Annual Audit Letter - Bebington

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audit 2002/2003 Annual Audit Letter Bebington and West Wirral Primary Care Trust INSIDE THIS REPORT PAGE 2 Summary Report • Introduction • Key messages PAGE 3 • Background to our audit • The purpose of this letter • Audit objectives PAGE 4 • Scope of the Audit • Audit fee • Accounts PAGE 5 • Governance PAGE 8 • Performance management PAGE 11 • Future audit work • Status of our Annual Audit Letter to the PCT • Closing remarks PAGE 12 Appendix 1 • Reports issued during 2002/2003 audit Annual Audit Letter - Bebington.doc – Draft Reference: Version 1 Date: February 2004 audit 2002/2003 SUMMARY REPORT Key messages Introduction The implementation Programme for the NHS Financial standing Plan continues to drive and direct developments within all NHS organisations. The framework of The PCT met all of its key financial targets for targets and milestones within the NHS Plan has 2002/2003. For the current financial year the set the agenda for local action plans for underlying Health Economy deficit of £12.5m 2002/2003 and beyond and the aspiration to has been reduced to £4.6m through the use of meet those targets has continued to be a major short-term initiatives and non-recurring savings. challenge for all organisations within the NHS. However, it is now recognised that there is scarce spare resources within the system and in As part of its strategy, Delivering Improvement these ...

Sujets

• management
• risk management
• managers

Informations

• Publié par: Chiev
• Nombre de lectures: 23
• Langue: English

Extrait

audit2002/2003 Annual Audit Letter

Bebington and West Wirral Primary Care Trust

I N S I D E T H I S R E P O R T

P A G E 2

Summary Report •Introduction •Key messages

P A G E 3 •Background to our audit •The purpose of this letter •Audit objectives

P A G E 4 •Scope of the Audit •Audit fee •Accounts

P A G E 5 •Governance

P A G E 8 •Performance management

P A G E 1 1 •Future audit work •Status of our Annual Audit Letter to the PCT •Closing remarks

P A G E 1 2

Appendix 1 •Reports issued during 2002/2003 audit Reference: Annual Audit Letter - Bebington.doc – Draft Version 1

Date:

February 2004

audit 2002/2003

Introduction

The implementation Programme for the NHS Plan continues to drive and direct developments within all NHS organisations. The framework of targets and milestones within the NHS Plan has set the agenda for local action plans for 2002/2003 and beyond and the aspiration to meet those targets has continued to be a major challenge for all organisations within the NHS.

As part of its strategy,Delivering Improvement Together,the Audit Commission is committed to supporting and commenting on the progress in implementing the NHS Plan. In tandem with this the Audit Commission is committed to reviewing the quality of data that contributes to the Performance Assessment Framework which underpins the NHS Plan.

In the performance section of this Annual Audit Letter we have reported on the Phase II work on the implementation of the NHS Plan.

Our 2003/2004 Phase III reviews of NHS Plan Implementation and Data Quality will focus on the LDP process and related systems as well as assessments against key targets. Linked to this the Audit Commission has chosen to focus this year’s data quality reviews on the data underpinning Reference Costs and HRGs. We have just commenced these pieces of work and will report on them to the Audit Commission and PCT later this year.

The key messages for the audit are highlighted in the letter for the Board’s attention.

We acknowledge that the PCT must continue to work closely with its partners in the local health community to develop appropriate action plans to help address several of the issues raised in this letter.

Annual Audit Letter – Audit 2002/2003

K e y m e s s a g e s

Financial standing

SUMMARY REPORT

The PCT met all of its key financial targets for 2002/2003. For the current financial year the underlying Health Economy deficit of £12.5m has been reduced to £4.6m through the use of short-term initiatives and non-recurring savings. However, it is now recognised that there is scarce spare resources within the system and in these circumstances it will be challenging for the PCT and the broader Health Economy to achieve financial balance for 2003/2004 and beyond. In addition the likely impact of ongoing initiatives in reducing the underlying deficit is not yet clear. Directors will need to review the validity of these initiatives, the extent of any savings that are achieved and initiate appropriate remedial action if necessary.

Performance management

The award of two star status to the PCT is a positive indication of the performance management arrangements that the organisation has in place. Nevertheless, the PCT recognises that the opportunity exists for substantial improvements in a number of key risk areas:

•

•

•

•

•

access to a GP within 24 hours

addressing the maintenance backlog

emergency admission to hospital for children with lower respiratory tract infections

primary care management – acute conditions

timely delivery of community equipment to patients

Given our earlier comments regarding financial standing, Directors will need to consider the extent to which fundamental improvements in the overall performance rating can be achieved without additional cost pressures. In relation to the identified specific risks Directors will need to identify and implement new and innovative ways of addressing these risks within the constraints of existing resources.

Our work around decision implementation, although still ongoing, has highlighted a number

Bebington and West Wirral Primary Care Trust (Draft Version 1) – Page2

of key barriers to success in project implementation at the PCT:

•

•

•

unclear project evaluation and review mechanisms

underestimation of capacity required to deliver projects

poor project accountability and reporting structures

These risks have been recognised and the PCT has identified ways of addressing these issues.

Directors will need to ensure that the barriers to success are neutralised if the PCT is to succeed in implementing the changes required to improve performance management without adding to existing cost pressures.

Corporate governance

Robust and effective governance arrangements are essential for the PCT Board, and in particular non-executive Directors to understand their fundamental role in giving strategic direction to the PCT, in particular driving change to improve financial standing and performance management. The PCT has completed its second annual self-assessment for the three core controls assurance standards. Significant improvement has been made upon the 2001/2002 performance, most especially in terms of Risk Management and Governance suggesting that a greater understanding of roles and responsibilities is starting to develop from the Board level down. Nevertheless, recognises that action is required to secure further improvements in order to meet the target score of 95% for all three of the core standards. Directors should monitor the implementation of agreed action plans to enable compliance with appropriate Department of Health Guidance.

Background to our audit

As a PCT now in its third year Bebington and West Wirral is more established than more recently formed bodies and its management arrangements have had time to evolve and stabilise. Although changes are still being made as experience is gained the focus is increasingly on planning and securing improved health services for the local population.

With the abolition of Health Authorities, and the creation of a Strategic Health Authority and many more PCTs, the NHS environment in which Bebington and West Wirral PCT operates has fundamentally changed. The PCT recognises that it has a key role in improving health services across the wider health community and participates positively in partnerships to achieve its objectives.

Our audit has been designed around this wider perspective and wherever possible we have reflected this in reporting in this letter.

The purpose of this letter

This Annual Audit Letter to the Board summarises the conclusions from our 2002/2003 audit. It also summarises the significant issues arising from our audit, together with our comments on other current issues.

More detail on the specific aspects of our audit can be found in the separate reports we have issued during the year. These reports are discussed and agreed with key officers and presented to the Audit Committee. The reports we have issued are listed at the end of this Letter for information.

Audit objectives

The audit has addressed the requirements of the Code of Audit Practice issued by the Audit Commission. We have adopted a risk based approach to planning and our audit has focused on the significant financial and operational risks that the PCT faces which are relevant to our audit. Central to the audit are the corporate governance arrangements in the PCT. The audit is then structured around the three key elements of our responsibilities, as shown in Exhibit 1 overleaf:

34.5

99.5

24.5

Standards of financial conduct, fraud and corruption

Our audit has addressed the requirements of the Code of Audit Practice and we have worked with the PCT to maximise the benefits of the integrated audit approach. We have reviewed your arrangements for dealing with risks and we have undertaken more detailed work in identified areas of higher audit risk.

34.5

24.5

99.5

£000

Plan 2002/04

The accounts were prepared to an adequate standard. However, the quality of initial working papers in support of the accounts was less than satisfactory but nevertheless papers produced at our request during the audit were adequate. If we are to meet the revised deadlines proposed by the Department of Health for the 2003/2004 financial accounts the PCT will have to achieve significant improvements in the quality of initial working papers that it provides in support of the accounts. We gave an unqualified opinion on the accounts on 31 July 2003.

Audit area

EXHIBIT 1

£000

Statement of Auditing Standard (SAS) 610 ‘Reporting to those charged with governance’ applies to the audit of your accounts for the first time in 2002/2003. The SAS requires auditors to report to those charged with governance (as distinct from management) certain matters before they give an opinion of the financial statements.

Legality of financial transactions Financial standing

Opinion

The proposed fee for our 2002/2004 audit was set out in our audit plan. The table below sets out our latest estimate of the actual fee for 2002/2004 on the basis that work remains in progress.

The Audit Commission has circulated a statement that summarises our key responsibilities as external auditors to all audited bodies. Our audit has been conducted in accordance with the principles set out in that statement. The contents of this letter, and our other reports, should be viewed in the context of that statement.

Systems of internal financial control

We gave an unqualified audit opinion on the PCTs Annual Accounts for 2002/2003.

General

TOTAL CODE OF PRACTICE AUDIT FEE

Accounts

Use of resources

SAS610

158.5

Governance

Performance

Accounts

It should be noted that in order to bring the Audit Commission financial year in line with that of the NHS and Local Government, the current plan covers the period from November 2002 to March 2004. In this time we will deliver two statutory audits and two annual audit letters.

Audit fee

We reported the following matters to the Audit Committee under SAS610 on 18 July 2003.

EXHIBIT 2 THE AUDIT FEE

The three main elements of audit objectives

Anticipated 2002/04

Scope of the Audit

158.5





Revenue resource limit £95.550m

EXHIBIT 3 SAS610 REPORT

The PCT met its financial targets in 2002/2003. For 2003/2004 and beyond Directors will need to take appropriate action to ensure that year-end financial balance is achieved and to address the underlying financial deficit within the Health Economy.

EXHIBIT 4 KEY FINANCIAL TARGETS

£99.993m

Revenue resource limit

EXHIBIT 5 REVENUE RESOURCE LIMITS

£108.879m

Net operating costs £95.447m

Surplus of £103k

Our audit did not identify any weaknesses in accounting and internal control systems other than those that you are already aware of and in respect of which appropriate corrective action is being taken

the contingent liability of £7.009m in Note 18 was overstated by £1.483m

administration costs of £4.076m needed to be included in Note 3.2

Expenditure during the year £21k

£118.128m

Financial standing

Duty to breakeven at the year-end

Capital resource limit £21k

None of the amendments impacted on the key financial targets of the PCT.

Material weaknesses in the accounting and internal control systems identified during the audit

Our views about the qualitative aspects of your accounting practices and financial reporting

All non-trifling errors identified during the course of our audit where amended by management

The 2003/2004 financial year is the first of a three-year allocation package which aims to assist PCTs achieve financial stability by undertaking medium term financial planning through the provision of indicative resource allocations for the 2003/2004 to 2005/2006 period. The base revenue resource limits for the PCT, including capacity monies but excluding non-recurrent funding, are:

Performance

Target

The PCT achieved its key financial targets during 2002/2003 as detailed in Exhibit 4:

We issued an unmodified auditor’s report

Expected modifications to the auditor’s report

Unadjusted misstatements

Issue

Our conclusion

Governance

The Wirral Health Economy forecast an underlying deficit of £12.5m for 2003/2004.





Target met? 

We reported to the Audit Committee a total of 23 errors requiring amendment in the annual accounts all of which where agreed and actioned. There where 3 errors classified as being material:

Over recovery of costs £41k

94% of all bills paid within 30 days

96% of total value of bills paid within 30 days

There are no matters that we wish to draw to your attention

Any other relevant matters.

Pay non-NHS creditors within 30 days of receipt of goods invoice

2004/2005

We have identified no such matters during the course of our audit.

With the exception of the annual report which was not available at the time of audit, we have carefully considered the qualitative aspects of the PCTs accounting practices and financial reporting. No matters have come to our attention that we would wish to draw to the attention of those charged with governance

correct comparative 2001/2002 needed to be included in the accounts

•

Provider full cost recovery

Matters specifically required by other auditing standards to be communicated to those charged with governance

•

•

Financial year

2003/2004

2005/2006

However, through a series of cost saving exercises, the use of spare resources and the receipt of an additional £3m of non-recurring funding as a result of arbitration this forecast deficit has been reduced to £4.6m (as at 31 August 2003) of which £2.3m relates to Bebington and West Wirral PCT

The Health Economy is currently working together to address the remaining deficit of £4.6m. Regular Director of Finance meetings are held with the twin aims of:

•

•

developing a medium term strategy to address the underlying deficit of £12.5m

achieving year-end financial balance across the Health Economy for 2003/2004

The underlying deficit is no longer seen as purely a financial issue and there are two projects ongoing within the Health Economy designed to address the shortfall in resources. The first is a Programme of Service Redesign which seeks to move appropriate patient services out of the hospital setting and into the community. However, initial indications suggest that whilst the implications of this project are cost neutral for 2003/2004 there may be additional costs of up to £2m that would fall to be met in 2004/2005 and 2005/2006. Directors will therefore need to consider the ongoing viability of this project at appropriate intervals.

The second project is centred entirely within Wirral Hospital Trust and is essentially a cost benefit analysis of current baseline activity and costs with a view to identifying the benefits that accrue from additional investment above the baseline. This project has only recently commenced and it is too early to comment upon its impact. In addition all new developments that add to the deficit have been prohibited across the health economy during 2003/2004.

Despite these initiatives it is difficult to see how the PCT, and the broader Health Economy, will address the remaining shortfall in resources in order to achieve a balanced position for 2003/2004, as there is no longer any ‘spare’ capacity within the system.

Legality of financial transactions

There were no significant issues arising.

We have reviewed the Trust’s overall arrangements and are satisfied that the Trust is proactive in addressing legal issues. There are no issues arising which we need to report.

Compliance with core controls assurance standards

The PCT has completed its self-assessments for the three core controls standards. Arrangements have improved for all standards most notably for risk management. Nevertheless, continued action is required to ensure that the required level of compliance is attained across all standards. Directors should closely monitor the implementation of agreed action plans to ensure compliance with Department of Health Guidance by the end of the current financial year.

The PCT is responsible for putting in place arrangements to ensure the proper conduct of its financial affairs and to monitor their adequacy and effectiveness in practice. The key test of these systems of internal control is compliance with the three core controls assurance standards of:

•

•

•

Governance

Financial management

Risk management

The PCT has carried out self-assessments against these three core standards. Internal audit has reviewed and is satisfied with the evidence provided by the PCT to support each criterion scored. The PCT has improved arrangements in respect of all three of the core standard, but most particularly in terms of risk management as demonstrated by the overall scores:

EXHIBIT 6 CONTROLS ASSURANCE SCORES

Standard

Risk management

Governance

Financial management

2001/02 score

31%

59%

88%

2002/03 score

71%

67%

89%

Change

+40%

+8%

+1%

The PCT acknowledges that improvements are still required in all areas in order to meet the target score of 95% and an action plan has been developed to secure necessary improvements as shown below:

EXHIBIT 7 CONTROLS ASSURANCE ACTIONS

Standard

Risk management

Governance

Finance management

Issues for action

The PCT is to undertake further work to:

•

•

evidence and support its risk management training programme

continuously analyse risk and ensure the risk management framework is embedded across the PCT

Internal audit have reported that the key issues for action are:

•

•

Further development and implementation of the assurance framework

Continual update and review of strategic risks across the PCT

As in 2001/2002 the key issue outstanding remains the development and implementation of a financial strategy. The move to three- year indicative resource allocations should facilitate the development of such a strategy

In order to comply with the requirements of the Department of Health’s guidance ‘Governance in the NHS: Statement of Internal Control 2001/2002 and Beyond) and supplementary guidance issued in 2002/2003 the PCT should closely monitor the implementation of the agreed action plan.

Standards of financial conduct/fraud and corruption

Arrangements for the prevention and detection of fraud and corruption have continued to develop throughout 2002/2003. Nevertheless, Directors should continue to monitor the implementation of formal policy and procedures devised by the PCT to safeguard both its assets

and professional reputation. The Audit Commissions National Fraud Initiative (NFI) 2002 has identified a significant number of data matches requiring further investigation and work is currently by the Local Counter Fraud Specialist in this area is currently on-going.

Significant emphasis is placed on the need for a strong anti-fraud culture within NHS bodies. The PCT is responsible for ensuring that it has arrangements in place to ensure proper standards of financial conduct by staff and non- executive directors and to prevent and detect the occurrence of fraud and corruption.

We did not identify any significant concerns in respect of the PCT’s arrangements to prevent and detect fraud and corruption. However, there is scope to secure further improvements in the PCT’s arrangements for the administration of Joint Finance Grants and within its procurement processes.

Joint Finance Grants

The PCT Joint Finance Programme for 2002/2003 shows a total revenue grant aid for the year of £1.66m divided between:

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•

•

•

•

Wirral Metropolitan Borough Council

Wirral and West Cheshire Community NHS Trust

Birkenhead and Wallasey PCT

Bebington and West Wirral PCT

Grant aid to voluntary organisations

The opportunity exists for the PCT to improve and develop arrangements for monitoring and controlling joint finance in an effective and robust manner. Our work identified a number of specific areas where mandatory requirements had not been complied with and where arrangements fell short of suggested good practice.

Our review of this area was reported to the PCT in June this year and an action plan was agreed with management.

Internal Audit

Arrangements are satisfactory

Internal Audit is a vital element of the control environment within any organisation. Our work, therefore, included a review of Internal Audit’s work in 2002/2003 with the objective of:

•

•

assessing whether Internal Audit had met the mandatory standards set out in the NHS Internal Audit Manual

assessing the extent to which we as external auditors can rely on Internal Audit’s testing

We are satisfied from our review that the PCT’s Internal Auditors, Mersey Internal Audit Agency (MIAA), met the mandatory standards and that their work had been carried out to a satisfactory standard. There was wide-ranging coverage of the main financial systems and the key areas vulnerable to fraud and corruption.

National Fraud Initiative

Every two years the Audit Commission undertakes the National Fraud Initiative (NFI) which is a data matching exercise undertaken nationally. The NHS was included within this exercise for the first time in 2002 and the overall aim of the NFI is to provide audited bodies with a series of prioritised data matches that may indicate the existence of some irregularity or potential fraud, for example indicating whether an individual continues to be paid despite having left the organisation to either retire or take employment elsewhere.

The data matches do not provide conclusive evidence of fraud and it is the responsibility of individual organisations to investigate the data matches to determine whether there is fraud.

From the 2002 exercise the PCT had 51 data matches of which 45 where classified as being ‘high priority’ which are those matches based on the most robust data. The data matches from the NFI are currently being investigated by the PCT’s Local Counter Fraud Specialist (LCFS) and the final return summarising outcomes from the investigations is to be made by the LCFS to the Audit Commission by the end of 2003.

We will summarise the key findings from this exercise in the 2003/2004 Annual Audit Letter.

Performance management

Directors need to continue to monitor the PCT’s performance against the targets and service delivery requirements contained in the NHS Plan and the PCT should secure improvements in the quality of data that it uses to inform strategic and operational decisions.

Implementation of the NHS Plan

The NHS Plan, published in July 2000, set out the Government’s vision of a health service designed around the patient, recognising that this will require investment and step change reform. The NHS Plan is an ambitious agenda and its implementation raises significant business risks for all NHS bodies. The Audit Commission considers that it is in the public interest for external auditors to monitor and report on local health bodies’ progress in implementing the key priorities in the NHS Plan.

The results of individual reviews at both PCTs and Acute Trusts were used to draw out common themes across the health economy at Strategic Health Authority (SHA) level and we prepared SHA briefings in March 2003. The results also fed into the Audit Commission’s national report ‘Achieving the NHS Plan’ published in June 2003.

Locally, we were required to:

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•

•

assess whether the PCT is at high or low risk of not achieving key NHS Plan targets

determine whether the PCT has the capacity to improve in priority areas and to outline any critical success factors, or factors hindering performance

make specific judgements about the adequacy of financial management and performance management arrangements

We issued our report to the PCT in January 2003. A summary is outlined in Exhibit 8 overleaf:

Systems in place to meet National Service Frameworks:

Appointment with primary health care professional within 24 hours

High

Low

Likely

Possibly

Possibly

Low

Older people

Mental health

CHD

Recruitment of extra Doctors and Nurses

Establishment of PALs

Low

Low Low Low

Unlikely

Possibly Possibly Possibly

High

Possibly

Performance management

Financial balance

Low Low

Unlikely

Unlikely

Management capacity

New contracts and improving working lives

High

Personal medical services

Low

Possibly

Capacity to improve

Possibly Possibly

Possibly

Maintenance backlog cleared by 2004

Cancer

EXHIBIT 8 SUMMARY OF PROGRESS

• • • •

Objective

Likely

High

We issued our report to the PCT in January 2003. A summary is outlined in Exhibit 9 below:

Sickness absence

Objective

Vacancy rate

CHD Registers

Exeter system

As part of the 2003/2004 audit we will be reviewing further progress on the NHS Plan Implementation. As the targets become more challenging the need for strong partnerships is increasingly important. The emphasis will therefore be on the LDP process and related systems as well as assessments against key targets. The review will examine the extent to

Reference costs

High

High

Low

High

Low

High

Risk

Issues

In October 2002, the Department of Health published ‘Reforming NHS Financial Flows:

Several months activity data not collected during the initial set-up period for the PCT

No internal monitoring of completeness or accuracy of sickness absence data

All practices have a CHD register

Responsibility lies with Central Operations Mersey – no changes in system or staffing

Low

Low

Risk

An action plan has again been developed to address those areas of highest risk and our 2003/2004 audit work is tailored to investigate further both the sickness absence and reference cost issues.

The NHS Plan emphasised how important it is for the NHS to have good quality data to underpin the assessment of performance. The review was based on the NHS Performance Assessment Framework (PAF), the main basis for measuring NHS performance. Since the PCT is not responsible for delivering any of the services covered by the PAF, our review focused on the additional indicators in the Commission’s Audit Guide that are specific to PCTs.

EXHIBIT 9 DATA QUALITY –KEY MESSAGES

Training and Read code templates well developed. Scope to improve accessibility, quality and completeness of data

Primary care information development

Data Quality

Single telephone access to GP out of hours care

Single telephone access through NHS Direct

An action plan has been developed to consider those areas where there is least likelihood of improvement.

The uptake of PMS contracts has been very low at the PCT. Despite considerable effort by the management team only two practices have adopted PMS contracts with the remainder of GPs indicating that they found the proposed new GP contract more attractive than PMS. The PCT has taken the decision that it will not proactively encourage further PMS applications.

which performance is sustainable as well as assess the capacity to improve. Auditors will be asked to probe key targets in more detail, in particular the degree to which patients views and experiences are considered in planning and service development. Our detailed work in this area will be undertaken during the Autumn of 2003.

Internal accuracy and completeness checks are poor

Introducing Payments by Results’, which proposed that PCTs move away from commissioning services through block agreements and towards paying all NHS providers for the activity they undertake based on a standard national price tariff, derived from the National Schedule of Reference Costs. The new funding arrangements are designed to reward efficiency, support patient choice and plurality of provision and encourage sustainable reductions in waiting times, and will be phased in over the next three years.

Linked to this the Audit Commission has chosen to focus this year’s data quality reviews on the data underpinning Reference Costs and HRGs. The overall aim of the review is to assist the PCT to improve the quality of its 2004 reference cost submission by reviewing the 2003 data. Our detailed local work will be undertaken at the PCT during the autumn of 2003.

Decision implementation

The PCT is responsible for implementing a significant number of projects within the local health economy. Our work has identified a number of barriers to the successful implementation of these projects which at best cause delays and difficulties in securing appropriate action and at worst could result in the failure of projects that would significantly benefit patients. Directors should ensure that appropriate action plans are developed to minimise the number and impact of such barriers.

As the size of the management agenda continues to grow and with managers already juggling relatively large portfolios of responsibilities there are concerns that key tasks may get overlooked. In particular a feature of the challenging agenda for PCTs is the lack of time to follow through all decisions to ensure that the appropriate action has been taken, at the appropriate time, at the appropriate cost and that the outcome reached was that which was intended, and also that the original decision taken was consistent with the strategic direction of the PCT.

In order to identify how the PCT can improve its decision implementation process are reviewing

the action planning and delivery mechanisms for:

•

•

Investment for Change Funding - a number of modernisation and service development projects within a £0.5m budget currently being implemented(in order to track the projects through from decision making to service development and review)

Musculo Skeletal Services - a project that has already been completed or is at a more advanced stage of implementation in order to identify the lessons to be learned

Our work has a significant elapsed time as it requires us to follow through a number of live projects under the investment for change heading. We have therefore agreed to issue a series of interim reports during the course of our review to provide initial feedback and facilitate early action by the PCT. To date we have issued one interim report and the main themes identified are shown overleaf:

EXHIBIT 10 DECISION IMPLEMENTATION

Project

Investment for change funding

Musculo- Skeletal Services

Issues

All projects reviewed are classified as amber or green in terms of risk of delivery

A number of projects are being progressed without necessarily having robust action plans or being formally linked to the LDP process

The evaluation mechanisms in terms of effecting change and modernising services for some services appear unclear

Where there have been delays in project development they have been mainly around recruitment processes.

Initial observations on barriers to successful project implementation include;

•

•

•

•

•

No dedicated champion for the scheme

Lack of IT capacity to support project implementation

Poor availability of administration support

Unclear project accountability and reporting structure

Underestimation of the capacity required to deliver the project which requires a significant change in historic working patterns across a number of health partners.

We will continue to monitor the progress of the projects and provide further interim feedback during the remainder of 2003/2004. We will provide our final report in the Spring of 2004 and summarise progress again in the 2003/2004 Annual Audit Letter

Future audit work

Our audit programme for 2003/2004 is included in the Audit Plan 2002-2004 which was issued in January 2003. The key areas of audit work to be completed in 2003/2004 are:

•

•

•

•

NHS Plan Implementation

HRGs/Reference Costs

Sickness absence systems

Local Counter Fraud Services (LCFS) review

Work has already commenced in all of these areas and we will report our key findings to you in the 2003/2004 Annual Audit Letter.

We will discuss the timetable for planning the 2004/2005 audit with key officers early in 2004.

Status of our Annual Audit Letter to the PCT

Our Annual Audit Letter is prepared in the context of the Statement of Responsibilities of Auditors and Audited Bodies issued by the Audit Commission. Annual Audit Letters are prepared by appointed auditors and addressed to Directors and Officers. They are prepared for the sole use of the audited body, and no responsibility is taken by auditors to any Director or Officer in their individual capacity, or to any third party.

Closing remarks

This letter will be discussed and agreed with the Chief Executive and the Director of Finance. A copy of the Letter will be provided to all Board Members and will be presented to the Audit Committee in October 2003.

Finally, I would like to take this opportunity to express my appreciation for the assistance and co-operation provided during the course of the audit. Our aim is to deliver a high standard of audit which makes a positive and practical contribution which supports the Trusts own agenda. We recognise the value of your co- operation and support.

Sheila Kilkenny District Auditor September 2003