Last week saw the publication of the Pembrokeshire and Derwen NHS Trust's annual report for 2003/2004. The report reveals a period of intense activity and change in all areas of the Trust and highlights the exciting developments which have occurred, together with the challenges which have been tackled with commendable enthusiasm and energy by the Trust's dedicated workforce. The highlights for the year included the opening of new adult mental health and psychiatry of old age in-patient facilities on the award-winning Bro Cerwyn site in Haverfordwest, supported by leading edge Crisis Resolution services; excellent progress on the planned reprovision from St. David's Hospital in Carmarthen and the development and approval of new integrated health and social care developments in both Pembroke Dock and Tenby. Staff also worked extremely hard to achieve end of year waiting time targets and the income and expenditure target agreed by the Welsh Assembly Government. During the year, increasing service pressures continued, the most notable being a 12 per cent increase in attendances at Withybush Hospital's accident and emergency department. A business case for the development of a new department is currently being prepared and is one of the key strands of the Trust's plans to address these growing pressures. The year began with the publication of the Commission for Health Improvement Report into the Trust's services. Although this proved very challenging for the Trust, it was an opportunity for a thorough review of services. This involved a wide variety of stakeholders across Pembrokeshire, Ceredigion and Carmarthenshire and is assisting with developing and improving the range and quality of local service provision. The Trust employs over 3,000 staff in acute, community, mental health and learning disability services and throughout the report, their loyalty and commitment is evident. Tribute is paid to them by the Trust's chairman and chief executive and also to the Trust's statutory and non-statutory partners and to the many voluntary helpers who give their time so generously to support patients and staff. During the year, new Trustwide management structures were agreed. These have streamlined arrangements and have put the Trust on a good footing to modernise and improve services in line with the recommendations arising from the review of Health and Social Care in Wales, as advised by Derek Wanless. The annual report was presented to the Trust Board and the public at the Trust's annual meeting held in Carmarthen last Thursday.