http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/Annual_Report_2007-08

s e e l k r i K r e i h t l a e h A

Annual Report and Summary Financial Statements 2007/08

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Contents 2 3 4 5 6 7 8 10 11 12 12 13 15

Welcome All about Kirklees PCT PCT’s commissioning and provider role Organisational structure PCT Board Our vision and values A healthier Kirklees Planning for emergencies Working with our partners Making people safe Reducing the time people wait How we performed in other areas Primary care investment

16 17 18 18 19 19 20 20 23 23 24 25

Involving our communities Listening to our patients First class commissioning Continuously improving quality Our commitment to learning Research and research governance How we measure up Our workforce Environmental agenda Risk management Declarations of interest Director of finance report

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Welcome

from the Chief Executive and Chairs

Welcome to the Annual Report which constitutes the operating and financial review for Kirklees Primary Care Trust (PCT) for the period 1 April 2007 to 31 March 2008.

Last year’s annual report came at a time of unprecedented change in the NHS with the reduction in the number of PCTs across England, the drive to return the NHS to financial balance and the strengthening of the PCT’s commissioning role, all of which presented us with significant challenges here in Kirklees.

Twelve months on we are proud to report that Kirklees PCT is now fully established and in a strong position to meet future challenges. We have returned the organisation to a healthy financial position and are making great strides in strengthening our commissioning capability to ensure that we spend public money wisely and achieve the best possible health for all the people of Kirklees.

We have continued to strengthen working relationships with our key partners across the health economy. This has been particularly so with Kirklees Council where we have a Joint Director of Public Health.

Improving health is now one of the Council’s key strategic priorities and the joint public health director is helping us focus our attention on making improvements in health and reducing the health inequalities that exist across Kirklees.

During the year we have also completed a Joint Strategic Needs Assessment in

partnership with Kirklees Council. This has provided us with a wealth of information on the needs of the people in the seven localities that make up the borough of Kirklees. We will use this information to better engage with our local community through our agreed locality model of working and in shaping future PCT and local authority investment plans. The Joint Strategic Needs Assessment has also strongly influenced the content of the Local Area Agreement for Kirklees, the delivery of which is one of our strategic priorities.

The PCT is beginning to change its emphasis, concentrating more on its commissioning role and developing capacity and capability to become a world class commissioning organisation. Local clinicians are best placed to lead the commissioning process and work has been on going during the year to ensure that practice based commissioners and other clinical leads are playing a central role in influencing the way we commission services.

However as well as our commissioning responsibilities we are also a major provider of primary care and community health services employing over 1,200 staff who deliver service to patients who require care and support 24 hours a day, 365 days of the year. In order to separate our commissioning and provider functions we have established a separate Provider Board chaired by the Vice Chair of the PCT. Our Provider Services staff are drawing up a new vision looking at providing world class

community health and healthcare services that support and improve health, well being and independence.

We will continue to support their growing independence and have, for the first time this year, produced a separate Annual Review of the services we directly provide.

The review charts the work and success of our provider arm and we would recommend that it is read in conjunction with this Annual Report.

Looking forward to 2008/09 we will continue to tackle the issues affecting our local community including obesity particularly in relation to food and physical activity as well as tobacco control, mental health and sexual health. We will continue to improve access and choice for patients and deliver services closer to people’s homes where it is safe to do so. By the end of the year we will see a new primary care centre in Dewsbury open 8am to 8 pm seven days per week. We will also be playing our part in managing the impact of our operations on the environment with greater focus on the green agenda and how as a major employer we can reduce our carbon footprint.

The NHS celebrated its 60th anniversary in July 2008 and we marked the anniversary with a number of local events. The publication of the NHS Next Stage Review, Our NHS, Our Future will set the direction of travel for the NHS over the next decade.

The changes that have been happening over the last year could not have taken

place so successfully and put us in such a strong position without the hard work and commitment of all our staff. We would also acknowledge the contribution made by the many front line clinicians who work as members of the Professional Executive Committee (PEC), clinical leads or contribute to practice based commissioning. Your contribution and support is very much appreciated and valued. Thank you.

Rob Napier, Chairman Mike Potts, Chief Executive David Anderson, Chair Professional Executive Committee

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st ru T re a C ry a m ri P s e le k ir K All about Kirklees Primary Care Trust (PCT) was set up in 2006 and is the local NHS body responsible for making sure all health services are in place to meet the needs of local people.

Like other PCTs, we have three main functions: • Engaging with the local population to improve health and well-being • 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 has seven localities, which have been identified by the PCT and the local authority. These are:

South West Yorkshire Mental Health NHS Trust. Other partners include the community and voluntary sector. We are all working together to make sure the health services you need are right for you.

Our population is around 400,000 but projections show a significant increase to 450,000 by 2029. A significant factor is our large and increasing black and minority ethnic population (14.4%) which is mainly Asian.

There are 74 general practices in the area with a total of 241 family doctors, 59 dental practices, 88 pharmacies and 42 opticians, as well as hospitals within its boundaries.

The PCT employs more than 1,200 staff and had a budget of £530 million for 2007/08.

• The Valleys

Batley

Cleckheaton

Dewsbury Mirfield Ravensthorpe

• North Huddersfield • South Huddersfield

Huddersfield

• Denby Dale and Kirkburton • Dewsbury and Mirfield • Spen Valley • Batley, Birstall and Birkenshaw.

An important part of our job is to develop and work in partnership with other key statutory stakeholders including Kirklees Council, Calderdale and Huddersfield NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust and the

Kirkburton

Slaithwaite Honley

Marsden Meltham

Holmfirth

Denby Dale

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PCTs commissioning and provider role The PCTs main function is that of a commissioner of NHS services for the people of Kirklees.

Commissioning in the NHS is the process by which we ensure the health and care services provided most effectively meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs and prioritising health outcomes to producing products and services, and managing service providers.

Ultimately good commissioning in the health service will help people live healthier and longer lives.

Therefore the PCTs commissioning responsibilities include: • A detailed understanding of the heath and care needs of the people of Kirklees • A good knowledge and understanding of health care research and evidence based practice • Strong partnership working with other key partners who can influence the health and well being of local people • 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

• 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 main stream NHS providers • Contract management, performance and evaluation.

While there is a lot to be proud of in the way we commission services in the NHS there are also a number of significant opportunities for improvement. During 2008/09 and beyond we will be working towards achieving outstanding performance in the way we commission health and care services in line with the Department of Health’s World Class Commissioning initiative.

You can find out more about World Class Commissioning by visiting www.dh.gov.uk/worldclasscommissioning

“Good links with patients, carers and the local community to understand their experiences of local health services.”

PCTs provider responsibilities As well as being a commissioner the PCT is also a provider organisation directly providing the following primary care and community services: Services directly provided by Kirklees PCT and the Kirklees Provider Service during 2007-08 include: • • • • • • • • •

Health visiting District nursing School nursing Community dental services Therapy services Contraception and sexual health Health promotion Home loans of equipment A range of specialist nursing services including: - Child protection - Community diabetes

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Organisational structure The Chief Executive is accountable for the day to day running of the PCT and its eight directorates. Each directorate is led by a director who has responsibility for a range of functions.

- - - - -

Continence Infection control TB Liaison health visitor Sickle cell health visitor Health visitor for the homeless and asylum seekers The PCT’s Provider Service has been set up at ‘arms length’ from the main commissioning organisation with a separate Provider Board chaired by the Vice Chair of the PCT. The Board also has non executive director membership and a Director of Provider Services who acts as the managing director for the organisation. The business relationship between the PCT Provider Service and the PCT as commissioner is conducted in the same way as with all other providers through a formal contract.

During 2008/09 we will continue to strengthen the arms length relationship and explore options for the future management of PCT provider functions.

The Directorate of Corporate Services is responsible for enabling and supporting the PCT’s corporate 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 supporting organisational development, communications and patient and public involvement.

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 local delivery plan and Local Area Agreement.

The Directorate of Finance makes sure robust financial controls are in place so that the PCT can meet its statutory duties and achieve financial balance. It also supports managers and staff in ensuring that the services we commission and provide deliver value for money.

The Directorate of Performance and Information manages performance systems and processes for the PCT 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 the PCT’s Information Management and Technology (IM&T) strategy.

The Directorate of Patient Care and Professions provides professional advice, leads on the re-design of primary care services and acts as the clinical governance watchdog for the PCT. It is also responsible for professional development and education.

The Directorate of Public Health delivers key public health goals, working in partnership with the local authority. 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 such as a flu pandemic.

The Directorate of Human Resources and Organisational Development leads on human resources and organisational development for Kirklees and Calderdale PCTs. The directorate also provides support for workforce planning and development.

The Directorate of Provider Services see page 4 for details.

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PCT Board The Kirklees PCT Board meets every month in public and is responsible for agreeing the strategic direction, policy and performance of the PCT. It is also responsible for making sure the key requirements of corporate governance are in place. This includes public accountability, integrity, openness and the important area of public involvement.

From April 2007 to March 2008, members of the Kirklees PCT Board were:

Non Executive Directors

Rob Napier Chairman

Vanessa Stirum Non-Executive Director (Vice Chairman)

Executive Directors

Valerie Aguirregoicoa Non-Executive Director

Tony Gerrard Non-Executive Director

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

Carol McKenna Executive Director of Commissioning and Strategic Development

Dr David Anderson Professional Executive Committee (PEC) chair

The chairman and non-executive members of Kirklees Primary Care Trust (PCT) Board are local ‘lay’ people who work together with the Executive members and form the governing Board of the PCT.

Committees and sub committees of the Board • Audit Committee • Governance Committee • Patient and Public Involvement Committee

Mehboob Khan Non-Executive Director

Rob Millington Non-Executive Director

Imran Patel Non-Executive Director

Other Directors in attendance at Board meetings

• Finance and Performance Committee • Remuneration and Terms of Service Committee • Professional Executive Committee.

Helena Corder Director of Corporate Services

Dr Peter Flynn Director of Performance and Information

Sue Ellis Director of Human Resources and Organisational Development

Robert Flack Director of Provider Services

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Our vision and values

Professional Executive Committee The Professional Executive Committee (PEC) is responsible for giving clinical leadership to the PCT. Its functions include setting priorities, developing service strategies and making sure these are implemented in the services that the PCT offers. The committee is accountable to the Board through the PEC Chairman.

From April 2007 to March 2008, PEC members were: • Dr David Anderson, GP – Chair

Our vision is: Working together to achieve the best health and well being for all the people of Kirklees.

The PCT has adopted the following values: Dr David Wood, Dentist - Vice Chair

Dr Ajit Mehrotra GP

• Dr David Wood, Dentist - Vice Chair • Mike Potts - Chief Executive

• To recognise that people are at the heart of everything we do • To support people in taking responsibility for their own health and well being

• Sheila Dilks - Executive Director of Patient Care and Professions

• To show understanding, dignity and respect for all our clients, partners and staff

• Dr Judith Hooper – Executive Director of Public Health

• To encourage open, clear and honest communication

• Bryan Machin – Executive Director of Finance

• To value diversity and challenge discrimination

• Helena Corder – Director of Corporate Services • Robert Flack – Director of Provider Services

Dr Anil Aggarwal GP

Dawn Gordon District Nurse

• To be accountable for the decisions we make, the work we do, the resources we use and the impact on the environment.

• Dr Peter Flynn – Director of Performance and Information • Dr Ajit Mehrotra - GP

We will:

• Dr Anil Aggarwal – GP • Dawn Gordon - District Nurse • Sarah Brackwell - Health Visitor • Angela Ladocha - School Nurse

Non members in attendance: Vanessa Stirum – Non Executive Director

• To encourage innovation and continuous improvement and celebrate the contribution made by our staff

Sarah Brackwell Health Visitor

Angela Ladocha School Nurse

• Work in partnership with local people and all relevant organisations to promote, protect and improve health and well being and reduce the health inequalities that exist within our community • Achieve real involvement of patients’ staff and our local community in identifying their needs and sharing responsibility for improving health,

prioritising service development and allocating resources • Make sure that services are available as close as possible to people’s homes, are delivered safely and to the highest standards and offer patients and their families a positive experience of the NHS in Kirklees • Encourage new and innovative ways of delivering services that offer choice, improve health and well being are sensitive to the diverse needs of our community and are easily accessed and delivered in an environment that staff and local people can be proud of • Make sure that services are evidence based both clinically and are cost effective and also offer the best possible health outcomes within available resources • Develop a learning environment that promotes continuous professional development, motivates people to achieve their full potential and aids recruitment and retention of high calibre staff • Achieve the highest standards of probity and accountability, manage risk and maintain effective governance arrangements that ensure that the organisation is run efficiently within available resources and in a way that inspires public confidence.

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A healthier Kirklees Helping people to lead healthier lives is one of the key priorities for Kirklees PCT. We are committed to increasing the length of time people live in each of our localities, but if we are to do this we must concentrate on helping people to stop smoking, reduce the amount they drink, increase their physical activity levels and help them to eat more healthily.

Obesity The Kirklees Obesity Programme has been developed to reduce the number of people in Kirklees that are obese or overweight by providing the support they need to reduce or maintain their weight. This includes aspects of physical activity, food and emotional health and wellbeing as recommended by the National Institute for Health and Clinical Excellence (NICE) guidance.

We have consulted widely with the public and practitioners to find out more about what they would like to see and what the barriers are that they are facing. This information will help us to commission and develop effective weight management services. We are also working with a wide range of partners from across Kirklees including the highways and transport services, planning and the Healthy Schools team, to make sure that everyone is working together on the issue of obesity.

Existing weight management services have continued to develop and expand,

particularly children’s services such as Mind, Exercise, Nutrition, Do It (MEND).

The priority for 2008/09 is to work closely with all our partners in primary and secondary care, the voluntary sector, private sector, council and the public to develop and shape appropriate weight management services to meet the needs of the population of Kirklees.

Sexual health We are continuing to work to make sure people who use sexual health services in Kirklees receive a high quality and easily accessible service and this year we have been able to offer sexual health screening and testing in a community based setting.

This work is supported by the recently launched Kirklees Young People Friendly (KYPF) quality standard which will ensure that once all services have signed up they will be friendly and welcoming for young people.

Additionally 2007 saw the launch of the Chlamydia screening programme across Kirklees. We have successfully screened more than 1000 people. The aim of the programme is the early detection of Chlamydia in those who may have no symptoms and the prevention of onward transmission of the disease.

For further information about sexual health services in Kirklees, please call the Contraception and Sexual Health team on 01484 344260.

Baby deaths At the start of 2008, the Director for Public Infant deaths Health published in north Kirklees a report into infant death in north Kirklees.

The in-depth investigation was prompted by baby death rates in the area being at least 60 per cent higher than the national average. The findings revealed high levels of smoking and poor health in pregnant women plus the return of rickets in newborn babies and a relatively high number of babies born with inherited abnormalities.

January 2008

In 2008 we will be looking at why important health messages are not getting across and how we can support mothers to have healthy pregnancies. We will also be revising information where necessary, stepping up staff training and launching a campaign about diet and lifestyle for the whole family.

Tobacco Since April 2007 more than 2000 people across Kirklees have successfully managed to stop smoking with help from trained stop smoking advisors.

Since the Smokefree legislation was put in place in July 2007, the Kirklees Stop Smoking Service has seen a big increase in the number of people wishing to stop as a result of the ban. The team has worked jointly with the local authority to ensure compliance with the legislation and to support those smokers who are affected.

The Kirklees Stop Smoking Service is also investigating how to target people doing routine jobs and manual workers by looking at creating links with local football clubs and using innovative

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“Since April 2007 more than 2000 people across Kirklees have successfully managed to stop smoking with help from trained stop smoking advisors.” advertising techniques to reach this group.

As well as the smokefree legislation, this year saw the legal age of buying tobacco raised from 16 to 18. This has resulted in more targeted work with young people to support them to stop smoking and indeed to prevent them from starting in the first place. The Kirklees Stop Smoking Service will continue to offer free, confidential help and support to smokers who want help to quit by making sure help is available at convenient times and locations, providing a first class service to local people.

For further information about stop smoking, please contact the Kirklees Stop Smoking Service on 01924 351498.

Oral health

Developments in 2008 include:

The level of tooth decay in Kirklees is one of the worst in England with children under five having two or more decayed teeth. Our target is to reduce levels of tooth decay by 15% over the next three years. To do this we have increased our level of investment in dental funding by £1.4 million. We have also increased the amount of oral health education taking place in schools as well as in dental practices with the Department of Health’s Brushing for Life campaign, which included giving out free toothbrushes and toothpaste.

• Introduction of pregnancy and pain as new referral criteria

Furthermore, we have funded the British Dental Association ‘good practice award’ for all dental practices in Kirklees.

Expert Patients Programme

Physical activity The Practice Activity and Leisure Scheme (PALS) has continued to work towards its aim of encouraging people with, or at risk of, specific health conditions, to become more active, more often with a view to improving health and wellbeing. Over 2000 new patients have taken part in the scheme this year with over 171 group activities available on a weekly basis and more professionals are referring people to it than ever before.

It was also runner up in the Regional NHS Health and Social Care Awards 2008 in the category of Improving Health and Reducing Health Inequalities.

• Development of a specialist programme of activity for patients referred under the two new criteria • Expanding the Get Food Wise and Exercise Programme • Development of a physical activity care pathway to support health professionals to appropriately signpost patients.

For further information about accessing the PALS services, please call 01484 234095.

The Expert Patients Programme is a free sixweek course run by Kirklees PCT designed for people with long-term medical conditions such as diabetes and heart disease. More than 400 people have taken part in the programme which has helped them to manage their condition better, increased their confidence and helped some get back to work full time.

The PCT is also working in partnership with Kirklees Council and the Carers Gateway to run the ‘Looking after me’ programme which is designed to support carers’ needs.

For information about the Expert Patients Programme, please call 01924 351431.

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The Healthcare Commission Improvement Review scored the Kirklees Drug and Alcohol Action Team (DAAT) and Kirklees PCT approach to commissioning and treatment as 4-star (excellent). The results reflect well on the last two years during which time significant investments have been put into drug services, and in particular in the specialist treatment services managed by the Lifeline Project.

The Kirklees DAAT has also invested more money in doctors, workers and nurses for drug and alcohol treatment services, counselling, and support for families including a new resource centre and workers to support drug using parents, their children and family who support them.

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At the end of the 2007, the PCT in partnership with Kirklees Drug and Alcohol Action Team (DAAT), Kirklees Council and other partners launched the Kirklees Alcohol Strategy to help tackle the district’s growing drink problem through improved prevention, treatment and enforcement measures.

Kirklees PARTN ERSHI

Kirklees ranks worse than the Kirklees national average for harmful Alcohol strategy drinking, male 2007- 2010 deaths from chronic liver disease and alcohol-related ! ! recorded ! l l oho Alcoho One ! e Alc crime. The s in thre a re e ng inc increasi Currently Living in Kirklees survey 2005 reported a dramatic increase in consumption with one in three men and one in four women drinking over sensible limits. This compares to one in six men and one in 12 women in 2001.

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Kirklees PCT, in partnership with Kirklees Council, published their first Joint Strategic Needs Assessment for Kirklees in February. The Health and well-b eing key issues for the report is a review people of Kirklees of the health and social care needs of the local population and replaces the annual public health report previously produced by primary care trusts. Key findings of the report concluded that heart disease is the second biggest cause of premature death in Kirklees after cancer, 1 in 4 adults are still smoking and 1 in 5 children admit to having smoked a cigarette, nearly half of 14-year olds drink every week.

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In 2007/08, more than 2000 heroin and crack users accessed treatment, and with the waiting time for services falling from 13 weeks in 2004 to less than a week, we are now planning to further improve access to these crucial interventions.

The services provide assessment, care, planned treatment and support to access other services that will help individuals affected by drugs and alcohol to rehabilitate back into the community.

Many service users in the last year have started education and training courses as well as employment, and we are hoping to get more than 100 people into education, employment and training over the next year.

Planning for em As a Category 1 organisation (that is legally required to respond directly to an emergency), Kirklees PCT has a duty under the Civil Contingencies Act 2004, to have in place systems and procedures to lead and coordinate the local NHS response, should a major incident occur within the PCTs area of operations.

In addition the PCT is required to be able to support and work with other organisations such as Kirklees Council to support them should they require assistance.

The PCT has a Major Incident Plan and other contingency plans that are regularly updated, to ensure it is able to do this.

During 2007/08 like many areas of the country, Kirklees suffered severe flooding.

The PCT supported Kirklees Council and the emergency services in order to minimise the impact of these events on the health of members of the public.

The Kirklees PCT is required by law to annually test its ability to respond to a

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Working with our partners

mergencies major incident. The PCT tested these plans in March 2008 using a live exercise. The outcomes of this exercise have been used to improve the PCTs emergency planning infrastructure and communications processes.

During 2007/08 the PCTs emergency planning systems have been subjected to internal and external audit by the Department of Health. The outcome of these audits was that the PCTs systems were found to be extremely satisfactory.

Looking forward, during 2008 the Kirklees PCT is working (alongside all NHS organisations in the UK) to improve its ability to respond to a Flu Pandemic should one occur.

In summary, the Kirklees PCT has put in place the resources and staffing to ensure it is able to respond to a major incident should one occur.

For further information on emergency planning within Kirklees PCT please contact the Emergency Planning Lead on 01484 466000.

The PCT works closely with four GP consortia and 11 stand-alone GP practices that make up Practice Based Commissioners (PBC) in Kirklees. Each consortium and practice has designated PCT staff working with them from commissioning, finance, performance and information and medicines management.

This close working has enabled the successful development of PBC. The majority of respondents to the national practice based commissioning survey, conducted on behalf of the Department of Health by MORI, rated the PCT as ‘good to very good’ for the PBC support provided to practices. The PCT was also awarded the national runner’s up prize for its practice based commissioning approach by the NHS Alliance in October 2007.

Our contracts and agreements with our providers include performance standards which are regularly reviewed and acted upon. We work closely with other PCTs that commission from the same providers to minimise duplication and ensure consistent approaches.

Where appropriate we involve both primary and secondary care clinicians in discussions about service developments.

For example, we have jointly developed services for older people with the local council, especially in community care and intermediate care services.

Diabetes Year of Care In 2007/08 Kirklees PCT along with partners at the Calderdale & Huddersfield NHS Foundation Trust, and Calderdale PCT were selected as one of three national pilot sites for the Diabetes ‘Year of Care’ Project.

The ‘Year of Care’ describes the ongoing care a person with a long term condition should expect to receive (usually over the course of a year) including support for self-management. This project aims to test how the ‘Year of Care’ approach to designing, delivering and commissioning services can be developed and delivered.

Following this success, the pilot has been set up in six practices across Kirklees and Calderdale and will involve everyone who works to support people with diabetes across the health economy. The preparatory phase commenced in September with the agreement that we would have a new service model agreed

by April this year. Following this there will be a 12 month ‘test period’.

As a pilot site we are expected to design a number of ‘Year of Care’ packages that meet the needs of specific groups and which allow choice within each package – this includes testing the range of services that need to be in place in order to support that choice. We are also expected to deliver shared decision making between patients and healthcare professionals. The final challenge will be to test how commissioners can link micro-level commissioning at an individual level to commissioning across a whole population.

Together with the other two pilot sites, North of Tyne and Tower Hamlets, we are able to share experiences and use the learning from other areas with the vision of being able to transfer this across the whole population and other long term conditions.

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Reducing the time people wait

Making people safe Children and young people The safeguarding children team at Kirklees PCT provide a range of services, working with partner agencies to improve outcomes for children. They also provide skilled expertise, knowledge and support within and outside the organisation on all aspects of safeguarding children.

brought up in a caring, safe environment (Kirklees Children and Young People’s Services plan 2006 – 2009). The plan also acknowledges that child protection work is strong in Kirklees and that it must remain a priority.

Vulnerable adults

Policies, procedures and guidance relating to safeguarding children and young people are currently being reviewed in order to ensure they reflect local and national guidance, that the appropriate recruitment processes are in place and increased inter-agency working and collaboration is taking place to ensure safeguarding children is high on the agenda.

Significant work has been undertaken in the past year including developing the PCT’s internal policies and training packages. Training regarding vulnerable adults is included as part of the PCT’s induction programme for all new staff. A leaflet has been developed which includes key contacts in the PCT and local authority and how to access procedures.

This has gone to the whole workforce as well as all independent contractors.

The Local Public Service Board for children in Kirklees is committed to supporting the areas most vulnerable and disadvantaged members and it believes that all children and young people have the right to be

The PCT is represented on the Kirklees Vulnerable Adults Board and further work is underway to strengthen work with commissioners and providers of services for vulnerable adults.

Reducing the time people wait for their treatment is a priority for the PCT. Over the last 12 months we have made sure that patients are treated sooner as well as redesigning new ways of care to make the patient’s experience a good one.

With partners in neighbouring PCTs and our acute trusts we met the 18 week standard from referral to treatment for March 2008. By December 2008 no patient should wait longer than 18 weeks from referral by their GP to treatment in hospital.

The time is measured from when a patient is referred for treatment and the “clock” will stop when the patient begins treatment in most instances.

Patients may choose to have their treatment at a centre other than their local hospital in order to be treated sooner. GPs are also able to book some referral appointments for patients during their consultation through a system called Choose and Book. This enables patients to select a time that is more convenient for them. GPs will also offer their patients lifestyle advice to ensure they are prepared and healthy enough to be treated.

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s a re a r e th o in d e rm o rf e How we p Patient waiting times are measured in two ways. We are moving from the traditional method of measuring waits for parts of a pathway, such as how long does a patient wait for an outpatient appointment or an in patient procedure, to the more appropriate referral to treatment time which is the whole patient pathway.

Inpatient and day cases Throughout the year there were 10 reported breaches of the 26 week inpatient maximum waiting time target, involving six patients across Kirklees. In each case we have worked closely with the provider organisation to understand the causes and to minimise the impact on the patients involved.

First outpatient appointment

“Reducing the time people wait for their treatment is a priority for the PCT.�

During the year there were four breaches of the 13 week outpatient waiting time target. Again we have, and will continue, to work with all our providers to understand how such breaches can be avoided.

Diagnostic tests Seven patients breached the 13 week diagnostic target for 15 key tests. We are working with our acute providers to make sure that patients do not wait more than six weeks in 2008/09.

Accident and Emergency (A&E) We have introduced additional staffing into A&E departments to make sure that patients with minor illness are treated appropriately as well as those with major injury being seen quickly.

We have continued to work with the ambulance service to provide services to people living in rural areas of the PCT. We are working with all our partners to develop a new and integrated Urgent Care service for the people of Kirklees.

Cancer In local cancer services we have achieved all the national cancer waiting time targets. The majority of patients who need treatment in Leeds are seen within the 62 day target, but we recognise that there is still room for improvement so we will be working with Leeds and other PCT colleagues to make sure the 62 day target can be achieved and sustained for all cancer patients. The new Cancer Reform Strategy was launched in December 2007 and we are working with our local hospitals and other key stakeholders to assess the local

implications and plan the work needed during 2008/09 to further improve cancer and palliative care services.

conditions in the community has made a significant impact on our community services.

We look forward to the national launch of the End of Life Care Strategy in 2008/09. We have completed a review of local end of life care services and know there are areas that need strengthening, for example, in the co-ordination of care. Improvements have been made this year in the services provided by local care homes and four are going forward for Gold Standards Framework (GSF) accreditation which means that they will have reached nationally recognised quality standards in the provision of end of life care.

Route to a Solution has enabled us to make investment in community services in a way that will meet the growing needs of the population, enhance the work of the extended primary health care team and allow greater integration between primary and community services.

A further 14 homes in Kirklees have joined the phase 4 GSF programme.

Route to a Solution Designing the future workforce and developing the role of the community nursing service is an essential part of delivering high quality primary and community services.

This year we have worked with colleagues and partners to understand the needs of service users and the relationship between clinicians that will lead to closer working relationships and greater integration between primary and community care.

The changing needs of the public and the growth in the number of people who are living longer with complex

More than 300 clinicians from across 15 specialties in primary and secondary care and managers have committed to taking part in three engagement sessions and three more meetings to look at current ways of working and how these can be improved. Patients have also been involved as part of the governance arrangements, both at the engagement sessions and via individual organisations’ patient involvement work.

As a result, services have been developed closer to home, greater flexibility and choice has been provided and this has resulted in shorter waiting times.

14 Children with a disability and complex needs We are working towards implementing ‘Aiming High’ for disabled children and ‘Standard 8’ of the National Service Framework for Mental Health. We are also developing and implementing personalised care and individualised budgets for disabled children.

Long term conditions This year has seen a significant investment in the management of long term conditions which will continue over the next 12 months. We are working with all partners across the health economy to bring care closer to home and increase the range of services for people with long term conditions.

Maternity matters Expectant mothers have the right to make an informed choice about where to give birth. Options are likely to be a consultantled hospital unit, a midwife-led unit either in hospital or in the community, and home birth. To make sure mothers are able to give birth in a place of their choice, we have set up the Maternity Matters initiative which links in with the development and implementation of Women of Child Bearing Age Programme. Together these will create more choice for women and contribute to reduced infant death rates.

We also have a clinical network for children and maternity care working with the acute trusts to address issues of service delivery which is working well.

We will be investing in assistive technology to support people who want to manage their conditions themselves with rapid access to specialist advice and support and we will be improving the social care support to both users of the service and their carers.

Mobile healthcare Kirklees PCT was one of the first PCTs in the country to use a high-tech mobile operating theatre unit to reduce waiting times for day case patients who require dermatology, plastic surgery and podiatric surgery treatments. The unit was based at Holme Valley Memorial Hospital. In accordance with the NHS Plan, this is one of the ways in which the PCT is looking to provide services that were previously only available in an acute setting, closer to home. The unit was supplied by Vanguard Healthcare using sophisticated technology and built to Department of Health standards.

The unit incorporated a large clinical area comprising anaesthesia, operating room and first-stage recovery. In addition, Vanguard also supplied qualified and experienced theatre nurses to assist the NHS surgeons in delivering the procedures.

The day surgery staff at the hospital worked closely with the team in the mobile theatre to treat more than 250 patients, over a six week period, who needed plastic and podiatric surgery.

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Primary care investment There has been continued investment in primary care services in 2007/08 to make sure patients get the best possible care and treatment as close to home as possible.

Quality and Outcomes Framework In 2004 GPs agreed to a new contract to give patients more choice, easier access and better services closer to home. As part of the new contract, a Quality and Outcomes Framework (QOF) was designed to raise organisational and clinical standards in primary care whilst rewarding practices for their efforts. Under the system, 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 2007/08, the value of QOF points was £125 (per point). The clinical domain remains the primary focus for QOF with a maximum of 655 points available across 19 disease areas. Practices in Kirklees achieved an average of 637 points in the clinical domains – 96% of the maximum available. The average number of total points achieved per practice was 934 from a potential 1000. Total points achieved at

individual practices ranged from 604 to 1000.

Personal dental service (PDS) contract From 1st April 2006, patients have benefited from new reforms in NHS dentistry which gave powers to Primary Care Trusts, allowing them to provide dental services to meet local needs. As a result of the contract, patient charges are now simpler and fairer reducing 400 separate charges to three simple bands.

NHS dentistry is locally commissioned – with PCTs keeping the money to plan and pay for local services.

Dentists now have the security of a guaranteed NHS income, enabling them to plan ahead with the certainty of a fixed monthly payment for their NHS work. NHS dental services continue to be provided across Kirklees PCT and the provision of additional funding in 2008/09 will enable the commissioning of an increase in services to help meet the needs of those requesting to receive routine dental care.

There are 62 NHS dental contracts in Kirklees and the PCT did not lose any dentists through the implementation of the new contract.

In hours emergency dental access scheme The in hours service continues to be a well used service for patients who do not have access to regular dental care. The service

allows people to be seen if they have a dental emergency. A ‘follow up’ session to enable patients to receive a definitive course of treatment following an out of hour’s emergency appointment is being trialed in Kirklees PCT with a view to expanding this service if successful.

Community dental service The Community Dental Service (CDS) provides specialist dental care to children and adults with specific needs and work continues to develop the service further to meet the changing needs of Calderdale and Kirklees PCT areas.

Close working with our pharmacists Improving access to pharmacy services Throughout the year, five new pharmacies providing services for at least 100 hours each week have opened across the PCT. Patients now have access to an extended network of local pharmacies that provide NHS pharmaceutical services many of which are open from 7.30am till 11pm Monday to Saturday, and at least 6 hours on Sundays. This is the highest level of access to NHS pharmacies ever achieved.

In a new development, many local pharmacies now offer smoking cessation advice as part of an integrated smoking cessation support programme across the PCT. This includes the provision of some treatments without the need to obtain a prescription from a GP.

Significant progress has been made towards the introduction of paperless prescriptions, with 60% of pharmacies having taken the first step by introducing the new ‘electronic prescription service’.

This first stage 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.

Improving access to medicines Throughout the year, 53 patient group directions have been developed to enable more patients to safely access medicines through a range of health professionals without the need to see their doctor for a

16 prescription. This has significantly improved patient access to medicines in a number of areas including contraception and sexual health, Chlamydia treatments, immunisation, medicines to assist smoking cessation as well as medicines used to treat minor illnesses.

There has been continued growth in the number of qualified non medical prescribers (nurses and pharmacists) within Kirklees PCT, with more robust systems having been put in place to ensure appropriate governance standards are being maintained by the PCT.

Assuring medicines standards are maintained The medicines management team has conducted inspection and monitoring visits regarding the safe and secure handling of medicines for 10 PCT clinics, and has completed monitoring visits for all community pharmacies across the PCT, with action plans being agreed to improve standards where necessary.

The PCT medicines management team has also been working closely with GPs throughout the year to improve the quality and cost effectiveness of prescribing, with: • Cost efficiencies of over £750,000 • 9000 patient medication reviews and adjustments • Full achievement of 164 of the medicines management quality objectives agreed with GP practices, with improvement in the majority of the remaining 52 agreed objectives • Provision of regular Medicines Management Newsletters providing guidance to front line clinicians • Development and implementation of clinical guidelines.

A major area of development has been the introduction of a local ‘Drugs Intelligence Network’ to make sure systems and processes are in place for the safe and secure handling and use of controlled drugs. This has been developed in collaboration with other local agencies, with Kirklees PCT acting as the lead organisation for this work.

Involving our communities One of our key priorities is to make sure patients are involved and at the centre of everything we do. We encourage patients and the public to share their ideas and experiences with us and use this feedback when we are planning new services to understand if and how services need to be improved.

Working in partnership with colleagues from the local authority, partnership agencies and voluntary groups we have set up the Patient and Public Involvement Steering Group (sub-committee of the Board) and the Involvement and Engagement Operational Group. These groups will be making sure the PCT is actively involving and working in partnership with the public and service users, to design, review, monitor and deliver quality services that meet people’s needs.

We also listen to patients in the following ways:

Patient Advice and Liaison Service (PALS) During 2007/08 the PCT’s Patient Advice and Liaison Service (PALS) has dealt with more than 3000 calls. The majority of enquiries to PALS relate to access to NHS services or requests for advice and information about health and social care.

Questionnaires are also sent to people who contact PALS to allow us to evaluate the service provided and to check people are satisfied with the outcome. We are hoping to launch a texting service for PALS later this year to encourage young people to feel able to contact the service as well as those who have difficulty during working hours.

Health and lifestyle survey Earlier this year the PCT worked closely with Kirklees Council to distribute a major survey on health and lifestyle to more than 70,000 people living across each of our seven localities. The survey covered a range of topics and aimed to highlight the key health and social issues that face people, such as, personal behaviours and aspirations including smoking, diet and physical activity to employment and living conditions. The results of the survey will be known later in the year and will be used to help plan services and set priorities.

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“Patients are involved and at the centre of everything we do.”

Patient and Public Involvement Forum During the year, the PCT worked closely with the Kirklees Patient and Public Involvement (PPI) Forum. The Chair of the forum was also a co-opted member of the PCT Board. Due to national changes Local Involvement Networks (LINKs) will take over from PPI Forums in 2008/09.

Cloverleaf Advocacy will be 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. Cloverleaf has been supporting people to access health and social care services since 1995 and the PCT will work closely with them in their new role.

Patient survey Every year, the PCT takes part in the national patient satisfaction survey which is sent out at random to more than 1,200 local people. The survey gives patients the chance to have their say on various

aspects of the NHS including services provided by family doctors, the quality of care, communication with healthcare professionals, information, medicines, involvement in their care, referrals and health promotion. The results of the 2008 survey will be available on the Healthcare Commission website www.healthcarecommission.org.uk.

Kirklees Readers’ Panel At the start of 2008 we set up the Kirklees Readers’ Panel with Kirklees Council to look at how information is produced. There are more than 60 volunteers and voluntary organisations represented on the group and it is hoped that their involvement will lead to information being provided in formats that are easy for people to understand as well as identifying where the gaps are.

Quality and Outcomes Framework – patient experience survey It was the responsibility of the Patient and Public Involvement Team to review the quality outcomes framework (QOF) patient survey that is conducted in all GP surgeries across Kirklees.

Each GP surgery conducted a survey which their patients were asked to be part of. The survey asked patients questions about their experience of attending the surgery, their consultation with the GP, the accessibility to the surgery and what they feel they would like to see improved.

The GP practices are awarded money for carrying out this piece of work and have to demonstrate from the results of the survey what actions they will be taking to improve services in their surgery.

Listening to our patients We are continually working to improve services for you and welcome your suggestions. The PCT receives many compliments from patients and their families and if you have a comment or compliment then please let us know.

We aim to provide a high quality service for patients but occasionally things can go wrong. When they do, it’s important to let us know quickly so that we can try to put them right for you and learn from the experience. The PCT has a dedicated Complaints Manager who makes sure all complaints are thoroughly investigated, following national guidance, to ensure the best outcome for the patient.

Actions are taken to address the issues and provide an explanation. The majority of complaints are resolved at this stage.

However, when patients remain dissatisfied, they can contact the Healthcare Commission who will independently review issues including those involving PCTs, GPs, pharmacists, and dentists.

In the last 12 months, we have received and fully investigated 47 complaints some of which led to changes and improvements in how services are delivered.

Improvements include: • Improving the community nursing record keeping • More staff attending records management, complaints and conflict resolution training

• An amendment to the electronic booking service • Changes to how information is shared between A&E department and the community nursing teams.

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 the PCT, 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 the PCT website. However, if this is unavailable, it can be requested in writing and will be provided unless it is subject to an exemption.

During 2007/08, the PCT received 121 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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First class commissioning We commission from a wide range of local provider organisations, including Calderdale and Huddersfield NHS Foundation NHS Trust, the Mid Yorkshire Hospitals NHS Trust, South West Yorkshire Mental Health NHS Trust and the PCT’s own Provider Services team.

We work collaboratively with each of these organisations within a contractual framework and we meet regularly to review things like waiting times, quality, activity levels and service developments.

The PCT has an excellent track record of partnership working, whether this is with hospital providers, the local authority, voluntary organisations or the independent sector. We also involve patients and carers in the planning of local services, for example, in our local planning structures for cancer services we have a patient representative who sits on the group as an equal partner with other members representing stakeholders across Kirklees.

Kirklees PCT was awarded £6.63million from the Department of Health’s Community Hospital Fund. This is being used to implement part of the PCT’s Strategic Service Development Plan. It will allow more care to be provided closer to home, and will facilitate improved patient pathways and customer experience.

The Community Hospitals Fund will initially be used to support developments at Holme Valley Memorial Hospital and Princess Royal Community Health Centre. It will give patients access to diagnostic tests in a timely and convenient manner as well as

improved access to specialist services.

The PCT works closely with all its primary care contractors. Meetings are held with all the local representative committees, medical, dental, pharmaceutical and optometry , the minutes of which are reported to the PEC. Individual practice visits are also arranged regularly to discuss contract issues.

How we plan services Planning within the NHS is now being driven by patients, users, carers, front line clinicians and other staff, rather than national targets and top-down management. This is focused on finding ways in which to improve services and develop good practice and value for money.

Working with Kirklees Council, practice based commissioning units and local representatives, we use key outcomes and indicators combined with other information, such as the Joint Strategic Needs Assessment to identify and commission appropriate health services for each health priority.

Action plans for each of the priority areas are achieved through teams of staff known as Health Improvement Teams (HITs). Each HIT is responsible for tackling a health priority e.g. tobacco or obesity, developing commissioning plans and monitoring the performance and quality of the services within their area of activity.

The HITs involve a diverse membership of primary care clinical leads and professionals from the relevant core directorates, such as public health, governance and audit.

Continuously improving quality We continue to introduce new policies and local and national guidelines as a way of supporting quality improvements and clinical governance.

All policies are based upon best practice and are evidence based. The PCT’s Policy Group ensures clinical policy development is driven by the staff with clinical expertise. We have introduced methods to improve the way we implement local and national guidance.

During 2007/08 we have been developing ‘Quality Indicators’ to provide us with alternative ways of measuring the quality of care we provide and have focused on measuring patient experience.

The programme of practice protected time for community dentists, family doctors and PCT staff continues. This is time that allows professionals to keep their skills up to date and forms part of their contracts. At these sessions the PCT provides cover for GP practices so their staff can receive up to date, evidence based education and training.

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Our commitment to learning Kirklees PCT is committed to the principles of providing flexible and effective learning, training and development opportunities for all staff to ensure they are competent and confident in their work, and equipped with up to date knowledge and skills.

Research indicates that a competent and confident workforce leads to better health outcomes for patients.

There are four elements to the PCT’s training and education programme: 1. Induction training is offered to all new employees. This one day programme includes a variety of mandatory and some compulsory training topics.

2. Statutory training which Kirklees PCT must provide and all staff must undertake.

3. Continual Professional Development (CPD) is offered to all staff to enable them to keep up to date with current practice, and also allow for progression in their careers. This includes: • Long courses i.e. degrees and nationally recognised qualifications • Conferences and seminars • In-house courses.

4. Externally run courses mandatory training is also provided for specific staff.

Courses include:

• Specialist training for our clinicians and training delivered by Human Resource Shared Services (HRSS); such as recruitment, selection and employment law for staff that manage or supervise other staff • Attendance at university / college • Open learning / distance learning • Mentorship and shadowing.

All staff have access to a number of leadership training programmes some of which have been developed and delivered in collaboration with The Institute of Leadership and Management. These are run in-house and lead to an accredited qualification.

The PCT also works closely with the Yorkshire and the Humber Strategic Health Authority to access funding for specific training, including NVQ level 2 and 3 training for all administrative and clerical staff.

The PCT continues to support and approve funding for staff who qualify to study at a higher degree or post graduate level, or for those who wish to obtain an occupational qualification.

We are currently looking at all aspects of learning including our training and education programmes to ensure we continue to provide the best and most flexible learning opportunities for staff to enable them to provide the best possible care to the people we serve.

Research & research governance Healthcare research provides important evidence of treatments and practices that are effective and plays a vital role in continuously improving the care the PCT provides.

To make sure all the research carried out in the NHS is safe and of high quality, PCTs are required to follow the research governance standards of good practice.

The PCT has effective research governance systems in place through a shared service level agreement with a neighbouring PCT and delivered through a local acute trust.

In 2008 we are reviewing our research arrangements to ensure we continue to meet research governance requirements and that staff are effectively supported to engage in research as appropriate and make best use of research findings to improve care.

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How we measure up Each year the Healthcare Commission, a national body, assesses the quality of health care through the Annual Health Check.

The Annual Health Check scores NHS Trusts on how well they manage their finances, resources such as staff and property and on the quality of services they provide. The scores are based on information gathered throughout the year. With the Annual Health Check are a number of standards known as the Standards for Better Health.

The results of the 2007/08 Annual Health Check will be available in early autumn 2008 on the Healthcare Commission’s website www.healthcarecommission.org.uk We assessed our continued compliance with the Standards for Better Health, which includes 24 core national standards which every NHS Trust is required to follow. The standards measure what matters to patients and the public including: is it safe and clinically effective; are services accessible and patient focused; is action

being taken to improve and protect the health of local people and to tackle inequalities.

Each Trust must declare their compliance with the standards to the Healthcare Commission. The declaration also informs patients and the public of the standard of quality of care provided by the PCT. Our declaration was submitted to the Healthcare Commission at the end of April 2008 and has been published on the Commission’s website and the PCT’s website.

As part of this declaration the PCT also submitted its statement on our compliance with the national hygiene code. This code is a powerful tool in fighting infection and explains how organisations should work to make sure that patients are cared for in a clean and safe environment.

After 2008/09 the Healthcare Commission will merge with another national body the Commission for Social Care Inspection (CSCI) and will introduce a new way of assessing the quality of health and social care services.

Our workforce The PCT strives to have a workforce that is equipped and empowered to deal with the needs, concerns and questions from patients and the public.

We greatly value our staff and will continue to commit resources to provide learning and development opportunities for the entire workforce. We will also look at where and how our services are Staff groups employed

delivered, working with patients, the public and our staff to provide flexible services.

Staff figures The PCT employs over 1, 200 staff, of which 45% work full time and 55% work part time. 92% of our workforce is female. The current level of sickness across the PCT is 5% and staff turnover is 9.2%.

Total number

2007/08 Permanently employed staff

Other number

Medical and dental

23

23

0

Ambulance staff

0

0

0

Administration and estates

383

346

37

Health care assistants and other support staff

94

88

6

Nursing, midwifery and health visiting staff

375

368

7

Nursing, midwifery and health visiting learners

0

0

0

137

134

3

Social care staff

0

0

0

Other

0

0

0

Total

1012

959

53

Scientific, therapeutic and technical staff

21 hours or work annualised hours. To date around 76 staff have taken up one of the flexible working options.

Leadership and organisational development Regular management and team leader training sessions are held across the PCT on a variety of management topics. A number of career development workshops have been held for staff that may have been affected by the recent organisation changes.

Policies and procedures

During the year 99% of staff who were affected by organisation changes were successfully redeployed into jobs across the PCT. The PCT continues to promote and support staff in accessing coaching and mentoring using internally trained professionals with the aim of developing the PCT’s future leadership strategy. The leadership strategy identifies the core skills for those with responsibility for managing and leading staff. During the year around 60 team leaders in Provider Services undertook a week long development programme. A further programme for around 30 managers in Provider Services is planned for 2008.

During the year the HR team has revised a number of employment policies and procedures including career break, secondment, maternity leave, grievance and alcohol and substance misuse in the workplace. The PCT has also developed policies and procedures covering equality and diversity, disabled people and health and safety. All policies and procedures are available to view on the PCT’s website. The Provider Services team are currently piloting for twelve months a flexible working scheme called ‘Options’. This allows staff to buy additional leave, undertake compressed

The majority of PCT staff now have a personal development review (PDR) meeting with their manager. This meeting is designed to allow staff the opportunity to discuss their work objectives with their manager as well as agree their development needs. Development needs are determined in accordance with the needs of the service and link to the employee’s Knowledge and Skills Framework (KSF) outline. A future target for the PCT is to ensure that all staff have a PDR meeting with their manager and also have a KSF outline for the job they do. The

review the PCT will invest additional resources in the areas of greatest need.

The PCT also has a formal staff involvement process through its PCT staff partnership forum with accredited trade union representatives. These meetings have helped to develop a number of employment policies and procedures for the PCT.

Staff involvement The PCT believes in involving staff in all aspects of its business, including service development. In the Provider Services team a significant number of staff including nurses and GP’s have been involved with ‘Route to a Solution’- a review of district nursing services in GP practices. This review provided staff with an opportunity to contribute their views concerning future staff numbers/skill mix to support GP practices. Following completion of the

PCT has recently appointed a KSF project officer who will support PCT managers/ team leaders to use the PDR and KSF process.

The PCT has committed to the Investors in People (IIP) standard and skills pledge and is using the IIP framework as part of this commitment to achieve the vision and values developed across the PCT last year.

During 2008 the PCT will introduce a workforce plan which should not only meet service/operational requirements, but also help to ensure it continues to employ the right staff with the right skills to deliver the right services to the local population both now and in the future.

22 A commitment to equality The PCT actively monitors the composition of its workforce. The PCT works with other agencies to encourage future recruitment to the PCT and NHS. During the year the PCT attended a number of career events at local schools. The PCT also participated in a development event for local school teachers which aimed to provide them with information about the PCT and NHS and also provide information about the different types of careers available to students.

At the end of 2007 the composition of the PCT’s workforce by ethnic origin was as follows: White/British

88%

Indian

2.5%

Pakistani

3%

Other groups

6.5%

Staff Recruitment and Equal Opportunities Monitoring Period: April 2007 to March 2008 • 179 appointments made • 2782 applications received for the above jobs The above applicants declared their ethnic origin as follows: White/British

1874 (67%)

Indian

312 (11.5%)

Pakistani

277 (10%)

Other minority groups

248 (9%)

Not declared

71 (2.5%)

Following the appointment to the 179 jobs the people appointed declared their ethnic origin as follows: White/British

138 (77%)

Indian

11 (6%)

Pakistani

13 (7%)

Other minority groups

5 (3%)

Not declared

12 (7%)

Celebrating achievement The PCT is committed to thanking staff for their service to the PCT and NHS. Each year the PCT holds an annual Long Service Awards ceremony to pay tribute and give recognition to staff who have worked for 25 years and 40 years in the NHS. This year, 40 staff from across the PCT were presented with awards at a special ceremony. One member of staff received special recognition for her 40 years service to the NHS and 39 staff received an award for their 25 years service to the NHS. The PCT also made a number of other awards including team of the year, employee of the year, an unsung hero award and an award for the employee who made a significant contribution towards improving patient care. Additionally a number of PCT staff and teams have received national/regional awards for their work.

The ‘Celebrating the Talents’ showcasing event held at the end of the year was also a great success with staff from across the PCT sharing learning and innovative practice with colleagues from the health economy, local authority and partner organisations. In the coming year we will continue to not only share and celebrate

our staffs success, but support others in developing practice to meet future needs.

• Pre-employment assessments

Occupational health services

• In-service (sickness/absence) referrals

During the year the HR team commissioned two new Occupational Health Service (OHS) providers for both PCT employed staff and for GPs, dentists and their staff.

• Health surveillance

From 1st April 2008, the Mid Yorkshire Hospitals NHS Trust will provide OHS for all PCT employed staff. The service to staff includes a designated occupational health nurse who is available to PCT staff at a number of locations across the PCT area on specified days of the week. Staff can either make an appointment or drop in to discuss any relevant occupational health issue.

The service is led by a qualified occupational health consultant physician.

The OHS includes the following services:

• Immunisations

• Advice concerning needle stick incidents/injuries • Work based assessments e.g. VDU and correct usage • Attendance at relevant PCT meetings including infection control, health and safety • Staff counselling services Employee Health Care Direct provide a similar Occupational Health Service to GP’s, dentist’s and their support staff as of January 2008.

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orking for a

Risk management Risk management continues to be a key element in the business of running the PCT both internally with our patients and staff and also with the services that we commission.

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BON ACTIO R N A

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Over the last year Kirklees PCT has been working with neighbouring health organisation and Kirklees Council to increase awareness amongst staff of the green agenda. In November 2007, as a health community, we launched the ‘10% Less Campaign’ particularly focusing on reducing water, gas and electricity consumption.

C

Environmental agenda

en gre

Posters have been displayed in PCT premises prompting staff about what they can do at work and at home to reduce carbon emissions such as switching lights off, making sure taps are turned off after use and not leaving equipment on standby. In support of this work the PCT is recruiting a Carbon Reduction Project Officer who will help the PCT introduce recycling and green travel schemes.

As a result the PCT has been involved in a number of risk management actions designed to measure our effectiveness and to make changes where gaps have been identified.

Earlier in the year the PCT was selected to pilot the new NHS Litigation Standards for PCTs which resulted in a number of policy and procedural changes. The assessment was both challenging and rewarding with the PCT moving on to demonstrate further compliance with the standards.

Training and education are vital actions to support the risk management agenda with many risk reduction training programmes being designated as mandatory for all staff including health and safety, fire, records management, infection control and the management of violence and aggression.

At the time of writing risk management

training has reached 82% of all staff which includes Board members who attended bespoke training sessions designed for their roles and responsibilities.

As part of a structured risk management programme including reviews of all reported incidents, the risk management team have been active across all directorates providing advice, support and guidance. A specific part of this programme has been the introduction of standard tools for measuring compliance against legislation and best practice which is being used on all premises regarding health and safety, fire, records and security.

The objective behind all risk management programmes is to reduce the potential of anything going wrong and to ensure that the work environment is safe for patients, staff and the public. The achievement of this objective can be demonstrated in the Trust receiving a prestigious award from the Royal Society for the Prevention of Accidents.

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Declarations of interest Executive directors Mike Potts Sheila Dilks Dr Judith Hooper Bryan Machin Carol McKenna Directors Helena Corder Sue Ellis Robert Flack

Chief Executive Director of Patient Care and professions Director of Public Health Director of Finance Director of Commissioning and Strategic Development

None None

Director of Corporate Services Director of Human Resources and Organisational Development Director of Provider Services

None Shared post with Calderdale PCT - remunerated as shared service with Calderdale PCT; Adoption Panel member Independent role on Adoption Panel (until Sept 2007), Wakefield Metropolitan District Council (unremunerated) Membership of Sports Club Committee – York Cricket playing captain; Spouse works for North Yorkshire and York PCT as a physiotherapist and manager; member of MCC assistant area representative with endorsing rights None

Peter Flynn Director of Performance Non executive directors Rob Napier Chairman Valerie Aguirregoicoa Director Tony Gerrard Director Mehboob Khan Director Rob Millington

Director

Vanessa Stirum Director Imran Patel Director Professional Executive Committee Dr David Anderson Chairman David Wood Vice Chair Dr Ajit Mehrotra

PEC member

Dr Anil Aggarwal Angela Ladoca Dawn Gordon Sarah Brackwell

PEC PEC PEC PEC

member member member member

Salaried GP in Kirklees; Partner is a salaried GP in Kirklees PCT area; mental health training None Spouse was the director of Business Development at Care UK plc (until March 2008)

Spouse is a Non Executive Director at Barnsley Foundation Trust Independent member of the West Yorkshire Police Authority and Director and Company Secretary of a Aguirregoicoa Ltd None Elected member of Kirklees Council; Director of Excol consulting; Board member of LGA; Board member of the Standards Board of England; Member of WYFS; Deputy Chief Whip at the LGA and Member of the Labour party.

Employment with Syngenta Ltd until 31 January 2007; holding in Astra Zeneca plc plus other minor shareholdings.

Spouse has a shareholding in Astra Zeneca plc; is a governor Almondbury High School; Secretary at Lowerhouses and Longley Community group; director of Castle & Minster Credit Union.

None None GP at the Grange Group Practice; spouse and daughter are employees of Kirklees PCT. Proprietor of Wood’s dental practice; member of the Local Dental Committee; holder of honorary contracts with Leeds Teaching Hospital NHS Trust and Mid Yorkshire Hospitals NHS Trust; PMS GP from Windsor Medical Centre at Dewsbury, Member of the Executive of North Kirklees Consortia and also serve as Chairman of the LMC (Kirklees) Partner at Meltham Rd Surgery and Executive member of the Three Valleys commissioning Consortia None None None A full copy of the Board and PEC declarations of interest is available on request.

25

Director of Finance Report on Financial Performance In this section you will find our Summary Financial Statements for the year 2007/08 and other important financial information. The PCT’s full Accounts for the year are available from the PCT on request.

The PCT receives two types of financial allocations from the Department of Health to enable us to carry out our functions; revenue for day to day services and capital for the purchase of equipment and improvement of buildings. We must ensure that our spending does not exceed either of these allocations and I am pleased to report that we achieved a small underspend against both revenue and capital allocations.

The Strategic Health Authority is maintaining a strategic reserve for resource transfers to and from PCTs. Over the past two years the PCT has had its revenue allocations reduced by a total of £19.8m.

We expect our revenue allocation to be in turn increased to reflect our future spending and investment plans.

The PCT has achieved a surplus of £4.4m against its revenue allocation. This represents only 0.8% of our total allocation and will be carried forward into 2008/09 for the benefit of Kirklees residents. The PCT spent £529 million during the year on services for the Kirklees population maintaining existing services but also improving the quality of services, reducing

waiting times to access services and introducing new services. You will have read about many of these in this Annual Report.

The table to the right shows the different types of services we commission for Kirklees residents.

We invested over £1m capital investment during the year including over £250,000 on information technology in GP surgeries and community health centres and making available nearly £500,000 for improvements in dental practices.

Looking forward to 2008/09, the PCT has been allocated £29m of new revenue money. We plan to spend this by continuing to improve waiting times, by continuing to provide services closer to people’s homes, to continue to extend services for people with continuing care needs and by making significant investment in services to improve the care of people with long term conditions.

We will also make further significant investments in addressing health inequalities in Kirklees, targeting our resources where we have identified the greatest need. We plan to spend over £2m providing a superb new ward environment for patients at Holme Valley Memorial Hospital and improving the infrastructure to enable more services to be provided there.

Service Commissioned

Amount Spent (£m)

% of total PCT commissioning spend

265

54

72

15

Acute hospital services Mental health and Learning Difficulty Services Community services

27

5

Primary care from GPs, dentists, opticians and pharmacists

72

14

Prescribing in primary care

61

12

£497

100%

Prescribing in primary care Primary care from GPs, dentists, opticians and pharmacists Community services Mental health and Learning Difficulty Services Acute hospital services

A full copy of the accounts can be obtained by contacting the Finance Department on 01484 466000.

26 Financial performance targets The PCTs’ performance for 2007/08 is as follows:

2007/08 £000

2006/07 £000

Total net operating cost for the financial year

529,202

489,302

3,402

3,173

Operating Costs less non-discretionary expenditure

525,800

486,129

Revenue Resource Limit

530,205

487,035

4,405

906

0

0

4,405

906

2007/08 Number

2007/08 £000s

Total bills paid in the year

19,556

59,867

Total bills paid within target

15,510

47,856

79.31%

79.94%

Less: Non-discretionary Expenditure

Under/(over) spend against Revenue Resource Limit Unplanned support received Operational Financial Balance

Better Payment Practice Code

Percentage of bills paid within target

The PCT aims to meet the national target for paying 95% of its bills within 30 days. For 2007/08 the PCT failed to meet this target paying only 79% of bills within 30 days.

An action plan has been in place for 2007/08, with the aim of meeting a target of 90% of bills paid in month by December 2007. This was achieved and work will continue in 2008/09 to ensure the improvement continues.

We are committed to securing value for money and competitive quotation. Tendering procedures are in place for the purchase of goods and services.

Management costs Management costs (£000s) Weighted population (Number) Management cost per head of weighted population (£)

2007/08

2006/07

8,725

9,449

378,145

372,548

23.07

25.36

27 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) comprise the PCT Chairman (Rob Napier) and three NonExecutive directors (Mehboob Khan, Imran Patel and Vanessa Stirum). The NonExecutive director who chairs the Audit Committee does not attend in order to ensure separation of duties. The Chief Executive is in attendance (except when his own terms and conditions are considered).

The Committee is supported by the Human Resources Directorate.

The role of the Remuneration and Terms of Service Committee The role of the RSTC 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.

Statement of the policy on remuneration of higher paid employees for current and future financial years The PCT 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 1st April 2007.

This helps to ensure that the PCT 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 RSTC 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.

Assessments are conducted using established PCT appraisal and personal development planning processes, which

include clearly defined responsibilities with measurable objectives.

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 per cent of the rechargeable pay bill, with a consolidated and pensionable annual uplift of 1.30 per cent with effect from 1st April 2007.

Explanation of relative importance of the relevant proportions of remuneration which are, and which are not, subject to performance conditions Please refer 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 2007/2008 All payments are disclosed in the table on page 28-29.

Salary and pension entitlements of senior managers for 2007/2008 See table on page 29-30.

28 Remuneration of members of Kirklees PCT Board and PEC Name and title

2007-08

2006-07

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

David Anderson

45 - 50

20 - 25

David Wood

5 - 10

5 - 10

Ajit Mehrotra

5 - 10

5 - 10

Anil Aggarwal

5 - 10

5 - 10

Angela Ladocha

0-5 6 Months Worked

Sarah Brackwell

0-5 6 Months Worked

Dawn Gordon

0-5 6 Months Worked

David Kelly Interim PCT

June Watson Interim PCT

Tina Quinn Interim PCT

Gill Hawksworth Interim PCT

James Garritt Interim PCT

Carl Dickinson Interim PCT

Rosie Norbury Interim PCT

Sandra Bramall Interim PCT

Sally McIver Interim PCT

0-5

5 -10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5

5 - 10

6 Months Worked

0-5 6 Months Worked

5 - 10

29 Non Executive Directors - salaries and allowances Name and title

2007-08

2006-07

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

30 -35

V Aguirregoicoa

5 - 10

5 - 10

T Gerrard

5 - 10

0-5

M Khan

5 - 10

5 - 10

I Miya-Mohammed Patel

5 - 10

0-5

V Stirum

5 - 10

5 - 10

R Millington

5 - 10

0-5

Senior managers - salaries and allowances Name and title

2007-08 Salary (bands of £5,000) £000

Mike Potts

125 - 130

Chief Executive

Bryan Machin

95 - 100

Executive Director of Finance

Judith Hooper Executive Director of Public Health Helena Corder Director of Corporate Services Carol McKenna

105 - 110 65-70 80 - 85

Other Remuneration (bands of £5,000) £000

2006-07 Benefits in kind (Rounded to the nearest £00) £00

Salary (bands of £5,000) £000 60 -65 26 Wks worked 35 - 40 20 Wks worked 70 - 75 65 - 70 75 - 80

Executive Director of Comm & Strat Dev

Peter Flynn

80 - 85

Director of Performance

Sheila Dilks

75-80

Executive Director of Patient Care

Sue Ellis

80 - 85

Director of HR

Robert Flack Director of Provider Services

75-80

10 - 15 8 Wks worked 5 - 10 4 Wks worked 15 - 20 12 Wks worked 35 - 40 26 Wks worked

Other Remuneration (bands of £5,000) £000

Benefits in kind (Rounded to the nearest £00) £00

1-2

30 Senior managers - pension entitlements Name and title

Mike Potts

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 2008

Lump sum at age 60 related to accrued pension at 31 March 2008

Cash Equivalent Transfer Value at 31 March 2008

Cash Equivalent Transfer Value at 31 March 2007

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

£00

2.5 - 5

12.5 - 15

50 - 55

155 - 160

889

766

73

0 - 2.5

0 - 2.5

25 - 30

80 - 85

350

324

13

2.5 - 5

7.5 - 10

35 - 40

105 - 110

599

530

39

0 - 2.5

2.5 - 5

20 - 25

60 - 65

293

265

15

0 - 2.5

5 - 7.5

16 - 20

45 - 50

192

157

22

0 - 2.5

5 - 7.5

10 - 15

35 - 40

191

154

23

5 - 7.5

15 - 17.5

15 - 20

45 - 50

292

186

71

2.5 - 5

7.5 - 10

25 - 30

80 - 85

407

348

35

0 - 2.5

5 - 7.5

5 - 10

15 - 20

63

39

16

Chief Executive

Bryan Machin Executive Director of Finance

Judith Hooper Executive Director of Public Health

Helena Corder Director of Corporate Services

Carol McKenna Executive Director of Comm & Strat Dev

Peter Flynn Director of Performance

Sheila Dilks Executive Director of Patient Care

Sue Ellis Director of HR

Robert Flack Director of Provider Services

31 Operating cost statement for the year ended 31 March 2008 2007/08 £000s

Balance sheet as at 31 March 2008

2006/07 £000s

Gross Operating Costs

518,902

479,008

Intangible assets

Less: Miscellaneous Income

(17,830)

(17,311)

Tangible assets

Commissioning Net Operating Costs

501,072

461,697

Investments

Gross Operating Costs

32,422

33,471

Less: miscellaneous income

(4,328)

(5,899)

Provider Net Operating Costs

28,094

27,572

529,166

489,269

0

0

Provider

Interest Receivable Interest payable Net Operating cost for the Financial Year

36

33

529,202

489,302

Statement of recognised gains and losses for the year ending 31 March 2008 2007/08 £000

2006/07 £000

Fixed asset impairment losses

(138)

0

Unrealised surplus / (deficit) on fixed asset revaluations/ indexation

1,086

912

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

Additions / (Reductions) in “other reserves”

0

0

948

912

0

(1,408)

948

(496)

Recognised gains and losses for the financial year Prior period adjustment - other Gains and losses recognised in the financial year

31 March 07 £000

107

27

17,979

17,295

0

0

18,086

17,322

361

220

4,712

6,775

FIXED ASSETS

Commissioning

Net Operating Costs before interest

31 March 08 £000

0

CURRENT ASSETS Stocks and work in progress Debtors Cash at bank and in hand

559*

5

TOTAL CURRENT ASSETS

5,632

7,000

CREDITORS: Amounts falling due within one year

(34,041)

(33,540)

NET CURRENT ASSETS / (LIABILITIES)

(28,409)

(26,540)

TOTAL ASSETS LESS CURRENT LIABILITIES

(10,323)

(9,218)

(142)

(142)

(2,338)

(2,690)

(12,803)

(12,050)

(17,013)

(15,337)

Creditors: Amounts falling due after more than one year Provisions for liabilities and charges TOTAL ASSETS EMPLOYED FINANCED BY: TAXPAYERS EQUITY General Fund Revaluation reserve

4,210

3,160

Donated asset reserve

0

127

Government grant reserve

0

0

Other reserves

0

0

(12,803)

(12,050)

TOTAL TAXPAYERS EQUITY

* £554k of this relates to cash held in a pooled budget with Kirklees Council.

32 Cash flow statement for the year ended 31 March 2008 31 March 2008 £000s OPERATING ACTIVITIES Net cash outflow from operating activities

(526,330)

SERVICING OF FINANCE: Interest paid Interest element of finance leases

0 (36)

Net cash inflow/(outflow) from servicing of finance

(36)

CAPITAL EXPENDITURE Payments to acquire intangible assets Receipts from sale of intangible assets Payments to acquire tangible fixed assets Receipts from sale of tangible fixed assets

(87) 0 (1,165) 224

Payments to acquire fixed asset investments

0

Receipts from sale of fixed asset investments

0

Net cash inflow/(outflow) from capital expenditure

(1,028)

Net cash inflow/(outflow) before financing

(527,394)

FINANCING Net Parliamentary Funding

527,948

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

527,948 554

Audit services £000 Statutory Audit Services

385

33

Statements Statement of the Chief Executives responsibilities as the Accountable Officer of the organisation

Statement of directors responsibilities in respect of the accounts

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:

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:

• 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 17th June 2008 Dated..................................................................................................................................

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.

17th June 2008 ..............................................

Date ........................................................... Chief Executive 17th June 2008 ..............................................

Date ..........................................................Finance Director

34 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 31 to 32.

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.

Related Party Transactions Kirklees Primary Care Trust is a body corporate established by order of the Secretary of State for Health.

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 Kirklees Primary Care Trust.

The following General Medical Practitioners receive personal remuneration as Board and PEC members, their practices receive remuneration in accordance with GMS/PMS contracts as below:

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.

Dr D Anderson (full year) Dr AP Mehrotra (full year) DR A Aggarwal (full year) Dr D Kelly (interim PEC, 6 months) DE Wood (full year)

Practice payments to related party £ 1,661,821 310,947 1,241,311 1,033,565 663,940

Basis of opinion I conducted my work in accordance with Bulletin 1999/6 ‘The auditors’ statement on the summary financial statement’ issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of our audit opinion on those financial statements.

The Department of Health is regarded as a related party. During the year Kirklees Primary Care Trust has had a significant number of material transactions with the Department, and with other entities for which the department is regarded as the parent Department. These entities are listed below:

Opinion In my opinion the summary financial statement is consistent with the statutory financial statements of the Trust for the year ended 31 March 2008. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements (18 June 2008) and the date of this statement.

.................................................

5 September 2008

The Mid Yorkshire NHS Trust Calderdale and Huddersfield Foundation Trust

2007-08

2006-07

89,522

82,363

116,495

107,102

Leeds Teaching Hospitals NHS Trust

36,332

33,150

South West Yorkshire Mental Health Trust

36,451

34,447

Yorkshire Ambulance Service

9,848

8,483

North Yorkshire and York PCT

5,849

5,000

Prescription Pricing Authority

63,663

58,761

Paul Lundy – District Auditor Audit Commission, Kernel House, Killingbeck Drive, Killingbeck, Leeds, LS14 6UF

In addition, the Primary Care Trust has had a significant number of material transactions with other Government and other central and local Government bodies. Most of these transactions have been with Kirklees Metropolitan Council.

35

36 Celebrating the 60th anniversary of the NHS in July 2008

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: PW2529 • Date of publication: Aug 08 • © Kirklees Primary Care Trust