Contents page
Introduction 3
A starting point 5
Respecting others’ beliefs 6
Everyone has rights 8
What is Mersey Care NHS Trust? 11
Service development 12
Equality, diversity and human rights 19
Complaints 23
Making experiences count 24
Finance Director’s report 29
The Trust Board 33
Senior Manager’s remuneration report 35
Performance information 38
Independent Auditor’s report 46
Summary financial statements 47
Acknowledgements and references 51
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Beatrice
Fraenkel
Alan
Introduction Yates
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Gary Hibbert
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A starting point…
The World Health staff experiences
reflecting the core
Organization says that people human rights values
with mental health problems of fairness, respect,
equality, dignity and
are exposed to a wide range autonomy – the
of human rights violations. FREDA principles.”
Its Mental Health and Human Rights Project Mersey Care is one of
concludes the consequences of such five NHS trusts
discrimination and stigma can “impact on a working with the
person’s ability to gain access to Department of Health
appropriate care, to integrate into society, and British Institute of
and to recover from illness.” Human Rights on the
Human Rights in Healthcare project.
Here in the UK, human rights in public The learning from this project has been
services is often seen as an issue for the incorporated in the latest edition of
legal department, according to a report by Human Rights in Healthcare – A
the Department of Health (October 2008). framework for local action, which aims
But not so in Mersey Care… to show how a human rights-based
The Human Rights in Healthcare report approach can be of practical value to
makes the point that everyone in the UK organisations and individuals.
comes into contact with the NHS at some This role has enabled the Trust to learn
point in their lives, usually when they are at more about human rights and how they
their most vulnerable. Therefore it is can be applied in healthcare. It has piloted
essential that human rights are taken into new approaches to the way the NHS works
account when delivering services to ensure with people with learning disabilities – one
quality care. of the groups that are most at risk of
Director, service users and carers Lindsey having their human rights infringed.
Dyer explained: “Put simply, a lack of Mersey Care gave evidence to Parliament’s
understanding and respect for people’s Joint Committee on Human Rights stating:
human rights is bad for their health. “We have taken the view that service users
“That’s why Mersey Care decided a long and carers across the whole of the Trust,
time ago to put human rights at the heart including people with learning disabilities,
of the way it provides its services. The have the right to be involved in decisions
starting point was to involve the people that affect them.” In its report A Life Like
who use our services in everything we do. Any Other? Human Rights of Adults with
Learning Disabilities (2008), the Joint
“This was to ensure the way our services Committee responded: “This is the kind of
are designed and delivered will be better institutional respect for human rights which
for everyone, with service user, carer and we have been calling for.”
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Lee Kane
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Listening to patients
Due to the very nature of its For the past 12 months a group of 10
patients at Ashworth Hospital have been
high secure environment helping staff in the rehabilitation and
Ashworth Hospital is often social care service make an audio-visual
presentation now being screened to new
shrouded in mystery and a staff within the high secure service.
lack of understanding by the Called “A Typical Day”, the 23-minute
digital display gives a unique perspective on
wider community. hospital life using recordings by patients
The idea that people detained there, and carers combined with scrolling still
many of whom have committed serious pictures of its facilities.
crimes, can be treated with the same Patients describe everything from wake up
underlying FREDA principles as other NHS times, meal breaks, patient movements
patients may seem incongruous to some within the secure area, visits to education
members of the public. But not to those classes, recreational and therapeutic
who work there… activities, the primary care health centre, as
For many patients arriving at Ashworth well as visiting sessions and social events.
Hospital for the first time their perception Rehabilitation service team leader George
of fairness, respect, equality, dignity and Davies, who helped coordinate the project
autonomy have been fixed by extremes of with Tracy Wilkins, said: “This is the
life experiences and state of mind. patients’ interpretation of their way of life –
There are around 36 patients admitted not ours.
each year, staying for an average of seven “When we originally discussed the project
years, although each case is individual and with patients they were reluctant and
some stay longer. An admissions unit unsure, but over the year more and more
carries out initial treatment while the people got involved and their enthusiasm
patient undergoes a thorough assessment. comes out in the production.
A longer term care plan is drawn up and
the patient moved onto one of 15 wards “The result is a more interactive version
providing a total of 228 beds. of life at Ashworth told by patients in
their own words. There is also quite a bit of
One way which marks out the Trust’s humour in it, which all involved felt
rights-based approach to involving the was important, as generally staff and
people who use its services is the way patients have a good rapport based on
it introduces new staff to the work of a mutual respect.
the Trust.
“We gave patients the opportunity of an
This begins at the interview stage – more equal say on the content and it adds
than 2,500 Mersey Care staff have been realism to a worthwhile project which will
interviewed for jobs by a panel including hopefully benefit all involved.”
service users and carers since the process
began several years ago. Ashworth Hospital is commissioning a
professional film in 2009 to be viewed by
Moving on to the Trust’s corporate carers of newly admitted patients – the
induction for all new employees, service involvement of patients in “A Typical Day”
user and carer representatives talk about will prove invaluable experience.
their experiences in an effort to raise
awareness, aid understanding and tackle
stigma. As it is not physically possible for
high secure patients to participate in this
process a way has been found to involve
them too.
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Garry Kinsey
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Mersey Care is one of only three trusts of Mersey Care is committed to campaigning
its kind in the country – it provides for better services, improving the outcomes
specialist mental health and learning for its service users and their carers, and
disability services for adults in Liverpool, combating the stigma around mental illness
Sefton and Kirkby, a population of around and learning disability.
one million people.
During the year it ran a number of local and
It has a wider role too, offering medium regional campaigns aimed at raising
secure services for Merseyside and awareness, including the ‘Get Clean’
Cheshire, and high secure services covering campaign to encourage people into a fast-
England and Wales at Ashworth Hospital. track community drug programme, and
successful World Mental Health Day events
Mersey Care also provides a number of
with Everton In The Community (now called
community and in-patient addiction services
the Everton Foundation) and the Homeless
for a wide catchment area, for instance
Outreach Team.
outreach alcohol clinics extending to St
Helens; and residential drug detoxification SOME FACTS
for clients from Liverpool, Knowsley, Sefton,
Mersey Care:
St Helens, Blackpool and Preston – a service
assessed recently as “good” by the • Typically provides care, treatment and
Healthcare Commission and the National support to more than 21,200 service
Treatment Agency. users a year
Using its specialist knowledge and • Is dispersed across some 61 sites both of
experience led to the launch of Alcohol its own and premises rented from others
Services Knowsley (ASK) in April 2008,
• Has around 700 in-patient beds on 13
providing community-based alcohol
sites
treatment for hazardous, harmful
and moderately dependent drinkers • Makes 45,000 outpatient attendances
in Knowsley. and contacts
Meanwhile, the contracts for primary care • Has 18,000 day hospital attendances
mental health psychological interventions
• Serves a population of one million for
offered to GP surgeries in Liverpool and
Liverpool, Sefton and Kirkby for
Sefton moved to another NHS provider.
community and secondary care and more
The Trust, first established in 2001, has for specialist secure services.
around 5,400 staff and an income of £196
Mersey Care provides:
million a year. This budget, an increase of
£6 million on the previous year, enabled the • Adult mental health services
Trust to continue to develop new services
• Older people’s mental health services
including ASK, crisis resolution home
treatment, and assertive outreach teams. • Learning disability services
The year also saw the opening of • Addiction services
Liverpool’s first Psychiatric Intensive Care
• Psychological services
Unit, offering an eight-bed in-patient
facility for men whose levels of mental • Mersey forensic psychiatry services
distress are so acute that they need
• High secure services.
intensive care. Previously patients needing
such intensive care were sent out of the
area and into private sector establishments.
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SERVICE DEVELOPMENT
Mersey Care continued to build on its Being the place people want to work to
achievements of the previous year with attract, support and develop a high
significant improvements in 2008-2009 and quality workforce
future developments in the pipeline.
• Mersey Care hosted a seminar on ‘Secure
The Trust plans to introduce Clinical Services for Women’ as part of a series of
Business Units during 2009-2010 with the events organised by the North West
intention of maintaining standards of Forensic Academic Network. The event,
clinical excellence, whilst providing cost- held at indigo, Maghull, included a talk
effective services that are more readily able by guest speaker Karen Newbigging, joint
to respond to business opportunities. leader for the national programme for
gender equality and women’s mental
Examples of significant progress
health within the Care Services
madeduring 2008-2009 are highlighted
Improvement Partnership (CSIP).
below under our strategic aims:
• The Trust celebrated the graduation of
Involving service users and carers, in
the first 15 assistant practitioners, who
their own care and all aspects of the
completed a foundation degree in
Trust, to focus the work of the Trust on
Assisting Professional Practice (Mental
the need of service users and carers at
Health). The Trust welcomed colleagues
all times
from NHS North West and Edge Hill
• A pilot survey among Crisis Resolution University to the graduation ceremony
Home Treatment service users was held at the Maghull site.
launched to help ensure services are
• The Knowledge and Library Services had
tailored to the needs of the local
the official opening of the new Rathbone
community and that resources are
Learning Suite, serving to further
targeted effectively and efficiently.
strengthen the links between the Trust
• Building on a successful initiative to and the University of Liverpool, a key
involve service users and carers in partner in the bid for the redevelopment
reviewing adverse incidents, the Trust’s of the suite.
Complaints Management Team worked
• A world leader in Neuro-rehabilitation
with the Director, service users and carers
praised the work of Ashworth Hospital’s
to extend their involvement to include the
Centre for Cognitive Rehabilitation.
investigation of complaints.
Professor Gordon Muir said “The centre
• Mersey Care’s Initiative to involve service was very impressive and the skills
users and carers in a wide range of developed transferable worldwide”.
activities was highlighted as an example
• Twenty six staff from Boothroyd ward on
of good practice in the Royal Colleague
the Southport General Infirmary site were
of Psychiatrists’ three-year Fair Deal for
the first in the Trust to complete a six
Mental Health campaign launched in
week course in person-centred dementia.
July 2008.
They were joined by services users and
• The independent patient advocacy service carers when receiving their awards.
at Ashworth Hospital, now provided by
• Fifteen Band 3 staff started a pioneering
the charity Together: Working for
training programme designed to enhance
Wellbeing, celebrated a successful year at
their roles working with patients with a
its annual review. Presentations outlined
wide range of mental health problems.
the team’s activity over the year and the
The course was devised in partnership
outcomes of the positive patient
with the practice development team in
satisfaction survey completed by service
high secure services and Liverpool John
users, staff and commissioners.
Moores University.
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Michael Dwerryhouse
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Carol’s story…
Carol Legge is proud
of the terraced house
where she lives.
She is supported by professional carers
who ensure she can manage as
independently as possible within the
community and with the least level of
control or interference in what is, after all,
her life. “Things are much better now. One of the
big things I’m really pleased I can do
But Carol, who is a service user with
myself is my medication. Years ago they’d
learning disabilities, sadly remembers this
never have let me do that and I’d always
was not always the case. It’s a past she
have staff watching me.
does not like to dwell on, but has come to
understand there is a major difference in “I’m all right now, but I used to be bad
the way her needs are addressed now, as tempered and run off and the police
opposed to 10, 20 or more years ago. would bring me back. Staff didn’t
understand how I felt and it made me so
“I feel much happier about my life. I’ve
angry; I’d get so upset they’d have to
been living in this supported house now
restrain me so I didn’t hurt myself.
for three or four years. The carers who stay
with me are great; they really help and “Things couldn’t be more different now.
take me out. I go horse riding once a When I wake up in my house the staff give
week – Queenie is my favourite; I’ve loved me some space to come around, and
horses since I was little and I’m really because of that I’m usually chirpy, so that
good with them.” shows they treat me with respect.
When she was an in-patient Carol says she “I’m planning my 40th birthday party – I’m
would not have enjoyed such freedoms. going to have a big limo and wave to
Mersey Care’s learning disability service everyone as we drive along.”
has been working closely with Carol and
Carol’s views have been vital in not just
other agencies that support her to ensure
helping Mersey Care support her, but
a rights-based approach addresses her
other individuals too.
needs. This has given Carol the autonomy
to live, with appropriate support, the way A core group of staff from the learning
she chooses, which is her human right. disability service and wider Trust has
directly involved Carol and other service
users in drawing up a framework and
toolkit which could help other health and
social care organisations nationally
understand and implement a human
rights-based approach.
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Carol Legge
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Tommy Jackson
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The Trust continued its The Equality and Human Rights Team is
developing the integration of the human
commitment to Equality, rights-based approach into the clinical
Diversity and Human Rights areas of the Trust. This has commenced
with the inclusion of the Human Rights Act
and is due to produce its into training, covering subjects such as The
second Single Equality Mental Health Act and Control and
Restraint/Personal Safety Training.
Scheme in 2009.
The Senior Leadership Team also
The scheme will include human rights and undertook human rights training from the
will detail the Trust responses and actions British Institute of Human Rights and
to legal requirements, best practice and training has been provided to service users
advice on how it will continue to establish and carers, around Equality, Human Rights
value-based services. and Equality Impact Assessment.
To prepare for this a comprehensive Mersey Care involves service users and
training programme was completed to carers in ensuring it meets its own values
ensure that the Quality Impact Assessment and standards in respect of Equality and
(QIA) process is intrinsic within both policy Human Rights.
and service development and measures are Stonewall and Disability Employment
being taken to ensure that this continues. Benchmarking establishes the Trust’s
The annual staff survey report continues to positioning in relation to the standards
show the Trust is effective in the provision maintained by others and to develop an
of training in equality. Mersey Care has action plan to ensure that it improves its
developed the training around the provisions for staff. The Trust continued to
Knowledge and Skills Framework (KSF), meet the standards required to be a ‘Two
with the initial programme focusing on Tick’ employer, a national standard for
primary sessions for KSF levels 1 and 2 employing disabled people.
which impacts on the largest staff groups. Our aim for the coming year is to ensure
A secondary training session based around that equality and human rights continue to
KSF level 3 has also been re-launched. be fundamental to the way we provide
The Trust continued to arrange further services and support staff.
training opportunities to assist staff in
understanding the experiences, needs and
rights of both other employees and people
who use our services.
Human Rights are a key objective for
Mersey Care. The Trust completed the
second phase of the project with the
Department of Health and the British
Institute for Human Rights.
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ENVIRONMENTAL ISSUES
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EMERGENCY PLANNING
During 2008 - 2009 the Trust Board approved a new Major Incident Plan which is fully
compliant with the requirements of the NHS Emergency Planning Guidance 2005 and all
associated guidance.
To complement this and to test the effectiveness of plans Mersey Care facilitated two
major incident exercises, exercise Archie and exercise Ruby. It also participated in exercise
Rising Tide, a Merseyside-wide exercise assessing the effects of an outbreak of
pandemic influenza.
Under the direction of the Executive Director for Nursing and Care, the executive lead for
emergency planning, an Emergency Planning Forum was established in April 2008 and
has continued to meet regularly throughout the year. The Forum is charged with the
responsibility for reviewing and assessing the results from major incident exercises and
ensuring that identified weaknesses are rectified and recommendations for
improvements are implemented. The Forum also has responsibility for testing the major
incident plan, the service business continuity plans and driving forward the emergency
planning agenda across the Trust.
RISK MANAGEMENT
The primary purpose of risk management The Trust Board approved a revised Risk
is to enable individuals and the Trust to Management Strategy which provides the
deal competently with all key risks, Trust with clear direction regarding the
clinical and non-clinical, thereby providing management of risk at all levels of the
more confidence that the Trust will organisation. This document was amended
achieve its objectives. to include specific detail of:
To meet the requirements of the • The revised committee structure now in
Statement on Internal Control the Trust place to manage risk.
Board is required to have in place:
• The process for Board review of the
• Clear objectives, which provide the organisational risk register and
framework for all the Trust’s activity. assurance framework.
• Structures and risk identification systems • How risk is managed locally.
to manage identified risks to the Trust.
• The explicit duties of key individuals in
• Robust controls for the management of the organisation.
risk.
• The monitoring arrangements to ensure
• Appropriate monitoring and review compliance with the Strategy.
of mechanisms that provide assurance
Mersey Care also received the highest
to the Board that the system of
possible score for its Assurance
risk management across the Trust
Framework. The Head of Internal Audit
is effective.
Opinion determined that, “an assurance
This year the Trust successfully achieved framework has been established which is
Level 1 compliance with the NHS Litigation designed and operating to meet the
Authority Risk Management Standards for requirements of
mental health and learning disability trusts the Statement on Internal control and
and, for the first time, was able to declare provide reasonable assurance that there
full compliance with all of the core is an effective system of internal control
Standards for Better Health. to manage principal risks identified by
the organisation”.
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John’s story…
John is a 45-year-old in- John said:
“Dylan’s one of
patient at the Rathbone the best. I’ve seen
Low Secure Unit for men him quite a few times
before but never at the Arena.
with severe and enduring It was great being there.”
mental health problems. Roy commented: “This has opened it
up for John and he has proved that
Before he became unwell John enjoyed he can do it. It’s good for him and
many rock concerts, but when his all- good for the other patients too. It
time favourite singer-songwriter Bob shows we do listen to them and
Dylan announced he was performing in respect their needs.”
Liverpool John didn’t think he was well
enough to go. The Low Secure Unit is one of a new
generation of mental health units
John’s social care worker Roy Broad providing spacious and therapeutic
explained: “It took a lot of planning accommodation that Mersey Care is
and we had terrific co-operation from aspiring to in future proposed facilities.
the staff at the Echo Arena, once we During 2008-2009 the unit continued
explained the situation, but we were to win national accolades over how it
determined that John would not miss involves its service users.
his favourite performer because of
his illness.
“In the run up to the concert we were
able to take John on an advance visit to
the Arena on a number of occasions
and were met by security manager
Jezz Lucket who showed us around
the venue, familiarising us with the
layout of everything we might need
such as toilets.
“It was important to John because he
might otherwise become anxious in the
strange surroundings of this huge
venue and we knew how much this
meant to him.
“As far as we were concerned it was
helping John get better and he should
be able to go and see a concert like this
like anyone else, with appropriate
supervision and care.”
He was escorted to the concert and
met by Arena staff – who even
managed to get Bob Dylan’s autograph
for him!
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COMPLAINTS
Trust-wide
The total number of complaints received in Mersey Care in 2008-2009 was 325 with 322 (99%)
responded to within 25 working days or within timescales agreed with the complainant. These
figures included 166 complaints in local services where 164 (99%) were responded to within 25
working days/agreed timescales and 159 in high and medium secure services where 158 (99%) were
responded to within 25 working days/agreed timescales.
Total 166 164 (99%) 159 158 (99%) 325 322 (99%)
An increase in the volume of complaints was experienced from second quarter due to a change in
the reporting mechanism employed by the Trust.
From 5th August 2008 the Trust assumed the role of an ‘Early Adopter Site’ for the Department of
Health’s new complaints policy,‘Making Experiences Count’ and as a result collated and
subsequently reported complaints which had previously been resolved by the individual services.
Healthcare Commission
Three complaints were sent to Healthcare Commission for consideration of Independent Review.
Of these:
Local Services 2* 1 - 1
High Secure 1 1 - -
Services
Totals 3 2 - 1
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Sarah Keen
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Sarah’s story…
Listening to other people and By listening to the
responding to their views is an essential views of young
part of treating everyone with equality, carers like Sarah,
respect and fairness. But one group Mersey Care set out
coming into contact with mental health to create dedicated
services – young carers – felt ignored. visiting areas just for
families.
Helping them voice their needs has been
children’s charity Barnardo’s, which Sarah added:
through its Action for Young Carers “When that first
project has been working in partnership family room was
with Mersey Care to ensure their rights, opened we decided
and the rights of their family members, to ‘test it’ and gave it
are respected. our own Jellybaby
seal of approval – the
Taking a human rights-based approach
same thing happens every time a new
Mersey Care recognised that everyone has
one opens.”
a right to a private, family life.
Service director Carol Bernard said: “We’ve
But the experience of children was they
come a long way since the first family
were generally overlooked by health
room was set up at Stoddart House,
professionals. When youngsters were able
Aintree, in 2001.
to visit family members it was on busy in-
patient wards, an environment far from “Thanks to the involvement of Barnardo’s
comforting, private or with dignity for the and the direct feedback from their young
families concerned. carers of the need for safe and
comfortable visiting facilities, we now have
Sarah Keen, now aged 23, was one of the
a network of family rooms in all our adult
first group of young carers to get involved
in-patient units.
eight years ago. She said: “I remember
visiting my mum and asking staff at the “We have also extended them across other
time if there was anywhere we could go to services including brain injury, older
sit and talk privately, but there just wasn’t. people’s, learning disabilities, forensic,
high secure and addiction services.”
“The ward was noisy and I was nervous
having some of the other patients around. During 2008-2009 the partnership
All I wanted was some space and time to between Mersey Care and Barnardo’s has
be with my mum. continued to listen to young carers and
examples of its good practice have been
“When we started talking to Barnardo’s
featured at national conferences, awards
and the Trust started listening to us
and films.
through them, it was just simple things like
a comfortable Working as part of a national pressure
homely room, group, Barnardo’s has persuaded the
somewhere Department of Health to include people
private and with parenting needs on the list of service
with a few users who should be given intensive
toys, that support under the Care Programme
made all the Approach, the care plan framework
difference.” introduced in October 2008.
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The Trust had capital funding of £8.2 million Income (£) 150
available in 2008-2009 and spent £6.5 million
during the financial year. The balance of £1.7
100
million will be carried forward for capital
investment in future years.
50
3 To Operate Within the
External Financing Limit (EFL) 0
2003 2004 2005 2006 2007 2008 2009
The Trust has a duty to hold a maximum cash
balance of £4,011,297 at the end of the year, YEAR Income
which was achieved by the Trust.
4 To Achieve a 3.5% Return on
the Assets Owned by the Trust The level of income the Trust receives has
increased consistently over the last seven
This target was achieved with a 3.7% return years. This is summarised in Graph 1.
on net assets, which is within the Department
of Health’s tolerance of 3% to 4%.
The Trust was able to secure additional
investment that increased the funds available for Chart 1 -Analysis of income
services from £190 million in 2007-2008, to
£195.7 million in 2008-2009. Funds of £4.2
million were made available as a contribution to 4%
inflationary pressures. The balance was used to
support service developments, including: 14%
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EXPENDI TURE
3%
4%
The Trust has used the income it
receives to fund the cost of services
8% provided. The major areas of cost
are summarised in Chart 2.
6% Staff Costs
Clinical supplies
and services
Establishment &
Premises Costs
Other costs
Depreciation and
Amortisation
79%
2500
2000
Number of Staff
0
2006 2007 2008 2009
YEAR
Medical and Nursing Staff Other Clinical Staff Non Clinical Staff
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CAPITAL
The Trust spent £6.5 million on capital schemes during the year. An
analysis of how capital resources have been used is summarised in Table 1.
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Included in Executive
Directors at 31.03.09
Non- Executive
Directors and
Chairman
Co-opted Members
of the Trust Board
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REGISTER OF INTERESTS
Name Job Title Declaration 2008-2009
Mrs Beatrice Fraenkel* Chairman • Liverpool City Councillor
• Chair of Cosmopolitan Housing Association
• Non-executive Director Cosmopolitan Housing Group
• Director, Normal Properties Ltd.
• Chair - Architects Registration Board
• School Governor, The King David High School
• Fellow of the Royal Society of Arts
Mr Steve Hawkins* Chairman • Chief Executive, Local Solutions
Mr Leslie Byrom Non-Executive Director • Local Government Association - (Chairman, Fire Service Management
Committee) (until June 2008)
• Merseyside Fire and Rescue Authority - (group leader) (until June 2008)
• FireBuy Ltd (Ex officio Director) (until June 2008)
• Reserve Forces and Cadets Association - (Board member)
• North West Regional Assembly - (Party leader, Chair of Audit and
Governance Committee) (until June 2008)
• St Johns Ambulance Council for Merseyside - (Board member)
• Sefton MBC - elected member
• Byrom & Thomas Chartered Surveyors - partner
Mr Peter Caswell* Non-Executive Director • Trustee of Phakamisa: Pinetown Methodist Church Mission Trust (UK)
Ms Janette Fiddaman Non-Executive Director • Company Secretary - Davidamoto
Mr Brian Lawlor Non-Executive Director • Chair - Lee Valley Housing Association Ltd.
• Elected Member of Board of Governors, Aintree University
Hospitals NHS Foundation Trust
• Partner - Morecrofts LLP Solicitors
• School Governor - Melling Community School
• Trustee - Royal School for the Blind (Liverpool) Ltd.
• Vice Chairman Marine Football Club
• Director - Rossett Park Land Company Ltd.
• Company Secretary - Northern Premier Football League Ltd.
• Member of the Merseyside and Cheshire Courts Board
Mrs Elizabeth Powell Non-Executive Director • Director, Age Concern Liverpool (Services) Ltd.
Mr Robert Non-Executive Director • Chairman - United Utilities Trust Fund
Michael Shields* • Deputy Chairman - The Manufacturing Institute
• Associate, AMION Consulting Ltd.
• Principal, URC Associates
Mrs Margaret Swinson* Non-Executive Director Nil Return
Mr Neil Willcox Non-Executive Director • Director, Resman Ltd.
Mr Alan Yates Chief Executive • Partner - Head of Speech and Language Therapy Service at
Royal Liverpool and Broadgreen University Hospital
Mr Martin Brown Interim Executive Director Nil Return
of High Secure Services
Mrs Anne Cleminson Trust Secretary Nil Return
Mrs Kim Crowe Executive Director of Service • Non-Executive Director of Furniture Resource Centre Group
Development and Delivery
Mrs Kath Davies Acting Director of Organisational • Director, Tyre and Battery Specialists Ltd.
Development
Mr John Doyle Director, TIME Project Nil Return
Dr David Fearnley Medical Director/ Deputy Nil Return
Chief Executive
Mrs Christine Hughes Director of Corporate Affairs • Magistrate for the City of Liverpool
• Trustee, Netherton Feelgood Factory
Mr Tony Oakman* Executive Director Local Services Nil Return
and Social Care
Mr Neil Smith Executive Director of Finance and Nil Return
Performance
Name *Note
Mrs Beatrice Fraenkel Commenced in post 01/12/08
Mr Steve Hawkins Finished in post 30/11/08
Mr Peter Caswell Finished in post 31/12/08
Mrs Margaret Swinson Finished in post 30/11/08
Mr Robert Michael Shields Commenced in post 01/02/09
Mr Tony Oakman Finished in post 04/01/09
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7.1 Emoluments
2008/09 2007/08
Salary Other Benefits Salary Other Benefits
Remuneration in Kind Remuneration in Kind
Notes:
1 Beatrice Fraenkel was appointed as Chairman on 1st December 2008 and Stephen Hawkins retired as
Chairman on 30th November 2008.
2 Peter Caswell retired as a Non-executive Director on 31st December 2008.
3 Michael Shields was appointed as a Non-executive Director on 1st February 2009.
4 Margaret Swinson retired as a Non-executive Director on 30th November 2008.
5 Tony Oakman, Executive Director of Local Services and Social Care, left the Trust on 4th January 2009.
6 Kath Davies was Acting Director of Organisational Development from 1st June 2008.
7 Martin Brown commenced as Interim Executive Director of High Secure Services on 1st July 2008.
8 Catherine Anne Thompson and Protasia Torkington retired as Non-executive Directors on
30th November 2007.
9 Leslie Byrom and Neil Willcox were appointed as Non-executive Directors on 1st December 2007.
10 Gill Dolan commenced as Director of Strategy and Business Development on 17th April 2006 and left the
Trust on 31st December 2007.
Benefits in kind are the taxable gains on lease cars and home to work expenses.
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Alan Yates - Chief executive 35.0 - 37.5 245 -250 1,361 879 322 0
Kim Crowe - 27.5 - 30.0 140 - 145 715 477 185 0
Executive director of
organisational development
David Fearnley - 5.0 - 7.5 70 - 75 250 179 46 0
Medical director
Tony Oakman - 10.0 - 12.5 115 - 120 538 366 87 0
Executive director of local
services and social care
Neil Smith - 17.5 - 20.0 130 - 135 540 355 123 0
Executive director of finance
and performance
Karen Wilson - 20.0 - 22.5 130 - 135 568 373 130 0
Executive director of nursing
and care
Kath Davies - 22.5 - 25.0 115 - 120 621 357 149 0
Acting director of
organisational development
Martin Brown - 0 0 0 0 0 0
Interim executive director
of high secure services
Gill Dolan - 0 0 0 0 0 0
Director of strategy and
business development
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STAFF SICKNESS
The Trust had a sickness absence target of 5.65% for the year 2008-2009, based on the
average for mental health trusts for the previous year. This was a challenging target and the
out-turn figure for the year was 6.61%. However there were encouraging reductions in staff
absence towards the end of the year e.g. January 6.57%, February 5.99%, March 5.40%.
SNAPSHOT OF PERFORMANCE
Age Group
Source: COM Information Services Exeter ASCT Download 13th November 2008
* MINI 2000 uses two of the Index of Multiple Deprivation scores (IMD) for 1998 together with the Office of National
Statistics (ONS) areas of residence classifications to predict population prevalence of psychiatric hospital admissions.
** High Secure Services cover North West, West Midlands and Wales.
No MINI 2000 scores are available for Wales and so the population has not been weighted.
Source:
The Information Centre for Health & Social Care 2009: Primary Care Organisations
GP Membership Populations
Self-esteem can be very low when people are mentally ill and dignity
may be the only thing they feel they have left. To lose one’s dignity or
not be treated with dignity, I feel, would be the last straw.
SERVICE USER
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Dale Fogg
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Admissions Average
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Mental Health Trusts are required to demonstrate that service users discharged on a CPA are
followed up within 7 days of discharge. During 2008-2009, 94.99% of service users discharged
on a CPA were followed up within 7 days. The chart shows the percentage of service users
followed up within 7 days of discharge against the national target.
Source: Epex, Adult Mental Health Directorate, Older Peoples Service, Forensics service.
The Early Intervention in Psychosis Service works with people aged 16-35 who are experiencing their first
episode of pyschosis or who are showing signs or symptoms of developing an episode of psychosis. The
service has successfully worked to increase the number of people it reaches, and was able to exceed the
Department of Health's target for the number of new service users seen during 2008-2009.
The chart shows the Trust's performance against the Government's target in 2008-2009.
Source: Early Intervention Service
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Episodes DH Target
The Crisis Resolution Home Treatment Service works with people experiencing a crisis in order
to avoid admission to hospital as appropriate. The service co-ordinates admissions to in-patient
beds and facilitates early discharge from hospital. The service has successfully worked to
increase the number of people it reaches, and was able to exceed the Department of Health's
target for the number of episodes of care managed by the Trust during 2008-2009.
The chart shows the Trust's performance against the Government's target in 2008-2009.
Source: Epex
The Assertive Outreach Service works with people who find it difficult to engage with
traditional mental health services. The service has successfully worked to increase the
number of people it reaches, and was able to exceed the Department of Health's target
for the number of service users seen during 2008-2009.
The chart shows the Trust's performance against the Government's target in 2008-2009.
Source: Epex
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Monthly average Cumulative average Mental Health Trust National Average (5.65%)
Staff sickness has decreased during 2008-2009, particularly during the last quarter.
At the end of March 2009, the cumulative sickness rate was 6.61% compared with
6.72% during 2007-2008. The long-term sickness rate across the Trust was 4.16%.
The Trust has implemented a new Management of Attendance Policy from 1st March 2009.
Source: ESR
In 2008-2009 an average of 55 delayed discharges were reported at the end of each month,
compared with 54 during 2007-2008. The average proportion of beds occupied by delayed
discharges in 2008-2009 was 13.11%.
The Trust is working with Commissioners to resolve issues that lead to delays occurring.
Source: Epex
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Directorate Total
Adult Mental Health Acute Services 23,563
Alcohol Treatment Services 1,858
Brain Injuries Rehabilitation Unit 242
Drug Dependency Services 4,998
Forensic (Medium Secure) Services 247
Learning Disability Service 2,069
Older Peoples Services 11,482
Psychotherapy Services 656
Rathbone Rehab Centre 365
Total 45,480
Directorate Total
Adult Mental Health Acute Services 4,551
Older Peoples Services 13,389
Total 17,940
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The High Secure Service operates with wards of a maximum of 20 patients. The wards are split into
two service types; Admission and High Dependency, and Specialist Services to cater for specific
patient needs. The table indicates the number of patients cared for by service type as at 31st March
2009. The repatriation process between the three high secure hospitals is now complete, and
following the retraction process bed numbers have been fixed at 228 during 2008-2009.
Source: PACIS
No. % of No. % of
Destination Patients Discharges Region Patients Population
Medium Secure Unit 56 78.87% Eastern 2 0.75%
High Secure Hospital 8 11.27% London 7 2.61%
Prison 5 7.04% Northern 10 3.73%
Court 1 1.14% North West 126 47.01%
Deceased 1 1.14% South & West 1 0.37%
Total 71 100% South East 1 0.37%
Trent 1 0.37%
During 2008-2009, 71 patients were discharged from High Wales 54 20.15%
Secure Services. The table shows where these patients were West Midlands 63 23.51%
discharged/transferred to. There were a higher number of
discharges than in 2007-2008. The majority of High Secure Yorkshire 3 1.12%
patients discharged during 2008-2009 went to a medium Total 268 100%
secure unit (78.87%). The service has worked hard to
repatriate patients to Broadmoor and Rampton as The table shows the number of patients accessing High
appropriate and in line with modernisation plans. Secure Services in 2008-2009. From the information it can
Source: PACIS and High Secure Service be seen that the majority of patients came from the North
West and West Midlands regions (47.01% and 23.51%
respectively). Source: PACIS
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Julian Farmer
Date: 10th June 2009
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2008/09 2007/08
£000 £000
Unrealised surplus/(deficit) on
fixed asset revaluations/indexation (8,299) 12,724
Total recognised gains and losses for the financial year (741) 20,378
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CAPITAL EXPENDITURE
Payments to acquire tangible fixed assets (8,086) (13,362)
Payments to acquire intangible assets 0 (795)
FINANCING
Public dividend capital received 0 9,563
Public dividend capital repaid 0 (6,318)
Other capital receipts 136 0
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Management costs
2008/09 2007/08
Management costs 11,854 11,252
The Better Payment Practice Code requires the Trust to aim to pay all valid non-NHS invoices
by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.
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2008/2009 2007/2008
£000 £000
FIXED ASSETS
CURRENT ASSETS
CREDITORS:
Amounts falling due within one year (10,592) (12,335)
CREDITORS:
Amounts falling due after more than one year 0 0
FINANCED BY:
TAXPAYERS' EQUITY
Public dividend capital 57,161 57,161
Revaluation reserve 63,596 73,298
Government grant reserve 864 768
Other reserves 59,907 59,907
Income and expenditure reserve 3,946 2,038
The financial statements were approved by the Board on 10th June 2009 and signed on its
behalf by:
Chief Executive
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