http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/End-Year_20Performance_20Report_1_

End-Year Performance Report 2007/08

Produced by: Performance Team – May 2008

CONTENTS Page 1.

National & Local Objectives – Summary

1

2.

Access to Services

9

Secondary Care Access Primary Care Access Access to NHS Dentistry Ambulance Response Times Choose & Book

9 18 19 21 23

Improving Health of the Population/Reducing Health Inequalities

25

Obesity Smoking Sexual Health Infant Mortality Diabetes

25 27 28 35 38

4.

Long-Term Conditions

39

5.

Patient /User Experience

42

Patient Choice Patient Safety/Infection Control Patient & Public Involvement

42 43 48

Clinical Priority Programmes

49

Cancer Substance Misuse Mental Health Learning Difficulties Children Older People CHD

49 54 58 62 63 70 73

Cross-Cutting Strategies

75

Finance Corporate Governance Equality & Diversity (refer to PPI) Practice Based Commissioning Workforce Clinical Governance Information Management & Technology Prescribing

75 76

3.

6.

7.

Performance Report – May 2008

77 79 81 84 88

NATIONAL & LOCAL PRIORITIES - SUMMARY Access to Services

Pages 9 - 24

Secondary Care Access: As the responsible Commissioner, the PCT, must ensure no-one is waiting for treatment longer than the national waiting times standard. By December 2008, the whole patient journey will be managed and measured as one and no-one should be waiting longer than 18 weeks from GP referral through the different stages of hospital treatment, i.e. diagnostics, outpatients and inpatients. During 2007/08 there were 10 breaches of the national inpatient waiting time guarantee, however, these breaches related to 5 patients only and for outpatient national waiting time guarantee, there were 4 breaches that related to 3 patients only. PCT performance for 2007/08, as at 31st March 2008, for referral to treatment waiting time data shows:18-weeks+ referral to treatment (admitted) Target 85%, Actual 86.3% 18-weeks+ referral to treatment (non-admitted) Target 90%, Actual 96% 26-week+ Inpatient waiting time guarantee Target 0, Actual 10 13-week+ Outpatient waiting time guarantee Target 0, Actual 4 6-week+ waiting time standards for 15 key diagnostic tests As at 29th February 2008 - Target 118, Actual 79

A & E Waits: The NHS target requires that at least 98% of patients spend four hours or less in any type of A&E from arrival to admission, transfer or discharge. 'National Standards, Local Action' sets out that NHS organisations are required to maintain achievement of this target. PCTs are assessed on their commissioning of A&E services and on any A&E services they may provide, such as minor injuries units and Walk-In Centres. PCT performance for 2007/08 as at 31st March 2008:Total time in A & E: four hours or less target 98% and actual 97.68%

Primary Care Access: All patients who wish to do so should be able to see a GP within 2 working days and a primary healthcare professional within 1 working day – achievement of this target is seen as an indicator of progress on the overall reform of the NHS. The PCT’s reported performance in the January 2008 survey is:Access to a GP – 100% Access to a Healthcare Professional – 99.4%

The surveys are now carried out quarterly instead of monthly and the next survey will be carried out in April 2008.

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Access to NHS Dentistry: Since 1st April 2006 PCTs have had responsibility for commissioning primary care dental services to reflect local needs and priorities. This includes ensuring that an appropriate out-of-hours emergency care service is available for local patients receiving continuing care from a local practice, local patients not receiving continuing care, and visitors to the area. It also includes an obligation on PCTs to provide appropriate access to urgent dental care, both in and out of core working hours.

Access to an NHS Dentist

A & E Ambulance Response Times: Currently the clock starts for measuring ambulance response times when 3 pieces of key information have been obtained (location, telephone number and chief complaint).

Ambulance Trusts should respond to 75% of category ‘A’ calls within 8 minutes and 95% of category ‘A’ Calls within 19 minutes 95% of Category ‘B’ calls within 19 minutes. PCT performance for 2007/08 as at 31st March, 2008:% response to Category A calls within 8 minutes: Target 75%, Actual 73.5% % response to Category A Calls within 19 minutes Target 95%, Actual 96% % response to Category B calls within 19 minutes: Target 95%, Actual 92.3%

From 1 April 2008, the clock will start earlier - when the call is connected to the ambulance control room. Ambulance trusts and PCTs will be assessed against this new standard from 2008/09 onwards.

Choose & Book: Giving patients more choice about how, when and where they receive treatment is one cornerstone of the Government's health strategy. The PCT is committed to ensuring an increase in the level of choice offered each year, offering routine choice of hospital provider at point of booking for all patients. As at 31st march, 2008, PCT performance for 2007/08 shows:Unique Booking Reference Number as a % of GP referrals Target 90%, Actual 44%

Improving Health of Population/Reducing Health Inequalities

Pages 25 - 38

NHS Trusts have a key role in helping to improve the health of communities and prevent disease. The Government’s White Paper ‘Choosing Health’, published in November 2004, set out a programme of action for the NHS to achieve this. Priorities within the White Paper include tackling inequalities in health, reducing the numbers of people who smoke and halting the year-onyear rise in obesity in children through diet and physical activity.

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Obesity: is associated with many illnesses and is directly related to increased mortality and lower life expectancy. Tackling obesity is a national and local priority.

Smoking: A national and local priority is the reduction in the numbers of people who smoke, helping people stay ‘stop’ smoking and smoking prevention. Smoking is proven to lead to heart disease, stroke, cancer and many other fatal diseases. From national and local consultation exercises, many people feel this is an area in which they needed more support in addressing the problem. Because many people were concerned about the affects of second-hand smoke; and because many parents were concerned about their children taking up smoking. PCT performance for 2007/08 as at 31st March 2008 shows:4-week smoking quitters Target 2857, Actual 2880

Sexual Health (including screening): The PCT is actively working with all partners by improving access to services, information and support to improve the sexual health and well-being of the people of Kirklees. PCT performance for 2007/08 as at 31st March, 2008 is shown as:Reduce teenage conception rates Target 36.26%, Actual 43.9% % of patients offered appointments at GUM clinic within 48 hours Target 100%, Actual 100% % of patients seen at GUM clinic within 48 hours Target 95%, Actual 89.5% % of people aged 15-25 accepting Chlamydia screening Target 2650, Actual 598

Infant Mortality: The Government is fully committed to the promotion of breastfeeding, which is accepted as the best form of nutrition for infants to ensure a good start in life. It also recognises that helping pregnant women give up smoking leads to health benefits for themselves and their unborn children. Since the inception of the NHS Stop Smoking Services in 1999, local Services have had a particular focus on helping pregnant women who smoke to give up. PCT performance for 2007/08 as at 31st March, 2008:% of mothers known to be smoking at the time of delivery Target 7%, Actual 15.4% % of mothers initiating breastfeeding Target 64.53%, Actual 70.5%

Diabetes: is a chronic and progressive disease that has an impact upon almost every aspect of life. It affects infants, children, young people and adults of all ages, and is becoming more common. Diabetes is the leading cause of blindness in people of working age in the UK. PCT performance for 2007/08 as at 31st March 2008:% of diabetic patients offered diabetic retinopathy screening – 100%

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Long Term Conditions

Pages 39 - 41

The recognised outcome of improving the management of patients with enduring chronic disease is to significantly improve their quality of life. This will be achieved through a particular focus on:

Effective management of disease related symptoms, and a Reduction in the overall impact of frequent hospital admission through the provision of alternative models of care.

Recruitment of community matrons

Consequently, there is an imperative to progress work that reduces the overall number of patients who develop chronic diseases and the timely diagnosis of patients so that appropriate management of their symptoms can be established. As at 31st March, 2008, PCT performance for 2007/08 shows:Number of community matrons and case managers Target 25, Actual 14.4 Number of Very High Intensity Users (VHIUs) Target 2031, Actual 469 Emergency Bed Days Target 223,194, Actual 182,183

Patient/User Experience

Pages 42 - 48

Patient Choice: Giving patients more choice about how, when and where they receive treatment is one cornerstone of the Government's health strategy. The PCT is committed to ensuring an increase in the level of choice offered each year, offering routine choice of hospital provider at point of booking for all patients. As at 31st November 2007, the latest data available, PCT performance is showing:Patient recollection of choice Target 80%, Actual 44%

Patient Safety/Infection Control: Keeping patients safe is a key priority for the PCT and the PCT is actively working with partners; to ensure year-onyear reductions in MRSA & Clostridium Difficile infections, expanding to cover other healthcare associated infections as data from mandatory surveillance becomes available through service level agreements and contracts.

Working relations with Mid Yorkshire Hospital Trust have been excellent, with good robust engagement from both partners, this needs reflecting with Calderdale & Huddersfield Hospital Foundation Trust. PCT performance for 2007/08 as at 31st March, 2008, shows:Number of MRSA Number of Clostridium Difficile Performance Report

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Patient & Public Involvement: Kirklees PCT is committed to actively involving and working in partnership with the public and service users, to design, review, monitor and deliver quality services that meet the local population’s health needs by:

Making Patient and Public Involvement an integral part of PCT working when designing, reviewing and delivering services and using information to improve service user experience.

Implementing a two way process of communication between the PCT, the public and service users.

Recognition of the diversity of the public and service users.

Raising awareness and promoting active involvement of staff in the principles of Patient and Public Involvement.

A ‘Stronger Local Voice’ sets out the Government's plans for the future of patient and public involvement in health and social care. These plans include the establishment of Local Involvement Networks (LINks) which will replace patient forums. LINks will work with existing voluntary and community sector groups, as well as interested individuals to promote public and community influence in health and social care.

Clinical Priority Programmes

Pages 49 - 74

Cancer (including cancer screening): The PCT continues to work collaboratively to ensure the sustained delivery throughout 2007/08 of a maximum waiting time of 2-week from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals one month from diagnosis to treatment for all cancers and 2 months from urgent referral to treatment for all cancers. PCT performance as at 29th February, 2008, shows:2-weeks Target 100%, Actual 99.7% one month Target 98%, Actual 98.4% two months Target 95%, Actual 91.5%

Cancer Screening - Breast: One in 9 women will develop breast cancer at some time in their life. Breast cancer is more common in women over 50. Breast screening can help find changes in the breast before there are any other signs or symptoms. If changes are found at an early stage, then there is a good change of a successful recovery. PCT position as at 31st March 2008 for 2007/08 performance shows:% of women screened within 36 months Target 90%, Actual 52%

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Cancer Screening - Bowel: evidence suggests that implementation of a National Bowel Cancer Screening Programme should reduce cancer mortality by around 15% in those people screened and should contribute to the delivery of the Public Service Agreement (PSA) target for all cancers that will achieve a reduction in mortality by 2010.

Substance Misuse: Problem drug use and harmful alcohol use are public health and social issues that are exacerbated by deprivation or personal problems experienced by individuals and a lack of awareness about the risks involved. If not addressed effectively, there are wider consequences for the community in terms of increased crime and anti-social behaviour. As at 31st March 2008, PCT performance for 2007/08 shows:number of people in drug treatment programmes Target 2000, Actual 2055 % of people retained in drug treatment programmes Target 80%, Actual 81%

The PCT, working with all health and social care partners, is committed to reducing the harm caused by drug and alcohol misuse through various promotions of prevention initiatives and provision of treatment programmes.

Mental Health: The National Service Framework (NSF) for Mental Health addresses the mental health needs of working age adults up to 65. It sets out national standards, national service models, local action and national underpinning programmes for implementation; and a series of national milestones to assure progress, with performance indicators to support effective performance management. An organisational framework for providing integrated services and for commissioning services across the spectrum is also included. PCT performance as at 31st March 2008 for 2007/08 shows:number of people receiving early intervention services Target 32 Actual 37 number of people receiving crisis resolution services Target 850, Actual 506 number of people receiving assertive outreach services Target 170, Actual 104

Learning Difficulties: working collaboratively, the PCT is actively Implementing standards and milestones within ‘Valuing People’.

Children: The National Service Framework (NSF) for Children, Young People and Maternity services is a 10-year plan that is expected to be delivered by 2014. The NSF standards are split into 11 key areas. The delivery of the standards outlined within the NSF is key to the delivery of the Every Child Matters agenda.

Older People: A strategic aim for the PCT is to improve and maintain the quality of life of Kirklees older citizens by promoting partnerships to deliver healthy living activities, sustain peoples’ independence and to promote Performance Report

May 2008

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positive views of ageing. The Vision for Older People’ sets the key areas of importance for older people living in Kirklees, which was the product of a 3 month consultant period, and is used as a tool for shaping the delivery of older peoples’ services across Kirklees, in partnership with health and social care agencies.

CHD: cardiovascular disease – heart disease, stroke and related conditions account for about two thirds of all premature deaths in England. Since the launch of the Coronary Heart Disease National Service Framework in March 2000 much progress has been made across Kirklees to develop services which are more effective, modern and timely.

Cross-Cutting Strategies

Pages 75 - 91

Finance: Financial stability is both a key objective and a minimum standard for NHS bodies. Effective financial planning should provide the essential platform on which to manage and achieve the initiatives set out in the Public Service Agreement (PSA) 2005-2008. All NHS organisations have to achieve financial balance and contain expenditure within Resource Limits & Cash Limits.

Corporate Governance: All healthcare organisations should apply the principles of sound clinical and corporate governance; actively support all employees to promote openness, honesty, probity, accountability and the economic, efficient and effective use of resources; undertake systematic risk assessment and risk management (including compliance with the controls assurance standards); challenge discrimination, promote equality and respect human rights.

Equality & Diversity: by ‘equality’ we mean treating people fairly and by ‘diversity’, we mean “valuing people’s differences”. The PCT is committed to ensuring that staff and service users are treated equally and the principle of embracing quality and diversity are common in relation to race, gender, age, sexuality religion and belief or disability (refer to PPI section).

Practice Based Commissioning: Practice Based Commissioning (PBC) is described by the Department of Health as “playing a vital role in health reform.”

Across Kirklees, PBC is lead by four consortia and eleven stand alone practices. They have a key remit in agreeing strategic direction with the PCT, engaging primary care practitioners in service redesign based on the needs of their populations and enabling the resourced shift of services from secondary to primary care.

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PBC also brings a much greater link between commitment of resources, through prescribing and referral into secondary care for example and responsibility for those resources through the allocation of an indicative budget.

Workforce: The NHS must demonstrate that it is making the most effective use it can of public money to deliver quality healthcare. A significant proportion of NHS funding is spent on staffing, and an effective workforce is key to ensuring our ambition in both commissioning and providing services.

Clinical Governance: is the process by which the NHS seeks to improve the quality of its services commissioned and/or provided and safeguard high standards of care. It was introduced to the NHS in 1999 in ‘A First Class Service, Quality in the NHS’.

Information Management & Technology: All healthcare organisations use effective and integrated information technology and information systems which support and enhance the quality and safety of patient care, choice and service planning and commissioning.

Prescribing: The Medicines Management Team have consistently delivered improvements in both the cost effective use of resources and improvements in the quality of medicines management and prescribing across the PCT. Actively working with key stakeholders to develop equity and evidence based prescribing.

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Access to Services 1.

Secondary Care Access: Stages of Treatment Director Lead: Carol McKenna The specific measures of progress made towards 18 weeks referral to treatment (RTT) are: 1.1

Number of pathways completed within 18 weeks Director Lead Carol McKenna Lead Manager Jim Barwick

Data is being collected to look at how many admitted and non-admitted pathways/patients are seen within 18 weeks. By December 2008:• •

85% of patients admitted for care done so within 18 weeks.

90% of patients on non-admitted pathways commencing treatment or being discharged within 18 weeks.

18-weeks Referral to Treatment – Admitted – Weekly Data

Kirklees PCT- Total Percentage Of Admitted Patients Treated within 18 Weeks 2007/08 100% 80% 60% 40% 20% 0%

06

13

20

27

03

10

January

17

24

02

09

16

February

23

30

06

March

April

2008 60%

58%

63%

60%

59%

62%

61%

72%

76%

82%

83%

80%

86%

89%

Trajectory 54.7%

53.3%

53.4%

52.9%

58.2%

61.4%

64.1%

67.0%

81.4%

85.2%

85.2%

85.3%

85.3%

85.5%

Actual

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18-weeks Referral to Treatment – Admitted – 2007/08 Data

Kirklees PCT : 18 Weeks Referral to Treatment (Admitted)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07 Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Actual

67.0%

56.4%

51.1%

54.4%

49.8%

53.4%

53.4%

55.1%

54.8%

63.6%

60.0%

72.0%

86.3%

Profile

51.0%

35.9%

40.3%

44.8%

49.3%

57.7%

58.2%

62.7%

67.2%

71.6%

52.9%

67.0%

85.3%

The Issues March 2008 data is non-validated at the time of reporting.

The Consequences and associated risks The RTT standard will not be met and recovery towards the trajectory will be challenging.

The Actions moving into 2008/09 At both Mid Yorkshire Hospital Trust and Calderdale & Huddersfield Foundation Trust the focus will continue on ensuring that commissioned activity is delivered, however, there will be increased focus on delivering new and reformed pathways of care to sustain the 18-week position. Operational processes have been put in place to enable this.

Data completeness improves as Trusts validate their waiting lists and apply clock stops to patients where the clock stop has previously been unknown.

Therefore, when the patients are reported as data complete it looks like they have had an 18-week+ wait. In reality, they have not; it is just that the clock has not been stopped. These are one off issues and are part of the Trusts improvement in data completeness. Data completeness for the PCT is satisfactory.

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As further reassurance, the acute trusts have reviewed patients that were referred 18 weeks ago to see if these have been treated in 18 weeks. These patients will have known clock start and clock stops and therefore robust data completeness. Encouragingly these patients have been treated within 18 weeks. Therefore as the backlogs of patients are treated and data completeness improves (both happening) we can be confident that 18 week RTT times will be inline with the trajectory. Therefore, if long waiters and incomplete data are removed, then patients are currently being seen within 18-weeks.

There remain significant risks in Orthopaedics. This is a West Yorkshire wide issue and securing additional capacity is being co-ordinated by the Strategic Health Authority (SHA). The problem for Kirklees PCT is more acute at Mid Yorkshire Hospital Trust where additional activity has been sourced in the independent sector and patients are being treated. There is an ongoing weekly performance review of the back log of patients waiting more than 18 weeks and the treatment of these patients. The PCT, with MHYT have met with the SHA and the Department of Health to gain reassurance for the activity plans to clear the back log. This may mean a dip in admitted performance for which there is an agreed trajectory.

In addition, the PCT is committed to a co-ordinated approach to all development, activities and commissioning issues, related to Orthopaedic and Musculoskeletal Care.

Role out Route to a Solution approach to the CHFT health economy, reflecting best practice currently within the MYHT health economy.

18-weeks Referral to Treatment – Non Admitted – Weekly Data

Kirklees PCT - Total Percentage Of Non Admitted Patients Treated Within 18 Weeks 2007/08 100% 80% 60% 40% 20% 0%

06

13

20

27

03

10

January

17

24

02

09

16

February

23

30

06

March

April

2008 Actual

60%

Trajectory 60.2%

Performance Report

22%

51%

82%

89%

89%

95%

94%

95%

94%

97%

96%

96%

95%

34.0%

78.3%

78.9%

80.5%

85.8%

87.0%

88.2%

90.0%

90.0%

90.0%

90.0%

90.0%

90.0%

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18-weeks Referral to Treatment – Non Admitted – 2007/08 Data .

Kirklees PCT : 18 Weeks Referral to Treatment (Non Admitted)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Mar-07 Apr-07 May-07 Jun-07

Jul-07

Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08

51.0%

64.5%

66.3%

67.5%

70.8%

72.3%

71.4%

57.6%

60.6%

61.2%

82.8%

94.0%

96.0%

Profile 63.0%

60.0%

62.7%

65.5%

68.2%

70.9%

73.6%

76.4%

79.1%

81.8%

78.9%

88.2%

90.0%

Actual

The Issues March 2008 data is non-validated at the time of reporting.

The Consequences and associated risks Early achievement of the standard.

The Actions moving into 2008/09 Maintain progress.

Continued integration of actions for admitted pathways with non-admitted pathways.

Those patients that are currently attending outpatients and being treated are in the main within 18-weeks and we are confident that the standard will continue to be met beyond March 2008.

1.2

Inpatient Internal Trajectory Waiting Time Lead Director: Carol McKenna and Lead Manager: Rachel Carter The Issues The current waiting time guarantee for inpatient treatment is 26-weeks. The PCT has breached this limit on 10 occasions in 2007/08, these are detailed in the Breach Report section.

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The targets for individual stages of treatment were removed during the year and data is no longer collected to monitor against these.

The Consequences and associated risks Through the year there were 10 reported breaches of the 26 weeks inpatient maximum waiting time target, involving 5 patients across the PCT. In each case we have worked closely with the provider organisation to understand the causes and to minimise the impact on the patients involved.

The Actions moving into 2008/09 Actions to reduce waiting times are included in the 18 week section of this report.

Breaches of guaranteed waiting times are taken very seriously by both commissioners and providers. All individual breaches are investigates and discussed to identify any actions that can prevent recurrence.

1.3

Outpatient Milestone Waiting Time

The Issues The current waiting time guarantee for outpatient activity is 13-weeks. The PCT has reported 4 breaches of this target in 2007/08, these are detailed in the breach report section.

The Consequences and associated risks In each case we have worked closely with the provider organisation to understand the causes and to minimise the impact on the patients involved.

The Actions moving into 2008/09 Actions to reduce waiting times are included in the 18 week section of this report.

Breaches of guaranteed waiting times are taken very seriously by both commissioners and providers. All individual breaches are investigates and discussed to identify any actions that can prevent recurrence.

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1.4

6 weeks+ waits for 15 diagnostic tests Lead Director Carol McKenna Lead Manager Rachel Carter

Kirklees PCT : Patients Waiting 6-weeks > for 15 Key Diagnostic Tests 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Apr-07

May-07

Jun-07

Jul-07

Jan-08

Feb-08

6 weeks +

3008

2736

2258

1369

Aug-07 Sep-07 1037

627

Oct-07 361

Nov-07 Dec-07 292

243

252

79

Mar-08 0

Profile

4604

4005

3361

2808

2256

1750

1269

855

533

256

118

0

The Issues The February and March data is non-validated at the time of reporting. The target is for no patient to wait more than 6 week from 1st April, 2008. the PCT is on trajectory to achieve this and has confirmed with its main providers that this should be achievable.

The Actions moving into 2008/09 Regular monitoring will continue throughout 2008/09.

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Breach Report for 2007/08 as at 31st March 2008 1.1.1. 26 Week Inpatient Breach Report Cumulative Total Breaches = 10, Number of patients = 5

Month

Provider Area / Commentary Specialty April 2007 MYHT Ophthalmology 1 Patient has been notified to us as a breach at the end of April 07, retrospectively in September 07. They also breached the standard on Feb 07 and Mar 07, current understanding in 07/08 this will be counted as only 1 breach. Was treated on 15th May. July 2007 MYHT Ophthalmology 2 patients breached the standard August MYHT Ophthalmology The same 2 patients in July also breached the 2007 standard in August December LTHT Neurology Breach due to lack of elective capacity to treat.

2007 Neurosurgeon is not prepared to operate on his long waiters at Nuffield. Not appropriate to transfer to another surgeon.

January LTHT Neurology Same patient that breached in December (refer to 2008 above) February LTHT Plastic Surgery 2 patients breached the standard 2008 March LTHT Plastic 1 patient breached the standard 2008 Surgery

1.1.2. 13 Week Outpatient Breach Report Cumulative Total Breaches 4, Number of patients = 3

Month

Provider

June 2007

LTHT

June CHFT 2007 December MYHT 2007

Performance Report

Area / Specialty Percutanerous Transluminal Coronary Angioplasty (PTCA) Clinical Haematology T&O

Commentary This has been recorded on the statutory return.

On further investigation the patient had been recorded twice on LTHT Patient Administration System (PAS) and was not a breach.

2 Breaches are in Clinical Haematology Due to clinic cancellation

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1.1.3. Monthly Referral to first seen in 2 weeks Total Breaches 2, Number of patients = 2 Month

Provider

July 2007

MYHT

Area / Specialty Cancer

July 2007

Bradford

Cancer

Commentary 1 Breach Gynaecology due to patient appointment being moved by rescheduling office without informing fast track office.

1 breach urology ultrasound cancelled on day of test.

1.1.4. Referral to Treatment 31 Days Total Breaches 1, Number of patients = 1 Month

Provider

July 2007

CHFT

Area / Specialty Cancer

Commentary 1 Breach Urology No Appointment Available due to training

1.1.5. Referral to Treatment 62 Days Month

Provider

May 2007

MYHT

Area / Specialty Cancer

May 2007

CHFT

Cancer

July 2007 July 2007

MYHT

Cancer

CHFT

Cancer

Performance Report

Commentary KPCT achieved 92.7% against a target of 95% with 3 breaches in Urology, 1 in Head and Neck and 1 other at MYHT contributing towards this underperformance KPCT achieved 92.7% against a target of 95% with 2 breaches in Lung, 1 in Urology and 1 other at CHFT contributing towards this underperformance KPCT achieved 94.3% against 95% target.

2 breaches at MYHT contributed to this.

KPCT achieved 94.3% against 95% target.

4 breaches at CHFT contributed to this.

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2. Secondary Care Access: A & E Waiting Time Standard Lead Director: Carol McKenna and Lead Manager: Jim Barwick

A & E Waits - % of patients waiting 4 hours or less 98% 96% 94% 92% 90%

Jun-07

Sep-07

Dec-07

Mar-08

Actual

98.14%

98.03%

97.47%

97.68%

Profile

98%

98%

98%

98%

Key Achievements A & E Action Plan for Mid Yorkshire Hospital Trust has been developed and is being implemented.

Issues The action plan will not deliver the waiting time standard. Poor performance at Pinderfields and satisfactory performance at Dewsbury will result in an overall poor performance with Mid Yorkshire Hospital Trust (MYHT). Performance at Huddersfield is poor and there is an intention to develop an action plan similar to MYHT. Underperformance will impact on the PCT’s 2007/08 performance rating.

The Action moving into 2008/09 Streaming in A & E at Dewsbury.

A & E Action Plan for MYHT with a focus on Pinderfields.

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3.

Primary Care Access Director Lead: Carol McKenna and Lead Manager: Mark Jenkins The Issues Results of the January 2008 Primary Care Access Survey highlighted:

Access to a GP 100% Access to a Healthcare Professional 99.4% (due to capacity issues within a single practice)

The survey is now undertaken quarterly, not monthly. The next survey will take place in April 2008.

The Consequences and associated risks National target not achieved will impact on the PCT’s 2007/08 Performance Rating.

The Actions moving into 2008/09 The PCT is actively working with the specific practice to ensure contingency plans are in place for the future, this was an isolated incident, and the PCT is confident that the national target for future surveys will be met.

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4.

Access to NHS Dentistry Director Lead: Carol McKenna and Lead Manager Lead: Clare Priestley The Issues In January 2007, the Kirklees PCT dental waiting list was 4600. The allocated growth funding received from the Department of Health has enabled commissioning of more capacity in practices across Kirklees in areas of high need, linking with the oral health strategy and in April 2008, the majority of patients who were on the PCT waiting list prior January 2008 were allocated to dental practices. The waiting list has again increased and now stands at 2000 from February to May 2008.

The end of year reviews with all dental practices will highlight where practices have the capacity to take new patients and it is anticipated that more patients will be taken from the list.

There are still specific issues associated with orthodontic provision which is being assessed through the PCT. This will result in the requirement to increase capacity to meet the needs and assist with the current 18 to 24 month wait.

Secondary dental care in Maxillofacial/Oral Surgery is also being highlighted as an area in need of addressing and could be enhanced by the provision of Dentists with a Special Interest (DwSPI). This is also being determined by the PCT in the form of a questionnaire to all GDPs about referral pathways.

Existing Initiatives to improve the position Kirklees PCT operates an in hour’s emergency dental service for patients who have a specific need but are without access to routine dental care. Patients are offered definitive treatment for the presenting problem. This has been in operation in the north since 2005 as part of the dental contracts for those practices that were in the pilot Personal Dental Services (PDS) scheme, at no additional cost to the PCT. In south the service was agreed additional to the baseline contract sum of a small number of practices. This is operated through Local Care Direct and follows strict criteria.

Additionally, an out of hour’s services is operated through Local Care Direct, at Huddersfield Royal Infirmary. This covers patients without and with a regular dentist outside normal working hours, weekends and bank holidays.

The pilot scheme for ‘follow-on’ treatment for patients who have attended an emergency out of hour’s appointment but who require completion of treatment has proved very successful and this service is being rolled out a number of practices across Kirklees.

There are many GDPs across Kirklees who are willing to see patients who may not fit the criteria for a dental emergency. Patients who are waiting for heart surgery need to be dentally fit before the surgery can take place. An

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agreement with a number of GDPs across the PCT has been made to see these patients as priority.

Future planning/initiatives Whilst the placement of those on the waiting list for routine dental care is a priority, it is evident that there is a cohort of patients who only wish to receive dental care when they have a problem. To place these in a dental practice will not be beneficial to the patient or the dental practice. This cannot be quantified, however, it is evident that some patients put their names on the waiting list having had emergency treatment and because they have been told to do so but when the problem is resolved they do not wish to accept routine care. It is also evident that some patients when allocated to a dental practice do not wish to see the dentist unless they have an emergency.

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5.

A & E Ambulance Response Times Lead Director: Carol McKenna and Lead Manager: Rachel Carter The Issues Yorkshire Ambulance Service (YAS) full-year performance against the target for 75% of “Category A” calls (immediate life threatening situations requiring urgent assistance) to receive an emergency response within 8 minutes is 73.5%, ie. not achieved. Performance is measured across the whole of YAS and therefore 12 PCTs in Yorkshire &The Humber will have the same performance recorded against this standard. YAS also failed the target for 95% of Category B calls within 19 minutes, achieving only 92.3%. The 95% target for Category A patients within 19 minutes was achieved (performance 96%).

The Consequences and associated risks The targets for 2008/09 are more onerous than 2007/08. The 75% and 95% targets remain, but time taken will be measured from when the emergency call is connected to the ambulance service, rather than from when three key pieces of information have been recorded. Yorkshire Ambulance Service will not achieve the new Category A target, and is unlikely to achieve the new Category B target, for 2008/09. Underperformance in 2007/08 will impact on the PCT’s 2007/08 performance rating.

The Action moving into 2008/09 The SHA is closely involved in performance managing this issue. An action plan has been agreed between YAS and the PCTs and the PCTs are providing additional funding to improve the trajectory and bring forward the time when the 75% will be achieved in-month to September. It will not be possible for YAS to over-perform sufficiently for the remainder of the year to bring the cumulative performance above the 75% target.

Ambulance Response to Category A Calls within 8 Minutes 77.0% 76.0% 75.0% 74.0% 73.0% 72.0% 71.0% 70.0% Apr-07

MayAugJun-07 Jul-07 07 07

Sep07

Oct07

Nov07

DecFebJan-08 07 08

Mar08

Actual 75.2% 75.6% 75.8% 75.7% 76.4% 75.1% 74.9% 74.4% 73.8% 73.7% 73.7% 73.5% Profile

Performance Report

75%

75%

75%

75%

75%

May 2008

75%

75%

75%

75%

75%

75%

75%

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Ambulance Response to Category A Calls within 19 minutes 97.0% 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% 90.0% Apr-07

MayAugJun-07 Jul-07 07 07

SepDecOct-07 Nov-07 Jan-08 Feb-08 Mar-08 07 07

Actual 96.7% 96.7% 96.6% 96.5% 96.5% 96.3% 96.3% 96.2% 96.1% 96.1% 96.1% 96.0% Profile

95%

95%

95%

95%

95%

95%

95%

95%

95%

95%

95%

95%

Ambulance Response to Category B Calls within 19 Minutes 95.0% 94.0% 93.0% 92.0% 91.0% 90.0%

Apr- May- Jun07 07 07

Jul07

Aug- Sep- Oct- Nov- Dec- Jan07 07 07 07 07 08

Feb- Mar08 08

Actual 93.2% 93.3% 93.2%93.2% 92.8% 92.7% 92.7%92.5% 92.2% 92.3% 92.4%92.3% Profile 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

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May 2008

95% 95%

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6.

Choose and Book Director Lead Carol McKenna and Lead Manager Rachel Carter

Converted UBRNs as a % of GP Referrals

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Actual

36.3%

33%

37%

35%

38%

33%

40%

35%

40%

40%

40%

44%

Profile

90%

90%

90%

90%

90%

90%

90%

90%

90%

90%

90%

90%

The Issues The current situation locally is there is not enough utilisation of the Choose and Book system amongst GP practices within the Kirklees PCT. Performance is better in the South Kirklees area than in North Kirklees area.

The Consequences and associated risks In recent months the PCT has improved its performance both in absolute terms, and relative to other PCTs in the region and nationally. However, performance remains significantly below target that will impact on the PCT’s 2007/08 performance rating.

The Actions moving into 2008/09 A PCT action plan was approved by the Senior Management Team. This included additional LES payments in 2007/08, a new LES in 2008/09 and various forms of improved communication.

In addition, the roll-out of Directly Bookable Services (DBS) within our provider organisations will increase the advantage to referrers of using Choose and Book and hence should further improve performance.

DBS roll-out at Calderdale & Huddersfield Foundation Trust has been delayed because of a national software problem, and is expected to pick up in Performance Report

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August 2008. Mid Yorkshire Hospital Trust currently has four services live on DBS and have a programme to roll-out a further 22 services by the end of November 2008.

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Improving Health of the Population/Reducing Health Inequalities 7.

Improving Health/Reducing Health Inequalities: Obesity Director Lead: Judith Hooper and Lead Manager: Tim Fielding Kirklees Obesity Programme Obesity (having a Body Mass Index of 30 or above) is a serious health issue which causes 6% of all deaths per year, reduces length of life by an average 9 years and increases the risk of heart disease, diabetes and some cancers.

In Kirklees, around 1 in 5 of all adults is obese and around 1 in 3 of all adults is overweight, so more than half of all adults are overweight or obese. Levels of adult obesity in Kirklees are probably above the national average, and levels have been increasing steadily for several years and are expected to continue increasing. Adult obesity is an issue across the whole district with no significant differences across Wards.

Children who are overweight and obese are also more likely to be obese as children and as adults. In Kirklees, around 1 in 10 children in Reception Year and 1 in 6 in year 6 are obese. Levels of child obesity in Kirklees are increasing steadily are expected to continue increasing.

The Obesity Programme focuses on halting the increase in the number of adults and children in Kirklees who are obese from a baseline of 18% adults with a BMI of 30 or more for adults in 2007 (based on Tracker Survey 2007) and a baseline of 9.4% Reception year and 16.4% Year 6 (NCHD 2006). This programme includes those who are already overweight and gaining weight or are obese, and focuses on helping them to lose weight including via medical interventions where appropriate.

The primary prevention aspects of obesity are addressed through the physical activity, food and emotional well-being programmes and strong links will be built between these and the Obesity Programme. It does not include preventing people from becoming overweight nor does it deal with the consequences of obesity, eg. muscular-skeletal pain or diabetes.

Issues Lack of capacity continues to have an impact on programme delivery. Low levels of recording of height and weight in GP practices, though improved, means it is highly likely that Local Delivery Plan targets will not be achieved Consequences and associated risks National target not achieved and will impact on the PCT’s 2007/08 performance rating.

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The Actions moving into 2008/09

Development and implementation of the Obesity Programme Plan.

Service redesign and implementation taking place from April 2008.

Key services are already in place through the Young PALS and MEND programmes, both of which are specifically designed for young people and incorporate the elements of physical activity, food and emotional well-being. MEND works on a family basis.

To support request for a repeat of the Tracker Survey and to ensure a consistent BMI measurement is included in future surveys, to enable performance monitoring of the impact of the programme on population prevalence of obesity.

Explore the feasibility of incorporating obesity recording and referral within a Choosing Health Locally Enhanced Service.

We review the ALDP /Healthcare commission performance indicator regarding BMI data from GP practices in the context of adult obesity prevalence data and also the local enhanced service (LES) from Q4 2007/08.

Continue moving towards commissioning services through the social marketing demonstration with 16-24 year olds in further and higher education.

Pilot the ODS (Organisational Development Service) Model with obesity services.

Develop links with wider partners regarding the obesigenic environment in line with Healthy Weight/Healthy Lives Strategy, eg. planners, transport and highways.

Ensure obesity programme incorporates healthy weight/healthy lives and Darzi review recommendation.

Undertake further local analysis of national child measurement programme data.

.

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8.

Improving Health/Reducing Health Inequalities: Smoking Cessation Director Lead: Judith Hooper and Lead Manager: Rachel Spencer

4 Week Smoking Quitters

3000

2500

2000

1500

1000

500

0

Actual Profile

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

218 227

434 454

791 678

1183 938

1401 1165

1579 1392

1663 1201

2010 1810

2331 2000

2449 2300

2583 2579

2880 2857

The PCT achieved the 2007/08 year-end milestone. In October 2007 our intermediate advisor provision increased to include pharmacies and patients seen from November 2007, that improved capacity and ensured better patient choice.

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9.

Improving Health/Reducing Health Inequalities: Sexual Health – Reduce Teenage Conception Rates Director Lead: Judith Hooper and Lead Manager: Rachel Spencer Key Achievements 2007/08 There were 10 factors identified in the “Deep Dive” Reviews that characterised the successful areas in England where teenage conception rates have reduced significantly. The Kirklees Strategy is working towards ensuring that all these factors, around prevention, are in place, to affect change.

In one area – Communication – we have initiated a Media and Communication sub-group as a joint venture between Teenage Pregnancy and Sexual Health. Effective communication is seen as central to a partnership working, access to services and informed choice. A joint strategy can tailor information to the needs of young people, parents and communities, ensuring that it is culturally sensitive as well as accurate and timely. The subgroup is in the process of developing Terms of Reference, a Media & Communication Strategy and a supporting plan of action.

The annual conception data for 2006 was released by the Office of National Statistics (ONS) on 29th February 2008. The under 18 conception rate in Kirklees has increased from 43.4% in 2005 to 43.9% in 2006. The increase is not significant, albeit, that it is heading in the wrong direction. Overall, Kirklees has achieved a reduction in its 2006 under 18 conception rate of 9.7% (since the baseline year of 1998).

As the overall England rate (2006) has reduced by only 13.3% since the baseline year of 1998, it seems that Kirklees is in line with the majority of other Local authorities in achieving smaller than expected reductions in its under 18 conception rate.

The identified measures for success are in the process of being fully implemented. The TPS takes a targeted approach to working with the most vulnerable groups of young people in areas identified as having a high rate of conception. Activities, health promotion/education schemes and tailored services for young people within Kirklees aim to reduce risky behaviours and to help young people to make healthy choices The Issues: It is unlikely that Kirklees will achieve the Government’s ambitious target to reduce under 18 conception rates by 50% by 2010 (year end 2011/12) in order to achieve a 50% reduction in its conception rate, Kirklees would need to reduce its rate by 10% per year (from 2006 – 2010).

The DfES ‘traffic-light’ ratings which have been re-calculated to compare the local area’s actual progress against the progress expected in 2005 for the local area to meet its 2010 reduction target, have resulted in a shift in rating for Kirklees from ‘amber/green’ to ‘amber/red’

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.

It is likely that the under 18-conception rate will continue to reduce in Kirklees and nationally, but not at a rate which would allow the ambitious 2010 target to be met. The challenge is in bringing partners together to tackle the underlying circumstances and to reduce inequalities and social exclusion.

The Consequences and associated risks National priority/key target not achieved that will impact on the PCT’s 2007/08 performance rating.

The Actions moving into 2008/09 •

• •

• •

•

•

• •

•

Actively engaged all key mainstream delivery partners who have a role in reducing teenage pregnancies – Health, Education, Social Services and Youth Support Services - and the voluntary sector Ensured effective communication, which is central to partnership working, access to services and informed choice Improved contraceptive and sexual health advice services so that they are more accessible and young people-centred, with a strong remit to undertake health promotion work, as well as delivering reactive services; ‘C’ card scheme to be developed Strengthened the delivery of PSHE in schools, with support from the LA to develop comprehensive programmes of R&SHE in all schools Adopted a targeted approach to working with the young people at greatest risk of teenage pregnancy, in particular with Looked After Children Ensured that the workforce involved with young people is trained to be knowledgeable, skilled and confident in R&SH matters; ensure the availability (and consistent take-up) of training (eg. R&SHE) for professionals in partner organisations working with the most vulnerable young people. Training needs to be mandatory for the key mainstream delivery partners Ensured that the Youth Service is well resourced, providing things to do and places to go for young people; ensure that it takes a clear focus on addressing social issues affecting young people, such as sexual health and substance misuse Working towards raising the aspirations of young people Working with parents to help improve the communication between young people and their parents/carers – programme to be developed and implemented Working with Children’s Centres to develop strategies to target teenage parents and their children and support teenage parents

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10.

Improving Health/Reducing Health Inequalities: Sexual Health - 48 hour access to GUM Director Lead: Judith Hooper and Lead Manager: Rachel Spencer Key Achievements 2007/08 The National Support Team (NST) visited Kirklees PCT on 30th October 2007 to conduct a rapid assessment of the GUM clinic at Princess Royal Community Health Centre. Following this visit 5 recommendations were been made, mainly in reference to operational changes that could be made within the clinic.

CHFT developed a detailed action plan on how they would implement these recommendations.

The GUM clinic at MYHT has been visited and the consultant has shared his achievements in how the clinic managed to turn its waiting times from 40% 48 hour access to 100% (offered). This has been shared with CHFT. The Issues Inability to recruit to the GU consultant vacancy. A locum consultant has been recruited and a nurse consultant vacancy has been created.

Additionally, health advisers are being employed to support the less consultant focussed approach to GUM service, The Consequences and associated risks The actual performance against the planned trajectory dropped slightly in September 2007 but has since improved. Under-achievement against this national target will impact on the PCTs 2007/08 Performance Rating.

The Actions moving into 2008/09 •

The service specification for the PCT provider services was reviewed at a contracting meeting on the 5th December 2007, this would enable CaSH to provide tier 2 sexual health services and potentially divert activity away from GUM.

•

More frequent meetings instigated with CHFT to review the action plan to ensure achievement.

•

A business case has recently provisionally been approved for the University Practice to provide Tier 2 STI services.

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% of patients offered an appointment to be seen at a GUM clinic within 48 hours

100%

90%

80%

70%

60%

50% Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Actual

64.4%

61.5%

57.2%

55.8%

67.6%

64.3%

65.3%

72.3%

93.9%

96.9%

96.9%

100.0%

Profile

74.9%

77.1%

79.4%

81.6%

83.9%

86.1%

88.3%

90.5%

92.8%

95.1%

97.3%

100.0%

% of patients offered an appointment within 48 hours by clinic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Apr-07 Princess Royal

May-07

Jun-07

Jul-07

Aug-07 Sep-07

Oct-07

Nov-07 Dec-07

Jan-08

92.27% 54.97% 39.70% 23.61% 42.40% 37.25% 39.49% 49.08% 89.10% 94.60%

Feb-08 Mar-08 100%

100% 100% 100% 100% Chadwick Clinic 41.15% 68.49% 78.57% 91.84% 96.38% 99.67% 100% 74.90% 77.10% 79.40% 81.60% 83.90% 86.10% 88.30% 90.50% 92.80% 95.10% 97.30% Profile

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May 2008

100% 100% 100%

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% of patients seen within 48 hours at a GUM clinic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Actual Profile

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

59.1% 68.1%

58.3% 70.5%

49.3% 73.1%

46.3% 75.5%

61.0% 77.8%

56.1% 80.3%

56.5% 82.8%

60.4% 85.2%

79.0% 87.7%

84.9% 90.1%

86.3% 92.5%

83.8% 94.9%

% of patients seen at a GUM clinic within 48 hours by clinic

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Profile Princess Royal Chadwick Clinic

NB.

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

68.1% 81.6% 39.6%

70.5% 52.3% 65.6%

73.1% 36.9% 63.4%

75.5% 21.5% 74.0%

77.8% 40.9% 83.2%

80.3% 33.1% 84.5%

82.8% 33.2% 88.1%

85.2% 36.9% 68.5%

87.7% 67.7% 90.5%

90.1% 85.5% 90.5%

92.5% 85.5% 90.5%

94.9% 85.5% 90.5%

January, February and March data by clinic is non-validated for the % of patients seen at a GUM clinic within 48 hours by clinic.

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11.

Improving Health/Reducing Health Inequalities: Sexual Health – Chlamydia Screening Director Lead: Judith Hooper and Lead Manager: Rachel Spencer

The cumulative number of 15-24 year olds screened or tested for chlamydia 3000

2500

2000

1500

1000

500

0

2007/08 Q1

2007/08 Q2

2007/08 Q3

Actual

175

595

598

Profile

1060

1590

2650

2007/08 Q4 2650

The Issues There are 2 Chlamydia Screening Programmes that serve the Kirklees PCT population, one is a Huddersfield & Calderdale service and is hosted by Kirklees PCT and the second is a Wakefield & North Kirklees programme hosted by Wakefield District PCT. The ‘actual’ screenings are significantly below planned trajectories. Several reasons, i.e. more screening sites needed, the low number of GP practices that participate in the screening programme in the North Kirklees locality and the large number of GP practices that participate in the Programme in the South Kirklees locality not carrying out sufficient screening.

However, it has been highlighted that a significant number of Chlamydia screens were being requested through GPs but these requests were not being recorded through the Programme as the specific form was not being completed. This was supported by an audit performed in the labs. The GPs felt that it was time consuming to complete another form, particularly when a lot of the screens were part of a triple swab. As a result the Commissioner has worked with the lab in CHfT to make sure that all pathology forms contain a proviso that any Chlamydia screen within the required age group would be passed to the Chlamydia screening office. This process will begin in April 2008. The screening programme that covers North Kirklees is currently taking up this issue with MYHT.

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The Consequences and associated risks The trajectories set for Q1, Q2 & Q3 have not been met. Q4 actual data not published at the time of reporting. Q4 target is 15%. The national screening targets for 2007/08 have not been achieved and will impact on the PCT’s 2007/08 Performance Rating.

The Actions moving into 2008/09

There were three GP practices in North Kirklees that just started screening for figures to be included in September 2007 figures.

A meeting took place at the college in Dewsbury to see if they are interested in screening.

Local employers who employ larger numbers of young people were contacted to see if any are interested.

Dewsbury Rugby Club approached to publicise the service.

A marketing campaign ran from January to March ’08 with an increase seen in screening as a result, however, this has not been significant so a ‘social marketing’ approach is being explored to help reduce the stigma associated with young people accessing screening.

Screening has commenced in TOP services which is producing significant numbers of screens for the service.

Screening in antenatal services is also being explored.

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12.

Improving Health/Reducing Health Inequalities: Infant Mortality Director Lead: Judith Hooper and Lead Manager: Rachel Spencer Smoking During Pregnancy

Percentage of Women Smoking During Pregnancy

20

15

10

5

0 Jun-07

Sep-07

Dec-07

Mar-08

Actual

17.2

14.3

15.2

15.4

Profile

9.2

9.3

8.3

7.0

The PCT had very challenging trajectories for 2007/08, which is the lowest across Yorkshire and Humber. The other PCTs trajectories range from 12.0% to 32.1%.

In terms of actual performance the range across the SHA area is from 9.9% to 29.4%, with Kirklees PCT performing slightly better than the SHA average of 17.7%.

A local trajectory for 2007/08 had been developed which looked at smoking at delivery by locality. Using the 06/07 data as a baseline the target is to reduce the percentage smoking by 1% over the course of 07/08 in those localities that are at or under the SHA figure of 18% and to reduce those localities that are over this figure to 18%. This data excludes south Asian women.

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12.1

Improving Health/Reducing Health Inequalities: Breastfeeding Director Lead: Judith Hooper and Lead Manager: Julie Tolhurst Kirklees PCT Breastfeeding Policy

Breastfeeding Initiation Rates

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jun-07

Sep-07

Dec-07

Mar-08

Actual

64.2%

66.8%

69.9%

70.5%

Profile

61.6%

63.0%

58.2%

64.5%

Breastfeeding represents the first vital step towards healthy nutrition for the child, adolescent and adult (WHO,1998). Research from Public Health Collaborating Centre on Maternal and Child Nutrition demonstrates that breastfeeding has a major role to play in public health, promoting health in both short and long term for baby and mother and that breastfeeding plays a key role in addressing health inequalities in the UK. (Dyson, 2006) Kirklees PCT Breastfeeding Policy was approved June 07. The aim of the policy is to enable health care staff that has contact with breastfeeding women to provide sufficient information / support to enable women to breastfeed exclusively for six months, and then as part of their infant's diet ideally into the second year. (Department of Health, 2003) Key Achievements 2007/08 • • • • •

Kirklees Breastfeeding initiation rates 2007-8 have increased by nearly 10% since 2006-7.

Improved breastfeeding initiation and continuity data recording by maternity and community staff.

PCT Breastfeeding Policy approved and disseminated to staff.

Parent’s policy guide produced and disseminated to health centres.

Breastfeeding Champion training for Health Visitors completed.

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• • •

Breast pumps disseminated to team leaders for supporting breastfeeding mothers.

Service Level Agreements agreed for breastfeeding centres of excellence (Huddersfield & Batley).

Breastfeeding Awareness week 2007 supported with range of activities and promotion to women/families.

Next Steps 2008/09 i. ii. iii. iv.

PCT working towards Baby Friendly Accreditation for standardised process for quality breastfeeding service including audit, training and promotion.

Continual improvement of breastfeeding data recording.

Expand provision of breastfeeding centres of excellence across Kirklees.

Audit implementation of PCT Breastfeeding Policy.

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13.

Improving Health/Reducing Health Inequalities: Diabetes Director Lead: Judith Hooper and Lead Manager: James Williams Diabetic Retinopathy Screening Programme Diabetic eye disease is the primary cause of blindness in the working-age population. This is due to a complication of diabetes that affects the blood vessels of the retina – a condition called retinopathy. Retinopathy can be effectively treated if detected at an early stage through retinal screening, and blindness can be prevented in 90% of those at risk with appropriate treatment.

The screening programme aims to reduce blindness due to diabetic retinopathy. It does this by identifying all eligible persons with known diabetes. These diabetics are invited to attend for an annual eye screen.

Appropriate follow up and treatment is provided for all those found to be affected by diabetic retinopathy. The number of patients on the Kirklees PCT diabetes register as at 31st March 2008 stands at 16,879.

During 2007/08 the Kirklees PCT completed a European Tender process that resulted in the awarding of a 3 year contract to1st Retinal Screen Ltd. This contract will ensure that a person centred, systematic diabetic retinopathy screening service will be provided to the population of South Kirklees.

Working collaboratively with the Yorkshire and Humber Strategic Health Authority, the PCT has procured a new diabetic retinopathy software management system. This procurement will mean greater standardisation of diabetic screening software systems across the PCTs in Yorkshire and the Humber.

The PCT is currently reviewing the existing screening programme that caters for the diabetic population of North Kirklees. This review is part of an overall strategic assessment of diabetes services within Kirklees.

The PCT has initiated a needs assessment and pilot programme in one area of Kirklees (Huddersfield North). The aim of this programme is to identify how best to support hard to reach diabetics and ethnic minorities in localities where the prevalence of diabetes is high. This outcome of this needs assessment will used to improve the way in the PCTs supports diabetic patients in similar localities within Kirklees.

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Long-Term Conditions 14.

Long Term Conditions Director Lead: Sheila Dilks Lead Manager: Monica Plested 14.1

Community Matrons and Case Managers The Issues The number of whole time equivalent (wte) Community Matrons remains below target. The number of wte community matrons now stands at 12.13, but, does not genuinely reflect the number of Very High Intensive Users (VHIUs) to be case managed, as several staff is out of case load for 0.4 or 0.2 of their working week. A total of 12 days ie. 2.4 wte is used on education for the community matron role that does not include routine yearly training.

The number of case managers is now 2 wte due to another member of staff leaving, however, a further 5 case managers are in the process of being recruited.

The Consequences and associated risks The PCT has not met its 2007/08 plan figure (25) for numbers of community matrons being in post and this will impact on the PCT’s 2007/08 performance rating.

The Actions moving into 2008/09 One wte was recruited from the November 2007 recruitment drive.

The general standard of applicants was poor. Since then, in April 08 recruitment of 2 discharge co-ordinators and a clinical lead on a secondment basis has been made. 2 of these were within the existing team so have only increased by 1 wte.

Another recruitment drive is underway and interviews are taking place as this report is being written. We have had a much better response both in numbers and calibre of applicants, however, it is disappointing and frustrating to see the lack of care taken in completion of application forms. Although specific staff has been recognised as eligible for recruitment, we have been unable to shortlist them due to incomplete information on application forms.

The discussions with the University of Huddersfield have been successfully completed with a new course specifically catering for the needs of the community matron starting in September 2008. It will be 15 month duration instead of 24 months and will be funded to the same level as the nurse practitioner course. There are 9 places being made available to us this September.

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The latest PARR+ figures are demonstrating that significant savings continued to be made (data available upon request).

Number of Community Matrons and Case Managers

25.0

20.0

15.0

10.0

5.0

0.0

14.2

Jun-07

Sep-07

Dec-07

Mar-08

Actual

12.5

13.2

13.4

14.13

Profile

25

25

25

25

Very High Intensity Users (VHIUs)

Number of Very High Intensity Users

2000

1500

1000

500

0

Performance Report

Jun-07

Sep-07

Dec-07

Actual

324

348

434

469

Profile

1740

1820

1910

2031

May 2008

Mar-08

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The Issues The number of Very High Intensity Users target was calculated based on how many Community Matrons and Case Managers there were. The numbers are significantly below target at 469.

The use of Community Matron and Case Managers time to remove unsuitable patients from the PARR+ data.

A need to review the current case loads with regards to appropriate levels of care and input from Case managers and Community Matrons.

The Consequences and associated risks The PCT has not met its 2007/08 target of 2031 VHIUs and this will impact on the PCT’s 2007/08 performance rating.

The Actions moving into 2008/09 Work continues with Community Matrons and Case Managers using the PARR data to identify suitable patients to be case managed.

Clinical staff time is being used to validate this information.

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Patient/User Experience 15.

Patient Choice Lead Director: Carol McKenna and Lead Manager: Rachel Carter The Issues Patient recollection of being offered choice is measured via a bimonthly questionnaire, issued by provider organisations to patients that have gone via Choose and Book, and collated by Mori.

The results of the November questionnaire indicate that Kirklees performance has improved since July with 44% of patients stating that they remember having been offered choice, an increase of 6% since July. The target is 80%.

The Consequences and associated risks There is a significant delay in obtaining data to measure performance against this indicator. Results of the November bi-monthly survey were available in March and reflect the results of some of the actions taken by the PCT October/November 2007. Under performance in this area will impact on the PCT’s performance rating.

The Actions moving into 2008/09 Kirklees introduced an additional LES payment in 2007/08 to incentivise referrers to ensure patients are aware of available choices.

There was a national media campaign during March 2008 that is expected to improve general awareness of choice. It had been anticipated that measurement of this indicator would stop during 2008/09. However, it will now continue, at least in the short-term, to measure the impact of the national media campaign.

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16.

Patient Safety - Infection Control/Hospital Acquired Infections Director Lead: Judith Hooper and Lead Manager: Jane O’Donnell 16.1 MRSA The Issues - MYHT A total of 72 MRSA bacteraemia cases were reported up to and including 31st March 2008, this includes all post 48 hour and pre 48 hour cases. Of the 72 cases reported, 44 were post 48 hour cases and 28 pre 48 hour admission blood cultures. 11 of the pre 48 hour cases were attributed to Kirklees PCT and 17 to Wakefield District PCT. This exceeds the agreed annual LDP trajectory of 35 by 37.

Weekly meetings continue to be held within the health economy with representation from the Department of Health MRSA/HCAI Improvement Team, and the Strategic Health Authority. Activities to improve the current level at MYHT:·

· · ·

An intensive educational programme to all wards and clinical areas.

Directors and Assistant Directors from MYHT with the support from Wakefield and Kirklees PCT have delivered training sessions to 934 staff; with a total of 1398 having attended training (includes cascade training). Junior Doctors were highlighted as low in attendance for training; they are to be targeted at future training events.

Close monitoring of High Impact Interventions audits.

Prudent antibiotic prescribing.

Ongoing learning from the RCA investigations, lessons learnt shared and action plans formulated and monitored.

Detailed action plans have been developed by all organisations which are reviewed at the health economy meetings. The development of a joint health economy action plan is now in a draft format, which includes attitudes, behaviours, competency which links to the RCAs. Governance arrangements, accountability and leadership.

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MRSA Infections - MYHT

14

12

10

8

6

4

2

0

Actual Profile

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

7 3

1 3

5 3

9 3

8 3

6 3

6 3

4 3

7 3

5 3

12 3

3 2

The Issues - CHFT The total year end figure was 32 cases of MRSA bacteraemia reported across the whole health economy of Kirklees (Huddersfield) and Calderdale PCT’s.

Of these 18 were reported to be pre 48 hour admission blood cultures, 8 were attributed to Kirklees and 10 to Calderdale PCT. 14 were recorded as post 48 hour admission positive blood cultures. This exceeds the agreed annual trajectory by 17 cases. To ensure a health economy focus on MRSA bacteraemia all members of the health economy participate in the RCA investigation to identify how and when the infection could have being prevented and ensuring the learning is addressed. An action plan has been produced in response to the Department of Health, MRSA/ HCAI Improvement Team visit on the 15th and 16th November 2007, a task force group has been set up to monitor progress.

5 key messages in the plan:· · · · ·

Hand hygiene.

Cleaning.

Challenging poor practice.

Antibiotic prescribing.

Invasive devices.

As a consequence of not achieving the target, fortnightly meetings are held across the health economy including a representative from the Department of Health MRSA/HCAI Improvement Team to ensure a collaborative health economy approach by strategic planning and the direction of operational delivery.

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MRSA Infections - CHFT

10 9 8 7 6 5 4 3 2 1 0 Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Actual

3

5

3

3

3

3

3

1

3

2

1

2

Profile

1

2

1

1

1

2

1

1

1

2

1

1

16.2

Mar-08

Clostridium Difficile

The Operating Framework for 2007/08 set out the requirement for PCTs to agree local targets with the local acute trusts for Clostridium difficile. The local targets, agreed in line with Department of Health guidance are: CHFT target is 1 case or less per 1,000 bed days MYHT target is 0.8 cases per 1,000 bed days The Issues 2007/08 is the baseline year being used for Clostridium difficile monitoring and there is a requirement to have a 30% reduction by March 2011.

The Actions moving into 2008/09 MYHT achieved the locally agreed target of 507 cases with a final outturn of 328 Clostridium difficile infections in the over 65 years. Weekly Clostridium difficile ward rounds at DDH and Pinderfields ensure the continued vigilance of antibiotic prescribing.

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Clostridium Difficile MYHT 600 500 400 300 200 100 0 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Actual

43

79

102

140

171

192

210

228

247

273

300

328

Profile

43

86

129

171

213

255

297

339

381

423

465

507

CHFT The local target of 204 cases of Clostridium Difficile infections has been achieved with a total for 2007/08 of 199 cases in the 65 years and older. In people 2-64 years old from 1st April 2007 to 31st March 2008 there were 38 cases reported. Therefore the total number of all cases reported was 237.

Clostridium Difficile CHfT 250

200

150

100

50

0

16.3

Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08

Actual

14

30

52

65

85

94

119

140

158

171

183

199

Profile

17

34

51

68

85

102

119

136

153

170

187

204

Kirklees PCT

The deep clean at Holme Valley Memorial Hospital (HVMH) has been completed following remedial works. There were 4 cases of Clostridium difficile infections reported at HVMH in 2007/08.

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The Infection Control Team continues to progress the focus on the areas identified from the Root Cause Analysis investigations.

A Provider Services Infection Prevention and Control action plan has been developed and agreed. The action plan will be monitored by Kirklees Infection Control Committee.

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17.

Patient and Public Involvement Director Lead: Helena Corder and Lead Manager: Jill Dufton An Assistant Director of Communications was appointed in February 2008 and will be responsible for developing a new overarching communications and involvement strategy.

The Picker Institute who the PCT commissioned to carry out the 2007/08 annual patient survey has sent the survey data to the Healthcare Commission and Picker will produce a Final Report for the PCT in May 2008.

Additionally the Patient and Public Involvement (PPI) team are currently involved in the Quality Outcome Framework (QOF) assessments around GP patient surveys as well as being involved in urgent care engagement and consultation work and Slaithwaite and Liversage procurement consultation process.

QOF has now finished and the PPI team are working with the contracts team to improve the process for next year.

The PPI and Communications Teams have worked closely with colleagues in commissioning and other health care organisations across West Yorkshire on providing urgent care services and this work will continue when an agreement has been reached on the service specification.

Slaithwaite and Liversage Procurement Consultation process has now come to an end. Doctors Shamsee and Ward have been successful in their application for Slaithwaite and Doctors Ghafoor and Khan for Liversedge, both with effect from 1st April 2008.

We are working closer than ever with our partners at Kirklees Metropolitan Council (KMC). Together we are looking at ways in which we can actively work in partnership and have the opportunity to be able to share experiences and values and gain the views of the public.

One of the ways in which we are looking at doing this is by bringing together KPCT and KMC Readers Panels as we believe there is a vast amount of experience, knowledge and skills within the membership of both panels. By bringing them together we feel it will enrich the expertise that both panels already have.

The PPI team will be organising some internal and external road shows later this year to promote the PPI team and the PALS service. Posters will be distributed with dates and venues later this year.

Equality & Diversity In all these areas of work the area of greatest risk and concern is equality and diversity. The Board has already raised this at a previous meeting and agreed to additional resources in the short term to move forward on this agenda, particularly equality impact assessments and monitoring issues. An Equity and Diversity Officer will be recruited during early 2008/09.

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Clinical Priority Programmes 18.

Cancer Director Lead: Carol McKenna and Lead Manager: Janet Cawtheray

Kirklees PCT : 62/31/14 Day Target 100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

62 Day

100%

93%

96.0%

94.0%

97.0%

96.0%

100%

98.0%

91.0%

94.0%

94.0%

91.5%

31 Day

100%

100%

100%

99%

99.0%

100%

100%

99.0%

99.0%

99.0%

99.0%

14 Day

100%

100%

100%

100%

100%

100%

100%

100.0%

100.0% 100.0% 100.0%

98.4% 99.7%

Key Achievements 2007/08 Leeds Teaching Hospital Trust have put additional outpatients sessions on and increased capacity.

The Issues The above graph shows a fully validated Kirklees PCT summary position for the year, up to and including February 2008. March data is not available at the time of reporting. Monthly reports will only be included by exception.

Half the breaches are at both Mid Yorkshire Hospital Trust and Calderdale & Huddersfield Foundation Trust relate to Leeds Teaching Hospital Trust (LTHT). Even though LTHT have put on additional outpatient sessions and increased clinical capacity, we are still expecting breaches due to the backlog of work. Despite the additional capacity LTHT are still forecasting breaches in February and March due to backlog of activity. The Cancer Network and the Strategic Health Authority are aware.

14 Day Target Performance has been consistently maintained at 100%.

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31 Day Target Overall 2007/08 position is 100% achievement, although there have been a couple of months where this has slipped to 99% (still above national target of 98%) due to capacity issues at Mid Yorkshire NHS Trust and Leeds Hospitals NHS Trust.

62 Day Target The target for 62 days is 95% and performance this year exceeded the national target in the first 4 months of the year (up to August 2007), however, there has been a slight underperformance between August ’07 and February ‘08 when it slipped to 91%. The majority of the 62 day breaches are when patients have been referred locally to a specialist cancer centre either at Leeds or Bradford. These are in the main the complex pathways where diagnosis is not straightforward.

There has been a lot of operational disruption for LTHT with the transfer of services from Cookridge Hospital to St James’ Hospital in December 2007 and January 2008.

The PCT continues to work collaboratively with the main cancer centres to ensure the excellent performance is maintained.

The Consequences and associated risks The under performance of the 62 day target is a risk as we will be monitored against this for the whole year.

Failure to achieve one of these targets is unlikely to affect the performance rating for 2007/08 on its own, but must be considered alongside performance of all existing targets performance. Underperformance will impact on the PCT’s 2007/08 performance ratings.

The Actions moving into 2008/09 • • •

Further work taking place working with acute trusts to get more timely information particularly on breaches.

Work is also ongoing with Referrers to ensure fast track deadlines are met.

Acute Trusts have in place pathway co-ordinators who track patients through from referral to treatment. There is a particular focus on ensuring patients move through the pathway seamlessly and timely, with potential breaches and breaches being dealt with. Where these occur the learning is taken and actions taken to reduce the risk of such instances re-occurring.

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19.

Cancer – Breast Screening Director Lead: Judith Hooper and Lead Manager: Jini D’Cruz The Issues The latest report for the NHS Breast Screening Programme for the North East, Yorkshire and the Humber Region covers the quarterly periods from September 2006 to March 2008. The Pennine Unit is the breast screening service provider for most of West Yorkshire’s PCTs, excluding Leeds and Wakefield, and covering a total population of 137,500. For the Pennine Unit, the report shows a continuing decline to meet the national round length target of 90% eligible women aged 50-64 years, being invited for screening within 36 months of their previous screen. However this figure had reached 91% at 38 months for the January to March 2008 period.

Coverage measures the proportion of eligible women who received a screen in the previous 3 years; the national target for this is 70% which has been easily achieved for the Kirklees population showing that the Pennine Breast Screening Service has been effective in this field.

The drop in performance to meet the round length target of 90% in 36 months was due to the introduction of 2 views of each breast instead of one, and the increase in the age range of women screened from 50-64 years to 50-70 years. Coupled with an increasing number of older people in this age range over the next 3-4 years, pressure on the service will continue. More recent pressures on the service have been caused by attrition of staff due to sick leave and maternity leave, and a shortage of qualified radiographers to carry out the screening. This has been addressed through the recruitment of additional staff.

Changes to direct entry technology, QARC ceasing to provide medical physics support to the service and the need to replace a variety of equipment will impact on the service.

The new Cancer Reform Strategy (Nov. 2007) requires the extension of the age range for screening from 47 – 73 years, for the Pennine Unit this will mean a 21% increase in the age cohort between 2005 to 2010, causing further pressures to the service.

The Consequences and associated risks National target not achieved will impact on the PCT’s performance rating for 2007/08.

The Actions moving into 2008/09 •

Regular meetings between Kirklees PCT, the Lead Commissioner and Pennine Breast Screening Service, have been re-established.

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•

•

A paper is being drawn up to summarise the options available to reduce round length to the desired 36 months in the short term and to plan for the extended targets in the long term, which will enable Commissioners to balance the need to reach the 36 month target with the financial implications.

An update report on the breast-screening programme is due to go to the May meeting of the Board.

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20.

Cancer - Bowel Screening Director Lead: Carol McKenna and Lead Manager: Janet Cawtheray National evidence suggests that implementation of a National Bowel Cancer Screening Programme should reduce cancer mortality by around 15% in those people screened and should contribute to the delivery of the PSA target for all cancers that will achieve a reduction in mortality by 2010.

By December 2009 implementation of local screening programmes should have commenced. Calderdale, Kirklees & Wakefield Health Communities have agreed to be a local screening centre.

A bid was put in to join the National Phase II implementation but this was unsuccessful. We are waiting for the timetable for Phase III implementation to reapply. This is likely to be in early 2008/09.

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21.

Substance Misuse Director Lead: Carol McKenna and Lead Manager: Tony Cooke The Issues Challenging stretch targets in 2007/08 were met and the outcome of the Healthcare Commission Improvement Review of substance misuse commissioning was 4* excellent. We increased both the numbers in treatment and the quality of the services provided in 2007/08. The manner in which performance is assessed has changed in 2008/09 but we are confident of continued advances. Our new 3 year Commissioning Strategy outlines our approach to further improving quality via full implementation of clinical guidance and the evidence base whilst also refocusing on access into, and out of services.

The Consequences and associated risks We are planning on delivering further stretch targets and to do this are reviewing services to ensure: • • • • •

There are more and clearer pathways into services Pathways out of services and successful discharge is prioritised Housing, employment and aftercare services are enhanced Primary care and community based interventions are in place to reduce demand on specialist services Clinical capacity is enhanced and clinical governance structures are strengthened

A consequence of more people in treatment being retained for longer is improved general health, reducing wider health costs, though in the short term there is an impact via increased prescribing costs for users requiring substitute medication.

The Actions moving into 2008/09 The Drugs & Alcohol Action Team (DAAT) has committed to expanding shared care and increasing the role of primary care provision in general by reinvesting resources currently spent on specialist Tier 3 and 4 interventions.

Improved pathways will continue to deliver more people into services and performance management of providers and dedicated action plans will improve both the number and quality of exits from the treatment system. In addition, the Treatment Outcomes Profile will be completed on each individual. This outcome monitoring system will better enable us to tailor treatment to individual need, making it more effective.

We are also undertaking a review of prescribing practice to ensure that clinicians are implementing new NICE guidance on prescribing. We are also reviewing offender management systems to ensure drug using offenders receive effective treatment via the Drug Intervention Programme and Drug Rehabilitation Requirements.

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% of drug misuers who were retained in treatment for 12 weeks or more

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

21.1

Mar-07

Jun-07

Sep-07

Dec-07

Actual

75.7%

78.4%

79%

80%

Mar-08 81%

Profile

73.0%

77%

78%

79%

80%

Alcohol Misuse The Issues Treatment provision is effective but limited and the DAAT and PCT have committed to expand this in 2007/08. There is a need for significant expansion of provision to meet need, both via primary care (early intervention) and criminal justice (after arrest/conviction) settings. Substance misuse remains one area of the health system that has large numbers of the potential treatment population outside services, both for drugs and alcohol, and the costs to Kirklees are high. Initial estimates of the annual costs to Kirklees of alcohol misuse are £132m based on extrapolation from the national costs of £20bn (DoH 2007).

There are increases in drinking levels among the under 25s as evidenced by the CLIK survey, and this had long-term implications for obesity, life expectancy, CHD, etc.

The network of services recommended by Models of Care for Alcohol Misuse (this is similar to a National Service Framework) are not in place in Kirklees but commissioners are working towards developing clear interventions and care pathways. Treatment service provision currently only touches a very small percentage of problem drinkers, and there remains a need for additional workers focussed on primary care, counselling and to develop ‘alcohol treatment requirements’ for offenders. These have been commissioned but are not yet in place.

The Consequences and associated risks The risk for the PCT is the inadequate levels of provision that will impact on other services. The Joint Strategic Needs Assessment and Regional Public

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Health Observatory data show escalating levels of alcohol misuse across most parts of Kirklees and for both adults and young people. If left unchecked these will contribute to levels of CHD and stroke, liver disease, cancer, etc.

Alcohol is also a major contribute to domestic violence, crime and accidents requiring A & E attendance.

The Actions moving into 2008/09 Kirklees Partnership’s Alcohol Strategy was officially launched on Wednesday 7th November 2007 and is led in partnership between Kirklees DAAT (Drugs & Alcohol Action Team) and Public Health, with involvement from all key partners such as Local Authority, Police, Fire, Voluntary Sector, Service Users, Licensing Industry, etc. The event was well attended and attendees made extensive contributions as to how the strategy and the actions from it need to develop.

The launch of the strategy is just the start of the work to reduce alcohol related harms. The purpose of the strategy is to bring a whole host of related initiatives in Kirklees into a common framework and increase mutual understanding between services to improve outcomes There is a lot of very good provision, some of which has been funded via the recent award of Neighbourhood Renewal resources. All schools will receive improved support and an education and prevention scheme is incorporated into the Personal, Social Health and Citizenship curriculum.

The Licensing strategy is effective and there is a good understanding about the need to properly manage the nighttime economy. Likewise there are some very good community safety initiatives such as alcohol control zones, Best Bar None schemes and Taxi Marshals, though these are often funded from short-term money, A series of training events (practice protected time) have been held. There are already a number of initiatives in development across Kirklees, for example within the PCT we are developing a training programme to enable workers to identify people with alcohol problems and to deliver alcohol focussed brief interventions In early 2008, the PCT mainstreamed 3 Neighbourhood Renewal funded posts (2 x treatment workers and 1 x health improvement practitioner) and found additional resources for an alcohol detox nurse.

Next Steps I. Implementation of a locally enhanced service and shared care model in primary care II. An alcohol Health Improvement Team (HIT) is being created that will include a clinical lead and input from social services. This will act as a reference group for alcohol treatment issues and feed into the wider alcohol strategy group.

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III. DAAT and Probation are investigating the possibility of developing an ‘alcohol treatment referral’ scheme for people offending as a result of their alcohol misuse.

IV. Dependent upon addition resources being secured, tender a fully integrated alcohol service that is able to offer interventions at all stages of need from brief interventions in primary care through to structured treatment.

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22.

Mental Health Director Lead: Carol McKenna and Lead Manager: Vicky Dutchburn The National Service Framework (NSF) for Mental Health (1999) together with the national suicide prevention Strategy (2002) provide the key policy context within which this report considers the mental health of adults of working age.

The Older People’s National Service Framework provides the key policy context in relation to older people’s mental health.

Choosing Health (2004) identified mental health as one of six overarching public health priorities and this has recently been reinforced in the health Challenge England – next steps for choosing health (2006).

The Government’s consultation preceding the publication of ‘Our health, Our Care, Our Say’ (2006), found that there was huge demand for more support for emotional well being. Making It Possible (2005) identified positive steps that every one can take to improve their health and wellbeing.

At the same time, the social exclusion unit report on mental health and social exclusion (2004) and the more recent Reaching Out: An Action Plan on Social Exclusion (2006) have focused on programmes of social inclusion Frequency and type of performance reports to be produced:•

Bi-annual updates against the local mental health commissioning strategy action plan.

•

Annual updates against the mental health NSF indicators; (which includes finance mapping, approx 40 service/workforce indicators which are set annually and a themed service review again set annually), and the learning disability health check; (which includes approx 25 service/workforce indicators).

Priority Service Areas:22.1

Assertive Outreach Services

The Issues The number of people receiving assertive outreach services is currently being under achieved.

The SHA have advised that there will be no change to the definition or agreed counting against this target until Crisis Resolution Service targets have been fully addressed.

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The Consequences and associated risks The PCT has been reassured by the SHA that there is no pressure to achieve this target. Clarity on definitional guidance has been sought from the SHA and they are in discussion with National Leads.

The Actions moving into 2008/09 A national review has been undertaken and feedback is awaited.

A future development that will help improve performance is the dual diagnosis service that will align to the assertive outreach team and will be included in the counting where in line with national guidance.

People Receiving Assertive Outreach Services

175

150

125

100

75

50

25

0

22.2

Jun-07

Sep-07

Dec-07

Mar-08

Actual

106

107

105

104

Profile

170

170

170

170

Early Intervention Services

The Issues Service operational from December 2007.

The Consequences and associated risks No service available for access by local resident population with identified need. National target not achieved and potential impact on PCT’s 2007/08 Performance Ratings.

The Actions moving into 2008/09 The PCT has now commissioned phase 1 of an Early Intervention Psychosis Service. South West Yorkshire Mental Health Trust (SWYMHT) is the

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identified provider, they have recruited staff for the service and they begin in post from the end of November.

SWYMHT have confirmed that this phase of the service will be fully operational and will deliver against a revised local trajectory of 32 clients by the year-end, (16 by end of quarter 3 and a further 16 by end of quarter 4), in comparison to the LDP trajectory of 64). The trajectory for future years will be increased to 20 new cases per quarter to ensure the PCT delivers its national requirements of 192 by end of financial year 2009/10. The SHA is aware of this plan and the Trust Board has previously agreed to see reporting against local profiles.

People Receiving Early Intervention in Psychosis Services

70

60

50

40

30

20

10

0 Jun-07

Sep-07

Dec-07

0

0

16

37

LDP Profile

16

32

48

64

Local Profile

0

0

16

32

Actual

22.3

Mar-08

Crisis Resolution Services

The Issues The number of people receiving a service through Crisis Resolution Team is currently being under-achieved. Clarity on definitional guidance has been sought from the SHA and they are in discussion with National Leads.

A number of issues have been raised relating to the crisis activity targets, many of which had been reported by other mental health providers and commissioners.

The Consequences and associated risks The SHA have advised that there will be no change to the definition or agreed counting against this target until feedback from the regional and national reviews has been received.

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The Actions moving into 2008/09 A national review has been undertaken to review crisis activity. NIMHE have been tasked to undertake the regional review looking at crisis activity in Yorkshire & The Humber. SWYMHT representatives met with NIMHE on 31st August 2007, to review how crisis services are delivered and feedback still awaited.

People Receiving Crisis Resolution Services 900 800 700 600 500 400 300 200 100 0 Jun-07

Sep-07

Dec-07

Mar-08

Actual

147

239

500

506

Profile

213

425

638

850

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23.

Learning Difficulties Director Lead: Carol McKenna and Lead Manager: Vicky Dutchburn Background Valuing People: A New Strategy for Learning Disability for the 21st Century (2001) sets out new opportunities for people with a learning disability, their families and carers. It is underpinned by four key principles: •

•

• •

Legal and civil rights – People with learning disabilities have the right to a decent education, to grow up to vote, to marry and have a family, to express opinions, with help and support where necessary.

Independence – The starting presumption should be independence, rather than dependence, with public services providing the support needed to maximise this.

Choice – People with learning disabilities want a real say in where they live, what work they should do and who looks after them.

Inclusion – Enabling people with learning disabilities to do those ordinary things make use of mainstream services and are fully included in local communities.

The report aims to inform the implementation of national, regional and local priorities. The choice of indicators, has in part, been guided by key issues, recommendations and targets identified in a range of policies including the national service framework(1999) and Choosing Health (2004).

The report has provided us with an opportunity to bring together a number of indicators that will be collated from different programmes over the year and will provide quarterly performance updates on the PCTs key performance (LDPr) indicators, Our main providers key performance indicators, NICE Compliance and Serious untoward incidents.

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24.

Children Director Lead: Carol McKenna and Lead Manager: Lynne Hall-Bentley Background The National Service Framework (NSF) for Children, Young People and Maternity services is a ten year plan that is expected to be delivered by 2014.

The NSF standards are split into 11 key areas. The delivery of the standards outlined within the NSF is key to the delivery of the Every Child Matters agenda. Standards 6 and 7 focus on the delivery of care in hospital for sick children.

The National service frameworks focus across all five outcomes and are not only to do with health services. Within each standard there are key targets rationale for there achievement and good practice guidance from areas that have been beacon sites, or awarded good practice or are early adopters sites for example in midwifery.

Previously the Strategic Health Authority has led four networks relating to the delivery of the 11 standards 1.

2.

3.

4.

the well child the ill child child and adolescent mental health maternity services

This programme is beginning to re-emerge as the re-focusing of agendas following merger occurs. There is emerging pressure relating to the performance management of the delivery of the NSF targets.

At recent national events health commissioners have been shown the medium term targets being attached to the delivery of NSF and these are particularly challenging for areas such as child and adolescent mental health services which have found it difficult to achieve the first three proxy targets.

Progress to date Standard 1 – promoting health and well being, identifying needs and intervening early focuses on the delivery of the child health promotion programme.

The PCT is on target to deliver the child health promotion programme across all seven localities. Currently commencing the process of commissioning.

Key areas of activity Health visiting service specification Parenting support strategy and associated commissioning The delivery of an agreed service specification for Health Visitors is currently out to consultation. A key component is the integration of service delivery across children centres general practice and health visiting. Each locality is Performance Report

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also looking at their locality priorities and actions to achieve improved health outcomes in a number of areas reflected in the joint strategic needs assessment this will ensure that core service delivery meets the national recommendations whilst promoting the focus on each of the seven localities specific health needs The Risks Integrated service delivery will take time to achieve and deliver and will be dependent upon the infra structure and population needs of locality Links to other work streams

Locality working and the integration of children’s services plus links to joint commissioning in the future.

Standard 2 – supporting parenting Progress to date There is progress being made with the delivery of a parenting strategy across Kirklees with business cases being developed to ensure implementation Key gaps are information for parents and carers and the early intervention of evidence based care for children with learning disabilities and /or difficulties and challenging behaviours. The business case for learning difficulties and disabilities is in the process of being implemented and will see integrated seamless services for children with LD The Risks Co-ordination and clarity of support and where it is available and how to access needs to be further clarified and commissioned in a coordinated way.

Links to other work streams

Parenting strategy Universal needs assessment Maternity matters programme Infant mortality

Standard 3-child young person and family centred services Progress to date Further progress is required with regards to all staff working with children skilled in common core of skills, knowledge and competencies.

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The Risks Need to evidence a process delivering partnership provision to deliver coordinated care. Transition agenda Links to other work streams

Workforce development plan Localities agendas Children’s trust arrangements Joint commissioning

Standard 4 – growing up into adulthood Progress to date There are significant gaps within this standard that require meeting prior to 2014, to deliver high quality transition processes for children growing into adulthood The Risks Services address targets for the reduction of alcohol, teenage pregnancy substance misuse, sexually transmitted infections and suicide.

Young people in special circumstances receive targeted or specialist services which are easily accessible and meet there needs – there are significant gaps within health provision as well as others.

Transition processes are planned in partnership and focus n the needs of young people and are inclusive and meet with young people’s wishes and needs.

All services for young people contribute towards assisting young people to take on increasing responsibility for there own lives.

Services support parents to support there child through transition.

Respecting and involving young people in their care.

Links to other work streams

Emotional health and well-being partnership group Joint commissioning Clinical networks with the acute hospital service providers.

CAMHS Service Improvement Group Learning Disabilities Care Pathway Group Adhd pathway development.

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Standard 5 – safeguarding and promoting the welfare of children and young people Progress to date Performance on target The Risks Work in progress to commission and implement for the process required following a child’s death.

Links to other work streams

Integrated processes in place via safeguarding board All services and work streams should incorporate elements of this standard

Standard 6 - children and young people who are ill Progress to date Key progress required in some areas namely the development of children’s community nursing services across Kirklees. The delivery of the long terms conditions agenda for children particularly diabetes and respiratory care.

The supported self care agenda for children young people and families.

Links to other work streams

Specialist assessment agenda Safeguarding Delivery of health care commission action plans The development of clinical care network across Yorkshire and the Humber region The reconfiguration of hospital services.

Standard 7 – children and young people in hospital This standard applies to every service and department that delivers care to children’s within a hospital setting Progress to date There are areas of work in place and being developed to monitor evidence against this standard The Risks Areas for improvement include the public health agenda relating to the improvement of health and the reduction of inequalities. Children, young people and families offered choices in care including location and treatment Performance Report

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and for children this choice could be about when to take medication and what form that’s in. Integration and coordination of services, this is a key area within the Darzi work streams for children focusing on improving health care in primary care Links to other work streams

CAF Safeguarding Delivery of health care commission action plans The development of clinical care network across Yorkshire and the Humber region The reconfiguration of hospital services.

Standard 8 – disabled children and young people and those with complex health needs Progress to date Within this standard there is evidence of good practice within the children with a disability team. There needs to be further work to integrate health and education and social services and third sector to ensure families gain a coordinated service from the point of referral through identification to care delivery. The every disabled child matters agenda will require focus on a needs assessment and commissioning and delivery of joined up services a key element being families only have to tell there stories once. A key gap is the need for a children and young disabled people strategy and partnership group that can take this work forward. In addition a review is being undertaken across additional needs which need to be incorporated .

A work programme has been set up to look at palliative care provision across Kirklees based upon a needs assessment which has been undertaken regionally Work has begun on looking at Personalised Care and Individualised budgets.

The Risks • • • • • • • • • • •

Lack of Multi – agency strategy within local network i.e. children’ partnership boards Accessible play and leisure supported by health as identified within the strategy.

Camhs provision to children with a disability.

Access to Housing, Equipment and Assistive Technology Early identification Integrated diagnosis and intervention plan Supporting parents/strengthening families Co-ordination of healthcare The Expert Patient Programme Palliative care Transition into adulthood

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•

Planning and commissioning services

Standard 9 - the mental health and psychological well-being of children and young people Progress to date A stock take was undertaken which identified the following areas The main issues identified where 1.

2.

3.

4.

5.

6.

7.

8.

9.

waiting times provision of on call services. inconsistencies between Dewsbury and Huddersfield Services lack of an agreed strategy performance data against a minimum data set pathway development involvement of users and carers workforce profile for region and local use. tier 4 provision.

An Action Plan has been identified to deliver targets against this standard with the formation of an emotional health and well-being partnership group which will focus on three areas:1. the development and consultation through to agreement of a joint strategy for emotional; health and well-being across Kirklees the strategy is in at the draft consultation phase 2. The delivery of a modernised service which has clear referral criteria and a significant reduction in waiting times. This element will incorporate workforce and detailed pathways Waiting times appear to have come down but reassurance required that this is sustainable – regular performance data still not being received.

3. The prevention arm will provide a prevention strategy that will connect to Kirklees prevention strategy and deliver improved outcomes for children and young people once implemented.

The Risks Waiting times are coming down but remain an issue. Inequity of provision across Kirklees is still a major concern but we have a plan in place. CHFT have put in place a CAMHS clinical directorate and we are working together to commission services against an agreed specification with a reliable activity base.

Links to other work streams

Regional and national CAMHS agenda Regional commissioning Joint commissioning Locality agenda

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Service improvement groups

Standard 10 - Managed via the medicines management route within the Kirklees health economy.

Standard 11 - maternity services.

Progress to date Programme plan in place with three key areas of work 1. clinical pathways of maternity care 2. wider involvement of children centres and others with pregnant women 3. data flows and information to manage decision Significant work required within the commissioning of services to move forward to pro-actively commissioned services across Kirklees Work is ongoing with regards to the proposed models of delivery for example the delivery of locality midwifery services integrated into the children’s centres and general practice The Risks Capacity is an issue within the commissioning agenda Links to other work streams

Infant mortality Reconfiguration of hospital services Children’s centre agenda Practice based commissioning Improved health and well-being of mothers

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25.

Older People Lead Director: Carol McKenna and Lead Manager: Lesley Delaney Vision for Older People in Kirklees ‘The Vision for Older People’ sets the key areas of importance for older people living in Kirklees, which was the product of a 3 month consultant period, and is used as a tool for shaping the delivery of older peoples’ services across Kirklees, in partnership with health and social care agencies.

The following themed areas of importance have been identified: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Citizenship and involvement A place to live Money Getting around Leisure and social activities Learning Keeping safe Health and well being Support in daily life Carers Information and access to services Culture

The strategic aim is to improve and maintain the quality of life of Kirklees older citizens by promoting partnerships to deliver healthy living activities, sustain peoples’ independence and to promote positive views of ageing.

The Vision is underpinned by important principles about the way in which we should respond to the needs of older people. We believe we should: -

listen to older people enable older people to make informed choices and exercise choice and control over lives Give older people time to make important decisions at difficult times and provide them with the best possible information to do so Involve older people in decisions about their lives Support older people in negotiating the maze Involve and support carers Respect the dignity and privacy of older people Recognise individual differences Provide integrated services

The vision has clear linkages with the priorities set out in the Local Area Agreement and the National Service Framework for Older People (DH 2001), and the second part of the NSF, along with a vast array of national policies and strategies focusing on improving services across health and social care for older people.

Lead officers have been identified to provide progress reports to the Older Peoples Partnership Board and the Local Public Service Board for Adults and Performance Report

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Healthier Communities. It is recognised that a wide range of organisations and services are delivered already and seeks to build upon these partnerships to facilitate collaborative working.

Health and Well Being Lead officers – Lesley Delaney (Strategic Development Manager, Kirklees PCT) and Julie Allen (Older Peoples Partnership Commissioning Manager, Joint PCT and KMC) The UK population is gradually becoming older. In Kirklees, by 2015 there is predicted to be an additional 14,746 people over 65, and by 2025 an additional 30,000 people over 65 (POPPI.org.uk).

Objectives:

Access to health and well being opportunities which are close to home, responsive, flexible, with no professional/organisational boundaries.

People should be supported to manage their own ill health wherever possible and should be fully involved in all decisions about their care.

Services should be delivered by a trained and skilled workforce, reflecting cultural diversity and ethnicity.

Services should focus on keeping well as opposed to treatment of ill health.

People approaching retirement age should, if they desire, have access to an assessment that helps them plan for good health in their retirement. All older people should receive a regular assessment of their health if required.

Timely access to hospital treatment when this is in their best interests and should be supported to leave hospital as quickly as possible when better and more appropriate care could be provided at home or elsewhere.

People should be able to access and benefit from a wide range of palliative care schemes which promote and enhance dignity in end of life care.

People should be encouraged to exercise personal responsibility for pursuing healthy lifestyles with appropriate access to advice and information.

Kirklees PCT perspective The PCT has been involved in the inception of ‘The Older Peoples Vision’ with its partners and with setting up and delivery of the work of the Older Peoples Partnership Board. In March 2007, the appointment of the Older Peoples Partnership Commissioning Manager (joint post with KMC) was appointed, and more recently, Sept 2007, the identification of a Strategic Development Manager for Older People within Commissioning Directorate.

In January 2008, the Older People Health Improvement Team will be established that will oversee the implementation of some of the key areas of delivery across Health and Social Care in Kirklees. This group will report to Performance Report

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the Kirklees Executive commissioning group and the Older Peoples Partnership Board, along with providing updates to the PCT Board.

Key areas of development are: -

Intermediate care – reviewing existing services and to commission services that are equitable and fit for purpose Stroke services – to implement across Kirklees the standards set out in the National Stroke Strategy (DH Dec 07) Falls – to finalise the Falls Strategy for Kirklees and to implement it across health and social care Older Peoples Mental Health – March 2008 Joint Commissioning Strategy for Mental health – the first document to include the way forward for mental health services from 18+.

The Older Peoples’ agenda is vast with many other overlapping agendas such as Long Term Conditions, End of Life care, Carers, etc, and current structures and ways of working assist to ensure the linkages and development of services in a coordinated way.

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26.

CHD Director Lead: Carol McKenna and Lead Manager: Sara Fletcher Coronary Heart Disease (CHD) Cardiovascular disease – heart disease, stroke and related conditions – account for about two thirds of all premature deaths in England. Since the launch of the coronary heart disease National Service Framework in March 2000 much progress has been made across Kirklees to develop services which are more effective, modern and timely.

As well as the CHD NSF, NICE guidance and the JBS 2, guidance for the Primary Prevention of CVD have continued to drive service change. An additional chapter of the CHD NSF has also been launched (Chapter 8) concerning arrhythmias, AF and premature death.

Recently a National Stroke Strategy has been launched which will drive service change further into the future ensuring prompt treatment, diagnosis and long term care of stroke patients and their families.

Key achievements •

• • • •

Primary Angioplasty across Kirklees is up and running which means better prognosis for patients who are having a heart attack. As a result very few patients are requiring Thrombolysis.

Primary Prevention Nurse Led service is reviewing patients at High risk of developing CVD (North Kirklees only) Rapid access chest pain clinics have been operational for some time and see patients well within the two-week target.

Heart Failure Nursing service will be operational in the New Year.

GPwSI service in Huddersfield has been commission by the Three Valleys PBC consortium to see patients with arrhythmias and/or palpitations.

The Issues • • •

•

• •

Delivering Chapter 8 of the CHD NSF Delivering the Heart Failure agenda and meeting the health care commission’s service review standards.

Redesigning cardiac rehabilitation services to reflect our changing population and include all cardiology patients who have been shown to benefit from rehabilitation.

Meeting LDP targets, which require our GP, practices to have validated primary prevention of CVD registers. Currently the majority of GP practices in North Kirklees have registers and very few of the practices in South have registers.

Implementing the National Stroke Strategy across Kirklees.

Working closely with PBC colleagues to support their commissioning plans around CVD and ensure that the PCT takes a collaborative and innovative approach.

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• • •

Redesigning the primary prevention of CVD nursing service to meet the needs of all the population of Kirklees.

Performance managing the delivery of CVD NICE guidance.

Meeting the 18-week targets for CVD patients.

The Consequences and associated risks (short-term) Not delivering the LDP targets for the number of GP Practices who have a Primary Prevention of CVD by March 2008 and the potential impact on the PCT’s 2007/08 performance rating.

The Actions moving into 2008/09 • • • •

Establishing a Kirklees PCT Cardiology Health Improvement Team (HIT) to commission new services and drive service change.

Implement the PCT Action Plans for Heart Failure.

Commission and implement the 18-week CVD pathways.

Develop Service Specifications for Cardiac Rehabilitation and Primary Prevention of CVD.

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Cross-Cutting Strategies 27.

Finance Lead Director: Bryan Machin and Lead Manager: Julie Lawreniuk The PCT has a number of statutory financial duties/targets that are shown in the table below along with the forecast performance for 2007/08 as at 31st March 2008. A separate up-date will be provided to the Board.

Kirklees Primary Care Trust Financial Performance Summary March

Year End Forecast - Financial Duties

Revenue Allocation Capital allocation Provider Allocation 531

Performance Report

Plan ÂŁm

Forecast Actual ÂŁm

Forecast Target Achieved

530

536

yes

2

1

yes

27

27

yes

531

525

yes

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28.

Corporate Governance Director Lead: Helena Corder and Lead Manager: This section of the Report covers overall governance and the review of the PCT’s committee structure and includes information governance and risk management.

The PCT has now been operating for just over a year and has been developing continuously over this period of time. The PCT has reviewed its systems and processes for governance for example the development of the Provider Board and arrangements to put at arms length the PCT provider unit.

Risk Management - the PCT has in place the Board Assurance Framework which is now operational within the Performance Accelerator system and risk tabs will be attached to all action plans within the system to support the overall PCT risk register. The PCT is currently preparing for assessment to meet the NHS Litigation Authority assessment to meet the level 1 standard for PCT’s has put action plans in place to meet level 2 requirements that will enable automatic compliance with a number of the Healthcare Commission core standards.

Information Governance – the PCT has carried out a base line assessment against the requirements of the information governance toolkit and has developed an action plan to address the agreed key issues. Previously Kirklees PCT scored 65% providing an amber rating and we are striving to achieve green this year.

Equality and Diversity Refer to PPI Section

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29.

Practice Based Commissioning Lead Director: Carol McKenna and Lead Manager: Jan Giles Key Achievements 2007/08 The development of Practice Based Commissioning (PBC) during 2007/08 has seen the establishment of the North Kirklees Commissioning Consortium and the Dewsbury Commissioning Consortium and the continuation of the Huddersfield Commissioning Consortium and Three Valleys Consortium as well as twelve stand-alone practices. This has resulted in all practices (except one) participating in PBC. The support provided by the PCT to PBC has been enhanced with each consortium and stand-alone practice now having designated commissioning, finance, performance and information and medicines management personnel working with them.

Twenty four business cases have been approved during the year, resulting in service development through PBC in a range of service areas, including diabetes, heart failure, diagnostic services, care for people with long-term conditions and minor surgery The local incentive scheme for PBC has been well received by practices and has attracted high level of participation and recognition at SHA level, with several PCTs adopting a similar model.

The Ipsos MORI survey of General Practices, about the implementation of PBC, has now been undertaken each quarter over the past nine months. This shows that the Kirklees position compares favourably with the national position in the following areas: • • • • • •

The practice has been given an indicative budget by the PCT The indicative budget has made a difference to the way in which the practice operates ( Confidence that the commissioning plan will free up resources % of practices saying that the PCT has provided a financial incentive scheme for PBC in 2007/08 % rating managerial support provided by PCT for PBC as good Format of information provided for PBC by the PCT classified as good

The PCT was presented with the runner up award for Practice Based Commissioning by the NHS Alliance at the NHS Alliance annual conference in November 2007. The focus of this award was the creation of partnerships between the PCT and Practice Based Commissioners.

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The Issues The Ipsos MORI survey demonstrated concerns in the following areas:• •

% age of practices agreeing that the PCT has a robust process for submitting business cases Quality of information provided for PBC by the PCT classified as good

The development of the HIT teams has lead to some concern among practice based commissioners about how to engage successfully as partners with the broad range of agendas that they cover.

The Consequences and associated risks The successful continued development of PBC requires a robust process for business cases that enables appropriate business cases to be agreed and implemented within a short timescale The provision of information that practices have confidence in is a key element of support that the PCT is expected to provide to practices The ability of Practice Based Commissioners to participate in agreeing the strategic direction for the HITs is key to sustaining a high level of interest in PBC from practices.

The Actions moving into 2008/09 The business case process has been reviewed and a new process has been agreed which will bring together PBC, HIT and corporate business cases.

This will commence in June 2008. The accreditation of business cases is being taken forward by the Patient and Professions Directorate to ensure these tie in with the timescales for the approval of business cases.

Data quality continues to be a high priority. A data queries process has been established to enable practices to feed in their concerns. Issues raised through this process are examined in detail. A users group for practices to contribute to the development of the GP reporting system has been set up.

Work continues to enable the engagement of Practice Based Commissioners on the work of the HITs through the Commissioning Forum. This has included incorporating participation in HITs into the management (clinical engagement) allowance for PBC.

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30.

Workforce Director Lead: Sue Ellis and Lead Manager: Laura Campbell The NHS must demonstrate that it is making the most effective use it can of public money to delivery quality healthcare. A significant proportion of NHS funding is spent on staffing, and an effective workforce is key to ensuring our ambition in both commissioning and providing services.

15 high-level indicators of efficiency that identify potential areas for improvement have been produced by the NHS Institute for Innovation and Improvement. These indicators are not targets. There is no specified level, which trusts must achieve on each indicator. Their purpose is to enable managers and clinicians to identify areas where productivity or efficiency might be improved in their organisation in four key areas: finance, clinical productivity, workforce and prescribing or procurement.

These indicators can be used locally to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care and to generate ideas on how to achieve these savings.

Arising from these high-level indicators are the key three measures counted nationally relating to workforce:

Reducing staff turnover Reducing sickness absence Reducing agency costs

Further indicators are currently under development. Such HR data is routinely collated for Kirklees PCT, as an employer, on a quarterly basis and reported to the PCT Governance Committee and HR Shared Services Governance Board. Monitoring information regarding sickness absence and turnover is also routinely provided to managers and there is an ongoing schedule of development programmes for managers and supervisors in handling HR issues. The development of the new Kirklees Workforce Scorecard for 2008/2009 will help to ensure that workforce performance issues continue to be monitored and improved on an ongoing basis.

Work to develop a workforce planning framework for Kirklees PCT is welladvanced. The framework, which should enable the PCT to meet its workforce planning requirements under the 2008/2009 Operating Framework, is due to be considered by the PCT Board in May 2008. Links have been made with partner organisations to ensure constructive workforce planning networks are developed externally as well as internally.

Further, the HR and OD Shared Service provide a range of support in organisational development, training, and workforce planning and ensuring we meet statutory requirements and regulation in our employment of staff.

The performance indicators under development will be improved in the next financial year by the introduction of the electronic staff record (ESR). The project to introduce the arrangements for all PCT staff continues on track.

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The latest milestone was a readiness assessment submission on 26 October 2007, which has now been approved. Local solution testing and introductory arrangements will produce an intensive period of work during December 2007, up to 1 April 2008.

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31.

Clinical Governance Director Lead: Sheila Dilks and Lead Manager: Sue Smith Context There exists an extensive and enduring policy context for quality and clinical governance spanning several years. More recently the Department of Health has articulated a vision of world class commissioning that seeks to directly impact on the health and well-being of the population by driving unprecedented improvements in quality and safety. The Darzi report in 2007 similarly aspires to a world class service for all.

In their 2006/2007 report the Healthcare Commission (HC) recognised that significant improvements have been made in health services but that there is more to do for services to be world class.

The creation of a new regulatory body the Care Quality Commission (CQC) will provide independent scrutiny of the decisions made by primary care trusts as to what service they purchase on behalf of their communities.

In the meantime health care organisations continue to be assessed against the Standards for Better Health as part of the quality component of the Annual Health Check (AHC).

Local Achievements The last year has witnessed significant progress in quality improvements and clinical governance all within the contest of major organisational change in the PCT. A more detailed annual report on quality and clinical governance will follow which aims to capture the extent of achievements and the challenges ahead. In the meantime the following highlights just a few of these achievements: Developing a Quality Framework We have been working with colleagues to develop and embed quality indicators within the contracts and commissioning processes. Fundamental to this is the expectation that: • • • • •

Local quality indicators will align with national standards and targets to provide a performance matrix All services commissioned will meet and exceed these quality indicators, standards and targets Clinical engagement will be a high priority We will make better use of existing data and align this work with the PCT’s performance reporting systems.

Care pathways will be utilised to take evidence of best practice and quality indicators into practice. This will also facilitate parent and staff engagement.

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A schedule of quality indicators is now available that focus in the first instance on:• • •

Access Clinical care Patient experience

Fit for Purpose Clinical Governance Structures, Systems and Processes The organisation had inherited a wealth of quality and clinical governance experience and expertise from predecessor organisations. Many systems and process have been harmonised and significant progress has been made to embed them in everyday practice. Further work is needed to ensure they meet the changing needs of the PCT and ensure continuous quality improvement remains a high priority and is at the heart of everything we do.

During the last 3 months the Clinical Governance Team has been working with colleagues to develop proposals for clinical governance arrangements in Provider Services.

Alongside this clinical governance structures, systems and processes are being reviewed to ensure the organisation continues to meet its statutory responsibilities for quality and clinical governance. At the same time this review will ensure that clinical governance systems, processes and development plans are explicitly aligned with national and local strategic priorities.

Proposals for quality and clinical governance developments, including a revised strategy for 2008 – 2010, will be presented by the PCT and Provider Boards in the New Year.

Standards for Better Health We have been preparing for our May 2008 declaration of compliance against the core standards. The declaration, once submitted, will be published on the Healthcare Commission website, together with all other Trusts declarations of compliance.

A time limited project group has been established to steer this activity and to ensure an integrated approach is taken when considering all elements of the quality components of the AHC. A report detailing our position against each element with any necessary action plans was presented to the Governance Committee and Trust Board in January 2008.

Clinical Governance Team Developments To ensure we remain responsive to the evolving needs of the organisation, be effective and provide added value we are: • Carrying out a programme of team development to strengthen our capacity and capability Performance Report

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•

•

Developing a communication marketing strategy to profile and market the ethos, approach, functions of quality and clinical governance and of the team Working with colleagues to ensure we take an independent approach to quality and governance and make best use of skills and resources

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32.

Information Management & Technology (IM&T) Director Lead: Peter Flynn and Lead Manager: Ian Wightman IM&T: The national programme for IT (NPfIT) in the NHS is a key strategic programme to provide the essential information infrastructure to help realise the Government’s vision first set out in the NHS Plan, of a health service focussed on the needs and wishes of patients and their carers.

Its aim is to support the NHS to deliver better, safer care to patients, via new computer systems, services and infrastructure that, in primary care, link GPs and community services to hospitals.

It aims to improve patient care by enabling clinicians and other NHS staff to increase their efficiency and effectiveness by giving them access to patient information safely, securely and easily.

A key element of the programme is creating a NHS Care Records Service to improve the sharing of patients' records across the NHS with their consent.

All healthcare organisations use effective and integrated information technology and information systems which support and enhance the quality and safety of patient care, choice and service planning and commissioning.

1.

IT Infrastructure and Hardware To ensure that IT equipment is appropriate, in place and meets the PCT and dependant partners IT requirements for:a. Provider Services b. GP Practices c. Corporate Services

Actions required are; .

Objective Actions to date Establish A complete and Electronic collection dynamic Asset register and dynamic trawl of

by March 2008 all networked IT assets has been completed across all Areas ; provider, corporate services and GP practices.

Establish an effective replacement and repair solutions process by March 2008 Performance Report

Evaluation of current system completed In process now in operation Procurement process May 2008

Further Actions Proactive programme of replacement and/or upgrade commencing 2008 through to 2012 (4 year rolling programme)

Status

Procurement process needs evaluation 2008/09

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discussion with supplies completed and new system agreed Electronic collection and dynamic trawl of all networked IT assets identifies all non-NPfIT compliant IT kit

Ensure IT kit is of NPfIT specification or functioning at the required level.

Ensure IT infrastructure and back office functions are appropriate for PCT functions/requirements

2.

Management of the HIS relationship.

Merger of Staff IT accounts completed.

Infrastructure upgrades agreed incorporating increased network band width and archiving and storage function.

Reactive replacement of non functioning IT kit occurring and proactive replacement upgrade underway of functioning kit which is non NPfIT compliant.

On going work continuing to ensure solutions appropriate through out 2008/09 particular actions 1. increased network band width to practices 2. Replacement of N3 links 3. corporate data repository

Clinical Applications a. Provider Services b. GP Practices Actions required are;

Objective Establish Deployment of CfH LSP TPP System 1 to provider services in PCT.

Performance Report

Actions to date All community (except supporting families deployed by July 2008

May 2008

Further Actions Child Health (Huddersfield) delayed due to procurement issues – actions in place to reallocate Go live date (between July-Aug 08) Supporting Families in South September 2008 Additional services CaSH SEPT 2008 expected

Status

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Support and maintenance of non-LSP clinical systems Implementation of GPSoC scheme (GP Clinical systems meeting national IT requirements).

3.

Walk in centre Clinical application in place

All practices signed up to GPSoC Contracts signed by practices to join GPSoC scheme completed.

Community Dental services deployment of new clinical application from April 08.

PCT – Practice contracts to be signed

by End of April 2008

Benefits Realisation

Objective Establish Use IT as an enabler to support the realisation of benefits to the Organisation,

Actions to date Financial benefits; PCT savings on existing maintenance contracts (Epex3) and GPSoC systems across the PCT.

Further Actions Support Provider planning

Status

Benefits report to be established for the NPFiT products deployed from 2006/07

Safer systems; better security of the system and data by hosting the server in Category 1 secure building: Application meets the NPfIT vision and aims Full audit trail of IT system IT system is now supporting the collection and collation of 18weeks wait data Web-based information resource developed for Practice Based Commissioners Use IT as an enabler to support the realisation of benefits for patients; clinical safety, patient Performance Report

appropriate patient and clinical data to be shared between clinicians across community and primary care settings (60% of May 2008

The ability to utilise remote booking and internet appointments Work closely with the SHA benefits realisation Page 86 of 91

choice and confidentiality

clinicians to date) Paper light clinical recording reduces the need for storing physical records Use of National clinical templates validated by expert clinical reference groups

team fully and provider service improvement team to realise benefits Joint approach planned between SHA / acute Trust (Mid Yorks) and PCT to pilot Econsultation for diabetes services

Pilots to evaluate the appropriate use of new technology to support new ways of working in provider services IT kit in place to support patient choice.

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33.

Prescribing Director Lead and Lead Manager: Neill MacDonald Medicines Management & Prescribing The Medicines Management team have consistently delivered improvements in both the cost effective use of resources and improvements in the quality of medicines management and prescribing across the PCT during 2007/08.

Key Achievements 2007/8:Cost effective use of resources •

•

•

Overall under-spend on primary care prescribing budget of £1.5m (equates to £340,000 when PBC rules are applied) based on February data.

Cost efficiencies for key medicines management work streams in practices have released at least £750,000 of resources on a recurrent basis.

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

Quality of prescribing •

• •

•

•

•

Performance Report

There has been significant work with practices across the PCT to improve the quality of prescribing. Much of this work is linked to the GP Contract and the “Quality & Outcomes Framework” (QOF).

Three key areas of prescribing to action have been agreed with 95% of practices. These actions include clinical audits, medication review programmes, cost efficiency programmes.

Over 9,000 patient medication reviewed and adjusted by medicines management team members.

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.

Development and implementation of clinical guidelines, including antimicrobial formulary. Wound management formulary and guidelines, lipid management.

Full engagement with PBC consortia, with prescribing and medicines management being a key feature of PBC plans for 2008/09.

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

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Access to Medicines: •

•

•

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 prescription.

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

A new community Pharmacy based Smoking Cessation advice/ support service commenced January 2008, that assists smokers to access Nicotine replacement therapy and provides support to enable them to quit more easily. This has provided an improved access to these services outside normal surgery hours and without the need to obtain a prescription from a GP. 5 new pharmacies opened during 2007/08, providing services for at least 100 hours each week have opened across the PCT, bringing the total to 9 pharmacies opening for at least 100 hours each week (total pharmacy numbers across Kirklees = 88). Patients now have access to an extended network of local pharmacies that provide NHS pharmaceutical services, many of which are open from 7.30am until 11pm Monday to Saturday and at least 6 hours on Sundays. This is the highest level of access to NHS pharmacies ever achieved.

Patient safety improvements •

• •

•

6 National Patient Safety Agency alerts have been received and have been implemented locally via the medicines management team in collaboration with local acute trusts to improve patient safety in respect to medicines. All but two have been fully implemented, with actions ongoing with the remaining two.

Revised policies for ‘cold chain’ and ‘non medical prescribing’.

Completed monitoring visits for all community pharmacies across the PCT, with action plans being agreed to improve standards where necessary.

The medicines management team have conducted inspection and monitoring visits in respect to the safe and secure handling of medicines for 10 PCT clinics.

Education & training •

•

Performance Report

Training and education has been provided in a number of areas, including: Immunisation & Vaccination, Legalities and how to use Patient Group Directions, Cytotoxic drug therapy, Repeat dispensing, Electronic transfer of prescriptions, Interpretation of prescribing information for practices.

Provision of training plenary sessions for PBC consortia on medicines management issues and to PCT staff on patient Group Directives, Cold Chain and immunisation and vaccination.

May 2008

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Communication •

•

•

Regular publication (2 monthly) of the Medicines Management Newsletter, which contains information on cost saving initiatives, topical clinical issues, guidance on drug choices, drug / patient safety issues plus much more. This is widely circulated.

Antibiotic awareness campaign – this is run in January 2008, with the main aim in improving awareness in respect to conditions that do not require antibiotics, and to assist in reducing the levels of drug resistance which results from inappropriate prescribing.

Participation in local disease awareness campaigns (respiratory bus, smoking, ask about medicines week)

Interface issues •

•

Development of a single Area Prescribing Committee across Calderdale, Kirklees and Wakefield PCTs, encompassing Calderdale & Huddersfield Foundation Trust, Mid Yorkshire NHS Trust and South West Yorkshire NHS Trust. Main work focus is on Shared Care, and clinical guidelines to improve the consistency of care across the health community, and in particular across the interfaces.

Introduction of a local Controlled Drugs Local Intelligence Network to ensure that 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 across South West Yorkshire.

Pressure areas 2007/8 Prescribing cost growth in a number of areas is significantly above average in a number of areas, these are currently under review, and include:

Dressings Drugs for Chronic Pain Feed products Continence / stoma appliances

Key work areas for 2008/9 • • • • • • Performance Report

Reduction in medicine waste –medicines waste locally estimated at between £6 million and £12 million annually. £470,000 potential cost efficiencies identified for 2008/9 Better Care Better Value prescribing indicators Healthcare Commission prescribing indicators (Benzodiazepines & antibiotics) Alternative routes for dressings purchase – to reduce waste and improve cost efficiency Instigate medication review programme by Practice Pharmacists May 2008

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• • •

Performance Report

Develop Long Term conditions medicines management support to patients and other healthcare professionals.

Medicines Management training and education – patients, Health & social care workers.

Identify QOF areas for 2008/9 for agreement with practices

May 2008

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