Mission and Aim
Advancing care for patients with neoro-musculoskeletal disease/disability through research, teaching and excellence in clinical practice, and to be endorsed by others as a world class leader in this field
5
8
12
16
Our Mission
Contents
5
Welcome to the RNOH
13
Modernising the RNOH
6
Overview of the Year
17
Listening to Our Patients
7
Performance Statement
19
Clinical Outcomes
23
Working for the RNOH
27
Teaching and Research
31
Events at the RNOH
32
RNOH in the News
9
Introducing our Clinical Services Joint Reconstruction Shoulder Surgery Peripheral Nerve Injury Spinal Surgery Spinal Injury Bone Tumour Medical & Rehabilitation Metabolic Medicine
19
33
Infrastructure and Financial Statements
23
Contents
30
32
4 Welcome
Welcome 5
Welcome to the Royal National Orthopaedic Hospital
The Royal National
The RNOH is based on two sites. Our main site is at Stanmore in Middlesex
Orthopaedic Hospital NHS
and our Central London outpatients facility is in Bolsover Street. As a
Trust (RNOH) provides a
national centre of excellence, the RNOH treats patients from across the
comprehensive range of
country, many of whom have been referred by other hospital consultants
neuro-musculoskeletal health
for second opinions or for treatment of complex and/or rare conditions.
care, ranging from the most acute spinal injury or complex
The RNOH also plays a major role in teaching junior doctors and future
bone tumour to orthopaedic
orthopaedic surgeons as well as nurses and other health professionals.
medicine and specialist
Our teaching and our clinical effectiveness are enhanced by our work in
rehabilitation for chronic back
research and development and our academic links with University College
pain sufferers.
London (UCL) and other academic partners.
This broad range of neuro-musculoskeletal services
All patients benefit from the skills of our team of highly specialised
is unique within the NHS.
consultants, many of whom are nationally and internationally recognised for their expertise and experience. Supporting every area of our work are teams of dedicated nurses, therapists and other highly specialised clinical staff who are recognised in their own right for their clinical expertise in neuro-musculoskeletal care.
6 Overview
In July 2004 the RNOH got the go ahead from the Department of Health to move to the next stage in the planning process for the new hospital in Stanmore. This means RNOH is now one of 15 hospitals across the country developing plans for major capital investment and for us this will result in a state-of-the-art new hospital building for patients and staff here in Stanmore.
Overview 7
Performance
Key Challenges and Achievements
As we get closer to realising
The RNOH has now addressed the shortcomings in its arrangements for
our plans, we recognise that
managing waiting lists and it has achieved the government targets for
the hospital must demonstrate
seeing all patients within the maximum waiting times since August 2004.
that it continues to provide
However, failure to achieve this target in previous months led to a zero
high-quality services and that
star rating for the RNOH.
it is operating on a sound financial basis. The star rating
Our particular challenge during the year has been balancing income with
results for this year
expenditure, and for the first time in recent years the RNOH ended the
demonstrated that the RNOH
year with a deficit. This has resulted from a drop in income as routine
performs well in all clinical
operations are moved to local hospitals and to treatment centres. The
areas but failed to meet
RNOH focuses on complex operations that cannot be done elsewhere.
targets with its waiting times
Whilst this is sensible in terms of patient care, it is these complex
and financial management.
operations that are generally less well reimbursed within the NHS. The RNOH is now taking measures to reduce expenditure, to maximise income and to prepare for the new financial regime whereby all hospitals are paid
Donald Hoodless,
at a national tariff. RNOH has been working with the other specialist
Chairman
orthopaedic hospitals to ensure that the tariff accurately reflects the cost of the work that we undertake.
Andrew Woodhead,
We would like to extend our thanks to all our staff, who work hard in
Chief Executive
difficult conditions, to provide patients with such a high quality of service and we appreciate your support in helping to bring about the rebuilding of the hospital.
8 Clinical Services
Clinical Services 9
Introducing the Royal National Orthopaedic Hospital’s
Clinical Services Joint Reconstruction
arising from hip disorders that started in childhood and
The RNOH has a national and international reputation
the full range of surgery for arthritis such as:
for its expertise in the treatment of joint disorders. Specialist Consultant Surgeons from the hospital take
● Primary Replacement
part in education across the country and internationally.
● Revision Surgery
They are also leaders in research and development in
● Hip Reconstruction
their area of expertise. Foot and Ankle Knee
The Foot and Ankle unit at the RNOH treats a wide
The RNOH treats all problems associated with the knee
range of foot and ankle problems including the
in adults, including the diagnosis and treatment of
treatment of severe congenital deformities and
problems arising from knee disorders deriving from
amputations. The unit has special expertise in the
sports injuries, accidents and all aspects of arthritis.
correction of major foot deformities, the management of complex foot conditions and tendon transfers.
The RNOH is also leading in the development of knee
Patients benefit from the multidisciplinary approach
cartilage transplantation and plays an important role in
with on-site orthotics and artificial limb makers.
terms of research in knee services. Shoulder Surgery Hip
The Shoulder and Elbow Service provides a tertiary-
RNOH are leaders in the treatment and research of all
level referral service for patients with complex
problems associated with the hip in adults. This service
problems of the shoulder and elbow. The key areas
includes the diagnosis and treatment of problems
addressed are complex forequarter instability, primary
10 Clinical Services
and
revision
arthroplasty
(including
CADCAM
Spinal Surgery
replacement), complex shoulder pain syndromes, and
The Spinal Surgery Unit at the RNOH is the largest
failed or failing rotator cuff disease. The unit comprises
spinal unit in the UK. Last year over 1,800 spinal
of two Consultants and a Specialist Clinical
operations were performed. The unit is unusual in that
Physiotherapist along with an Extended Role
it integrates six Orthopaedic Spinal Surgeons and two
Practitioner from the Physiotherapy Service.
Neurosurgical Spinal Surgeons who provide expertise over the whole range of spinal conditions. The
At any one time, a number of national and
majority of treatment undertaken is for degenerative
international Clinical Fellows are attached to the
spinal conditions such as spinal deformity, however,
service. There is a strong emphasis on interdisciplinary
surgery is undertaken for patients with spinal injury or
working with the Physiotherapy and Occupational
spinal tumours.
Therapy teams. Spinal Injury Peripheral Nerve Injury (PNI)
The Spinal Cord Injury Centre at RNOH is one of only
The current scope of the Peripheral Nerve Injury Unit’s
11 in the UK designated to receive and treat spinal cord
work includes the diagnosis and the treatment of
injured patients. The unit currently has 24 beds,
injuries to major nerves and in many cases the cause of
comprising of 8 acute beds and 16 rehabilitation beds.
the injury is a high-speed road traffic accident.
A
There is however the capacity to treat up to 40 patients
considerable proportion of the work is urgent or even
within the RNOH at any one time. Patients are admitted
emergency, most especially when there has been
predominantly from the south east of England on an
damage to a great artery.
urgent referral basis. The aim is to admit all patients as soon as possible following their injury. The unit consists
The Peripheral Nerve Injury Unit works very closely
of a team of multi-professional specialists who work
with specialist units within London, most especially
towards a patient focused service and rehabilitation is
with the National Hospital of Nervous Diseases, Queen
based around patient centred goals.
Square and with the Department of Academic Neurology at the Royal Post Graduate Medical School
Bone Tumour
at the Hammersmith Hospital. Close links are also
The RNOH Bone Tumour unit treats a third of all bone
maintained with hospitals throughout the country.
tumours in England. The specialist surgical team and
Clinical Services 11
multidisciplinary staff combine to give the highest
At the RNOH, the Occupational Therapists look at a
quality diagnosis and treatment of rare bone tumours.
patient’s ability to function in everyday life before,
Specialist surgery in tumour excision, limb salvage and
during and after their treatment here.
joint reconstruction are supported by the department
For some, such as the Spinal Cord Injury and Brachial
of Biomedical Engineering, UCL where custom
Plexus Injury clients, it’s a long process of gaining
implants are designed and manufactured including the
confidence, rebuilding activities and getting used to
revolutionary ‘growing prosthesis’.
specialist equipment and techniques.
Medical & Rehabilitation
Metabolic Medicine
Physiotherapy
The Metabolic Unit provides specialist care for patients
The Physiotherapy Department at the RNOH provides a
with metabolic bone diseases. There is access to
service to inpatients undergoing surgery and also
specialist medical and nursing staff, modern diagnostic
patients who are admitted for specialist intensive
facilities and clinical research. The most common of
rehabilitation.
the conditions seen in the unit is osteoporosis, although as a tertiary referral centre the unit is also
We have a team of Physiotherapists at Stanmore and
involved in the management of patients with rare and
at Bolsover Street, who treat outpatients referred
complex metabolic bone conditions. The Metabolic
from consultants and GPs. It has been a very busy
Unit offers care for both adult and paediatric patients,
year, with our staff treating 500 more patients than
and provides a unique service for all patients with
the previous year. Recruitment and retention remains
life-long medical conditions.
an important focus to ensure high standards are maintained and we are fortunate in our ability to
Children and Adolescent Services
attract high calibre staff.
The RNOH is a national centre of excellence for the treatment
of
children
and
adolescents
with
Occupational Therapy
orthopaedic conditions. Surgery is performed to correct
'Occupational Therapy enables people to achieve
congenital limb abnormalities, treat bone tumours and
health, well being and life satisfaction through
correct spinal deformities. Excellent medical treatment,
participation in occupation.' College of Occupational Therapists 2003.
nursing and support services are provided to enable children and adolescents to improve their physical abilities, education and emotional well being. Throughout this time, families are supported and fully involved in all aspects of their child's care.
12 Modernising
Bolsover Street
Stanmore Redevelopment
Since the approval of the Strategic Outline Case in July 2004 the Redevelopment Project Team, in conjunction with clinicians, service managers and heads of department have been developing the clinical model, operational policies, functional content and schedules of accommodation which together form the design brief
Modernising 13
Modernising the RNOH - Investing in Orthopaedics
Progress to date
capital planning and engineering, NHS management and
The Project Team have been working with the Trust’s
the project management of large schemes. Members of
external advisers to provide a design that can not only be
the Design Panel Review recognised that the Public
accommodated on the current Stanmore site but also
Sector Comparator design had been closely driven by the
provides the correct clinical adjacencies.
Clinical Model.
These plans are drawn up for the Trust to describe how
Both the Trust and panel members emphasised that the
it would build this new hospital should it be able to do
new hospital must respond to the needs of patients,
so. This is called a ‘Public Sector Comparator’, and
their relatives and professional carers by providing an
describes the type and style of hospital that the Trust
environment in which patients and staff are able to
would build on the RNOH if it were doing the work. The
develop relationships, which enable patients to feel safe
RNOH currently has drawings and graphic impressions of
and independent and staff to feel motivated and valued.
the proposed appearance of the new development. The Panel understood the importance of providing NHS Design Panel Review
services within one major building. They also felt that
An NHS Design Panel Review, followed by a workshop,
locating the new hospital building in the centre of the
was held in December 2004/January 2005. The panel’s
site was the best possible solution, in order to maximise
remit was to provide advice, guidance and support to the
views from patient areas.
NHS in the form of a design review and subsequent report, highlighting comments and recommendations.
It also satisfied planning requirements for minimizing
The panel consisted of a range of professionals with
building height by constructing the building in a natural
experience in architecture and design, urban design,
bowl shaped valley.
14 Modernising
Outline Planning Application
Gateway Project Review
Following a culmination of more than a year’s work, the
The Health Gateway Project Review Level 1 was carried
Outline Planning Application for the redevelopment of
out in January 2005. The Review Team recognised that
the Stanmore site was submitted to the London Borough
good progress had been made on the project since the
of Harrow in July 2005 for consideration in their October
previous Gateway Review. The Trust received an amber
planning committee. The Outline Planning Application
status and the following were highlighted as areas of
reflected the advice of the NHS Design Panel and
good practice:
included an environmental statement. In summary the Trust, through the application, is seeking permission for
● Extensive clinical engagement has provided a
the redevelopment of the Stanmore site to provide a
sound basis for workplace design and new
state of the art, exemplar design hospital with associated
working practices.
educational facilities, staff accommodation, affordable and private housing, together with appropriate landscaping, parking and other highways works.
● The joint working with other Orthopaedic Trusts in developing their response to the Department of Health in connection with Payment by Results.
The Trust’s approach towards the redevelopment of the RNOH site has been guided by the following objectives:
● The innovative approach to communications with patients through a redevelopment project website.
● The need to meet the current and future clinical and operational requirements of the hospital.
Communications and Public & Patient Involvement In progressing the redevelopment, the Trust has been
● The need to address key national,
involving and consulting with patients, staff and the
London-wide and local planning policy
public. A Communications and Public Redevelopment
requirements, in particular those that deal
Forum has been established to influence the way that
with the green belt.
the redevelopment project is delivered. The forum is made up of patients from North Central London and
● The need to secure planning consent to
Barnet PCT representatives who are enthusiastic about
enable the design of the new hospital to be
contributing positive suggestions and ideas that will
developed in detail.
influence the way the Trust designs and operates in the
Modernising 15
new hospital. In addition the Redevelopment Team has
voluntary income to fully realise the vision of a new state
developed an RNOH patient website forum, where
of the art orthopaedic hospital. The main focus for
patients can interact and obtain the latest news and
2004/2005 has been to ensure that sufficient funds are
information regarding the redevelopment.
in
place
for
the
new,
much
needed
family
accommodation, known as Phase One of the Next Steps
redevelopment campaign and costing £2 million.
The Trust will continue to work on the Outline Business Case (OBC) for approval in the autumn of 2005 with an
At the time of writing we have raised £1,775,000
OJEU advert being placed in early 2006.
towards Phase One of the campaign and need to raise the outstanding £225,000 by the end of 2005 so that
Bolsover Street
building work can begin in January 2006. We are
The issue of whether to redevelop the Bolsover Street
grateful to Ronald McDonald Children’s Charities for
Outpatients Department continued in 2004-05. Six
their outstanding contribution towards the new family
bidders were short listed and they were invited to
accommodation. A further £2 million has been secured
develop their briefs and submit their bids. Following an
in pledges and gifts from individuals, trusts, and
extensive interview process involving a Consultant
companies towards the new RNOH building. Former
Surgeon and a Senior Nurse, Ridgeford & Manhatten
patients are also providing tremendous help with the
Lofts were selected as the party to go forward to
campaign by participating in sponsored events or
preferred bidder status. The bid was strong with a
organising their own fundraising events to raise funds.
highly respected architectural practice (HOK) on board. We are delighted that HRH The Duke of York, as Patron, If it is decided to continue with one redevelopment of
has agreed to host a lunch at Buckingham Palace
the Bolsover Street site, sign off would be expected in
towards the end of 2005 for our key and prospective
April 2005.
donors. The involvement of His Royal Highness is greatly appreciated.
Fundraising The beginning of 2005 saw the appointment of the hospital’s first Head of Fundraising and the development of a fundraising strategy to raise £15 million from
16 Patients
Patients 17
Listening to Patients
In 2004/2005 the RNOH Treated 9,209 inpatients and saw 58,225 outpatients Patient and Public Involvement
Director of the Trust. There are several patient
The Trust continues to strengthen its commitment to
members on the Group and a member of the Harrow
patient and public involvement. In particular the RNOH
Council for Race Equality will be in attendance from
has achieved the following:
Summer 2005. This year, the Disability Advisory Group was incorporated into the PPI Group.
● Implementation of the Patient and Public Involvement Strategy.
This year there has been extensive discussion on Volunteer Services within the Trust to maximise effort
● Further development the range of patient information available with patient involvement.
and initiatives to build up a full volunteer service to support the Trust. This work is ongoing and in partnership with the Friends of the RNOH. The PPI
● Working closely with the Patients Forum, the
Group monitors the Trust’s ‘Say So’ Campaign, which
Trust has set up a joint project to improve the
asks for comments, suggestions and feedback from
patients, experience within the Outpatients
both staff and patients.
Department. Patient Advice and Liaison Service (PALS) ● Analysing and ensuring action plans from the findings of National Patient Surveys are carried out.
The PALS Service, which was implemented within the Trust in April 2002, has continued to achieve the main aims of the service, which are as follows:
Patient & Public Involvement Group (PPI) The Trust continues to strengthen its Patient and Public Involvement Group chaired by a Non Executive
● Solve patient problems promptly without the need for a formal complaint.
18 Patients
● Improve the patient experience
However, in general this year’s survey is somewhat disappointing and has highlighted a number of areas
● Provide information about the Trust services
that need to be addressed. An action plan has been implemented to address these areas and the RNOH
The PALS service continues to grow, with 815 enquiries
eagerly awaits the results from the next survey.
recorded during the past year, an overall increase of 29% on the previous year. The PALS Manager
A full copy of the Trust’s outpatients and inpatients
undertakes an Inpatient Satisfaction Survey each
surveys can be obtained from the Healthcare
month.
Commission web site at www.chi.gov.uk.
National Outpatients Survey 2003-2004, published January 2005 Following the results of the national outpatients survey undertaken between 2003-2004 the Trust has seen improvement in the following areas:
● The time spent with the doctor.
● The explanation given to the patient on what would happen to them.
● The explanation of risks and/or benefits.
● The explanation on how to take new medication (an action from the previous survey).
● The explanation on the purpose of the medication.
Clinical Outcomes 19
Clinical Outcomes
Clinical Governance
to improve the standards of hospital cleanliness. The
A full copy of the published Clinical Governance Annual
Trust held a week long programme of audit and
Report can be obtained by contacting Kathryn Corder,
cleaning identified areas which were deemed to be
Assistant Director of Clinical Governance on 020 8909
below standard.
5339 or by email at
[email protected] Clean Your Hands Campaign – 10th April 2005 Infection Control
This is a National Patient Safety Agency initiative to
The Trust has initiated and participated in a number of
promote hand hygiene and reduce hospital acquired
local and national campaigns designed to improve
infection. A preliminary hand hygiene audit was
standards of infection control including:
carried out across all ward areas.
NHS Clean Hands Save Lives – October 2004
The Trust continues to report a very low incidence of
This was an awareness campaign launched by the
acquired infection.
North Central London Strategic Health Authority to improve compliance with hand washing with the aim
Mandatory MRSA Bacteraemia Surveillance
of reducing hospital acquired infection.The campaign was predominantly aimed at patients. The Trust
1 April – 30 June 2004
0 cases
1 July – 30 September 2004
1 case
1 October – 31 December 2004
1 case
1 January-31 March 2005
2 cases
distributed the leaflets with admission packs on the patient’s arrival.
Think Clean Day – 8th February 2005 This was an initiative from the Department of Health
20 Clinical Outcomes
Clinical Outcomes 21
● All complex spinal surgery is undertaken using a
Safer Surgery/Postoperative Infection As a single specialty hospital undertaking elective
skilful team of ‘spinal cord monitoring’ specialists
treatment, the Trust is exposed to less infection than
checking the spinal cord function during
most hospitals and maintains low overall infection rates.
surgery.
In early 2005, the RNOH’s Joint Reconstruction Unit began a research study of vaccination against
● The Trust uses a ‘cell saving’ system during
Staphoreous Infection. The survey will continue through
complex surgery which recycles the patient’s
2005 and data will be analysed in 2006. Other factors
own blood, ensuring reduced need for an
that contribute to better clinical outcomes and low
external supply or transfusion.
infection rates are: ● High risk patient’s have better access to internal ● All theatres have ‘Laminar Flow’ systems
critical care facilities than most hospitals, as
designed to create a ‘clean air’ environment
RNOH patient’s are not competing for limited
during surgery.
NHS critical care beds.
Surgical Site Surveillance Dates
No. of
No. of
% of
operations
infections
infections
Apr-June 2004
162
0
0.0
Jul-Sep 2004
152
1
0.7
Oct-Dec 2004
159
4
2.5
22 Working
Working 23
Working for the Royal National Orthopaedic Hospital
Trust Values
Developing our Staff
Following a period of consultation, which included staff
Improving Working Lives
workshops and Board discussion, the Trust has
The Trust is seeking ‘Practice Plus’ accreditation in
developed a new set of values:
November 2005. To help improve the working lives of all staff, the Trust has provided the following over the past
● Open, honest and support
● Respect for patients and staff
year:
● Open forums (opportunity to discuss topics of interest with directors)
● Patient focus ● An anonymous telephone line to enhance
● Trust and equality
communication
● Integrity, compassion and dignity
● Increased security levels
● Committed to excellence and high performance
● Competency programmes for nurses and a
range of inter-professional training sessions
In addition the Trust’s aim has been modified – “to be the specialist orthopaedic hospital of choice by providing outstanding patient care, research and education through our staff.”
● Staff information days to highlight benefits
available to staff
24 Working
Staff in post 2004-2005 (at 31st March 2005) Nursing Allied Health Professionals Administration/Management Ancillary/Technicians Medical TOTAL
400 106 268 71 113 958
Race Equality/Equality and Diversity The Diversity group continues to address diversity issues in relation to recruitment and career progression within the Trust. 2 staff members are participating in the BEL leadership programme for BME staff. A BME network is being launched to provide a forum for BME staff to support each other.
Medical 12% Ancillary/ Technicians 7%
The Board recently ratified the Trust’s new Race Equality Nursing 42%
Scheme, which is based on learning and best practice achieved through the RES published in 2002 and demonstrates the ongoing work towards improving
Administration/
Management
28%
integration of race equality into the Trust’s processes, systems and practices. Allied Health Professionals 11%
Listening to our Staff The Trust participated in the National NHS Staff Attitude Survey at the end of 2004. Results, which showed some improvements on the previous year, were received in March 2005 and since then many staff have
Agenda for Change
attended feedback sessions. An action plan was
Management and Staff Side have worked well in
formulated and has since been achieved. Specifically,
partnership to progress the introduction of new pay
the Trust has:
scales under Agenda for Change. As at July 2005, more than half of the Trust’s staff are being rewarded under the harmonised pay and conditions. The introduction of
● Updated policies (including the introduction of a retirement policy)
the Knowledge and Skills Framework is underway and will support an improved appraisal/development review process for staff.
● Enhanced childcare advice and support
Working 25
● Developed a new induction programme for clinical staff
Improving the Quality of Working Lives of RNOH Staff Benita Hexter, Physiotherapy/Agenda for Change Staff Side Lead
● Developed a set of Trust values Excellence in Customer Service Recognising Our Staff
Switchboard Team, Stanmore
Staff Achievement Awards 2004 The Trust held its annual Staff Achievement Awards after
Excellence in Leadership
the 2004 Annual General Meeting. Staff were
Pam Barsby, Physiotherapy & Steve Crane,
nominated by colleagues in a range of categories. A
Histopathology
multi-professional group (including a Non Executive Director) met to agree on the winners and runners-up.
Innovation
The winners in 2004 were:
Rachel Brown, Angus Mackinnon Ward & Greenacre Gardens – Medirest
Improving the Quality of Care Barbara Newman, Rehab Ward
Improving the Effectiveness of Trust Services The Pre-Admission Team
Contributing to Research and Education Lorraine Larkin, Alan Bray Unit
Enhancing the Trust’s Reputation The Shoulder & Elbow Service
26 Teaching
Teaching 27
Teaching & Research
Research & Development
healing. His reseach activites span basic non-human
External review of research
disease models to leading multi-centre clincial trials. He
The RNOH, in collaboration with UCL, initiated an
is also President of the International Society of Fracture
external review of research activity in November 2004.
Repair.
The
review
was
undertaken
by
a
panel
of
internationally recognised academic clinicians, and
Joint Research Strategy
took the form of panel interviews for each area of
As part of the prelude to the review, the RNOH and
research.
IOMS reviewed and updated their joint research strategy. The revised strategy focussed on achieving
The panel’s report highlighted the high quality of
both academically important targets (i.e. publications
research undertaken and the unique partnership
in high impact journals, research funding from
between basic science, translational research and
esteemed sources) and clinically important targets (i.e.
excellence in the management of musculoskeletal
developing research that supports the evidence base
disease.
for clinical care, modifying practice following reseach evidence).
New appointment Professor David Marsh agreed to take the post of
As part of this process, the Academic & Research
Professor of Clinical Orthopaedics, and will begin in
Board modified the funding strategy to support
September 2005. He has been consulted on all the
strategically important subjects (e.g. ring-fenced
strategic changes to R&D made during this year.
funding for a PhD studentship in the Skeletal
Professor Marsh is an internationally recognised
Neoplasm programme and short-term clinical research
academic clinician with special interest in fracture
posts).
28 Education
Clinical Trials 29
The ARB also agreed to form 5 joint research
Clinical Trials
programmes:
The Trust continues to expand its portfolio of clinical trials and is currently involved in studies investigating
● Skeletal Neoplasia
medicinal
products
for
osteoporosis,
knee
osteoarthritis, chronic spinal injured patients and ● Musculoskeletal repair and regeneration
MRSA.
● Prosthesis design and tissue integration
We have now trained over 100 surgeons in the technique of cartilage transplantation which repairs
● Quality of independent living – Neuromuscular
damaged cartilage, usually following a sporting injury; to date over 300 patients have now been treated using
● Quality of independent living – Musculoskeletal
this technique and will be monitored over a two year period to evaluate the outcome. The outcomes
Education
forming this study will provide NICE with information
The Trust continues to provide a range of courses
that will be important in determining whether this
aimed at orthopaedic surgeons in training.
technique should be provided routinely by the NHS.
Following the success of our first Anaesthetic and
The Trust is also in the process of establishing a
Critical
dedicated Clinical Trials Centre in partnership with
Care
Jamboree,
aimed
at
Consultant
Anaesthetists and trainees, we plan to hold a similar event in the autumn of 2005. We are also holding additional courses for Physiotherapists specialising in the treatment of the shoulder and will be hosting a national conference on children’s bone disease in early 2006.
University College London and Biomedica.
The second Buttercup Walk on June 27th was a huge success with more than 300 patients and their families taking part.
This year, RNOH patient and Eastenders’ Phil Mitchell (Steve McFadden), came along to lend his support to the event. Steve spent many hours signing autographs and chatting to fans during the day.
Sylvester McCoy, better known as Dr Who, also took part, having recently undergone treatment at the RNOH.
The fantasic sum of over £30,000 was raised by walkers and donors. This was matched only by the good weather and enjoyment for all the family on the stalls and rides.
The Buttercup Walk continues to go from strength to strength.
Events 31
Events at the Royal National Orthopaedic Hospital
Staff at the Royal National Orthopaedic Hospital (RNOH) in Stanmore were once again celebrating their success after picking up another award for their revolutionary ‘bionic bone’ for children with bone cancer.
Orthopaedic Surgeon Mr Tim Briggs and Research Scientist Jay Meswania from Biomedical Engineering at Stanmore accepted the National Health and Health & Social Care Award
Social Care Award for the Best Innovative Device at a ‘NHS Live, in
for Growing Prosthesis
Docklands on Wednesday 7 July 2004. Presenting them with the award was
at ‘NHS Live’
top TV celebrity Carol Smillie, Secretary of State for Health John Reid and Director of Research and Development for the NHS, Professor Sally Davies.
The Awards recognise some of the best examples of dedication and personal commitment in health and social care across the UK and celebrate the achievements of the staff who work each and every day in the service of other people.
32
RNOH in the News
Finances 33
Financial Statements
The Trust's Finances and Summary Financial Statements 2004/05 RNOH Trust Board - 2004/2005
Mr Donald Hoodless OBE
Mr Jonathan Tymms
Mr Tim Briggs
Chairman
Director of Finance
Joint Medical Director
Andrew Woodhead
Mr Mark Vaughan
Professor Martin Ferguson-Pell
Chief Executive Officer
Director of HR & Corporate Affairs
Director of Research and Development
Mr Morton Creeger
Mr Eric Fehily
Co Vice Chairman
Director of Projects
Ms Dee Hackett Director of Operations
Mrs Stecia Laddie
Mr Anthony Palmer
Co Vice Chairman
Director of Nursing
(Left October 2004) Mark Masters
Professor David Delpy
Mrs Sheila Puckett
Non Executive Director
Director of Service Improvement (From Feb 2004)
Mr Jagdish Rajput MBE Non Executive Director
Dr Saroj Patel Director of IM & T
Mr Michael Cohen
(From March 2005)
Non Executive Director Dr Steve Herman Mrs Lesley Perkin Director of Operations (From November 2004)
Joint Medical Director
Director of Estates and Facilities
34 Finances
Director Interests
Better Payment Practice Code
No Director or key senior staff has reported any
The Better Payment Practice Code requires the Trust to
interests that are likely to conflict with their role of
aim to pay all valid non-NHS invoices by the due date,
conducting the business of the Trust. During the year,
or within 30 days of receipt of goods or valid invoice,
no Director or Senior Manager or parties related to
whichever is the later. Details of compliance with the
them has undertaken any material transactions with
code are given on page 43.
the Trust. Audit Appointment of the Trust’s Directors
The Trust’s external auditors are PKF (UK) LLP, who
The appointment of the Chief Executive is by a panel
were appointed by the Audit Commission on a
comprising the Chairman, Medical Director, and the
five-year term, beginning in November 2002.
Chief Executives of Barnet PCT and North Central London Strategic Health Authority. The appointment is
The Trust did not engage PKF (UK) LLP to undertake any
open-ended. Appointments of other Executive
work other than that specified by the Audit Commission
Directors are by the Board of Directors.
in 2004/05.
Remuneration of Senior Managers
In accordance with the Audit Commission's Code of
The Remuneration Committee, in line with NHS
Audit Practice, PKF (UK) LLP have communicated to
guidance, determines remuneration and terms of
those charged with governance (the Audit Committee)
service for the Chief Executive, other Executive
that: they are not aware of any relationships that may
Directors and other Senior Managers. The Chairman
bear on the independence and objectivity of the audit
chairs the Committee and the remaining membership
engagement partner and audit staff which are
is all the Non-Executive Directors. Remuneration of the
required to be disclosed under Section 610.3 of the
Chairman and Non-Executive Directors is determined
Statements of Auditing Standards; and that they have
by the Secretary of State for Health.
complied with the Audit Commission’s requirements in relation to independence and objectivity.
Full details of Senior Managers’ remuneration are given on pages 41 and 42. Details of management and
The cost of the work performed by PKF (UK) LLP in
administration costs are given on page 43.
2004/05 was £140,000.
Finances 35
The Trust has an Audit Committee whose purpose is to
described elsewhere in this report. Our current site
make sure that the Trust’s financial and management
configuration contributes to expenditure pressures and
systems and controls are working effectively. In order
requires the commitment of nearly all the Trust’s
to ensure the Committee’s independence and
capital expenditure. The Trust had achieved Income
objectivity, its members are drawn exclusively from the
and Expenditure breakeven or surplus in the previous
Trust’s Non-Executive Directors.
four years but this year financial challenges resulted in a deficit at the end of the year.
Mr J Rajput chairs the Committee, and the other members who have served during the year are Mr M
The Trust continues to strive for a strong and robust
Creeger and Mrs S Laddie. It meets four times a year.
financial foundation upon which to build its future development and success. We will continue to work
Statement of Internal Control
on ensuring that the Payment by Results funding
The Trust's Statement of Internal Control explains the
regime recognises the complexity of the work that we
Trust's system of internal control. The full Statement,
do. We will also look to continue to ensure our
signed by the Chief Executive, is included in the
redevelopment proposals secure the long-term benefit
Annual Accounts, available from the Communications
of operating within a financially stable environment.
Department.
This will ultimately ensure that we make the best possible use of the resources that we attract for the
The Trust’s Financial Statements 2004/05
care of our patients, teaching and research.
Like many NHS organisations, the RNOH operates within a challenging financial environment. In
This will be a major focus of the year ahead and beyond.
particular, at this Trust there are two factors that drive many of the financial challenges we face. Firstly, there is the new NHS funding regime, Payment by Results,
Andrew Woodhead
under which a standard tariff is used to reimburse the
Chief Executive Officer
cost of patient care. The RNOH continues to deliver complex, high-cost specialist work whilst this funding regime fully develops. Secondly, there is the need to
Jonathan Tymms
redevelop our estate and facilities, plans for which are
Director of Finance
36 Finances
Independent Auditors’ Report to the Directors of
Board for use in the United Kingdom.
the Royal National Orthopaedic Hospital NHS Trust on the Summary Financial Statements
Opinion In our opinion the Summary Financial Statements are
We have examined the Summary Financial Statements
consistent with the Statutory Financial Statements of
set out on pages 37 to 43. This report is made solely to
the Trust for the year ended 31 March 2005 on which
the Board of the Royal National Orthopaedic Hospital
we have issued an unqualified opinion.
NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set
We have not considered the effects of any events
out in paragraph 54 of the Statement of Responsibilities
between the date on which we signed our report on
of Auditors and of Audited Bodies, prepared by the
the Statutory Financial Statements (10th August 2005)
Audit Commission.
and the date of this statement.
Respective responsibilities of Directors and Auditors The directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the Summary Financial Statements
Signature:
Date: 09/09/05
with the Statutory Financial Statements. PKF (UK) LLP, We also read the other information contained in the
Farringdon Place,
Annual Report and consider the implications for our
20 Farringdon Road,
report if we become aware of any misstatements or
London EC1M 3AP.
material inconsistencies with the Summary Financial Statements.
The Trust’s Financial Statements 2004/05 The financial information presented in the Summary
Basis of opinion
Financial Statements is a summary of the Trust’s full
We conducted our work in accordance with Bulletin
Annual Accounts. These are available on demand from
1999/6 ‘The auditor’s statement on the Summary
the Communications Department at the address given
Financial Statements’ issued by the Auditing Practices
inside the back cover of this Report.
Income and Expenditure for the year ended 31st March 2005 Title37 1
2004/05
2003/04 (As restated)
£000
£000
53,117
51,400
8,161
8,294
(63,698)
(58,690)
OPERATING (DEFICIT)/SURPLUS
(2,420)
1,004
(DEFICIT)/SURPLUS BEFORE INTEREST
(2,420)
1,004
62
49
(19)
(20)
(DEFICIT)/SURPLUS FOR THE FINANCIAL YEAR
(2,377)
1,033
Public Dividend Capital dividends payable
(1,416)
(1,033)
RETAINED (DEFICIT)/SURPLUS FOR THE YEAR
(3,793)
0
Income from activities
Other operating income
Operating expenses
Interest receivable Other finance costs - unwinding of discount
38 Balance Sheet as at 31st March 2005
31 March 2005
31 March 2004
£000
£000
72,913
58,057
72,913
58,057
Stocks and work in progress
1,827
1,183
Debtors
5,790
5,867
362
341
7,979
7,391
(10,224)
(6,261)
NET CURRENT (LIABILITIES)/ASSETS
(2,245)
1,130
TOTAL ASSETS LESS CURRENT LIABILITIES
70,668
59,187
(926)
(982)
69,742
58,205
Public dividend capital
38,439
39,863
Revaluation reserve
27,326
13,137
Donated asset reserve
10,148
7,663
Government grant reserve
0
0
Other reserves
0
0
Income and expenditure reserve
(6,171)
(2,458)
TOTAL TAXPAYERS EQUITY
69,742
58,205
FIXED ASSETS Tangible assets
CURRENT ASSETS
Cash at bank and in hand
CREDITORS: Amounts falling due within one year
PROVISIONS FOR LIABILITIES AND CHARGES
TOTAL ASSETS EMPLOYED
FINANCED BY:
TAXPAYERS' EQUITY
Statement of Total Recognised Gains and Losses for the year ended 31st March 2005 Title39 1
(Deficit)/surplus for the financial year
2004/05
2003/04
£000
£000
(2,377)
1,033
(1,658)
0
18,669
4,580
0
8
(257)
(238)
14,377
5,383
before dividend payments
Fixed asset impairment losses
Unrealised surplus on fixed asset revaluations/indexation
Increases in the donated asset and government grant reserve due to receipt of donated and government grant financed assets
Reductions in the donated asset and government grant reserve due to the depreciation, impairment and disposal of donated and government grant financed assets
Total gains and losses recognised in the financial year
40 Cash Flow Statement for the year ended 31st March 2005
31 March 2005
31 March 2004
£000
£000
3,918
(1,577)
62
49
62
49
Payments to acquire tangible fixed assets
(1,123)
(1,754)
Net cash outflow from capital expenditure
(1,123)
(1,754)
DIVIDENDS PAID
(1,416)
(1,033)
1,441
(4,315)
0
0
1,441
(4,315)
2,600
4,336
Public dividend capital repaid (not previously accrued)
(4,024)
0
Net cash (outflow)/inflow from financing
(1,424)
4,336
17
21
OPERATING ACTIVITIES Net cash inflow/(outflow) from operating activities
RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: Interest received
Net cash inflow from returns on investments and servicing of finance
CAPITAL EXPENDITURE
Net cash inflow/(outflow) before management of liquid resources and financing
MANAGEMENT OF LIQUID RESOURCES Net cash inflow/(outflow) from management of liquid resources Net cash inflow/(outflow) before financing
FINANCING Public dividend capital received
Increase in cash
Total Accrued Pension at age 60 at 31 March 2005 (bands of £5000)
£000
£000
£000
£000
Benefits in Kind (Rounded to the nearest £100)
Real Increase in pension at age 60 (bands of £2500)
Title
Other Remuneration (bands of £5000)
Name
Salary (bands of £5000)
Salary and Pension Entitlements of Senior Managers 2004/05 Title41 1
D Hoodless
Chairman
A Woodhead
Chief Executive
M Masters
Director of Estates & Facilities
70-75
7.5-10
40-45
J Tymms
Director of Finance
70-75
0-2.5
40-45
5,300
M Vaughan
Director of Human Resources
70-75
5-7.5
55-60
3,300
S Patel
Director of IM & T
5-10
A Palmer
Director of Nursing
75-80
10-12.5
75-80
L Perkin
Director of Operations (from Nov '04)
30-35
7.5-10
35-40
Director of Operations (to Oct '04)
35-40
10-12.5
65-70
Director of Projects
75-80
5-7.5
35-40
M Ferguson-Pell Director of Research
10-15
0-2.5
0-5
S Herman
Joint Medical Director
15-20
T Briggs
Joint Medical Director
25-30
20-22.5
135-140
S Puckett
Director of Service Improvement
J Rajput
Non-Executive Director
5-10
S Laddie
Non-Executive Director
5-10
D Delpy
Non-Executive Director
5-10
M Creeger
Non-Executive Director
5-10
M Cohen
Non-Executive Director
5-10
D Hackett E Fehily
20-25 105-110
2.5-5
115-120
20-25
135-140 55-60
The benefits in kind in all cases are leased cars made available for personal use.
5-7.5
3,700
20-25
Chairman
15-20
A Woodhead
Chief Executive (from June 2003)
80-85
0-2.5
25-30
Director of Corporate Development (to October 2003)
40-45
2.5-5
15-20
Director of Estates & Facilities (from December 2003)
15-20
0-2.5
0-5
J Tymms
Director of Finance IM & T
65-70
0-2.5
15-20
4,900
M Vaughan
Director of Human Resources
65-70
0-2.5
10-15
3,400
A Palmer
Director of Nursing
65-70
0-2.5
15-20
D Hackett
Director of Operations (from December 2003)
25-30
*
*
Director of Operations and Acting Chief Executive (to September 2003)
35-40
(2.5-5)
5-10
Director of Projects
65-70
0-2.5
5-10
M Ferguson-Pell Director of Research
10-15
0-2.5
0-5
S Herman
Joint Medical Director
10-15
0-2.5
0-5
T Briggs
Joint Medical Director
15-20
5-7.5
30-35
S Puckett
Director of Service Improvement (from February 2004)
5-10
0-2.5
0-5
J Rajput
Non-Executive Director
5-10
J Lammiman
Non-Executive Director (to November 2003)
0-5
S Laddie
Non-Executive Director
5-10
D Delpy
Non-Executive Director
5-10
M Creeger
Non-Executive Director
5-10
M Cohen
Non-Executive Director (from December 2003)
0-5
P Shelton
M Masters
N Griffiths
E Fehily
95-100
*Consent to disclose withheld
The benefits in kind in all cases are leased cars made available for personal use.
Benefits in Kind (Rounded to the nearest £100)
Total Accrued Pension at age 60 at 31 March 2005 (bands of £5000)
D Hoodless
Other Remuneration (bands of £5000)
Title
Salary (bands of £5000)
Name
Real Increase in pension at age 60 (bands of £2500)
42 Salary and Pension Entitlements of Senior Managers 2003/04
1,100
3,300
1,200
Management Costs 43
2004/05
2003/04
£000
£000
3,135
2,757
61,278
59,694
2004/05
2004/05
Number
£000
Total bills paid in the year
18,426
23,466
Total bills paid within target
10,904
12,727
59.00%
54.00%
Management Costs Income
Better Payment Practice Code - measure of compliance
Percentage of bills paid within target
Feedback and Further Information For further information and for a full copy of the Trust’s Financial Accounts please contact the Communications Department:
Communications Department Royal National Orthopaedic Hospital NHS Trust Brockley Hill Stanmore Middlesex HA7 4LP
Tel: 020 8909 5570 Email:
[email protected]
Published, designed and produced by the RNOH Communications
www.rnoh.nhs.uk
Department
Royal National Orthopaedic Hospital NHS Trust
Telephone 020 8909 5570 Email:
[email protected]
Brockley Hill Stanmore Middlesex HA7 4LP
www.rnoh.nhs.uk
