CKWCB-12-182b_20120706_letter_to_Mike_Pott_CKW_re_annual_review

6 July 2012 Mike Potts Chief Executive NHS Calderdale, Kirklees and Wakefield

NHS Yorkshire and Humber West One Dumcombe Street Leeds LS1 4PL Tel: 0113 295 2000 www.yorksandhumber.nhs.uk

Dear Mike Thank you for attending the Annual Review held at Blenheim House on 21 May. The review contained a number of positives, with an improving picture in some areas. However during the Mid Year Review in January, performance risk issues were discussed at length and a commitment to timescales for recovery was given. In some cases these improvements have not been made, so both for you as a Cluster and the emerging CCGs this is a cause for concern.

I have reflected below the areas we discussed during the review and I have reinforced the assurances that you have provided in terms of delivery in 2012/13.

Year-end Performance 2011/12 Year-end performance at Mid Yorkshire Hospitals was a cause for concern in the areas of A&E and RTT. A&E performance did not deliver the 95% standard for either Q4 or year-end and this was a disappointment especially given that MYH had delivered the A&E standard in Q3.

The admitted standard for RTT was not delivered for Q4, however the outturn position of 89% at the end of March was a much improved position based on the performance of the previous three quarters. You explained that at year-end you had 37 patients waiting over 52 weeks and we expressed concern at this number.

For CHFT, we raised concerns with regard to the number of patients waiting over 52 weeks and you assured us that of the 59 patients waiting over 52 weeks, 54 of these patients were erroneous and a result of data errors. We were clear that it is unacceptable for any patient to wait for a year for their treatment and urged you to ensure that the right systems and processes are in place so that waiting lists are validated on a regular basis and all patients are seen in a timely manner.

Public Health – it was pleasing to note that performance in the public health arena is largely positive. Mortality rates are improving in the CKW Cluster and there has been an improvement in the delivery of health checks, smoking quitters and smoking in pregnancy.

Access Monies Reference was made to the access monies which were released in to the system in the final quarter of Q4, to assess the impact of this funding in relation to delivery of the access standard and you were confident that you could reconcile spend with yearend delivery of the targets. Once this work has been completed this will be picked up via the performance route.

Chair: Kathryn Riddle

Chief Executive: Ian Dalton

From 3 October 2011 NHS North East, NHS North West and NHS Yorkshire and the Humber - the three strategic health authorities in the North of England - will be placed under a single management framework and work together as NHS North of England.

Performance to Date 2012/13 Moving in to Q1 MYH have made significant improvements in their A&E performance and it is pleasing to note that they are now delivering 96.31% year to date. We were keen to understand if this current position was sustainable and you described the systems and processed that have been established across the health economy to guarantee delivery. You explained with clarity the difference that strong leadership and clear lines of accountability has made within MYH and in line with this your confidence in delivery of key standards moving forwards. The minimum expectation is that this standard is delivered in both Q1 and moving forwards in to 2012/13; this will require a relentless approach if success is to be sustained.

We noted with satisfaction that the RTT provisional data for April is positive, this being the first month that MYH have delivered all of the RTT standards. You gave assurance that the Cluster is sighted on improving this position by securing performance delivery at specialty level across the Trust. You explained that the remaining backlog is currently sitting in 5 specialties and that the impact of clearing this may depress admitted performance for a period, but the Cluster has provided assurance that MYH will deliver sustainably from the end of Q1 moving forwards, the expectation that this standard is delivered and sustained from the end of Q1 remains. We agreed that we would have a further conversation with regard to the delivery of RTT outside of the review meeting.

We discussed general performance issues at CHFT and whilst there doesn’t seem to be any headline concerns, there have been a few erratic dips in performance which are a slight cause for concern, this, coupled with the significant management changes at the Trust, makes it important to remain well engaged with the Trust to assure yourselves of delivery moving forwards.

Flu Vaccination We highlighted the importance of enacting the flu vaccination program early this year ensuring that all staff groups are targeted including clinical and medical students and midwives to ensure an uptake of 75% of staff in each of your Trusts. We would urge you to closely monitor the flu vaccination program in your Cluster as we move forwards towards winter 2012/13.

Finance and Quality Assurance From a commissioner perspective we were pleased to note that all control totals have been met for 2011/12 year end. However from a provider perspective there are significant financial risks in MYH relating to a £20m year end deficit for 2011/12 and the planned £26m deficit for 2012/13. We discussed the finance issues in some detail and you highlighted the £23m CIP which is in place across MYH this year.

With regard to due diligence and quality assurance of CIPs, we were keen to understand how this process operates across the CKW health economy. You described the risk based approach in place which provides a clear framework for CIP, risk and quality triangulation explaining that MYHT CIP schemes that are rated amber or red following quality impact assessment, are then subject to confirm and challenge at the monthly CKW Cluster Quality Board which informs the Cluster Contract Board. Both of these meetings are chaired by CCG Clinicians. The red or amber rated schemes are also a focus for the Trust Nurse Director/Medical Director at their regular meetings.

With regard to the CIP in MYH you explained that a significant amount of these savings would be realised by workforce change; you reported that that these could include clinical posts. We were keen to understand what methodology the Trust has in place to ensure that the baseline is a safe organisation when triangulated with the number of serious untoward incidents and concerns raised

by CQC. You gave assurance that you are fully engaged with the quality and safety agenda at MYH, however we agreed that given the importance of this, further discussions will be continued outside of the review meeting.

Workforce We highlighted some issues relating to a deteriorating picture relating to the results of the annual staff survey and sickness absence levels at MYH both of which are a cause for concern. We stated the importance of both the cluster and the Trust having a clear joint understanding the workforce data to enable a shared and co-ordinated view of the issues.

Planning and QIPP We recorded our thanks to you for delivering your plan and milestones to NHS North of England within the required timescales and congratulated you on the quality of your plan. We highlighted the exigent commitment that you have made in terms of the 5.6% reduction in non-elective activity over the coming year. You were keen to assure us of the significant number of primary care schemes that are in place across the health economy to enable this aspiration to be realised.

Quality and Safety We were concerned to note that HCAI year-end performance was poor across both your provider organisations; in terms of MRSA at MYH and CDiff performance at CHFT. Worryingly CHFT has already had seven cases of CDiff against a trajectory for the year of 33 cases. You described in some detail the measures that are in place both within your main provider organisations and across primary care to eradicate HCAI risk from the system. We want to see a strong focus in this area and you maintaining a collaborative approach across the health economy.

Transition We were pleased to note that CCG development across the health economy is now on track, particularly in the Wakefield CCG where there were some initial problems, it was highlighted that the Wakefield and Calderdale CCGs are in the first wave of authorisation.

FT Pipeline We discussed the ongoing issue of MYH becoming an FT and the work that was being done to determine whether the Trust can achieve FT status in line with its TFA. You gave us assurance that you were fully engaged in this work and that you and the CCGs are committed, in partnership with the wider health system, to securing a resolution and clarity as to the future of the Trust as early as possible.

Public Health We were pleased to note that the public health transition across the Cluster seems to be progressing smoothly with robust partnerships across the health economy, you were clear about the risks of the transition but highlighted that there are already three joint appointments in post across the three Local Authority areas. We commended the work that has taken place in this area noting the progress that has been made.

Reputation and Management of the System We were keen to understand issues within the Cluster. You raised a number of issues including the A&E services at Pontefract Hospital. You explained that more general engagement was required on big issues such as this in order to build up public confidence moving forwards and that the Cluster saw this as its responsibility in partnership with its providers.

Summary In summary we thanked you for the candour of the conversations we had engaged in during the review meeting. It was clear that there remain some challenging issues within the Cluster but it was pleasing to see a real sense of engagement from both PCT and CCG colleagues.

With regard to the performance agenda we outlined our expectations for the universal achievement of all performance targets by the end of Q1, noting that a separate conversation re RTT would take place outside the review meeting. We reiterated the need for an improved level of delivery and sustainability in relation to the targets and issues such as patients waiting over 52 weeks, which should now be a thing of the past.

We reflected that financial and strategic issues continue to be a challenge for MYH and emphasised the importance that a sense of clarity be established as soon as possible to plan the way forwards.

With regards to the transition we were pleased to note that a significant amount of work has taken place across the health economy and credit was given to everyone round the table.

We concluded the review by commenting that this year is an important year which is most certainly not without risk. The complexity and uncertainty of the environment in which we are working must not allow distraction from the challenging agenda that you are facing. I would urge you to retain the vital focus that is required to ensure that patient safety and the quality of care remain your priority.

Yours sincerely

Ian Dalton CBE Chief Executive NHS North of England