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Annual Report
2011
12
Annual Report 2011 12
Welcome
NHS Kirklees
Contents Welcome
4
The changing face of the NHS
8
Our priorities
12
Working in partnership
14
Improving services, improving health
18
Quality counts
26
Engagement with our patients and public
30
Valuing our sta
34
Lean and green
40
Planning for an emergency
42
Equality and diversity
44
Finance
46
Statement
65
Declarations of interest
66
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Annual Report 2011 12
Welcome
Welcome to our annual report for 2011/12 from Angela Monaghan, Chair and Mike Potts, Chief Executive This has been a momentous year for the NHS nationally, and no less for us here in Kirklees. Just as the year ended the Health and Social Care Act 2012 passed into statute, marking the culmination of a process which has already seen huge organisational change.
Business as usual for local people
We have worked hard to ensure that the NHS locally is in good shape to adapt to the requirements of the new Act and, despite the undoubted upheaval of the changes, we are delighted to report that it is still business as usual for local people. If you dip into some of the stories later in
Calderdale, Kirklees and Wakefield District working together
Perhaps the most significant change during the year has been our joining together with NHS Calderdale and NHS Wakefield District, as a cluster of primary care trusts. The cluster is led by one Board, with one Chair and one Chief Executive. Supporting the Board in Kirklees is a Chief Operating Officer, Carol McKenna, who is responsible for the day to day running of the Primary Care Trust (PCT). However, while coming together under one board, the three PCTs have not merged and we each continue as a statutory body in our own right until abolition of the PCTs at the end of March 2013.
We are not alone in making these arrangements: across the country, 152 PCTs have moved into 50 clusters. The benefits have been huge, enabling us to secure resilience during transition, helping us to make efficiency savings and, crucially, allowing us to provide robust support for the emerging clinical commissioning groups as they prepare to take over the commissioning reins in April 2013
Quality, improvement, productivity and prevention (QIPP)
NHS Kirklees, like NHS organisations across the country, faces a huge challenge – the ‘QIPP’ challenge - to work more efficiently and to contribute to the £20bn savings which the NHS has to achieve by 2015. As you read on in this report, you will find out more about some of the ways in which we are making our contribution.
to ensure not only that the local NHS is financially sustainable, but that healthcare itself is transformed. Our aim is to ensure we transform services so that patients can rely on safe, high quality care that delivers outcomes comparable with the best in the country
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More importantly, however, you will see how we are working together across the local health and social care system
this report, you will see that we are continuing to extend access to GP services, we are still committed to helping local people lead healthier lives, and we are actively working to secure the long term future of clinical services both in hospital and in the community.
Welcome
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NHS Kirklees
Community services We also want to mark another major shift that has affected us here in NHS Kirklees. We have always been proud of the staff who provide services out in the community, from district nurses to therapists, and from health visitors to stop smoking experts. Under the previous government’s Transforming Community Services agenda we were required to separate our commissioning activities from our service provision, which meant that these crucial local services moved out of PCT management.
At the beginning of October 2011 we reached the end of this long process, with the launch of Locala Community Partnerships, a social enterprise. Although patients will see no immediate difference from these moves, from a staff point of view this has been a time of significant upheaval. We thank them for their hard work in making the change so smooth, for their continued commitment to providing the best possible care for their patients and we wish them all well for the future.
Our commitment
Angela Monaghan Chair
Mike Potts Chief Executive
So, change and challenge have been the backdrop to all the achievements of the year and it is a tribute to both the commitment of our staff and the constructive support of our partners in the public, private and voluntary sectors that we have continued to see improvements in services and care. We remain determined that local people should have confidence in local health services, and that people who currently have some of the poorest health outlooks in the country, should have a healthier future
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Annual Report 2011 12
Kirklees in proďŹ le
NHS Kirklees
Kirklees in proďŹ le
424,000 registered patients 71 GP practices 60 dental practices 40 opticians 98 pharmacies
acute services provided by: The Mid Yorkshire Hospitals NHS Trust at Dewsbury and District Hospital Calderdale and Huddersfield NHS Foundation Trust in Huddersfield mental health services provided by South West Yorkshire Partnership Foundation Trust community nursing, therapies and other local healthcare provided by Locala Community Partnerships, a social enterprise emergency ambulances and patient transport provided by Yorkshire Ambulance Service
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Kirklees is a mix of urban communities and rural areas. The number of people living here is predicted to rise by 12% by 2030. By the same year it is estimated that one in five people will be aged over 65 years, of whom one in six will be aged over 85 years. Fifty years ago one child in ten could expect to live to 100, now it is one in four Kirklees has an ethnically diverse population including people of Pakistani, Indian, Irish, AfricanCaribbean and black African origin. The South Asian population is increasing, particularly in parts of North Kirklees where one in three of the population is now of South Asian origin.
The changing face of the NHS
Annual Report 2011 12
The changing face of the NHS
The changing face of the NHS
Throughout this report you will read references to different organisations which are coming into being as a result of the reforms embodied in the Health and Social Care Act 2012. These include clinical commissioning groups, the National Commissioning Board, Health and Wellbeing Boards as well as arrangements for the transition of public health responsibilities to local authorities. Here you will find a guide to the key elements of these changes:
Local Involvement Networks (LINks) will be transformed into HealthWatch and will ensure that the views and feedback from patients and carers is an integral part of local commissioning across health and social care.
GP practices have come together into Clinical Commissioning Groups (CCGs) and from April 2013 they will take over the majority of the commissioning responsibilities currently carried out by the PCT. Other health professionals and lay members are included on the Boards of the CCGs
Commissioning Support Units (CSU). These organisations are being set up to provide specialist commissioning support which is available to CCGs if required. The Cluster approach to developing commissioning support has been to work in partnership with our CCGs to understand what they will need and whether they will want to build their own capacity, buy it in or share with other organisations. A key decision has been to develop a CSU across West Yorkshire that will cover our
within NHS Kirklees, we have two clinical commissioning groups, NHS Greater Huddersfield CCG and NHS North Kirklees CCG. Both of our CCGs are leading and implementing the business plan and operating plan for 2012-13, including leading all quality, improvement, productivity and prevention (QIPP) schemes and agreeing their own commissioning intentions each CCG has also been formally established as a sub-committee of the Cluster Board called a Clinical Commissioning Executive (CCE) and has been delegated 100% of the appropriate commissioning budget Strategic Health Authorities (SHAs) will be abolished in March 2013 Primary Care Trusts (PCTs) will be abolished at the end of March 2013 the majority of the PCT’s public health responsibilities will be
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transferred to Kirklees Council. The PCT has been working with the Council and the CCGs to ensure that plans are in place for an effective transition of staff and programmes
Cluster, and the neighbouring Cluster of NHS Airedale, Bradford and Leeds. This will offer support services to CCGs covering a population of 2.3 million. The new year (2012-13) has opened with the appointment of Alison Hughes as interim Managing Director to lead this organisation through the process of authorisation
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The changing face of the NHS
NHS Kirklees
Chris Dowse, Shadow Accountable Officer, NHS North Kirklees Clinical Commissioning Group and Dr David Kelly, Chairman, NHS North Kirklees Clinical Commissioning Group
Dr Steve Ollerton, Chair, NHS Greater Huddersfield Clinical Commissioning Group
Health and Wellbeing Boards will bring together key decision makers to set a clear direction for the commissioning of health care, social care and public health, and to drive the integration of services across communities. CCG representatives are members of these Boards, and each is already working in shadow form, building on existing mature
relationships and developing their joint agenda there will also be a number of new national bodies which will set the direction for local services, including the NHS Commissioning Board, Public Health England and HealthWatch England.
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The changing face of the NHS
Our local Clinical Commissioning Groups (CCGs)
In our area we have two CCGs, NHS Greater Huddersfield CCG and NHS Kirklees CCG, each serving a distinct part of the Kirklees area.
NHS Greater Huddersfield CCG
NHS Greater Huddersfield CCG has 40 member practices, representing 238,000 patients in Huddersfield and the Valleys. The CCG is chaired by Dr Steve Ollerton, a practising GP based in Skelmanthorpe. The CCG has a clear vision: by being informed by their local population and clinicians, it will drive the improvement of healthcare services through leadership, innovation and excellence. Its priorities are to ensure: improved patient outcomes, improved consistency and quality of care improved patient experience
NHS North Kirklees CCG
Enabling the population of North Kirklees to live longer, healthier and happier lives is the vision of NHS North Kirklees Clinical Commissioning Group. Chaired by Dr David Kelly, NHS North Kirklees CCG draws its membership from 31 GP practices - representing 185,000 patients - in the Mirfield, Spen, Batley, Birstall, Birkenshaw and Dewsbury areas. NHS North Kirklees CCG, along with CCGs nationally, has been set a series of priorities to work towards: keeping people safe preventing premature death improving quality of life for people with long term conditions supporting recovery from injury and illness creating a positive patient experience. Within that priority framework, there are some significant challenges. Already, one in three adults living in the area has a long term health condition such as diabetes and asthma. On top of this, by 2030, at least one fifth of the population will be over 65 years of age. Infant death rates are declining locally, but are still too high.
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NHS Kirklees
improved patient safety empowered patients; putting the patient at the centre through better integration with social care, provision of good quality care, improvements in mortality, morbidity, quality of life, staying healthier for longer, listening to patients, focusing on prevention and self care. NHS Greater Huddersfield CCG is passionate about making a difference to the health of the people in the area. It is committed to achieving this through commissioning high quality, accessible services that make a real difference to patients and the population.
NHS North Kirklees CCG believes that tackling obesity and lack of physical activity - especially amongst children – as well as encouraging more people to give up smoking will help to prevent life limiting conditions as patients grow older. This ambition is set against a backdrop of increasingly stretched NHS resources and challenging budget targets.
For 2012/13 both of the Kirklees CCGs are operating in shadow form, increasingly taking on the responsibilities of the PCT by becoming subcommittees of the Board (the Clinical Commissioning Executives or CCEs) with delegated powers to commission services. Also during the year both CCGs will be going through a national process of authorisation to ensure that they are ready to take on full commissioning responsibilities from April 2013. Given the evidence to date we are confident that as the PCT lays down its responsibilities, the CCGs will be in a strong position to promote the healthcare of local people.
Our priorities
Annual Report 2011 12
Our priorities
Our priorities
Our strategic decision-making is driven by both national priorities and by the characteristics and needs of local people. The assessment of local needs is carried out jointly by us and our partners in Kirklees Council. The resulting report – our Joint Strategic Needs Assessment (JSNA) - takes a snapshot look at the health of the population. It uses this information to map trends which show what health
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problems might look like in the future. On this basis we are able to plan future service provision that can best meet the changing needs of the district. If you would like to see the current JSNA for our district, it can be found at:
www.kirklees.nhs.uk
Along with our colleagues we are committed to three overarching strategic goals:
Our priorities
NHS Kirklees
Control
Maintaining quality and safety
Managing the money
Delivering performance
Maintaining resilience
Create
Creating the new commissioning system
Building a new relationship with the public
Prioritising transformational change
Close
Formal closure of the PCT Handing over our legacy
By putting the programmes in place that support these goals, we believe that in the coming year we will deliver measurable differences: ÂŁ9.5m of QIPP initiatives 50% of savings over the next three years being transformational, and a sound basis for further transformation across our health economy
Provider development Celebrating our achievements
authorised Clinical Commissioning Groups (CCGs) successful public health transition safe transfer of functions to the NHS Commissioning Board. You can read more about how we intend to meet our objectives in the NHS Calderdale, Kirklees and Wakefield District Cluster Operating Plan for 2012-15 at:
www.kirklees.nhs.uk/public-information/publications/plans
Delivering quality, improvement, productivity and prevention (QIPP)
We have a strong record of managing within our financial resources, and of meeting our targets for savings that also transform services. Although the PCT itself will not be here after the current year, the imperative for transformational change will remain and will require more than a few months to implement and embed. To ensure that improvements continue into the future, we have worked with our clinical commissioners to agree five transformational QIPP programmes for 2012-15: preventing unplanned admissions and managing long term conditions changing planned care pathways alternative community services
strengthening mental health and learning disability provision Introducing assistive technology and risk stratification. These choices have been made on the basis of local need, understanding of best practice and in response to local people who have told us clearly that they want to see the best outcomes, even where that might mean doing things differently. They want more joined up care and they want to see as much care as possible close to home. As clinicians, partners and patients work together on the service redesign that will bring about these changes, we are confident that the future of local healthcare is in good hands.
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Working in partnership
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Our priorities
Transforming the system
Making a real difference in the long tem, both financially and in improved outcomes, will take new ways of thinking and concerted effort by commissioners, providers and recipients of services alike.
NHS Kirklees
During the year we brought our planning together into two overarching health and social care transformation programmes, one covering Calderdale and Huddersfield and one covering North
Hu dd er sfi el
Calderdale and
In NHS Kirklees we have a stake in both of the major transformation programmes.
D eld efi ak W
istrict and North Kir kle es he al t
NHS Calderdale NHS Wakefield District NHS Kirklees
Our health and social care partnership programme focuses on the big programmes of work which will put the health and social care economy into a stronger position to be financially sustainable, improve performance and also help one of
transformation care ial oc ds an
WakeďŹ eld District and North Kirklees health and social care transformation
A process of engagement has been developed so that provider organisations, and in particular their clinical leadership, are equal partners in designing how changes can be developed. Local authorities have also played a central role in shaping the transformation agenda.
h
d
l care transfo socia rma tio and h n t l a he
Kirklees and Wakefield District.
our local hospital providers, The Mid Yorkshire Hospitals NHS Trust to achieve Foundation Trust status (Dewsbury and District Hospital is part of The Mid Yorkshire Hospitals NHS Trust).
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Working in partnership
The programme covers: Mid Yorkshire NHS Trust’s clinical services strategy - NHS Kirklees , NHS North Kirklees CCG and other relevant stakeholders are all engaged in testing and challenging the Trust’s options for service reconfiguration to ensure that they are clinically effective, financially sound, and will provide the services that patients want urgent care - ensuring that effective, integrated services sit behind the 111 telephone number which is being introduced nationally in 2013 for patients who need healthcare in a hurry care outside hospital - promoting joined up care between community services and the local authority’s services to keep people out of hospital, or to help them to be fit to return home after a stay in hospital improving quality and access to primary care - building on what has already been achieved and helping to
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keep patients with long term conditions out of hospital by identifying their risks and monitoring their condition. maternity, children and young people - aiming to ensure that children, young women and their families achieve the best possible outcomes.
www.kirklees.nhs.uk
Working in partnership
Calderdale and Huddersfield health and social care transformation
There has been a long-standing Transformational Board operating across this geographical footprint bringing together partners from across the local health and social care economy to drive change. Its main area of focus has been delivery of system change in planned and unplanned care. Whilst this work has enabled both commissioners and providers to deliver their financial aspirations, it is recognised that, in order to meet the challenges going forward, we need to again review the current configuration of services. This work started back in 2005, when the health community set out its five year vision. The work to refresh this vision has been agreed with all parties, including NHS Greater Huddersfield CCG, and will be
NHS Kirklees
commissioner-led. The aims of the work are consistent with our aspirations, in that they will: ensure a strategy for the next five years to deliver high quality care in the most appropriate setting ensure care will be delivered in a system which is in the top 10% nationally for safe, reliable, patientcentred care – maximising technology to deliver and support care maximise the advantages of the NHS reforms and respond to demographic changes focus on meeting the needs of people living with long-term conditions create an affordable and sustainable model of service, where local leaders are recognised for their approach to partnerships and integrating care.
The timeline for this work is being agreed at the time of writing, but it is anticipated that public consultation will begin in November 2012, and that, final decisions on any significant change will be taken in Spring 2013.
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Improving services, improving health
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Improving services, improving health
NHS Kirklees
Health care is changing with the focus switching from hospitals to the community. Not many years ago, even the simplest diagnostic tests meant a trip to a hospital clinic. Now, many screening services are offered at your local GP surgery or somewhere much closer to your home.
rushed to hospital as an emergency.
There’s also a greater emphasis on keeping people well and helping them to manage long term conditions such as diabetes, so they don’t need to be
We’ve already laid good foundations during 2011-12, and here are just some of the examples of where we’re improving services and improving health.
We also encourage people to ‘Choose Well’ and help them to understand the options when someone needs to get medical help quickly out of surgery hours – a trip to A&E should be the last resort, not the first.
Seeing a GP – getting better Measuring the quality of your GP services 100% of GP practices within Kirklees are signed up to the new local GP contract, which contains key performance targets to make sure patients receive the highest quality care at their GP surgery. This is fully operational, with practices in Kirklees measured on how easy it is for patients to get appointments, care for patients
with long term conditions and childhood vaccinations/immunisations. And all our GP practices take part in the Quality Outcomes Framework (QOF) which covers a range of clinical and non-clinical topics to make sure that patients with a wide range of conditions are identified and monitored.
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Improving services, improving health
Caring for your eyes
Eyecare goes ‘PEAR’ shaped A new Primary Eyecare Assessment Referral System (PEARS) has been set up in Kirklees, meaning that patients with sudden eye problems can be seen in local opticians rather than having to be referred to hospital clinics. As well as offering a more convenient service for patients, this is preventing waits and providing a fast referral to hospital for those who really need it. The service is committed to achieving the following outcomes:
to treat patients within the primary care setting, where appropriate, reducing the number of A&E attendances, and in some cases, first outpatient attendances to ensure patients are directed to the correct patient pathway with the appropriate urgency of the initial diagnosis, reducing potential consultant to consultant referrals and any delays in treatment (where onward referral is required) to clearly signpost patients to other appropriate services e.g. pharmacists.
to improve access by delivering care closer to home at high street opticians
Taking your medicine
Electronic Prescription Service release 2 (EPSr2) Technology is improving all the time and our pharmacies have embraced a new electronic prescription system which can generate, receive and process prescriptions electronically (EPSr2). This will get rid of the bulk of the paper administration associated with prescribing and dispensing. We have been described as one of the few exemplar PCTs in the introduction of EPS which delivers huge cash saving
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across the NHS. The NHS issues around 1.5 million paper prescriptions every working day in England, rising by around five percent each year. Patients can now choose the most convenient pharmacy to collect their prescriptions from and, as an extra benefit, by seeing patients on a regular basis, pharmacists will have a good understanding of which medicines patients are taking.
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Improving services, improving health
NHS Kirklees
New Medicine Service (NMS) Patients newly diagnosed with long term conditions, such as asthma and Chronic Obstructive Pulmonary Disease (COPD), Type 2 diabetes, and high blood pressure are benefiting from the New Medicine Service (NMS). Through NMS, a pharmacist will help people to get maximum impact from their medicine. The idea came from research which showed that advice from a pharmacist can help to improve the uptake and use of medicines which is a vital part of the patients self care regime. If patients use their medicines wisely they are more likely to manage their condition well and less likely to need emergency hospital support.
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Improving services, improving health
Open wide
Making it easier to see a dentist We have continued to work with local providers across the district to create access to high quality dental care and have put extra money into buying more capacity so it is easier for people to get an appointment or treatment with an NHS dentist.
Living with illness
Patients can now contact their nearest dental surgery to register, or if the practice has reached its full capacity, West Yorkshire Urgent Care Services will help to find another suitable dentist close by.
Better care for Kirklees people with diabetes Patients with diabetes are being looked after by a primary care team which is bringing changes to the way their condition is being managed. Patients can now review their own results before attending their annual care planning review meeting. They can make an appointment to get all the necessary pre-review tests done and receive the results by post a week or so before the review meeting. The annual review meeting gives each patient the chance to share information with their healthcare team about: any issues and concerns, including clinical issues
their experience of living with diabetes access to other services and support. Each patient then agrees the priorities or goals for the next year and the actions that need to be taken with their healthcare professional. ‘The diabetes self care handbook’ has been developed which includes basic information about diabetes, self care options available in Kirklees and care planning. We are now extending the care planning training and supporting resources to include cardiovascular disease.
Putting patients in control of their pain A pioneering health programme which has helped hundreds of people in Kirklees manage their long term health conditions has been extended until August 2012. It initially focused on chronic musculoskeletal pain but because of its success has recently been expanded to cover chronic obstructive pulmonary disease (COPD) and chronic chest problems. Funded by the Health Foundation,
NHS Kirklees, NHS Calderdale and the Calderdale and Huddersfield NHS Foundation Trust were one of only eight sites chosen nationally to take part in the Co-creating Health Programme. It helps people develop the skills, knowledge and confidence to manage their long term conditions with the support of a specially trained team of clinicians and tutors.
The programme does not just help people with long term conditions, but also helps NHS staff improve the support they are able to provide through training.
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Improving services, improving health
NHS Kirklees
Specialist advice to support primary care diabetes teams GP practices using the SystmOne clinical system are now able to gain specialist diabetes advice on-line from the diabetes specialist team at Dewsbury and District Hospital. Rather than referring patients with non-urgent diabetes problems to hospital, practice teams’ patients can be asked if they want to resolve their clinical issue through an e-consultation with the specialist team. This new way of working not only allows patients with diabetes to be managed closer to home, but builds on the strong relationship between primary and secondary care. This enhances the knowledge of the primary care diabetes team and avoids unnecessary referrals.
Early indicators are showing a 75% reduction in referrals. An added bonus is that both teams now use SystmOne to record consultations which greatly improves communication with patients and primary care as well as reducing the risk of prescribing errors. SystmOne also allows secondary care consultants to access GP records. This has reduced duplication and improved the quality of care as well as making clinics more proactive because there is more time to spend with patients promoting self care. The e-consultation service will be extended to support care for other patients with long-term conditions.
Improvements in avoiding infant death The number of babies dying within the first year of their life has reduced in Kirklees. But although the number is falling, it is still higher than the national average. During the year we published a report together with Kirklees Council which showed that effective support services are needed to help people to change the behaviours that might lead to their babies dying unnecessarily. These include improving community engagement work, currently directed through the Auntie Pam’s pregnancy peer support service based in Dewsbury. More women are being helped to access maternity services and are being encouraged to reduce smoking,
drinking and maintain a healthy body weight by eating healthily and doing more physical activity. The report highlights the need to improve genetic awareness among Pakistani communities and in depth training has been provided to relevant health and social care professionals within these communities.
To read the report in full visit www.kirklees.gov.uk/infantmortality
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Improving services, improving health
NHS Kirklees
Bowel cancer campaign supported by local residents
To save lives and help raise awareness of the signs and symptoms of bowel cancer for the over 50s, residents of Kirklees (community champions) took part in a new campaign in October 2011. They helped to communicate the importance of early diagnosis and educated others about the signs and symptoms. Through this campaign NHS Kirklees, along with the Yorkshire
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Cancer Network, helped to break down the barriers that stop people from going to see their GP. For further information on bowel cancer, visit: www.nhs.uk/bowelcancer
Quality counts
Annual Report 2011 12
Quality counts
Quality counts
A strong focus on quality and safety is the driving force that underpins all our commissioning: we constantly seek assurance about the safety of services, and we proactively seek opportunities to improve the quality of the services provided. Quality and safety is the first item considered at every Board meeting,
and it is a standing item for our Clinical Commissioning Executive. We monitor a vast array of information that helps us understand exactly what is happening about the things that matter to patients, including waiting times, infection rates, same sex hospital accommodation and many others.
Here are some of the highlights from the past year:
Target Patient Safety Reduction in healthcare associated infection, including a reduction in numbers (maximum of 13 cases) of MRSA 2-week urgent referrals: cancer 93% of possible cancer patients are to wait no longer than two weeks from an urgent referral to a first outpatient appointment Stroke The national standard states that 80% of people who have had a stroke should spend at least 90% of their time in hospital on a stroke unit Diabetes 100% of people with diabetes are to be offered Diabetic Retinopathy Screening Mental Health A minimum of 64 cases to be served by early intervention services Choose and Book Giving patients more choice about ‘How, When and Where’ they receive treatment with access to a named consultant given to a minimum of 70% of people End of Life Care To provide all adults nearing the end of life, regardless of diagnosis, access to high quality palliative care, giving more people the choice to die at home, including in a care home
Source: Cluster Board Routine Performance Report 2011/12
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Achieved
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Quality counts
Learning from the experience of our patients
Sometimes things don’t go as they should, however, and we ensure that any complaints we receive are thoroughly investigated to achieve the best possible outcome. We encourage a culture that seeks and then uses people’s experiences to make services more effective, personal and safe.
NHS Kirklees
During 2011/12 our Customer Liaison Service received 993 enquiries and the
Information Governance Team received 314 requests for information under the Freedom of Information Act. In the same period we received and responded to 179 complaints. We also supported GPs, pharmacists, dentists and opticians to respond thoroughly to the complaints they received.
We aim to make sure that people in Kirklees receive the highest possible standards of care. It’s important that all patients have confidence in local health services and that people know how they can make a comment on the health services they receive.
2 1 We received the following number of complaints about independent contractors:
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Medical (GP)
Total 81
Dental Pharmaceutical
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Between 1 April and 30 September 2011, Kirklees Community Healthcare Services received 18 enquiries and 16 complaints. Some of the lessons we have learned from the complaints we received resulted in the following improvements to patient care:
Optical
service improvement fostering a more open and transparent culture assisting service users when encountering access or service problems.
To contact our Customer Liaison Service call 01484 464464.
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Quality counts
NHS Kirklees
Managing the risks
In January 2012 we aligned our risk register and risk reporting procedures, using a live database system and timeline across the three PCTs.
Our risk management systems enable us to monitor and test how health services are provided, including the performance of our commissioned services against government targets and best practice standards such as treatment times and control of infection in hospitals.
The way we manage risk is a key element of how we aim to ensure safety and quality. 28
Effective incident reporting, complaints and public involvement all contribute to our risk management, and add to our knowledge of what is happening with our services and how the public receive and perceive NHS services. Internal systems of control and communication ensure that serious issues are raised in a timely and relevant way within the organisation, from specialist team meetings through to Cluster Board meetings where appropriate.
Our risk management teams report incidents nationally to the National Patient Safety Agency and to the Counter Fraud and Security Management Service. This helps us compare ourselves with other organisations and learn lessons to prevent similar incidents from happening in our area. Risk management forms part of our integrated governance arrangements and evidence shows that well managed organisations have better outcomes, including: safe and clinically effective services for patients maintenance of core services in times of emergency better value in our use of resources better health outcomes for our population. In other words, good governance can save lives.
Engagement with our patients and public
Annual Report 2011 12
Engagement with our patients and public
Engagement with our patients and public Listening to what people tell us about local NHS services, instead of relying on existing knowledge and assumptions helps us to meet people’s needs better. We can develop high quality, more responsive services when we involve and listen to people already using them and those who might use them in the future.
We also make sure people understand and comment about our plans and why some services need to be changed. The Department of Health introduced a new duty to inform the public about our engagement and consultation activities. To show how we met this duty in 2010/11, we published a detailed Patient and Public Involvement Annual Report which is available at:
www.kirklees.nhs.uk/get-involved/patient-public-involvement
The report for 2011/12 will be published by September 2012 which will provide more detailed information about the engagement exercises and consultations that are given here.
Your experience of urgent healthcare services within Calderdale, Kirklees and Wakefield ‘Urgent care’ describes the NHS services you use when you need advice or treatment immediately, but which is not an emergency or life-threatening. We set up a new urgent care system in 2008 called the West Yorkshire Urgent Care Service. The contract for this service is coming to an end soon and we wanted your views on what a new service should www.kirklees.nhs.uk/get-involved
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look like and to hear about your experiences of the current service. During a three month engagement project people told us that they valued the service. However, there did seem to be a lack of awareness about urgent care services. Further information about this engagement exercise is available at
www.kirklees.nhs.uk
Engagement with our patients and public
More patient choice on community services
Residents living in Calderdale, Kirklees and Wakefield District are soon to have more choice when, where and who provides some community based services.
NHS Kirklees
The initiative is part of the Government’s commitment to allow patients who are referred for a particular service, to be able to choose from a list of qualified providers who meet NHS standards for quality, care and value for money. During September and October 2011, we asked local patients, patient groups, members of the public and other stakeholders for their views on which services they would like to see more choice of providers in.
Based on the response to the survey and further prioritisation and benefits appraisal carried out by NHS Kirklees and emerging CCGs, the following services will now be opened up to any qualified provider in 2012/13: adult hearing services in the community (Wakefield District, North
Kirklees, Greater Huddersfield, Calderdale CCGs) diagnostic tests closer to home (Wakefield District, North Kirklees, Greater Huddersfield, Calderdale CCGs) primary care psychological therapies adults (Calderdale CCG).
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Engagement with our patients and public
Mid Yorkshire Clinical Services Strategy
The NHS in Mid Yorkshire wants local people to help shape the future of hospital services. NHS Kirklees, along with The Mid Yorkshire Hospitals NHS Trust and other partners, is developing plans and proposals for future hospital services. These plans are being developed based on information gained from engagement with service users and staff from October to December 2011 which is likely to lead to further public consultation early next year. It is important, however, we hear the views of local before then, and this includes you.
For details on how to get involved and for further information visit:
www.kirklees.nhs.uk/get-involved/mid-yorkshire-clinical-services-strategy
32
www.kirklees.nhs.uk
Engagement with our patients and public
Care home support consultation
NHS Kirklees is proposing to oer a new service to all individuals living in care homes. This service is planned to be in place by September 2012. The proposed service will
NHS Kirklees
oer each individual a health review up to three times a year and will support care home sta and other health providers in meeting the changing health needs of individuals.
The Engagement Team developed an Engagement and Communications plan which was agreed by the Care Home Support Service Specification Group which comprises representatives from both Clinical Commissioning Groups and NHS Kirklees. One of the aims of the service is to prevent unnecessary hospital admissions by facilitating timely access to the appropriate health advice and interventions. The Care Home Support Team may include a number of different health professionals such as a pharmacist, a GP, an advanced nurse practitioner and a physiotherapist.
As part of the plan a questionnaire was designed to gain feedback from Care Home managers, Care Home staff, provider organisations, healthcare providers and voluntary and community sector organisations on the proposal. The questionnaire invited them to have their say in shaping the initial proposals and consider what this new service might additionally offer.
33
Valuing our sta
www.kirklees.nhs.uk
Valuing our staff
Ensuring that healthcare continues to meet the needs of local people requires motivated, capable and committed staff. It has undoubtedly been a challenging year for staff as the pace of change has continued to increase.
Support during organisational change
NHS Kirklees
Despite this, and at a time of great uncertainty, staff have continued to work hard to ensure that patients receive the best possible services and that we use resources in the best possible way.
In order to support our staff colleagues through this time we have organised a range of initiatives: organisational change briefings
career management workshops
pensions advice sessions
human resources drop-in sessions.
financial planning sessions
Staff survey To help us monitor the views and opinions of our staff, we take part in the national NHS staff survey. This helps us to understand where we need to concentrate our efforts and improve as an employing organisation. 79% of our staff completed the Staff Survey in 2011, which was a 17% increase on last year’s figure of 62%. Our top three highest scores showed that our staff:
feel that there are still good opportunities to develop their potential at work feel satisfied with the quality of work they are able to deliver believe the PCT has a good commitment to work-life balance. We scored less well for the percentage of staff receiving health and safety training in the past 12 months but in 31
areas out of 38, NHS Kirklees was average or above average compared with other PCTs nationally. In 14 of those areas we scored in the top 20% of PCTs in the country. We are also once more in the top 20% of PCTs nationally for honouring the NHS Constitution pledge to ‘develop and support staff’, something of which we are very proud.
35
Annual Report 2011 12
Valuing our staff
Monitoring
We continue to monitor sickness data and provide relevant support to staff according to their needs. During this year our sickness rate was 2.5%, which was exactly in line with our target. We also take our responsibilities for equality and diversity very seriously and comply with our duty to monitor our workforce on key employment indicators by ethnicity, disability status, age and gender. We try to ensure that our workforce represents our local communities and that all employees are treated fairly and equally.
Our staff
Gender
Disability Count
%
Male
46
19
Female
201
81
Count
%
No
207
84
Yes
10
4
Not Declared
30
12
Religious Belief Count
%
Atheism
28
11
Buddhism
1
0
Christianity
124
50
Not Declared
67
27
Islam
12
5
Other
12
5
Sikhism
2
1
Staff taking part in sporting activities to support the NHS Challenge
Sexual Orientation Count
%
1
0
Heterosexual
486
75
Not Declared
58
23
Lesbian
2
1
Gay
36
www.kirklees.nhs.uk
Valuing our sta
NHS Kirklees
Age Group Count
%
Under 25
6
2
25-34
62
25
35-44
80
32
45-54
73
30
55+
26
11
Dr Judith Hooper, Director of Public Health for NHS Kirklees and Kirklees Council, Torchbearer, London 2012 Olympic Games
Ethnic Origin Count
%
218
88
White - Irish
3
1
White - Any other White background
2
1
Mixed - White & Black Caribbean
1
0
Mixed - White & Asian
1
0
Asian or Asian British - Indian
8
3
Asian or Asian British - Pakistani
9
4
Asian or Asian British - Bangladeshi
2
1
Asian or Asian British - Any other Asian background
1
0
Black or Black British - Caribbean
1
0
Any Other Ethnic Group
1
0
White - British
37
Annual Report 2011 12
Valuing our sta
Community services
Until the end of September 2011, Kirklees Community Healthcare Services (KCHS) was part of our organisation. In October 2011, the service relaunched as a social enterprise called Locala. For the period April to September the sickness rate for KCHS sta was 4.2%, and below you can see how the community workforce was made up: Gender
Disability Count
%
80
6
1165
94
Male Female
Count
%
No
1041
84
Yes
35
3
Not Declared
169
14
Religious Belief Count
%
Atheism
90
7
Christianity
672
54
7
1
Not Declared
374
30
Islam
45
4
Judaism
3
0
Other
49
4
Sikhism
5
0
Hinduism
Staff Awards event winners 2011
Sexual Orientation Count
%
Bisexual
1
0
Gay
2
0
Heterosexual
830
67
Not Declared
407
33
5
1
Lesbian
38
www.kirklees.nhs.uk
Valuing our sta
NHS Kirklees
Award ceremony for trusts who gained NHS Challenge recognition at bronze, silver or gold - NHS Kirklees achieved a gold award. From left: Sir David Nicholson: NHS Chief Executive, Mike Potts: NHS Calderdale, Kirklees and Wakefield District Cluster Chief Executive, Patricia Muramatsu: Self Care Lead and Jonathan Edwards: former Olympic champion
Age Group Count
%
Under 25
22
2
25-34
230
18
35-44
361
29
45-54
440
35
55+
192
15
Count
%
1120
90
B White - Irish
13
1
C White - Any other White background
9
1
Mixed - White & Black Caribbean
5
0
E Mixed - White & Black African
2
0
F Mixed - White & Asian
2
0
G Mixed - Any other mixed background
1
0
H Asian or Asian British - Indian
30
2
J Asian or Asian British - Pakistani
30
2
K Asian or Asian British - Bangladeshi
1
0
L Asian or Asian British - Any other Asian background
2
0
M Black or Black British - Caribbean
15
1
N Black or Black British - African
5
0
P Black or Black British - Any other Black background
1
0
R Chinese
1
0
S Any Other Ethnic Group
3
0
Z Not Stated
5
0
Ethnic Origin A White - British
39
Lean and green
www.kirklees.nhs.uk
Lean and green
NHS Kirklees
We encourage sta, patients and visitors to think lean and green when it comes to the environment. Wherever we can we are asking people to take opportunities to reduce waste and the use of utilities and minimise any negative impact on the environment.
Here are some of our green initiatives:
Within our own properties we do everything we can to reduce energy consumption: new boilers and heating controls have been fitted at health centres in Slaithwaite, Skelmanthorpe, Liversedge, Marsden and Fartown new double glazed windows have been installed at health centres in Marsden, Liversedge and Skelmanthorpe three redundant sites at Almondbury, Savile Town and Crosland Moor have been disposed of, reducing our energy consumption and revenue costs Holme Valley Memorial Hospital has had an extensive programme of refurbishment including the replacement of the central boiler plant, modern boilers, double glazing, increased insulation and low energy lighting, significantly reducing the carbon footprint of the site Shaw Cross has been fully refurbished including new boilers and windows and a new, better insulated roof. A recycling scheme at the NHS Kirklees headquarters at Broad Lea House has seen a reduction in our carbon footprint of CO2 by more than 10 tonnes. Special bins have been placed around the building so that staff can throw away a
range of waste from paper and cardboard to plastic bottles and cans and know they will be recycled. NHS Kirklees has also put a green travel plan in place and we estimate that car sharing and our staff shuttle bus service means we have saved more than 13 tonnes of CO2 a year. We have a group of staff who swapped four wheels for two by taking advantage of a cycle to work scheme. Sixteen people got themselves a new bike and in turn saved themselves some money, improved their health and fitness and reduced the number of cars on the road.
41
Planning for an emergency
www.kirklees.nhs.uk
Planning for an emergency
NHS Kirklees
Emergency planning is all about being prepared and ready to provide a rapid, eective response to major incidents which may happen in our area, responding to patient need and helping protect the health of local people.
Our emergency plans have been tested at local, national and regional level with staff taking part in a number of emergency planning exercises including a major event in November 2011. This was designed to test how the NHS in West Yorkshire would cope if there were an incident with mass casualties. We continually update and change our plans in light of the lessons learnt from these exercises, providing further training for staff to update their skills and knowledge.
43
Equality and diversity
www.kirklees.nhs.uk
Equality and diversity
We take our responsibilities for equality and diversity very seriously. We consider what our local communities need and how their needs can best be met by the services we commission. We are determined to reduce health inequalities through understanding the health needs of local communities and making the services we commission inclusive and accessible.
Further information about the NHS Equality Delivery System can be found at: www.kirklees.nhs.uk/public-information/equality-and-diversity
NHS Kirklees
Equality is for everyone and we strive to design services that are equally available, making sure that: services are open when they are needed people understand the information they are given people understand what to do if things don't go well.
This ensures that we do the best for all our population and also ensures that we meet our legal responsibilities, which are carried out through the NHS Equality Delivery System. By implementing this system, communities help us determine how well we are doing and what we could do dierently or better in the future.
45
Director of Finance commentary
www.kirklees.nhs.uk
Finance
2011/12 performance
I am pleased to report that NHS Kirklees has once again achieved all the financial duties set for it by the Government. We received two separate allocations of money from the Department of Health for 2011/12: a revenue allocation of £692 million which we used to commission and provide health services for the population of Kirklees, many of which you can read about elsewhere in this Annual Report.
Revenue allocation
NHS Kirklees
a capital allocation of £2.2 million which we used for improvements to buildings, equipment, and information technology. This report summarises how we have invested this money to deliver and improve health care and services for Kirklees residents. It also highlights some of the key challenges that we have addressed during 2011/12 and those that face us in the coming years.
We delivered the planned surplus of £8.2 million (1.2%) against our revenue allocation. This will be carried forward to support investments in services in 2012/13.
By properly managing our finances we delivered our planned efficiency programme of just over £13.3m, on top of the £15m delivered in 2010/11. We did this by putting community services in place to reduce unnecessary hospital admissions and stays, improving the efficiency of primary care prescribing and reducing administration expenditure. We ensured we received the best value from contracts with independent providers such as dentists and GPs. We also increased the efficiency of community services. We spend our money with a range of organisations. These include NHS and non-NHS hospitals, community organisations, GPs (including prescription costs), dentists, optometrists, and
pharmacists. We also spend our money helping people to improve their health and well-being, such as helping people to stop smoking, promoting healthy lifestyles and encouraging access to screening services. During the year we established a new Community Interest Company: Locala. We transferred the range of community services which we previously provided ourselves to this new organisation, in line with government policy. These services include district and school nursing services, health visiting services, community dental services and a range of other prevention and treatment services. More information about Locala can be found at: www.locala.org.uk
47
Annual Report 2011 12
Finance
The following chart provides a summary of how we spent your money (£m):
57
72 37
10
1
82
2
9
28 4 18
34 5
Total 664
6
60
7
282
Capital allocation
8
24
Medical (GP’s)
2.
Prescribing
3.
Dentists
4.
Opticians
5.
Learning difficulties
6.
Mental illness
7.
Maternity
8.
General and acute
9.
A&E
10. Community health services
During the year we have invested £2.2 million in improving infrastructure, equipment and information technology. The main areas where we have invested are: £900k to improve a number of GP premises to support the delivery of primary and community health services £350k on a new West Yorkshire Rape Crisis Centre £500k on improved information technology and communications infrastructure to support enhanced working arrangements £400k on routine maintenance of buildings and initial works on the
48
1.
improvement of day surgery and dental facilities at the Holme Valley Memorial Hospital. This will be completed in 2012/13. We have also made grants of around £250k to a number of GPs to help them make infection prevention improvements and to enable better access to their premises.
www.kirklees.nhs.uk
Finance
Looking forward
2012/13 is NHS Kirklees’ final year, and our commissioning responsibilities will be transferred to other organisations by April 2013. We are working hard to ensure that we hand over a stable financial position to these organisations. This is a challenging agenda and, in line with all other areas of the public sector, we are working within tight financial constraints. We are working to improve our efficiency by continuing to reduce management and running costs, working jointly with other Primary Care Trusts (PCTs), and focusing on those things which help us to make the biggest improvements to the health services available to the people of Kirklees. During 2011/12 we significantly reduced our running cost by around £4m, or 20% of the total. We will continue to work with partners across West Yorkshire to deliver cost
NHS Kirklees
The two shadow Clinical Commissioning Groups for Kirklees have been in existence for a year and we are working with them to hand over responsibility for commissioning and financial management in the lead up to April 2013.They will then become new statutory accountable bodies. We are also working with other bodies, such as the local authority and the NHS Commissioning Board to ensure that we successfully hand over responsibility for public health and primary care commissioning to them. We have also clustered with neighbouring PCTs covering Wakefield and Calderdale. This combined body is responsible for overseeing the successful implementation of the new arrangements and ensuring the proper and orderly closure of the PCT at the end of 2012/13.
effective commissioning support services that allow the new GP commissioners to concentrate on making improvements to services for patients. We are also working hand in hand with NHS hospitals, GPs, dentists, and other partners to ensure that the services they provide are done so in a cost effective way.
NHS Kirklees takes its responsibilities for safeguarding public money and achieving value for money very seriously. On behalf of the Board, the Audit Committee considers financial governance. Members of the Committee receive regular reports from our external auditors, the Audit Commission, and from our internal auditors. In addition to their statutory audit of the PCT’s accounts, the Audit Commission also provide a number of other reports that help us achieve value for money.
49
Annual Report 2011 12
Finance
Summary financial statements The Summary Financial Statements that accompany this report are taken from the Annual Accounts for 2011/12. The Summary Financial Statements are intended to highlight and summarise the key financial information contained in the Annual Accounts. If you would like to receive a full set of the accounts or a copy of our Annual Governance Statement please contact:
Director of Finance NHS Kirklees Broad Lea House. Bradley Business Park. Dyson Wood Way. Bradley. Huddersfield. HD2 1 GZ Tel. 01484 464000 E-mail: financepa@kirklees.nhs.uk
Financial performance targets 2012 This shows that we have delivered our planned revenue surplus of £8.2m against our revenue allocation. This will be carried forward to support investments in services in 2012/13. 2011-12 £000 The PCT’s performance for the year ended 31 March 2012 is as follows: Net operating cost for the financial year 683,351 Revenue resource limit 691,590 Under/(over)spend against revenue resource limit (RRL) 8,239
2010-11 £000 660,654 668,554 7,900
Statement of Comprehensive Net Expenditure for year ended 31 March 2012 This shows a summary of how we spent our money and is split between employee benefits, other costs, and income.
50
2011-12 £000
2010-11 £000
Administration Costs and Programme Expenditure Gross employee benefits Other costs Income Net operating costs before interest Finance costs Net operating costs for the financial year
30,408 670,145 (18,536) 682,017 1,334 683,351
47,702 635,103 (23,334) 659,471 1,183 660,654
Other Comprehensive Net Expenditure Impairments and reversals put to the revaluation reserve Net (gain)/loss on revaluation of property, plant and equipment Total comprehensive net expenditure for the year
3,717 (3,965) 683,103
87 (734) 660,007
www.kirklees.nhs.uk
Finance
NHS Kirklees
Statement of ďŹ nancial position at 31 March 2012 This shows our assets and liabilities. The non-current assets include health centres, GP premises, administrative buildings, IT and other equipment which are either used to deliver services or allow us to commission them effectively. The current assets include stock, mainly equipment, to help people live at home, and money owed to us by NHS and other organisations. The current liabilities are amounts we owe to other bodies for the provision of services. We try to ensure that we pay other bodies promptly and our performance in doing so is shown in the Better Payment Practice Code below. 31 March 2012 ÂŁ000
31 March 2011 ÂŁ000
Non-current assets: Property, plant and equipment Intangible assets Trade and other receivables
33,499 0 0
Total non-current assets
33,499
32,445 21 0 32,466
258 3,000 1 3,259
236 4,583 1 4,820
801
801
4,060
5,621
37,559
38,087
Current liabilities Trade and other payables Provisions Borrowings
(40,556) (5,169) (712)
(44,653) (967) (712)
Total current liabilities
(46,437)
(46,332)
(8,878)
(8,245)
Non-current liabilities Trade and other payables Provisions Borrowings
0 (1,065) (24,815)
(9) (1,180) (25,581)
Total non-current liabilities
(25,880)
(26,770)
Total assets employed:
(34,758)
(35,015)
Financed by taxpayers' equity: General fund Revaluation reserve
(37,289) 2,531
(37,343) 2,328
Total taxpayers' equity:
(34,758)
(35,015)
Current assets: Inventories Trade and other receivables Cash and cash equivalents Total current assets Non-current assets held for sale Total current assets Total assets
Non-current assets plus/less net current assets/liabilities
51
Annual Report 2011 12
Finance
Statement of changes in Taxpayers' Equity for the year ended 31 March 2012 This shows the movements in taxpayer’s equity for the year and how these are reflected in the reserves of the PCT. It also shows the funding received from parliament by the PCT in the year.
Balance at 1 April 2011 Net operating cost for the year Net gain on revaluation of property, plant, equipment Impairments and reversals Transfers between reserves Total recognised income and expense 2011-12
General fund £000 (37,343) (683,351)
45
3,965 (3,717) (45)
Total reserves £000 (35,015) (683,351) 3,965 (3,717) 0
(683,306)
203
(683,103)
Net Parliamentary funding
683,360
Balance at 31 March 2012
(37,289)
Revaluation reserve £000 2,328
683,360 2,531
(34,758)
Services commissioned This shows how we invest our money in providing a range of services for the population of Kirklees. 2011-12 £000
2010-11 £000
54,923 64,550 27,509 4,257 17,717 2,528
53,945 65,213 25,796 4,101 16,758 1,901
Total Primary Healthcare purchased
171,484
167,714
Purchase of Secondary Healthcare Learning difficulties Mental illness Maternity General and acute Accident and emergency Community health services Other contractual
17,527 59,770 23,614 282,178 37,202 71,530 231
15,702 63,858 23,994 274,329 36,768 67,873 511
Total secondary healthcare purchased
492,052
483,035
Total healthcare purchased by PCT
663,536
650,749
Purchase of Primary Health Care GMS / PMS/ APMS / PCTMS Prescribing costs Contractor led GDS and PDS General ophthalmic services New pharmacy contract Non-GMS services from GPs
52
www.kirklees.nhs.uk
Finance
NHS Kirklees
Statement of cash flows for the year ended 31 March 2012 This shows that we have been able to fund expenditure on services from within our available cash. This means that we stayed within our cash limit, which is the amount of cash given to us by the government each year. 2011-12 £000
2010-11 £000
Cash Flows from Operating Activities Net operating cost before interest Depreciation and amortisation Impairments and reversals Interest paid (Increase)/decrease in inventories (Increase)/decrease in trade and other receivables Increase/(decrease) in trade and other payables Provisions utilised Increase/(decrease) in provisions
(682,017) 1,622 (265) (1,305) (22) 1,583 (4,199) (410) 4,468
(659,471) 2,538 (1,241) (1,187) 34 1,104 366 (252) 404
Net cash inflow/(outflow) from operating activities
(680,545)
(657,705)
Cash flows from investing activities (Payments) for property, plant andequipment
(2,049)
(1,001)
Net cash inflow/(outflow) from investing activities
(2,049)
(1,001)
(682,594)
(658,706)
Cash flows from financing activities Capital element of payments in respect of finance leases and on-SoFP PFI and LIFT Net Parliamentary funding
(766) 683,360
(727) 659,336
Net cash inflow/(outflow) from financing activities
682,594
658,609
Net increase/(decrease) in cash and cash equivalents
0
(97)
Cash and cash equivalents (and bank overdraft) at beginning of the period
1
98
Cash and cash equivalents (and bank overdraft) at year end
1
1
Net cash inflow/(outflow) before financing
53
Annual Report 2011 12
Finance
Staff This shows the number of staff we employ (based on whole time equivalent numbers) and the areas in which they work. The reduction in numbers of staff is partly due to the transfer of community services to Locala on the 1 October 2011, and partly due to reducing staff numbers in administration and estates as we make reductions in our running costs. 2011-12
Total Permanently Number Employed Number
Other Number
Average Staff Numbers Medical and dental Administration and estates Healthcare assistants and other support staff Nursing, midwifery and health visiting staff Scientific, therapeutic and technical staff Other
13 319 74 237 64 8
12 303 61 230 61 6
1 16 13 7 3 2
Total staff numbers
715
673
42
1,207
1,193
14
2010-11 total staff numbers
Staff sickness absence This shows the number of days lost through staff sickness and expresses this as an average number of working days lost per staff year. 2011-12 Number 8,138 980 8.30
Total days lost Total staff years Average working days lost
2010-11 Number 12,251 1,205 10.17
PCT running costs This shows the staff and non-staff costs incurred by the PCT in managing its work, and shows the reductions in running costs made during the year
54
Commissioning Services
Public Health
Total
PCT Running Costs 2011-12 Running costs (£000s) Weighted population (number in units) Running costs per head of population (£ per head)
14,350 401,821
2,280 401,821
16,630 401,821
35.71
5.67
41.39
PCT Running Costs 2010-11 Running costs (£000s) Weighted population (number in units) Running costs per head of population (£ per head)
17,769 401,282
2,600 401,282
20,369 401,282
44.28
6.48
50.76
www.kirklees.nhs.uk
Finance
NHS Kirklees
Better Payment Practice Code NHS Kirklees is signed up to the Better Payment Practice Code and aims to pay all its valid invoices by the due date or within 30 days receipt of a valid invoice, whichever is later. By agreeing to these terms, NHS Kirklees has sent a clear signal to its customers and suppliers that it is committed to good credit management and paying on time. Details of compliance with the code are included within annual accounts note 6.1 and also within the summary financial statements below. 2011-12 Number
2011-12 ÂŁ000
23,371 22,186
113,721 106,351
Percentage of non-NHS trade invoices paid within target
95%
94%
2010-11 performance
96%
94%
Non-NHS Payables Total non-NHS trade invoices paid in the year Total non-NHS trade invoices paid within target
Audit services This shows what we spent in year on audit fees with our external auditors. Our auditors are appointed by the Audit Commission. The audit fee is based on the size of the PCT and the adequacy of its financial arrangements. 2011-12
2010-11
Analysis of operating costs: Audit fees Other auditors remuneration
221 0
279 0
Total audit fees
221
279
Related party transactions
Pension liabilities
Kirklees Primary Care Trust is a body corporate established by the Secretary of State for Health. During the year none of the Board members or members of the key management staff or parties related to them has undertaken any material transactions with the PCT.
Details of how pension liabilities are treated in the accounts and a reference to the statements of the relevant pension scheme are included in accounting policies note 7.4 in the annual accounts and the Remuneration Report, see pages 58-64.
55
Annual Report 2011 12
Finance
About the remuneration report Section 234B and Schedule 7A of the Companies Act, as interpreted for the public sector, require NHS bodies to prepare a Remuneration Report containing information about the remuneration of directors. In the NHS, the report will cover those senior managers “having authority or responsibility for directing or controlling the major activities of the NHS body. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments.” Membership of the Cluster Remuneration and Terms of Service Committee (RTSC)
The Remuneration and Terms of Service Committee (RTSC), prior to the creation of the CKW cluster, comprised the Chairman (Rob Napier) and three non-executive directors (NEDs): (Mehboob Khan, Imran Patel and Vanessa Stirum). After clustering, the RTSC comprised Ann Liston (Chair)
The role of the Remuneration and Terms of Service Committee
The role of the RTSC is to make decisions about appropriate remuneration and terms of service for the Chief Executive, directors, Clinical Executive members’ allowances and, in exceptional circumstances, individual issues arising for staff on Agenda for Change terms. This includes the determination of basic pay for the Chief Executive and other directors, together with any annual uplifts and performance bonuses.
56
Cluster NED, Mehboob Khan, Cluster NED and Roger Grasby, Cluster NED. The non-executive director who chairs the Audit Committee does not attend in order to ensure the separation of duties. The Chief Executive is in attendance (except when his own terms and conditions are considered).
www.kirklees.nhs.uk
Finance
Statement of the policy on remuneration of higher paid employees for current and future ďŹ nancial years
NHS Kirklees works within the Pay Framework for Very Senior Managers in Strategic and Special Health Authorities, Primary Care Trusts and Ambulance Trusts as set out by the Department of Health. This became operable from 1
April 2007and helps to make sure that NHS Kirklees is able to recruit, retain and motivate high calibre staff and is consistent, competitive and comparable to other PCTs.
Explanation of methods used to assess whether performance conditions were met and why those methods were chosen
The RTSC reviews appropriate levels of pay for the Chief Executive and other directors under the Very Senior Managers Framework. In line with best employment practice, where performance should be assessed by the line manager, the Chief Executive conducts the performance assessments for the directors. The Chairman assesses the performance of the Chief Executive. Assessments are conducted
using established appraisal and personal development review processes, which include clearly defined responsibilities with measurable objectives. The discretionary element of pay is covered by performance bonus arrangements. This is referred to above in the section on the statement of the remuneration of higher paid employees.
NHS Kirklees
Explanation of relative importance of the relevant proportions of remuneration which are, and which are not, subject to performance conditions Please refer to information on the role of the Remuneration and Terms of Service Committee.
Summary and explanation of policy on the duration of contracts, notice periods and termination payments Chief Executive and director appointments are made on a substantive basis, with notice provisions normally six months clearly identified and articulated in the contract.
SigniďŹ cant awards made to past senior managers during 2011/12 All payments are disclosed in the tables on pages 58-61.
Salary and pension entitlements of senior managers for 2011/12 See tables on pages 58-64.
57
Annual Report 2011 12
Finance
Remuneration report Clinical Executive Committee - salaries and allowances [Audited] 2011 / 2012
2010 / 2011
Name
Salary Other (Bands of Remuneration £5,000) (bands of £5,000)
David Anderson
0 - 5,000 3 Months
15,000- 20,000
Jim Lee
0 - 5,000 2 Months
20,000 - 25,000 10 Months
Ajit Mehrotra
0 - 5,000 2 Months
5,000 - 10,000
Anil Aggarwal
0 - 5,000 2 Months
5,000 - 10,000
Anuj Handa
0 - 5,000 2 Months
5,000 - 10,000 9 Months
Dawn Gordon
0 - 5,000 2 Months
5,000 - 10,000
Bert Jindal
0 - 5,000 2 Months
5,000 - 10,000 9 Months
Liz Clough
0 - 5,000 2 Months
5,000 - 10,000 9 Months
Carl Chapman
0 - 5,000 2 Months
5,000 - 10,000 9 Months
58
Benefits in kind (Rounded to the nearest £00)
Salary Other (Bands of Remuneration £5,000) (bands of £5,000)
The Clinical Executive Committee was abolished during the year when we introduced shadow Clinical Commissioning Groups (CCGs) in June 2011. These are transitional arrangements in preparation for the handover of commissioning responsibilities to Clinical Commissioning Groups, when they become new statutory bodies on 1 April 2013. In Kirklees we have two shadow CCGs, one covering Greater Huddersfield and one covering North Kirklees. A number of GPs, nurses, and practice managers sit on these shadow groups. We reimburse their employing GP practices, to allow them to free up these individuals to attend shadow board, commissioning, and other meetings and to carry out the significant amount of work required in the lead up to formal handover of commissioning
Benefits in kind (Rounded to the nearest £00)
responsibilities in April 2013. This funding allows the practices to make arrangements to cover the clinical commitments of the GPs and to avoid any reduction in the clinical care they provide to their patients. In 2011/12 the aggregate amount of funding used to support this important work was: for Greater Huddersfield we spent £365,000, which allowed eight individuals to be released by their practices for North Kirklees we spent £290,000, which allowed eight individuals to be released by their practices. This funding is from the amount which the Department of Health has required PCTs to make available to support the development of Clinical Commissioning Groups.
www.kirklees.nhs.uk
Finance
NHS Kirklees
Director - salaries and allowances During the year we entered into a clustering arrangement with NHS Calderdale and NHS Wakefield District. This is one of the transitional working arrangements to support the introduction of CCGs in April 2013. The new Calderdale, Kirklees, and Wakefield NHS Cluster (CKW Cluster) is responsible for ensuring the establishment of CCGs and the orderly transfer of commissioning responsibilities to them. This clustering arrangement commenced in June 2011, and was completed in October 2011. In June the three PCTs agreed to have a single team of executive directors. In October 2011 they agreed to have a single team of nonexecutive directors.
The first two tables below show the remuneration of all those non-executive and executive directors who have held a post in the year as a director of NHS Kirklees, before and after this clustering arrangement came into being. The third table shows the full remuneration of those directors who have held a cluster post during the year. Where directors have held a cluster post, their remuneration in these roles has been split across the CKW cluster, based on the relative populations served by the constituent PCTs. NHS Kirklees picked up 44% of the cluster remuneration, and this share is reflected in the first two tables where appropriate.
Non-executive Directors [Audited] 2011 / 2012 Name Title
Salary Other (Bands of Remuneration £5,000) £ (bands of £5,000) £
2010 / 2011 Benefits in kind (Rounded to the nearest £00) nearest £00)
Salary Other (Bands of Remuneration £5,000) £ (bands of £5,000) £
Rob Napier Chairman - NHS Kirklees
15,000 -20,000 6 months
Angela Monahan Chairman - CKW Cluster
5,000 - 10,000 6 months
Tony Gerrard NHS Kirklees & CKW Cluster
5,000 - 10,000 12 months
10,000 15,000
Mehboob Khan NHS Kirklees & CKW Cluster
5,000 - 10,000 12 months
5,000 10,000
Keith Wright CKW Cluster
0 - 5,000 6 months
Ann Liston CKW Cluster
0 - 5,000 6 months
Roy Coldwell CKW Cluster
0 - 5,000 6 months
Sandra Cheseldine CKW Cluster
0 - 5,000 6 months
Roger Grasby CKW Cluster
5,000 - 10,000 6 months
Benefits in kind (Rounded to the nearest £00) nearest £00)
35,000 40,000
200
Imran Patel NHS Kirklees
0 - 5,000 6 months
5,000 10,000
Valerie Aguirregoicoa NHS Kirklees
0 - 5,000 6 months
5,000 10,000
Vanessa Stirum NHS Kirklees
0 - 5,000 6 months
5,000 10,000
Rob Millington NHS Kirklees
0 - 5,000 6 months
5,000 10,000
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Annual Report 2011 12
Finance
Executive Directors [Audited] 2011 / 2012 Salary (bands of Other £5,000) Remuneration (bands of £5,000) Mike Potts - Chief Executive 70,000 - 75,000 12 Months
2010 / 2011
Bonus Benefits in (bands kind of (Rounded to £5,000) the nearest £00) 5,000 10,000
Bryan Machin - Director of Finance 10,000 - 15,000 2 months Andy Leary - Director of Finance 15,000 - 20,000 4 months
Salary (bands of Other £5,000) Remuneration (bands of £5,000)
Bonus Benefits in (bands kind of (Rounded to £5,000) the nearest £00)
5,000 125,000 - 130,000
5,000
800 100,000 - 105,000
5,000
1,700
Jonathan Molyneux - Director of Finance 60,000 - 65,000 6 months Matt Walsh - Medical Director 35,000 - 40,000 5,000 10 months 10,000 Judith Hooper - Director of Public Health 125,000 - 130,000 12 Months
120,000 - 125,000
Helena Corder - Director of Corporate Services 15,000 - 20,000 3 months
70,000 - 75,000
185,000 190,000
Carol McKenna - Director of Commissioning & Strategic Development 10,000 - 15,000 1,000 80,000 - 85,000 2 months
5,000
Ann Ballarini - Cluster Director of Commissioning & Service Development 30,000 - 35,000 1,100 10 months Peter Flynn - Director of Performance 45,000 - 50,000 12 Months
5,000
85,000 - 90,000
5,000
Sue Cannon - Director of Quality & Governance 30,000 - 35,000 10 months Sheila Dilks - Director of Patient Care 10,000 - 15,000 165,000 2 months 170,000
80,000 - 85,000
Sue Ellis - Director of Human Resources *1 35,000 - 40,000 0 - 5,000 10 months
4,200
80,000 - 85,000
Robert Flack - Director of Provider Services 40,000 - 45,000 6 months
2,500
80,000 - 85,000
60
0 - 5,000
5,000
0 - 5,000
5,000
*1 For the last 2 months of the year the post of Director of HR was held by June Goodson-Moore. She is employed by the Airedale, Bradford and Leeds NHS Cluster and her full salary costs are disclosed in their annual reports.
www.kirklees.nhs.uk
Finance
NHS Kirklees
CKW Cluster Remuneration [Audited] Dates
Full Costs (Bands of £5,000)
BIK (Rounded to £100)
Mike Potts Cluster Chief Executive
01.04.11 to 31.3.12
135,000140,000
4,200
Jonathan Molyneux Cluster Director Of Finance
10.10.11 to 31.3.12
140,000145,000
Andy Leary Cluster Director of Finance
01.04.11 to 02.10.12
55,00060,000
5,800
Ann Ballarini Cluster Director of Commissioning and Service Development
01.06.11 to 31.3.12
75,00080,000
2,400
Peter Flynn Cluster Director of Commissioning and Service Development
01.06.11 to 31.3.12
70,00075,000
4,200
Sue Ellis Cluster Director of Human Resources and Organisational Development
01.06.11 to 22.01.12
50,00055,000
3,500
June Goodson Moore Cluster Director of Human Resources and Organisational Development
23.01.12 to 31.3.12
See note *2
Matt Walsh Cluster Medical Director
01.06.11 to 31.3.12
85,00090,000
Sue Cannon Cluster Director of Quality and Governance (Nursing)
01.06.11 to 31.3.12
70,00075,000
Angela Monaghan Cluster Chair
01.10.11 to 31.03.12
15,00020,000
Keith Wright Cluster Non Executive
01.10.11 to 31.03.12
5,000-10,000
Ann Liston Cluster Non Executive
01.10.11 to 31.03.12
0-5,000
Roy Coldwell Cluster Non Executive
01.10.11 to 31.03.12
0-5,000
Mehboob Khan Cluster Non Executive
01.10.11 to 31.03.12
0-5,000
Tony Gerrard Cluster Non Executive
01.10.11 to 31.03.12
5,000-10,000
Sandra Cheseldine Cluster Non Executive
01.10.11 to 31.03.12
5,000-10,000
Roger Grasby Cluster Non Executive
01.10.11 to 31.03.12
5,000-10,000
Name Title
Other (Bands of £5,000)
Executive Directors
10,00015,000
800
This table shows the full cost of each named individual for the period stated. *2 For the last two months of the year, the post of Director of HR was held by June Goodson-Moore. She is employed by the Airedale, Bradford and Leeds NHS Cluster and her full salary costs are disclosed in their Annual Report.
61
Annual Report 2011 12
Finance
Paymultiples Reporting bodies are required to disclose the relationship between the remuneration of the highestpaid director in their organisation and the median remuneration of the organisation’s workforce.
The banded remuneration of the highest paid director in NHS Kirklees in the financial year 2011-12 was £125,000-£130,000 (2010-11, £130,000-£135,000). This was 4.6 times (2010-11, 4.9 times) the median remuneration of the workforce, which was £27.6k (2010-11, £26.5k). In 2011-12, no (2010-11, none) employees received remuneration in excess of the highest-paid director. Remuneration ranged from £14k to £130k rounded up to the nearest £1k, (2010-11 £5k to £135k). In 2010-11 we employed a number of apprentices, which is reflected in the lower pay range for that year. In calculating the highest paid director, total remuneration includes salary, nonconsolidated performance-related pay,
62
benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. We have used our share of cluster directors remuneration only in calculating the highest paid director. The highest paid director in 2011/2012 received a payment for termination benefits. Although this was the highest value, it was not used to calculate the pay multiples as this director was not employed in a management role in the PCT. In calculating the median remuneration, we have based this on the salary costs only, as this is more reflective of the true median remuneration costs of our workforce. In calculating the median remuneration, we have grossed up part time staff to their equivalent full time remuneration.
Finance
www.kirklees.nhs.uk
NHS Kirklees
Pension benefits [Audited] Real increase Real increase Total accrued Lump sum at in pension at in pension pension at age 60 age 60 lump sum at age 60 at 31 related to (bands of aged 60 March 2012 accrued £2,500) (bands of (bands of pension at 31 £2,500) £5,000) march 2012 ( bands of £5,000)
Cash Real increase Real increase Employer’s Equivalent in Cash in CETV contribution Transfer Equivalent to Value at 31 Transfer stakeholder March 2012 Value pension
Mike Potts - Chief Executive 5 - 7.5
15 - 17.5
65 - 70
195 - 200
1440
1234
168
35 - 40
105 - 110
625
517
92
150 - 155
1084
962
92
70 - 75
0
405
-418
Bryan Machin - Director of Finance 0 - 2.5
0 - 2.5
Judith Hooper - Director of Public Health 0 - 2.5
5 - 7.5
50 - 55
Helena Corder - Director of Public Health -2.5
-2.5
20 - 25
Carol McKenna Director of Commissioning and Strategic Development 0 - 2.5
0 - 2.5
20 - 25
60 - 65
318
253
57
15 - 20
55 - 60
393
335
47
20 - 25
65 - 70
0
464
-478
100 - 105
659
585
56
10 - 15
30 - 35
134
99
32
40-45
130-135
751
569
164
125-130
883
761
98
Peter Flynn - Director of Performance 0 - 2.5
2.5 - 5
Sheila Dilks - Director of Patient Care 0 - 2.5
0 - 2.5
Sue Ellis - Director of Human Resources 0 - 2.5
0 - 2.5
30 - 35
Robert Flack - Director of Provider Services 0 - 2.5
5 - 7.5
Matt Walsh - Medical Director 2.5-5
12.5-15
Sue Cannon - Director of Quality and Governance 2.5-5
7.5-10
40-45
Ann Ballarini - Cluster Director of Commissioning and Service Development 0-2.5
0-2.5
25-30
85-90
628
573
37
40-45
130-135
829
714
57 - Note 1*
Andy Leary - Director of Finance 0-2.5
2.5-5
The table shows the pensions information for directors who were employed by NHS Kirklees during the year, either directly or as part of the CKW clustering arrangements. The remuneration for J Molyneux was not pensionable and therefore no information is available to disclose. Note 1* - This is the real increase for the proportion of time in post
63
Annual Report 2011 12
Finance
Cash Equivalent Transfer Value A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement, when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total
membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries
Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another
scheme or arrangement) and uses market valuation factors for the start and end of the period as notified by the Government Actuaries Department.
Exit package information 2011-12
2010-11
Exit package cost band (including any special payment element)
*Number of compulsory redundancies Number
*Number of other departures agreed Number
Total number of exit packages by cost band Number
*Number of compulsory redundancies Number
*Number of other departures agreed Number
Total number of exit packages by cost band Number
Less than £10,000 £10,001-£25,000 £25,001-£50,000 £50,001-£100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000
0 0 0 0 0 0 0
1 2 6 0 0 1 0
1 2 6 0 0 1 0
0 0 0 0 0 0 0
4 8 6 12 4 1 0
4 8 6 12 4 1 0
Total number of exit packages by type (total cost)
0
10
10
0
35
35
£000s 0
£000s 391
£000s 391
£000s 0
£000s 1,642
£000s 1,642
Total resource cost
Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Terms and Conditions. Where the PCT has agreed early retirements, the additional costs are met by the PCT and not by the NHS Pensions Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table. This disclosure reports the number and value of exit packages
64
agreed in the year. Note: the departures of staff may take place in a future period. The disclosure for 2011/12 does not include the provision made for future departures of £2,582k. For 2010-11, the comparators have been amended to also exclude the provision made for future departures of £404k
www.kirklees.nhs.uk
Statement
NHS Kirklees
Statement of the Chief Executive’s responsibilities as the Accountable Officer of the Primary Care Trust The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; value for money is achieved from the resources available to the primary care trust; the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them;
effective and sound financial management systems are in place; and annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer
6 June 2012 Date
Signed Mike Potts, Chief Executive
65
Annual Report 2011 12
Declarations of interest
Cluster Board Declarations of Interest Register 2011/12 Board Member
Role
Interests Declared
Angela Monaghan
Chair
None
Sandra Cheseldine
Non Executive Director
Roy Coldwell
Non Executive Director
Chair of the Trustees Board for Wakefield District Citizens Advice Bureau Trustee and Company Secretary of Catalyst Science Discovery Centre Director of RS Clare and Company Lubricants manufacturer Non-Executive Director PICME-Business Improvement Consultancy Risk Management Consultant – HFL Risk Services
Tony Gerrard Roger Grasby
Non Executive Director Non Executive Director
Ann Liston
Non Executive Director
Keith Wright
Non Executive Director
Mike Potts
Chief Executive
None
Ann Ballarini
Executive Director of Commissioning & Service Development
None
Sue Cannon
Executive Director of Quality and Governance (Nursing) Sue Ellis (until January Director of Human 2012) Resources and Organisational Development Peter Flynn
66
Director of Tony Gerrard Associates Ltd Independent Member – West Yorkshire Police Authority Justice of the Peace – Wakefield/Pontefract Bench Non-legal member – Employment Tribunal Chair/Director, Spectrum Community Health CIC Ltd Independent Member of West Yorkshire Police Authority Counsellor and external training manager - Leeds Counselling Treasurer, Hope Baptist Church, Hebden Bridge Director of ICATs Ltd. (a dormant company) NHS consultancy support to NHS organisations
None Spouse is an Employee at Gilthwaites First School, Denby Dale Church Council Secretary and worship leader Denby Dale Methodist Church
Director of Performance and None Commissioning Intelligence
www.kirklees.nhs.uk
Declarations of interest
NHS Kirklees
Board Member
Role
Interests Declared
Dr Andrew Furber
Executive Director of Public Health – NHS Wakefield District
Trustee – North to North Health Partnership. Honorary Senior Clinical Lecturer – Sheffield University
Gill Galdins
Chief Operating Officer – NHS Wakefield District Executive Director of Public Health – NHS Kirklees
None
Chief Operating Officer NHS Calderdale Chief Operating Officer – NHS Kirklees Interim Executive Director of Finance and Efficiency Executive Director of Public Health – NHS Calderdale Medical Director
None
Dr Judith Hooper
Julie Lawreniuk Carol McKenna Jonathan Molyneux Graham Wardman Matt Walsh
Employed by GP contractor to Calderdale, Kirklees and Wakefield District PCT’s – GP assistant Meltham Road Surgery Partner provides services under contract to CKW via Bradford Hospital Trust – Tier 2 Pain Service South Kirklees
None None None Ownership of a 2/7 share of premises at Thornton Medical Centre, Bradford (a PMS practice with a Bradford contract) Spouse is an employee of Calderdale and Huddersfield Foundation Trust
If you have any questions about local health services, you can call our Customer Liaison Service on 01484 464464 or email enquiries@kirklees.nhs.uk You can find out more about NHS Kirklees on our website: www.kirklees.nhs.uk
67
NHS Kirklees. Broad Lea House. Bradley Business Park. Dyson Wood Way. Bradley. Huddersfield. HD2 1 GZ Tel. 01484 464000 www.kirklees.nhs.uk
If you require this report in another format such as large print, audio tape or other language, please contact The Communications Team on 01484 464 000. Reference: Kd62712 Date of publication: Sept 12 速 Kirklees Primary Care Trust www.kirklees.nhs.uk