Wrightington, Wigan and Leigh. Health Services Charity

Transcription

1 Wrightington, Wigan and Leigh Health Services Charity Registered Charity Number Annual Accounts for the year ended 31 March 2011

2 Wrightington, Wigan and Leigh Health Services Charity Annual Accounts for the year ended 31 March 2011 Contents Foreword... 3 Reference and Administrative details... 4 Structure, Governance and Management... 5 Objectives and Strategy... 6 Risk management... 6 Reserves Policy... 6 Investment Policy... 7 Statement of Trustees Responsibilities... 9 Independent Auditor's Report to the Trustee of Wrightington, Wigan and Leigh Health Services Charity Statement of Financial Activities Balance Sheet Notes to the accounts Accounting Policies Related Party transactions Analysis of voluntary income gross income from investments and cash on deposit Incoming resources from charitable activities Cost of generating funds Analysis of charitable expenditure Allocation of support costs and overheads Analysis of grants Analysis of staff costs Auditors remuneration Fixed asset investments Analysis of current assets Analysis of current liabilities and long term creditors Contingencies Commitments Analysis of unrestricted funds Material unrestricted funds detail

3 Trustee Annual Accounts for Wrightington, Wigan and Leigh Health Services Charity for the Year ending 31 st March 2011 Foreword The Corporate Trustee is pleased to present the Charitable Funds Annual Accounts for the year ended 31 March The accounts have been prepared by the Corporate Trustee in accordance with Part VI of the Charities Act 1993 and the Charities (Accounts and Reports) Regulations The Charity s accounts include all the separately established funds for which the Wrightington, Wigan and Leigh NHS Foundation Trust is the major beneficiary. The report also incorporates funds assigned to NHS Ashton, Leigh and Wigan PCT and Ashton, Leigh and Wigan Community Healthcare NHS Trust which are maintained under the same governance arrangements. These funds are incorporated into the accounts as their value is below the former diminimus level as established by the Department of Health. However, arrangements are being made to transfer these funds to the respective NHS organisations in line with Charities Commission regulations. The Charity has a Corporate Trustee: Wrightington, Wigan and Leigh NHS Foundation Trust. The members of the Trust Board who served during the financial year were as follows: All of the below Directors were in post for the 12 month period to 31st March 2011 except where indicated. Chairman Mr L Higgins Chief Executive Mr A Foster Director of Human Resources/ Deputy Chief Executive Mr W Livingstone (01/04/10 to 17/10/10) Acting Director of Human Resources Mrs M Cloney (28/06/10 to 17/10/10) Director of Human Resources Mr J Lenney (18/10/10 ongoing) Director of Finance and Informatics Mr K Griffiths Director of Nursing and Performance / Deputy Chief Executive Mrs G Harris Director of Strategy and Planning Mr S Nicholls (04/10/10 ongoing) Medical Director Mr C Chandler (01/04/10 to 05/04/10) Medical Director Dr U Prabhu (12/04/10 ongoing) Non Executive Director Mrs L Barnes Non Executive Director Mr S Ball Non Executive Director Mr R Armstrong Non Executive Director Mrs P McCann (01/04/10 17/09/10) Non Executive Director Mr R Collinson Non Executive Director Mr G Bean Non Executive Director Mr N Turner (30/03/11 ongoing) The Corporate Trustee of the Charity is Wrightington, Wigan and Leigh NHS Foundation Trust, as the corporate body, and conducts the business of the Charity through the Charitable Trust Board. Members of the Trust Board are not individual trustees under Charity Law but act as agents on behalf of the Corporate Trustee, a function performed through the governance arrangements of the Trust. The Corporate Trustee fulfils its legal duty by ensuring that funds are spent in accordance with the objects of each fund and the trustee respects the wishes of our generous donors to benefit patient care and advance the good health and welfare of patients and staff. 3

4 Reference and Administrative details The Wrightington, Wigan and Leigh Health Services Charity, registered Charity Number , was entered on to the Central Register of Charities on 15 th August The Corporate Trustee passed a resolution on 16 th December 2009 to dissolve the Charity s 37 special purpose constituent charities as part of a strategy to modernise funds and further promote more effective use of Charity resources. This resolution was accepted by the Charity Commission and the constituent charities removed from their register of Charities on 28 th April This resolution also provided the opportunity to restructure funds in supporting the strategy to further enhance the Charity s effectiveness. From 1 st April 2010, resulting from the restructure, the 111 individual funds were replaced with five Clinical divisional operational funds, plus those relating to NHS Ashton, Leigh and Wigan PCT and Ashton, Leigh and Wigan Community Healthcare NHS Trust which remains unchanged. As a consequence the accounting details contained in the primary statements and supporting notes to these accounts relating to the financial year 2009/10 have been amended to reflect the change in fund structure. Further details on the constitution of the Charity is available on the Charity Commission website Charitable funds received by the Charity are accepted, held and administered as funds and property held on trust for purposes relating to the Health Service in accordance with the National Health Service Act 1977 and the National Health Service and Community Care Act 1990 and these funds are held on trust by the Corporate Trustee. Principal office The principal office for the Charity is: Wrightington, Wigan and Leigh NHS Foundation Trust Trust Headquarters The Elms Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Advisors The following companies were retained by the Charity during 2010/11: Bankers National Westminster Bank Plc Corporate Banking Services Sovereign Business Park Kingscroft Court Wigan WN1 3AP Investment Advisors Epic Asset Management Limited 22 Biliter Street London EC3M 2RY Trust Solicitors External Auditor Weightmans Solicitors Deloitte LLP First Floor 1 City Square 3 Piccadilly Place Leeds Manchester LS1 1AL M1 3BN 4

5 Structure, Governance and Management The full name of the Charity is Wrightington, Wigan and Leigh Health Services Charity. The Charity was created following the merger of Wrightington Hospital NHS Trust and Wigan and Leigh Health Services NHS Trust on 1 st April The Wrightington, Wigan and Leigh NHS Foundation Trust were licensed as a Foundation Trust from 1 st December The special purpose trusts of the Charity are each registered with the Charity Commission of England and Wales and were originally created by a declaration of trust now amended by supplemental deed following the merger. These were removed from the register of charities on 28 th April 2010 as part of the funds restructure. The Charity registration number is During 2010/11, in line with the approved Charity restructure, the day to day management of the five divisional were delegated to individual divisional committees made up of a variety of staff members and independent governors. Each divisional committee has approved terms of reference to conduct the business of their funds and meet frequently to: - To develop five year business plans for the divisional fund. - To develop and monitor spending plans throughout the financial year in line with the 5 year plan. - To review, consider and, when appropriate, approve applications for funding from each divisional charitable fund. - To ensure that charitable monies are used effectively within the Division, in line with the donor s wishes. - To ensure that all approved applications are for the benefit of the Trust and Division and add value and benefits in addition to the standards delivered in providing NHS services. The Charitable Trust Board has established a strategy of governance review to further enhance the objectives and effectiveness of the Charity. This includes: i. Governance arrangements for standards and monitoring. ii. To review fund objectives and strategy to maximise benefits to the Charity. iii. To review risk management arrangements with regular risk assessments. iv. To review the reserves strategy. v. To establish a policy for receiving donations. These objectives are supported by a framework of activities and timescales. The Charitable Trust Board responsibilities and terms of reference i. To agree the purpose and strategy of the Charity. ii. To agree expenditure from the funds, as per the Trust s Standing Financial Instructions. iii. To determine the Charity s investment strategy. iv. To agree all significant fund raising initiatives. v. To produce an Annual Report outlining all the Charity s key achievements and areas of specific patient / public interest. Decisions are made and approved by the Corporate Trustee at separate meetings of the Charitable Trust Board, in which only Charity business is conducted. So far, as the Corporate Trustee is aware, there is no relevant audit information of which the Charity s auditor is unaware. The Corporate Trustee has taken all the steps that it ought to have taken to make itself aware of any relevant audit information and to establish that the Charity s auditor is aware of that information. 5

6 The Board members do not receive any additional remuneration or payment for expenses whilst serving on the Charitable Trust Board. The accounting records and day to day administration of the funds are dealt with by the Finance Directorate located at Buckingham Row, Brick Kiln Lane, Wigan. WN1 1XX. Objectives and Strategy The principal objects and purposes of Wrightington, Wigan and Leigh Health Services Charity as set out on the trust deed are: To provide for any charitable purposes relating to the National Health Service. The Charity works alongside the Trust to ensure that the advancement of healthcare is achieved on a daily basis. The Charitable Trust Board approved the following mission statement: The mission of Wrightington Wigan and Leigh Health Services Charity is to further improve the quality of patient care, support its staff, provide training and education, and promote medical research, in health care activities which are not covered or fully supported by central NHS funds. This is achieved through the generosity of the general public and by fundraising activities, events and appeals. Risk management As part of the charitable fund governance arrangements a charitable fund risk register is established and is a standing agenda item at all Charitable Trust board meetings. All risks on the register have been reviewed in order to reflect whether there are any new risks or the current risks have been mitigated in part or in full, or require escalation for further consideration. The Charity does not have any significant residual risks. Reserves Policy The Charitable Trust Board approved a revised Reserves policy at their meeting on 13 th October The new reserves policy is illustrated below: Executive Summary The Corporate Trustee recognises its statutory obligation to ensure that funds should be spent effectively and promptly in accordance with the Charity s governing document and objectives. The Charity resources comprise of five wholly unrestricted funds, which can be spent on any purposes of the Charity, for which the day to day management is delegated to named fund managers. The Charity is supported by a centrally held revaluation reserve comprising of realised and unrealised gains from investments. As part of the Charity s annual business plan process, robust financial management and a positive approach to risk management it is prudent to retain a level of reserves to mitigate the impact of any unforeseen circumstances. 6

7 Risk assessment of the value of reserves held The value of reserve maintained is reflective of: The robustness and monitoring of the funds plans as approved annually by the Corporate Trustee. The level of risk and mitigating actions as set out in the Charity s risk register and resulting action plans. An annual review of the Charity s investment policy, portfolio and risk. Identified risks Loss of research income. Reduction in planned income levels to support expenditure plans. Potential exceptional / unforeseen items of expenditure. Reduction in investments. Value of reserves held To continue with the policy of centrally retaining the investment revaluation reserve of 236k as the committed reserve, at circa 10% of total funds. The value of this reserve is to be reviewed by the Corporate Trustee on an annual basis in line with updated plans and regularly throughout the year to ensure the reserve continues to be sufficient to mitigate any potential risks to the Charity in fulfilling its objectives. Frequency of Policy review. The Reserves policy will be reviewed annually by the Corporate Trustee in line with the business plan process. Investment Policy The investment policy is as follows: All investment decisions must comply with the Trustee Act 2000 and the specific requirements of trustee investment powers i.e. 1. To take proper professional investment advice; and 2. To have regard to the standard investment criteria. The overriding objective is to safeguard the Charity s assets, whilst investing in markets that will minimise risk and provide a steady income in line with market conditions and interest rates. In line with a recommendation from the Trust s investment advisors, the Charitable Trust Board approved a revision to the investment portfolio to extend the maximum period of certificates of deposit from 12 months to 24 months. 7

8 The investments are illustrated below: Government Gilts 50,387 50,273 Certificates of Deposit 2,341,662 2,518,851 Cash held as part of investment portfolio 4,755 25,998 2,396,804 2,595,122 8

9 Statement of Corporate Trustee Responsibilities The corporate trustee is responsible for preparing the Trustee Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice). The law applicable to charities in England & Wales requires the corporate trustee to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the Charity and of the incoming resources and application of resources of the Charity for that period. In preparing these financial statements, the corporate trustee is required to: - select suitable accounting policies and then apply them consistently; - observe the methods and principles in the Charities SORP; - make judgments and estimates that are reasonable and prudent; - state whether applicable accounting standards have been followed [subject to any material departures disclosed and explained in the financial statements]; and - prepare the financial statements on the going concern basis unless it is inappropriate to presume that the Charity will continue in business. The corporate trustee is responsible for keeping proper accounting records that disclose with reasonable accuracy at any time the financial position of the Charity and enable them to ensure that the financial statements comply with the Charities Act 1993, the Charity (Accounts and Reports) Regulations 2008 and the provisions of the trust deed. It is also responsible for safeguarding the assets of the Charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The corporate trustee is responsible for the maintenance and integrity of the Charity and financial information included on the Charity's website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions. By delegated authority on behalf of the Corporate Trustee Signed: Chairman * Date: 27 th July 2011 Signed: Trust Board Director Date: 27 th July 2011 The Board may authorise another board member to sign in place of the Chairman. 9

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11 INCOMING RESOURCES Statement of Financial Activities For the year ended 31 March 2011 Incoming resources from generated funds Unrestricted Unrestricted Note Voluntary income Donations Legacies voluntary income Activities for generating funds Fundraising events Investment income Incoming resources from charitable activities incoming resources RESOURCES EXPENDED Costs of generating funds 6 (14) (6) Charitable activities Patients Comforts and Welfare 7 (71) (144) Purchase of New Equipment 7 (513) (406) Patient Information Centre - Wrightington - (9) Medical Research and Education 7 (301) (298) Staff Welfare - Education & Training 7 (38) (60) charitable activities (923) (917) Governance costs 8 (27) (37) resources expended (964) (960) Net outgoing resources before other recognised gains & losses (371) (179) Realised and unrealised gains on investment assets Net movement in funds (367) (170) Reconciliation of funds funds brought forward 2,775 2,945 funds carried forward 2,408 2,775 11

12 Balance Sheet As at 31 st March 2011 Unrestricted Unrestricted Note Fixed assets Investments 12 2,397 2,595 fixed assets 2,397 2,595 Current assets Debtors Investments Cash at bank and in hand 5 1 current assets Liabilities Creditors: Amounts falling due within one year 14 (131) (161) Net current assets assets less current liabilities 2,408 2,775 Net assets 2,408 2,775 The funds of the charity: Unrestricted income funds Unrestricted income funds 2,172 2,537 Revaluation reserve unrestricted income funds 17 2,408 2,775 charity funds 2,408 2,775 The notes on pages 13 to 20 form part of these accounts. Approved by the Charitable Trust Board on 27 th July 2011 and signed on its behalf by: Trustee 12

13 Notes to the accounts 1. Accounting Policies a. Basis of preparation The financial statements have been prepared under the historic cost convention, with the exception of investments which are included at market value. The financial statements have been prepared in accordance with Accounting and Reporting by Charities, Statement of Recommended Practice (SORP 2005) issued in March 2005 and applicable UK Accounting Standards and Charities Act. b. Funds structure Unrestricted income funds comprise those funds which the Corporate Trustee is free to use for any purpose in furtherance of the charitable objects. Unrestricted funds include funds, where the donor has made known their non binding wishes. The major funds held are disclosed in note 17. c. Incoming resources All incoming resources are recognised once the Charity has entitlement to the resources, it is certain that the resources will be received and the monetary value can be measured with sufficient reliability. d. Incoming resources from legacies Legacies are accounted for as incoming resources either upon receipt or where the receipt of the legacy is virtually certain. This will be once confirmation has been received from the representatives of the estate that payment of the legacy will be made or property transferred and once all conditions attached to the legacy have been fulfilled. e. Resources expended Expenditure is recognised when a liability is incurred. Grant commitments are recognised when a tangible obligation arises that result in payment being unavoidable. Grants are only made to related or third parties in furtherance of the charitable objects of the fund. A liability for such grants is recognised when approval has been given by the Corporate Trustee. f. Irrecoverable VAT Irrecoverable VAT is charged against the category of resources expended for which it was incurred. g. Allocation of overhead and support costs Overhead and support costs have been allocated as a direct cost and apportioned on an appropriate basis between Charitable Activities and Governance Costs. It is apportioned across Charitable Activities by way of a fixed cost per fund for statutory and governance requirements with a variable support cost apportioned via the number of transactions on the funds. h. Cost of generating funds The cost of generating funds includes the management fee from EPIC Asset Management Limited and the cost of fundraising activity. I. Charitable activities Costs of charitable activities comprise all costs incurred in the pursuit of the charitable objects of the Charity. These costs comprise direct costs and an apportionment of overhead and support costs as shown in note 7. 13

14 j. Governance costs Governance costs comprise all costs incurred in the governance of the Charity; i.e. the costs of meeting statutory and regulatory requirements. k. Fixed asset investments Investments are stated at market value as at the balance sheet date. The Statement of Financial Activities includes the net gains and losses arising on revaluation and disposals throughout the year. The certificates of deposit and narrow range investments are included in the Balance Sheet at market value as at 31 March l. Realised gains and losses All gains and losses are taken to the Statement of Financial activities as they arise. Realised gains and losses on investments are calculated as the difference between sales proceeds and open market (purchase date if later). Unrealised gains and losses are calculated as the difference between market value at the year end and opening market value (or purchase date if later). m. Pensions Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at The scheme is unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of Secretary of State, in England and Wales. It is not possible for the NHS foundation trust to identify its share of the underlying scheme liabilities. Therefore, the schemes accounted for as a defined contribution scheme. Employers pension cost contributions are charged to operating expenses as and when they become due. Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill health. The full amount of the liability for the additional costs is charged to the operating expense at the time the trust commits itself to the retirement, regardless of the method of payment. 2. Related Party transactions During the year none of the members of the Charitable Trust Board, key management staff or parties related to them has undertaken any material transactions with Wrightington Wigan and Leigh Health Services Charity. Board members (and other senior staff) take decisions both on Charity and Trust business matters but endeavour to keep the interests of each discrete and do not seek to benefit personally from such decisions. Declarations of personal interest have been made in both Charity and Trust business matters and are available to be inspected by the public. The Corporate Trustee has purchased Directors and Officers liability insurance. 14

15 3. Analysis of voluntary income Donations Unrestricted Unrestricted Funds Funds Restated Clinical Support Services Divisional Fund 4 5 Medicine Divisional Fund Musculoskeletal Divisional Fund Nurse Director Divisional Fund 2 7 Surgery Divisional Fund Ashton, Leigh and Wigan Community Healthcare NHS Trust 1 12 Sub Legacies Medicine Divisional Fund Nurse Director Divisional Fund Surgery Divisional Fund 1 3 Sub gross income from investments and cash on deposit Held in UK Held in UK Dividend income from Government gilts 3 3 Interest from Certificates of Deposits Incoming resources from charitable activities The income was primarily from the provision of training courses in furtherance of the Charity s objects in both the current and previous years. The income received by the Mobility Centre was for the provision of driving assessments. Unrestricted Unrestricted Funds Funds Ashton Leigh and Wigan Community Healthcare NHS Trust - 1 Muscloskeletal Divisonal Fund Medicine Divisonal Fund

16 6. Cost of generating funds Unrestricted Unrestricted Funds Funds Cost of managing investment portfolio 8 6 Cost of fundraising Analysis of charitable expenditure The Charity undertook direct charitable activities and made available grant support to Wrightington, Wigan and Leigh NHS Foundation Trust in support of donated assets: Activities undertaken Grant funded Support directly activity Costs Patients Comforts and Welfare Purchase of New Equipment Medical research & Education Staff Welfare - Education & Training Allocation of support costs and overheads Allocation and apportionment 2010/11 Allocated to Residual for Basis of to Governance Costs Governance apportionment Apportionment Salaries & related costs Fixed allocation plus number of transactions Insurance Governance Internal Audit Governance External Audit Governance In 2009/10 these costs where: Salaries & related costs Insurance Internal Audit External Audit Restructure

17 9. Analysis of grants All grants are made to the Wrightington, Wigan and Leigh NHS Foundation Trust in the form of donated assets. No grants are made to individuals. 10. Analysis of staff costs Detailed below is an analysis of staff resources utilised by the Charity. The staff employed to carry out research and educational activities on behalf of the Charity are employees of the Wrightington Wigan and Leigh NHS Foundation Trust and as such have the same terms and conditions as other Trust staff. In this regard the Charity does not directly employ its own staff. However, the cost of providing these charitable activities is not subsidised by the Trust and as such the Charity reimburses the Trust for the costs of employment and is wholly responsible for meeting any costs as a result of this employment not continuing. In this regard the Charity has identified a resource that is protected within the approved reserves policy. Salaries and wages Social security costs Pension costs The average number of employees in the year WTE * WTE * MSK 7 7 Medicine * WTE - whole time equivalents There were no employees with emoluments greater than 60,000. Board members do not receive any additional remuneration or payment for expenses whilst serving on the Charitable Trust Board. 11. Auditors remuneration The auditors remuneration of 6,240 (2010: 11,750) is related solely to the statutory audit. No other additional services are provided. 17

18 12. Fixed asset investments Movement in fixed asset investment Market value brought forward 2,595 2,690 Add: additions to investments at cost 7,522 6,266 Less disposals at carrying value (7,724) (6,370) Add net gain on revaluation 4 9 Market value as at 31 March 2,397 2,595 Historic cost as at 31 March ,392 2,585 Market value as at 31 March 2011 Held in UK Held in UK Investments in Government Gilts Cash held as part of investment portfolio 2,347 2,545 market value of fixed asset investments 2,397 2, Analysis of current assets Debtors under 1 year Accrued income - Gift Aid Scheme 3 2 Research course income debtors falling due within one year Analysis of current liabilities and long term creditors Creditors under 1 year Bank overdraft - - Trade creditors 6 12 Accruals Contingencies The Trust has no contingent liabilities or gains. 18

19 16. Commitments The Trust has no material legally binding commitments except the arrangement with the Wrightington Wigan and Leigh NHS Foundation Trust in relation to the ongoing salaries for staff employed under contract with the Trust to carry out research and education activities undertaken directly by the Charity. 17. Analysis of unrestricted funds Balance Incoming Resources Gains & Balance b/fwd Resources Expended Losses c/fwd Restated Divisional Funds Musculoskeletal Divisional Fund 1, (319) 2 1,162 Medicine Divisional Fund (440) Surgery Divisional Fund (85) Nurse Director Divisional Fund (78) Clinical Support Services Divisional Fund 41 5 (10) - 36 Ashton, Leigh & Wigan Community Healthcare NHS Trust Mobility Centre (25) SOS 12 - (2) - 10 Other small value funds (4) 16 1 (4) - 13 Ashton, Leigh & Wigan PCT ALW PCT General 8 - (1) - 7 Funds including revaluation reserve 2, (964) 4 2, Material unrestricted funds detail Musculoskeletal Divisional Fund (MSK) MSK services undertaken at Wrightington Hospital and Royal Albert Edward infirmary. This divisional fund will be utilised to enhance various patient areas, to provide funding for the current research posts in place at Wrightington Hospital, to purchase items of equipment that are required to further enhance a patients stay in hospital an to provide funding for staff development to attend conferences and course Medicine Divisional Fund Division of medicine within Leigh Infirmary and Royal Albert Edward Infirmary. The divisional fund will be utilised on enhancing patient areas and wards making their surroundings more comfortable and aesthetically pleasing; to purchase medical equipment that will improve the service already available; and for the development of the staff within the division to attend conferences and courses as and when required. 19

20 Surgery Divisional Fund This divisional fund will be utilised to improve the services which the surgical division provides in particular staff development, purchase of medical equipment and other miscellaneous items needed by the division. Nurse Director Divisional Fund This fund is for patient and staff benefits; and for the enhancement of the patient s experience and the provision of retirement vouchers. Clinical Support Services Divisional Fund This fund will be utilised to improve the service which the clinical support service undertakes, in particular staff training and development; to ensure a higher standard of service and service developments; and to ensure that the division keeps pace with an ever changing environment. Ashton, Leigh and Wigan Community NHS Trust Mobility Centre Fund For the relief of disabled people who attend the Mobility Centre at Wrightington Hospital by (i) providing a service for such disabled people to allow time to acquire or maintain their mobility through use of a motor vehicle, and (ii) providing a medical and technical assessment advice and contract for specialised driving instruction and the adaptation and purchase of motor vehicles. Save our Skeletons (SOS) Fund To raise awareness and funds for the purchase of capital equipment and offer resources leading to the betterment of services for Osteoporosis sufferers within the borough. NHS Ashton, Leigh and Wigan PCT Ashton, Leigh and Wigan PCT General Fund For any charitable purpose or purposes relating to the National Health Service wholly or mainly for NHS Ashton, Leigh and Wigan Primary Care Trust. 20