South Western Ambulance Service NHS Trust. annualaccounts2008/09. We respond. quickly and safely to save lives, reduce anxiety, pain and suffering

South Western Ambulance Service NHS Trust We respond quickly and safely to save lives, reduce anxiety, pain and suffering

Contents annual accounts - foreword Statement of the Chief Executive s responsibilities as the Accountable Officer of South Western Ambulance Service NHS Trust. 05 Statement of Directors responsibilities in respect of the accounts 06 Statement on internal control 07 1. Scope of responsibility 07 2. The purpose of the system of internal control 08 3. Capacity to handle risk 09 4. The risk and control framework 09 Assurance Framework 11 5. Review of effectiveness 13 6. Commentary on Head of Internal Audit Opinion 16 02 03 Independent auditor s report to the Board of Directors of South Western Ambulance Service NHS Trust 17 Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources 19 Certificate 20 Independent auditor s report to the Board of Directors of South Western Ambulance Service NHS Trust on the NHS Trust Summarisation Schedules 21 Income and expenditure account for the year ended 31 March 2009 22 All income and expenditure is derived from continuing operations. 22 Balance sheet as at 31 March 2009 23 Statement of total recognised gains and losses for the year ended 31 March 2009 25 Cash flow statement for the year ended 31 March 2009 26 Notes to the accounts 28 1. Accounting policies 28 Capitalisation 29 2. Segmental analysis 40 3. Income from Activities 41 4. Other Operating Income 41 5. Operating Expenses 42 6. Staff costs and numbers 44 7. Better Payment Practice Code 46

annual accounts - foreword 8. Other gains and losses 47 9. Finance Costs & Interest receiveable 48 10. Intangible Fixed Assets 48 11. Tangible Fixed Assets 50 These accounts, for the twelve month period ending 31 March 2009, have been prepared by the South Western Ambulance Service NHS 13. Debtors 54 Trust in accordance with the NHS Act 2006. 14. Other Financial Assets 55 16. Other Financial Liabilities 59 Ken Wenman 17. Provisions for liabilities and charges 60 Chief Executive and Accountable Officer 18. Movements on Reserves 61 Dated: 11.05.09 19. Notes to the cash flow Statement 62 20. Capital Commitments 64 21. Post Balance Sheet Events 64 Statement of the Chief Executive s responsibilities as the Accountable Officer of South Western 22. Contingencies 64 Ambulance Service NHS Trust. 23. Movement in Public Dividend Capital 65 The Secretary of State has directed that the Chief Executive should be the Accountable Officer of the Trust. The relevant responsibilities of 24. Financial Performance Targets 65 the Accountable Officer is set out in the Accountable Officer Memorandum issued by the Department of Health. These include ensuring that: 04 25. Related Party Transactions 68 There are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate 26. Private Finance Transactions 69 governance; 05 27. Pooled Budget 71 Value for money is achieved from the resources available to the authority; 29. Third Party Assets 75 Expenditure and income of the authority has been applied to the purposes Parliament and conform to the authorities which govern 30. Intra-Government and Other Balances 75 them; 31. Losses and Special Payments 75 Effective and sound financial management systems are in place; Glossary of financial terms 76 Annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as Accountable Officer. Signed Ken Wenman Chief Executive Dated: 11.05.09

Statement of Directors responsibilities in respect of the accounts The Directors are required under the NHS Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the organisation and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts Directors are required to: Statement on internal control 1. Scope of responsibility The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation s policies, aims and objectives. I also have responsibility Apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; Make judgements and estimates which are reasonable and prudent; State whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. for safeguarding the public funds and the organisation s assets for which I am personally responsible as set out in the Accountable Officer Memorandum. The Trust recognises the value of being able to provide assurance that it is on target to achieve its objectives and has identified any risk to The Directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial their achievement. To that end our assurance processes have been further strengthened during 2008/09, both internally and externally: position of the organisation and to enable them to ensure the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the Trust and for taking reasonable steps for the prevention of fraud and other irregularities. Internally, the Trust Board approved a new Assurance Framework at the end of March 2008 for the year ahead and reviewed this document at each subsequent meeting throughout the year. Internal Audit had declared the 2007/08 Framework as presenting a low risk to the Trust. The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the financial Two minor recommendations were made which were then incorporated into the new Framework for 2008/09. The Framework for 2008/09 statements. was reviewed by Internal Audit in March 2009 and found again to be of low risk. Recommendations were made to include deadlines for 06 07 action plans, and to rate the risk of not achieving the objective and not simply the risk to the Trust. These will be incorporated into the new By order of the Board framework for 2009/10. Date: 11.05.09 Ken Wenman Chief Executive The Assurance Framework is an important document for the Trust as it links all significant objectives to the Trust s risk register, identifying Date: 11.05.09 Jennie Kingston Finance & Performance Director gaps in controls/assurances, and providing clear evidence within the document that those gaps have been addressed. Items which are completed in year are removed only with the approval of the Board, and new items are added as they are identified, although no further items were added during 2008/09. The Framework is also reviewed by Directors Group, the Audit Committee, and the Governance Committee by individual committee/group responsibility. The Governance Committee provides the forum for all Governance issues, including Corporate and Clinical Governance, and is the Committee to which the Risk Management Group reported until November 2008 when its agenda and business were incorporated into the remit of the Governance Committee and the Group disbanded following a complete fit for purpose review of the Trust s risk management arrangements. The Governance Committee met every two months throughout 2008/09. Its agendas are formed from an annual business cycle agreed at the start of each year. The Audit Committee provides assurance to the Board that the Trust s governance arrangements are fit for purpose.

The Trust Board and the Audit and Governance committees undertake a self assessment periodically throughout the year which includes a review of governance arrangements and of their own effectiveness. Each forum has an annual cycle of business and a record is maintained throughout the year of all business discussed. 3. Capacity to handle risk The Trust s Associate Director of Strategic Communications & PR/FT Programme Lead is the director with lead responsibility for risk management, with the Head of Governance as the designated senior manager. Externally, regular quality monitoring meetings are held with the Trust s lead commissioners for both emergency and urgent care services. The lead commissioner for emergency services also has an open option to attend the Trust s Governance Committee. The Trust has a comprehensive Risk Management Strategy which is reviewed annually and is supported by robust risk management processes. The Strategy was revised and re-approved by the Board in March 2009 following review and revision of the risk management processes in November 2008. As Accountable Officer, I also attend regular performance review meetings with the Strategic Health Authority, as well as forums with the Chief Executives of the other national ambulance Trusts. Training for the Trust Board is scheduled twice yearly into its business cycle, and annually for other staff. The Risk Manager and Health, Safety & Security Manager also provide training for other staff as necessary including at core induction. 2. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, The Risk Management Strategy and other key documents, such as the Investigation Guide, and Incident Reporting Policy are published for aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is staff on the Trust intranet to which all personnel have access. based on an ongoing process designed to: 08 09 identify and prioritise the risks to the achievement of the organisation s policies, aims and objectives, 4. The risk and control framework evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. Leadership and Strategy The Risk Management Strategy requires all risk management to be systematic, robust and evident. It requires that risk management processes are applied to business planning at all levels and that risk management issues should be communicated to key stakeholders The system of internal control has been in place in South Western Ambulance Service NHS Trust for the year ended 31 March 2009 and up to the date of approval of the annual report and accounts. where necessary. The strategy covers clinical, organisational and financial risk, and identifies the key management structures and processes defining objectives and responsibilities within the Trust. It confirms the Trust s commitment to developing a responsible culture. This, in turn, helps to maximise the identification, reporting and avoidance of risk, promoting the safest possible environment for patients and staff. The Strategy is approved annually by the Trust Board and is published on the Trust s intranet. Embedding Risk Management The risk management process is incorporated within the Strategy and was revised during 2008/09 to refine and improve upon the arrangements for identification and assessment of risk at all levels. The Corporate Register now comprises only risks rated at over 15; the Executive Directors Register contains risks rated from 12 to 15; and the Directorate Registers (managed by individual directors) contain local risks rated up to and including 11.

Risk management is embedded in all Trust processes and areas - the Trust s incident reporting system is web based and extensively used by staff at all levels. Directors, managers, and staff side representatives attend the Governance Committee (and formerly the Risk Management Group) and contribute to the identification and assessment of risks on the Risk Register. The Trust was assessed in December 2008 against by the Risk Manager, Head of Governance, and Associate Director of Strategic Communications & PR/FT Programme Lead. A log is kept of each new risk assessed and this is reviewed at Directors Group at each meeting. The matrix used by all when rating risks has been simplified to be as user-friendly and clear as possible. level 1 of the new NHSLA risk management standards and achieved a pass of 45/50 criteria. A further assessment will be undertaken against level 2 of the standards during 2009/10. An implementation plan has been disseminated to managers to support achievement at this level. Assurance Framework This is a key governance tool for the Trust and the objectives within it (which are all linked to the Trust s risk register) are categorised as follows: The risk management process, which is incorporated within the strategy, sets out how risks should be identified, reported, assessed and prioritised using a defined scoring methodology; and provides guidance on acceptable risk and how to manage control failure. Context for Risk Management As part of its risk management processes, the Trust has developed a joint response to some key risks with other agencies, eg: resilience plans Corporate Objectives (identified through the business planning process) Board Objectives (key issues identified, possibly one off) Annual Health Check S4BH Compliance (by domain) Annual Health Check National Targets National Targets/Guidance (additional items such as compliance with key legislation eg Mental Capacity Act, Civil Contingencies Act with other emergency services and authorities; information sharing agreements with partner organisations; and providing regular assurance etc) to the local Overview & Scrutiny Committees through attendance at their meetings; as well as attending regular quality monitoring meetings 10 11 with lead commissioners for the urgent care and A&E services. Gaps in controls/assurances are identified and the Framework clearly highlights action required to meet the gaps as well as the assurance measures which will demonstrate that the objectives are being achieved. The revised risk matrix includes consideration of context in terms of stakeholders in the assessment of the impact of any risk identified including upon others such as: patients; the public; service users; and the Department of Health. Board and committee paper front covers all contain reference boxes for the Assurance Framework, Auditors Local Evaluation (ALE), S4BH and other key references, and a record is kept of all business discussed at the Board and its committees. Following each meeting the Risk Identification and Evaluation The identification of new risks is now and has been throughout 2008/09 a standing item on the agenda for Board committees and key Framework is updated with assurances provided and is also updated from other sources such as meeting minutes, and approved policies. This creates a comprehensive record of all assurance provided and a complete picture for Board members. working groups. This ensures that each forum considers risk at the end of each meeting and has been very effective in focusing the groups attention on risk. Any risks identified are passed to the Risk Manager and duly considered and rated at a weekly Risk Watch forum attended No new items are added or redundant items removed without the approval of the Board. Information Governance Further to the Trust s corporate risk management framework, and linked into it, the Trust s Information Governance arrangements include dedicated management of risks to the information held by the Trust in order to reflect the specific requirements, defined through the Information Governance Toolkit and ISO 27001/2, for managing information security risks. These risks are reported to the Governance Committee, and the Learning From Experience Group as the designated forum to consider issues arising from incidents reported and trends

that emerge from these. None of the incidents reported during the year 2008/09 were classified, under the Department of Health criteria for information incidents, as Serious Untoward Incidents. This section of the Statement of Internal Control has been signed off by the Trust s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations Senior Information Risk Owner as assurance of the arrangements that are in place. 5. Review of effectiveness NHS policy for the transfer of personally identifiable data was reinforced in the wake of the series of confidentiality breaches in the public sector towards the end of 2007. Significant work was subsequently undertaken in the Trust in the latter part of 2007 and early 2008, overseen and monitored by its Strategic Health Authority, to identify all transfers of personally identifiable data outside the Trust and ensure they were conducted securely and in accordance with NHS security standards. This, and other work required to ensure personal data is handled securely within the Trust, has been continued throughout 2008/09 to provide assurance that the Trust is complying with national requirements. This is reflected in a score of 83% being submitted in the annual assessment against Information Governance Toolkit As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. standards. My review is also informed by reports from external auditors, assurances provided by the Audit Committee and its officers, and compliance Compliance with the standards for better health assurance and Internal Audit reports to support the core standards self assessment declaration The Trust is not fully compliant with the core standards for better health. 12 13 I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the work of and A declaration of non-compliance with 2 core standards has been made for 2008/09, one standard was compliant by year end, but the other will not be compliant until part way through 2009/10. See section 5. assurance reports and minutes provided by the committees of the Board (Audit, Governance, Equality and Diversity, and Better Value, Better Care), and Directors Group. A plan to address weaknesses and ensure continuous improvement of the system is in place and the primary mechanism for this will be the Assurance Framework and the supporting committees and reporting structures: Compliance with equality, diversity and human rights legislation Control measures are in place to ensure that all the organisation s obligations under equality, diversity and human rights legislation are complied with. The Board receives assurance reports and minutes from all its committees, as well as reviewing and approving the Assurance Framework at each meeting and receiving reports from Internal and External Audit. NHS Pension Scheme As an employer with staff entitled to membership of the NHS Pension scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer s The Governance Committee has been in place for over eighteen months evolving over that time into a vital forum for the development and review of governance systems and quality improvements including: governance policy and strategy (new and annual review); assurance framework; patient experience; patient safety; health and safety reports; NHSLA implementation; risk registers; identification of new risks; identification of new legislation; learning from experience; infection prevention and control; implementation of NICE guidelines; clinical audit and effectiveness; information governance; HR activity; policy register; annual health check updates; safeguarding updates; feedback from sub groups.

The Audit Committee and Internal and External Audit, have developed, approved, and monitored a programme for the year to assess the effectiveness and fitness for purpose of key assurance processes and systems of internal control, including assessment of 6 S4BH standards The Trust will be submitting a declaration of almost met compliance with the core standards for better health. The two core standards which have declarations of non-compliance, either in year or at year end, are shown below. and the evidence collection process; review of the assurance framework; and review of risk management arrangements. The Trust, in April 2009, received endorsement from the Concordat of regulatory organisations (including the Healthcare Commission, Health & Safety Executive, and NHS Litigation Authority) that at its recent risk summit it had declared the Trust as an organisation about which: there was collective agreement that there were no areas of concern... The Healthcare Commission undertook a review of the infection control arrangements for two ambulance trusts in 2008/09, with this Trust being one of those chosen. The review/inspection took place from 17th to 20th February. The final report has now been received and the Trust was awarded a green/green compliant status with the hygiene code; the report contained no recommendations for the Trust. The Health and Safety Executive undertook a follow up inspection of the Trust s arrangements in March 2009 (they previously visited the Trust in January 2008), and although their report has not yet been received, no improvement notices have been issued to date. disposes of the information appropriately when no longer required (non-compliant in year, compliant at year end) 14 15 Annual Health Check Quality of Services (see section 4) The Trust has identified three gaps in assurance in 2008/09 as part of the Annual Health Check, one in the existing national targets and two in the standards for better health declaration. The 2008/09 KA34 identifies that the Trust under performed against the B19 performance target recording performance for the year at C4b Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that all risks associated with the acquisition and use of medical devices are minimised (non-compliant at year end) Prior to the introduction of new software to manage the Medical Devices function throughout the Trust it was identified that the Trust Board could not receive assurance that the whole process of medical devices from procurement to destruction is robust and complete for all devices owned by the Trust. An action plan has been put together to provide a work programme to achieve compliance with this standard, including: Assurance gained that Contractors are suitably qualified Equipment and Selection process rewritten Annual Report to the Board on Medical Devices to be developed Produce and implement procurement, defect reporting and disposal system Manufacturers guidelines to be added to the Intranet Audit of all Medical Devices Investigate Tracking Solution for Medical Devices Implement Medical Devices Management Computer System. C9 Healthcare organisations have a systematic and planned approach to the management of records to ensure that, from the moment a record is created until its ultimate disposal, the organisation maintains information so that it serves the purpose it was collected for and The Trust identified that an unacceptable level of requests for Clinical Records could not be located within three months of receiving the request and that adverse outcomes could possibly be experienced as a result of these untraced records. The Clinical Records Management Policy was amended Funding was secured Procurement of appropriate post-boxes and the subsequent fixing/fitting at stations Clinical Records Log sheets designed/printed and distributed to stations Guidelines drafted and staff informed of implementation of new process. 94.28%. The Trust anticipates that this level of performance will be recorded as an underachievement against the Annual Health Check. The overall rating for the Quality of Services section of the Annual Health Check is anticipated to be Good. However, the Trust has sustained performance at 95% since August 2008 and achieved 95% for the 9 months from 1 July 2008 to 31 March 2009. Annual Health check Quality of Financial Management The Trust has also provided the Audit Commission with information and evidence to support their Auditors Local Evaluation (ALE) assessment for 2008/09. The evidence collection process was supported by the establishment (at the start of the year) of a proactive ALE panel with membership from all key functions. The panel reviewed, with external auditors, the Trust s submissions for 2007/08 for each standard, identifying any gaps and agreeing a work programme to improve the scoring for 2008/09. The target set by the Trust was to achieve ALE level 4. Improvements have been made across all areas of ALE in 2008/09. However, the overall position is likely to be maintained at level 3. This will result in an annual health check rating of Good for the Quality of Financial Management section of the Annual Health Check.

Internal Audit Internal Audit assess the assurance framework for relevance and fitness for purpose at the end of each financial year and in March 2009 declared the 2008/09 framework as presenting a low risk to the Trust, with a recommendation to include the risk of not achieving each objective in addition to the risk to the Trust, and also deadlines for any action plans. These will be added to the framework document for 2009/10. Risk management and Standards for Better Health processes were also reviewed towards the end of 2008/09 and both found to present a low risk to the Trust. Independent auditor s report to the Board of Directors of South Western Ambulance Service NHS Trust Opinion on the financial statements I have audited the financial statements of South Western Ambulance Service NHS Trust for the year ended 31 March 2009 under the Audit Commission Act 1998. The financial statements comprise the Income and Expenditure Account, the Balance Sheet, the Cashflow Statement, the Statement of Total Recognised Gains and Losses and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out within them. I have also audited the information in the Remuneration Report that is described as having been audited. 6. Commentary on Head of Internal Audit Opinion The overall opinion stated by the Head of Internal Audit is that significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation s objectives and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls may put the achievement of particular objectives at risk. This report is made solely to the Board of Directors of South Western Ambulance Service NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission. Respective responsibilities of Directors and auditor 16 17 The opinion was based on the following: The directors responsibilities for preparing the financial statements in accordance with directions made by the Secretary of State are set out 1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes. in the Statement of Directors Responsibilities. 2. An assessment of the range of individual opinions arising from risk-based audit assignments contained within internal audit risk-based plans that have been reported throughout the year. This assessment has taken account of the relative materiality of these areas and management s progress in respect of addressing control weaknesses. My responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland). 3. An assessment of the process by which the organisation has arrived at its declaration in respect of the Standards for Better Health. 4. Any reliance that is being place on third party assurances. I report to you my opinion as to whether the financial statements give a true and fair view in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I report whether the financial statements and the part of the Remuneration Report to be audited have been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I also report to you whether, in my opinion, the information which comprises the commentary on the financial performance included within the Operational and Financial Review, included in the Annual Report, is consistent with the financial statements. I review whether the directors Statement on Internal Control reflects compliance with the Department of Health s requirements, set out in Guidance on Completing the Statement on Internal Control 2008/09 issued 25 February 2009. I report if it does not meet the requirements specified by the Department of Health or if the statement is misleading or inconsistent with other information I am aware of from my audit of the financial statements.

I am not required to consider, nor have I considered, whether the directors Statement on Internal Control covers all risks and controls. Neither am I required to form an opinion on the effectiveness of the Trust s corporate governance procedures or its risk and control Opinion In my opinion: procedures. I read the other information contained in the Annual Report and consider whether it is consistent with the audited financial statements. This other information comprises the Foreword, the unaudited part of the Remuneration Report, the Chairman s Statement and the remaining elements of the Operating and Financial Review. I consider the implications for my report if I become aware of any apparent misstatements or material inconsistencies with the financial statements. My responsibilities do not extend to any other information. the financial statements give a true and fair view, in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England, of the state of the Trust s affairs as at 31 March 2009 and of its income and expenditure for the year then ended; the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England; and information which comprises the commentary on the financial performance included within the Operational and Financial Review, included within the Annual Report, is consistent with the financial statements. Basis of audit opinion I conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit Practice issued by the Audit Commission and International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources of evidence relevant to the amounts and disclosures in the financial statements and the part of the Remuneration Report to be audited. It Directors Responsibilities also includes an assessment of the significant estimates and judgments made by the directors in the preparation of the financial statements, The directors are responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in the Trust s use of 18 19 and of whether the accounting policies are appropriate to the Trust s circumstances, consistently applied and adequately disclosed. resources, to ensure proper stewardship and governance and regularly to review the adequacy and effectiveness of these arrangements. I planned and performed my audit so as to obtain all the information and explanations which I considered necessary in order to provide me with sufficient evidence to give reasonable assurance that: Auditor s Responsibilities I am required by the Audit Commission Act 1998 to be satisfied that proper arrangement have been made by the Trust for securing the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error; and the financial statements and the part of the Remuneration Report to be audited have been properly prepared. economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires me to report to you my conclusion in relation to proper arrangements, having regard to the criteria for NHS bodies specified by the Audit Commission. I report if significant matters have come to my attention which prevent me from concluding that the Trust has made such In forming my opinion I also evaluated the overall adequacy of the presentation of information in the financial statements and the part of the Remuneration Report to be audited. proper arrangements. I am not required to consider, nor have I considered, whether all aspects of the Trust s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Conclusion I have undertaken my audit in accordance with the Code of Audit Practice and having regard to the criteria for NHS bodies specified by the Audit Commission and published in December 2006, I am satisfied that, in all significant respects, South Western Ambulance Service NHS Trust made proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2009.

Certificate I certify that I have completed the audit of the accounts in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Independent auditor s report to the Board of Directors of South Western Ambulance Service NHS Trust on the NHS Trust Summarisation Schedules I have examined the summarisation schedules numbered TRU01 to TRU35 of South Western Ambulance Service NHS Trust for the year ended 31 March 2009, which have been prepared by the Director of Finance and acknowledged by the Chief Executive. Lee Budge Officer of the Audit Commission 3-6 Blenheim Court, Lustleigh Close, Matford Business Park, Exeter, EX2 8PW. Dated 09.06.09 This report is made solely to the Board of Directors of South Western Ambulance Service NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission. In my opinion these summarisation schedules are consistent with the statutory financial statements. Lee Budge Officer of the Audit Commission 3-6 Blenheim Court, Lustleigh Close, Matford Business Park, Exeter, EX2 8PW. 20 21 Dated 09.06.09 Directors Responsibilities The Directors of South Western Ambulance Service NHS Trust state that, as far as they are aware, there is no relevant audit information of which the NHS body auditors are unaware. The Directors have taken all appropriate steps to ensure they are all aware of relevant audit information and that the auditors are aware of such information. Details of these assurances are specified within the Letter of Representation.

Income and expenditure account for the year ended 31 March 2009 Balance sheet as at 31 March 2009 NOTE Income from activities 3 118,765 105,465 Other operating income 4 3,553 5,403 Operating expenses 5-7 (120,827) (109,969) OPERATING SURPLUS/(DEFICIT) - 1,491 899 Cost of fundamental reorganisation/reconstruction - 0 - Profit/(loss) on disposal of fixed assets 8 24 13 31 March 2009 31 March 2008 NOTE FIXED ASSETS Restated Intangible assets 10 0 0 Tangible assets 11 39,393 40,611 Financial assets 14 0 - TOTAL FIXED ASSETS 39,393 40,611 CURRENT ASSETS Stocks and work in progress 12 909 865 Debtors 13 4,283 6,425 SURPLUS/(DEFICIT) BEFORE INTEREST - 1,515 912 Investments - 0 Interest receivable - 215 416 Other financial assets 14 0-22 Interest payable 9 (52) (55) 23 Cash at bank and in hand 19.3 6,668 1,144 Other finance costs - unwinding of discount 17 (40) (12) TOTAL CURRENT ASSETS 11,860 8,434 SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR - 1,638 1,261 Public dividend capital dividends payable - (1,313) (1,261) RETAINED SURPLUS/(DEFICIT) FOR THE YEAR - 325 0 CREDITORS: Amounts falling due within one year 15.1 (10,012) (9,132) Financial liabilities 16 0 - NET CURRENT ASSETS/(LIABILITIES) 1,848 (698) The 31st March 2008 accounts have been restated for a prior year adjustment for injury benefit which has reduced the I&E reserve by 1,307,000. The notes on pages 22 to 74 form part of these accounts. All income and expenditure is derived from continuing operations. TOTAL ASSETS LESS CURRENT LIABILITIES 41,241 39,913 CREDITORS: Amounts falling due after more than one year 15.1 (382) (483) Financial liabilities 16 0 - PROVISIONS FOR LIABILITIES AND CHARGES 17 (6,254) (2,994) TOTAL ASSETS EMPLOYED 34,605 36,436

31 March 2009 31 March 2008 NOTE FINANCED BY: TAXPAYERS EQUITY Public dividend capital 23 34,406 34,105 Revaluation reserve 18 (25) 2,328 Donated asset reserve 18 194 298 Government grant reserve 18 0 0 Other reserves 18 0 0 Statement of total recognised gains and losses for the year ended 31 March 2009 Surplus/(deficit) for the financial year before dividend payments 1,638 1,261 Fixed asset impairment losses (20) 0 Unrealised surplus/(deficit) on fixed asset revaluations/indexation (2,333) 2,271 Income and expenditure reserve 18 30 (295) Increases in the donated asset and government grant reserve due to receipt of donated and government grant financed assets 0 0 TOTAL TAXPAYERS EQUITY 34,605 36,436 Defined benefit scheme actuarial gains/(losses) 0 0 Additions/(reductions) in other reserves 0 0 The 31st March 2008 accounts have been restated for a prior year adjustment for injury benefit which has reduced the I&E reserve by Total recognised gains and losses for the financial year (715) 3,532 1,307,000. 24 Prior period adjustment (1,307) 0 25 The financial statements on pages 5 to 75 were approved by the Board on 04.06.09 and signed on its behalf by: Total gains and losses recognised in the financial year (2,022) 3,532 Signed: There was a prior year adjustment due to Injury Benefit of 1,306,634 Ken Wenman Chief Executive Date: 04.06.09

Cash flow statement for the year ended 31 March 2009 NOTE OPERATING ACTIVITIES Net cash inflow/(outflow) from operating activities 19.1 12,031 8,726 RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: Interest received 215 416 Interest paid (52) (55) Interest element of finance leases 0 0 Net cash inflow/(outflow) from returns on investments and servicing of finance 163 361 CAPITAL EXPENDITURE (Payments) to acquire tangible fixed assets (5,787) (6,422) NOTE Net cash inflow/(outflow) from management of liquid resources 0 0 Net cash inflow/(outflow) before financing 5,247 1,417 FINANCING Public dividend capital received 301 0 Public dividend capital repaid 0 (1,000) Loans received from the Department of Health 0 0 Other loans received 0 0 Loans repaid to the Department of Health 0 0 Other loans repaid 0 0 Other capital receipts 0 0 Capital element of finance lease rental payments (24) (76) Cash transferred (to)/from other NHS bodies 0 0 Receipts from sale of tangible fixed assets 153 13 Net cash inflow/(outflow) from financing 277 (1,076) (Payments) to acquire intangible assets 0 0 Increase/(decrease) in cash 5,524 341 Receipts from sale of intangible assets 0 0 26 27 (Payments to acquire)/receipts from sale of fixed asset investments - 0 (Payments to acquire)/receipts from sale of financial instruments 0 - Net cash inflow/(outflow) from capital expenditure (5,634) (6,409) DIVIDENDS PAID (1,313) (1,261) Net cash inflow/(outflow) before management of liquid resources and financing 5,247 1,417 MANAGEMENT OF LIQUID RESOURCES (Purchase) of financial assets with the Department of Health 0 0 (Purchase) of other current financial assets 0 0 Sale of financial assets with the Department of Health 0 0 Sale of other current financial asset 0 0

Notes to the accounts 1.4 Intangible fixed assets There are no intangible fixed assets in South Western Ambulance Service NHS Trust 1. Accounting policies The Secretary of State for Health has directed that the financial statements of NHS Trusts shall meet the accounting requirements of the NHS Trust Manual for Accounts which shall be agreed with HM Treasury. The accounting policies contained in that manual follow UK generally accepted accounting practice and HM Treasury s Financial Reporting Manual to the extent that they are meaningful and appropriate to the NHS. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts. 1.5 Tangible fixed assets Capitalisation Tangible assets are capitalised if they are capable of being used for a period which exceeds one year and they: - individually have a cost of at least 5,000; or - collectively have a cost of at least 5,000 and individually have a cost of more than 250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous 1.1 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of fixed assets at their value to the business by reference to their current costs. NHS Trusts are not required to disposal dates and are under single managerial control; or - form part of the initial equipping and setting-up cost of a new building, ward or unit irrespective of their individual or collective cost. provide a reconciliation between current cost and historical cost surpluses and deficits. Valuation 28 29 1.2 Acquisitions and discontinued operations Tangible fixed assets are stated at the lower of replacement cost and recoverable amount. On initial recognition Activities are considered to be acquired only if they are acquired from outside the public sector. Activities are considered to be discontinued only if they cease entirely. They are not considered to be discontinued if they transfer from one public sector body to another. they are measured at cost (for leased assets, fair value) including any costs such as installation directly attributable to bringing them into working condition. They are restated to current value each year. The carrying values of tangible fixed assets are reviewed for impairment in periods if events or changes in circumstances indicate the carrying value may not be recoverable. 1.3 Income Recognition Income is accounted for applying the accruals convention. The main source of income for the Trust is from commissioners in respect of healthcare services provided under local agreements. Income is recognised in the period in which services are provided. Where income is received for a specific activity which is to be delivered in All land and buildings are restated to current value using professional valuations in accordance with FRS15 every five years and in the intervening years by the use of indices. The buildings index is based on the All in Tender Price Index published by the Building Cost Information Service (BCIS). The land index is based on the residential building land values reported in the Property Market Report published by the Valuation Office. the following financial year, that income is deferred. Professional valuations are carried out by the District Valuers of the Revenue and Customs Government Department. The valuations are carried out in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual insofar as these terms are consistent with the agreed requirements of the Department of Health and HM Treasury. In accordance with the requirements of the Department of Health, the last asset valuations were undertaken in 2004 as at the prospective valuation date of 1 April 2005 and were applied on the 31 March 2005.

The valuations are carried out primarily on the basis of Depreciated Replacement Cost for specialised operational property and Existing Use Value for non-specialised operational property. The value of land for existing use purposes is assessed at Existing Use Value. For non-operational properties including surplus land, the valuations are carried out at Open Market Value. the District Valuer based on Department of Health guidance. The District Valuer should provide an estimate of the anticipated fair value of the assets on the same basis as the District Valuer values the NHS Trust s estate. Operational equipment is carried at current value. Where assets are of low value, and/or have short useful economic lives, these are carried at depreciated historic cost as a proxy for current value. Equipment surplus to requirements is valued at net recoverable amount. Additional alternative Open Market Value figures have only been supplied for operational assets scheduled for imminent closure and subsequent disposal. Depreciation, amortisation and impairments Tangible fixed assets are depreciated at rates calculated to write them down to estimated residual value on a Gains arising from indexation and revaluations are taken to the Revaluation Reserve. Losses arising from revaluation are recognised as impairments and are charged to the revaluation reserve to the extent that a balance exists in relation to the revalued asset. Losses in excess of that amount are charged to the current year s Income & Expenditure account, unless it can be demonstrated that the recoverable amount is greater than the revalued straight-line basis over their estimated useful lives. No depreciation is provided on freehold land and assets surplus to requirements. Assets in the course of construction and residual interests in off-balance sheet PFI contract assets are not depreciated until the asset is brought into use or reverts to the Trust, respectively. amount in which case the impairment is taken to the revaluation reserve. Diminutions in value when newly constructed assets are brought into use are charged in full to the Income & Expenditure account. These falls in Buildings, installations and fittings are depreciated on their current value over the estimated remaining life of the 30 31 value result from the adoption of ideal conditions as the basis for depreciated replacement cost valuations asset as advised by the Valuer. Leaseholds are depreciated over the primary lease term. Assets in the course of construction are valued at current cost using the indexes as for land and buildings, as above. These assets include any existing land or buildings under the control of a contractor. Equipment is depreciated on current cost evenly over the estimated life of the asset. Impairment losses resulting from short-term changes in price that are considered to be recoverable in the longer term are taken in full to the revaluation reserve. These include impairments resulting from the revaluation of Residual interests in off-balance sheet Private Finance Initiative properties are included in tangible fixed assets as assets under construction and payments on account where the PFI contract specifies the amount, or nil value at fixed assets from their cost to their value in existing use when they become operational. This may lead to a negative revaluation reserve in certain instances. which the assets will be transferred to the Trust at the end of the contract. The residual interest is built up, on an actuarial basis, during the life of the contract by capitalising part of the unitary charge so that at the end of the contract the balance sheet value of the residual value plus the specified amount equal the expected fair value of During 2008/09 the Trust impared Bridport ambulance station following the decision to dispose of the asset at a valuation lower than the NBV held on the Fixed Asset Register. the residual asset at the end of the contract. The estimated fair value of the asset on reversion is determined by Where the useful economic life of an asset is reduced from that initially estimated due to the revaluation of an asset for sale, depreciation is charged to bring the value of the asset to its value at the point of sale.

1.6 Donated fixed assets Donated fixed assets are capitalised at their current value on receipt and this value is credited to the Donated a fixed asset along with the liability to pay for it which is accounted for as a finance lease. Contract payments are apportioned between an imputed finance lease charge and a service charge. Asset Reserve. Donated fixed assets are valued and depreciated as described above for purchased assets. Gains and losses on revaluations are also taken to the Donated Asset Reserve and, each year, an amount equal to the depreciation charge on the asset is released from the Donated Asset Reserve to the Income and Expenditure account. Similarly, any impairment on donated assets charged to the Income and Expenditure Account is matched by a transfer from the Donated Asset Reserve. On sale of donated assets, the value of the sale proceeds is transferred from the Donated Asset Reserve to the Income and Expenditure Reserve. 1.9 Stocks and work-in-progress Stocks and work-in-progress are valued at the lower of cost and net realisable value. This is considered to be a reasonable approximation to current cost due to the high turnover of stocks. Work-in-progress comprises goods in intermediate stages of production. Partially completed contracts for patient services are not accounted for as work-in-progress. 1.7 Government Grants The Trust received no Government grants in the Financial year. 1.10 Research and development Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the following criteria: 1.8 Private Finance Initiative (PFI) transactions - there is a clearly defined project; The NHS follows HM Treasury s Technical Note 1 (Revised) How to Account for PFI transactions which provides - the related expenditure is separately identifiable; 32 33 practical guidance for the application of the Application Note F to FRS 5 and the guidance Land and Buildings - the outcome of the project has been assessed with reasonable certainty as to: in PFI schemes Version 2. - its technical feasibility; - its resulting in a product or service which will eventually be brought into use; Where the balance of the risks and rewards of ownership of the PFI property are borne by the PFI operator, the PFI obligations are recorded as an operating expense. Where the trust has contributed assets, a prepayment for their fair value is recognised and amortised over the life of the PFI contract by charge to the Income and Expenditure Account. Where, at the end of the PFI contract, a property reverts to the Trust, the difference between the expected fair value of the residual on reversion and any agreed payment on reversion is built up over the life of the contract by capitalising part of the unitary charge each year, as a tangible fixed asset. - adequate resources exist, or are reasonably expected to be available, to enable the project to be completed and to provide any consequential increases in working capital. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the income and expenditure account on a systematic basis over the period expected to benefit from the project. It is revalued on the basis of current cost. The amortisation charge is calculated on the same basis as used for depreciation i.e. on a quarterly basis. Expenditure which does not meet the criteria for capitalisation is treated as an operating cost in the year in which it is incurred. NHS Trusts are unable to disclose the total amount of research Where the balance of risks and rewards of ownership of the PFI property are borne by the Trust, it is recognised as and development expenditure charged in the income and expenditure account because some research and development activity cannot be separated from patient care activity. Fixed assets acquired for use in research and development are amortised over the life of the associated project.

1.11 Provisions The Trust provides for legal or constructive obligations that are of uncertain timing or amount at the balance sheet date on the basis of the best estimate of the expenditure required to settle the obligation. Where the Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. effect of the time value of money is material, the estimated risk-adjusted cash flows are discounted using the Treasury s discount rate of 2.2% in real terms. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of 3.3 billion against the notional assets as at 31 March 2004. However, after taking into account the changes in the benefit Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 17. and contribution structure effective from 1 April 2008, the Scheme actuary reported that employer contributions could continue at the existing rate of 14% of pensionable pay. On advice from the Scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme s liabilities. Up to 31 March 2008, the vast majority of employees paid contributions at the rate of 6% of pensionable pay. From 1 April 2008, employees contributions are on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. Non-clinical risk pooling The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are b) FRS17 Accounting valuation 34 35 risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and, In accordance with FRS17, a valuation of the Scheme liability is carried out annually by the Scheme Actuary as at in return, receives assistance with the costs of claims arising. The annual membership contributions, and any the balance sheet date by updating the results of the full actuarial valuation. excesses payable in respect of particular claims are charged to operating expenses as and when they become due. Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the Scheme Actuary. At this point the assumptions regarding the composition of the Scheme membership are 1.12 Pension costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The updated to allow the Scheme liability to be valued The valuation of the Scheme liability as at 31 March 2009, is based on detailed membership data as at 31 March 2006 (the latest midpoint) updated to 31 March 2009 with summary global member and accounting data. Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying Scheme assets and liabilities. The latest assessment of the liabilities of the Scheme is contained in the Scheme Actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

Scheme Provisions as at 31 March 2009 The scheme is a final salary scheme. benefits. Survivor pensions will be available to married and unmarried partners and will be equal to 37.5% of the member s pension. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the income and expenditure account at the time the Trust commits itself to the retirement, regardless of the method of payment. 1.13 Liquid resources Deposits and other investments that are readily convertible into known amounts of cash at or close to their carrying amounts are treated as liquid resources in the cashflow statement. The Trust does not hold any The Scheme provides the opportunity to members to increase their benefits through money purchase Additional Voluntary Contributions (AVCs) provided by an approved panel of life companies. Under the arrangement the employee/member can make contributions to enhance an employee s pension benefits. The benefits payable relate directly to the value of the investments made. From 1 April 2008 a voluntary additional pension facility becomes available, under which members may purchase up to 5,000 per annum of additional pension at a cost determined by the actuary from time-to-time. investments with maturity dates exceeding one year from the date of purchase. 1.14 Value Added Tax Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. Existing members at 1 April 2008 1.15 Foreign Exchange 36 37 Annual pensions are normally based on 1/80th of the best of the last 3 years pensionable pay for each year of Transactions that are denominated in a foreign currency are translated into sterling at the exchange rate ruling service. A lump sum normally equivalent to 3 years pension is payable on retirement. From 1 April 2008 there is the opportunity of giving up some of the pension to increase the retirement lump sum. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. On death, a pension of 50% of the member s pension is normally payable to the surviving spouse or eligible unmarried partner. on the dates of the transactions. Resulting exchange gains and losses are taken to the Income and Expenditure Account. 1.16 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them. Details of third party assets are given in Note 29 to the accounts. New entrants from 1 April 2008 Annual pensions for new entrants from 1 April 2008 will be based on 1/60th of the best 3 year average of pensionable earnings in the ten years before retirement. Members wishing to obtain a retirement lump sum may give up some of this pension to obtain a retirement lump of up to 25% of the total value of their retirement 1.17 Leases Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS Trust, the asset is recorded as a tangible fixed asset and a debt is recorded to the lessor of the minimum lease payments discounted by the interest rate implicit in the lease. The interest element of the finance lease payment is charged to the Income and Expenditure Account over the period of the lease at a constant rate in relation to the balance outstanding. Other leases are regarded as operating leases and the rentals are charged to the Income and Expenditure Account on a straight-line basis over the term of the lease.

1.18 Public Dividend Capital (PDC) and PDC Dividend Public Dividend Capital represents the outstanding public debt of an NHS Trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the NHS Trust. 1.21 Financial Instruments Financial assets Financial assets are recognised on the balance sheet when the Trust becomes party to the financial instrument contract or, in the case of trade debtors, when the goods or services have been delivered. Financial assets are A charge, reflecting the forecast cost of capital utilised by the NHS Trust, is paid over as public dividend capital derecognised when the contractual rights have expired or the asset has been transferred. dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the forecast average carrying amount of all assets less liabilities, except for donated assets and cash with the Office of the Paymaster General. The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets. A note to the accounts discloses the rate that the dividend represents as a percentage of the actual average carrying amount of assets less liabilities in the year. Financial assets are initially recognised at fair value. Financial assets are classified into the following categories: financial assets at fair value through profit and loss ; held to maturity investments ; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. 1.19 Losses and Special Payments Losses and Special Payments are items that Parliament would not have contemplated when it agreed funds for Financial assets at fair value through profit and loss the health service or passed legislation. By their nature they are items that ideally should not arise. They are Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with 38 39 therefore subject to special control procedures compared with the generality of payments. They are divided into embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value different categories, which govern the way each individual case is handled. Losses and Special Payments are charged to the relevant functional headings in the Income and Expenditure through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the Income and Expenditure Account. The net gain or loss incorporates any interest earned on the financial asset. Account on an accruals basis, including losses which would have been made good through insurance cover had NHS Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). Held to maturity investments Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held 1.20 EU Emissions Trading Scheme EU Emission Trading Scheme allowances are accounted for as Government Granted Other Current Asset, valued at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. at open market value. As the Trust makes emissions a provision is recognised, with an offsetting transfer from the Government Grant Reserve. The provision is settled on surrender of the allowances. The current asset, provision and Government Grant Reserve are valued at current market value at the Balance Sheet date. Available for sale financial assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the Revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to the Income and Expenditure Account on de-recognition.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset s carrying amount and the present value of the revised future cash flows discounted at the asset s original effective interest rate. The loss is recognised in the Income and Expenditure Account and the carrying amount of the asset is reduced directly, or through a provision for impairment of debtors. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through the Income and Expenditure Account to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 2. Segmental analysis 3. Income from Activities Strategic Health Authorities 474 23 NHS Trusts 2,479 3,738 Primary Care Trusts 109,629 97,891 Foundation Trusts 5,031 3,505 Local Authorities 613 0 Department of Health 277 294 NHS Other 0 1 Non NHS: - Private patients 103 10 - Overseas patients (non-reciprocal) 0 0 - Injury cost recovery 154 0 - Other 5 3 The following information segments the results of the NHS Trust by: 118,765 105,465 - Healthcare activities, being all the activities of the NHS Trust 40 41 4. Other Operating Income Healthcare Activities Total INCOME 122,318 110,869 Patient transport services 0 0 Education, training and research 123 124 SURPLUS/(DEFICIT) Segment surplus/(deficit) 325 Charitable and other contributions to expenditure 2,599 4,143 Common costs Transfers from Donated Asset Reserve Transfers from Government Grant Reserve 104 0 298 0 Surplus/(deficit) before interest 1,515 912 Non-patient care services to other bodies 46 46 NET ASSETS: Segment net assets 34,605 37,743 Rental income from finance leases Rental income from operating leases 0 0 0 0 Income generation 681 792 Other income 0 0 3,553 5,403

5. Operating Expenses Other includes Air Ambulance 2,488,000 5.1 Operating expenses comprise: Services from other NHS Trusts 31 41 Services from PCTs 176 134 Services from other NHS bodies 0 0 Services from Foundation Trusts 172 152 Purchase of healthcare from non NHS bodies 0 0 Directors costs 654 614 Staff costs 87,634 77,172 Supplies and services - clinical 3,141 2,639 Supplies and services - general 682 721 Consultancy services 447 102 Establishment 2,990 3,626 Transport 9,927 9,393 5.2. Operating leases 5.2/1 Operating expenses include: Hire of plant and machinery 0 0 Other operating lease rentals 1,099 1,364 1,099 1,364 5.2/2 Annual commitments under non - cancellable operating leases are: Land and buildings Other leases Premises 5,335 4,980 Operating leases which expire: 42 43 Impairment of debtors 29 47 Within 1 year 372 43 88 210 Depreciation 5,103 5,275 Between 1 and 5 years 76 371 228 152 Amortisation 0 235 After 5 years 259 277 0 0 Tangible fixed asset impairments and reversals 53 0 Intangible fixed asset impairments and reversals 0 0 707 691 316 362 Impairments and reversals of financial assets (by class) 5 47 Change in the fair value of financial instruments 0 - Audit fees 128 106 Other auditor s remuneration 0 0 Clinical negligence 55 43 Redundancy costs 597 92 Education and training 633 693 Other 3,035 3,857 120,827 109,969

6. Staff costs and numbers 6.1 Staff costs Total Permanently Employed Other Salaries and wages 75,822 74,017 1,805 66,360 Social Security Costs 4,487 4,487 0 4,176 Employer contributions to NHS BSA - Pensions Division 7,925 7,925 0 7,316 Other pension costs 0 0 0 0 6.2 Average number of persons employed 88,234 86,429 1,805 77,853 6.3 Employee benefits Nil 0 0 0 0 6.4 Management costs Management costs 5,824 5,433 Income 122,317 110,868 Total Permanently Other 44 Employed FinanceAndPlanning/NHSManagementCosts/fs/en. 45 Number Number Number Number Medical and dental 50 48 2 37 Ambulance staff 1,527 1,527 0 1,502 Administration and estates 439 400 39 350 Healthcare assistants and other support staff 309 309 0 314 Nursing, midwifery and health visiting staff 23 13 10 9 Management costs are defined as those on the management costs website at www.dh.gov.uk/policyandguidance/organisationpolicy/ 6.5 Retirements due to ill-health During 2008/09 there were 3 (2007/08, 10) early retirements from the NHS Trust agreed on the grounds of ill-health. The estimated additional pension liabilities of these ill-health retirements will be 295,851 (2007/08: 492,731). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division. Nursing, midwifery and health visiting learners 0 0 0 0 Scientific, therapeutic and technical staff 0 0 0 0 Social care staff 0 0 0 0 Other 0 0 0 0 Total 2,348 2,297 51 2,211

7. Better Payment Practice Code 7.1 Better Payment Practice Code - measure of compliance 2008/09 Number 000 Total Non-NHS trade invoices paid in the year 30,965 27,235 Total Non NHS trade invoices paid within target 30,285 27,235 Percentage of Non-NHS trade invoices paid within target 98% 100% Total NHS trade invoices paid in the year 739 4,702 Total NHS trade invoices paid within target 702 4,667 Percentage of NHS trade invoices paid within target 95% 99% The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later. 8. Other gains and losses Gain on disposal of fixed asset investments 0 0 (Loss) on disposal of fixed asset investments 0 0 Gain on disposal of intangible fixed assets 0 0 (Loss) on disposal of intangible fixed assets 0 0 Gain on disposal of land and buildings 0 0 (Loss) on disposal of land and buildings 0 0 Gains on disposal of plant and equipment 24 13 (Loss) on disposal of plant and equipment 0 0 Gain/(loss) on foreign exchange 0 0 Change in fair value of financial assets carried at fair value through profit and loss 0 - Change in fair value of financial liabilities carried at fair value through profit and loss 0-7.2 The Late Payment of Commercial Debts (Interest) Act 1998 46 Recycling of gain/(loss) from equity on disposal of financial assets 47 Amounts included within Interest Payable (Note 9) arising from claims made under this legislation 0 0 Compensation paid to cover debt recovery costs under this legislation 0 0 held for sale 0-24 13 TOTAL 0 0

9. Finance Costs & Interest receiveable Finance Costs Finance leases 52 56 Late payment of commercial debt 0 0 Loans 0 0 Bank loans and overdrafts 0 0 Other interest and finance costs 0 0 TOTAL 52 56 Interest Receivable Bank accounts 215 416 Impaired financial assets 0 - Other financial assets 0 - TOTAL 215 416 48 Total at 1 April 2008 0 0 0 0 0 49 10. Intangible Fixed Assets Software licences Licenses and trademarks Patents Development expenditure 000 Gross cost at 1 April 2008 0 0 0 0 0 Indexation 0 0 Impairments 0 0 0 0 0 Reclassifications 0 0 0 0 0 Revaluation 0 0 0 0 0 Additions purchased 0 0 0 0 0 Additions donated 0 0 0 0 0 Additions government granted 0 0 0 0 0 Disposals 0 0 0 0 0 Gross cost at 31 March 2009 0 0 0 0 0 Total Software licences Licenses and trademarks Patents Development expenditure Total 000 Amortisation at 1 April 2008 0 0 0 0 0 Indexation 0 0 Impairments 0 0 0 0 0 Reversal of impairments 0 0 0 0 0 Reclassifications 0 0 0 0 0 Revaluation 0 0 0 0 0 Charged during the year 0 0 0 0 0 Disposals 0 0 0 0 0 Amortisation at 31 March 2009 0 0 0 0 0 Net book value Purchased at 1 April 2008 0 0 0 0 0 Donated at 1 April 2008 0 0 0 0 0 Government granted at 1 April 2008 0 0 0 0 0 Purchased at 31 March 2009 0 0 0 0 0 Donated at 31 March 2009 0 0 0 0 0 Government granted at 31 March 2009 0 0 0 0 0 Total at 31 March 2009 0 0 0 0 0

11. Tangible Fixed Assets 11.1 Tangible fixed assets at the balance sheet date comprise the following elements: Land Buildings Excluding dwellings Dwellings Assets under construct and poa Plant and machinery Transport equipment Information technology Furniture & fittings 000 Total Depreciation at 31 March 2009 Net book value Land Buildings Excluding dwellings Dwellings Assets under construct and poa Plant and machinery Transport equipment Information technology Furniture & fittings 000 31 923 0 48 2,757 15,098 3,014 826 22,697 Total Cost or valuation at 1 April 2008 Additions purchased 7,694 14,731 0 4,563 3,282 24,074 5,230 1,111 60,685 0 766 0 2,973 24 2,218 420 20 6,421 Additions donated 0 0 0 0 0 0 0 0 0 Additions government granted 0 0 0 0 0 0 0 0 0 Impairments (15) (5) 0 0 0 0 0 0 (20) Reclassifications 0 333 0 (3,747) 73 2,152 888 301 0 Indexation (1,567) (1,213) 0 184 86 633 0 31 (1,846) Revaluation 0 0 0 0 79 (3) 0 0 76 - Donated at 31 0 0 0 0 194 0 0 0 194 50 Disposals 0 0 0 0 (35) (1,918) (1,234) 0 (3,187) March 2009 51 Cost or Valuation at 31 March 2009 Depreciation at 1 April 2008 Charged during the year 6,112 14,612 0 3,973 3,509 27,156 5,265 1,463 62,090 0 0 0 0 2,313 13,647 3,411 703 20,074 0 921 0 0 308 2,912 860 102 5,103 Impairments 31 6 0 48 0 0 0 0 85 Reversal of Impairments 0 0 0 0 0 (32) 0 0 (32) Reclassifications 0 (4) 0 0 0 0 0 4 0 Indexation 0 (5) 0 0 60 361 0 17 438 Revaluation 0 0 0 0 81 44 0 0 125 Disposals 0 0 0 0 (36) (1,803) (1,257) 0 (3,096) - Purchased at 1 April 2008 - Donated at 1 April 2008 - Government granted at 1 April 2008 - Total at 1 April 2008 - Purchased at 31 March 2009 - Government granted at 31 March 2009 - Total at 31 March 2009 7,694 14,731 0 4,563 707 10,391 1,819 408 40,313 0 0 0 0 262 36 0 0 298 0 0 0 0 0 0 0 0 0 7,694 14,731 0 4,563 969 10,427 1,819 408 40,611 6,081 13,689 0 3,925 558 12,058 2,251 637 39,199 0 0 0 0 0 0 0 0 0 6,081 13,689 0 3,925 752 12,058 2,251 637 39,393

Land Buildings Excluding dwellings Dwellings Assets under construct and poa Plant and machinery Transport equipment Information technology Furniture & fittings 000 Net book value 31 March 2009 Owned 6,081 12,837 0 3,925 752 12,058 2,251 637 38,541 Finance Leased 0 852 0 0 0 0 0 0 852 On balance sheet PFI contracts 0 0 0 0 0 0 0 0 0 PFI residual interests Total 31 March 2009 0 0 0 0 0 0 0 0 0 6,081 13,689 0 3,925 752 12,058 2,251 637 39,393 Total 11.4 The net book value of land, buildings and dwellings at 31 March 2009 comprises: Freehold 18,918 20,381 Long Leasehold 852 1,609 Short Leasehold 0 435 TOTAL 19,770 22,425 11.5 Economic Lives of Fixed Assets: Net book value 1 April 2008 Owned 7,694 13,743 0 4,563 969 10,427 1,819 408 39,634 Finance Leased 0 988 0 0 0 0 0 0 988 On balance sheet PFI contracts 0 0 0 0 0 0 0 0 0 PFI residual 0 0 0 0 0 0 0 0 0 Transport Equipment 2 15 52 53 interests Total 1 April 2008 7,694 14,731 0 4,563 969 10,427 1,819 408 40,611 Min Life Years Max Life Years Software Licences 5 5 Development Expenditure 0 0 Buildings exc dwellings 10 57 Plant & Machinery 5 10 Information Technology 5 10 Furniture and Fittings 5 5 12. Stocks and Work in Progress 11.3 The total amount of depreciation charged to the income and expenditure in respect of assets held under finance leases and hire purchase contracts: 31 March 2009 31 March 2008 Depreciation 31 March 2009 Depreciation 31 March 2008 Land Buildings Excluding dwellings Dwellings Assets under construct and poa Plant and machinery Transport equipment Information technology Furniture & fittings 000 0 0 0 0 0 0 0 0 0 0 65 0 0 0 0 0 0 65 Total Raw materials and consumables 909 865 Work-in-progress 0 0 Finished goods 0 0 TOTAL 909 865

13. Debtors 13.1 Debtors at the balance sheet date are made up of: Other Debtors include 0 prepaid pension contributions at 31 March 2009 ( 0 at 31 March 2008) 31 March 2009 31 March 2008 13.2 Provision for impairment of debtors 31 March 2009 Amounts falling due within one year: NHS debtors 2,733 2,593 Non NHS trade debtors 357 0 Provision for impairment of debtors (29) 0 000 Balance at 1 April 0 Amount written off during the year 0 Amount recovered during the year 0 (Increase)/decrease in debtors impaired 29 Other prepayments and accrued income 586 2,590 Balance at 31 March 29 Current part of PFI payment 0 0 Other debtors 182 790 Sub Total: falling due within one year Amounts falling due after more than one year: 3,829 5,973 By up to 3 months 0 By 3 to 6 months 0 54 NHS debtors 454 452 55 Non NHS trade debtors 0 0 Provision for impairment of debtors 0 0 13.3 Debtors past due date but not impaired: 31 March 2009 000 By more than 6 months 0 TOTAL 0 Other prepayments and accrued income 0 0 14. Other Financial Assets Other debtors 0 0 Sub Total: falling due after more than one year 454 452 TOTAL 4,283 6,425 Current financial assets Fixed financial assets 31 March 2009 31 March 2009 Financial assets carried at fair value through profit and loss 0 0 Held to maturity investments at amortised cost 0 0 Available for sale financial assets carried at fair value 0 0 Loans carried at amortised cost 0 0 TOTAL 0 0

15. Creditors 15.1 Creditors at the balance sheet date are made up of: Amounts falling due within one year: 31 March 2009 31 March 2008 Imputed finance leases element of on balance sheet PFI contracts 31 March 2009 31 March 2008 0 0 Other 10 12 Bank overdrafts 0 0 Current instalments due on loans 0 0 Interest payable 0 0 Payments received on account 0 0 Sub Total: amounts falling due in more than one year 382 483 TOTAL 10,394 9,615 NHS creditors 669 565 Non - NHS trade creditors - revenue 2,032 2,510 Non - NHS trade creditors - capital 1,607 996 Tax 836 834 VAT 0 0 Social security costs 787 730 15.2 Loans [and other long-term financial liabilities] 56 Obligations under finance leases and hire purchase 75 0 57 contracts Other creditors (1) 274 Other creditors include; nil for payments due in future years under arrangements to buy out the liability for nil early retirements over 5 years; and - 1,123,783 outstanding pensions contributions at 31 March 2009 (31 March 2008 109,904). - In 2007-08 South Western Ambulance Services NHS Trust paid their pension contributions on the 28th March 2008. Department of Health Other 31 March 2009 31 March 2008 Accruals and deferred income 4,007 3,223 Current part of finance leases element of on balance sheet PFI contracts 0 0 Sub Total: amounts falling due within one year 10,012 9,132 Amounts falling due: In one year or less 0 0 0 0 Between one and two years 0 0 0 0 Between two and five years 0 0 0 0 Amounts falling due after more than one year: Long - term loans 0 0 Obligations under finance leases and hire purchase contracts 372 471 NHS creditors 0 0 Over 5 years 0 0 0 0 TOTAL 0 0 0 0

In more than 1 year but no longer than 2 75 303 Department of Health Other 31 March 2009 31 March 2008 Wholly repayable within five years 0 0 0 0 In more than 2 years but no longer than 5 228 In more than 5 years 441 577 819 956 Less finance charges allocated to future periods (372) (485) Wholly repayable after five years, not by instalments Wholly or partially repayable after five years, by instalments 0 0 0 0 0 0 0 0 447 471 TOTAL 0 0 0 0 Total repayable after five years by instalments 0 0 0 0 16. Other Financial Liabilities Due within one year Due after more than one year 31 March 2009 31 March 2009 Loans [and long-term financial liabilities] wholly or partially repayable after five years: 31 March 2009 31 March 2008 Financial liabilities carried at fair value through profit and loss 0 0 58 Value Value 59 Interest rate outstanding outstanding % Terms of payment Nil 15.3 Finance lease obligations 31 March 2009 31 March 2008 Payable: In one year or on demand 75 76

17. Provisions for liabilities and charges Pensions relating to former directors Pensions relating to other staff Restated Legal claims Restructurings Other Total 18. Movements on Reserves Movements on reserves in the year comprised the following: Revaluation Reserve Donated Asset Reserve Government Grant Reserve Other Reserves Income and Expenditure Reserve Total At 1 April 2008 0 1,356 502 0 1,136 2,994 Arising during the year 0 771 63 0 3,190 4,024 Utilised during the year 0 (282) (509) 0 (2) (793) Reversed unused 0 0 (11) 0 0 (11) Unwinding of discount 0 40 0 0 0 40 At 1 April 2008 as previously stated 2,328 298 0 0 1,012 3,638 PPA: other 0 0 0 0 (1,307) (1,307) PPA: elimination of negative revaluation reserves in respect of change in policy on impairments 0 0 0 0 0 0 At 1 April 2008 as restated 2,328 298 0 0 (295) 2,331 At 31 March 2009 0 1,885 45 0 4,324 6,254 Transfer from the income and expenditure account 325 325 Expected timing of cashflows: 60 Within one year 0 0 5 0 4,248 4,253 Surplus/(deficit) on other revaluations/ (2,333) 0 0 (2,333) 61 Between one and five years 0 0 40 0 5 45 After five years 0 1,885 0 0 71 1,956 The Trust has made a provision for outstanding Agenda for change issue. This is shown in other. The Trust has made a provision for a personnel injury benefit and has required a prior period adjustment. This is shown in pensions relating to other staff. Fixed asset impairments (20) 0 0 (20) indexation of fixed/current assets Transfer of realised profits/(losses) to the income and expenditure reserve Receipt of donated/government granted assets Transfers to the income and expenditure account for depreciation, impairment, and disposal of donated/government granted assets 0 0 0 0 0 0 0 0 (104) 0 (104) Other transfers between reserves 0 0 0 0 0 0 Other movements on reserves 0 0 1,652,615 is included in the provisions of the NHS Litigation Authority at 31 March 2009 in respect of clinical negligence liabilities of the NHS Trust (31 March 2008 1,322,649). Reserves eliminated on dissolution 0 0 0 0 0 0 At 31 March 2009 (25) 194 0 0 30 199 Other Provisions also include Pre 1986 Holiday entitlements and the Ambulance Radio Project which has been increased on 2007/08. Prior period adjustment other relates to a increase in the provision for personal injury benefit relating to financial periods from 1996/97 to 2007/08.

19. Notes to the cash flow Statement 19.2 Reconciliation of net cash flow to movement in net debt 19. 1 Reconciliation of operating surplus to net cash flow from operating activities: Total operating surplus/(deficit) 1,491 899 Depreciation and amortisation charge 5,103 5,510 Asset impairments and reversals, and movement in financial instruments 58 0 Transfer from Donated Asset Reserve (104) (298) Transfer from the Government Grant Reserve 0 0 (Increase)/decrease in stocks (44) (89) (Increase)/decrease in debtors 2,142 442 Increase/(decrease) in cash in the period 5,524 341 Cash (inflow) from new debt 0 0 Cash outflow from debt repaid and finance lease capital payments 24 76 Cash (inflow)/outflow from (decrease)/increase in liquid resources 0 0 Change in net debt resulting from cash flows 5,548 417 Non - cash changes in debt 0 (55) Net debt at 1 April 2008 673 311 Net debt at 31 March 2009 6,221 673 Increase/(decrease) in creditors 165 1,706 Increase/(decrease) in provisions 3,220 556 Net cash inflow/(outflow) from operating activities before restructuring costs 12,031 8,726 62 63 Payments in respect of fundamental reorganisation/restructuring 0 0 Net cash inflow from operating activities 12,031 8,726 Asset impairments are split between the disposal of Bridport Ambulance station ( 37k) sold in April 09 and Trust HQ stores not relocating ( 5k), software write off ( 11k) and 5k for bad debt provision. 19.3 Analysis of changes in net debt At 1 April 2008 Cash Transferred (to)/ from other NHS bodies Other cash changes in year Non-cash changes in year At 31 March 2009 000 OPG cash at bank 1,142 0 5,524 6,666 Commercial cash at bank and in hand 2 0 0 2 Bank overdraft 0 0 0 0 Loan from the Department of Health due within one year 0 0 0 0 0 Other debt due within one year 0 0 0 0 0 Loan from the Department of Health due after one year 0 0 0 0 0 Other debt due after one year 0 0 0 0 0 Finance leases (471) 0 24 0 (447) Current asset investments 0 0 - Current financial assets 0 0 0 0 673 0 5,548 0 6,221

20. Capital Commitments Commitments under capital expenditure contracts at 31 March 2009 were nil (31 March 2008 nil) 23. Movement in Public Dividend Capital 21. Post Balance Sheet Events There are no post balance sheet events having a material effect on the accounts 22. Contingencies Public Dividend Capital as at 1 April 2008 34,105 35,105 New Public Dividend Capital received (including transfers from dissolved NHS Trusts) 301 0 Public Dividend Capital repaid in year 0 (1,000) Public Dividend Capital written off 0 0 Other movements in Public Dividend Capital in year 0 0 Contingent liabilities 0 0 Public Dividend Capital as at 31 March 2009 34,406 34,105 Amounts recoverable against contingent liabilities 0 0 Net value of contingent liabilities 0 0 24. Financial Performance Targets 24.1 Breakeven Performance The Trust s breakeven performance for 2008/09 is as follows: Contingent Assets 0 0 64 2006/07 2007/08 2008/09 65 000 Contingent Liability Note The South Western Ambulance Service NHS Trust is in discussion with local Trade Union Representatives about the Technician Band 4 role. If the negotiations falter the matter will be referred to the National Panel. The outcome of the National Panel would be uncertain and is not quantifiable. Turnover 104,602 110,868 122,318 Retained surplus/(deficit) for the year 1,012 0 325 Adjustment for: - Use of pre - 1.4.97 surpluses [FDL(97) 24 Agreements] 0 0 0-2006/07 Prior Period Adjustment (relating to 1997/98 to 2005/06) 0 0 0-2007/08 Prior Period Adjustment (relating to 1997/98 to 2006/07) 0 0 0-2008/09 Prior Period Adjustment (relating to 1996/97 to 2007/08 (1,258) (49) 0 - Adjustments for Impairments 53 - Other agreed adjustments 0 0 Break-even in-year position (246) (49) 378 Break-even cumulative position (246) (295) 83 Materiality test (I.e. is it equal to or less than 0.5%): - Break-even in-year position as a percentage of turnover -0.24% -0.04% 0.31% - Break-even cumulative position as a percentage of turnover -0.24% -0.27% 0.07%

Due to prior period adjustments of 1,258k in 2006-07 and 49k in 2007-08, the breakeven position has changed from a surplus of 1,012 in 2006-07 to a deficit of 246k and a cumulative deficit of 295k in 2007-08. The cumulative deficit carried forward to 2008-09 has been 24.4 Capital Resource Limit The Trust is given a capital resource limit which it is not permitted to overspend addressed by the Trust generating a surplus of 325k in 2008-09. 24.2 Capital cost absorption rate The Trust is required to absorb the cost of capital at a rate of 3.5% of average relevant net assets. The rate is calculated as the percentage that dividends paid on public dividend capital, totalling 1,313k, bears to the average relevant net assets of 31,371k, that is 4.2%. Gross capital expenditure 6,421 5,208 Less: book value of assets disposed of (130) (7) Plus: loss on disposal of donated assets 0 0 Less: capital grants 0 0 The variance from 3.5% arises from cash in bank of 6,668k compared to a plan of 1,144k. This is due to 4,200k more cash in bank to service provisions and not making a pensions payment of a 1,000k in March 09. The average assets used in the calculation was also affected by the changes to the reduction in value of land and buildings of 3,729k. Less: donations towards the acquisition of fixed assets 0 0 Charge against the capital resource limit 6,291 5,201 Capital resource limit 6,313 5,270 (Over)/Underspend against the capital resource limit 22 69 24.3 External financing The Trust is given an external financing limit which it is permitted to undershoot. 66 67 000 External financing limit (4,276) (1,321) Cash flow financing (5,247) (1,417) Finance leases taken out in the year 0 76 Other capital receipts 0 0 External financing requirement (5,247) (1,341) Undershoot/(overshoot) 971 20

25. Related Party Transactions South Western Ambulance Service NHS Trust is a body corporate established by order of the Secretary of State for Health. 26. Private Finance Transactions 26.1 PFI schemes deemed to be off-balance sheet During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with South Western Ambulance Service NHS Trust. Amounts included within operating expenses in respect of PFI transactions deemed to be off-balance sheet - gross 716 716 Amortisation of PFI deferred asset 0 0 The Department of Health is regarded as a related party. During the year South Western Ambulance Service NHS Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Net charge to operating expenses 716 716 Department. These entities are listed below: NHS Devon NHS Somerset NHS Cornwall & Isles of Scilly NHS Dorset 22.6 million 22.6 million 19.7 million 15.6 million NHS Bournemouth & Poole 12.5 million The estimated annual payments in future years are expected to be materially different from those which the NHS Trust is committed to make 68 NHS Plymouth 7.3 million 69 Torbay Care Trust Plymouth Hospitals NHS Trust Royal Devon & Exeter NHS Foundation Trust Taunton & Somerset NHS Trust Dorset County Hospital NHS Foundation Trust Royal Bournemouth & Christchurch Foundation Trust Royal Cornwall Hospital NHS Trust Poole Hospitals NHS Foundation Trust Northern Devon Healthcare NHS Trust Department of Health Devon Partnership NHS Trust Yeovil District Hospital NHS Foundation Trust NHS South West 8.6 million 0.9 million 1.0 million 1.2 million 0.8 million 0.8 million 0.6 million 0.5 million 0.3 million 0.3 million 0.2 million 0.3 million 0.5 million The NHS Trust is committed to make the following payments during the next year. PFI scheme which expires; Within one year 716 0 2nd to 5th years (inclusive) 0 746 during the next year. The Trust assumes the contract will end in 2009-10 and the relevant asset will revert to Sunguard Estimated capital value of the PFI scheme 690 1,055 Contract Start date: 01/12/2001 Contract End date: 30/09/2012 The Scheme is for an In-Vehicle Navigation System and Mobile Data (AVLS) linked to software at the Ambulance Control Centre via In addition the Trust has had a number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with the Inland Revenue. radiomasts throughout the region. The contract is with Sunguard for a period of 10 years and the start date is upon full acceptance of the equipment and software operating systems. The service provider is responsible for maintenance of all software and equipment. Remedies are available to the Trust should the service provider fail to maintain the contracted level of performance. In general there will be credits to reduce the monthly charge and a penalty points system. The credits and penalty points depend upon the severity, extent and time loss of the failure. If the service provider consistently fails on the contract there is a remedy for the Trust to seek an alternative service provider to take over the managed service.

26.2 Service element of PFI schemes deemed to be on-balance sheet The Trust is committed to make the following service payments during the next year. Amounts included within operating expenses in respect of the service element of PFI schemes deemed to be on-balance sheet 0 0 Amortisation of PFI deferred asset 0 0 PFI scheme which expires; Net charge to operating expenses 0 0 Imputed finance lease obligations comprise; Within one year 0 0 2nd to 5th years (inclusive) 0 0 Rentals due within 1 year 0 0 The estimated annual payments in future years are expected to be materially different from those which the Trust is committed to make during the next year. The likely financial effect of this is nil. Rentals due more than 1 year but less than 2 years 0 0 Rentals due within 2 to 5 years 0 0 27. Pooled Budget The Trust operated no pooled budgets during the year. Rentals due after 5 years 0 0 70 Sub total 0 0 28. Financial Instruments 71 Less: interest element 0 0 Financial Reporting Standard 29 requires disclosure of the role that financial instruments have had during the period in creating or changing TOTAL 0 0 the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Trust has with Primary Care Trusts and the way those Primary Care Trusts are financed, the NHS Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which these standards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-today operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities. The Trust s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust s Standing Financial Instructions and policies agreed by the Board of Directors. Trust treasury activity is subject to review by the Trust s internal auditors. Currency risk The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Interest-rate risk The Trust borrows from Government for capital expenditure subject to affordability as confirmed by the NHS South West. The borrowings are for 1-25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations. Total Floating Rate Fixed rate Noninterest bearing Gross financial assets 7,262 6,668 454 140 Weighted average interest rate Fixed rate Weighted average period for which fixed Noninterest bearing Weighted average term Credit risk At 31 March 2008 Because of the majority of the Trust s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposure as at 31 March 2009 are in receivables form customers, as disclosed in the debtors note. Sterling 1,596 1,144 452 0 2.20 21 0 Other 0 0 0 0 0.00 0 0 Liquidity risk Gross financial assets 1,596 1,144 452 0 The Trust s new operating costs are incurred under contract with Primary Care Trusts, which are financed from resources voted annually by Parliament. The trust funds it capital expenditure from funds obtained within it Prudential Borrowing Limit. The Trust is not, therefore, exposed to significant liquidity risks. Total Floating Fixed rate Noninterest average average average Weighted Weighted Weighted 28.1 Financial Assets 72 73 Rate bearing interest rate period for term Total Floating Rate Fixed rate Noninterest bearing Weighted average interest rate Fixed rate Weighted average period for which fixed Noninterest bearing Weighted average term Currency % Years Years At 31 March 2009 28.2 Financial Liabilities Fixed rate which fixed Noninterest bearing Currency % Years Years At 31 March 2009 Sterling (4,751) 0 (4,751) 0 2.9 11 0 Other 0 0 0 0 0.0 0 0 Gross financial liabilities (4,751) 0 (4,751) 0 Sterling 7,262 6,668 454 140 2.20 29 0 Other 0 0 0 0 0.00 0 0 At 31 March 2008 Sterling (36,274) 0 (2,169) (34,105) 9.0 12 0 Other 0 0 0 0 0.0 0 0 Gross financial liabilities (36,274) 0 (2,169) (34,105) Note: The public dividend capital is of unlimited term.

28.3 Financial Assets At fair value through profit and loss Loans and receivables Available for sale Total Embedded derivatives 0 0 0 0 NHS debtors 0 454 0 454 Non NHS debtors 0 0 0 0 Cash at bank and in hand 6,668 0 0 6,668 29. Third Party Assets The Trust does not hold assets on behalf of patients. 30. Intra-Government and Other Balances Debtors: amounts falling due within one year Debtors: amounts falling due after more than one year Creditors: amounts falling due within one year Creditors: amounts falling due after more than one year Other financial assets 0 0 140 140 Total at 31 March 2009 6,668 454 140 7,252 28.4 Financial Liabilities Balances with other Central Government Bodies 2,761 454 3,228 0 Balances with Local Authorities 140 0 0 0 Balances with NHS Trusts and Foundation Trusts 439 0 243 0 Balances with Public Corporations and Trading Funds 0 0 0 0 At fair value through profit and loss Other Total Balances with bodies external to Government 489 0 6,541 382 74 000 75 Embedded derivatives 0 0 0 Intra Government balances 3,340 454 3,471 0 At 31 March 2009 3,829 454 10,012 382 NHS creditors 0 0 0 Non NHS creditors 10 0 10 Borrowings 0 0 0 Private Finance Initiative and finance lease obligations 372 0 372 Other financial liabilities 4,369 0 4,369 Balances with other Central Government Bodies 1,709 452 313 0 Balances with Local Authorities 19 0 184 0 Balances with NHS Trusts and Foundation Trusts 180 0 25 0 Balances with Public Corporations and Trading Funds 704 0 227 0 Intra Government balances 2,612 452 749 0 Total at 31 March 2009 4,751 0 4,751 Balances with bodies external to Government 3,361 0 8,383 483 At 31 March 2008 5,973 452 9,132 483 31. Losses and Special Payments There were 552 cases of losses and special payments (31 March 2008: 395 cases) totalling 161,098 (31 March 2008: 206,532) during 31 March 2009. There were no cases over 250,000.

Glossary of financial terms Public Sector Payment Policy The Public Sector Payment Policy (PSPP) requires the Trust to aim to pay all valid non NHS invoices by its due date or within 30 days of receipt Balance Sheet of goods or valid invoice A statement of an organisations financial position at a point in time, its shows both sides of the financial position what an organisation owns and what it owes. Statement of Recognised Gains and Losses This statement brings together all the gains and losses of the organisation for the year and shows the aggregate increase in its net worth. In Capital Cost Absorption Rate The process whereby the cost of capital is incorporated within the costing process for the purpose of determining speciality and procedure addition to the surplus/deficit generated on the Income and Expenditure Account, it includes items such as gains and losses relating to the revaluation of fixed assets. pricing. Capital Resource Limit An expenditure limit agreed by the Department of Health limiting the amount that can be spent on capital purchases. Cashflow Statement 76 77 This statement reconciles the change in cash position of the organisation to its income and expenditure position, its investment in assets and its borrowing. External Financing Limit Cashflow target, NHS organisations cannot exceed a stated cash drawing requirement. Income and Expenditure Account This reports the income and expenditure incurred from normal operations of the organisation during the financial year, this excludes capital expenditure.

www.swast.nhs.u uk If you would like a copy of this report in another format such as Braille, audio tape, total communications (suits the needs of learning disabled) large print, another language or any other format, please contact: Email: publicrelations@swast.nhs.uk Fax: 01392 261560 Tel: 01392 261586 Post: Patient Advice and Liaison Services (PALS) Manager, South Western Ambulance Service NHS Trust, Abbey Court, Eagle Way, Sowton Industrial Estate, EXETER, Devon, EX2 7HY