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Working together to achieve the best health and well-being for all the people of Kirklees.
Annual Report
08|09
Contents
Contents 2 All about NHS Kirklees.............................................................................................. 3 NHS Kirklees’ commissioning and provider roles....................................................... 5 Our vision, values and goals...................................................................................... 8 Working with our partners....................................................................................... 9 Continuously improving quality and learning ....................................................... 11 Driving down waiting times.................................................................................. 13 Improving health and well-being.......................................................................... 14 Maternity matters................................................................................................. 18 Beating infection..................................................................... 18 Substance misuse and alcohol................................................ 19 Primary care developments..................................................... 20 Intermediate care...................................................................... 22 Creating even more choice..................................................... 22 Long term conditions.............................................................. 23 Mental health and learning disabilities.................................... 24 Listening to you................................................................. 24 Involving patients and the public in their local NHS...... 27 Risk management.............................................. 29 Valuing our staff............................................... 29 Making people safe.............................................. 32 Impact on the environment..................................................... 33 Contracts for services............................................................... 33 Our directorates....................................................................... 34 Our Board................................................................................ 35 Director of finance report....................................................... 36 Remuneration report.............................................................. 42 Welcome..................................................................................................................
NHS Kirklees Annual Report 08|09
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Welcome From the Chairman, Chief Executive and Professional Executive Committee (PEC) Chairman.
Welcome to the Annual Report of NHS Kirklees for 2008/2009 - another busy and challenging year for all of us. We changed our name from Kirklees Primary Care Trust to NHS Kirklees in 2008. We hope this reflects our role as the local leader of the NHS and helps people recognise us as the organisation responsible for spending NHS money and improving people’s health and well-being across Kirklees. Also in 2008/09 we joined in the celebrations of the 60th anniversary of the NHS with a number of local events and roadshows, culminating in a celebration of the achievements of our staff at a fabulous awards night. This year saw the publication of a number of important reports; all looking at how the NHS needs to change to face the challenges of the next 10 years. Many of these we are already addressing, often with our partners. World Class Commissioning is now the key way for making sure we deliver an NHS that is fair, person centred, effective and safe. It continues to focus our attention on our commissioning role and how we are building capacity and capability to be a truly world class commissioning organisation. When we were assessed in December we were among the top 20% of PCTs in the country and we hope to match or better this when we are assessed again next year.
Rob Napier, Chairman
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NHS Kirklees Annual Report 08|09
In 2009/10 and beyond we plan to make significant investments in long term conditions, mental health, drug and alcohol treatment and prevention programmes as well as tackling obesity and sexual health.
We have also strengthened the role of frontline doctors, nurses and other healthcare professionals in deciding priorities for investment and how local NHS services should be developed to best meet the needs of local people.
Extra cash will also be invested in primary care to improve access and premises, and the community hospitals programme will continue to develop intermediate care and move care closer to people’s homes.
Our Practice Based Commissioners have continued to lead many invaluable projects in their local areas, targeting those patients with the highest need and driving forward health improvements. More than 100 new business cases have been approved.
NHS Kirklees continues to be in a strong financial position and we were pleased to receive an increase in funding of 5.5% for both 2009/10 and 2010/11. This means we will have approximately an extra £32 million per year in the next two years and a budget of £617 million in 2009/10 to spend on improving the health and well-being of the people of Kirklees. In line with the national policy of moving those who provide services away from those who commission them, our provider arm now has its own Board and is continuing its plans to become an ‘arms-length’ organisation by the end of 2009/10. To mark this change in role, it too has changed its name: to Kirklees Community Health Services (CHS). Kirklees CHS has produced its own Annual Report, which should be read in conjunction with this report.
xecutive s, Chief E tt o P e ik M
Work is progressing on providing a new headquarters for NHS Kirklees. The Board agreed Bradley Business Park was the preferred choice from the two shortlisted locations in Huddersfield. The site was chosen for the space and flexibility of the accommodation and because this option represented the best overall value for money. The importance of our staff can never be under-estimated and we must thank them for their continued commitment and hard work. In 2009/10 we will continue to work towards the Investors in People standard, to demonstrate the value we place on our staff and the successes we can achieve with their help and commitment. We have a good team which is continually striving to make sure local people stay healthy and receive high quality healthcare, when they need it in the right place and at the right time.
David Anderson, Chair Professional Executive Committee
NHS Kirklees is the leader of the local NHS and was set up in 2006. It is responsible for improving the health of local people, reducing health inequalities, and making sure that health services are in place to meet the needs of our population.
Kirklees Council, we recognise this by working in partnership in the seven distinct localities that make up the district.
We have three main functions:
• Spenborough; and
• Engaging with the local population to improve health and well-being.
• Batley, Birstall and Birkenshaw.
• Providing community health services such as district nurses, school nursing and health visiting. • Commissioning other services on your behalf, such as GPs, dentists, pharmacists and opticians and funding hospital, mental health and residential care services. Kirklees is an interesting and diverse area with a population of 400,000 people – which is expected to grow by a further 33,000 by 2018. Kirklees has a higher proportion of our population from an ethnic minority than for England as a whole. Estimated figures in 2005 indicate that 15.5% of Kirklees’ population is from an ethnic minority, compared to the England average of 10.9%. The biggest local populations are those with Pakistani (6.9%) or Indian (4.2%) origins.
These localities are: • The Valleys; • Huddersfield North; • Huddersfield South; • Denby Dale and Kirkburton; • Dewsbury and Mirfield;
We are committed to partnership because we know that this is the only way to achieve real success for Kirklees. In particular, we have a strong relationship with Kirklees Council, including a joint Director of Public Health and other shared posts. This partnership is helping us focus our attention on making improvements in health and reducing the health inequalities that exist across Kirklees. There are numerous health challenges in Kirklees. Particular issues include high infant mortality rates; rising levels of obesity because of poor diet and lack of physical activity; tooth decay in children; drug and alcohol misuse; numbers of people smoking; high rates of teenage pregnancy; and high levels of diabetes and heart disease.
Many of the people living within our boundaries identify closely with the locality in which they live, rather than with Kirklees as a whole. Together with
Batley
Social issues which we are tackling with other partners to achieve the vision set out in our strategy, include: infant mortality and a life expectancy below the national average; educational attainment; a low skill, low wage economy; lack of confidence in some of our towns (particularly in North Kirklees – Dewsbury and Batley); and community relations.
All about NHS Kirklees
All about NHS Kirklees
Kirklees is an interesting and diverse area with a population of 400,000 people – which is expected to grow by a further 33,000 by 2018. We also work with other key stakeholders, such as Calderdale and Huddersfield NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust and the South West Yorkshire Partnership NHS Foundation Trust (previously known as South West Yorkshire Mental Health Trust), as well as the community and voluntary sector. There are 75 general practices in the area with a total of 256 family doctors, 58 dental practices, 93 pharmacies and 42 opticians. NHS Kirklees employs more than 1,542 staff and had a budget of £594 million for 2008/09.
Cleckheaton
Dewsbury Mirfield Ravensthorpe
Huddersfield Kirkburton
Slaithwaite Honley
Marsden Meltham
Holmfirth
Denby Dale
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NHS Kirklees’ commissioning and provider roles One of NHS Kirklees’ roles is to plan, pay for and monitor health improvement and health care services locally. This process is known as commissioning and it is our intention to become a world class commissioner in the NHS. It is a complex process and involves assessing the needs of the local population so we can understand what services we need to buy and who is best placed to provide them.
Good commissioning will help people to live healthier and longer lives by: • having a detailed understanding of the health and care needs of the people of Kirklees; • having a good knowledge and understanding of health care research and evidence based practice; • working with other key partners who can influence the health and well-being of local people; • having good links with patients, carers and the local community to understand their experiences of local health services and how they can be supported and encouraged to live healthier lives; • having expertise in drawing up detailed service specifications and procuring services from a broad range of providers including the independent and voluntary sector as well as mainstream NHS providers; and • contract management, performance and evaluation. It is our responsibility to make sure we understand what services we need and who is best placed to provide them. We work with existing providers to change the way services are delivered and improved. We also assess whether there are any gaps or shortfalls.
It is our responsibility to make sure we understand what services we need and who is best placed to provide them.
Our priorities are: • increasing choice and the range of services available; • providing care closer to home where it is safe and effective to do so; • improved access both in terms of location and timeliness; and • making the most of opportunities provided by an increasingly diverse range of organisations. During 2009 we will build on our knowledge of the healthcare market and respond to any gaps we identify including:
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• building on the findings of a market management programme run jointly with neighbouring PCTs; • prioritising areas where we need to carry out a full market analysis; and • strengthening our focus on patient choice.
Commissioning NHS Kirklees commissions services from a wide range of local organisations including Calderdale and Huddersfield NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust, South West Yorkshire Partnership NHS Foundation Trust and Kirklees Community Healthcare Services, as well as non-NHS organisations such as private companies and social enterprises, local GPs, dentists and optometrists. We meet regularly to review things like waiting times, quality, activity levels and service developments. We work with existing service providers to redesign and improve services and we assess service gaps in terms of availability or quality and identify clear strategies to address these, using effective procurement to bring new providers into Kirklees. These new providers might include ‘traditional’ NHS service providers as well as the independent sector, voluntary or not for profit organisations and others. We have assessed current levels of provision for primary care services across our localities and it is clear from this analysis that certain localities face shortfalls in certain areas, for example, numbers of GPs which mean higher list sizes than elsewhere in Kirklees. Local clinicians have a key role in assessing local needs and shaping priorities. Their professional experience of delivering care, combined with their understanding of service users’ needs, is crucial to designing high-quality, personalised health and care services.
We are already embedding clinical leadership into our commissioning processes. In 2008/09 we have:
• appointed clinical leads in some of our health priority areas, such as mental health, long term conditions and musculo-skeletal services; • demonstrated our commitment to Practice Based Commissioning (PBC) by putting in place the management capacity to support its development and actively promoting joint working between PBC and NHS Kirklees; • approved a number of proposals for service redesign developed by PBC teams such as the introduction of consultant-led specialist outreach clinics and new models of care for people with diabetes; and • made sure clinicians are involved in tendering exercises.
We have to develop a more strategic, long term and community focused approach to commissioning services, where we and other local commissioners work together with health and social care professionals to deliver improved local health. It is also placing greater emphasis on assessing local needs (e.g. through the Joint Strategic Needs Assessment), and prioritising investments to deliver long term improvements to health through a locality based planning approach. These changes are pivotal in addressing local health inequalities. WCC also supports the shift from treatment and diagnosis to prevention and the promotion of well-being.
NHS Kirklees’ commissioning and provider roles
In Kirklees, we are fortunate in having a number of clinicians already engaged in commissioning, as members of the Professional Executive Committee, through Practice Based Commissioning (PBC), and as clinical leaders in their own specialist areas.
World Class Commissioning (WCC) World Class Commissioning (WCC) is now the key way of delivering an NHS which is fair, person-centred, effective and safe. It was introduced to improve the way PCTs commission services and to make sure that there is an improvement in local people’s health and well-being. WCC has a rigorous assurance process which all PCTs, including NHS Kirklees, are assessed against. This provides a score and NHS Kirklees is rated in the top 20% of PCTs nationally. We scored highly for our work with our partners, particularly the local authority, in tackling local community issues, and the assessors were impressed with our work with clinicians. They concluded that NHS Kirklees also has the foundations in place to deliver on our challenges.
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Programme areas Working with local partners, stakeholders and our own staff, NHS Kirklees has put in place 11 programmes (see right) which are supported by a range of strategies and aim to improve the health and wellbeing of local people and reduce health inequalities. We have a particular focus on long term conditions with specific priorities relating to older people and vulnerable adults. Our Health Improvement Teams (HITs) work within the 11 broad programmes, with Choosing Health and long term conditions subdivided further into specific areas of work. The HITs are made up of primary care clinical leads and professionals from the relevant directorates, such as public health and commissioning.
Delivering Healthy Ambitions NHS Yorkshire and the Humber published Healthy Ambitions in June 2008 in response to the NHS Next Stage Review. This provides an invaluable benchmark against which we can check our own local vision and plans.
The programmes are: Planned care including cancer and palliative care To commission the best standard of care and work with providers to make sure that national standards for access are met.
Primary care To commission high quality primary care for all and reduce any variations which exist in different areas of Kirklees.
Children and young people To improve the health of and reduce health inequalities amongst children and young people.
Drugs and alcohol To improve both the numbers of people treated and the personal and community outcomes for people in receipt of drug and alcohol services.
Infection control Reduce the number of avoidable Health Care Associated Infections to zero across Kirklees.
Urgent care Make sure that people with an urgent care need can access appropriate high quality services in a timely manner and that these services work well together.
Healthy pregnancy and maternity Place women and families at the centre of their pregnancy journey; listening to and supporting them in identifying their needs and commission effective services and support to meet these needs.
Long term conditions (including physical and sensory) Embed into our local health and social care community an effective, systematic approach to the care and management of patients with long term conditions.
Learning disabilities To empower and enable individuals with learning disabilities to lead a full and, as far as possible, ordinary life as part of the community with the same hopes and aspirations as everybody else.
Mental health To improve people’s mental health and well-being by commissioning a broad range of services that address people’s needs promptly and effectively.
Choosing health Promote healthy lifestyles for all and tackle health and well-being inequalities through working in partnership to embed evidence based programmes.
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As well as commissioning health care, NHS Kirklees has traditionally provided services directly for local people. During the last 12 months, in common with Primary Care Trusts across the country, the provider arm of the organisation has been increasingly working at ‘arm’s length’ from the commissioners and has a new name Kirklees Community Healthcare Services (CHS). Whilst still under the umbrella of NHS Kirklees, for example staff are employed by NHS Kirklees, Kirklees CHS is working its way towards becoming a stand-alone organisation. During 2008-09, Kirklees CHS continued to provide a large and diverse range of primary, community and public health services both in local premises and in people’s homes. On 1 April 2009 Kirklees CHS signed a contract with NHS Kirklees to formalise the provision of community healthcare services. This means the business relationship between the two organisations is on the same basis as NHS Kirklees has with other service providers, such as Calderdale and Huddersfield Foundation Trust, Mid Yorkshire Hospitals Trust and South West Yorkshire Partnership NHS Foundation Trust. Kirklees CHS has its own Board, chaired by the vice-chairwoman of NHS Kirklees. The Director of Provider Services has become the Kirklees CHS Managing Director and is joined on the Board by executive and non-executive members. As 2009/10 progresses, the make up of the Board will change and the new organisation will continue to evolve and become increasingly separate from NHS Kirklees.
A new look for a local hospital Kirklees Community Healthcare Services is managing the exciting £2 million refurbishment of the Hawthorn Ward complex at Holme Valley Memorial Hospital, Holmfirth. The £2 million scheme will provide state-of-the-art single and three-bed en-suite rooms to replace outdated facilities on Maple Ward. Cutting-edge design, technology and construction methods will combine to provide an environment second to none for local people.
Kirklees CHS continued to provide a large and diverse range of primary, community and public health services both in local premises and in people’s homes.
NHS Kirklees’ commissioning and provider roles
Providing healthcare services in Kirklees
Artist’s impression of the new Hawthorn Ward at Holme Valley Memorial Hospital
All smiles at Batley Health Centre
A very “productive” workforce
Our community dental team based at Batley Health Centre was the first in Kirklees to be allowed to join the prestigious British Dental Association Good Practice Scheme. This means the Batley service – provided by Kirklees Community Healthcare Services for adults and children with special needs – meets the 102 requirements of the nationally recognised scheme and local people can be assured they are receiving the best possible dental care.
Releasing more time to care is the aim behind the productive ward training project which staff at Holme Valley Memorial Hospital completed during 2008/09. They looked at their ward environment, made changes and streamlined processes, giving them more time to spend with their patients. The productive concept is now being rolled out across Kirklees Community Healthcare Services with teams and managers taking up training and making changes that really make a difference to their services.
More information about these developments and other initiatives and achievements is available in the Kirklees Community Healthcare Services Annual Report.
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Our vision and values Working together to achieve the best health and well-being for all the people of Kirklees
• Recognising that people are at the heart of everything we do
• Valuing diversity and challenging discrimination
• Supporting people in taking responsibility for their own health and well-being
• Showing understanding, dignity and respect for all our clients, partners and staff; and
• Encouraging innovation and continuous improvement and celebrating the contribution made by our staff
• Being accountable for the decisions we make, the work we do, the resources we use and our impact on the environment.
• Encouraging open, clear and honest communication
To achieve our vision, we have to have clearly defined goals. These reflect our local priorities and also national ones. Placing the person at the centre of everything we do by:
Improve quality and promote safety by:
Promote local sensitivity through effective commissioning by:
• helping people to understand and take responsibility for their own health;
• commissioning services that are safe, of the highest standards, based on the best clinical evidence and are also value for money;
• setting outcomes and actions that reflect local needs and priorities; and
• supporting people to feel in control, able to manage their problems and make healthier choices; • providing people with a choice of service at home or as close to home as possible; • commissioning services which are based on, and responsive to, the person’s needs and preferences; and
• encouraging new and innovative ways of delivering services that are sensitive to the diverse needs of our community, demonstrate improvements in quality and are delivered in an environment that staff and local people can be proud of; and
Improve health and reduce health inequalities by:
• being an organisation that encourages staff to want to continue to develop professional skills, achieve their full potential and is able to attract and retain high calibre staff.
• achieving the best possible health outcomes within available resources;
Promote choice and accessibility by:
• commissioning services that include prevention, detection, treatment and the consequences of ill health; and
• providing a range of services and treatments and making sure they are accessible and as near to home as possible.
• reducing gaps in services and support.
Work well in partnership with communities, individuals and their families, staff and organisations by:
• involving local people in creating and delivering solutions.
• making sure local people, especially people who use services and our staff are involved in identifying what they need, agreeing priorities, creating solutions and taking action.
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• acting at the right level, locally, regionally, or nationally depending on the issue or outcome desired.
Promote strong clinical leadership to drive service redesign and innovation by: • making sure clinicians have the skills to be fully involved in all aspects of the commissioning process.
Be a visibly credible organisation, operating to the highest standards by: • achieving the highest standards of probity and accountability, managing risk and maintaining effective governance arrangements to make sure that the organisation is run efficiently within available resources and in a way that inspires public confidence.
NHS Kirklees is committed to working with its partners to deliver the goals we share for local people. These can be found in a number of documents:
Kirklees Partnership
Kirklees Partnership Executive
• Kirklees Health and Well-being Strategy • The Local Area Agreement (LAA) • Comprehensive Area Assessment • Safeguarding Strategy. NHS Kirklees works closely with a range of public, private and voluntary sector partners as part of the Kirklees Partnership – our Local Strategic Partnership (LSP). The LSP is committed to achieving a number of outcomes set out in the LAA.
Children and Young People Local Public Service Board
Adults and Healthier Communities Local Public Service Board
Working with our partners
Working with our partners
Safer, Stronger Communities Local Public Service Board
Kirklees Partnership Executive The Executive drives and co-ordinates the overall work of the Kirklees Partnership and makes sure the Local Public Service Boards (LPSBs) are working together effectively.
Regeneration and Sustainable Development Local Public Service Board • take responsibility for making sure progress towards the stated outcomes is achieved; and • make sure arrangements meet specific statutory requirements, for example the Children’s Act, Crime and Disorder Act.
Local Public Service Boards (LPSB’s)
LPSB priorities
The LPSB’s:
• increase educational attainment and progress beginning in the early years;
• develop and agree their relevant section of the Sustainable Community Strategy and Local Area Agreement; • agree programmes of work and the use of resources to achieve identified outcomes; • maintain an overview of progress and trends;
Children and young people:
• improve the life chances of vulnerable children and young people; • tackle the factors that contribute to physical and emotional well-being, so children and young people develop healthy minds and bodies; and • provide opportunities for young people to enjoy themselves.
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Safer stronger communities: • develop cohesive communities where people from different backgrounds and ages get on well together; • increase resident satisfaction with their local area; • promote a strong community and vibrant voluntary sector; • reduce crime, anti social behaviour and the fear of crime; • address the factors that relate to offending and so reduce re-offending; and • reduce the harm caused by drugs and alcohol to the people of Kirklees, including users, their families and the wider community.
Healthier communities and older people:
Practice Based Commissioning (PBC)
• enable older people to enjoy more years in good health and to be active and independent;
NHS Kirklees also works closely with four GP consortia and 10 stand-alone practices that make up Practice Based Commissioners (PBC). Through PBC, new and improved services are now available closer to home across Kirklees. These include diabetes, diagnostic tests and pain management.
• support people with long term conditions to be independent and in control of their own condition; • promote healthy lifestyles for all and improve mental well-being; and • improve maternal health to improve the health of babies and reduce the number of children dying before their first birthday.
Economic development and the environment: • reduce worklessness and narrow the gap between disadvantaged groups and the rest of Kirklees; • increase skill levels of the working age population to increase the employability of the local labour market; • grow and sustain local businesses; • combat and plan to adapt to climate change; • reduce waste and increase recycling; • increase the number of affordable homes available in Kirklees; and • tackle congestion on our roads and increase the number of local community based bus services.
All practices involved in PBC must agree a plan with NHS Kirklees which sets out what the practice wants to achieve to meet the needs of a particular population. Across Kirklees the consortia and stand-alone practices have agreed commissioning plans for 2008/09 which were presented to the Professional Executive Committee.
Through PBC, new and improved services are now available closer to home across Kirklees. In July 2008 a Kirklees PBC Strategic Framework was also agreed which sets out the future of PBC in Kirklees. The success of the close working between NHS Kirklees and local GPs was recognised in our first World Class Commissioning assessment. In February 2009 a commissioning college was set up to bring together PEC members, PBCs and clinical and management leads from Health Improvement Teams. The college meets monthly to agree the strategic direction for key services such as stroke and maternity. This is already proving to be an effective, co-ordinated approach bringing together a range of expertise to develop local health care.
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Continuously improving quality
Research and research governance
We have continued to make sure we deliver the actions in our Quality and Clinical Governance Strategy. This includes meeting local and national quality standards and making sure that the guidance and policies used by our staff are based on evidence and will benefit patients. Our aim is always to improve the experience patients have of using our services.
In response to national guidance and to make sure we continue to comply with research governance standards we have assessed how to make the best use of our research skills and resources. The aim is to make sure that research is safe, high quality and focused on outcomes for patients and that staff have appropriate skills and support. This includes access to research skills training when necessary.
We now have a number of quality indicators that will help us measure the quality of care we commission. These have been developed with clinical staff and are part of the contracts with organisations that provide services. Our knowledge and learning programme has been reviewed to provide a range of innovative training and learning opportunities for staff to develop and maintain their skills to deliver safe and high quality care.
How we measure up - a fair health check The Annual Health Check rates how NHS Trusts perform against a number of standards, targets and how trusts use their resources. Each year NHS Kirklees has performed well in the Annual Health Check, maintaining a fair rating for the quality of services provided and on how well the organisation’s resources are managed. In 2008/09 the Healthcare Commission found that NHS Kirklees fully met all 24 Standards for Better Health (SfBH). The SfBH assessment measures things that are important to patients and the public. Services are patient focused, accessible, safe and clinically effective and what action is taken to tackle health inequalities. The review also identified areas where NHS Kirklees is taking a lead and performing well against national targets. These include: • maintaining the four hour maximum wait in A&E from arrival to admission, transfer or discharge; • maintaining a two week maximum wait from urgent GP referral to first
outpatient appointment for all urgent suspected cancer referrals; • maintaining delayed transfers of care at a minimal level; • maintaining a maximum wait of 26 weeks for an inpatient appointment; and • maintaining a maximum wait of 13 weeks for an outpatient appointment. The overall scores also show that we have made significant progress in a range of areas including health inequalities, efficiency and financial balance.
Continuously improving quality and learning
Continuously improving quality and learning
As part of the declaration the PCT also includes statements on how others see us and our compliance with the hygiene code which helps organisations tackle infection and create clean and safe environments. Our evidence to date indicates we have improved on last year but will not know the results for the 2008/09 Annual Health Check until the autumn of 2009. For details of the results of the 2008 staff survey, please see valuing our staff, page 28.
Care Quality Commission From 1 April 2009 the Care Quality Commission (CQC) brought together the roles of the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection. The main activities of the CQC are: • monitoring and inspecting all health and adult social care; • registration of health and social care providers to make sure they are meeting common quality standards; • using their enforcement powers if standards are not being met; and • improving health and social service by undertaking regular reviews. More information about what they do is available on the website www.cqc.org.uk
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Improving knowledge and learning NHS Kirklees is continuing to provide effective learning, training and development opportunities for all its staff. This will make sure staff are confident and competent in carrying out their work, as well as having up-todate knowledge and skills. In 2009 we signed the Skills Pledge in line with Lord Leitch’s report published in 2006. He recommended a major change in the way young people and adults were trained to plug the skills gap and stop Britain lagging behind. We are actively encouraging and supporting all employees to gain skills and qualifications that will help them to progress in their careers and meet the needs of the organisation.
We are committed to supporting pre-registered nursing and allied health professional students as we recognise that these are the future NHS workforce. Our training and education programme has three elements: • Induction – all new employees are offered a one day induction programme including a variety of mandatory and some competencybased training topics. • Mandatory/statutory training – these are programmes which NHS Kirklees legally has to offer to all staff: fire; health and safety; basic life support and infection control. During 2008/09 all clinical staff attended infection control training and 99% attended child protection training.
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• Continual Professional Development (CPD) – CPD is offered to all staff to keep them up-to-date with current practice and the latest evidence-based practice. The Training and Professional Development Team works closely with all directorates and specific staff groups and undertakes a detailed training needs analysis. The team then develops and facilitates specific bespoke professional development and leadership courses to meet any training needs. During 2008/09, more than 40 members of our support staff achieved a National Vocational Qualification (NVQ) at varying levels in subjects including business and administration, customer care and health and social care. NHS Kirklees is also working closely with NHS Yorkshire and the Humber and 15 other NHS trusts in West Yorkshire to take forward different ways of learning – including e-learning. We have worked closely with the Strategic Health Authority, the Learning Skills Council and Yorkshire Forward to identify and access funding for specific training, as well as local further education and higher education institutions in developing educational partnerships so the best possible education is delivered to all staff. We are committed to supporting preregistered nursing and allied health professional students from the local universities and employ practice learning facilitators to support this very important work, as we recognise that these are the future NHS workforce.
Waiting times for Kirklees patients are coming down due to the efforts of NHS Kirklees, local hospitals and community providers. 18 weeks The 18 week standard is a national waiting time standard for treatment by a hospital consultant. It means that patients can expect to wait no more than 18 weeks from referral by their GP to treatment by a hospital consultant. Those that wait more than 18 weeks do so because of patient choice or clinical exception. The standard is that no more than 10% of patients waiting for inpatient treatment and no more than 5% of patients waiting for outpatient treatment should wait more than 18 weeks, and for only the reasons described. NHS Kirklees has met this standard for its patients and will strive to reduce waiting times further. In many specialties the waiting times are much less than 18 weeks. We continue to work with clinicians in the hospital as well as in community settings to make sure that our patients have an improved experience of the local NHS, with services that are of a high standard, accessible and convenient to them.
Inpatients
take action to avoid breaches in the future. To put these figures into context, there were 44,631 inpatient or day-case procedures and 74,283 outpatient procedures and 62,918 first outpatient appointments during following GP referral 2008/09.
Diagnostic tests (15 designated tests) At the end of January 2009, we had 133 patients who waited longer than the six week target for these 15 tests. Last year the target was 13 weeks. At that date our providers reported activity of 79,837 tests for Kirklees patients. For 2009/10 there were 96,803 tests carried out. There were 1388* reported breaches of the six week target for the 15 key diagnostic tests. *the same patient could have breached the target.
Accident and Emergency (A&E) NHS Kirklees has worked with the A&E departments in both Mid Yorkshire Hospitals NHS Trust and Calderdale and Huddersfield NHS Foundation Trust to reduce and manage waiting times and make sure patients are seen as quickly as possible by the most appropriate healthcare professional. Extra staff are now working in A&E departments - a GP and advanced nurse practitioner and are available to see patients who present with a minor ailment or illness, at the busiest times.
Throughout the year, 36 patients waited longer than 26 weeks for inpatient care. We have worked closely with the provider organisations throughout the year to try to minimise the number of patients breaching this target.
Of the 156,653 patients attending A&E across Kirklees in 2008/09, 97.64% of them were seen, treated or admitted within four hours.
First outpatient appointment
We have continued to support the provision of the community paramedic service to the rural areas of Kirklees.
During 2008/09, 18 patients waited longer than 13 weeks for outpatient appointments. We are working closely with our providers to minimise this and
Yorkshire Ambulance Service (YAS)
We are working closely with Yorkshire Ambulance Service on specific projects to help improve their response times.
Year end figures for whole YAS Category A patients are within eight and 19 minutes of calling an ambulance and Category B within 19 minutes. A8
79.4%
Target 75%
A19
96.1%
Target 95%
B19
90%
Target 95%
Driving down waiting times
Driving down waiting times
Year end figures for Kirklees A8
63%
Target 75%
A19
96%
Target 95%
B19
86.9%
Target 95%
Cancer Once again local cancer services have achieved the national cancer waiting time targets. Patients who need treatment in Leeds are seen within the 62 day target on the whole, and we are constantly striving to achieve improvements working with Leeds and other PCT colleagues to make sure the 62 day target is achieved and sustained for all cancer patients. The Cancer Reform Strategy (December 2007) has seen us working closely with our local hospitals and other key stakeholders and a work plan has been developed for 2009/10 to further improve cancer and palliative care services. The End of Life Care Strategy was launched in 2008/09 and following the completion of a local review we are now working on a joint strategy with Calderdale across health and social care. In summer 2009 we appointed a registered nurse to take the end of life pathway programme into the community to support doctors and nurses in their education and decision making for patients at the end of life, not just with cancer, but other life threatening illnesses.
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Improving health and well-being Our vision is to achieve the best health and well-being for all the people of Kirklees. During 2008/09 we have helped to improve the health of local people through many initiatives and work programmes. A sample of these is featured below: Tobacco In 2008/09, the Kirklees Stop Smoking Service helped more than 2,000 people successfully stop smoking. There are now more clinics available than ever before at a variety of times and locations across Kirklees. Social marketing work was commissioned to find out what would motivate or de-motivate routine and manual workers who smoke to quit and to see what they think about the Kirklees Stop Smoking Service as well as any barriers they might have in using this service. The results will be fed into redesigning or changing the way the local service advertises itself to specific groups of people.
The public health tobacco programme has been successful in achieving a Fund for Innovation Award from the Queen’s Nursing Institute. This is a joint award with the Kirklees paediatric nursing team and will be used to commission a new smokefree homes worker. This bespoke service will offer support and encouragement to families that are not able to access mainstream services.
Oral health NHS Kirklees has continued to invest in the oral health of its population by increasing access to dental care year on year, particularly for disadvantaged groups or those who do not attend a dentist regularly, and to improve the quality of the services provided. More than half of adults and three quarters of children in Kirklees saw a dentist in the last two years, which is higher than the national average. In a dental health survey carried out in 2008, 75% of adults reported that they had attended a dentist in the previous 12 months, and usually went to their dentist regularly for a check up, rather than when experiencing a problem. However one in five of the adults who responded felt they had poor oral health and were in need of some treatment. We have continued with our oral health improvement and preventative activities to tackle the poor state of oral health in children.
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NHS Kirklees Annual Report 08|09
In 2008/09 we considered, in discussion with Kirklees Council and the Overview and Scrutiny Committee, the merits of water fluoridation as a means of improving dental health and reducing health inequalities. As a result NHS Kirklees Board agreed to ask the Strategic Health Authority (SHA) to commission a technical study to find out if it is possible to add fluoride to the local water and how much this would cost. When we receive this information the Board will consider whether to support water fluoridation and whether to request the SHA to undertake a public consultation before a final decision is taken.
NHS Kirklees is committed to providing high quality and easily accessible sexual health services. A key priority is to reduce the number of teenage pregnancies across Kirklees so our focus is supporting and empowering young people to take responsibility for their sexual health and well-being. When a young person chooses to access sexual health services for advice, support or contraception, all services commissioned through NHS Kirklees are encouraged to meet the Department of Health ‘You're Welcome’ standards for young people friendly services. A local scheme, Kirklees Young People Friendly (KYPF) award, complements the national standards and a number of local services are already accredited. We have developed a contraception service which young people can access through any GP registered to the scheme. Our work with GPs and pharmacists will increase access to contraception to include emergency hormonal contraception. These services will be open access and available to all young people throughout Kirklees. In 2008/09, the Chlamydia Screening Programme (CHLASP) also targeted young people to increase the number of people going for screening. Activity was focused on local concerts, cinemas, sports stadiums, nightclubs, university and pee in a pot events at fresher’s week and college open days. Postal kits were sent out to young people and made available in venues such as cinemas. A
high profile bus advertising campaign with the branding pee for a pod with an iPod as a prize also took place. So far, 8003 young people have been screened and we anticipate that this will continue to rise next year.
Obesity In Kirklees, more than half of all adults are either overweight or obese. Local data gathered through the National Child Measurement Programme shows that around one in 10 children aged four to five (reception year) and one in six aged 10 to 11 (Year 6) are obese. Following consultation with the public and healthcare practitioners we have reviewed the weight management service available in Kirklees. The obesity programme team has also provided all GP practices with a set of standardised weighing and measuring equipment to support the application of the new weight management service. A new website was launched in March 2009 to inform and engage people in Kirklees about weight management. The
healthyweight4kirklees website (www.healthyweight4kirklees.nhs.uk) also forms the foundation of the Kirklees Healthy Weight Network for health professionals and partners, allowing them to share best practice, access current information and support each other to deliver the Kirklees obesity programme.
Improving health and well-being
Sexual health
More than half of adults and three quarters of children in Kirklees saw a dentist in the last two years, which is higher than the national average. MEND is now available to children, aged seven to 13 in Kirklees, and is part of a nationwide project created to make a positive impact on children who are overweight and their families. MEND stands for Mind, Exercise, Nutrition, Do it! The programme encourages children and their families to change unhealthy attitudes to food and eating, to empower them to make informed food choices and to exercise on a regular basis. Alongside the obesity programme, the Kirklees food programme has a number of work streams to enable residents to improve healthy eating so they can enjoy life long health. More than 430 food businesses across Kirklees have been awarded the Healthy Choice Award, of which 391 have achieved the highest level – the Gold Award. 94% of local schools are engaged in the Healthy Schools Programme and 62% have achieved Healthy Schools Status.
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Breastfeeding
Infant deaths
Expert Patients Programme
Breast fed babies are less likely to become obese in later childhood and breastfeeding can prevent mothers having health problems in later life.
The infant mortality rates in Kirklees are the second highest in Yorkshire and Humber and amongst the highest in England. There is marked variation across the localities in Kirklees.
The Expert Patients Programme is a free eight to 10 week course run by NHS Kirklees for people with long term conditions, such as heart disease and diabetes. All our programmes include a session on physical activity led by Kirklees Council’s Physical Activity Development Team.
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NHS Kirklees Annual Report 08|09
Deaths in infants aged under 1 year Huddersfield North
Huddersfield South
Spen Valley
Colne Valley
Holme Valley
Kirklees
National
Rate per 1000
Mirfield
2008/09 saw the launch of the Active for Life scheme, which enables people who experience mental ill health to become more active, plus we have developed a range of activities for under fives and their families.
The Department of Health Infant Mortality National Support Team (NST) visited Kirklees in March 2009. They highlighted the strong health partnerships in Kirklees and made recommendations to improve delivery.
Dewsbury
Key achievements this year include the introduction of two new referral criteria - pain and pregnancy - into the Practice Activity and Leisure Scheme (PALS). The number of people accessing the scheme has also increased with more than 2,500 patients taking part in physical activity sessions.
Our two Expert Patients Programme support groups continue to run monthly and we have doubled the number of courses we hold. We have also recruited three more volunteer tutors this year, bringing our total to 14.
Denby Dale & Kirkburton
The physical activity programme has continued to work to encourage those who are least active, to become more active, more often, to improve their health and well-being.
During 2008/09, 26 programmes have taken place across Kirklees – with 231 people receiving support to help them better manage their condition and increase their confidence.
Birstall & Birkenshaw
Physical activity
Following the report into infant deaths by our Director of Public Health in 2008, we have continued to gather more detailed information from local women, local healthcare professionals, maternity services and Children’s Centres. We now have a strategy for pregnancy care (see p18) and a team of staff working on a project which focuses on women of child bearing age, to help them rethink how they cope with life without having to rely on cigarettes or alcohol, as well as how they might consider cooking for the family and being more physically active.
Batley
Breastfeeding rates are continuing to improve in Kirklees, with 70% of women known to be starting, and work continues to encourage women to breastfeed from birth. A Baby Friendly Initiative (BFI) postholder was appointed in November 2008 and increasing numbers of women are being supported through Baby Cafés – breastfeeding centres of excellence - in Batley and Huddersfield.
8.5
•
•
9.3
6.9
8.1
5.9
8.5
•
•
7.0
4.9
• Fewer than five cases or a rate derived from fewer than five cases
NHS Kirklees is actively working with Kirklees Council and other partners on new social marketing techniques. Throughout 2008/09 NHS Kirklees worked on a number of social marketing projects to tackle the following priority issues: • Obesity: Targeting 16-24 year olds. This project is one of the National Social Marketing Centre’s demonstration sites and has involved a wide range of stakeholders to develop specific projects.
The Joint Strategic Needs Assessment will help to shape future health and social care services in Kirklees • Women of Child Bearing Age (WOCBA): One of the key findings of the 2008 Infant Deaths in North Kirklees Report, was that maternal behaviours such as alcohol consumption, diet, physical activity and particularly smoking in pregnancy profoundly affected the health of the unborn child. This project aims to address these issues. • Tobacco: Increasing the numbers of routine and manual workers accessing the NHS Stop Smoking Service. • Cervical screening: NHS Kirklees is also involved in a regional project to increase uptake of cervical screening.
Joint Strategic Needs Assessment
Emergency planning
NHS Kirklees, in partnership with Kirklees Council, has refreshed its Joint Strategic Needs Assessment (JSNA) to reflect the changing health needs of our population. This describes the future health and well-being needs of local people and helps shape how services are designed and delivered to meet those local needs. The development of the JSNA has enabled us to identify key issues for specific people, such as older people, carers, people with learning disabilities, and women of child bearing age. It also looks at key conditions such as heart disease, emotional well-being, pain, obesity, diabetes and dementia, and wider living and working factors such as employment and housing as well as personal behaviours such as smoking, alcohol consumption, eating habits, physical activity levels and sexual health. Key findings of the report tell us that the main challenges facing children and young people continue to be infant deaths, personal unhappiness, social isolation and obesity, which is rising year on year. The report will help to shape future health and social care services in Kirklees and is available on our website or the council’s Kir klees PART NERS HIP website.
Health and well-b eing key issues for the peo ple of Kirklees
Joint Strategic Need
s Assessment for
2009
Kirklees
One of the main functions of NHS Kirklees is to respond to emergency situations that pose a threat to the health and well-being of local people. In common with other statutory bodies such as the police, fire service and Kirklees Council, NHS Kirklees has to develop, test and revise its emergency plans so it can comply with national standards set out in the Civil Contingencies Act 2004.
Improving health and well-being
Using social marketing
NHS Kirklees continues to develop and test its preparations for a flu pandemic. Our plans have been extensively reviewed by the Department of Health. We have robust procedures in place and continue to test and revise these in line with new guidance or evidence received. During 2009, we will be fully testing our pandemic flu plans with all local partners. NHS Kirklees also monitors the possibility of any accidental or deliberate incident and has plans in place to work with partners to deal with the outcomes of a deliberate terrorist attack within Kirklees. James Williams, Assistant Director in Public Health, was one of the first people in the country to be awarded a Diploma in Health Emergency Planning. James was one of only 83 people to gain the diploma from 174 people who undertook this new course. To find out more about what the government is doing to protect the public please go to the Government’s emergency preparedness website at www.cabinetoffice.gov.uk/ ukresilience.aspx. If you want to find out more about emergency planning in Kirklees please go to www.kirklees.gov.uk/answers/ emergency-plan/emergency-plan. shtml
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Maternity matters
Beating infection
NHS Kirklees and key stakeholders have developed the Healthy Pregnancy and Maternity Services Strategy to make sure we can support healthy pregnancies and develop maternity care which centres on the woman and her family. We also hope this strategy will improve infant mortality rates in Kirklees.
NHS Kirklees is committed to delivering a safe, effective and efficient infection control service so outbreaks of infection are minimised and patient care is safe and clean.
In 2008/09, we have taken the following action: • A phased implementation plan to deliver a fit-for-purpose integrated community-based maternity service, which meets the needs of women and families in Kirklees. • Identified resources needed to provide extra health and social care support to pregnant women and their families in Dewsbury and rolled this out to other areas of high needs across Kirklees, through dedicated family support workers in Children’s Centres.
• Piloting initiatives in Dewsbury, such as café style ‘shop front’ drop-ins and pampering opportunities to encourage early booking into maternity services • A new Practice Based Commissioning working group to make sure there is effective engagement and communication with GPs and other independent practitioners (for example, pharmacists). In 2009/10 we will continue to deliver the projects outlined in our strategy and make links into other programmes such as women of child bearing age, health visiting services, integrated working in Children’s Centres, teenage pregnancy and family nurse partnership. Priorities include information sharing across services and agencies, developing the roles and skills of healthcare professionals, promoting local support groups and networks and providing women and families with the information they need to have a healthy pregnancy.
In 2008/09 all clinical staff received mandatory infection control training and NHS Kirklees achieved the clostridium difficile infection target set by NHS Yorkshire and the Humber. NHS Kirklees staff worked with partners in the local health economy to reduce Healthcare Associated Infections (HCAI) in hospitals or as a result of healthcare interventions. National targets for the incidence of MRSA at Calderdale and Huddersfield NHS Foundation Trust were met. The organisation also received the Care Quality Commission registration as a service provider without conditions. Unfortunately, Mid Yorkshire Hospitals NHS Trust narrowly missed its target for 2008/09. Plans for 2009/10 are: • to agree roles and responsibilities with the Health Protection Agency for tackling infection in care homes; • develop a training programme for care homes; • continue to make sure infection prevention is embedded within the organisation; and • work with partners to further reduce the incidence of healthcare associated infections.
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NHS Kirklees Annual Report 08|09
Substance misuse and alcohol
Substance misuse and alcohol Substance misuse
Alcohol
We are continuing to build strong services that focus on improving the quality and scope of interventions for people with drug problems, reduce waiting times and expand the clinical team responsible for leading our substance misuse prescribing services.
NHS Kirklees continues to implement the Kirklees Alcohol Strategy in a bid to tackle the district’s growing alcohol misuse problems.
The Lifeline charity continues to be our main provider, and in 2007/08 2,055 drug users were treated, 85% of these successfully (National Treatment Agency, 2008).
• increase people’s awareness of sensible drinking levels, especially young people;
In October 2008, a new service offering drop-in wound care for injecting drug users was officially launched in Dewsbury. This 12 month pilot between NHS Kirklees, The Mid Yorkshire Hospitals NHS Trust and Lifeline is supported and funded by the Queen’s Nursing Institute and the Community and District Nurses’ Association. Our strong partnership approach helped us record a second consecutive four star (excellent) inspection from the Healthcare Commission in its improvement review. Our priorities for 2009/10 include: • improving re-integration of service users into the community by working more closely with housing and employment providers; • reviewing structured psycho-social interventions; • reviewing support for 16 to 25 yearolds and making sure services are appropriate; • working closely with colleagues in children’s services to deliver better outcomes for families, carers and children of parents who misuse substances; and • improving treatment outcomes for crack and cocaine users.
The strategy sets out to:
• reduce alcohol-related health problems, anti-social behaviour and crime; • expand and improve access to treatment; and • work with the licensing industry to maintain a thriving and responsible night time economy. Unfortunately, Kirklees has worse figures than the national average for many alcohol indicators and the Joint Strategic Needs Assessment continues to identify alcohol issues as a high priority for improvement. The numbers of people drinking above safe levels has increased, and young people’s drinking also worsened between 2005 and 2008. As a result NHS Kirklees has agreed extra funding for treatment services and Kirklees Council has agreed joint funding for interventions targeted at offenders. This has led to the expansion of interventions in primary care, with 60% of all GP practices signed up to deliver screening and brief interventions. An integrated treatment service is currently being tendered for, and will go live in October 2009. This service will operate from two main sites in Dewsbury and Huddersfield and will
treat more than 1,200 people with serious alcohol problems every year by 2011. This will include people who are committing violent crime as a result of their drinking, and an ongoing evaluation will determine the impact of a service that could make a real difference in many communities in Kirklees.
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Primary care developments Quality and Outcomes Framework The Quality and Outcomes Framework (QOF) is designed to raise organisational and clinical standards in primary care whilst rewarding practices for their efforts. As part of the framework, GP practices score points for achievement against a range of indicators - such as the number of patients with heart disease who also receive a flu jab. The more points the practice achieves, and the more services they provide, the more money they earn, although the final sum paid to practices is also adjusted to take account of their workload and the relative health of patients in their area. Throughout 2008/09, the average value of a QOF point was £124. Practices in Kirklees achieved an average of 635 points in the clinical domain – 98% of the maximum available. The average number of total points achieved per practice is currently 917 from a potential 1,000. Total points achieved at individual practices ranged from 705 to 942.
Dental services Increased access to NHS dental services continued to be provided across Kirklees to give more patients the opportunity to benefit from regular dental care. The NHS Kirklees dental waiting list has been reduced from more than 10,000 in 2006/07 to 2,000 in 2008/09. Dental practices work closely with NHS Kirklees to allocate patients to practices, although not all practices have the capacity to take new patients. Up to 40% of patients allocated to practices from the waiting list fail to make contact or fail to attend and maintain regular appointments. A pilot domiciliary dental service has been undertaken in 2008/09 to determine the need for providing routine dental care to care homes.
Emergency dental service More in-hours emergency access appointments have been developed in dental practices across Kirklees for patients without a regular dentist who need emergency treatment. The success of the ‘follow-on’ service for patients who need definitive dental care having received temporary treatment in the out of hours service, has enabled the roll out of this provision to be made and therefore increase the numbers of appointments available.
Community dental service Community dental services continue to provide specialist dental care for children and adults with specific needs and work continues to develop the service further to meet the changing needs across Kirklees.
Improving access to pharmacy services Four new pharmacies opened across Kirklees, one of which is an internet pharmacy, and two which provide services for at least 100 hours each week. This increases the network of pharmacies in Kirklees to 93. Of these,
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NHS Kirklees Annual Report 08|09
10 provide services for at least 100 hours each week providing access to NHS pharmaceutical services between 7 am and midnight Monday to Friday, and 8 am to 10 pm on Saturdays and Sundays. This is the highest level of access to NHS pharmacies ever achieved. In 2008/09 NHS Kirklees undertook a comprehensive inspection and monitoring programme of community pharmacies to make sure they provide high quality services to patients. There has also been continued progress with the introduction of paperless prescriptions, with 86% of pharmacies introducing a new ‘electronic prescription service’. This uses computer technology to transmit patients’ medication details confidentially through use of a unique bar code on the paper prescriptions issued by their GP. This new way of working reduces the risk of errors and improves the speed at which patients can receive their medication. Community pharmacies carried out more than 6,500 medicines use reviews in the first nine months of 2008/09 - an average of 73 reviews per pharmacy – which is a significant increase on the previous year. These reviews help to identify any problems patients might be having taking their medicines and suggest improvements. Two successful public awareness campaigns took place in 2008/09. The first helped to reduce medicines waste across Kirklees by approximately £140,000, and the second educated people when not to use antibiotics, as well as the risks associated with excessive antibiotic use. Seven GP practices and 10 pharmacies in the Fartown area have worked together to introduce a pilot minor ailments scheme. This service removes the need for patients registered with the seven practices for an appointment to access medicines for a specified list of minor ailments. This has improved patient access to medicines and to GPs by releasing some GP appointments.
Throughout the year, a comprehensive review of all Patient Group Directions was undertaken so more patients can safely access medicines through a range of health professionals and without the need to see their doctor for a prescription. This has significantly improved patient access to medicines in a number of areas, including contraception and sexual health, chlamydia treatments, immunisation, as well as those used to treat minor illnesses.
been delivered to local authority care workers in the Cleckheaton and Lindley areas. These enable social care workers to undertake basic level health tasks in the community. It is a joint venture between health and social care. NHS Kirklees’ medicines management team has continued a rolling programme of inspection and monitoring visits around the safe and secure handling of medicines for community clinics, GP practices and community pharmacies, with action plans being agreed to improve standards where necessary.
There has been continued growth in the number of qualified non-medical prescribers (nurses and pharmacists) within NHS Kirklees, with a total of 169 community nurse prescribers, 69 independent nurse prescribers, nine pharmacist prescribers, and one allied heath professional supplementary prescriber. Relevant health professionals are encouraged to train as non-medical prescribers, especially where this will promote wider access to healthcare and medicines for patients and closer to their homes.
The team has also continued to work closely with GPs and local hospitals to improve the quality and cost effectiveness of prescribing, with:
Systems for sharing prescribing data amongst non-medical prescribers have been developed so there is better peer support and to make sure local formularies are adhered to.
• agreement and implementation of around 260 clinical audit topics to improve the quality of patient care and cost-effectiveness of prescribing;
Maintaining medicines standards Key medicines policies have had a major review in 2008/09, including the Medicines Management Policy, Controlled Drugs Policy and the Cold Chain Policy. These incorporate current best practice to maintain the highest standards in the handling and use of medicines. Training packages for medicines and medicines management have also been reviewed and are included as an integral module in our mandatory training programme. We have also developed new training packages for domiciliary care workers, which have
• cost efficiencies of more than a quarter of a million pounds achieved; • a predicted underspend of £1.8 million on a prescribing budget of £61 million;
Glaucoma referral refinement scheme Following a pilot in South Kirklees in December 2008, NHS Kirklees has implemented a glaucoma referral scheme across the whole of Kirklees. This means people can be diagnosed more quickly as part of routine eye tests. The optometrist can now refer a patient directly to the hospital clinic instead of having to go back to their GP.
Primary Care developments
Improving access to medicines
During next year, we aim to develop a community based eye care service for people who have the sudden outset of eye problems or sight loss. Across Kirklees we will have a number of optometrists who will be specially trained to assess, diagnose and treat some acute eye problems. This will allow patients to access emergency care in the community instead of having to go to Accident and Emergency.
• regular hands-on pharmacist and technician support to 69 out of 74 GP practices;
• regular medicines management and community pharmacy newsletters; • pharmacist representation on Health Improvement Teams (HITs); and • development and implementation of clinical guidelines and public awareness campaigns.
Optical services NHS Kirklees is keen to develop the level of eye care provided in the community so that patients can get help and care closer to their homes and avoid unnecessary hospital visits. We are working closely with community optometrists to identify what services we can develop together.
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Intermediate Creating even more choice care The aim of intermediate care is to bridge the gap between hospital and primary and community care and provide a joined up service to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living. In 2008/09 we worked with providers of intermediate care services in Kirklees and identified key areas for the development of a Kirklees Intermediate Care Pathway (KICP). The following service developments will now take place: • a single point of contact for services; • intermediate care services skilled to care for people with both intermediate care and mental health problems; • dedicated pharmaceutical support; and • funding to support education of staff. The single point of contact in the south of Kirklees is fully operational and has already placed more than 150 patients within our services since it started in December 2008. Mental health services are being commissioned to be based within our intermediate care teams and support the KICP. The redesigned Kirklees Intermediate Care Pathway is being launched in September 2009.
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NHS Kirklees Annual Report 08|09
All patients can expect a choice of where they want to receive hospital treatment. NHS Kirklees is committed to making sure patients have a choice of where they are cared for and developments in 2008/09 include: New vasectomy service in Dewsbury The process of booking and having a vasectomy is now more convenient for men in Kirklees with the introduction of a new community service. A urologist will perform the procedure under local anaesthetic at Dewsbury Health Centre. This will cut down on waiting times, stop the need for an inpatient stay and provide a more relaxed environment for patients to have the procedure.
Community hospitals project The community hospitals project at Holme Valley Memorial Hospital promises to deliver care closer to home for patients in the Valleys and surrounding localities of Kirklees. The aim of the project is to improve the patient experience and clinical outcomes through facilities
which are fit for the future and aligned to the NHS Yorkshire and the Humber plan ’Healthy Ambitions’ and our five year strategic plan. The space and services will be designed in conjunction with the public to make sure the facilities are well used and continue to have a sense of being owned by the community. Services will also be developed in response to needs identified in the Joint Strategic Needs Assessment (JSNA) and will be designed by Health Improvement Teams (HITs) and Practice Based Commissioning Consortia. Existing services provided at Holme Valley Memorial Hospital will be maintained. An invitation to tender was issued in spring 2009 to find suitable partner organisations to help develop the detailed business case and to clarify in detail what services will be provided, what facilities are needed and the best solutions for delivering this. A final business case will be available in October 2009 which will detail the planned timetable for delivery. NHS Kirklees Strategic Plan - Ambitions for a Healthy Kirklees 2009 – 2013 also includes a need for enhanced primary care and community hospital facilities in central Huddersfield. This development (location yet to be agreed) will operate alongside the existing facility at Dewsbury Health Centre and the planned facility at Holme Valley Memorial Hospital. The central Huddersfield hub will offer a wide range of primary and secondary care services delivered in modern accessible surroundings.
In Kirklees, more than 200,000 people are living with a long term condition. People with long term conditions account for 80% of GP consultations and 36% of overall bed day usage in hospitals. Partnership and consultation underpin our approach to the Long Term Conditions Strategy. Widespread consultation with users is central to our work and in September 2008 a stakeholder summit took place to confirm that we were heading in the right direction. The event also showcased some of the new and existing services available for people with long term conditions. Throughout 2008/09 the Long Term Conditions Partnership Board has involved users and clinicians in service redesign and the commissioning of care pathways. This has included consultation on the generic care pathway, the redesign of intermediate care services and Year of Care user focus groups. Effective partnerships with all appropriate agencies are vital for improving long term condition care locally. All long term conditions, including diabetes, renal, stroke, cardiology, respiratory, neurology, pain and self care have Health Improvement Teams (HITs) whose main objective is to commission care that is responsive to local needs and will lead to improved outcomes for the individual and their carers.
The Year of Care programme was set up in September 2007 and has continued to bring about improvements for patients and health professionals. NHS Kirklees is amongst only three organisations to pilot the Year of Care initiative nationally. It has been set up in three GP practices in Kirklees and involves everyone who works to support people with diabetes. These practices are Blackburn Road in Birkenshaw, The Grange in Fartown, Huddersfield and the Kirkburton Group Practice, in Huddersfield. In 2009/10 the Year of Care project team will be providing training to all staff and continuing to work with GP practices to support them in the early implementation phase of the change in the way the diabetes service is delivered. The aim is for everyone with a long term condition to feel supported and have a personalised care plan supported by, and developed in partnership, with a clinician. Throughout 2008/09, NHS Kirklees has also appointed 25 community matrons and five social care case managers as part of a long term conditions team to offer patients with complex, chronic long term conditions intensive personalised care in their own homes. These teams are community based, and each member of the team works with a
small cluster of GPs to help patients take control of their own condition, reduce unnecessary hospital admissions and improve an individual’s confidence and well-being. We will build on the developments achieved through the Quality and Outcomes Framework and primary care knowledge of individuals to improve continuity of care and care co-ordination for people with long term conditions.
Tackling long term conditions
Tackling long term conditions
People with a long term condition are able to access telehealth monitoring equipment that supports and facilitates self care, enables the clinicians to have remote access to an individual’s vital signs and monitoring, allows a clinician to enhance the individual’s personalised action plan and will consequently reduce dependence on health or social care professionals along with inappropriate use of emergency health or social care services and a reduction in unplanned admissions.
The aim is for everyone with a long term condition to feel supported and have a personalised care plan
We have learned from the national Diabetes Year of Care pilot the importance of person-centred care planning. This means individuals: • set their own goals, supported by high quality information; • take personal responsibility for their own health; and • are the experts for the management of their condition.
NHS Kirklees Annual Report 08|09
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Mental health and learning disabilities
Listening to you
NHS Kirklees aims to help local people with mental health issues to maintain and improve their wellbeing. For those who experience mental health distress, the intention is to obtain the highest level of independence within their communities, through the use of quality support networks and services.
Sometimes things go wrong in the NHS and, when they do, people might want to make a complaint and have their concerns investigated. NHS Kirklees welcomes and values any comments or suggestions on your health care services, so we learn from these and make improvements where necessary.
A number of new initiatives have been introduced in Kirklees in 2008/09. Kirklees Joint Mental Health Commissioning Strategy was launched in June 2008 and set out a joint vision to improve mental health services and the benefits this will bring to people. The strategy was drawn up by NHS Kirklees and Kirklees Council and
demonstrates how we work in partnership to involve service users and their carers to shape mental health care. New health action plans for people with a learning disability were also developed by South West Yorkshire Partnership NHS Foundation Trust, NHS Kirklees and Kirklees Involvement Network (KIN) to give people more accessible information about their health. The health action plans help to put people with learning disabilities in control of their own health by having all their health information recorded in one place and advising them where to go if they need help and advice. The plan also enables people to share information with health professionals; it serves as a diary for health appointments and contains useful contact information.
Rob Napier, Nicola Cromack and Cllr Margaret Bates at the health action plan launch
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NHS Kirklees Annual Report 08|09
Most concerns can be resolved easily, often at the time they arise. Alternatively, the Patient Advice and Liaison Service (PALS) can help people to reach a solution or advise on alternative courses of action. In some cases, a complaint might be lodged with NHS Kirklees for any of the services we commission or that are provided by Kirklees Community Healthcare Services (KCHS). These are managed through our Complaints Policy and Procedure using specialist trained staff.
NHS Kirklees welcomes and values any comments or suggestions on your health care services, so we learn from these and make improvements where necessary
Commissioning complaints Orthodontic provision in Kirklees
9
Exceptional Cases Committee – unsuccessful requests
3
Length of time taken to review / reimburse continuing care funding
2
Lack of available car parking spaces at a health centre
2
Choose and Book
1
Kirklees Community Healthcare Services complaints Rehabilitation services
5
District nursing
4
Health visiting
4
Community dentistry
3
Other
4
We aim to learn from all complaints and improve those services. Here are a few examples where we have done this: You said
We did
A patient travelled to their clinic appointment not knowing the clinic had been cancelled.
The service has reviewed its procedures and in future when clinics are cancelled patients will be notified by telephone and letter.
Nine complaints were received from concerned parents regarding the length of time their children had to wait before starting their orthodontic treatment.
NHS Kirklees is undertaking a detailed review of the provision of orthodontic treatment for Kirklees to work out its future service needs.
Two complaints were made about the amount of parking available when attending a health centre.
The PCT is reviewing the parking policy at local health centres to increase the number of allocated spaces.
New complaints process The Parliamentary and Health Service Ombudsman first published the Principles for Remedy in October 2007, and reprinted with minor amendments in February 2009. The aim is to secure suitable and proportionate remedies for complainants whose complaints are upheld and, where appropriate, for
others who have suffered injustice or hardship as a result of the same maladministration or poor service. NHS Kirklees is reviewing all associated policies and procedures in light of the new guidance and has a clear objective to fully comply with all the new requirements.
Serious Untoward Incidents
Listening to you
During 2008/09 NHS Kirklees handled 37 complaints. The following table shows a breakdown of these complaints:
NHS Kirklees receives information on Serious Untoward Incidents (SUIs) from the commissioned services within its boundaries in order to both identify learning opportunities for improving patient safety, and to make sure that the commissioned service have robust arrangements in place to investigate incidents and prevent reoccurrence. The table below shows that we received one notification of missing patient records; this incident was investigated by NHS IT security management services.
Summary of other personal data related incidents in 2008/09 Category
Nature of incident
Total
v
Other
1
Freedom of Information The Freedom of Information Act gives general right of access to all types of information held by public authorities. Members of the public are able to request information held by NHS Kirklees, whether it be personal to them or publications produced by the organisation. We aim to make as much information as possible available to people via the publications scheme on our website. However, if this is unavailable, it can be requested in writing and will be provided unless it is subject to an exemption. During 2008/09, NHS Kirklees received 277 requests for information about a range of issues particularly from researchers, the media and companies wishing to target products to particular audiences.
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Involving patients and the public in their local NHS NHS Kirklees is working hard to involve patients and the public in our work so they can help shape local health services. We encourage patients and the public to share their ideas and experiences and we use this feedback when we are planning new services so they are as personal as possible. There are now more ways than ever for local people to have their say about health services which are important to them. These include:
‘Have your say ’ A ‘Have your say’ card means patients can have their say and feedback their views on local health services .The postcards have a freepost address and are available at various community venues or from the NHS Kirklees website www.kirklees.nhs.uk under the get involved section. During 2008/09 we received 21 cards with suggestions or feedback.
Patient Opinion Comments can also be sent to Patient Opinion – an independent, not-forprofit organisation www.patientopinion.org.uk. Patient Opinion allows patients to share their experiences of health care, which helps to inform other patients, as well as improve services.
NHS Choices Patients can post comments about any aspect of local NHS care or treatment by visiting the official NHS website www.nhs.uk. medical conditions and treatments.
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NHS Kirklees Annual Report 08|09
Patient Advice and Liaison Service (PALS)
accessibility to the surgery and what they would like to see improved.
Our Patient Advice and Liaison Service is now well established. During 2008/09 the service dealt with 10,009 calls for help, advice and information on service matters. The majority of PALS enquiries were about access to NHS services or requests for advice and information about health and social care. Telephone 01484 466172 / 466214.
Key themes emerging from this survey were that the GPs were keen to know how the patient experience side of QOF would change as the survey will be carried out nationally rather than locally next year. Many practices were interested in pursuing customer care training for GPs and their staff.
This year we launched a text service for PALS to encourage young people to contact the service as well as those who have difficulty contacting us during working hours.
The Kirklees Readers’ Panel is a group of more than 60 volunteers who read new and updated information sent out by NHS Kirklees. Working in partnership with Kirklees Council, it has not just looked at NHS documents, but local authority ones as well.
Due to the high proportion of dental queries to PALS, a freephone dental registration line was set up following discussions with the PCT’s dental team. The number is 0800 587 2417.
Local Involvement Network (LINk) NHS Kirklees has been working closely with Cloverleaf Advocacy, the host for the Kirklees Local Involvement Network (LINk). The aim of LINKs is to give communities a stronger voice in how their health and social care services are delivered.
Quality and Outcomes Framework – patient experience survey The Patient and Public Involvement team reviewed the Quality Outcomes Framework (QOF) patient survey that is carried out in all GP surgeries across Kirklees. Each GP surgery asked its patients questions about their experience of attending the surgery, their consultation with the GP,
Kirklees Readers’ Panel
In 2008/09 it looked at information ranging from posters and leaflets to more detailed documents. The overall aim of the group is to make sure that information is easy to understand and accessible to everyone. Subjects have included: • peer support for breastfeeding; • district nursing service; • having an operation; • a minor ailment service; • pain management service; • podiatry posters; • top tips to help your baby’s physical development; • urgent care service in West Yorkshire; • volunteers handbook; • vasectomies; • the Telehealth project; • Disability Discrimination Act; • information for relatives and carers of an adult who was dying; and • Kirklees Transcription Service.
Health communications
Your guide to local health services
In 2008/09 NHS Kirklees consulted with the public about a number of key issues. Examples where the public have influenced decision making include:
NHS Kirklees is also committed to informing the public about its work as the local leader of the NHS.
A 32-page A5 booklet “Your Local NHS” was published in December 2008 and delivered to 180,000 homes. This provided information about the range and quality of local Your services available to local people to NHS help them make the right choices and use services more appropriately. This year it also included details about GP access and listed contact details for all GPs in Kirklees.
• Consultation on Slaithwaite and Liversedge health centre. Patients were given the opportunity to be involved throughout the process, have a say on the changes and contribute to development of plans. • Urgent care – The PCT conducted a formal engagement process about the provision of urgent care services in the area to enable the preparation of plans and appoint a new provider. • Mental health commissioning of health and well being services – involvement of mental health services in the design, commissioning and monitoring of local health and well being services. The work informs both the commissioning process and the Mental Health Partnership Board on an annual basis. • Consultation on a new 8am to 8pm health centre in Dewsbury, which opened in March 2009.
Health Talk “Health Talk” is a regular newsletter which is delivered directly into 180,000 homes across Kirklees to inform our residents and stakeholders about our role and the work we do. It was produced following feedback from a communications and engagement workshop in which community groups highlighted the public need for regular information from the NHS about what we do. The first issue was sent out in December and the PLUS second in March 2009. Feedback so far has been very positive. Issue 2 • Spring
New 8am to 8pm GP-led centre for Kirklees Is your child protected?
Cancer victim’s praise for the NHS
Your local NHS
2009
Your local NHS 1
2008/09
Your guide to local health services
Your local NHS 2 Staying healthy 6 Pointing you in 18 the right direction Useful contacts 31
Involving patients and the public in their local NHS
Consultations
Press coverage NHS Kirklees has a positive working relationship with the local media. We take a proactive approach with the media in an attempt to reach our target audiences as well as shape public opinion about the local NHS. In the last 12 months, the communications team has issued 102 media releases.
Volunteering NHS Kirklees is passionate about its volunteers, who give up their free time to enhance the core work of the organisation. There are currently 64 active volunteers, with a further 37 in training, working for NHS Kirklees in a range of capacities, from giving practical advice, information and support to promoting good health.
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Valuing our staff Risk management Risk management is an integral part of how NHS Kirklees operates, both with our patients and staff and with the services that we commission. NHS Kirklees has been actively measuring our effectiveness, identifying gaps and making changes, where necessary or to benefit patients.
To meet our commitment to staff and to achieve our values and goals we are striving to gain Investors in People accreditation. NHS Kirklees now employs 1,542 staff in a range of occupations and professions including: Registered nurses
39.4%
These actions include:
Health care assistants and support posts
13.3%
• Completion of the new NHS Litigation Authority’s Standard for PCTs.
Allied health care professionals
7.8%
• Reviewing our mandatory training programme.
Scientific and professional
1.5%
Medical and dental
3.5%
• Introducing specialist training for key staff who deal with risk issues daily.
Administrative and clerical
27.1%
Senior managers
6.6%
Estates
0.5%
• Being awarded the RoSPA Bronze Award for Health and Safety.
Students
0.3%
• Safe and Secure Premises Design (SBD) is a police initiative that encourages the building industry to adopt a number of crime prevention methods which help to reduce the chances for crimes to be committed and the fear of crime, which results in a safer and more secure environment. Every member of staff must attend health and safety, fire, records management, infection control and the management of violence and aggression training. Risk management training has been delivered to 86% of all staff as well as bespoke training for the Board.
A commitment to equality NHS Kirklees actively monitors the composition of its workforce. The profile of the workforce by ethnic origin is highlighted below: White
89.5%
Mixed background
0.8%
Asian
5.7%
Black
1.2%
Other ethnic group/Chinese 0.3% Undefined/not stated
2.5%
An Equality and Diversity Project Officer was appointed in August 2008. NHS Kirklees’ single equality scheme and action plan has been reviewed and new equality objectives have been set for each directorate. The equality and diversity working group meets regularly and oversees and the implementation of the scheme. A project plan has been produced on how NHS Kirklees will embed equality impact assessments. Four half-day workshops have been held and further training is planned. We undertook the Diversity Driver self assessment which was facilitated by the Fair Play Partnership. Through this an action place has been identified.
Staff celebrations NHS Kirklees values its staff and celebrates the contribution made by them. Throughout 2008 a range of events were arranged for our workforce including:
NHS Kirklees Diamond Awards event This event celebrated the long service, achievements and dedication of our colleagues at a special awards ceremony in October 2008. More than 100 nominations were received. A range of staff awards such as recognition for innovation in patient care and leadership were available.
NHS Kirklees’ risk management team review all reported incidents and provide advice, support and guidance to all parts of the organisation. Standard tools for measuring compliance against legislation and best practice are being used in all premises for health, safety, fire and security.
Gwen Bachelor receiving her 40 years long service award
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NHS Kirklees Annual Report 08|09
In September 2008, NHS Kirklees hosted the Celebrating the Talent event where a number of departments and teams presented examples of service innovation and good practice. Staff also showcased their work in a market place setting.
Childcare support To help our staff balance work and family commitments, we have a childcare and carers support service provided by Mid Yorkshire Hospitals NHS Trust and Calderdale and Huddersfield Foundation Trust. During 2008/09 the service provided a number of opportunities for our staff across Kirklees including: • Maternity workshops. • Informal baby massage / parent craft classes. • Childcare voucher scheme. • Pre-school support and school holiday support. A number of holiday clubs are run during the main school holidays for children aged four to 14. • The NHS Childminding Network offers a flexible service to NHS staff. Membership of our carers focus group, which provides carers support for staff caring for a family member, partner or friend who is ill, frail or disabled, continued to increase.
Occupational health and staff counselling service To help our staff live a healthy life, the Human Resources / Organisational Development (HR/OD) team commissioned an occupational health and staff counselling service provided by Mid Yorkshire Hospitals NHS Trust. The occupational health team provide advice and support on all health and safety issues and the staff counselling service provides an independent and confidential service - without a waiting list. The HR/OD team also commissioned an occupational health service for GPs, dentists and their staff across Kirklees and this service is provided by Employee Healthcare who are part of Kirklees Council.
Managing stress and sickness During the last year and following the approval of the management guidance for stress at work, eight roadshows were organised by the HR/OD across Kirklees. The purpose was to provide advice and guidance for managers and team leaders to help them manage stress at work. Ninety-five managers and team leaders have attended the roadshows so far.
Staff partnership forum
Valuing our staff
During the celebration event, 45 staff were also recognised for 25 years service with the NHS. Batley health visitor, Gwen Bachelor, received a special award for 40 years service.
We continue to hold monthly meetings between management and staff representatives to discuss issues of mutual concern including reviewing human resources policies and procedures. During 2008 the following policies / procedures were approved: • equality / diversity; • bullying and harassment; and • management guidance on stress at work. The forum also considers service changes which impact on staff including the transfer of staff into new services or buildings. Currently we are consulting with staff over the move to a new headquarters building in Bradley, Huddersfield. Agreement has also been reached about transferring a small number of staff from weekly to monthly pay and discussions are ongoing about the lease car scheme.
The sickness rate for PCT staff during 2008 was 3.85%.
Policies and procedures During the year the HR/OD team have revised a number of employment policies and procedures. They include policies on equality / diversity, disabled people and health and safety.
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Recruitment During 2008/09, 444 staff have been recruited to the organisation and during the same period the recruitment service at Beckside Court, Batley, dealt with more than 7,000 applications. The HR/OD team ran six recruitment and selection workshops and 82 managers and team leaders attended. More workshops are planned throughout 2009. For recruitment to senior posts, the HR/ OD team has a number of staff who are accredited to run a range of psychometric tests and assessment centres. This means we test our applicants to the highest level to make sure we appoint the best candidates for these roles. The HR/OD team continue to promote NHS Kirklees and the NHS in general as a great place to work. This has included attendance at numerous career events in schools, colleges and with the general public. The team has also provided input onto university courses and provided mock interviews in various schools.
Staff training and leadership development During 2008/09 there has been a considerable investment in staff and leadership training and development across the organisation. We have reviewed our induction programme to make sure that all new starters receive appropriate information, support and development at both a local and corporate level when they join NHS Kirklees. A training needs analysis and review of the World Class Commissioning competencies has highlighted the range of skills, knowledge and capabilities that will be needed in future to deliver the commissioning agenda. A leadership programme is currently being commissioned to meet these identified needs. An organisational development plan has also been developed to take NHS Kirklees forward during 2009/10. Coaching has been provided on a oneto-one and group basis to support individuals and teams working towards their goals, to drive performance
improvement and also manage change affecting their work roles. Through the Investors in People champions group, a number of focus groups were held with staff to identify what we can do to improve their working lives in Kirklees. Steps taken to address issues include: • improve communication, making sure this is two-way; • review and extend flexible working opportunities, where appropriate; and • improve the Personal Development Review (PDR) process so that all staff have a clear understanding of what is expected from them and that they receive appropriate training and development.
Our commitment to developing our leaders NHS Kirklees is committed to developing its leaders within the PCT and agreed a Leadership Strategy in 2007. Over the past year as part of our ongoing development of the Board and directors and the World Class Commissioning process we have designed a programme for both the NHS Kirklees Board and our directors as leaders of the organisation. NHS Kirklees was one of the first PCTs in the country to commit to a programme of Board and director development to support World Class Commissioning. We have commissioned a 12 to 18 month programme of work with KPMG. This programme is designed to meet not only the individual needs and aspirations of our team, but also make sure that collectively we have the right behaviours, skills and knowledge at director and Board levels. This work will contribute to achieving our growth and development outlined in our Organisational Development Plan. We have also placed an emphasis on clinical development and reshaped the
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Workforce planning and development
Kirklees Community Healthcare Services
Discrete workforce planning projects are taking place, including a project in partnership with Kirklees Council, looking at the workforce for the services to under fives.
Specific dedicated training sessions were developed and delivered for middle managers and team leaders within Kirklees Community Healthcare Services. This was practical, ‘hands on’ training which has helped to clarify managers’ roles, their responsibilities and to help them carry out their job and support and develop their staff. Other training sessions have included personal development reviews, a half yearly employment law update with practical interactive sessions and other relevant topics.
Knowledge and Skills Framework (KSF) The KSF clearly identifies the knowledge and skills our staff need to do their jobs. The appraisal process uses this information to provide feedback on their performance and how they have contributed to the organisation’s overall goals. It is also the way in which we identify training and development needs for teams and individuals.
NHS Kirklees carried out risk assessments of its workforce and identified mitigating actions. It also worked with its main NHS providers to carry out similar risk assessments. These plans were submitted to the Strategic Health Authority in September 2008, as well as our medium term workforce and training projections.
A training needs analysis of the existing commissioning skills in the organisation and Practice Based Commissioner partners took place in late 2008 and the development of a NHS Kirklees commissioning college is underway to address the development needs identified.
Annual NHS staff survey Between October and December 2008, our staff took part in the sixth annual NHS national staff survey. With an above average response rate of 66%, this survey helps us gather information that will improve the working lives of our staff and provide better care for patients. From our full sample of staff, the Healthcare Commission selected a random sample of staff responses to feed into the national report, based on the findings of almost 290,000 NHS staff.
The findings highlighted that NHS Kirklees was rated in the best 20% of PCTs in England in the following areas:
Valuing our staff
workings of our Professional Executive Committee with new appointees as clinical leaders and stronger links with Practice Based Commissioners. This has included development of the concept of a commissioning college which enables stakeholders to be informed and inform decisions regarding the PCT commissioning agenda. This is underpinned by collective and individual development.
• Staff feeling satisfied with the quality of work and patient care they are able to deliver. • Staff feeling valued by their work colleagues. • Staff working in a well structured team environment.
Out of the 36 key findings, NHS Kirklees has improved in 18 areas • Commitment to helping staff find a good balance between their work and home life. • Recommending NHS Kirklees as a place to work. • Fewer staff reporting feeling the pressure of their work. • Fewer staff reporting suffering work related stress. • Fewer staff witnessing potentially harmful errors, near misses or incidents. • Fewer staff saying that they intend to leave their jobs. Out of the 36 key findings, NHS Kirklees has improved in 18 areas, eight remain unchanged from last year, and the remaining 10 key findings are new to the survey in 2008. Action plans will be presented to the NHS Kirklees Board. More information is available from the Care Quality Commission’s website www.cqc.org.uk
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Making people safe The safeguarding team at NHS Kirklees provides a range of services and provides skilled expertise, knowledge and support within and outside the organisation on all aspects of safeguarding. Working in partnership with Kirklees Council and other key partners, the safeguarding team has strong and effective links across the Kirklees health economy. We all work together to make sure that safeguarding children and vulnerable adults is high on the agenda to improve outcomes for these vulnerable groups.
We all work together to make sure that safeguarding children and vulnerable adults is high on the agenda to improve outcomes for these vulnerable groups.
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NHS Kirklees Annual Report 08|09
NHS Kirklees is a key member of the Kirklees Safeguarding Children Board and Kirklees Safeguarding Adult Board. The safeguarding team also works closely with all those who commission and provide services to make sure that safeguarding is reflected in all aspects of service delivery. Over the last year, safeguarding policies and procedures have been reviewed to incorporate local and national policy and safeguarding is reflected in NHS Kirklees’ strategic priorities. Three new members of staff have also joined the safeguarding team in 2008/09 and safeguarding responsibilities are now included in all employee job descriptions. Work is ongoing to make sure that all services which are developed and delivered include safeguarding. During 2008/09, the team has worked with children’s social care and the police around domestic abuse, and a number of training events have been held for independent contractors, including GP practices, dental practices and community pharmacies.
The safeguarding team is committed to ongoing professional development and many members have successfully completed or enrolled for postgraduate studies in safeguarding or child health courses. Other developments include improvements to the safeguarding area of the PCT’s intranet site and new safeguarding leaflets, which have been circulated to all staff. All this work will continue in the coming year and work is currently underway to develop a safeguarding newsletter which will be distributed throughout the organisation twice a year. Other key areas of work for 2009/10 include strengthening links with all areas of service to make sure that safeguarding children and vulnerable adults remains a priority in Kirklees.
Continued plans to reduce our impact on the environment in 2009/10 include: • recycling printer cartridges; • encouraging the recycling of paper waste; and
re
BON ACTIO R N A
fu tu
al
NH
Sw
orking for a
en gre
We have contracts with a number of companies who provide a variety of services which are essential for the work of the organisation. Listed below are details of these contracts: Cleaning: Initial Cleaning Services MITIE Management Ribchesters (Broughton House only) Calderdale & Huddersfield NHS Foundation Trust (CHFT)
Maintenance:
• encouraging staff to share car journeys and looking at incentives we might offer to staff who use alternative transport to, or within work, such as cycling.
c r lo You
Since then, the Sustainable Development Unit has consulted upon and launched Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England which sets challenging targets for NHS organisations to reduce their carbon emissions by 60% by 2050. The NHS Sustainable Development Unit provides leadership, support and policy guidance to the NHS in
NHS Kirklees has recruited a carbon reduction project officer who will work closely with colleagues in Kirklees Council to make sure we put plans in place to support the carbon reduction targets in the Local Area Agreement and meet the needs of the NHS strategy.
er
In 2008/09 we have continued to promote our '10% less' campaign to make sure energy is not being wasted. Posters are displayed around our premises to remind staff to save energy by turning off light switches and equipment at the end of the day and there have been regular features in the staff newsletter.
England on promoting sustainable development and mitigating climate change.
C
NHS Kirklees has been involved in the green environmental agenda since 2007 in a bid to reduce its impact on the environment, including the setting up of a local health economy group, which also involves Kirklees Council to reduce carbon emissions.
Impact on the environment and Service contracts
Impact on the environment Service contracts
CHFT – minor works, specialist works and repairs MITIE Management – minor works and repairs Medical Physics – equipment maintenance Dawmed – equipment maintenance Sterilizer Consultancy Services – equipment maintenance Algeo – equipment maintenance Connaught – asbestos surveys Environmental Water Systems – equipment maintenance Waterchem – legionella checks SRCL – clinical waste collection PHS – sanitary waste collection Kirklees Council – domestic waste collection Various contractors for refurbishment and repairs.
Buildings: Semperian Asset Management – Batley, Cleckheaton, Dewsbury, Eddercliffe, and Ravensthorpe health centres. Numerous individual leases with private landlords, GP’s and companies.
Security and fire: Gough & Kelly ADT Hallmark Fire Ltd
Chubb BDI
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Our directorates The Chief Executive is accountable for the day to day running of NHS Kirklees and its eight directorates. Each directorate is led by a director who has responsibility for a range of functions. The Directorate of Corporate Services is responsible for enabling and supporting the PCT’s corporate functions and agenda. It works across all directorates, contributes to the strategic priorities and makes sure statutory duties and legislation are complied with. It is also responsible for leading risk management, communications, patient and public involvement and supporting organisational development. The Directorate of Commissioning and Strategic Development reviews, plans and develops a wide range of high quality, responsive and efficient healthcare services. It also supports practice based commissioners and manages the strategic plan and Local Area Agreement.
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NHS Kirklees Annual Report 08|09
The Directorate of Finance provides financial management support and advice to enable the organisation to meet its statutory financial duties, including keeping our revenue and capital expenditure within our allocation. It also supports managers and staff in making sure that the services we commission and provide deliver value for money and that we have robust financial governance across the organisation. The directorate also hosts an estates team which provides strategic estates and facilities advice within NHS Kirklees and to external stakeholders such as GPs. The team also makes sure that the buildings our staff work in are managed to an acceptable standard of safety and cleanliness.
The Directorate of Patient Care and Professions provides professional advice, leads on the re-design of primary care services and commissions services for people with long term conditions. It also acts as the clinical governance watchdog for NHS Kirklees and leads on quality improvement and patient safety, as well as being responsible for professional development and education.
The Directorate of Performance and Information manages performance systems and processes for NHS Kirklees so that it can measure its performance against national and local targets. It also evaluates the performance of our primary, community and secondary care services. This directorate also leads on the implementation of the National Programme for Information Technology and is responsible for the delivery of information and IT services to the organisation.
The Directorate of Human Resources and Organisational Development leads on human resources and organisational development for NHS Kirklees and NHS Calderdale. The directorate also provides support for workforce planning and development.
The Directorate of Public Health delivers key public health goals, working in partnership with Kirklees Council. It influences the commissioning of services to make sure they improve health locally and reduce inequalities. It is also responsible for infection control and being prepared to cope with emergencies.
Our Provider Services, Kirklees Community Healthcare Services (KCHS), is accountable and responsible for managing a range of primary and community care services as outlined on page 7.
Our Board
Our Board NHS Kirklees Board meets monthly in public and keeps a strategic overview of the organisation and makes sure that it meets its statutory, financial and legal responsibilities. The Board provides leadership, makes decisions about healthcare services as well as plans to improve them. It also makes sure performance targets are met and that the finances of the organisation are managed properly with accurate information. The Board is made up of non-executive directors, who are local lay people, who work with the executive directors and help the Board to be sure that it is working in the public interest and keeps its patients and the public properly informed. Clinical expertise is provided by the PEC with representation from local GPs, nurses and other health professionals and social services. Committees and sub committees of the Board: • Audit Committee • Governance Committee • Communications and Public Relations Committee • Finance and Performance Committee • Remuneration and Terms of Service Committee • Professional Executive Committee (PEC).
Professional Executive Committee
• Dr Ajit Mehrotra - GP
The Professional Executive Committee (PEC) is responsible for giving clinical leadership to NHS Kirklees.
• Dawn Gordon - District Nurse
The PEC works closely with the senior management team at NHS Kirklees in setting priorities, developing service strategies and making sure these are implemented in the services that we offer. The committee is accountable to the Board through the PEC Chairman. Other key functions of the PEC include: • commissioning and supporting Practice Based Commissioning;
• Dr Anil Aggarwal - GP • Sarah Brackwell - Health Visitor • Angela Ladocha - School Nurse
Non members in attendance: • Vanessa Stirum - Non Executive Director
Local Authority representatives: • Sally McIvor, Head of Adult Social Care and Operations • Karen Worrall, Head of Localities, Children and Young People’s Services.
• clinical effectiveness and clinical governance; and • leading clinical communications with partners and stakeholders.
Our PEC members are: • Dr David Anderson, GP – Chairman • Dr David Wood, Dentist - Vice Chairman • Mike Potts - Chief Executive • Sheila Dilks - Executive Director of Patient Care and Professions • Dr Judith Hooper - Executive Director of Public Health • Bryan Machin - Executive Director of Finance • Helena Corder - Director of Corporate Services • Robert Flack - Director of Provider Services • Dr Peter Flynn - Director of Performance and Information
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Director of Finance’s report I am pleased to report that NHS Kirklees has once again achieved all the financial duties set for it by the Government. NHS Kirklees receives two separate allocations of money from the Department of Health. Our revenue allocation totalled £584 million in 2008/09 which we used for our day-today activities, many of which you can read about elsewhere in this Annual Report. Our capital allocation was £4.1 million and we used this for one-off purchases or for improvements to our buildings, equipment or information technology. We began the year planning to spend £2.8 million less than our revenue allocation and to carry forward that underspend to 2009/10. At the end of the year we have achieved this. The underspend, which is only half a per cent of our allocation, will be spent in 2009/10. NHS Kirklees received a 5.5% recurrent increase in its revenue allocation for 2008/09 of £29 million. After meeting the costs of inflation we were able to make significant investments in improving access to health services, improving the quality of services in hospitals, improving the environment and safety in doctors’ and dentists’ surgeries and increasing the number of healthcare professionals working in the community. For example: • We significantly increased spending on hospital services to make sure patients were able to receive their treatment within the 18 week target.
36
• More than £1 million was spent on increasing access to NHS dental services and we started to invest £800,000 on improving dental surgeries. • We made a significant investment in our long term conditions programme, employing more community matrons and other health professionals to provide care to people in their own homes and helping to avoid unnecessary admissions to hospital. This will continue in 2009/10. • We have committed more than £1.5 million increasing the numbers of district nursing staff as part of a modernisation and improvement programme for community services. • We continue to provide new money for new treatments; for example, we provided more than £500,000 to meet the costs of new treatments for people with the eye condition Age Related Macular Degeneration (ARMD). NHS Kirklees’ expenditure is incurred mainly in our contracts with a wide range of organisations, both NHS and non-NHS, hospitals and community organisations, GPs, including prescription costs, dentists, optometrists, pharmacists and others. We also spend our money helping people to improve their health and well-being, such as helping people to stop smoking, promoting healthy lifestyles and encouraging access to screening services.
Hospital services
• We spent more than £1 million on new mental health services.
Primary healthcare (GPs, dentists etc)
• New guidance on responsibilities for funding continuing care (i.e. care provided over an extended period of time to meet physical or mental health needs that have arisen as a result of disability, an accident or illness) required us to commit more than £4 million during the year on meeting peoples’ needs.
Mental health services
NHS Kirklees Annual Report 08|09
Community services A&E Maternity Learning difficulties
The following chart provides a summary of how we spend your money. Hospital services
£259m
Primary healthcare (GPs, dentists etc)
£151m
Mental health services
£60m
Community services
£49m
A&E
£31m
Maternity
£21m
Learning difficulties
£11m
During 2008/09 we managed our money flexibly to meet changing circumstances. We faced an increase in costs due to an unexpected increase in people needing hospital treatment and the costs of specialist treatments, mainly carried out at Leeds Teaching Hospitals, was higher than forecasted. Some of our new investments also took longer than anticipated to implement. We have also had the benefit of money we placed in a Strategic Investment Fund held on our behalf by the Yorkshire and the Humber Strategic
During the year, NHS Kirklees agreed to play its part in resolving the financial deficit at Mid Yorkshire Hospitals NHS Trust. As part of an agreement with the Trust, the Strategic Health Authority and NHS Wakefield District, we agreed that £11 million of our Strategic Investment Fund should be used to meet this deficit. £3.7 million was used in 2008/09, part of the £5 million referred to above, with a further £3.7 million in each of the next two years. At the start of 2009/10, we had £15 million in the Strategic Investment Fund of which £7.4m is committed to Mid Yorkshire Hospitals NHS Trust and £7.6 million remains available to the PCT. Moving on to our capital allocation of £4.1 million, more than £2 million is being spent to provide a new modern ward at Holme Valley Memorial Hospital. At the start of the year we had planned that this work would be completed by 31 March, but the ward is now expected to open in the summer. This means that about half of the money was spent in 2008/09 but we have been able to agree with the Strategic Health Authority that the balance of the money will be available to us in 2009/10. We have also improved the facilities and environment at Moorfields Health Centre and at Fartown Health Centre. We continue to invest in information technology in community services and in doctors’ surgeries. Overall, we have spent £3 million of capital money, £1.1 million less than our allocation and therefore we have achieved the requirement not to overspend our capital allocation. In addition to the requirement that we do not overspend our allocation of revenue and capital money we must
also not spend more cash in total than we have. Over the year we have not used £3 million of the cash available to us. Over the longer term there is a risk to the PCT in that any withdrawals from the Strategic Investment Fund which increase our revenue allocation are not matched by increased cash. We are working closely with the Strategic Health Authority to manage this risk. In respect of the current economic climate, NHS funding appears to have been protected over the next two years and NHS Kirklees has been advised of a 5.5% increase in our revenue allocation in each year. We are however anticipating that after that any increased allocation will only be sufficient to meet the costs of inflation. The need to achieve maximum value for money for every pound we spend will continue to be absolutely vital. We have written down the value of our assets by £1.8m in 2008/09 to reflect the potential reduction in their value. Apart from Holme Valley Memorial Hospital, NHS Kirklees does not have a significant amount of land and buildings and we judge that, over the medium term, any loss of value will be recovered. NHS Kirklees takes its responsibilities for safeguarding public money and achieving value for money very seriously. On behalf of the Board, the Audit Committee considers financial governance. The members of the committee receive regular reports from our external auditors, the Audit Commission and from or internal auditors. In addition to their statutory audit of the PCT’s accounts, the Audit Commission also provide a number of other reports that help us achieve value for money.
would follow International Financial Reporting Standards (IFRS) from 2008/09, later deferred to 2009/10. As a result NHS bodies’ accounts for 2009/10 will need to be in the new IFRS format, this effectively means a transition date of 1 April 2008, as 2009/10 IFRS based accounts will need to include comparative figures for 2008/09. During the year NHS Kirklees has been preparing for the implementation of IFRS and have restated the 2007/08 closing balance sheet using IFRS rules. The Audit Commission has undertaken a review of the processes we have put into place and their overall assessment is that our arrangements are adequate.
Director of Finance’s report
Health Authority. At the beginning of the year we had £20 million in this fund and planned to use £10 million of it during 2008/09. Over the course of the year we have withdrawn and used £5 million.
This Annual Report contains a set of Summarised Accounts for 2008/09. If you would like to receive a full set of the accounts or a copy of our Statement on Internal Control (SIC) please contact: Director of Finance NHS Kirklees St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH Tel: 01484 466145 e-mail: financepa@kirklees.nhs.uk
To date, the NHS has largely followed rules set out in the UK Generally Accepted Accounting Practice when preparing accounts, however in the 2007 budget report it was announced that all public bodies following the Treasury’s financial reporting manual
NHS Kirklees Annual Report 08|09
37
Staff
Better Payment Practice Code 2008/09
Staff groups employed Total number
Permanently employed number
Other number
57
57
0
0
0
0
465
441
24
Healthcare assistants & other support staff
98
98
0
Nursing, midwifery & health visiting staff
430
427
3
Nursing, midwifery & health visiting learners
0
0
0
124
122
2
Social care staff
0
0
0
Other
0
0
0
1174
1145
29
Medical and dental Ambulance staff Administration and estates
Scientific, therapeutic and technical staff
Total
Services commissioned Service commissioned
Acute hospital services Mental health and learning difficulty services
Amount spent
% of total PCT commissioning spend
311
54%
71
12%
Community services
49
8%
Primary care from GPs, dentists, opticians and pharmacists
89
15%
Prescribing in primary care
62
11%
Total
582
The PCT’s performance for 2008/09 is as follows:
2008/09 £000
2007/08 £000
Total net operating cost for the financial year
585,103
529,202
3,575
3,402
Operating costs less non-discretionary expenditure
581,528
525,800
Final revenue resource limit for year
584,315
530,205
2,787
4,405
Under / (over) spend against revenue resource limit
38
NHS Kirklees Annual Report 08|09
Details of compliance with the code are included within annual accounts note 6.1 and also within the summary financial statements below. 2008/09 number
2008/09 £000
Total bills paid in the year
30,995
74,136
Total bills paid within target
28,827
69,664
93.01%
93.97%
Percentage of bills paid within target
Management costs 2008/09
2007/08
9,837
8,725
378,145
378,145
26.01
23.07
Management costs (£000s) Weighted population (Number) Management cost per head of weighted population (£)
Financial performance targets
Less: non-discretionary expenditure
NHS Kirklees is signed up to the Better Payment Practice Code and aims to pay all its valid invoices by the due date or within 30 days receipt of a valid invoice, whichever is later. By agreeing to these terms NHS Kirklees has sent a clear signal to its customers and suppliers that it is committed to good credit management and paying on time.
Audit services £000 Statutory audit service Other auditor's remuneration Total
296 0 296
2008/09
2007/08
£000
£000
666,147
518,902
(120,057)
(17,830)
546,090
501,072
Gross operating costs
43,783
32,422
Less: miscellaneous income
(4,770)
(4,328)
Provider net operating costs
39,013
28,094
585,103
529,166
Commissioning Gross operating costs Less: miscellaneous income Commissioning net operating costs
Director of Finance’s report
Operating cost statement for the year ended 31 March 2009
Provider
Net operating costs before interest Interest receivable
0
0
Interest payable
0
36
585,103
529,202
Net operating cost for the financial year
Statement of recognised gains and losses for the year ended 31 March 2009
Fixed asset impairment losses Unrealised surplus / (deficit) on fixed asset revaluations/indexation
2008/09
2007/08
£000
£000
0
(138)
(1,770)
1,086
Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets
0
0
Additions / (reductions) in the General Fund due to the transfer of assets from/(to) NHS bodies and the Department of Health
0
0
Additions / (reductions) in "other reserves"
0
0
(1,770)
948
Recognised gains and losses for the financial year Prior period adjustment - other Gains and losses recognised in the financial year
Related party transactions
Pension liabilities
Kirklees Primary Care Trust is a body corporate established by the Secretary of State for Health.
Details of how pension liabilities are treated in the accounts and a reference to the statements of the relevant pension scheme are included in accounting policies note 1.14 in the annual accounts and the remuneration report, see page 45.
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 the PCT.
0
0
(1,770)
948
NHS Kirklees Annual Report 08|09
39
Balance sheet as at 31 March 2009 31 March 2009
31 March 2008
£000
£000
91
107
FIXED ASSETS Intangible assets Tangible assets
17,841
17,979
Investments
0
0
Financial assets
0
0
17,932
18,086
566
361
6,207
4,712
CURRENT ASSETS Stocks and work in progress Debtors Other financial assets
0
0
90
559
6,863
5,632
(39,887)
(34,041)
0
0
NET CURRENT ASSETS / (LIABILITIES)
(33,024)
(28,409)
TOTAL ASSETS LESS CURRENT LIABILITIES
(15,092)
(10,323)
(3,620)
(142)
Cash at bank and in hand * TOTAL CURRENT ASSETS CREDITORS : Amounts falling due within one year Other financial liabilities falling due within one year
Creditors: Amounts falling due after more than one year Other financial liabilities falling due after more than one year
0
0
(1,976)
(2,338)
(20,688)
(12,803)
(23,031)
(17,013)
2,343
4,210
Donated asset reserve
0
0
Government grant reserve
0
0
Other reserves
0
0
(20,688)
(12,803)
Provisions for liabilities and charges TOTAL ASSETS EMPLOYED FINANCED BY: TAXPAYERS EQUITY General fund Revaluation reserve
TOTAL TAXPAYERS EQUITY
* £87k of the cash held by the PCT as at the 31/03/09 reflects cash held in pooled budgets.
40
NHS Kirklees Annual Report 08|09
31 March 2009 £000
£000
OPERATING ACTIVITIES Net cash outflow from operating activities
(577,107)
Director of Finance’s report
Cash flow statement for the year ended 31 March 2009
SERVICING OF FINANCE AND RETURNS ON INVESTMENT: Interest paid
0
Interest received
0
Interest element of finance leases
0
Net cash inflow / (outflow) from servicing of finance and returns on investment
0
CAPITAL EXPENDITURE Payments to acquire intangible assets Receipts from sale of intangible assets Payments to acquire tangible fixed assets
(19) 0 (2,928)
Receipts from sale of tangible fixed assets
0
Payments to acquire fixed asset investments
0
Receipts from sale of fixed asset investments
0
Payments to acquire financial instruments
0
Receipts from sale of financial instruments
0
Net cash inflow / (outflow) from capital expenditure
(2,947)
Net cash inflow / (outflow) before financing and management of liquid resources
(580,054)
MANAGEMENT OF LIQUID RESOURCES (Purchase) of other current asset investments
0
Sale of other current asset investments
0
Net cash inflow / (outflow) from management of liquid resources
0
Net cash inflow / (outflow) before financing
(580,054)
FINANCING Net Parliamentary Funding
579,585
Other capital receipts surrendered
0
Capital grants received
0
Capital element of finance lease rental payments
0
Cash transfers (to) / from other NHS bodies
0
Net cash inflow / (outflow) from financing Increase / (decrease) in cash
579,585 (469)
NHS Kirklees Annual Report 08|09
41
Remuneration report About the remuneration report Section 234B and Schedule 7A of the Companies Act, as interpreted for the public sector, require NHS bodies to prepare a remuneration report containing information about the remuneration of directors. In the NHS, the report will cover those senior managers “having authority or responsibility for directing or controlling the major activities of the NHS body. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments.”
Membership of the Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee (RTSC) comprises the Chairman (Rob Napier) and three nonexecutive directors (Mehboob Khan, Imran Patel and Vanessa Stirum). The non-executive director who chairs the Audit Committee does not attend in order to make sure separation of duties. The Chief Executive is in attendance (except when his own terms and conditions are considered).
NHS Kirklees works within the Pay Framework for Very Senior Managers in Strategic and Special Health Authorities, Primary Care Trusts and Ambulance Trusts as set out by the Department of Health and which became operable from 1 April 2007. This helps to make sure that NHS Kirklees is able to recruit, retain and motivate high calibre staff and is consistent, competitive and comparable to other PCTs.
Explanation of methods used to assess whether performance conditions were met and why those methods were chosen
The committee is supported by the Directorate of Human Resources and Organisational Development.
The RTSC reviews appropriate levels of pay for the Chief Executive and other directors under the Very Senior Managers Framework. In line with best employment practice, where performance should be assessed by the line manager, the Chief Executive conducts the performance assessments for the directors. The Chairman assesses the performance of the Chief Executive.
The role of the Remuneration and Terms of Service Committee
Assessments are conducted using established appraisal and personal development review processes, which include clearly defined responsibilities with measurable objectives.
The role of the RTSC is to make decisions about appropriate remuneration and terms of service for the Chief Executive, directors, PEC members’ allowances and in exceptional circumstances individual issues arising for staff on Agenda for Change terms. This includes the determination of basic pay for the Chief Executive and other directors, together with any annual uplifts and performance bonuses.
42
Statement of the policy on remuneration of higher paid employees for current and future financial years.
NHS Kirklees Annual Report 08|09
The discretionary element of pay qualifying direction is covered by performance bonus arrangements as referred to above in the section on statement of the remuneration of higher paid employees. In this year, the total cost of bonuses must not exceed 5% of the rechargeable pay bill, with a consolidated and pensionable annual uplift of 2.2% with effect from 1 April 2008.
Explanation of relative importance of the relevant proportions of remuneration which are, and which are not, subject to performance conditions Please refer to information on the role of the Remuneration and Terms of Service Committee.
Summary and explanation of policy on the duration of contracts, notice periods and termination payments Chief Executive and director appointments are made on a substantive basis, with notice provisions normally six months clearly identified and articulated in the contract.
Significant awards made to past senior managers during 2008/2009 All payments are disclosed in the table on pages 43-44.
Salary and pension entitlements of senior managers for 2008/2009 See table on page 45.
Remuneration Report
Professional Executive Committee - salaries and allowances Name and title
2008-09 Salary (bands of £5,000) £000
2007-08
Other Benefits in remuneration kind (bands of (Rounded to the £5,000) nearest £00) £000
£00
Salary (bands of £5,000) £000
David Anderson
45 - 50
45 - 50
David Wood
10 - 15
5 - 10
Ajit Mehrotra
10- 15
5 - 10
Anil Aggarwal
10 - 15
5 - 10
Angela Ladocha
10 - 15
0-5 6 months worked
Sarah Brackwell
10 - 15
0-5 6 months worked
Dawn Gordon
10 - 15
0-5 6 months worked
Other Benefits in remuneration kind (bands of (Rounded to the £5,000) nearest £00) £000
£00
Non-executive directors - salaries and allowances Name and title
2008-09
2007-08
Salary (bands of £5,000)
Other remuneration (bands of £5,000)
Benefits in kind (Rounded to the nearest £00)
Salary (bands of £5,000)
Other remuneration (bands of £5,000)
Benefits in kind (Rounded to the nearest £00)
£000
£000
£00
£000
£000
£00
Rob Napier, Chairman
35 - 40
35 - 40
Valerie Aguirregoicoa
5 - 10
5 - 10
Tony Gerrard
5 - 10
5 - 10
Mehboob Khan
5 - 10
5 - 10
Imran Patel
5 - 10
5 - 10
Vanessa Stirum
5 - 10
5 - 10
Rob Millington
5 - 10
5 - 10
NHS Kirklees Annual Report 08|09
43
Directors - salaries and allowances Name and title
2008-09
2007-08
Salary (bands of £5,000)
Other remuneration (bands of £5,000)
Benefits in kind (Rounded to the nearest £00)
Salary (bands of £5,000)
Other remuneration (bands of £5,000)
Benefits in kind (Rounded to the nearest £00)
£000
£000
£00
£000
£000
£00
Mike Potts, Chief Executive
125 - 130
125 - 130
Bryan Machin, Director of Finance
100 - 105
95 - 100
Judith Hooper, Director of Public Health
110 - 115
105 - 110
Helena Corder, Director of Corporate Services
70 - 75
65-70
Carol McKenna, Director of Commissioning & Strategic Development
80 - 85
80 - 85
Peter Flynn, Director of Performance
85 - 90
80 - 85
Sheila Dilks, Director of Patient Care
80 - 85
75-80
Sue Ellis, Director of HR/OD
80 - 85
80 - 85
Robert Flack Director of Provider Services
80 - 85
75-80
[Where more than one individual occupied the same post over the year details must be disclosed here]
44
NHS Kirklees Annual Report 08|09
Name and title
Real increase in pension at age 60
Real increase in pension lump sum at aged 60
Total accrued pension at age 60 at 31 March 2009
Lump sum at age 60 related to accrued pension at 31 March 2009
Real increase in Cash Equivalent Transfer Value
Employer’s contribution to stakeholder pension
(bands of £2,500)
(bands of £2,500)
(bands of £5,000)
(bands of £5,000)
£000
£000
£000
£000
£000
£000
£000
£000
Mike Potts, Chief Executive
0 - 2.5
0 - 2.5
50 - 55
160 - 165
1196
889
199
Bryan Machin, Director of Finance
0 - 2.5
0 - 2.5
25 - 30
85 - 90
486
350
89
Judith Hooper, Director of Public Health
2.5 - 5
7.5 - 10
40 - 45
120 - 125
872
599
180
Helena Corder, Director of Corporate Services
0 - 2.5
0 - 2.5
20 - 25
60 - 65
389
293
62
Carol McKenna, Commissioning & Strategic Development
0 - 2.5
0 - 2.5
15 - 20
50 - 55
251
192
38
Peter Flynn, Director of Performance
0 - 2.5
2.5 - 5
10 - 15
40 - 45
272
191
54
Sheila Dilks, Director of Patient Care
0 - 2.5
2.5 - 5
15 - 20
50- 55
408
292
76
Sue Ellis, Director of HR/OD
0 - 2.5
2.5 - 5
25 - 30
85 - 90
554
407
96
Robert Flack, Director of Provider Services
0 - 2.5
0 - 2.5
5 - 10
20 - 25
89
63
17
Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former
Cash Cash Equivalent Equivalent Transfer Transfer Value at 31 Value at 31 March 2009 March 2008
scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs
Remuneration Report
Pension benefits
are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries
Real increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
NHS Kirklees Annual Report 08|09
45
Declarations of interest Executive Directors Mike Potts Chief Executive Sheila Dilks Director of Patient Care and professions Dr Judith Hooper Director of Public Health Bryan Machin Carol McKenna Directors Helena Corder Sue Ellis
Robert Flack
Director of Finance Director of Commissioning and Strategic Development Director of Corporate Services Director of Human Resources and Organisational Development Director of Provider Services
Peter Flynn Director of Performance Non Executive Directors Rob Napier Chairman Valerie Director Aguirregoicoa Tony Gerrard Mehboob Khan
Director Director
Rob Millington
Director
Vanessa Stirum
Director
Imran Patel
Director
Professional Executive Committee Dr David Chairman Anderson David Wood Vice Chair Dr Ajit Mehrotra PEC member
46
Dr Anil Aggarwal
PEC member
Angela Ladocha Dawn Gordon Sarah Brackwell
PEC member PEC member PEC member
NHS Kirklees Annual Report 08|09
None None Partner is a clinical lead for NHS Kirklees and provides self care training and musculoskeletal service None None None Shared post with NHS Calderdale, post at Board level shared with Calderdale; spouse is a teaching assistant in Gilthwaites First School, Denby Dale employed by Kirklees Council; Methodist Church Lower Cumberworth safeguarding and children’s co-ordinator and worship leader Membership of Sports Club Committee - York Cricket Club - Captain; Member of MCC area representative with endorsing rights; spouse works for North Yorkshire and York PCT as physiotherapist and manager None Spouse is a Non Executive Director at Barnsley Foundation Trust Independent member of West Yorkshire Police Authority; Company Secretary/Executive Director of Aguirregoicoa Ltd; sister is employed by Mid Yorkshire Hospitals NHS Trust Director of Tony Gerrard Associates Ltd Councillor of Kirklees; Governor of Greenhead College; Member of West Yorkshire Fire Authority; Board member of the Standards Board of England; Board member of Local Government Association; Member of Council of Europe; private company shareholder in Excol Consulting Ltd Non Executive Director of Kirklees Community Healthcare Services; Board Member of LPSB – regeneration and sustainability; share holdings in Astra Zeneca and various others School Governor at King James School, Almondbury, Huddersfield; Trustee of King James Foundation; Non Executive Director and Chair of Kirklees Community Healthcare Services Health Committee Member of the Indian Muslim Welfare Society (IMWS) – IMWS is a Registered Charity; Local Authority Officer of City Of Bradford Metropolitan District Council GP Principal at Grange Group Practice; spouse works for Kirklees Community Healthcare Services as a health visitor Proprietor of Woods Dental Practice, Mirfield; honorary contracts with Mid Yorkshire Hospitals NHS Trust and Leeds Teaching Hospitals Trust; member of the Local Dental Committee; clinical tutor at Leeds University Registered PMS GP at Windsor Medical Centre, 2 William Street, Leeds Road, Dewsbury; Chairman Kirklees LMC, Forrest Burlinson Accountants, Owl Lane, Shaw Cross, Dewsbury. Partner at Meltham Road Surgery, Lockwood, Huddersfield; Executive Member of the Three Valleys Commissioning Consortium; Secretary Huddersfield Friends Group of Martin House None None Company Secretary of Brackwell Consultancy Services (self employment vehicle for husband); Director of Termsol Ltd (partners company)
Statements
Statements Statement of the Chief Executives responsibilities as the Accountable Officer of the organisation The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: • There are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance • Value for money is achieved from the resources available to the authority • The expenditure and income of the authority has been applied to the purposes intended by Parliament and conform to the authorities which govern them • Effective and sound financial management systems are in place • 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 an Accountable Officer.
Signed...................................................Chief Executive
12 June 2009
Dated.......................................................................
Statement of directors responsibilities in respect of the accounts The directors are required under the National Health Service 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: i. apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; ii. make judgements and estimates which are reasonable and prudent; iii. state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the organisation and to enable them to ensure that 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 health authority and hence for taking reasonable steps for the prevention of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the financial statements. By order of the board. 12 June 2009 ............................................Date ........................................................................................................Chief Executive 12 June 2009 ............................................Date ...................................................................................................... Finance Director
NHS Kirklees Annual Report 08|09
47
Independent auditor’s statement to the Board of Directors of Kirklees Primary Care Trust Opinion on the summary financial statement I have examined the summary financial statement set out on pages 39 to 41. This report is made solely to the Board of Directors of Kirklees PCT in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission.
Respective responsibilities of directors and auditor The Directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement.
Basis of opinion I conducted my work in accordance with Bulletin 2008/3 ‘The auditors’ statement on the summary financial statement in the United Kingdom’ issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of our audit opinion on those financial statements.
Opinion In my opinion the summary financial statement is consistent with the statutory financial statements of the Trust for the year ended 31 March 2009. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements (10 June 2009) and the date of this statement. Paul Lundy – Officer of the Audit Commission
10 August 2009
Audit Commission, Kernel House, Killingbeck Drive, Killingbeck, Leeds, LS14 6UF
48
NHS Kirklees Annual Report 08|09
NHS Kirklees St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH Tel: 01484 466000 Fax: 01484 466111 Minicom: 01484 466153 www.kirklees.nhs.uk
This report can be made available in other formats including large print, braille and audio. We can also arrange for articles to be translated into community languages. Please ring 01484 466223 or write to NHS Kirklees, St Luke’s House, Blackmoorfoot Road, Huddersfield, HD4 5RH.
Reference: AH3070 • Date of publication: Aug 09 • © Kirklees Primary Care Trust