both verbal and non-verbal communication in a 
more realistic environment. Since opening, the Trust has successfully completed two Royal 
College of Surgeons approved basic surgical skills courses together with other courses that 
include laparoscopic skills for gynaecologists, a hysterectomy master-class and various life 
support and resuscitation courses. Further developments will include multi-professional skills 
courses, advanced endoscopic training courses with a video link to theatres allowing live 
demonstrations of laparoscopic and endoscopic skills. 
 
Arts Programme   
 
Another eventful year for the Elixir Arts programme at QEH saw the completion of the Artists in 
Residence programme.  At the end of their year-long project involving consultations with 
patients and staff, residency artists Rachel Wingfield and Mathias Gmachl of Loop.ph presented 
several proposals for site-specific projects.  
 
These included a Roof Garden, Living Canopy –innovative lightweight tree-like structures 
supporting climbing plants and Reflections of the Familiar - a window design to filter out sunlight 
and heat from corridors. The Living Canopy project was chosen to be taken forward and was 
installed in the main Courtyard garden during the summer. Fourteen climbing plants will provide 
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a focus of interest and colour in the garden throughout the year. The Residency was supported 
by the Leverhulme Trust. 
 
Patients on Wards 3 and 4 enjoyed regular visits by musicians playing in the ward bays, during 
2008. Music ranged from European classics to Flamenco, Senegalese to Pop hits of the 50s 
and 60s. Frequently a party atmosphere developed on the wards and patients, visitors and staff 
joined in at times, singing and even dancing by their beds! The funding from Tesco Charity Trust 
also provided regular crafts sessions for Ward 4 patients during the autumn and a programme 
of visiting speakers, including a special reminiscence session to mark the NHS60 celebrations. 
 
The long-awaited Elixir Gallery was launched in December 2008, with a Staff Open Exhibition. 
Visitors were delighted and impressed by the very high standard of work submitted which 
included photographs, digital design, drawings and pastels. The Gallery, located between the 
West Entrance and the Just EAT Restaurant, will show a regularly changing programme of 
artwork by professional artists, local schools and staff, over future years. 
 
Patient Experience 
 
The Picker Institute was commissioned by the Trust to undertake the 2008 Inpatient Survey.   In 
total 829 patients were eligible for the survey, 379 (45.7%) returned a completed questionnaire. 
The results showed that, compared to the previous year, we were: 
 
•  significantly better on 2 questions regarding enough privacy when discussing condition 
or treatment and receiving copies of letters sent between hospital doctors and GPs at 
the time of discharge; 
 
•  significantly worse on 2 questions regarding having to wait a long time to get to bed on 
admission and discharge being delayed by 1 hour or more; 
 
•  showed no significant difference on 57 questions; 
 
Compared to other trusts we were disappointingly: 
 
•  significantly better on 1 question regarding the receiving copies of letters sent between 
hospital doctors and GPs at the time of discharge; 
 
•  significantly worse than average on 38 questions regarding waiting times, single sex 
accommodation , food choices, doctors / nurses behaviour / attitude, patient involvement 
and discharge; 
 
•  average on 25 questions.  
 
These results show that we still have a considerable way to go to attain the levels of patient 
satisfaction that other hospital trusts are achieving on a year by year basis. The Getting it Right 
for Patients strategy, launched in July 2007, has continued to tackle the areas of concern to 
ensure that changes are implemented successfully, and the following key improvements have 
been made: 
 
•  New standards of behaviour have been introduced to ensure that staff and patients are 
fully aware of what is expected of them in terms of attitude and behaviour. They have 
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been developed with the help of patient representatives and are shared with all who 
come to the Trust.  
 
•  We have introduced Patient Experience Trackers (PET), which allow patients to give us 
instant feedback on the quality of their care.  PET is an electronic surveying computer 
which, at the touch of a button, allows patients to rate various services, such as the 
quality of care, the quality of their food and the attitude of staff. The trackers have been 
introduced in several areas of the hospital and will allow up to date information to be 
collected, enabling us to react immediately to people’s concerns and to feedback to our 
patients the improvements we introduce as a result. 
 
•  The Matrons have been leading a drive in 2008 to improve nutrition, diet and 
refreshments for patients, as part of the Getting it Right for Patients strategy and also a 
key part of the national Essence of Care programme for setting benchmarks for good 
practice for nursing in the NHS. Protected mealtimes protocols have been introduced to 
wards and guidelines for staff focusing on the importance of food and drink for patients 
have been introduced together with the trialling of a new hydration system using water 
bottles on the wards.  
 
•  A four-week awareness campaign highlighted the importance of nutrition and the wider 
context in which it fits, with an emphasis on the broad range of nutritional issues that 
affect the hospital population, including both patients and staff.   NICE Guidelines were 
incorporated in the four major themes of the campaign:  
 

Fluids and hydration;  
- Healthy 
snacks 
 
-     the Malnutrition Universal Screening Tool (MUST) – all patients are   screened  
within 48 hours and weekly thereafter; 
-  diabetes, which focused on healthy eating to reduce and prevent the long-term 
complication of diabetes.  
 
•  A team of volunteers has been providing support to patients coming into the accident & 
emergency department by staffing a helpdesk to advise patients if they are in the right 
place and redirecting where necessary. 
 
Our priorities for 2009/10   
 
The merged Trust’s plans for 2009/10 were approved by the South London Healthcare NHS 
Trust Board on 29 April.  They are centred around seven core objectives: 
 
For each of these objectives we have identified a number of actions, which will be monitored by 
the Board throughout the year.    
 
OBJECTIVE 1  
  
Our patients. We will put patients at the centre of everything that we do. We will ensure that all 
patients experience care that is safe, maintains their dignity, treats them with respect and leads 
to agreed outcomes.   
  
 
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Actions and Outcomes  
  
1.1 Work in partnership with local commissioners to implement systems that respond to the 
views and experiences of patients and improve the patient experience of services.  
  
1.2 Work with our local commissioners to deliver substantial and meaningful reductions in the 
number of patients in our hospitals who report that they share sleeping or sanitary 
accommodation with members of the opposite sex.  
  
1.3 We will ensure a system wide focus on quality through ensuring that:  
  
•  our patients are safe – that care is provided in a clean and safe environment.  There will 
be a clear and systematic approach to improving patient safety;   
 
•  that care is effective from a patient perspective, measured through patient reported 
outcome measures (PROMS)* and other local patient survey mechanisms;  
 
•  that we deliver quality, personalised care focusing on the compassion, dignity and 
respect with which patients are treated and how easy it is for patients to access services, 
taking account of the need to promote equality for minority groups.  
  
1.4 Implement the new national complaints system, Making Experiences Count.  
  
1.5 Develop active and mutually supportive relationships with Local Involvement Networks 
(LINks) and local projects that provide feedback from local groups and communities.   
 
* Operating Framework – PROMs:   
. short questionnaires used to measure patients’ assessments of their own health and well-being – will 
play an important role in measuring the effectiveness of care, and contribute to the Commission for 
Quality and Innovation (CQUIN) payment framework.   
 
. PROMs put patients at the centre of determining the quality of services and will be introduced under the 
standard NHS contract for acute services.   
 
. From April 2009 they will cover patients undergoing elective hip and knee replacements, varicose veins 
and groin hernia surgery.   
 
 
 OBJECTIVE 2  
  
Financial viability.   We will develop and commence implementation of a strategy to achieve 
and sustain financial viability in readiness for a future foundation trust application, ensuring that 
our services are provided within available financial resources and that we get paid for the 
services we provide.    
  
Actions and Outcomes  
  
2.1 Maintain excellent health care services whilst ensuring that expenditure is contained within 
the income earned and provide value for money.  
  
2.2 Develop a financial plan that delivers run-rate balance within the  24 month timetable agreed 
by the Board within the Medium term financial Strategy (MTFS).  
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2.3 Implement a detailed programme of work to ensure that all activity undertaken is recorded, 
coded and charged appropriately, maximising the income available to the Trust over the next 
two years.  
  
2.4 Develop, implement and deliver a robust Cost Releasing Efficiency Savings (CRES) 
programme to ensure that the year end control total is met.   
 
     
OBJECTIVE 3  
  
Leadership and workforce.   We will provide positive leadership and effective management 
and engagement of staff at all levels and in all disciplines in the transition to the new 
organisation to ensure a safe and supportive working environment.   We will develop a 
workforce that is increasingly sensitive to the needs of patients, exploits every opportunity to 
improve its productivity without sacrificing quality of care, and is proactive and flexible in its 
approach to service change.   
  
Actions and Outcomes  
  
3.1 Provide positive leadership in the transition to the new organisation, communicating well 
with our staff to ensure a safe and supportive working environment.  
  
3.2 Build upon existing levels of staff empowerment and engagement, which are crucial to 
ensuring improved quality of care and effective implementation of the local clinical visions at the 
heart of High Quality Care for All.  
  
3.3 Staff satisfaction will be improved through our commitment to provide good workplaces and 
rewarding jobs for all of our staff.  
  
3.4 Ensure that we are a learning and nurturing organisation, providing appropriate levels of 
training, learning and development for all of our staff ensuring they have the skills they need to 
improve patient care.  
  
3.5 Develop and improve the performance appraisal process based on the knowledge skills 
framework.   
 
     
OBJECTIVE 4  
  
High Quality Clinical Care.  We will deliver high quality clinical care through the application of 
best clinical practice and by ensuring that the principles of clinical governance underpin our 
organisation’s culture, our systems and the working practices of our clinical teams and clinical 
services.  
 
 Actions and Outcomes  
  
4.1 Achieve compliance with all of the core standards within Standards for Better Health, 
through effective arrangements for the collection of evidence, periodic monitoring of compliance 
with them and prompt action where lapses are identified in respect of them.  
  
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4.2 Ensure the existence of strong clinical governance arrangement within Divisions, including 
the introduction of appropriate performance indicators for clinical quality and safety at specialty 
level.    
  
4.3 Ensure systematic organisation-wide processes for the review of compliance with NSF 
standards, NICE guidance and all relevant national regulatory bodies  
 
 
OBJECTIVE 5  
  
Healthcare acquired infections. We will continue to drive forward improvements in reducing 
health care acquired infections, to ensure that patients receive safe care that conforms to 
nationally agreed best practice and which leads to reductions in the incidents of Clostridium 
Difficile infections and MRSA.     
  
Actions and Outcomes  
  
5.1 Maintain compliance with the Health Act 2006 Code of Practice for the Prevention and 
Control of Health Care Associated Infection to ensure that patients receive safe care that 
conforms to nationally agreed best infection control practice, ensuring specifically:  
  
•   meeting national targets for MRSA;  
 
•   reduction in the rates of Clostridium Difficile;   
 
•   raising levels of cleanliness across all our sites as measured by the PEAT scores; and  
 
•   compliance with the Hygiene Code.  
 
 
     
OBJECTIVE 6  
  
National and Local Priorities:   We will demonstrate that the Trust is providing high quality 
cost effective services through achieving the national priorities highlighted in the Operating 
Framework and through the achievement of a high level of performance in the measures 
included within the Annual Health Check (or Care Quality Commission equivalent), including the 
Auditor’s Local Evaluation Assessments.   
  
Actions and Outcomes  
  
6.1 Improve performance to ‘Good’ for the Quality of Service element of the Annual Health 
Check (or Care Quality Commission equivalent), which will require achievement of the 
performance standards set for the new and existing national targets as well as achievement of 
the core standards within Standards for Better Health.  
  
6.2 Deliver the key access targets:  
  
•   18 week referral to treatment target (RTT);  
 
•   4-hour A&E treatment target;  
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•   All cancer targets – 2 week; 31 day and 62 day targets  
  
6.3 Deliver our commitments for keeping adults and children well, specifically:  
  
•   Deliver the Cancer Reform Strategy;  
 
•   Implement the Stroke Strategy;  
 
•   Improve maternity care, through delivering the requirements of Maternity Matters  
  
6.4 Work with PCTs and other local organisations to ensure robust plans are in place to enable 
an effective response to major incidents and to pandemic influenza.  During 2009/10 and 
beyond, these plans will be tested, reviewed and improved, as appropriate, to take account of 
lessons learned and of developments in the national arrangements for pandemic influenza 
preparedness.   
 
6.5 Work with PCTs to deliver local key priorities, specifically the (KPIs) key performance 
indicators and the Commissioning for Quality and Innovation (CQUINS) measures identified 
within the Service Level Agreements, developing local improvements plans and delivering 
improved patient pathways as necessary.  
  
6.6 Achieve level 3 (good) on those elements of the Auditor’s Local Evaluation (ALE) that are 
not dependent on setting a balanced budget, namely financial reporting, internal control, value 
for money, and financial management.  (Financial standing will be scored at level 1 (poor) whilst 
the Trust is in deficit.)  
 
 
 OBJECTIVE 7  
  
Services and facilities fit for the future. We will work closely with partners in primary and 
social care to develop new and improved services to benefit our local population, with particular 
emphasis on the quality of care within improved patient pathways.  We will ensure that our 
buildings, equipment and infrastructure are fit for purpose and capable of accommodating 
service change.   
  
Actions and Outcomes  
  
7.1 Work closely with PCT partners to contribute fully to the implementation of the APOH 
strategy, ensuring that the service changes agreed are developed into robust, deliverable and 
timely project plans.  
  
7.2 Ensure that a communications strategy is developed, which supports the service change 
agreed within the APOH plans.  
  
7.3 As a part of 7.1 above, produce Development Control Plans for each of the hospital sites, 
which deliver buildings and infrastructure that are capable of accommodating the agreed service 
changes.  
  
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7.4 Ensure that service transformation plans are developed and implemented to enable the 
Trust to achieve the productivity improvements required by the APOH strategy, specifically in 
the areas of length of stay, day case rates and theatre utilisation.  
 
 7.5    Engage with patients, our staff and the public to ensure safe, high quality and affordable 
services and work actively with all of our key partners to plan a viable future for our services and 
our organisation.   
 
Financial report 
 
Background 
 
The Trust has been unable to balance its income and expenditure consistently since it came 
into being in 2001. This has been the result of a numbers of factors including, in the past, 
operating inefficiencies and the high costs of our PFI scheme. The ‘excess’ costs of the PFI 
scheme – the costs that the Trust is unable to recover through the income it receives under the 
payment by results system of funding hospitals – have been assessed by independent 
consultants Tribal Consulting, and validated by Cambridge Economic Policy Associates, at 
approximately £8M per annum. The consequence of this history is that the Trust’s balance 
sheet at 31 March 2009 contains a negative income and expenditure reserve of £51M. 
 
The full accounts for the year ending 31 March 2009 are included within this document from 
page 41 onwards. The paragraphs which follow aim to describe in non-technical language our 
financial performance for the year, and should be read in conjunction with the accounts. 
 
 
Income and Expenditure 
 
Our income and expenditure plan for 2008/09 was designed to produce a deficit of £5.5M. This 
required us to plan and implement savings measures amounting to almost £9M in the year. The 
Trust was successful in achieving the deficit planned at the start of the year. A shortfall on 
planned savings was offset by higher than budgeted income.    
 
The table below compares the main elements of our income and expenditure account in 
2007/08 and 2008/09 and comments on the main changes between the two. 
 
Income and Expenditure 
 
  
2007/08 
2008/09 
Comment 
(£ million) 
(£ million) 
Income 
  
  
  
Income from 
141.3 145.9 Income 
from 
activities increased by 3.26% 
activities 
in 2008/09 from additional income for 
reduction in elective waiting times and 
improved recording of income from 
Overseas patients,  
Education, training 
5.1 
5.7 
There was an increase in-year for  
and research 
Education and Training Funding for both 
Medical (post-graduation) & Nursing staff 
groups. 
Other operating 
5.7 
6.0 
Small increase in income above inflation 
income 
relating to increased recovery of charges. 
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Total income 
152.1 
157.6 
  
Expenditure 
  
  
  
Pay 
-92.1 
-97.8 
A reduction in the number of permanent 
employees required a higher usage of 
agency staff than in the previous year. 
Non-pay 
-62.6 
-65.2 
The increase in non-pay arises from 
contractual increases in PFI payments 
and higher drug usage, in addition to 
annual cost inflation 
Total expenditure 
-154.7 
-163.0 
  
  
  
  
  
Interest 
receivable 
0.6 0.4  
 
Dividends 
payable 
-0.6 -0.2  
 
Asset Write Off 
 -0.5 
-0.1 
  
Surplus/(deficit) -3.1 
-5.5 
  
 
 
 
Capital expenditure 
 
As a PFI hospital our capital expenditure needs are lower than for similar-sized hospitals that 
have been financed in the traditional way, and our capital resource limit reflects this. During the 
year we invested £1.7M in 22 capital schemes. The table below summarises our capital 
expenditure for the year. 
 
Capital Expenditure 
 

 
2008/09 
Description 
(£ Million) 
IT Network and Equipment 
0.7 
Network and equipment to support our IT systems and 
Relocation of the Data Centre to the Hospital Site 
Surgical Equipment 
0.3 
Purchase  of  an Endosonography machine and other 
required surgical equipment  
Imaging  
0.3 
Enabling works and contribution to the replacement of 
the Cardiac Angiography Suite 
Other 
0.4 
Other clinical / IT equipment and enabling works 
Total 
1.7  
 
From 2007/08 the system of allocating capital resources to NHS trusts was changed as part of a 
wider set of financial changes announced by the Department of Health. NHS Trusts will, as a 
minimum, be required to spend the funds they set aside for the depreciation of their assets. If a 
trust wishes to spend more than this on capital investments, it needs to borrow the funds to do 
so. Trusts are only allowed to borrow if their financial strength, assessed by the Department of 
Health, indicates that they will be able to afford to make the repayments associated with these 
borrowings. QEH has the lowest financial strength rating because of its historic financial 
difficulties, which means that no borrowing has been available for capital investment in 2008/09, 
and we have been restricted to investing the sum set aside for depreciation and amortisation of, 
approximately £1.7M.  
 
The Trust urgently needs to upgrade the electricity power supply to the hospital and plan to 
carry out the work in 2009/10. An application for funding has been submitted to NHS London. 
The capital costs are expected to be £4.5M.  
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Cash 
 
The Trust had an External Financing Limit (EFL) of £5,302k, which it undershot by £232k.  The 
Trust had a cash balance of £3,406k at the year-end.  
 
As at last year-end the Trust has cumulative cash borrowings of £65.4m, relating to historic 
borrowing received by the Trust to fund past deficits.  These borrowings have not increased 
during the year ended 31 March 2009.   
 
NHS organisations are expected to comply with the Confederation of British Industry’s code on 
payment to suppliers, known as the Better Payment Practice Code (BPPC). Details of how we 
performed in relation to this code can be found in note 6 to the accounts. 
 
Other financial matters 
 
PFI  
 
Queen Elizabeth Hospital was constructed and is maintained under a PFI contract with Meridian 
Hospital Co plc (Meridian). The contract between Meridian and the Trust was signed in 1998 
and Queen Elizabeth Hospital opened to patients in March 2001. Under the arrangement, 
Meridian has granted a lease to the Trust for the exclusive use of the building and undertakes to 
maintain, repair, and replace building, engineering, electrical and other plant and machinery, as 
well as the fabric of the building and its grounds and gardens, over the 30 operational years of 
the contract. The Trust has the option to extend this operational period to 45 or 60 years. 
Meridian also provides catering, portering, domestic and cleaning, and a whole range of other 
services on the Queen Elizabeth Hospital site. These contracts are subject to market testing 
every five years (extendable to seven years with the agreement of both Meridian and the Trust). 
Meridian delivers its obligations through sub-contractors: Skanska Rashleigh Weatherfoil (SRW) 
and Skanska Facilities Services (SFS) provide the “hard” facilities management associated with 
the building, its fabric and equipment; ISS Mediclean provides the “soft” services, such as 
catering, portering and domestic services. The Trust retains ownership of the land at the QEH 
site.  Annual spend on the Meridian contract was £24M. 
The Trust also has a PFI contract with Toshiba Medical Systems for the repair, maintenance 
and replacement of our medical equipment. This is a 15 year contract which started in 2001, 
and requires Toshiba to replace medical equipment to an agreed lifecycle, or before if it fails or 
wears out, with an equivalent asset in line with the clinical preference of our clinicians. Annual 
spend on this contract was £4.0M. 
Organisations of key importance to the future of the Trust 
 
We receive the majority of our income from two NHS organisations, Greenwich Teaching 
Primary Care Trust and Bexley Care Trust, each of which commissions clinical services from 
QEH for the population it serves. We also receive smaller sums of money from NHS London to 
support undergraduate and postgraduate medical and non-medical education and training, as 
well as for research and development. We receive income from Oxleas NHS Foundation Trust, 
which operates a 90 bed mental health facility on the QEH site, from Queen Mary’s Sidcup NHS 
Trust for use of our facilities in the provision of oral and ophthalmology clinics at QEH, and from 
24

King’s College Hospital NHS Foundation Trust which operates a renal dialysis unit on the QEH 
site. 
 
Other important contractual relationships exist with Meridian Hospital Co plc and Toshiba 
Medical Systems, as described above, NHS Shared Business Services (NHS SBS) who run 
most of our finance, accounting and payroll services, and McKesson Information Solutions UK 
Ltd who provide and support our key clinical systems, as well as our Electronic Staff Record 
(ESR) system. 
 
The Trust is performance-managed by NHS London through its recently established arm’s 
length provider agency. 
 
Accounting policy changes 
 
From the 1 April 2008 the Trust was required to account for Financial Instruments under the 
provisions of FRS 25, FRS 26 and FRS29.  The Trust’s accounting policies have been amended 
to reflect this change.  
 
Pension liabilities 
 
Information about the accounting treatment of pension liabilities is provided in note 1.14 of the 
2008/09 accounts. 
 
Auditors 
 
The Trust’s auditors are PricewaterhouseCoopers LLP (PwC), who have been appointed by the 
Audit Commission as our external statutory auditor. In addition to the statutory audit carried out 
by PwC in 2008/09, at a cost of £216,000, additional work reviewing the Trust’s readiness for 
the implementation of International Financial Reporting Standards (IFRS) was done at a cost of 
£15,000.  
 
As far as the directors are aware, there is no relevant audit information of which the Trust’s 
auditors are unaware, and the directors have taken all steps to make themselves aware of any 
relevant audit information and to establish that the Trust’s auditors are aware of that information. 
 
Other Disclosures 
 
The Operating and Financial Review has been prepared in accordance with the NHS Trusts 
Manual for Accounts for 2008/09, as directed by the Secretary of State in accordance with 
Reporting Standard 1. 
 
How we are addressing our environmental, social and community responsibilities  
 
Whilst the Trust continues to take its responsibility for the reduction of its carbon footprint and its 
commitment to achieve the 2050 national carbon reduction targets seriously, the ability to move 
ahead with further initiatives has been delayed by the merger of Queen Elizabeth NHS Trust 
with Bromley Hospitals NHS Trust and Queen Mary’s NHS Trust.  However, following the 
merger and the reorganisation of the Estates and Facilities Directorate, it is envisaged that the 
responsibility for carbon management across the new organisation will be managed centrally 
under the auspices of the new Estates & Facilities Director.   
 
25

The Trust has continued however with its recycling initiative and extended recent trials to Ward 
levels with the intention to rollout the programme across the entire site during the forthcoming 
year.   
 
We are continuing to monitor the reduction of our waste output related to both clinical and 
domestic waste despite continued increases in patient activity.  We have had a number of 
discussions with energy consultants including Waterman Energy, Environment and Design who 
have indicated their ability to work with the Trust in order to facilitate carbon reduction initiatives 
and a request for further references have been sought with a view of creating a commercial 
partnership. 
 
Emergency planning   
 
Queen Elizabeth Hospital has in place a Major Incident Plan that is fully compliant with the 
requirements of Department of Health guidance ‘Handling Major Incidents: An Operational 
Doctrine’ and all associated and subsequent guidance. This plan was tested through a live 
rehearsal in July 2006 and a communications exercise during 2008.  The next live rehearsal will 
be held in 2009/10.  
 
The role of the Emergency Planning Officer has been combined with the role of the Head of 
Nursing for the Clinical Site Management Team and a new Emergency Preparedness Working 
Group has been established under the chairmanship of the Director of Operations. The working 
group are responsible for the development and implementation of the site’s Emergency 
Preparedness Action Plan.. This comprehensive business continuity plan will cover all 
significant operational threats to the hospital’s ability to continue to provide safe and high quality 
care to our patients. 
 
 
26

STAFFING REPORT 
 
In 2008/09 we planned to have an average 2,185 whole time equivalent (WTE) staff over the 
course of the year, comprising both permanent and temporary staff.  The number of substantive 
staff in post reduced during the year and staffing levels were maintained through increased use 
of temporary staff.   
 
Key achievements 
 
• 
As a key part of the Trust’s Getting it Right for Patients strategy we published robust 
standards of behaviour, developed and rolled-out A Positive Experience Every Time, the 
Trust’s customer care and diversity awareness programme, and introduced Dr Foster 
Patient Experience Trackers (PET) in to 10 wards or departments to capture patient 
experience. 
 
• 
The Trust launched its Mediation framework, having trained 30 staff at all levels and in 
all disciplines to provide an internal resource, to reduce the increasing amount of time 
spent by managers and staff in formal and often confrontational grievance processes by 
addressing issues speedily and informally. 
 
• 
We partnered with Kings College Hospital in a ground breaking Thought Leadership 
programme to stimulate innovative thinking in senior nurse leaders. 
 
• 
Successfully outsourced payroll administration to NHS Shared Business Services. 
 
• 
Enhanced the Queen Elizabeth Hospital as a state of the art teaching facility with the 
commissioning and opening of a SIFT funded Clinical Skills Laboratory.  This facility 
provides all staff with the opportunity to learn and practice clinical techniques, in a high 
tech simulated environment, without compromising patient care. 
 
• 
Introduced an electronic bank booking system to improve efficiency and release 
maximum resources for patient care. 
 
• 
Agreed a full business case for the introduction of e-rostering which will automate 
systems of time, attendance, rostering and sickness reporting and management. 
 
• 
Successfully tendered to Occupational Health Services and awarded the contract to 
Royal Marsden NHS Foundation Trust for commencement in 2009/10. 
 
• 
Made significant progress towards EWTD compliance in August 2009. 
 
• 
Appointed an Associate Director of Medical Education to take forward the Trust’s plans 
for medical education. 
 
• 
The August intake of doctors in training was successfully managed, with the majority of 
the Trust’s posts filled with Deanery appointments. 
 
• 
Consulted with staff on the proposed merger with Bromley Hospitals NHS Trust and 
Queen Mary’s Sidcup NHS Trust. 
 
27

Key workforce metrics 
 
•  Workforce actual against plan 
 
Workforce whole time equivalent (w.t.e.) actual remained between 2% and 3% below plan 
throughout the year, although the year closed on plan. Vacancy levels increased during the year 
from 9% to 11%, peaking at 14% mid year.  Bank staff employed flexibly made up the gap, 
though difficulty in recruiting sufficient bank staff led to an increased use of agency staff from 
less than 2% to over 8% of the monthly pay bill. Vacancy levels rose particularly for trained and 
specialist staff, with all clinical services experiencing a shortage. The majority of services were 
maintained, but the impact was most noticeable in areas where clinical activity had increased, 
where uncertainty in relation to A Picture of Health was highest, and where levels of maternity 
absence were high. (Source: Workforce Information Management System (WIMS) March 09). 
 
 
• Staff 
survey 
results 
 
The Trust’s scores in the annual staff survey showed an improvement in areas which had been 
of previous concern including job satisfaction and the intention to leave, the availability of 
counselling services and awareness in relation to infection control. The key indicator where the 
Trust continued to fall below average related to the provision of annual appraisal/Knowledge 
and Skills Framework reviews. 
 
• Ethnicity 
 
We have a diverse mix of employees, with nearly 35% of non-white ethnicity, compared with 
about 23% in the local population. Our active Black and Minority Ethnic network and a rich 
annual programme of cultural activities for staff and patients help to make the hospital an 
interesting and inclusive environment.  We have race equality, disability equality and gender 
equality schemes, and actively pursue the action plans, reporting annually to our Board and 
executive. 
 
 
•  Bank and agency staff usage 
 
The Trust makes good use of flexible staffing through its own internal bank, which has 
consistently met over 90% of demand.  However an significant increase in demand for 
temporary staff, and reduced availability, has led to a significant increase in the use of agency 
staff, in spite of action in the early part of the year to increase pay rates (Source: WIMS March 
09). 
 
 
• Staff 
turnover 
 
Staff turnover has been higher this year, at around 13%, though there was a peak at 14% mid 
year.  Uncertainty in relation to organisational and service change has had a significant impact, 
though the difficulty in some areas is in recruiting replacements for normal turnover rather than 
higher turnover itself. (Source ESR December 2008).  
 
 
 
28

• Sickness 
absence 
 
Levels of sickness absence have been managed at around 4.5% (Source: WIMS March 09) 
 
 
•  European Working Time Directive (EWTD) compliance 
 
The hospital is confident of compliance with the European Working Time Directive (EWTD) from 
August 1st 2009.  Of those rotas that were non compliant, three require recruitment of extra non 
training staff.  The remainder require some adjustment but do not require additional recruitment.   
 
•  Standards for Better Health compliance 
 
Following a declaration in 2007/08 based on staff survey evidence of ‘insufficient assurance’ for 
Standard C7e -“Healthcare organisations challenge discrimination, promote equality and 
respect human rights
” an extensive diversity training programme commenced in September 
2008 and rolled-out across the Trust to reflect both our new Standards of Behaviour for staff and 
enable the Trust to declare full compliance by year end. 
 
 
•  Staff involvement and consultation 
 
 
Our Joint Staff Council (JSC) has met regularly, involving itself in all aspects of the Trust’s 
business and receiving regular reports on the Trust’s performance.  The proposed merger with 2 
local hospital Trusts rose to the top of the agenda as the year progressed, and the Trust worked 
hard with local staff representatives to keep staff engaged and involved, both internally and 
through the local Partnership Committee set up to oversee staffing issues across outer south 
east London. 
 
Communication with staff continued through clinical directorates, through both regular and 
merger specific briefings and regular Open Forums hosted by the Chief Executive and Director 
colleagues. 
 
 
•  Learning and Development 
 
In conjunction with staff at the Nightingale School at King’s College London (KCL), a Thought 
Leadership programme was designed to meet the specific needs of the Trust in regard to 
encouraging a culture of continuous improvement and innovation.  
 
The first cohort of staff graduated in January 2009 and several of the participants have opted to 
convert their participation into academic credit; at least one is planning to join the M.Sc. in 
Leadership that is offered at KCL. All participants undertook a service improvement project as a 
means of putting Thought Leadership into practice. The programme will run again in September 
2009. 
 
A learning intervention that covered issues of improving service-user experience and 
addressing diversity was designed so that it might be run over two hours in workplace-based 
team meetings. Delivery was undertaken in each Directorate by the respective HR Manager. 
29

Feedback from these events was extremely positive, with staff clearly enjoying and feeling that 
they benefited from attendance. 
 
Over 30 staff across Queen Elizabeth Hospital went through a four-day training course in 
workplace mediation, delivered on behalf of the Trust by ACAS. A mediation scheme has been 
running in pilot form since Jan 2009; the scheme will be formally launched in June 2009. 
 
 
• Knowledge 
Services 
 
Knowledge Services continued to support evidence based practice through the provision of 
access to an increasing range of electronic resources supported by tailored group and individual 
training sessions and supplementary search services. The Healthcare Library now enjoys a 
regular slot on Trust inductions enabling the promotion of resources and services to staff at all 
levels of the organisation. 
  
The Healthcare Library recently participated in the South East London Regional Library survey 
enabling the benchmarking of user satisfaction with other regional Health Libraries. Over 85% 
of respondents found the overall service to be good or excellent, slightly higher than the 
regional average. Respondents made most frequent use of the library's print and electronic 
collections of journals and books while a significant percentage of Trust staff used the 
Healthcare Library services to assist with their Continuing Professional Development (38%) and 
made use of the literature search facilities (42%) and document delivery services (30%). 
 
 
 
•  Spiritual and pastoral care 
 
 
Chaplaincy Services at QE have continued to provide a range of pastoral and spiritual support 
to patients and staff, provided by a small paid team and a wide range of volunteers from many 
faiths.  The team provides a focal point for the Trust's multi-faith endeavours, in particular: 
 
•   A part-time Muslim bank chaplain has been appointed and is now undertaking regular 
weekly visitation of Muslim patients as well as providing guidance to colleagues, whilst 
teaching at Friday Prayers continues to be provided from Woolwich Mosque. 
•  A national Sikh initiative to have a week of prayer for healthcare has motivated the Sikh 
community to hold monthly Sikh prayers in our Prayer Room, a new development. 
•  Chaplaincy has been instrumental in the establishment of a Trust-wide mediation 
scheme for staff, enabling them to settle differences without recourse to formal and 
often adversarial procedures. This is linked to the work of contact officers, already 
facilitated by chaplaincy. 
•  Spiritual care links have been set up across all clinical areas and regular quarterly 
meetings are getting established, to enable greater staff awareness of the ‘how’ of 
spiritual and cultural care. 
•  The Hospice Outreach Team development has led to closer working between the 
hospice and the QE chaplaincy. 
30

REMUNERATION REPORT 
 
 
This report covers the remuneration of the Trust’s executive and non-executive directors, these 
being the only individuals with responsibility for directing or controlling the major activities of the 
Trust. 
 
Remuneration of the executive directors is determined by the Remuneration and Terms of 
Service Committee, membership of which is indicated in the table below. The Department of 
Health determines the remuneration of the non-executive directors. 
 
Executive directors are paid a spot salary, and do not receive performance related pay. 
 
The performance of Executive Directors is assessed each year by the Chief Executive, and 
considered by the Remuneration and Terms of Service Committee. The Chairman of the Trust 
assesses the performance of the non-executive directors.  
 
Executive director salaries were increased by 2.75% with effect from 1 April 2008, following an 
assessment of satisfactory performance.  
 
All substantive executive directors’ contracts are open ended, and provide for six months’ notice 
on either side on termination. In the event of early termination, the Trust’s liabilities are limited to 
payment in lieu of notice, except in the event of redundancy, when standard NHS conditions 
apply. There is no provision for compensation for early termination resulting from summary 
dismissal.  
 
All other senior managers are on national contracts, pay and conditions, following job matching 
or evaluation within the Agenda for Change framework. 
 
The salaries, allowances and pensions benefits of the directors are set out in the tables below. 
No significant awards have been made to past directors. 
 
Salaries and Allowances (audited element of remuneration report) 
 
 
2008/09 2007/08 
Salary  
Other 
Benefits in 
Salary  
Other 
Benefits in 
Remuneration
Kind 
Remuneration 
Kind 
(bands of 
(bands of  Rounded to  (bands of 
(bands of 
Rounded to 
£5000) 
£5000) 
the nearest 
£5000) 
£5000) 
the nearest 
£000 
£000 
  
  
  
  
Name and Title ◊ 
£0 £0 
£0  £0 
Colin Campbell* 
20-25 
  

20-25 
  

Lady Ann Jenkins*  
5-10 
  

5-10 
  

Sylvia Perrins*  
5-10 
  

5-10 
  

Gary Kent*  
5-10 
  

5-10 
  

Raoul Pinnell*  
5-10 
  

 
 
 
John Ballard*  
5-10 
  

 
 
 
Terina Riches 
70-75 
  

80-85 
  

31

Dr David Robson 
125-130 
35-40 

45-50 
145-150 

Lynn Saunders 
90-95 
  

85-90 
  

Elisa Steele 
80-85 
  

75-80 
  

Sally Storey 
65-70 
  

65-70 
  

Ruth Russell 
85-90 
  

80-85 
  

David Sulch 
30-35 
105-110 

 
 
 
David Wragg 
100-105 
  

95-100 
  

◊   See Appendix 2 for titles 
*   Member of the Remuneration and Terms of Service Committee. 
  Member of the Audit and Assurance Committee 
 
Changes in executive directors 2008/09 
•  Dr David Sulch became the Trust’s Medical Director from April 2008. 
•  Terina Riches left the Trust in February 2009.  
•  David Wragg, Director of Finance left the Trust on 31 March 2009. 
 
 
Changes in non-executive directors 2008/09 
 
•  John Ballard and Raoul Pinnell both joined the Trust as non-executive directors in May 
2008. 
 
Pension Benefits (audited element of remuneration report) 
 
Real 
Total 
Cash 
Cash 
Real 
Employers 
increase in  accrued 
Equivalent 
Equivalent  Increase in  Contribution to 
pension and  pension 
Transfer 
Transfer 
Cash 
Stakeholder 
related lump and related  Value at 31 
Value at 31  Equivalent 
Pension 
sum at 31  lump sum   March 2008  March 2009 
Transfer 
March 2009  at 31 March 
Value 
2009 
(bands of 
(bands of 
£000 £000 £000 
£2500) 
£5000) 
Name and title 
£000 £000 
To nearest £100
Ruth Russell 
0-2.5 
100-105 
270 
354 
54 

Terina Riches 
2.5-5 
135-140 
474 
649 
114 

Dr David Robson  
5-7.5 
340-345 




Dr David Sulch 
-12.5 -  -15 
100-105 
366 
422 
33 

Lynn Saunders  
5-7.5 
65-70 
241 
350 
72 

Elisa Steele  
2.5-5 
85-90 
281 
378 
63 

Sally Storey  
5-7.5 
95-100 
342 
478 
88 

David Wragg  
2.5-5 
80-85 
256 
347 
59 

 
•  As non-executive directors do not receive pensionable remuneration, there are no entries in 
respect of pensions for them. 
 
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the 
pension scheme benefits accrued by a member at a particular point in time.  The benefits 
valued are the member's accrued benefits and any contingent spouse's pension payable from 
the scheme.  A CETV is a payment made by a pension scheme, or arrangement to secure 
32

pension benefits in another pension scheme or arrangement when the member leaves a 
scheme and chooses to transfer the benefits accrued in their former scheme.  The pension 
figures shown relate to the benefits that the individual has accrued as a consequence of their 
total membership of the pension scheme, not just their service in a senior capacity to which the 
disclosure applies.  The CETV figures include the value of any pension benefits in another 
scheme or arrangement which the individual has transferred to the NHS pension scheme.  They 
also include any additional pension benefit accrued to the member as a result of their 
purchasing additional years of pension service in the scheme at their own cost.  CETVs are 
calculated within the guidelines and framework prescribed by the Institute and Faculty of 
Actuaries. 
 
 
 

Dr Chris Streather 
Chief Executive  
 
 
10.6.09 
 
 
 

 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

33

Appendix 1 
 
SERVICES PROVIDED AT QUEEN ELIZABETH HOSPITAL 
 
Accident & Emergency 
Medical Diagnostic Centre 
Adult Medicine 
Metabolism Clinic 
Anaesthetics Microbiology 
Anti-coagulation Services 
Mortuary 
 MRI 
Scanning 
Bereavement Services 
 
Biochemistry Neurology 
Blood tests (phlebotomy) 
Nuclear Medicine 
Blood transfusion 
 
Breast Services 
Obstetrics 
 Occupational 
Therapy 
Cancer Services (Oncology) 
Oncology (Cancer Services) 
Care of the Elderly 
Ophthalmology Clinics** 
Cardiology 
Oral Surgery Clinics**
Chemotherapy Orthopaedics
Clinical Haematology 
 
Colorectal Surgery 
Paediatric Medicine 
Community paediatric nursing 
Pain Management 
Coronary Care Unit 
Palliative Care*** 
CT scanning 
Pathology 
Cytology Pharmacy 
Cardiac Catheter Laboratory and Coronary  Phlebotomy (blood tests) 
Angioplasty 
Dermatology Physiotherapy 
DEXA Scanning 
Plastic Surgery****
Diabetic Medicine 
Podiatry 
Dietetics and Nutrition 
 
 Radiology 
Ear, Nose and Throat Clinics* 
Respiratory Medicine 
Endocrinology  
Endoscopy Rheumatology 
 
 
Fracture Clinic 
Sexual Health
Fertility Sleep 
Studies 
Gastroenterology Social 
Services
General Medicine 
Special Care Baby Unit 
General Radiology 
Speech and Language Therapy 
General Surgery 
Stroke Unit 
Genitourinary Medicine 
Surgical Appliances 
Gynaecology 
 
 Trauma 
Surgery 
Haematology  
Histopathology Ultrasound 
 
Upper Gastrointestinal Surgery 
Imaging Urology 
34

Immunology  
Infection Control 
Virology
Intensive Care 
 
 Women’s 
Services 
Lipid Clinic 
 
 X-ray 
 
* Service provided by Lewisham Hospital NHS Trust 
**Service provided by Queen Mary’s Sidcup NHS Trust 
*** Service provided by Bexley and Greenwich Cottage Hospice 
****Service provided by Guy’s and St Thomas’ Hospital NHS Foundation Trust 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

35

 
Appendix 2 
 
DIRECTOR BIOGRAPHIES 
  
 Colin Campbell - Chairman 
 Colin is a former technology director with a global accounting and financial services firm and is 
now a director of a number of small companies. He has been involved with the NHS since the 
late 1980's. He is an elected Local Government Councillor for Bexley where he lives. 
 
John Ballard – Non-Executive Director 
John was appointed as a Non-Executive Director on 1 May 2008.  He has a long career at 
senior levels in a number of Government departments, including latterly, as the Finance Director 
for the Department of Environment, Transport and the Regions. He is currently a Non-Executive 
Director and Chair of the Audit Committee for Northern Ireland Water and has similar roles with 
the Marine and Fisheries Agency.  He has also been a Trustee of the Great Ormond Street 
Children’s Hospital Charity since 2000.  John chaired the Audit and Assurance Committee from 
November 2008.  John continues with the new Trust as Non-Executive Director.  
 
William Bruce – Associate Director  
William was appointed Associate Director in April 2008, but had been closely involved with the 
Trust since 2003 when he first represented patients on the Board.  As a patient himself, he is a 
firm believer in a patient-led NHS and works closely with many people throughout the hospital to 
ensure this is a reality.  William chairs the QEH Patients’ Group – the successor to the Patients’ 
Forum.  He is a retired journalist and lives locally. 
 
Janet Grant – Director of Nursing and Patient care 
Jan joined the Trust as Interim Director of Nursing and Patient Care in February 2009.  She is a 
trained Children’s and General Nurse, qualified midwife and has nursing experience in Primary 
Care.  Prior to her appointment as Interim Director she has held a wide range of senior 
appointments including Deputy Director of Nursing at Oxford Radcliffe Hospitals, Director of 
Clinical Services and Quality at South East and South West Oxfordshire PCT and Lead Nurse 
at Thames Valley Strategic Health Authority.  Jan is passionate about nursing.  Her interests 
focus on professional development, public and patient involvement and organisational 
development.  Jan continues with the new Trust as Associate Director of Nursing, Woolwich. 
 
Lady Ann Jenkins - Vice-Chairman and Non Executive Director 
 Ann, who lives in Blackheath, previously served as a Non-Executive Director at Queen Mary's 
Sidcup NHS Trust. She is Chair of the Ranyard Memorial Charitable Trust, which runs two 
nursing homes, Dowe House and Mulberry House on the Lewisham/Blackheath borders.  Ann 
chairs the Clinical Governance and Risk Management Committee. 
 
Gary Kent - Non-Executive Director 
 Gary, who became a Non-Executive Director in January 2007, is an independent consultant 
specialising in procurement and has 25 years experience working in the commercial sector in 
fleet management, travel management and real estate. 
 
36

 
Sylvia Perrins - Non-Executive Director 
 
Sylvia lives in Eltham and is employed as the National Director for the National Skills Academy, 
Financial Services.  She is a qualified accountant and was Chair of the the Audit and 
Assurance Committee until November 2008. 
 
Raoul Pinnell – Non-Executive Director 
Raoul was appointed as a Non-Executive Director on 1 May 2008.  He has extensive business 
experience, gained in the Fast Moving Consumer Goods sector, with: H.J.Heinz, and Nestle; in 
Financial Services, with Prudential and NatWest; and in the Oil and Retail sector, where he 
became Chairman of Shell Brands International.  He  now has a portfolio of activities, including 
Trustee of Leonard Cheshire Disability. 
 
Lynn Saunders – Deputy Chief Executive 
 Lynn has worked in the local NHS since the early 1980s. As Project Manager, she helped 
develop the new Queen Elizabeth Hospital and then, as Director of Strategy and Planning, was 
responsible for opening the hospital in 2001. As the Trust's Director of Service Improvement 
Lynn has had responsibility for leading the organisation to achieve the NHS modernisation 
agenda. Lynn was appointed Deputy Chief Executive in May 2007 and now leads on corporate 
planning and development, business planning, performance monitoring, information, 
communications and external relations.  Lynn continues with the new Trust as Transitional 
Director of Strategy and Business Development.   
 
Terina Riches - Director of Nursing & Patient Care 
 Terina started in the NHS in 1976 and trained as a registered nurse. She joined the Trust in 
May 2000 as Director of Clinical Services following a variety of senior nursing and general 
management posts at St Mary's Hospital NHS Trust. She was appointed Director of Nursing 
and Patient Care in July 2006 and leads on ensuring the delivery of high quality nursing care. 
She is also the Director of Infection Prevention and Control.  Terina left the Trust in February 
2009.  
 
Dr David Robson – Chief Executive 
 David was appointed Chief Executive in April 2008. Prior to this he had served on the Trust 
Board first as Director for IM&T and since 2004, as Medical Director.  David became a 
Consultant Physician in 1978 and until his appointment as Chief Executive worked in Intensive 
Care and Cardiology.  
 
Dr David Sulch – Medical Director 
David was appointed Medical Director in April 2008.  Beginning his medical career in the 
Midlands, moving to SE London in 1993.   In 2001 he was appointment a Consultant Physician 
at Queen Elizabeth Hospital and from 2004, until becoming Medical Director, was Clinical 
Director of Acute Medicine.  As Medical Director his key concerns are the quality and 
organisation of the clinical services, together with the clinical governance arrangements of the 
Trust.  David continues with the new Trust as Transitional Medical Director. 
 
David Wragg - Director of Finance 
 David has been the Finance Director at QEH since January 2000. He leads the finance function 
and estates and facilities management. David has worked in the NHS since 1987, as finance 
professional, management consultant and external auditor. David is a qualified accountant and 
is one of the NHS appointed directors of NHS Shared Business Services (a joint venture 
37

company set up by the NHS and the private sector to deliver financial services to NHS clients). 
 
Ruth Russell - Director of Clinical Services 
Ruth qualified as a registered nurse in 1984 and pursued a career in nursing until she became 
General Manager of the Directorate of Surgery at Guy’s and St Thomas’ NHS Foundation Trust 
in 2003.  She joined Queen Elizabeth Hospital as General Manager, Surgery in August 2004.  In 
October 2006 she was appointed Director of Clinical Services and has overall responsibility for 
the performance of the clinical services provided by the Trust. 
 
 
Elisa Steele - Director of Information Communication Technology 
 
Elisa joined the Trust as Director of Information Communication Technology in July 2004. She 
was previously Head of IT Services at King's College Hospital. Elisa has worked in IT for over 
25 years including positions at the South East Regional Health Authority and in the private 
sector. Her outside interests include acting as a volunteer telephone counsellor for a national 
charity.  Elisa continues with the new Trust as Transitional Director of Information Management 
&Technology.   
 
Sally Storey - Director of Human Resources & Organisational Development 
Sally joined the Trust as Director of HR & OD in 2002.  She has over 20 years experience in HR 
in health care and in independent consultancy, in mental health, community, children's and 
learning disability services as well as general hospitals.  A Chartered Companion of the CIPD, 
Sally has a particular interest in the areas of diversity and leadership development, and 
maintains close involvement in these areas within her role. She is co-author of a number of 
published training packages for GP Practice Staff.  Sally continues with the new Trust as 
Associate Director of Human Resources, Woolwich. 
 
 
 
 

 
38

Appendix 3 
                  COMMITTEE STRUCTURE 
    
 

TRUST BOARD 
 
 
 
 
 
 

Audit & 
Clinical 
Trust 
Remuneration 
 
 
 
Assurance 
Governance & 
Executive 
& Terms of 
Finance 
 
Committee 
Risk 
Committee 
Service 
Committee 
 
Management
Committee 
 
 
 
 
 
 
 
 
 

Information 
Risk 
 
Capital 
 
 
Governance 
Management 
Clinical 
Planning 
ICT Strategy 
 Steering 
& NHS 
Governance 
Group   
Programme 
 Group 
Standards 
Executive 
Board 
 
Committee
 
 
 

 
 
 
Estates & 
 
Cancer 
Operations 
Control of 
Facilities 
 
Board 
Executive 
Infection 
Management 
 
Committee 
Group 
 
 
 
 

 
 
 
 
 
 
Clinical 
Health & 
Toshiba 
Meridian 
IT System 
 
Records 
Safety 
Investment & 
Liaison 
Managers 
 
Group 
Committee 
Liaison 
Committee 
Group 
 
Committee 
 
 
 
Data 
Clinical 
Medical IT 
Quality 
Coding 
Advisory 
 Group 
Group 
Group 
 
 
 
 
 
 
 

Clinical 
 
 
 
 
 
 
Incidents, 
 
 
 
 
Child 
 
  Complaints 
R&D 
Resuscitation 
Hospital 
Clinical 
Protection 
Medicines 

Committee 
Committee 
Transfusion 
Ethics 
Working 
Management 
Litigation 
Committee 
Committee 
Group 
Committee 
Committee 
39

Appendix 4 
             CLINICAL DIRECTORATE STRUCTURE 
       
                                
 
Director of Clinical Services 
•  Clinic
 
al Site Management Team (including 
  Emergen
 
cy Planning) 
• 
Pharmacy 
 
 
 
 
Directorate of Acute Medicine 
Emergency Department 
Care of the Elderly 
Surgical Appliances 
 
(including the Medical Diagnostic 
 
Acute Admitting Medicine 
Centre) 
Occupational Therapy 
 
 
 
Respiratory Medicine 
Stroke Unit 
Speech and Language Therapy 
(including the Respiratory 
 
 
Laboratory) 
Inpatient and Outpatient 
Dietetics 
 
Gastroenterology 
Diabetes Services (including 
Physiotherapy 
the Diabetic Day Centre) 
 
Directorate of Pathology 
Haematology (including Blood 
Microbiology (including the 
Histopathology (including the 
Transfusion 
Infection Control Team) 
Bereavement Service) 
 
 
 
Biochemistry 
Virology 
Cytopathology 
 
 
Immunology 
 
Directorate of Specialist Medicine 
Critical Care Services 
Haemato-Oncology and 
Imaging Services (including 
 
Chemotherapy 
Reprographics and Medical 
Resuscitation Training 
 
Photography 
 
Rheumatology 
 
Cardiology (including cardiac 
 
Anticoagulation Service 
diagnostics 
Neurology 
 
 
 
Outpatient Services 
Cancer Team 
Dermatology 
 
 
 
Medical Records 
Palliative Care 
Genito-Urinary Medicine 
 
Directorate of Surgery 
General Surgery 
Anaesthetics 
Sterile Supply Services 
 
 
 
Trauma and Orthopaedics 
Theatre Services 
Discharge Lounge 
 
 
 
Urology 
Waiting List Administration 
Hospital’s Main Reception Area 
 
 
Endoscopy Services 
 
Directorate of Women’s and Children’s Services 
 
 
 
Paediatrics (including 
Community Paediatric Nursing 
Gynaecology 
dedicated outpatient 
 
facility) 
Maternity Services 
 
 
40

 

QUEEN ELIZABETH HOSPITAL 
NHS TRUST 
 
 
 
 
 
 
 
 
 
 
ANNUAL ACCOUNTS 
2008/09 
 
 
 
 
 
 
 
 
 
41

 

STATEMENT OF THE CHIEF EXECUTIVE'S RESPONSIBILITIES AS THE 
ACCOUNTABLE OFFICER OF THE TRUST 

 
The Secretary of State has directed 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 Department of 
Health. 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. 
 
 
 
Signed...Dr Chris Steather.......................................................Chief Executive  
 
 
Date...10.6.09 
42

Queen Elizabeth Hospital NHS Trust – Annual accounts 2008/09  
  
STATEMENT ON INTERNAL CONTROL  
 
1. Scope of responsibility 
The Board is accountable for internal control. As Accountable Officer, the Chief 
Executive of this Board had responsibility for maintaining a sound system of internal 
control that supported the achievement of the organisation’s policies, aims and 
objectives. The Chief Executive for Queen Elizabeth Hospital NHS Trust for 2008/09 
was Dr. David Robson.  
He also had responsibility for safeguarding the public funds and the organisation’s 
assets for which they were personally responsible as set out in the Accountable Officer 
Memorandum. As Chief Executive they reported to the Chairman of the Trust and 
ensured appropriate systems existed to support the work of the Trust and the Board. 
They managed the executive team who had clear accountabilities and annual objectives, 
drawn from the annual plan of the Trust. 
He was also accountable to the NHS Chief Executive and Parliament through the 
provision of a wide range of information to the Department of Health, and through the 
formal monitoring of the Trust’s performance by NHS London. 
The Trust worked in partnership with other health and social care organisations in South-
East London and surrounding areas; principally Greenwich Teaching Primary Care Trust 
and Bexley Care Trust. During this year there had also been considerable input to the A 
Picture of Health Project Board on the redesign of services for Outer South East London 
(OSEL), and the Joint Transitional Committee on the proposed management merger of 
Queen Elizabeth Hospital NHS Trust, Queen Mary's Sidcup NHS Trust and Bromley 
Hospitals NHS Trust to form South London Healthcare NHS Trust from April 2009.  
 
2. The purpose of the system of internal control 
The system of internal control is designed to manage risk to a reasonable level and 
cannot 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 organisation’s policies, 
aims and objectives; 
• 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 was in place in Queen Elizabeth Hospital NHS Trust for 
the year ended 31 March 2009 and up to the date of approval of the annual report and 
accounts. 
 
3. Capacity to handle risk 
Queen Elizabeth Hospital NHS Trust’s capacity to handle risk was based around a clear 
Board approved Risk Management Strategy, effective leadership of the risk 
management process and staff trained and equipped to manage risk in a way 
appropriate to their authority.  
43

The key elements of the Trust’s capacity to handle risk were as follows: 
 
•  A formal Board committee structure was in place to oversee the Trust’s risk 
management activities and performance. There was a Non-Executive Clinical 
Governance and Risk Management Committee reporting to the Board. Executive 
management of risk was co-ordinated through the Trust Executive Committee, 
which reported to the Board, and was supported by the Risk Management and 
NHS Standards Committee (covering non-clinical risk and supported by the 
Health and Safety Committee) and the Clinical Governance Executive, which 
managed clinical risk through the coordination of eight specific sub-committees. 
The Audit and Assurance Committee was a Non-Executive committee which 
monitored the delivery of elements of the risk agenda. 
 
•  The Director of Finance was identified as the Board lead for non-clinical risk 
management, and the Medical Director and Director of Nursing & Patient Care 
were the joint Board leads for clinical governance and clinical risk management.  
 
•  The Trust invested in staff and systems resources to support these Directors in 
carrying out their risk management roles. The Head of Clinical Governance 
attended the Clinical Governance and Risk Management Committee as well as 
the Risk Management and NHS Standards Committee. 
 
•  The Trust provided risk management training for staff, which included risk 
assessment, for those with management responsibility, as well as basic risk 
management training for all new staff as part of their corporate induction. 
 
•  Communication of risk management matters, including sharing good practice, 
took place in a wide variety of ways, both at corporate and departmental level. 
These included the use of email and Team Briefing on matters of general interest 
or concern; the circulation of findings, and development of action plans, following 
reviews of complaints and incidents; clinical audit meetings; and departmental 
newsletters. 
 
4. The risk and control framework 
Risk, or change in risk was identified, evaluated and controlled as described in the 
Trust’s Risk Management Strategy and policy which were updated and approved by the 
Board in 2007/08. This described the overall approach and methodology for managing 
risks, and identified corporate and departmental responsibilities. It also included 
guidance on risk identification and assessment processes using a matrix-based model. 
Key risks were entered on to the Trust’s risk register and were reported to the Trust 
Board or its sub-committees
 
Risks and policies relating to data security and information governance were managed 
by the Information Governance Group and ICT Strategy Board, with both reporting to the 
Board via the Trust Executive Committee. Reports were routinely received identifying 
risks and issues by the Audit Committee and IT Project Boards. The Trust completed the 
annual self-assessment of the Information Governance Toolkit to assess the policies and 
procedures in place to manage information. The Trust had a number of policies relating 
to data security, sharing and access.   
44

 
Assessing and evaluating risk, and monitoring the environment of the organisation for 
fire and health and safety hazards, were a responsibility of line managers. In the course 
of 2008/09, the Trust maintained its CNST accreditation in maternity services at Level 2, 
this score having improved in 2006/07. The CNST accreditation for other services 
remained at Level 1. 
 
The Trust had a comprehensive incident reporting system in place, and a “whistle 
blowing” policy, which was revised in February 2006, for the anonymous reporting of 
staff concerns. Complaints were actively monitored and managed in line with 
Department of Health recommendations.   
 
The Assurance Framework embodied a summary of the assurances in place, and an 
assessment of the effectiveness of internal controls to mitigate the risks to the Trust 
achieving its organisational objectives. It described the key risks to achieving each 
objective, the internal controls in place, and an assessment of the assurances reported 
to the Board and its sub-committees. It also identified where there were areas of poor 
control, or where a lack of assurance existed.  This, together with other key processes, 
was used to provide the Board with assurance that an effective system of internal control 
was in place for the Trust.  
 
The Trust engaged with its key stakeholders in a number of ways, including hosting and 
being involved in meetings of the Patients’ Forum; holding regular open staff meetings; 
liaising with senior officers of the London Borough of Greenwich and with the Health 
Scrutiny Panels of the London Boroughs of Greenwich and Bexley; and regular meetings 
with the Trust’s PFI partners and their sub-contractors. Objectives were clearly linked to 
the priorities of other partners and the wider community. The Trust engaged formally 
with a range of statutory and voluntary sector partners to reflect the diverse needs of the 
catchment population.  
 
The Trust was not fully compliant with two of the core Standards for Better Health for the 
full year but was fully compliant by 31st March 2009. The detail is described in section 5 
under significant control issues. 
 
As an employer with staff entitled to membership of the NHS pension scheme, control 
measures were in place to ensure all employer obligations contained within the Scheme 
regulations were complied with. This included ensuring that deductions from salary, 
employer’s contributions and payments into the scheme were in accordance with the 
Scheme rules, and that member Pension Scheme records were accurately updated in 
accordance with the timescales detailed in the Regulations.  
Control measures were in place to ensure that all the organisation’s obligations under 
equality, diversity and human rights legislation are complied with. 
 
5. Review of effectiveness 
As Accountable Officer, of the successor body 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 
45

organisation who have responsibility for the development and maintenance of the 
system of internal control provide me with assurance. The Assurance Framework 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:- 
 
•  Reports from External Auditors; 
 
•  Reports from Internal Auditors; 
 
•  Reports from the Healthcare Commission; 
 
•  The results of the Clinical Negligence Scheme for Trusts (CNST) 
assessment; 
 
•  The assessment of the Information Governance Toolkit; 
 
•  The monthly finance and performance reports to the Board; 
 
•  Reports from a wide variety of other external bodies, including the Medical 
Royal Colleges, London Deanery, Clinical Pathology Accreditation (CPA), 
the Health & Safety Executive and the London Fire & Civil Defence 
Authority; 
 
•  The Trust’s assessment of compliance with the standards set out in 
Standards for Better Health; 
 
•  The Auditors Local Evaluation (ALE) to be reported as part of the 
Healthcare Commission’s Annual Healthcheck for 2008/09; and 
 
•  Third party assurances on NHS Shared Business Services and Electronic 
Staff Record activities. 
 
I have been advised on the implications of the result of my review of the effectiveness of 
the system of internal control by reference to the work of the Board, the Audit & 
Assurance Committee, the Clinical Governance and Risk Management Committee, and 
the Trust Executive Committee.  
 
The Board approves Corporate Objectives each year, and a Service & Development 
Plan designed to achieve those objectives. During the year the Trust Executive 
Committee and Board received monthly financial and performance management reports, 
which set out performance against the key plans and targets. The Board also reviewed 
overall progress in achieving the Corporate Objectives two or three times per year. 
 
The Audit and Assurance Committee has monitored both internal and external audit 
activity, and the effectiveness of key internal controls. An independent Internal Audit 
function was established and an annual plan of Internal Audit activity was approved and 
monitored by the Audit and Assurance Committee.  The committee also reviewed any 
incidence of fraud. Minutes of the Audit and Assurance Committee were reported to the 
Board. 
46

 
The Clinical Governance and Risk Management Committee scrutinized the Trust’s 
actions and performance on all clinical risk and governance matters. Minutes of this 
committee were reported to the Board. 
 
Significant Control Issues  
 
The Trust identified the following significant control issues, which could impact on future 
services: 
 
•  The Trust had an underlying financial deficit in 2008/09, of approximately £2m 
per annum. The actual reported deficit was £5.5m in 2008/09, of which £0.14m 
relates to asset disposals, while the remainder relates to other non-recurrent 
items.  
 
•  The Trust was unlikely to generate material surpluses that will enable it to 
recover historic deficits without a reconfiguration of clinical services within SE 
London. It therefore actively engaged in a project, known as ‘A Picture of Health’, 
which considered options for achieving this. The decision was held over into 
2009/10 as it was subject to review by an Independent Review Panel. It is 
planned that the Trust will merge with the other two outer South East London 
Hospitals to form the South London Healthcare NHS Trust in April 2009.   
 
•  Results of the internal audit review of waiting list data quality highlighted issues 
with the data accuracy in relation to the 18 week referral to treatment targets. 
Many of these issues have already been resolved and appropriate remedial 
action is also included within the Trust’s 18 week Action Plan. The Trust did not 
achieve the 18 week target for admitted patients but a plan has been developed 
to ensure that the target is fully achieved from April 2009.  
 
•  The Trust failed to achieve the A&E 4 hour target with 97.67% of patients waiting 
4 hours or less rather than the 98% required by the national target. The Trust has 
developed a model for performance improvement to enable a structured 
approach to delivering this target. 
 
•  The Trust was fully compliant with the core standards for better health for the full 
year apart from the following:  
 
Core standard C2, “Healthcare organisations protect children by following 
national child protection guidelines within their own activities and in their dealings 
with other organisations”, the Trust had insufficient assurance for compliance 
with this standard as it did not have a named doctor for safeguarding children for 
the whole year. The Trust was compliant by the end of the financial year. 
 
Core standard C7e, “Healthcare organisations challenge discrimination, promote 
equality, and respect human rights”, the Trust reported that it had insufficient 
assurance for compliance with this standard but was compliant by April 2009. 
Last year some responses from the Trust staff survey related to training and 
development meant that the Trust prudently assessed itself as not having 
adequate assurance. During 2008/09 the Trust developed and rolled out a 
47

 
 
programme entitled “A positive experience every time” covering diversity 
awareness and customer care. 
 
•  The Trust reported two incidents during 2008/09 where there was a breach of 
data security, both involving patient identifiable data being faxed to the wrong fax 
address. 
 
 
A plan to address weaknesses and ensure continuous improvement of the system is in 
place. 
 
 
 
   
Signed…Dr Chris Streather………………………………………… Chief Executive                
 
 
Date…10.6.09 
 
48

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 
 
 
 
10.6.09.....................Date...Dr Chris Streather………………….Chief Executive 
 
 
10.6.09.....................Date...Mr Robert Kirton....................Interim Finance Director 
 
 
 
 
 
49

Independent auditors’ report to the Directors of the Board of Queen Elizabeth Hospital 
NHS Trust  
 
Opinion on the financial statements 
 
We have audited the financial statements of Queen Elizabeth Hospital NHS Trust for the year 
ended 31 March 2009 under the Audit Commission Act 1998. These comprise the Income 
and Expenditure Account, the Balance Sheet, the Cashflow Statement, the Statement of Total 
Recognised Gains and Losses and the related notes. These financial statements have been 
prepared 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 set out therein. We 
have also audited the information in the Remuneration Report that is described as having 
been audited. 
 
This report, including the opinion, has been prepared for and only for the Board of Queen 
Elizabeth Hospital NHS Trust in accordance with Part II of the Audit Commission Act 1998 
and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of 
Auditors and of Audited Bodies prepared by the Audit Commission.  We do not, in giving this 
opinion, accept or assume responsibility for any other purpose or to any other person to 
whom this report is shown or into whose hands it may come save where expressly agreed by 
our prior consent in writing. 
 
Respective responsibilities of Directors and Auditors 
 
The directors’ responsibilities for preparing the financial statements and the Remuneration 
Report in accordance with directions made by the Secretary of State are set out in the 
Statement of Directors’ Responsibilities. 
 
Our responsibility is to audit the financial statements and the part of the Remuneration Report 
to be audited in accordance with relevant legal and regulatory requirements and International 
Standards on Auditing (UK and Ireland).  
 
We report to you our opinion as to whether the financial statements give a true and fair view, 
and whether the financial statements and the part of the Remuneration Report to be audited 
have been properly prepared, in accordance with the accounting policies directed by the 
Secretary of State as being relevant to the National Health Service in England. We report to 
you whether, in our opinion, the information which comprises the commentary on the financial 
performance included within the Operational and Financial Review, included in the Annual 
Report, is consistent with the financial statements. 
 
We review whether the directors' Statement on Internal Control reflects compliance with the 
Department of Health's requirements set out in “Guidance on Completing the Statement on 
Internal Control 2008/09”, issued on 25 February 2009.  We report if it does not meet the 
requirements specified by the Department of Health or if the statement is misleading or 
inconsistent with other information we are aware of from our audit of the financial statements. 
We are not required to consider, nor have we considered, whether the directors' Statement on 
Internal Control covers all risks and controls. We are also not required to form an opinion on 
the effectiveness of the Trust’s corporate governance procedures or its risk and control 
procedures. 
 
We read other information contained in the Annual Report, and consider whether it is 
consistent with the audited financial statements. This other information comprises only the 
Foreword, the unaudited part of the Remuneration Report, the Chairman's Statement and the 
remaining elements of the Operating and Financial Review and Staffing report. We consider 
the implications for our report if we become aware of any apparent misstatements or material 
inconsistencies with the financial statements. Our responsibilities do not extend to any other 
information. 
 
50

Basis of audit opinion 
 
We conducted our audit in accordance with the Audit Commission Act 1998 and the Code of 
Audit Practice issued by the Audit Commission, which requires compliance with International 
Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit 
includes examination, on a test basis, of evidence relevant to the amounts and disclosures in 
the financial statements and the part of the Remuneration Report to be audited. It also 
includes an assessment of the significant estimates and judgments made by the directors in 
the preparation of the financial statements, and of whether the accounting policies are 
appropriate to the Trust’s circumstances, consistently applied and adequately disclosed. 
 
We planned and performed our audit so as to obtain all the information and explanations 
which we considered necessary in order to provide us with sufficient evidence to give 
reasonable assurance that the financial statements are free from material misstatement, 
whether caused by fraud or other irregularity or error; and the financial statements and the 
part of the Remuneration Report to be audited have been properly prepared. In forming our 
opinion we also evaluated the overall adequacy of the presentation of information in the 
financial statements and the part of the Remuneration Report to be audited. 
 
Opinion 
 
In our opinion: 
 
• 
the financial statements give a true and fair view, in accordance with the accounting 
policies directed by the Secretary of State as being relevant to the National Health 
Service in England, of the state of the Trust’s affairs as at 31 March 2009 and of its 
income and expenditure for the year then ended;  
 
• 
the financial statements and the part of the Remuneration Report to be audited has 
been properly prepared in accordance with the accounting policies directed by the 
Secretary of State as being relevant to the National Health Service in England; and 
 
• 
information which comprises commentary on the financial performance included within 
the Operating and Financial Review and Staffing Report, included within the Annual 
Report, is consistent with the financial statements. 
 
 
 
 
 
PricewaterhouseCoopers LLP 
London 
 
11 June 2009 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

51

Conclusion on arrangements for securing economy, efficiency and effectiveness in the 
use of resources  
 
Directors’ Responsibilities 
 
The directors are responsible for putting in place proper arrangements to secure economy, 
efficiency and effectiveness in the Trust’s use of resources, to ensure proper stewardship and 
governance, and regularly to review the adequacy and effectiveness of these arrangements.  
 
Auditor’s Responsibilities 
 
We are required by the Audit Commission Act 1998 to be satisfied that proper arrangements 
have been made by the Trust 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 in relation to proper arrangements, having regard to the criteria for NHS 
bodies specified by the Audit Commission.  We report if significant matters have come to our 
attention which prevent us from concluding that the Trust has made such proper 
arrangements. 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. 
 
 
Adverse Conclusion 
 
We have undertaken our audit in accordance with the Code of Audit Practice. In so doing, we 
identified the following: 
• 
The NHS trust failed to ensure that its spending matched available resources in year; 
• 
The Trust’s financial strategy does not address the statutory requirement to ensure that 
spending matches available resources year on year. 
 
For the reasons set out above and having regard to the criteria for NHS bodies specified by 
the Audit Commission and published in December 2006, we are not satisfied that, in all 
significant respects, Queen Elizabeth Hospital NHS Trust made proper arrangements to 
secure economy, efficiency and effectiveness in its use of resources for the year ending 31 
March 2009, in that it did not put in place: 
 
•  a medium-term financial strategy, budgets and a capital programme that are soundly 
based and designed to deliver its strategic priorities; and 
 
•  arrangements to ensure that its spending matches its available resources. 
 
Auditors’ responsibilities 
 
Referral to the Secretary of State under s19 of the Audit Commission Act 1998 
 
We have a duty under the Audit Commission Act 1998 to refer the matter to the Secretary of 
State if we have a reason to believe that the body, or an officer of the body, 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. 
 
In July 2008, we referred a matter to the Secretary of State under section 19 of the Audit 
Commission Act 1998. This concerned the Trust’s inability to meet its break-even duty within 
the extended five year financial recovery period.  This referral reported that the Trust was 
projecting a deficit for the 2008/09 financial year.  
 
 
 

52

Certificate 
 
We certify that we have completed the audit of the accounts in accordance with the 
requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the 
Audit Commission. 
 
 
 
 
 
PricewaterhouseCoopers LLP 
London 
 
11 June 2009   
 
53

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED
31 March 2009
2008/09
2007/08
NOTE
£000
£000
Income from activities
2
145,870
141,302
Other operating income
3
11,697
10,819
Operating expenses
4-5
(163,082)
(154,670)
OPERATING DEFICIT
(5,515)
(2,549)
Loss on disposal of fixed assets
7
(135)
(516)
DEFICIT BEFORE INTEREST
(5,650)
(3,065)
Interest receivable
8
381
632
Other finance costs - unwinding of discount
14
(61)
(70)
DEFICIT FOR THE FINANCIAL YEAR
(5 330)
,
(2 503)
,
Public dividend capital dividends payable
(151)
(622)
RETAINED DEFICIT FOR THE YEAR
(5,481)
(3,125)
The notes on pages 5 to 34 form part of these accounts.
All income and expenditure is derived from continuing operations.
54

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
BALANCE SHEET AS AT
31 March 2009
31 March 
31 March 
2009
2008
NOTE
£000
£000
FIXED ASSETS
Intangible assets
9
1,055
1,355
Tangible assets
10
73,548
66,698
TOTAL FIXED ASSETS
74,603
68,053
CURRENT ASSETS
Stocks and work in progress
11
1,835
1,663
Debtors
12
26,541
27,240
Cash at bank and in hand
16.3
3,406
6,485
TOTAL CURRENT ASSETS
31,782
35,388
CREDITORS:  Amounts falling due within one year
13.1
(10,093)
(7,812)
     
    
NET CURRENT ASSETS
21,689
27,576
TOTAL ASSETS LESS CURRENT LIABILITIES
96,292
95,629
CREDITORS:  Amounts fallin
CREDITORS:  Amounts 
g
falling due after more than one 
 due after more than one y
  ear
year
13.1
(575)
(575)
(603)
(603)
PROVISIONS FOR LIABILITIES AND CHARGES
14
(3,712)
(3,600)
  
  
TOTAL ASSETS EMPLOYED
92,005
91,426
FINANCED BY:
TAXPAYERS' EQUITY
Public dividend capital
20
90,348
88,348
Revaluation reserve
15
51,929
48,268
Donated asset reserve
15
315
381
Income and expenditure reserve
15
(50,587)
(45,571)
TOTAL TAXPAYERS' EQUITY
92,005
91,426
   
   
Included within Public Dividend Capital are cash borrowings to the value of £65.4m, repayable to the 
Department of Health. These monies have been allocated to the Trust in the past to fund historic 
deficits.
The financial statements on pages 1 to 34 were approved by the Board on [date] and signed on its 
behalf by:
Signed: …Dr Chris Streather………………(Chief Executive)
Date: …10.6.09
55

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSES FOR THE YEAR ENDED
31 March 2009
2008/09
2007/08
£000
£000
Deficit for the financial year before dividend payments
(5,330)
(2,503)
Unrealised surplus on fixed asset revaluations/indexation
4,136
3,442
Increases in the donated asset and government grant reserve due to receipt 
20
156
of donated and government grant financed assets
Total gains and losses recognised in the financial year
(1,174)
1,095
56

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
CASH FLOW STATEMENT FOR THE YEAR ENDED
31 March 2009
2008/09
2007/08
NOTE
£000
£000
OPERATING ACTIVITIES
Net cash inflow/(outflow) from operating activities

16.1
(1,693)
29,025
RETURNS ON INVESTMENTS AND SERVICING OF FINANCE:
Interest received
382
632
Net cash inflow from returns on investments and servicing of 
382
632
finance
CAPITAL EXPENDITURE
(Payments) to acquire tangible fixed assets
(3,538)
(1,415)
(Payments) to acquire intangible assets
(79)
(487)
Net cash outflow from capital expenditure
(3,617)
(1,902)
DIVIDENDS PAID
(151)
(622)
Net cash inflow/(outflow) before management of liquid resources 
(5,079)
27,133
and financing
MANAGEMENT OF LIQUID RESOURCES
Sale of financial assets with the Department of Health
0
6,000
Net cash
 
inflow/(outflow)
 
 from management of liquid resources
0
6 000
,
Net cash inflow/(outflow) before financing
(5,079)
33,133
FINANCING
Public dividend capital received
2,000
2,097
Public dividend capital repaid 
0
(29,225)
Net cash inflow/(outflow) from financing
2,000
(27,128)
Increase/(decrease) in cash
(3,079)
6,005
57

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
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 NHS Trust Manual for Accounts which shall be agreed with HM Treasury.
Consequently, the following financial statements have been prepared in accordance with the 2008/09 NHS
Trusts Manual for Accounts issued by the Department of Health. The accounting policies contained in that
manual follow UK generally accepted accounting practice and HM Treasury's Government Financial Reporting
Manual to the extent that they are meaningful and appropriate to the NHS. 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 fixed assets at their value to the business by reference to their current costs. NHS Trusts are not
required to provide a reconciliation between current cost and historical cost surpluses and deficits.
1.2
Income Recognition
Income is accounted for applying the accruals convention. The main source of income for the Trust is from
commissioners in respect of healthcare services provided under local agreements (NHS contracts). Income is
recognised in the period in which services are provided. For patients whose treatment straddles the year-end
this means income is apportioned across the financial years on the basis of length of stay. Where income is
received for specific activity which is to be delivered in the following financial year, that income is deferred.
1.3
Intangible fixed assets
Intangible assets are capitalised when they are capable of being used in a Trust's activities for more than one
year; they can be valued; and they have a cost of at least £5,000.
Intangible fixed assets held for operational use are valued at historical cost and are depreciated over the
estimated life of the asset on a straight line basis, except capitalised Research and Development which is
revalued using an appropriate index figure. 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 recoverable.
Purchased computer software licences are capitalised as intangible fixed assets where expenditure of at least 
£5,000 is incurred.  They are amortised over the shorter of the term of the licence and their useful economic 
lives.
1.4
Tangible fixed assets
Capitalisation
Tangible assets are capitalised if they are capable of being used for a period which exceeds one year and
they:
- individually have a cost of at least £5,000;  or
- collectively 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
     
- form part of the initial equipping and setting-up cost of a new building, ward or unit irrespective of their
individual or collective cost.
The finance costs of bringing fixed assets into use are not capitalised.
58

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
Valuation
Tangible fixed assets are stated at the lower of replacement cost and recoverable amount. On initial recognition
they are measured at cost (for leased assets, fair value) including any costs such as installation directly
attributable to bringing them into working condition. They are restated to current value each year. The carrying
values of tangible fixed assets are reviewed for impairment if events or changes in circumstances indicate the
carrying value may not be recoverable.
Professional valuations are carried out by the District Valuers of the Revenue and Customs Government
Department. The valuations are carried out in accordance with the Royal Institute of Chartered Surveyors (RICS)
Appraisal and Valuation Manual insofar as these terms are consistent with the agreed requirements of the
Department of Health and HM Treasury. The land was revalued as at 1st April 2008 on a Modern Equivalent
Asset (MEA) basis. Subsequently the land value has been re-valued downwards based on the residential building 
land values reported in the Property Market Report published by the Valuation Office. 
All land and buildings are restated to current value using professional valuations in accordance with FRS15 every
five years and in the intervening years by the use of indices. The land and buildings indexation is based on the
indices issued by HM Treasury and permitted by FReM 5.2.7 (PES (2009)02) issued on 19th February 2009.  
The Department of Health has directed certain departures from the RICS Appraisal and Valuation Manual in all
periodic NHS valuation exercises. The most significant of these are as follows:
Specialised operational NHS assets are valued on the basis that the existing building will be replaced by an asset 
of similar construction, whereas the RICS Appraisal and Valuation Manual requires the valuer to have regard to a
modern substitute building where the cost is lower, except in cases where there is a paramount commitment to
the retention of an existing building; and
Additional assumptions, in addition to those required by the RICS Appraisal and Valuation Manual, are required
in the valuation of nonoperational assets to market value:      
- The NHS body is assumed not to be in the market for the asset;
- Regard is had to dividing properties into lots to achieve the best price; and
- No adjustments are made to reflect hypothetical “flooding of the market”.
The RICS Appraisal and Valuation Manual requires adjustments to be made to the valuation of a building in
respect of dilapidations. The Department of Health has directed that such adjustments should not be made for
NHS properties. 
The valuations are carried out primarily on the basis of Depreciated Replacement Cost for specialised
operational property and Existing Use Value for non-specialised operational property. The value of land for
existing use purposes is assessed at Existing Use Value. For non-operational properties including surplus land,
the valuations are carried out at Open Market Value.
Additional alternative Open Market Value figures have only been supplied for operational assets scheduled for 
imminent closure and subsequent disposal.
No adjustments are made to valuations for perceived functional or economic obsolescence, whereas the RICS
Appraisal and Valuation Manual includes such adjustments.
59

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
Gains arising from indexation and five-yearly revaluations are taken to the Revaluation Reserve.
Downward adjustments are made against the revaluation reserve to the extent that previous revaluations
are available. Falls in value when newly constructed assets are brought into use are also charged there.
These falls in value result from the adoption of ideal conditions as the basis for depreciated replacement
cost valuations.
All impairments resulting from price changes are charged to the Statement of Total Recognised Gains and
Losses for the year.
Residual interests in off-balance sheet Private Finance Initiative properties are included in tangible fixed
assets as 'assets under construction and payments on account' where the PFI contract specifies the
amount at which the assets will be transferred to the Trust at the end of the contract. The residual interest
is built up, on an actuarial basis, during the life of the contract by capitalising part of the unitary charge so
that at the end of the contract the balance sheet value of the residual value plus the specified amount equal 
the expected fair value of the residual asset at the end of the contract. The estimated fair value of the
asset on reversion is determined by the District Valuer based on Department of Health guidance. The
District Valuer should provide an estimate of the anticipated fair value of the assets on the same basis as
the District Valuer values the NHS Trust's estate.
Depreciation, amortisation and impairments
Tangible fixed assets are depreciated at rates calculated to write them down to estimated residual value on
a straight-line basis over their estimated useful lives. No depreciation is provided on freehold land and
assets surplus to requirements.
Assets in the course of construction and residual interests in off-balance sheet PFI contract assets are not
depreciated until the asset is brought into use or reverts to the Trust, respectively. 
Buildings, installations and fittings are depreciated on their current value over the estimated remaining life
of the asset as advised by the District Valuer.  Leaseholds are depreciated over the primary lease term.
Buildings, installations and fittings are depreciated on their current value over the estimated remaining life
of the asset as advised by the District Valuer.  Leaseholds are depreciated over the primary lease term.
Medical equipment and engineering plant and equipment
5 to 15
Furniture
10
Mainframe information technology installations
8
Soft furnishings
7
Office and information technology equipment
5
Set-up costs in new buildings
10
Impairment losses resulting from short-term changes in price that are considered to be recoverable in the
longer term are taken in full to the revaluation reserve. These include impairments resulting from the
revaluation of fixed assets from their cost to their value in existing use when they become operational. This
may lead to a negative revaluation reserve in certain instances.
60

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
1.5
Donated fixed assets
Donated fixed assets are capitalised at their current value on receipt and this value is credited to the
Donated Asset Reserve. Donated fixed assets are valued and depreciated as described above for
purchased assets. Gains and losses on revaluations are also taken to the Donated Asset Reserve and,
each year, an amount equal to the depreciation charge on the asset is released from the Donated Asset
Reserve to the Income and Expenditure account. Similarly, any impairment on donated assets charged
to the Income and Expenditure Account is matched by a transfer from the Donated Asset Reserve. On
sale of donated assets, the value of the sale proceeds is transferred from the Donated Asset Reserve to
the Income and Expenditure Reserve.
1.6
Private Finance Initiative (PFI) transactions
The NHS follows HM Treasury's Technical Note 1 (Revised) "How to Account for PFI transactions"
which provides practical guidance for the application of the Application Note F to FRS 5 and the
guidance 'Land and Buildings in PFI schemes Version 2'.
Where the balance of the risks and rewards of ownership of the PFI property are borne by the PFI
operator, the PFI obligations are recorded as an operating expense. Where the Trust has contributed
land or buildings to the PFI provider to be used in the PFI scheme, a prepayment is recognised, valued
at the net present value of the resulting reduction in the unitary charge payable under the PFI contract,
and amortised over the life of the PFI contract by charge to the Income and Expenditure Account.
Where the balance of risks and rewards of ownership of the PFI property are borne by the Trust, it is
recognised as a fixed asset along with the liability to pay for it which is accounted for as a finance lease.
Contract payments are apportioned between an imputed finance lease charge and a service charge.
1.7
Stocks and work-in-progress
St
k
Stocks
d
and
k i
work-in-progress are
l
d
valued
t
at th
the llower
f
of
t
cost
d
and
t
net
li
bl
realisable
l
value. Thi
This iis
considered to be a reasonable approximation to current cost due to the high turnover of stocks. Work-
in-progress comprises goods in intermediate stages of production.
Partially completed contracts for
patient services are not accounted for as work-in-progress.
1.8
Research and development
Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the
following criteria:
-
there is a clearly defined project;
-
the outcome of the project has been assessed with reasonable certainty as to:
-
its technical feasibility;
-
its resulting in a product or service which will eventually be brought into use;
-
adequate resources exist, or are reasonably expected to be available, to enable the project to be 
completed and to provide any consequential increases in working capital.
Expenditure so deferred is limited to the value of future benefits expected and is amortised through the
income and expenditure account on a systematic basis over the period expected to benefit from the
project. It is revalued on the basis of current cost. The amortisation charge is calculated on the same
basis as used for depreciation i.e. on a quarterly basis. Expenditure which does not meet the criteria for
capitalisation is treated as an operating cost in the year in which it is incurred. NHS Trusts are unable
to disclose the total amount of research and development expenditure charged in the income and
expenditure account because some research and development activity cannot be separated from
patient care activity.
Fixed assets acquired for use in research and development are amortised over the life of the associated
project.
61

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
1.9
Provisions
The Trust provides for legal or constructive obligations that are of uncertain timing or amount at the
balance sheet date on the basis of the best estimate of the expenditure required to settle the obligation.
Where the effect of the time value of money is material, the estimated risk-adjusted cash flows are
discounted using the Treasury's discount rate of 2.2% in real terms. 
Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS 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
Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is
disclosed at note 14.
Since financial responsibility for clinical negligence cases transferred to the NHSLA at 1 April 2002, the
only charge to operating expenditure in relation to clinical negligence in 2008/09 relates to the Trust's
contribution to the Clinical Negligence Scheme for Trusts.
Non-clinical risk pooling
The 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 as and when they become due.
1.10 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.pensions.nhsbsa.nhs.uk. 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 (until 2004, based on a five year
valuation cycle), and a FRS17 accounting valuation every year.  An outline of these follows:
a) Full actuarial (funding) valuation
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 last such valuation, which determined current 
contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that 
date.
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. 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 8.5% of their pensionable pay depending on total earnings.
b) FRS17 Accounting valuation
In accordance with FRS17, a valuation of the Scheme liability is carried out annually by the Scheme
Actuary as at the balance sheet date by updating the results of the full actuarial valuation.
62

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is
provided to the Scheme Actuary. At this point the assumptions regarding the composition of the Scheme
membership are updated to allow the Scheme liability to be valued.  
63

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
y
March 2006 (the latest midpoint) updated to 31 March 2009 with summary global member and accounting
data.
The latest assessment of the liabilities of the Scheme is contained in the Scheme Actuary report, which forms
part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These
accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery
Office.
Scheme Provisions as at 31 March 2009
The scheme is a 'final salary' scheme. 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 (AVCs) provided by an approved panel of life companies. Under the
arrangement the employee/member can make contributions to enhance an employee's pension benefits. The
benefits payable relate directly to the value of the investments made. From 1 April 2008 a voluntary additional
pension facility becomes available, under which members may purchase up to £5,000 per annum of additional
pension at a cost determined by the actuary from time-to-time.
Early payment of a pension is available to members of the Scheme who are permanently incapable of fulfilling
their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for
death in service, and five times their annual pension for death after retirement, less pension already paid,
subject to a maximum amount equal to twice the member’s final year’s pensionable pay less their retirement
lump sum for those who die after retirement, is payable.
Existing members at 1 April 2008
Annual pensions are normally based on 1/80th of the best of the last 3 years pensionable pay for each year of
service. A lump sum normally equivalent to 3 years pension is payable on retirement. From 1 April 2008 there
is the opportunity of giving up some of the pension to increase the retirement lump sum.
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 twelve months ending 30 September in the previous calendar year. On death, a
pension of 50% of the member’s pension is normally payable to the surviving spouse or eligible unmarried
partner.
New entrants from 1 April 2008
Annual pensions for new entrants from 1 April 2008 will be based on 1/60th of the best three-year average of
pensionable earnings in the ten years before retirement. Members wishing to obtain a retirement lump sum
may give up some of this pension to obtain a retirement lump of up to 25% of the total value of their retirement
benefits. Survivor pensions will be available to married and unmarried partners and will be equal to 37.5% of
the member's pension.
1.11 Liquid resources
Deposits and other investments that are readily convertible into known amounts of cash at or close to their
carrying amounts are treated as liquid resources in the cashflow statement. The Trust does not hold any
investments with maturity dates exceeding one year from the date of purchase.
1.12 Value Added Tax
Most of the activities of the 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.
1.13 Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the
accounts since the Trust has no beneficial interest in them. Details of third party assets are given in Note 25
to the accounts.
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Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
1.14 Leases
Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS Trust, the
asset is recorded as a tangible fixed asset and a debt is recorded to the lessor of the minimum lease
payments discounted by the interest rate implicit in the lease. The interest element of the finance lease
payment is charged to the Income and Expenditure Account over the period of the lease at a constant rate in
relation to the balance outstanding. Other leases are regarded as operating leases and the rentals are
charged to the Income and Expenditure Account on a straight-line basis over the term of the lease.
1.15 Public Dividend Capital (PDC) and PDC Dividend
Public Dividend Capital represents the outstanding public debt of an NHS Trust.  At any time the Secretary of 
State can issue new PDC to, and require repayments of PDC from, the NHS Trust.
A charge, reflecting the forecast cost of capital utilised by the NHS Trust, is paid over as public dividend
capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the
forecast average carrying amount of all assets less liabilities, except for donated assets and cash with the
Office of the Paymaster General. The average carrying amount of assets is calculated as a simple average
of opening and closing relevant net assets. A note to the accounts discloses the rate that the dividend
represents as a percentage of the actual average carrying amount of assets less liabilities in the year.
1.16 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 each individual case is handled.
Losses and Special Payments are charged to the relevant functional headings in the Income and
Expenditure Account 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).  
Note 27 is compiled directly from the losses and compensations register which is prepared on an accruals
basis for 2007/08.  
1.17 Financial Instruments
Recognition
Financial assets and financial liabilities which arise from contracts for the purchase or sale of nonfinancial 
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 above.  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 cashflows 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 classified as ‘Loans and receivables’.  Financial liabilities are classified as ‘Other 
financial liabilities’.
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Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
1.17 Financial Instruments (cont)
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: cash at bank and in hand, 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 
income and expenditure account.
Other Financial Liabilities
All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and 
measured subsequently at amortised cost using the effective interest method. The effective interest 
rate is the rate that discounts exactly estimated future cash payments through the expected life of the 
financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial 
liability.
They are included in current liabilities except for amounts payable more than 12 months after the 
balance sheet date, which are classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using the effective interest 
method and charged to the income and expenditure account.
Impairment of Financial Assets
At the balance sheet 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 cashflows 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 income and 
expenditure account and the carrying amount of the asset is reduced directly.
66

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
2. Income from Activities
2008/09
2007/08
£000
£000
Primary Care Trusts
126,157
121,365
Department of Health
18,707
19,130
Non NHS:
      - Private patients
83
105
      - Overseas patients (non-reciprocal)
557
331
      - Injury cost recovery
348
371
      - Other
18
0
145,870
141,302
Injury cost recovery income is subject to a provision for doubtful debts of 50% of the current
outstanding debt to reflect expected rates of collection.
3.  Other Operating Income
2008/09
2007/08
Education, training and research
5,720
5,140
Transfers from Donated Asset Reserve 
96
199
Non-patient care services to other bodies
3,162
3,290
Income generation
568
627
Other in
Other  come
income
2,1
, 51
151
1,563
,563
              
               
11,697
10,819
Included within Non-Patient care services to other bodies are the following significant items:
£000
£000
Oxleas SLA (This SLA is not activity related, it relates to the occupation 
of a Trust owned building by Oxleas NHS Foundation Trust).
1,684
1,646
PFI smoothing monies from the Department of Health. This income has 
been received as the Trust were one of the first to enter a PFI 
partnership. 
0
367
Greenwich Teaching PCT non-patient SLA for payroll and human 
resources services . 
620
600
67

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
4.  Operating Expenses
4.1 Operating expenses comprise:
2008/09
2007/08
£000
£000
Services from other NHS Trusts
1,151
835
Services from other NHS bodies
559
1,089
Directors' costs
873
842
Staff costs
96,978
91,284
Supplies and services - clinical
25,574
24,295
Supplies and services - general
7,716
7,190
Consultancy services
1,012
673
Establishment
1,417
1,364
Transport
507
555
Premises
21,057
19,705
Impairment of debtors
287
271
Depreciation 
855
876
Amortisation
449
421
Audit fees
216
218
Clinical negligence
2,142
2,259
Redundancy costs
237
20
Other
2,052
2,773
              
               
163,082
154,670
Other Expenditure includes the amortisation of the Trust Deferred Asset of  £1,025k (2007/08 £1,025k).
4.2 Operating leases
4.2/1 Operating expenses include:
Restated
2008/09
2007/08
£000
£000
Other operating lease rentals
108
103
108
103
4.2/2  Annual commitments under non - cancellable operating leases are:
Land and buildings
Restated
2008/09
2007/08
£000
£000
Operating leases which expire:
Between 1 and 5 years
10
6
After 5 years
98
97
108
103
               
               
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Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
5.  Staff costs and numbers
5.1 Staff costs
 
2008/09
2007/08
Total
Permanently 
Other
Employed
£000
£000
£000
£000
Salaries and wages
82,839
69,945
12,894
77,111
Social Security Costs
6,431
5,922
509
6,692
Employer contributions to NHS BSA -
Pensions Division
8,526
8,331
195
8,276
              
               
97,796
84,198
13,598
92,079
               
5.2 Average number of persons employed
Restated
2008/09
2007/08
Total
Permanently 
Other
Employed
Number
Number
Number
Number
Medical and dental
388
281
107
361
Administration and estates
463
394
69
464
Healthcare assistants and other support staff
pp
467
334
133
399
Nursing, midwifery and health visiting staff
866
706
160
850
Nursing, midwifery and health visiting learners
16
16
0
22
Scientific, therapeutic and technical staff
304
211
93
272
Other
11
2
9
3
               
Total
2,515
1,944
571
2,371
The 2007/08 number of staff has been restated to include agency staff.
69

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
5.3 Employee benefits
There were no employee benefits in 2008/09 (2007/08 £0).
5.4 Management costs
(Restated)
2008/09
2007/08
£000
£000
Management costs
6,306
5,643
Income
157,567
152,121
Management costs are defined as those on the management costs website at 
www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/en.
Management costs for 2007/08 have been restated to include £315k for internal and external audit costs.
5.5 Retirements due to ill-health
During 2008/09 there were 6 (2007/08, 6) early retirements from the NHS Trust agreed on the grounds of ill-health.
The estimated additional pension liabilities of these ill-health retirements will be £292k (2007/08: £333k). The cost of
these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.
6.  Better Payment Practice Code
6.1    Better Payment Practice Code - measure of compliance
2008/09
2007/08
Number
£000
Number
£000
Total Non-NHS trade invoices paid in the year
37,613
67,359
32,213
61,377
Total Non NHS trade invoices paid within target
28,456
55,846
24,070
56,313
Percentage of Non-NHS trade invoices paid within target
76%
83%
75%
92%
Total NHS trade invoices paid in the year
1,473
9,626
1,297
12,299
Total NHS trade invoices paid within target
761
6,492
948
11,852
Percentage of NHS trade invoices paid within target
52%
67%
73%
96%
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 statistics include some payments which were disputed but were not able to be recorded as such. These relate to
the Trust pharmacy system where there is insufficient data to measure compliance correctly. This has the effect of
worsening the Trust's reported performance against this target.
6.2 The Late Payment of Commercial Debts (Interest) Act 1998
During 2008/09 the Trust paid no interest arising from claims under this legislation (2007/08 £0), and paid no
compensation to cover debt recovery under this legislation (2007/08 £0).
70

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
7.  Losses on Disposal of Fixed Assets
2008/09
2007/08
£000
£000
(Loss) on disposal of intangible fixed assets
(4)
(66)
(Loss) on disposal of land and buildings
(49)
(11)
(Loss) on disposal of plant and IT equipment
(82)
(439)
(135)
(516)
8.  Interest receivable
 

2008/09
2007/08
£000
£000
              
               
Interest receivable
381
632
TOTAL
381
632
71

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
9.  Intangible Fixed Assets
Software Total
licences 
£000
£000 
Gross cost at 1 April 2008
2,572
2,572
Reclassifications
74
74
Additions purchased 
79
79
Disposals 
(12)
(12)
Gross cost at 31 March 2009
2,713
2,713
Amortisation at 1 April 2008
1,217
1,217
Charged during the year 
449
449
Disposals 
(8)
(8)
Amortisation at 31 March 2009
1,658
1,658
Net book value
- Purchased at 1 April 2008
1,333
1,333
- Donated at 1 April 2008
22
22
- Total at 1 April 2008
1,355
1,355
- Purchased at 31 March 2009
1,051
1,051
- Donated at 31 March 2009
4
4
- Total at 31 March 2009
1,055
1,055
Following a review of asset accounting a number of re-classifications have occurred between tangible assets
and intangible assets.
72

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
10. Tangible Fixed Assets
10.1 Tangible fixed assets at the balance sheet date comprise the following elements:
Land Buildings 
Assets under 
Plant and 
Transport 
Information 
Furniture & 
Total
excluding 
construct and 
machinery 
equipment 
technology 
fittings 
dwellings
poa
£000 £000  £000  £000  £000 
£000  £000 £000 
Cost or valuation at 1 April 2008
50,310
1,417
11,954
2,857
40
2,753
126
69,457
Additions purchased 
0
890
2,141
445
0
279
0
3,755
Additions donated 
0
20
0
0
0
0
0
20
Reclassifications
0
260
(558)
88
0
125
11
(74)
Indexation (23,826)
(119)
(650)
77
1
3
(24,514)
Revaluation 28,690
0
0
0
0
0
0
28,690
Disposals 0
(93)
0
(128)
0
(653)
0
(874)
Cost or Valuation at 31 March 2009
55,174
2,375
12,887
3,339
41
2,504
140
76,460
Depreciation at 1 April 2008
0
0
0
1,530
24
1,185
20
2,759
Charged during the year 
0
92
0
320
6
413
24
855
Indexation 0
0
0
40
0
0
40
Disposals 0
(44)
0
(83)
0
(615)
0
(742)
Depreciation at 31 March 2009
0
48
0
1,807
30
983
44
2,912
Net book value 
- Purchased at 1 April 2008
50,310
1,399
11,954
1,029
0
1,565
82
66,339
- Donated at 1 April 2008
0
18
0
298
16
3
24
359
- Total at 1 April 2008
50,310
1,417
11,954
1,327
16
1,568
106
66,698
- Purchased at 31 March 2009
55,174
2,289
12,887
1,291
0
1,520
76
73,237
- Donated at 31 March 2009
0
38
0
241
11
1
20
311
- Total at 31 March 2009
55,174
2,327
12,887
1,532
11
1,521
96
73,548
Following a review of asset accounting a number of re-classifications have occurred between asset categories and between tangible assets and intangible 
assets.
There were no fixed assets held under finance lease at the balance sheet date (2007/08 £0). Of the totals at 31 March 2009, the Trust had no assets held at
open market valuation (2007/08 £0). The reversionary interest in the hospital is shown in assets under construction at a value of £12.9m (2007/08 £11.8m). 
The land was re-valued by the District Valuer (MRICS) as at 1 April 2008 to £79m on an Modern Equivalent Asset (MEA) basis. 
73

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
10. Tangible Fixed Assets (contd)
10.2  Asset Financing
Land Buildings, 
Assets under 
Plant and 
Transport 
Information 
Furniture & 
Total
excluding 
construction 
machinery 
equipment 
technology 
fittings 
dwellings
and 
payments on 
account 
£000 
£000  £000 £000 £000  £000 £000 
£000 
Net book value 31 March 2009
Owned
55,174
2,327
0
1,532
11
1,521
96
60,661
PFI residual interests
0
0
12,887
0
0
0
0
12,887
Total 31 March 2009
55,174
2,327
12,887
1,532
11
1,521
96
73,548
Net book value 1 April 2008
Owned
50,310
1,417
0
1,327
16
1,568
106
54,744
PFI residual interests
0
0
11,954
0
0
0
0
11,954
Total 1 April 2008
50,310
1,417
11,954
1,327
16
1,568
106
66,698
10.3  The net book value of land, buildings and dwellings at 31 March 2009 comprises:
2008/09
2007/08
£000
£000
Freehold
57,501
51,727
TOTAL
57,501
51,727
74

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
11.  Stocks and Work in Progress
31 March 2009
31 March 2008
£000
£000
Raw materials and consumables
1,835
1,663
TOTAL 
1,835
1,663
12.  Debtors
12.1 Debtors at the balance sheet date are made up of:
31 March 2009
31 March 2008
£000
£000
Amounts falling due within one year:
NHS debtors
2,010
2,360
Provision for impairment of debtors
(1,742)
(1,674)
Other prepayments and accrued income
2,438
2,780
Other debtors
4,546
3,430
Sub Total: falling due within one year
7,252
6,896
Amounts falling due after more than one year:
Other prepayments and accrued income
19,289
20,344
Sub Total: falling due after more than one year
19,289
20,344
TOTA
TO
L
TA
26 541
,541
27
27,240
Within Other prepayments and accrued income greater than one year is the PFI Deferred Asset value of the
Hospital.
75

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
31 March 2009
£000
12.2  Provision for impairment of debtors
Balance at 1 April
1,674
Amount written off during the year
(219)
Amount recovered during the year
(183)
Increase in debtors impaired
470
Balance at 31 March
1,742
12.3  Debtors past due date but not impaired:
31 March 2009
£000
By up to 3 months
1,073
By 3 to 6 months
284
By more than 6 months
1,117
2,474
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Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
13.  Creditors
13.1  Creditors at the balance sheet date are made up of:
31 March 2009
31 March 2008
£000
£000
Amounts falling due within one year:
Payments received on account
1
81
NHS creditors
2,059
1,280
Non - NHS trade creditors - revenue
2,747
716
Non - NHS trade creditors - capital
378
508
Tax 
138
90
Other creditors
33
246
Accruals and deferred income
4,737
4,891
Sub Total: amounts falling due within one year
10,093
7,812
Amounts falling due after more than one year:
Other
575
603
Sub Total: amounts falling due in more than one year
575
603
              
              
TOTAL
10,668
8,415
Other creditors falling due after one year of £575k relates to the contract between Oxleas NHS
Foundation Trust, Meridian  and Queen Elizabeth Hospital NHS Trust for building improvement works.
There were no outstanding pensions contributions at 31 March 2009 (31 March 2008 £0).
13.2  Loans and other long-term financial liabilities
The Trust has no loans outstanding as at 31 March 2009 (£0 as at 31 March 2008).
13.3 Finance lease obligations
Queen Elizabeth Hospital NHS trust has no finance lease obligation (2007/08 £0).
77

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
14.  Provisions for liabilities and charges
Pensions 
Legal claims
Other
Total
relating to 
other staff
£000
£000
£000
£000
At 1 April 2008
3,236
302
62
3,600
Arising during the year
26
652
0
678
Utilised during the year
(254)
(77)
0
(331)
Reversed unused
(227)
(7)
(62)
(296)
Unwinding of discount
61
0
0
61
At 31 March 2009
2,842
870
0
3,712
Expected timing of cashflows:
Within one year
254
735
0
989
Between one and five years
2,588
135
0
2,723
Pension provisions relate to staff under early retirement arrangements. The timing of cashflows has been based on payments
made during 2008/09. The value of the provision is based on estimated lifespan of individuals, and final salaries at the date of
retirement.
Legal claims includes amounts that the Trust is legally or constructively liable for at the balance sheet date. Other claims represent
the insurance excess applied to legal claims against the Trust. The value of the provision is based on information provided by the
NHS Litigation Authority. 
£24,451k is included in the provisions of the NHS Litigation Authority at 31 March 2009 in respect of clinical negligence liabilities of
the NHS Trust (31 March 2008 £14,176k).
78

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
15.   Movements on Reserves
Movements on reserves in the year comprised the following:
Revaluation 
Donated 
Income and 
Total
Reserve
Asset 
Expenditure 
Reserve
Reserve
£000
£000
£000
£000
At 1 April 2008 as previously stated
48,268
381
(45,571)
3,078
Transfer from the income and expenditure account
(5,481)
(5,481)
Surplus on other revaluations/indexation of fixed/current assets
4,126
10
4,136
Receipt of donated/government granted assets
20
20
Transfers to the income and expenditure account for depreciation, 
(96)
(96)
impairment, and disposal of donated/government granted assets
Ot
Other transfers between reserves
(465)
0
465
0
At 31 March 2009
51,929
315
(50,587)
1,657
79

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
16.  Notes to the cash flow Statement
16. 1  Reconciliation of operating surplus to net cash flow from operating activities:
2008/09
2007/08
£000
£000
Total operating deficit
(5,515)
(2,549)
Depreciation and amortisation charge
1,304
1,297
Transfer from Donated Asset Reserve
(96)
(199)
Increase in stocks
(172)
(27)
Decrease in debtors
699
31,534
Increase/(decrease) in creditors 
2,036
(791)
Increase/(decrease) in provisions 
51
(240)
Net cash inflow from operating activities
(1,693)
29,025
16.2  Reconciliation of net cash flow to movement in net debt
2008/09
2007/08
£000
£000
Increase/(decrease) in cash in the period
(3,079)
6,005
Cash (inflow)/outflow from (decrease)/increase in liquid resources
0
(6,000)
Change in net debt resulting from cash flows
(3,079)
5
Net debt at 1 April 2008
6,485
6,480
Net debt at 31 March 2009
3,406
6,485
16.3  Analysis of changes in net debt
At 1 April 
Other cash 
At 31 
2008
changes in 
March 
year
2009
£000
£000
£000
OPG cash at bank
6,478
(3,079)
3,399
Cash in hand
7
0
7
               
               
6,485
(3,079)
3,406
80

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
17.  Capital Commitments
Commitments under capital expenditure contracts at 31 March 2009 were £360k (31 March 2008 £508k).
18.  Post Balance Sheet Events
On 1st April 2009 Queen Elizabeth Hospital NHS Trust merged with Bromley Hospitals NHS Trust and
Queen Mary's Hospital Sidcup NHS Trust to form South London Healthcare NHS Trust. 
19.  Contingencies
2008/09
2007/08
£000
£000
Contingent liabilities 
(662)
(644)
Net value of contingent liabiliies
(662)
(644)
Of the total contingent liabilities of £662k, £644k relates to the possible compensation on termination of a
contract between Macillan Cancer Relief and the Queen Elizabeth Hospital NHS Trust for contribution
towards the Oncology Unit at the Queen Elizabeth Hospital, and £18k relates to legal cases.
The compensation on termination clause is activated in the event that the agreement is terminated at any
time in the period of the 10 years from the completion of the hospital (2008/09 represents year 8 of the 10
year period).
20.   Movement in Public Dividend Capital
2008/09
2007/08
£000
£000
Public Dividend Capital as at 1 April 2008
88,348
115,476
New Public Dividend Capital received (including transfers from dissolved 
NHS Trusts)
2,000
2,097
Public Dividend Capital repaid in year 
0
(29,225)
Public Dividend Capital as at 31 March 2009
90,348
88,348
Cash
To maintain liquidity the Trust had cash borrowings issued as PDC to the value of £65.4m from the
Department of Health in 2006/07. This borrowing will require repayment and does not present a permanent
solution to the Trust's cash shortfall. Repayment terms have not yet been negotiated with the Department of
Health.
81

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
21.  Financial Performance Targets
21.1  Breakeven Performance
The trust's breakeven performance for 2008/09 is as follows:
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
£000
£000
£000
£000
£000
£000
Turnover
125,436
130,090
132,983
147,525
152,121
157,567
Retained surplus/(deficit) for the year
917
(9,186)
(19,289)
(7,244)
(3,125)
(5,481)
Adjustment for:
- 2005/06 Prior Period Adjustment (relating to 1997/98 to 2004/05)
(4,417)
(136)
0
0
0
0
- Other agreed adjustments
0
0
200
0
0
Break-even in-year position
(3,500)
(9,322)
(19,089)
(7,244)
(3,125)
(5,481)
Break-even cumulative position
(4,173)
(13,495)
(32,584)
(39,828)
(42,953)
(48,434)
Materiality test (I.e. is it equal to or less than 0.5%):
- Break-even in-year position as a percentage of turnover
-2.79%
-7.17%
-14.35%
-4.91%
-2.05%
-3.48%
- Break-even cumulative position as a percentage of turnover
-3.33%
-10.37%
-24.50%
-27.00%
-28.24%
-30.74%
The Trust received an adverse I & E movement of £0.2m in 2005/06 relating to RAB system. This movement has been adjusted.
The Trust's break-even performance is compared to a materiallity threshold of 0.5% of turnover, below which recovery of deficit within the framework of a
recovery plan will not be required by the Department of Health.
82

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
21.2  Capital cost absorption rate
The Trust is required to absorb the cost of capital at a rate of 3.5% of average relevant net assets. The rate is
calculated as the percentage that dividends paid on public dividend capital, totalling £0.15m, bears to the
average relevant net assets of £87m, that is 0.2%.
The Trust is set a dividend payment based on estimates of future assets and liabilities, completed a year in
advance of the opening period to which the dividend relates. During the estimation process for 2008/09 the
Trust recognised a material liability in respect of an expected cash loan with the Department of Health. The
Trust was not issued with this loan in 2008/09 causing the absorption rate to drop below the allowed 3%
threshold.
   
21.3  External financing
The Trust is given an external financing limit which it is permitted to undershoot.
2008/09
2007/08
£000
£000
£000
External financing limit
5,302
(27,128)
Cash flow financing
5,079
(27,133)
External financing requirement
5,079
(27,133)
Undershoot
223
5
21.4 C
   apital
Capital Resour
R
ce
esour
 Limit
The Trust is given a capital resource limit which it is not permitted to overspend
2008/09
2007/08
£000
£000
Gross capital expenditure
3,854
3,948
Less: book value of assets disposed of 
(136)
(517)
Less: donations towards the acquisition of fixed assets
(20)
(156)
Charge against the capital resource limit
3,698
3,275
Capital resource limit
3,718
3,823
Underspend against the capital resource limit
20
548
83

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
22.  Related Party Transactions
Queen Elizabeth Hospital NHS Trust is a body corporate established by order of the Secretary of State for Health.
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 Queen Elizabeth Hospital NHS Trust.
The Department of Health is regarded as a related party. During the year Queen Elizabeth Hospital NHS Trust has
had a number of significant transactions with the Department, and with other entities for which the Department is
regarded as the parent Department. These entities are listed below along with the corresponding amount of debtor
and creditor balances recorded at the year end, and amount received and paid during the year:
Debtor
Creditor
Income
Expenditure
2008/09 2007/08 2008/09 2007/08 2008/09 2007/08 2008/09 2007/08
£000s
£000s
£000s
£000s
£000s
£000s
£000s
£000s
Greenwich PCT
0
760
0
33
98,373
98,633
0
56
Bexley PCT
541
463
0
32
21,836
19,007
17
29
The NHS London 
88
86
0
0
6,175
5,610
5
44
 
 
The NHS li
  tigation Authority
0
0
2
0
0
0
2,234
2,373
Lewisham PCT
49
41
2
2
2,660
2,387
10
8
London Ambulance Service NHS Trust
0
0
13
14
0
0
851
887
NHS Blood and Transplant
0
0
31
0
0
0
1,168
1,235
NHS Purchasing and Supply Agency
0
0
171
204
0
0
0
2,413
Greenwich Council
0
40
0
2
5
40
2,759
1,586
Department of Health
1
0
1,124
0
18,746
19,130
0
137
In addition, the Trust has had a number of material transactions with other Government Departments and other central
and local Government bodies.
  
The Trust has also received revenue and capital payments from a number of charitable funds, certain Trustees are
also members of the NHS Trust Board. The Trust has received £20,125 worth of capital donations during 2008/09 (in
2007/08 £156k).                                                                                                                                                               
David Wragg, the Trust Finance Director was a Director of the NHS Shared Business Service, a joint venture between
Steria and the Department of Health created to manage finance transaction processing for NHS bodies. Mr Wragg
received no remuneration for this post.                                                                                                                     
The Trust has outsourced some of its finance processing functions to the NHS Shared Business Service part owned
by the Department of Health.
84

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
23.  Private Finance Transactions
23.1  PFI schemes deemed to be off-balance sheet
2008/09
2007/08
£000
£000
Amounts included within operating expenses in respect of PFI transactions 
26,957
26,316
deemed to be off-balance sheet - gross
Amortisation of PFI deferred asset
(1,025)
(1,025)
Net charge to operating expenses
25,932
25,291
The NHS Trust is committed to make the following payments during the next year.
PFI scheme which expires;
6th to 10th years (inclusive)
3,952
3,924
21st to 25th years (inclusive)
25,057
23,446
£000
£000
Estimated capital value of the PFI scheme 
116,153
116,153
Contract Start date:
01/01/2001
Contract End date:
31/12/2060
The Trust has entered into a 60 year PFI contract with Meridian Hospital Company PLC to supply the hospital premises
and a range of services. The Trust has undertaken an assessment of the contract under SSAP 21 (Accounting for
leases and hire purchase contracts) and FRS 5 (Reporting the substance of transactions) and determined that the
contract should be accounted for off balance sheet.
The Trust takes the view that the rights and privileges of ownership of the Hospital will transfer to the NHS after 30
years and there is the option to terminate the concession to provide Facilities Management services from the PFI
contractor at 30 and 45 years.
The Trust retains the freehold to the land on which the new hospital is based. The Trust has granted a headlease to
Meridian Hospital Company Plc for a period of 125 years. 
The Trust has assessed the lease agreement under SSAP 21 and FRS 5 and determined that the land should be
accounted for on balance sheet. The net book value of this land (disclosed in note 10.1) is £55.17 million.
Toshiba Managed Equipment
2008/09
2007/08
£000
£000
Estimated capital value of the PFI scheme 
6,094
6,094
Contract Start date:
27/09/2001
Contract End date:
14/09/2016
The Trust has entered into a 15 year PFI contract with Toshiba Medical Systems for maintenance and replacement of
medical equipment.  
The Trust has undertaken an assessment of the contract under SSAP 21 (Accounting for leases and hire purchase
contracts) and FRS 5 (Reporting the substance of transactions) and determined that the contract should be accounted
for off balance sheet.
85

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
24.  Financial Instruments
FRS 25, 26 and 29, Financial Instruments, requires disclosure of the role that financial instruments have
had during the period in creating or changing the risks an entity faces in undertaking its activities.
The NHS Trust is not exposed to significant financial risk factors arising from financial instruments.
Because of the continuing service provider relationship that the Trust has with local primary care trusts
and the way those primary care trusts are financed, the Trust is not exposed to the degree of financial
risk faced by business entities. Financial assets and liabilities are generated by day-to-day operational
activities rather than being held to change the risks facing the Trust in undertaking its activities.
Market risk
Market risk is the possibility that financial loss might arise as a result of changes in such measures as
interest rates and stock market movements. Market risk comprises three types of risk, where the fair
value or future cash flows could fluctuate because of movements in the underlying Interest rate risk,
Currency risk; and Price risk.
Interest rate risk
The Trust does not hold any investments. Other than the cash balance, the Trust's financial assets and
liabilities carry nil or fixed rates of interest and the Trust's income and operating cash-flows are
substantially independent of changes in market interest rates.
Currency risk
The Trust's transactions are almost all undertaken in sterling and so it is not exposed to foreign
exchange risk.
Price risk
The Trust has a number of contractual arrangements which are linked to the UK Retail Price Index (RPI),
for example the PFI contracts (Note 23) , therefore the Trust is exposed to price risk in line with
movements in the UK economy.
Credit risk
Credit risk is the possibility that other parties might fail to pay amounts due to the Trust. Credit risk arises 
from deposits with banks as well as credit exposures to the Trust's commissioners and other debtors.
The Trust's cash assets are held with the Office of the Post Master General only. The Trust does not
have surplus amounts of operational cash to invest. The Trust's net operating costs are incurred largely
under annual service agreements with local primary care trusts, which are financed from resources
voted annually by Parliament. An analysis of the ageing of debtors and provision for impairment can be
found at Note 12 "Debtors".
Liquidity risk
Liquidity risk is the possibility that the Trust might not have the funds available to meet its commitments
to make payments. Prudent liquidity risk management includes maintaining sufficient cash and the
availability of funding from an adequate amount of committed credit facilities. 
86

Queen Elizabeth Hospital NHS Trust - Annual Accounts 2008/09
24.1  Financial Assets
Loans and 
receivables
Total
£000
£000
NHS debtors
2,010
2,010
Non NHS debtors
2,206
2,206
Cash at bank and in hand
3,408
3,408
Total at 31 March 2009
7,624
7,624
24.2  Financial Liabilities
Other
Total
£000
£000
NHS creditors
2,059
2,059
Non NHS creditors
7,429
7,429
Total at 31 March 2009
9,488
9,488
87

Queen Elizabeth Hospital NHS Trust - Annual Accounts 200
25.  Third Party Assets
The Trust held £9k cash at bank and in hand at 31 March 2009 (£7k - at 31 March 2008) which relates to monies held by 
the NHS Trust on behalf of patients.  This has been excluded from cash at bank and in hand figure reported in the 
accounts.
26.  Intra-Government and Other Balances
Debtors: 
Debtors: 
Creditors: 
Creditors: 
amounts 
amounts 
amounts 
amounts 
falling due 
falling due 
falling due 
falling due 
within one 
after more 
within one 
after more 
year
than one 
year
than one 
year
year
£000
£000
£000
£000
Balances with other Central Government Bodies
1,407
0
1,592
0
Balances with NHS Trusts and Foundation Trusts
603
0
637
0
Balances with Public Corporations and Trading Funds
0
0
31
0
Intra Government balances
2,010
0
2,260
0
Balances with bodies external to Government
5,242
19,289
7,833
575
At 31 March 2009
7,252
19,289
10,093
575
Balances with other Central Government Bodies
1,956
0
277
0
Balances with Local Authorities
58
0
11
0
Balances with NHS Trusts and Foundation Trusts
529
0
765
0
Balances with Public Corporations and Trading Funds
0
0
0
0
Intra Government balances
2,543
0
1,053
0
Balances with bodies external to Government
4,353
20,344
6,759
603
At 31 March 2008
6,896
20,344
7,812
603
27.  Losses and Special Payments
There were 38 cases of losses and special payments (2007/08: 578 cases) totalling £140,000 (2007/08: £459,000)
during 2008/09.
88

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