http://www.kirklees.nhs.uk/fileadmin/documents/publications/plans/NHSK_Operating_plan_LowRes by NHS Kirklees

Ambitions for a Healthy Kirklees

Local Operating Plan 2009/10

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Contents Section 1

Introduction

Section 2

Local background

Section 3

Needs of our population

Section 4

Strategic context

Section 5

Local action to deliver regional strategic priorities

Section 6

Financial Planning

Section 7

IM&T

Section 8

Organisational development, including World Class Commissioning competency development trajectories

Section 9

Outcomes and trajectories against targets

Section 10

Monitoring arrangements

Appendix

A: Requirements for PCTs from Operating Framework 2009-10

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Section 1

Introduction This plan sets out how NHS Kirklees will deliver national and regional requirements, national priorities and a set of priorities for local action for 2009/10 in complete alignment with the 5 year strategic plan. It should also be read in conjunction with the workforce, IM&T, finance, communication & engagement and organisational development plans to ensure a comprehensive understanding of NHS Kirklees’ move towards becoming a world class commissioner.

We are responsible for improving the health and well being of local people and making sure that services are in place to meet their needs. We commission services from others, including GPs, dentists, pharmacists, optometrists, voluntary organisations and local and specialist hospitals. We are accountable for ensuring that these services are accessible, high quality and safe. This Operating Plan is grounded in the delivery of this vision and making a difference to the local population’s health, wellbeing and access to safe, high quality services.

The vision of NHS Kirklees is:

Working together to achieve the best health and wellbeing for all the people of Kirklees • Recognise that people are at the heart of everything we do; • Support people in taking responsibility for their own health and well-being; • Encourage innovation and continuous improvement and celebrate the contribution made by our staff; • Encourage open, clear and honest communication; • Value diversity and challenge discrimination; • Show understanding, dignity and respect for all our clients, partners and staff; and • Be accountable for the decisions we make, the work we do, the resources we use and our impact on the environment.

Section 1

Introduction

GOAL 1

Place the person at the centre of everything we do by: • engaging with people to help them understand and take responsibility for their own health; • supporting people to feel in control of managing their problems and able to make healthier choices of personal behaviours; • providing people with personal choice in accessing help and interventions as ‘close to home’ as feasible; • commissioning services which are based on, and responsive to, the person’s needs and preferences, so focus on outcomes; and • involving local people in creating and delivering solutions.

GOAL 2

Improve health and reduce health inequalities by: • achieving the best possible health outcomes within available resources; • commissioning services that encompass prevention, detection, treatment and the consequences of ill health; and • achieving equality of outcomes through targeting resources to follow needs and so reducing gaps in services and support.

GOAL 3

Improve quality and promote safety by: • commissioning services that are delivered safely and to the highest standards and are evidence based around clinical and cost effectiveness; • encouraging new and innovative ways of delivering services that are sensitive to the diverse needs of our community, demonstrate improvements in quality and are delivered in an environment that staff and local people can be proud of; and • developing a learning environment that promotes continuous professional development, motivates people to achieve their full potential and aids recruitment and retention of high calibre staff.

GOAL 4

To achieve our vision, we are driven by clearly defined goals and objectives. These goals have been reviewed and now reflect both the key national drivers and our local priorities. For these reasons, our goals form a ‘golden thread’ running through our plans, and will underpin our approach to the priority objectives and our 11 health programmes.

Promote choice and accessibility by: • providing people with a choice of a range of services and interventions and ensure that services are accessible, with the principle of ‘closer to home’ being applied as far as possible.

GOAL 5

Work well in partnership with communities, individuals and their families, staff and organisations by: • achieving real involvement of local people, especially users, staff and our local community in identifying their needs, agreeing priorities for commissioning , creating solutions and taking action.

GOAL 6

Promote local sensitivity through effective commissioning by: • setting outcomes and actions that reflect local needs and priorities • acting at the right level, e.g., locally or regionally, depending on the issue or outcome desired.

GOAL 7

Promote strong clinical leadership to drive service re-design and innovation by: • having the skills and capacity to enable effective clinical leadership and engagement in all relevant aspects of the commissioning process.

GOAL 8

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Be a visibly credible organisation, operating to the highest standards by: • achieving the highest standards of probity and accountability, managing risk and maintaining effective governance arrangements to make sure that the organisation is run efficiently within available resources and in a way that inspires public confidence.

Our Priority Programmes In order to achieve our vision and deliver specific measurable outcomes we have identified 11 priority programme objectives. Successful delivery of our priority programmes will enable us to address our vision, goals and outcomes. Essential to our success is the management and delivery of our 11 programmes as supported by our emerging Programme Deliver Strategy, investment plans and financial planning. These are listed overleaf and you will see reflected in the more detailed actions outlined later in the Plan.

(1)

Planned Care including Cancer & Palliative Care To commission the best standard of care and work with providers to ensure that national standards for access are met.

(2)

Primary Care To commission high quality primary care for all and reduce any variations that exist between different areas in Kirklees.

(3)

Children and Young People To improve the health of and reduce health inequalities amongst children and young people in Kirklees

(4)

Drugs and Alcohol To increase the number of people effectively treated and improve the quality of the interventions they receive by jointly commissioning evidence based services that intervene as early as possible and deliver strong outcomes for individuals, families and communities.

(5)

Infection Control Reduce the number of avoidable Healthcare Acquired Infections to zero across Kirklees.

(6)

Urgent Care Ensure that people with an urgent care need can access appropriate high quality services in a timely manner and that these services function effectively together

(7)

Healthy Pregnancy and Maternity Place women and families at the centre of their pregnancy journey; listen to and supporting them in identifying their needs and commission effective services and support to meet these needs.

(8)

Long Term Conditions include Physical & Sensory Impairment Embed into our local health and social care community an effective, systematic approach to the care and management of patients with LTC

(9)

Learning Disabilities To empower and enable individuals with learning disabilities to lead a full and, as far as possible, ordinary life as part of the community with the same hopes and aspirations as everybody else.

(10) Mental Health To improve peopleâ&#x20AC;&#x2122;s mental health and well-being by commissioning a broad range of services that address peopleâ&#x20AC;&#x2122;s needs promptly and effectively. (11) Choosing Health Promote healthy life styles for all and tackle health and well-being inequalities through working in partnership to embed evidence based programmes

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Section 3

Needs of our population In our Joint Strategic Needs Assessment (JSNA), published jointly with Kirklees Council in February 2008, we describe the future health and well-being needs of the local population. The JSNA forms the basis for planning, service development and is a key building block for the commissioning process for the next 5 to 20 years. The JSNA is currently being reviewed.

The process for developing the JSNA has enabled us to identify key issues for specific population such as for older people, carers, people with learning disabilities, women of child bearing age and people with physical/sensory impairment. It also looks at key conditions such as heart disease, stroke, diabetes etc; wider living and working factors such as employment, housing etc and personal behaviours such as smoking, alcohol, food and nutrition. These are shown in the table below:

Table 1: Kirklees Key Health and Well-being Issues

Being healthy â&#x20AC;&#x201C; conditions

Areas where our current response is under-developed to meet current or future needs

Areas where action is underway but more effective targeting is needed to address inequalities

Areas which are key issues for children and young people

mental-health & emotional well-being

heart disease & stroke

emotional well-being

diabetes

obesity

food

smoking

food

alcohol

physical activity

alcohol

obesity pain including musculoskeletal dementia Personal behaviours

smoking physical activity Living and working â&#x20AC;&#x201C; wider factors

housing condition and options

educational attainment

employment isolation and social networks educational attainment

The key health and well-being issues identified within the JSNA have an important role in developing our programme objectives. This Operating Plan sets out what we plan to deliver during 2009/10 to address these health and wellbeing issues.

Local Partnership Working with External Stakeholders. NHS Kirklees is committed to working with its partners to deliver shared goals to the Kirklees area. These shared goals are demonstrated in a number of supporting documents including: • the Kirklees Health and Well-being Inequalities Strategy; • Joint Strategic Needs Assessment • the Local Area Agreement; • Children and Young People’s Plan; and • the Safeguarding Strategy

Children and Young People Plan NHS Kirklees is a key partner in the development and delivery of Kirklees Children and Young People Plan. The Plan is systematically informed by the Joint Strategic Needs Assessment and the action plans designed to deliver the Every Child Matters Outcomes for Children, including Being Healthy, draw from the multi-agency Programme Plans, many of which are led by NHS Kirklees Programme Managers, as part of the Choosing Health Programme. NHS Kirklees, along with other key partners, has a statutory responsibility under Section 11 of the Children Act 2004, to safeguard and promote the welfare of children and young people and has strong partnership arrangements with statutory and non statutory agencies across Kirklees. Internal policies reflect local and national safeguarding policy and guidance (Working Together 2006; West Yorkshire Safeguarding Children Procedures 2007 ) in that capacity, capability and robust systems to safeguard children and young people are in place. Clear governance and accountability frameworks have been developed and work is underway to ensure that those agencies with whom services are

commissioned are meeting the required safeguarding standards, consistent with Local Safeguarding Children Board Procedures and standard requirements. This includes ensuring that safeguarding is explicitly defined in all contracts and service specifications of those providing services.

Maternity Matters Kirklees Maternity Matters stakeholder events identified a shared vision for healthy pregnancy and maternity care, described pathways for women with universal and targeted needs, and recognised the need to integrate clinical, health and social care through a woman and family centred approach. The Healthy Pregnancy and Maternity Services Strategy was developed from this work and from insight from pregnant women using services in North Kirklees as well as practitioners delivering those services. The purpose of the Strategy is to outline the goals for realising a vision and describe the outcomes that put women and their families at the centre of healthy pregnancy and in control of the services they need. Maternity Matters Board oversees the implementation of the Strategy and is a multi-agency Board with representation from NHS Kirklees, Kirklees Council Children and Young People Services, Children’s Centres and local Acute Trust Maternity Service Providers.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Patient Views and Feedback As part of World Class Commissioning we are committed to increasing service user and public engagement and greater clinical involvement throughout the commissioning process. Increased clinical and service user input, combined with a more accurate assessment of long term local requirements, ensures services are more closely designed to meet evolving service user needs and provide a good experience of the NHS in Kirklees.

•

• •

• We will therefore engage actively with local people. We already speak regularly to local people about their health and the sort of services and support they need. We have also started, through a social marketing approach, to help local people have healthier personal behaviours. Examples of this include: • Working with groups of people in our localities to develop locality plans; • Public consultations on major changes to services, e.g. Looking to the Future (2005/06 and continuing); • Public consultations on more local changes to services, e.g. on the future of Liversedge and Slaithwaite Health Centres (early 2007); • Urgent care consultation (spring 2007); • Service user surveys – whether organised nationally or locally by ourselves or by providers. We work with practices on a regular basis to monitor quality and accessibility. The findings identify needs, show whether services are up to standard and if individuals are experiencing a good level of care; • Creation of an Expert Patient Support Group to encourage better health through peer support; • Reference groups of service users

•

established for all Long Term Conditions HITs; Establishment of a Readers’ Panel to ensure that our public information leaflets are easy to read and understand; Consultation on the introduction of GP led health centres; A diabetes survey to obtain feedback for action on the care and support which local people with diabetes receive; Patient Public Involvement Forum/ LINks; Specific focussed consultations within communities whether issue or sociodemographic specific; and The local Overview and Scrutiny Committee.

The communications plan reflects and addresses issues arising from our continuing service user and public involvement work. It will also raise new concerns which will require further public engagement and discussion with partner organisations before crystallising into firm service development commitments. We will ensure that this happens. In planning services for the future, we will work closely with our local hospital trusts to ensure that our service users have access to the range of services they need, and that services are easily accessible, safe and of high quality. People should only attend hospital if the care they need cannot be safely provided in a community setting or in their own home. In all cases we will work closely with local communities when we need to review existing services, or are considering proposals for service reconfiguration or investment.

Throughout 2009/10 we will continue to actively engage, with some key examples of planned work being: • Continue to develop mechanisms to capture patients’ views and experiences of services as well as enabling the public to get involved. This will include Patient Opinion, Patient Feedback leaflet and publications such as ‘How can I get involved’ leaflet and ‘Have Your Say’ cards. Work will continue with the Readers’ Panel to gather views and inform the work of the organisation; • Developing ways for the public to get involved in service redesign for example the redesign of diabetes service in Kirklees and hip replacements; • Continue with local and national consultations as they arise, including the Mid Yorkshire Service Strategy and Holme Valley Community Hospital Project; • Staff training in the area of PPI will also be developed to embed PPI into the organisation. It is planned to produce and promote a PPI Toolkit and a leaflet on PPI Team’s role within the organisation. In order to progress this, PBC workshops will be held in line with continuous promotion of PPI; and • Maintain and strengthen relationships with key stakeholders, both internal and external, including the Local Involvement Network and University of Huddersfield.

Practice Based Commissioning Significant developments have taken place during 2008/09 building solid foundations for the future of practice based commissioners as part of the commissioning community for 2009/10 onwards. These developments place PBC at every stage of the Commissioning Cycle, bringing enhanced clinical input into commissioning coupled with a practical in depth knowledge of local issues. Following on from engagement events the Commissioning College has been established bringing together practice based commissioners, health improvement teams and Professional Executive Committee (PEC) to build commissioning capacity and capability. A partnership approach to the development of a strategic direction to the commissioning of services with the practice level in-depth knowledge about how the local population use services is emerging in a more structured manner. This facilitates PBC engagement and participation in setting the strategic commissioning direction. There is a multi-disciplinary team approach to supporting PBC and this includes capacity and capability in commissioning, finance, information, medicines management, performance and public health. One of the activities that continues to be enhanced is around how information can be provided and used by practices to develop their understanding of activity and use of resources. This in turn equips them to contribute to management of NHS Kirklees’ financial position. The PBC Local Incentive Scheme is a recognised model of best practice and aligns investment in the development of PBC in every practice with the key commissioning performance indicators.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Practice based commissioning is now beginning to influence and support the operational aspects of commissioning such as contract management. There is representation on the Quality Boards with providers which assesses and sets the direction of travel in terms of quality in contracts. Bringing this micro level of knowledge from general practice enables the PCT to constructively challenge providers at a more detailed and evidence based perspective.

Specialist Commissioning We will also have in place effective commissioning arrangements for specialised services provided in specialist centres to catchment populations of more than one million people. The underlying aim of the arrangements for commissioning specialised services is to ensure fair access to effective, high quality clinical services across our area. User numbers for such services are small and a critical mass of service users is needed in treatment centres to: • Achieve the best outcomes and maintain clinical competence; • Sustain the level of training of specialist staff; • Ensure cost effectiveness in provision; and • Make the best use of scarce resources. Although these services are required by far fewer people than those provided in primary care and local hospitals, they do account for around 10% of total PCT expenditure. To ensure that these services are commissioned effectively, we will continue to commission in partnership with the other PCTs in Yorkshire and the Humber through the Specialist Commissioning Group (SCG) structure.

The SCG brings together all PCTs in Yorkshire and the Humber to enable us to make collective decisions on the review, planning, procurement and performance monitoring of specialised services, as well as any other service where an integrated commissioning response/action is beneficial. Current priority areas include: • • • • •

Obesity surgery; Cancer reform; Cardiac services; Children’s services; Long term conditions – renal services, neurological conditions; and • Mental health.

Community Hospital Development The NHS Kirklees Strategic Plan requires the development of three community hubs providing extended primary care services and enhancing access to secondary care services in community settings. Dewsbury Health Centre is one hub, and Holme Valley Memorial Hospital will become another. A further site close to Huddersfield town centre will be developed as the third hub. The projects to develop a community health centre and hub at Holme Valley Memorial Hospital (HVMH) and in central Huddersfield are being taken forward as part of the Community Hospitals Programme. Work at HVMH has included the development of a high level service model and a vision for the future of the hospital based on an analysis of local needs and current provision, which uses the JSNA as its starting point. The next step is to develop a detailed business case for investment, including detailed service models, financial models and an analysis of the options available to achieve the vision of future service provision required by the strategic plan. 13

Similar work is required on the central Huddersfield project, where this will be preceded by initial engagement with stakeholders to help build a clear picture of their requirements. Both of these projects will be taken forward with the assistance of external management consultants. The key milestones for 2009/10 will be the delivery of the Outline Business Cases in summer 2009, and the Full Business Cases in late autumn 2009. Subsequent approval by the PCT Board and the Strategic Health Authority will enable the investment of capital funds from the Department of Health to assist the delivery of these projects.

Section 4

Strategic context The operating plan is drawn up within the context of the NHS Kirklees’ 5 year strategic plan. In doing so it addresses key national policy and drivers including: • NHS Next Stage Review / Healthy Ambitions; • World Class Commissioning; and • The NHS Operating Framework 2009/10.

National and Local Priorities It is crucial that our strategy and goals reflect and respond to the opportunities and direction of national policy and reform. The priorities for the NHS and direction for the next three-year planning cycle are set out in the annual NHS Operating Framework, in which the emphasis is on shifting from central direction-setting to local priority setting in partnership with local people and communities. The Kirklees Local Area Agreement (LAA) was held up as good practice by the Yorkshire and Humber Government Office, and building on the strength of the partnership working, was agreed ahead of national deadlines. Our strategy reflects the commitment to this approach. NHS Kirklees has already put structures in place to improve health and access to the most appropriate services of the local population. Health Improvement Teams have been established as part of the Commissioning and Business Planning Framework with clinical leadership. Current local performance challenges include hospital and community acquired 14

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

infections, long waiting times for inpatient care at tertiary providers, mental health targets, and access to A&E. Investment in terms of resource, workforce planning and organisational development over the next five years will support the delivery of the strategic plan and delivery of the national and local priorities. Our choice of outcomes for world class commissioning reflects the above. These, together with our existing priorities, e.g. Vital Signs for the LAA, form the basis of our future performance regime.

Local Priorities The outcomes, identified through a process of consultation as part of world class commissioning, have been chosen in line with local priorities as set out in the JSNA. In the majority of cases Kirklees is an outlier for each of the chosen measures. The local health priorities of Kirklees are directly linked to the chosen outcomes and in line with both NHS Kirklees’ vision and the ‘areas of care’ from the NHS Next Stage Review. The delivery of the national and local priorities will support the achievement of our goals not only in terms of outcomes but also in terms of ways of working. Through strong clinical leadership and focus on the priorities and performance challenges, NHS Kirklees will be able to commission effectively to improve health and reduce inequalities.

National Priorities: NHS Next Stage Review – Delivering Healthy Ambitions The results of the national NHS Next Stage Review (NSR) were published in June 2008. The final report of Lord Darzi’s review High Quality Care for All, builds on earlier national statements of policy, in particular Our Health Our Care Our Say: a new direction for community services (2006), Choosing Health (2005) which stretch back to The NHS Plan, published in 2000. The NSR sets out a vision to provide people with good quality social care and NHS services in the communities where they live. The NSR report sets out plans that build on progress and how innovation and creativity of staff can further improve services. The report commits the Government to change driven by empowering staff at a local level not through top-down targets. The NSR report is accompanied by publication in early July 2008 of the NHS Next Stage Review - Our vision for primary and community care. This sets out the Government’s intended direction for primary and community care in England, where essential standards are ensured and excellence is rewarded. It focuses on personal and responsive health care providing integrated care based around the person, not just their individual symptoms or care needs. In the Yorkshire and Humber area Healthy Ambitions was published by the Strategic Health Authority (SHA) at the same time as the national reports. This document provides an invaluable benchmark against which to check our own local vision and plans. Healthy Ambitions also stresses the importance of strong primary care to the overall health care system. A strong primary care system leads to lower overall costs, better prescribing, better individual

outcomes and higher service user satisfaction. The existing practice registered list based model is central to delivery but must be accompanied by intelligent commissioning of primary care services, supported by use of good quality clinical and public health data. The direction for the future of health and health care in Yorkshire and the Humber as set out by Healthy Ambitions chimes well with our own existing vision and we are already addressing many of the priorities which it identifies. Examples include the LAA which has set key targets in a number of these areas including the promotion of breastfeeding and reducing obesity. Significant progress is also being made on specialist community and mental health services.

Total planned additional investment for 08/09 is £250k (including cancer and end of life care)

Planned Care

Referral to treatment is within 18 weeks, or within any stretch targets.

Standard maintained through out year

July 2009

We have commissioned services and worked with providers to ensure that the 18 week standard has been met.

New services for people suffering from musculoskeletal conditions in primary care mean that service users have greater choice of provider and care is delivered closer to home.

Fully integrated pathway for MSK patients to access services appropriately with improved quality and outcomes, reduced waits and reduced duplication of services

Patients are satisfied with their care and clinical outcomes are maintained or improved.

Outcomes

Timeline

Initiative / Action

(Local action mapped by Healthy Ambitions pathway)

Programme monitored through planned care HITAccess related performance standards monitored through provider contracts

Programme monitored through planned care HIT. Access related performance standards monitored through provider contracts Activity levels Risks – lack of support for integration by providers; lack of clinical sign up for new pathways. Mitigation – promote and drive whole systems approach; key involvement of clinical lead.

Informed by provider contracts, monitored by Planned Care HIT and reports to F&P

Performance Management

Mitigating actions – monitor performance closely, increase / decrease activity commissioned from providers to meet demand and standard. Focus service improvement on challenged specialties with programme management and identified benefits for service improvements.

Risk – 18 week standard is not met.

Risks

The following outlines how Healthy Ambitions recommendations and pathways are being delivered through local plans. They reflect the key deliverables for 2009/10 as per detailed programme plans for the priorities of NHS Kirklees underpinning the Five Year Plan.

Local action to deliver regional strategic priorities

Section 5

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

The quality of referrals for cataracts will be improved, with patients being assessed by community providers such as optometrists prior to decision to refer for surgery. Assessment based on impact on quality of life will support a more personalised approach to care.

September 2009 â&#x20AC;&#x201C; latest date

November 2009

Commission a community based cataracts assessment and referral service

Commission a Primary Eyecare and Referral Service (PEARS)

People experiencing a range of acute eye symptoms will be able to access a timely responsive service closer to home, thus avoiding visits to A&E or hospital based eye services.

Outcomes

Timeline

Initiative / Action

Planned Care (continued) Risks

Patient experience surveys

Audit data

Referrals to secondary care

Activity data

Patient experience surveys

Audit data

Referrals to secondary care and conversion rates into cataract surgery

Performance Management

Ongoing

Pathways should be workable and achievable and support the vital signs targets

Cancer services meeting DOH targets and providing the local population with equitable access to services

November 2009

For cancer care, we will implement the changes required in the cancer reform strategy. This will allow individuals to receive their care in a timely fashion and have a say in how their care is delivered.

The development of pathways of care for planned care as well as in cancer services and palliative care. This ensures that the key significant steps in the pathway are understood by the individual as well as the clinicians. However, the pathway is flexible to allow for service user choice and clinician decision making. We will continue to work closely with the PCT and providers across the region to understand commissioning decisions and give a clear direction for planning cancer services to ensure the people of Kirklees are not disadvantaged.

Outcomes

Timeline

Initiative / Action

Cancer and End of Life

Mitigating actions â&#x20AC;&#x201C; monitor performance closely, increase / decrease activity commissioned from providers to meet demand and standard. Focus service improvement on challenged specialties with programme management and identified benefits for service improvements.

Risk of cancer pathways not being adhered to and CWT not met

Mitigating action to monitor performance and activity levels and review service contracts for increased capacity and demand

Risk for bowel cancer is greater uptake than national average on age group not funded for. Increased uptake of FOB results which require endoscopy and treatment of cancer beyond the designated 92p per head of population

Risks

Through Performance Indicators

Through the Going Forward on Cancer Pathways Forum and the engagement of local.

Informed by provider contracts and performance indicators

Through Cancer HIT and the Cancer Local Implementation group.

Performance Management

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

All GP practices and nursing homes will be using the EOL care pathways

August 2009

March 2010

Palliative care has been integrated into new pathways for long term conditions and the Gold Standard for end of life care has been adopted in some of our nursing homes.

Palliative care services will be improved. End of life care will be available for everyone with long term terminal conditions. Individuals and their families will be at the core of how care is commissioned and delivered.

The delivery of hospice services commissioned by the PCT is a good example of how we decide where and how care is delivered for a specific pathway of care in specific communities. The investments in palliative care will support this further.

The existing Lymphoedema Services is disparate and inequitable across the PCT. The service will be developed to incorporate non cancer as well as cancer patients and will include advanced treatments for all of the Kirklees population

Equitable service for cancer and non cancer Lymphoedema services across the district

All patients requiring Hospice care will have access whether they have a cancer or non cancer condition

All professionals caring for long term terminal conditions will have access to advise and education on EOL care

Outcomes

Timeline

Initiative / Action

Cancer and End of Life (continued)

Mitigating actions â&#x20AC;&#x201C; monitor performance closely for increased activity commissioned from providers to meet demand and standard.

Service demand may outstrip the service provision as health care professionals become aware of and able to diagnose Lymphoedema

Risks

Informed through provider contracts and performance indicators

Informed through provider contract and performance indicators

Informed through EOLSG, provider contract and performance indicators

Informed through EOL Strategy group, provider contracts and Performance indicators

Performance Management

The five Every Child Matters (ECM) outcomes achieved; Reduced inequalities in health; Increase in rate of breastfeeding; Reduction in infant mortality; Reduction in smoking rates; Reduction in obesity at school entry; Reduction in teenage conceptions; Increased service user involvement and satisfaction with service; Reduction in number of child protection cases; Reduction in (parental) alcohol misuse; Improved family nutrition; Reduction in Sexually Transmitted Infections (STI); Increased uptake of immunisations; Reduction in accidents; Improved oral health; Reduction in the incidence, severity and impact of Post Natal Depression;

December 2009

Develop and agree new specifications for health visiting and school nursing and ensure effective delivery.

Establish effective monitoring systems and ensure evaluation against outcomes.

Total planned additional investment is £647k

CYPP

Integrate service delivery across children’s centres, general practice and health visiting.

Ensure the programme is embedded in the roles of service providers and effectively delivered.

Ensure implementation of the new CYPP.

Outcomes

Timeline

Initiative / Action

Children’s

Insufficient HV capacity to deliver MH pathway as under an escalation plan.

Maternal Mental Health Pathway changed to meet NICE guidance – revised pathway to be agreed through Governance.

New HV spec not agreed – revise spec and re-consult

Failure to recruit to HV posts due to shortage – escalation plan in place (currently at amber)

Risks Children’s HIT will monitor delivery of CYPP

Performance Management

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Disabled Children

Teenage Pregnancy

Every Disabled Child Matters Charter

To implement ‘Aiming High for Disabled Children’ and ‘Standard 8 NSF’.

December 2009 onwards

Ongoing

There is an effective Teenage Pregnancy Strategy both agreed and implemented and the sexual health programme contributes to the Teenage Pregnancy strategic objectives.

Other key strategies, especially Alcohol and Drug, Food, Obesity, and Emotional Wellbeing have clear priorities for children and young people to have access to appropriately young friendly services that effectively address their needs

Timeline

Initiative / Action

Children’s (continued)

Families/carers have access to a variety of support options and are fully informed about what is available

Reduction in unwanted/unplanned teenage conceptions, better access to more effective services, improved self-esteem, better relationships

Improved emotional health and wellbeing for children and families; Reduction in admissions to A&E/hospital due to accidents and long-term conditions.

Outcomes

Risks

Ensure access to effective and appropriate services for disabled children.

Implementation of effective teenage pregnancy strategy, to develop and implement Sexual Health Programme

Performance Management

To implement a comprehensive Emotional Health and Wellbeing Strategy. To deliver a timely, integrated, high quality multi-disciplinary mental health service. This would ensure effective assessment, treatment and support for children, young people and their families.

Total planned additional investment is £300k

YAS inability to meet/sustain improvement – continued joint working and planning. Feedback may result in some changes being necessary.

Targets met. Patients receive improved service. Increasing levels of satisfaction

2009/10 and on-going

Ensure YAS performance improves year on year

Promote appropriate use of services through social marketing and feedback systems

1. Sign-up from the different parties not achieved. - Continuous work to ensure it is achieved.

ECC’s in place. All patients triaged in one place. Integrated working between primary, secondary and social care. This will mean that service users will know where to receive their care and from whom

2009/10 and on-going

Risks

Continue to develop streaming services within A&E departments

Improve self-esteem, increase resilience to stressors, improve self efficacy, better relationships, improved emotional literacy, less bullying, increased/improved assertiveness and better access to more effective Mental Health Services.

Outcomes

March 2010

Timeline

Initiative / Action

Urgent Care (Acute)

Emotional Health and Wellbeing

Seeking and monitoring of feedback

PI’s and regular reporting mechanisms.

Programme/project management PI’s

Performance Management

To improve emotional health and well-being for children and young people

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Outcomes We will integrate a new ‘Access and Assessment’ service for West Yorkshire that will provide consistent information for our service users and a central point for their urgent care needs to be addressed. Increasing levels of satisfaction

Timeline 2009/10 and on-going

2009/10

Initiative / Action

Services that work to deliver urgent care will be fully integrated. This includes OoHs services, A&E departments and ambulances services. These services will also work in tandem with GPs, secondary care and social care services.

We will continue to work with our communities and partners to improve the quality and accessibility of urgent care services and reduce inequities of care by continued social marketing and seeking feedback about our services.

Urgent Care (Acute) (continued)

Feedback may result in some changes being necessary.

To be delivered by NHSDirect

Risks

Seeking and monitoring of feedback

PI’s agreed and in place for start of contract.

Performance Management

Total planned additional investment is £400k

Lack of investment in community midwifery capacity – business case submission and contract negotiations with Providers

Every woman will feel in control over her choices and be fully informed and involved in the decisions about her pregnancy and the birth of her child. She will have equitable access to high quality services centred around her, her baby and her family’s needs. This will enable her to have as normal a pregnancy and birth as possible and as appropriate, taking account of both her and her partner’s wishes. Ensure women have access to effective support to make sustainable lifestyle changes relevant to the context of their lives and those of their families

March 2010

July 2009

March 2010

Enable women to support each other through peer groups in a range of settings familiar and comfortable to women themselves, by piloting a peer led “salon” approach in Dewsbury

Extend insight with pregnant women and practitioners to south Kirklees

The Strategy will ensure women and families are supported around their pregnancy and clinical needs, their health and lifestyle needs and their wider social needs including income, housing, domestic violence and substance misuse.

Lack of clarity of roles in delivering the care pathways – detailed multi-agency development of pathways

Failure to recruit experienced family support workers – support existing or newly qualified with comprehensive training programme

Failure to recruit trained and experienced midwives – programme of training for existing labour ward midwives supported by maternity support workers.

Risks

Outcomes

Timeline

Initiative / Action

Healthy Pregnancy and Maternity

Maternity Matters Board

Children’s HIT

Choosing Health HIT(s);

Maternity Matters Board

Children’s HIT

Choosing Health HIT(s);

Performance Management

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Total planned additional investment is £333k

Commission and implementation of a risk stratification tool to identify people with LTCs and ensure they are receiving the appropriate level of care, support and services with a view to reducing hospital referral or admission

Initiative / Action Outcomes Commissioning of services based on intelligence generated by predictive risk tool

Timeline June 2009

The Healthy Pregnancy Strategy aims to ensure that women are fully engaged in the development of information and are supported to inform commissioners and providers how services can best be provided to meet their needs

December 2009

Establish Maternity Services Liaison Committee for Kirklees. Ensure continued testing of the models and services through social marketing.

Long Term Conditions

Outcomes

Timeline

Initiative / Action

Healthy Pregnancy and Maternity (continued)

Lack of quality and consistency of data flows

No change of behaviour by clinicians as a result of available equipment

Information sharing not agreed

Predictive risk tool not procured in a timely manner

Risks

Failure to recruit trained and experienced midwives – programme of training for existing labour ward midwives supported by maternity support workers.

Lack of investment in community midwifery capacity – business case submission and contract negotiations with Providers

Risks

Appropriate referral of patients to services supporting LTC management

Identification by practices of those individuals at risk of admission

Implementation of predictive risk tool and utilisation by practices

Performance Management

Maternity Matters Board

Children’s HIT

Choosing Health HIT(s);

Performance Management

September 2009

June 2009

We will further improve our approach to LTC and introduce new pathways of care for service users with sensory impairment.

Development of specialist elements of the pathway in line with the standards set out in the disease specific National Service Frameworks, concentrating on bringing services closer to home and developing hospital services that offer rapid access to assessment, diagnostics and treatment,.

Address any health inequalities which will requires a focus on improving services in those areas where choice is limited and/or traditional services are having little impact

Work with localities to commission services that are appropriate to individual communities matching approach to need and improving access

Reduced health inequalities and improve equitable access to services across Kirklees

People will be managed and cared for in line with evidence of best practice

Lack of behavioural/cultural changes to lifestyle risk factors

Effective stakeholder engagement

Lack of quality and consistency of data flows

Availability of data to support service redesign

Availability of timely and appropriate diagnostics

Recruitment of skilled practitioners

Resistance to change traditional pathways of care

Availability of timely and appropriate diagnostics

Procurement of services to support people with sensory impairment Recruitment of skilled practitioners

Resistance to change traditional pathways of care

Monitor any inequalities within QoF, CAA, locality plans, JSNA and service utilisation data

Monitor any inequalities within QoF, CAA, locality plans, JSNA

Monitor compliance against National service frameworks and NICE guidance

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Competent workforce available to provide LTC management

September 2009

April 2009

Working with Higher Education Institutions and other providers to commission programmes that will meet the needs of the new pathways.

Introduction of a 24 hour generic health and social care workforce trained to provide the support of individuals and carers within their own homes or intermediate care settings

Development of training package to enable social care staff to support patients acutely unwell due to LTCs

Competent workforce available to provide LTC management

September 2009

Training needs analysis of health and social care workforce to deliver specialist and generic elements of LTC care pathways

Care delivered closer to home

Outcomes

Timeline

Initiative / Action

Long Term Conditions (continued)

Accreditation and competency assessments

Availability of adequate and effective training opportunities

Sustainability of competence in LTC management

Sustainability of LTC training provision

Patients managed inappropriately at home

Attendance and completion of training programme to develop skills to support people at home who have LTCs

Referral patterns to generic workers

Reduction in unplanned hospital admissions for LTCs

Lack of referrals to generic workers Poor patient of GP satisfaction with service

Training will be commissioned from appropriate providers

Lack of resource to commission appropriate training packages Availability of adequate and effective training opportunities

Lack of resource to commission appropriate training packages

Lack of resource to complete Training needs analysis

Performance Management

Risks

April 2009

April 2008 â&#x20AC;&#x201C; onwards Joint strategy developed by June 2010

Commission expansion of the single point of contact for health and social care service.

Extension of the community matron and case manager workforce by 50% and integration of this workforce alongside other generic practitioners such as GPs, Practice Nurses and District Nurses.

Commission community discharge coordinators to reach into the acute trusts to facilitate safe and appropriate discharge

Develop effective partnership and integration with all appropriate agencies locally

Care will be coordinated and consistent throughout Kirklees

Care will be delivered out of hospital in the community or the individuals home

LTC health and social care will be integrated and coordinated across all levels of the care pathway

People with high intensity needs or risks of health or social care crisis will be identified and case managed effectively

Lack of stakeholder engagement in partnership agenda

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Lack of referrals to be case managed

Identification of patients to be case managed

Availability of advance practitioner or prescribing training

Difficulties with recruitment

Poor patient or GP satisfaction with the service

Timely implementation of single point of access

Reduced duplication of assessment Timely access to appropriate services

Poor patient of GP satisfaction with service

Improved coordination or care

Audit to measure implementation of joint LTC strategy

Reduction in < 24 hour LTC activity

Reduction in emergency bed days from 08/09 baseline by 15%

Reduction in non elective activity and emergency bed days for ambulatory conditions from 08/09 baseline by 15% 09/10, 15% 10/11 10% 11/12

Implementation of common assessment framework

All referrals for health and social care services coordinated via single point of contact

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Cardio Vascular Disease

Improved life expectancy

March 2010 onwards

To offer those identified ‘at risk’ a personalized education package to enable them to reduce their risk factors e.g. healthier lifestyles and treatment.

Development of care pathways to diagnose and manage the consequences of heart disease on the individual

To increase in the number of referrals to appropriate mainstream services, e.g. stop smoking services

Self care will be an integral part of all LTC management

April 2008 onwards

Self care pathway will be included in all LTC programmes and long term conditions pathways.

Reduced levels of CVD

Difficulty engaging with stakeholders and service users to validate and revalidate care pathways

Services will be commissioned and pathways of care developed in consultation with service users

April 2008 onwards

Widespread consultation with users, such as stakeholder summits to check the direction of travel and revalidate the pathways.

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Users not representative of general public’s opinion re care pathways

Risks

Outcomes

Timeline

Initiative / Action

Long Term Conditions (continued)

Reduced mortality rates for CVD

Increased referrals to mainstream services to support ‘healthier lifestyles’

Development of accurate at risk cardiovascular registers

Annual GP survey

Patient reported outcomes and experience surveys

All people with LTCs will have a personalised care plan by 2010

LTC summit consultation events

Patient reference groups for all LTCs developed

Performance Management

To develop and implement care pathways for the effective and timely diagnosis and management of cardiovascular disease

To develop enhanced service schemes to support the identification and management of people who are at risk of developing cardiovascular disease

Cardio Vascular Disease

To increase the number of the target population who have been assessed and identified as

To develop ‘at risk’ registers within primary care

To implement services that are tailored to the individuals and the needs of the community to reduce their risk factors

Cardio Vascular Disease

March 2010 onwards

Recruitment of skilled practitioners

Identification by practices of those individuals at risk of admission

Integrated and coordinated risk identification across all levels of the care pathway

Care delivered according to CVD care protocols and guidance

Recruitment of skilled and competent staff to deliver ‘at risk’ care pathways

Stakeholder engagement/resistance to change traditional pathways of care

Resistance to change traditional pathways of care

Timely access to appropriate services

Care closer to home

Poor patient of GP satisfaction with service

Lack of behavioural/cultural changes to lifestyle risk factors

Effective stakeholder engagement

Improved coordination or care

Reduced health inequalities and improve equitable access to services across Kirklees

Reduction in primary care referrals new and follow up to secondary care (baseline and trajectory to be agreed)

Reduction in non elective activity and emergency bed days for CVD from 08/09 baseline by 15% 09/10, 15% 10/11 10% 11/12

All referrals for CVD coordinated via single point of contact

Monitor any inequalities within QoF, CAA, locality plans, JSNA and service utilisation data

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Cardio Vascular Disease

Work in partnership with Choosing Health programmes in Kirklees to ensure appropriate services are commissioned to support individuals to make changes in personal behaviours to reduce their risk of cardiovascular disease

Social marketing techniques used to enable services to be commissioned appropriate to the needs of the local population

To increase the number of the target population who have been risk assessed

To increase the number of the target population prescribed appropriate medication to reduce their risk

being at increased risk of developing cardiovascular disease, prescribed appropriate medication to reduce their risk

Initiative / Action

Long Term Conditions (continued)

Joint CVD strategy developed by June 20010

April 2008 â&#x20AC;&#x201C; onwards

March 2010 onwards

Timeline

Care will be coordinated and consistent throughout Kirklees

Reduced prevalence of CVD in Kirklees against 08/09 baseline

Services will be commissioned according to the needs of the individual and will be appropriate to the communities within Kirklees

Outcomes

Lack of stakeholder engagement in partnership agenda

Patient reported outcome and experience surveys

Adequate availability of social marketing expertise

Audit to measure implementation of joint CVD strategy

Reduced risk factors and personal health behaviour

Reduced prevalence of CVD

Services for people with CVD risk are accessed

Performance Management

Resources not available to meet the needs of effective use of social marketing

Risks

Stroke

Develop skills of health care professionals to respond appropriately to the signs of stroke or TIA

Adherence to national and local guidelines for the management of stroke

Prompt primary care assessment and appropriate referral for all individuals who have had TIA.

Develop skills of health care professionals to respond appropriately to the signs of stroke or TIA

Commission services responsive to the urgent requirements for assessment and management of stroke and TIA

September 2009, implement by April 2010

Rolling programme of training for health and social care staff available from September 2009

September 2009, implement by April 2010

Development of local guidelines and care pathways for the management of stroke and TIA

Emergency and out of hours services respond promptly and appropriately to risk factors associated with stroke and TIA.

Ongoing public and professional awareness campaigns

Prompt public and primary care assessment for risk factors associated with stroke

Develop effective partnership and integration with all appropriate agencies locally

All people who present with stroke or TIA are offered appropriate assessment management and follow up

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Unresponsive emergency services and other health care providers

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Unresponsive emergency services and other health care providers

Those with high risk of full stroke are assessed within 24 hours.

Brain imaging is available within 60 minutes of request including out of hours.

Reduced number of stroke related deaths

Adherence to national and local guidelines for the management of stroke

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Stroke

September 2009, implemented by April 2010

Commission services to support hyper-acute management of stroke.

March 2010 onwards

Development of local guidelines and care pathways for the management of stroke and TIA

Incorporate care planning into routine care of people at risk or with stroke.

Sept 09, implement by April 2010

Commission services to support acute management of stroke within a specialist stroke unit and supported by staff with specialist stroke management skills

Development of local guidelines and care pathways for the management of stroke and TIA

Timeline

Initiative / Action

Long Term Conditions (continued)

Individuals will feel supported and in control of their lifestyle choices

The individual will determine their care goals and have an individualised action plan to meet these goals

All people who suffer a stroke and supported and managed by specialist staff within an area dedicated to high quality stroke care

Outcomes

Access is available to a hyper-acute stroke service that provides access to 24 hour brain imaging, consultant stroke specialist and thrombolysis if appropriate.

Timely access to diagnostics and specialist care

Availability of resources to support care planning

Information/data collection systems not available

Patient reported outcomes and experience surveys

All people who have had a stroke will have a personalised care plan by 2010 Lack of stakeholder engagement

Recruitment of specialist stroke management staff

Access is available to a stroke unit for all individuals who suffer a stroke and people who have had a stroke spend 90% of their time in hospital in a stroke unit Timely access to diagnostics and specialist care

Unresponsive emergency services and other health care providers

Those with lower risk of full stroke but are presenting with TIA are assessed within seven days.

Performance Management

Timely access to diagnostics and specialist care

Risks

Development and implementation of care pathways for management of respiratory disorders in primary care including the integration of tele-health into routine care

Respiratory

All partners to actively promote pulmonary rehabilitation ensure effective marketing (internal/external) and signposting to clients.

Commission a comprehensive pulmonary rehabilitation programme comprising of an individualised exercise programme and education sessions which is integrated with the Expert Patient Programme.

Comprehensive rollout of Gold Standards framework and Liverpool care pathway within all care settings throughout Kirklees.

Stroke

March 2010 onwards

People with respiratory disorders will be managed within primary care if clinically appropriate

Individuals will be offered choice in their place of death and health or social care provision at end of life

Individuals will be offered choice in their health or social care provision

Reduced A&E visits and YAS callouts due to respiratory disorders from 08/09 baseline Lack of specialist staff to support people and their families

Lack of incentive to change behaviour or current practice

Reduced emergency admissions due to asthma and COPD 15% from 08/09 baseline.

Implementation of Liverpool care pathway and Gold Standards Framework

Annual GP survey

Lack of motivation to change current practice and behaviour

Lack of specialist palliative care staff to support people and their families at end of life

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Medical model of care continues within consultations

No reduction in emergency service utilisation as a result of care planning

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

April 2009

March 2010 onwards

June 2009

A comprehensive early supported discharge service for people with COPD

All people with respiratory disease and who smoke will be offered opportunities to stop smoking appropriate to their needs and resulting in successful quit attempts

Increase primary knowledge and understanding of appropriate assessment and referral pathway for sleep disordered breathing

Respiratory

Commission a primary care specialist sleep service for diagnosis and treatment of respiratory sleep related disorder

Timeline

Initiative / Action

Long Term Conditions (continued)

Reduced physical and psychological complications of sleep disordered breathing

Patients with sleep disordered breathing are accurately assessed and managed in line with national guidelines

Reduced smoking related respiratory diseases

Patients with exacerbation of COPD will be managed in the community by specialist respiratory practitioners

Outcomes

Patients accessed as suitable for early supported discharge will be discharged within 48hrs of their admission Reduced smoking in people with respiratory disease form 08/09 baseline

Annual audit of referrals to primary care specialist sleep service Adherence to national and local guidelines and care pathways

Lack of motivation to change current practice and behaviour

Unable to influence behaviour change

Recruitment of specialist staff

Lack of motivation to change current practice and behaviour Lack of incentive to change behaviour or current practice

Procurement of specialist services

Lack of referrals to tobacco control services and resources

Lack of incentive to change behaviour or current practice

Procurement of specialist services

Reduced average length of stay for COPD from 7 days to 5 days.

Performance Management

Recruitment of specialist staff

Risks

Respiratory

Commission a comprehensive pulmonary rehabilitation programme comprising of an individualised exercise programme and education sessions which is integrated with the Expert Patient Programme

Respiratory

Development and implementation of care pathways for management of respiratory disorders at end of life

Comprehensive rollout of Gold Standards framework and Liverpool care pathway within all care settings throughout Kirklees.

Incorporate care planning into routine care of people with respiratory disease

Commission primary care specialist assessment for oxygen and nebulised therapy.

Respiratory

March 2010 onwards

April 2009

Individuals will be offered choice in their place of death and health or social care provision at end of life

Individuals will be offered choice in their health or social care provision

Individuals will feel supported and in control of their respiratory disease

The individual will determine their care goals and have an individualised action plan to meet these goals

Patients receive diagnosis and management of respiratory disease in their right place, at the right time by the right person

Lack of specialist palliative care staff to support people and their families at end of life

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Medical model of care continues within consultations

No reduction in emergency service utilisation as a result of care planning

Availability of resources to support care planning

Information/data collection systems not available

Lack of stakeholder engagement

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Procurement of specialist services

Recruitment of specialist staff

Implementation of Liverpool care pathway and Gold Standards Framework

Annual GP survey

Patient reported outcomes and experience surveys

All people with respiratory disease will have a personalised care plan by 2010

Adherence to national and local prescribing guidelines including oxygen therapy

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

March 2010 onwards

June 2009

Development of care pathways for the diagnosis and management of diabetes in primary care

Increase uptake of services to prevent complications of diabetes for all people with diabetes.

A comprehensive service user education programme which has clear links to primary and secondary care and the Expert Patient Programme.

Diabetes

All partners to actively promote service user education ensure effective marketing (internal/external) and signposting to clients.

Timeline

Initiative / Action

Long Term Conditions (continued)

People feel supported and in control of their diabetes

Self care will be an integral part of all diabetes management

People with diabetes will be offered alternatives to non elective admissions to hospital

Outcomes

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Lack of specialist diabetes practitioners to support generalist staff, the public, people with diabetes and their families

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Risks

Reduced crisis calls due to diabetes from 08/09 baseline

Patient reported outcomes and experience surveys

All people with disease will have a personalised care plan by 2010

Increased uptake of : retinal screening foot screening service user and carer education programmes form 08/09 baselines

Reduced A&E visits and YAS callouts due to hyperglycaemia by 15% against 08/09 baseline.

Reduced emergency admissions due to diabetes or complications related to diabetes by 15% against 08/09 baseline

Performance Management

Neurology

Develop self care skills of individuals to manage their neurological condition effectively

All partners to actively promote service user education ensure effective marketing (internal/external) and signposting to clients.

Implementation of well evaluated self-management programmes.

Review the provision of rehabilitation services for people with neurological conditions which will have clear links to primary and secondary care and the expert patient programme

Incorporate care planning into routine care of people with diabetes

A wide range of resources will be available and accessible to the public across Kirklees.

Commission a comprehensive quality assured structured patient education programmes

Develop self care skills of individuals to manage their diabetes effectively

September 2009

People feel supported and in control of their neurological condition

Self care will be an integral part of all neurological condition management

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Lack of stakeholder engagement

Annual GP survey

Reduced non elective admissions for neurological conditions from 08/09 baseline

Patient reported outcomes and experience surveys

All people with neurological conditions will have a personalised care plan by 2010

Annual GP survey

Reduced non elective admissions for diabetes from 08/09 baseline

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Neurology

Development of standardised and quality assessed provision

Joint involvement of PCTs, social care and service user in all service developments

Reviewing the provision of services for people with epilepsy

Establishing a common approach to the use of existing and new disease modifying therapies for people with multiple sclerosis

Ensuring sufficient capacity is available within primary and secondary care to sustain the achievement of national waiting time targets.

Incorporate care planning into routine care of people with neurological conditions

A wide range of self care resources will be available and accessible to the public across Kirklees.

Commission comprehensive quality assured structured patient education programmes

Initiative / Action

Long Term Conditions (continued)

March 2010 onwards

Timeline

People with neurology conditions will be cared for effectively in the community

Prompt and accurate diagnosis of neurology conditions in primary care

Outcomes

Recruitment of skilled and competent staff to deliver new care pathways

Stakeholder engagement/resistance to change traditional pathways of care

Reduced inappropriate outpatient referrals for specialist opinion form 08/09 (trajectory to be agreed)

Improved service user feedback.

Reduced incidence of hospitalisation for neurological conditions by 15% against 08/09 baseline

Lack of incentive to change behaviour or current practice Lack of specialist neurology practitioners to support generalist staff, the public, people with neurology conditions and their families

Adherence to national and local guidelines

Performance Management

Lack of motivation to change current practice and behaviour

Risks

Neurology

To develop an end of life care pathway for people with neurological conditions working with appropriate voluntary sector partners e.g. Parkinsonâ&#x20AC;&#x2122;s Society, MS Society.

Comprehensive rollout of Gold Standards framework and Liverpool care pathway within all care settings throughout Kirklees.

Develop service user reference to oversee development and implementation of care pathways for neurological disease management

Develop training programme for health and social care professionals to manage neurological disease in primary care

Development and implementation of care pathways for the diagnosis and management of diabetes

Develop and establish the implementation of the role of the Neurological Alliance within local service provision.

for home care and community services related to neurological conditions

March 2010 onwards

Individuals will be offered choice in their place of death and health or social care provision at end of life

Lack of specialist palliative care staff to support people and their families at end of life

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Implementation of Liverpool care pathway and Gold Standards Framework

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

CHD

Development of care pathways for the diagnosis and management of care of patients with coronary heart disease or its physical and psychological consequences

Development of care pathways to diagnose and manage the consequences of heart disease on the individual

To increase in the number of referrals to appropriate mainstream services, e.g. stop smoking services

March 2010 onwards

April 2009

To ensure equitable and evidence based multidisciplinary programmes of secondary prevention and cardiac rehabilitation are available to individuals who have experienced a cardiac event

To offer those identified ‘at risk’ a personalized education package to enable them to reduce their risk factors e.g. healthier lifestyles and treatment.

Timeline

Initiative / Action

Long Term Conditions (continued)

Lack of motivation to change current practice and behaviour

Reduced levels of CVD

Lack of incentive to change behaviour or current practice

Lack of stakeholder engagement

Risks

Improved life expectancy

Outcomes

To adhere to national and local guidelines for the management of Coronary Heart Disease and related risk factors, and action is taken to reduce overall risk

Reduced mortality rates for CVD

Increased referrals to mainstream services to support ‘healthier lifestyles’ against 08/09 baseline

Development of accurate at risk cardiovascular registers

Performance Management

CHD

Develop and implement an evidence based pathway and related services for the diagnosis and management of people with heart failure

CHD

Continue to commission specialist stop smoking services which will enable those with established Coronary Heart Disease to access support for stopping smoking

Training programme for health and social care professionals to diagnosis and manage heart failure in primary care

Commission services which identify close family members at risk of those suffering sudden cardiac death

CHD

Reduced smoking related diseases

Lack of referrals to tobacco control services and resources Lack of stakeholder engagement

Unable to influence behaviour change

Reduced smoking in people with coronary heart disease from 08/09 baseline

Audit of management of patients with heart failure in line with NIHCE Clinical Guidance

June 2009

March 2010 onwards

Audit of adherence to national and local guidance

April 09

Reduce non elective activity due to heart disease by 15% form 08/09 baseline

To deliver a 10% increase per year in the proportion of people suffering a heart attack who receive Thrombolysis within 60 minutes of calling for professional help

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

CHD

A wide range of self care resources will be available and accessible to the public across Kirklees.

Commission comprehensive quality assured structured patient education programmes

Develop self care skills of individuals to manage their coronary heart disease effectively

Commission a comprehensive evidence based equitable programme of cardiac rehabilitation delivered by practitioners with specialist skills in cardiac rehabilitation

Review the provision of rehabilitation services for people with coronary heart disease which will have clear links to primary and secondary care and the expert patient programme

All people with heart disease and who smoke will be offered opportunities to stop smoking appropriate to their needs and resulting in successful quit attempts

Initiative / Action

Long Term Conditions (continued)

March 2010 onwards

Timeline

People feel supported and in control of their coronary heart disease

Self care will be an integral part of coronary heart disease management

Outcomes

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Risks

Annual GP survey

Reduced non elective admissions for neurological conditions from 08/09 baseline

Patient reported outcomes and experience surveys

Patients registered with Coronary Heart Disease receive advice and treatment in line with National Service Framework standards All people with coronary heart disease will have a personalised care plan by 2010

Performance Management

Total planned additional investment is £1383k

Mental Health

CHD

Full capacity December 2009 Implemented April 2009, full capacity April 2010

Primary Care Mental Health Services

Timeline

March 2010 onwards

Early Intervention in Psychosis

The PCT has commissioned or has planned intentions to commission new and significant mental health services:

Initiative / Action

Development and implementation of care pathways for management of cardiology disorders at end of life

Comprehensive rollout of Gold Standards framework and Liverpool care pathway within all care settings throughout Kirklees.

Incorporate care planning into routine care of people with coronary heart disease

Risk – Agreed standards are not met.

There will be emphasis on the promotion of independence and protection of vulnerable people. We will work on reducing reliance on institutional care by creating more suitable service solutions and packages of care for people in the community.

Risks

Lack of specialist palliative care staff to support people and their families at end of life

Lack of incentive to change behaviour or current practice

Lack of motivation to change current practice and behaviour

Outcomes

Individuals will be offered choice in their place of death and health or social care provision at end of life

Stretch monthly targets agreed End March 2010 – 3342 new referrals seen

Quarterly target = 26 new cases, by dec 09 192 new cases

Through provider contracts monthly & quarterly

Performance Management

Implementation of Liverpool care pathway and Gold Standards Framework

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Implemented October 2008

Section 136 of the Mental Health Act (1983)

Implemented September 2008, ongoing Transition service during 2009 Extends to new referral service 2010 onwards

2009/10

Psychiatric Intensive Care Unit.

Adult ADHD development

To facilitate 12 month work plan to manage current waiting list backlog to ensure service can achieve & maintain 18 week pathway

Enhanced specialist psychological therapy service providers to ensure that the 18 week standard will be achieved & maintained

To further develop governance arrangements to enhance service from 14 years by June 2009

Timeline

Initiative / Action

Mental Health (continued) Outcomes

Risks

Agreed access standards set within national best practice 18 week standard will be achieved & maintained by Sept 09

Agreed waiting list backlog will be cleared within financial year 2009/10

Baseline of 75 adults require transition into adult service

Eliminate the requirement for Out of Area placements

In line with agreed protocol & criteria â&#x20AC;&#x201C; achieve a statistically significant reduction in the number of individuals under section 136 detained within police cells

End March 2011 5013 new referrals seen

Performance Management

Employment service Self help Arts Physical activity Advice and support

In partnership, we will commission a range of services with third sector providers:

To Increase the number of adults in contact with mental health services who are in employment

To improve & sustain emotional & psychological well being within the Kirklees population by commissioning services which provide the right service in the right place at the right time

2009/10

2008/09 WAA contracts established

2009/11

Standard maintained throughout year

This will include initial development of need appropriate/ageless services across 3rd sector

The development and maintenance of sustainable communities will be supported to address social exclusion.

There will be changes in directly provided services alongside work to grow the voluntary and independent sector, offering people more choice and control.

There will be an emphasis on prevention and well-being.

Risks â&#x20AC;&#x201C; lack of support for integration by providers; lack of clinical sign up for new pathways. Mitigation â&#x20AC;&#x201C; promote and drive whole systems approach; key involvement of clinical lead.

Agreed capacity growth within contracts

Agreed targets set, which demonstrate statistically significant improvement calculated in accordance with the Target Negotiation Brief on baseline data for 2008/09 2009/10 increase of 1.25% = 16 new 2010/11 increase of 2.6% = 33 new

Through provider contracts monthly & quarterly monitoring

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

capacity to be increased across specific contacts by 20% to reflect Kirklees over 65â&#x20AC;&#x2122;s population Standard maintained throughout year & into future years

Gender specific Carers Advocacy

The partnership work underway will be further developed to deliver better outcomes and economies of scale. The health and social well-being of people who live in Kirklees is a high priority

Ensure existing robust commissioning and contracting relationships are maintained with providers, influence the mental health market through enhancing relationships.

Timeline

Initiative / Action

Mental Health (continued)

We will continue to build on our opportunities to repatriate Out of Area Treatments (OATs)

To develop a wide range of locally based services that deliver care for individuals as close to home as possible

Outcomes

Risk- inability of local providers to meet required pace of change Mitigation- Establish a clear PCT profile to support and enhance the PCTâ&#x20AC;&#x2122;s reputation within the market and support relationships with key stakeholders.

Risks

Through in year analysis of data to map trends in activity volume, type & cost

Performance Management

Developed infrastructure of core services to deliver evidence- based healthy eating service provision working with identified target groups; Success will result in: Improved healthy eating behaviour amongst target groups. Improved availability and quality of healthy eating training delivered by key services Increased provision of healthy eating key messages delivered by key services. 239 healthy cooking courses delivered in north Kirklees targeting vulnerable adults and women of a child bearing age. A minimum of 1912 individuals will have accessed the cooking tutor’s scheme.

Final service specification agreed. Recruitment of staff March 2009. Performance management via public health ongoing for 2 years through to 2011

Contract to be awarded April 2009 Performance management via Public Health on – going for 2 years through to 2011

Establish a Kirklees Community healthy cooking service.

Food

Outcomes

Develop role of key staff to support food behaviour change amongst identified target population groups (families& children, vulnerable groups) – Establish Food & wellbeing Service

Timeline

Food

Total planned additional investment is £753k

Initiative / Action

Choosing Health (Staying Healthy) Risks

Number of key workers trained to deliver Community Healthy cooking skills programmes in identified localities.

Number of participants reached via cooking courses.

Number of participants attending food messages training

Number of NHS /main role staff trained in healthy eating brief interventions.

Performance Management

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Food

Develop and disseminate & implement NHS Kirklees Breastfeeding policy to managers and staff.

Developing good practice amongst initiatives.

Ongoing 2009-2013.

To develop data relating to food access issues to inform commissioning of food initiatives in Kirklees. Identification & promotion of existing community food initiatives Kirklees wide.

Food

Ongoing

Access report to be completed by Sept 2009.

50 new business engaged year on year, total of 200 new business by 2013.

Ongoing scheme: 2009 â&#x20AC;&#x201C; 2013.

Increase Healthy Choice Award uptake in target settings.

Food

The success will result in a trust wide policy that is well communicated to all levels of staff

A comprehensive network of targeted food activity across Kirklees that is monitored by programme leads. Success will result in: Improved healthy eating behaviour amongst target groups and increased provision of healthy eating key messages delivered by key services.

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued) Risks

Audit monitoring tool to be implemented through BFI process

Number of organisations accessing accredited training.

Number of organisations engaged Eatwell partnership network & website.

Quarterly monitoring figures provided by provider of service

Service specification in place, performance managed by programme leads

Number of participants reached via cooking courses.

Performance Management

2010 onwards

Encouraging eye tests, advice on tiredness, alcohol and medicines - home assessment and surveillance can reduce falls in frail older people.

Seat belt education campaigns (leading to behaviour change)

Accidents

Start in 2009 for 3 years.

Improve access & take up of Healthy Start across Kirklees

Food

Ongoing

Improve breastfeeding data recording/ retrieval systems.

Food

Reduction in number of rear seat and front seat passengers killed or injured as a result of a vehicle crash who are unrestrained

Reduction in the number of Kirklees residents who are killed or seriously injured as a result of a road traffic crash as vehicle occupants or pedestrians

Fewer older people injured as a result of fall preventable due to pharmacology

The aim of the action is to increase the take up of healthy start supplements. Success will be achieved if each year there is an increase in take up to a target of 60% take up in 2012/13.

The success will result in an increase in breastfeeding rates

Deaths

Morbidity/serious injuries

Reduction in KSI as a result of vehicle crashes in parsons having had intervention

Service specification will require monthly monitoring of the take up of adults and childrenâ&#x20AC;&#x2122;s supplements and number of distribution points across Kirklees.

Improved breastfeeding rates at 6-8 week duration â&#x20AC;&#x201C; vital sign target

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Reduction in number of child pedestrians injured/killed by motor vehicles in built up areas Reduction in number of cyclists killed or suffering head injury follow vehicle collision

Change in behaviour in parents restraining children in cars appropriately, reduction in number of children injured killed as vehicle occupants

20 mph zones (leading to injury reduction and behaviour change)

Cycle helmet education campaigns (leading to behaviour change) and cycle helmet legislation (leading to behaviour change)

Child restraint loan schemes (leading to behaviour change) and child restraint legislation (leading to behaviour change)

Accidents

Reduction n in number of older adults having road traffic crashes related to cognitive decline

2010 onwards

Designing signals and road markings for the more limited capabilities of older drivers.

Accidents

Reduction in number of older adults having road traffic crashes related to cognitive decline

2010 onwards

Encouraging the use of automatic transmission cars for older people (in advance of cognitive decline)

Outcomes

Timeline

Accidents

Initiative / Action

Choosing Health (Staying Healthy) (continued) Risks

Hospital Admissions children as passengers in vehicles

A&E Attendances

Hospital Admissions

A&E Attendances

Hospital Admissions

A&E Attendances

Hospital Admissions

A&E Attendances

Hospital Admissions

A&E Attendances

Performance Management

Alcohol

Develop & implement new, evidence-based A&E/Hospitalbased Alcohol Service.

Work with partners to ensure that all are aware of, & utilising, appropriate, relevant & accurate information.

Ensure consistent messages around sensible drinking, units etc are delivered throughout all awareness raising activity.

Commission creative input to develop specific targeted awareness raising activity &/or campaigns based on the outcomes of the local social marketing insight work undertaken in 2008.

DDH currently being engaged.

HRI ready to commence recruitment as soon as finance confirmed.

Delayed due to Business Case process December 2008.

Number of recognisable awareness raising campaigns / activities in places.

Campaigns to develop and be rolled out throughout 2009/10.

Effective service in place in both A&E departments, with support available to broader hospital setting. Improved care pathways between hospital and specialist community service. Support LAA local alcohol indicators No. adults in structured specialist alcohol treatment. Reduced alcohol related A&E attendances, & reduced assaults associated with night time economy.

Reduce alcohol-related attendances at A&E

Increased awareness & understanding of current alcohol guidelines.

Improve peopleâ&#x20AC;&#x2122;s awareness of safe levels of alcohol consumption

Tender to go out in April 2009.

Recruitment delayed due to Business Case process delay.

Lack of interest (CLIK data & social marketing insight shows that alcohol is not considered a problematic issue, nor an area where individuals are keen to make a behaviour change).

Reduction in rate of hospital admissions per 100,000 for alcohol related harm.

Under development: Effective way to measure & evidence the impact of awareness raising activity is currently being explored. Guidance is being sought from DH/COI, NHS Kirklees PH Health Intelligence & other PCTs who have undertaken similar activity.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Alcohol

Consistency of approach across all partners around the undertaking of alcohol screening, the provision of simple structured advice, & extended brief interventions, & appropriate onward referral / signposting for additional support. Integrated multi-agency alcohol treatment system delivering evidence based, needs assessed, holistic, care coordinated interventions, promoting social integration.

Assessment of training needs of frontline staff across Kirklees to inform training plan February April 2009.

November 2009

Increase numbers of frontline staff able to undertake alcohol screening, offer simple structured advice, and/or extended brief interventions

Tender & contract specialist adult alcohol treatment service.

Improve the availability of and access to relevant and effective treatments for alcohol misuse

Lack of interest / sign up from Primary Care.

Improve earlier identification of alcoholrelated health problems.

Ongoing development & delivery of SBI LES in Primary Care.

Engagement with primary care & PBC to encourage sign up to the alcohol screening & brief Intervention Local Enhanced Service.

Extremely high levels of latent demand leading to high waiting lists, lack of service satisfaction, poor service reputation, continued high levels unmet need.

Lack of support from partner agencies, particularly in terms of resources.

CPC commissioned to support the tender.

Lack of capacity to meet training needs.

Staff not released for training.

Alcohol not considered an appropriate issue &/or not relevant to their role.

Risks

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

LAA local alcohol targets a. Numbers adults in specialist structured alcohol treatment b. % adults exiting specialist structured alcohol treatment in a planned way.

2008/09: 35% of practices with LES 2009/10: 60% 2010/11: 65% 2011/12: 70% 2012/13 75%

Number of GP practices signed up to the screening & brief intervention Local Enhanced Service (LES) the detail of targets in relation to the SBI LES:

Performance Management

Provide an occupational health, safety and return to work support service to businesses

Businesses with active health and safety arrangements

Provide training to improve knowledge and skills of workers and support them to deal with work related health issues

Reduce flows on to Incapacity Benefit from employment

Health Adviser presence in a number of GP surgeries

Better Health at Work

Up to date DH sensible drinking guidance disseminated.

WOCBA identified as a key target group within screening, simple structured advice & extended brief intervention training.

WOCBA identified as a key target group within awareness raising activity.

Better Health at Work

Alcohol

Ongoing

To provide an occupational health service for individuals with work related health conditions. Earlier return to work, reduction in flow onto incapacity benefit

Support and maintain the health of the working population.

Reduce number of accidents and reduced sickness absence. Improve employee safety

Reduced number of accidents and reduced sickness absence. Improved employee safety.

Reduced sickness absence and earlier return to work

Focus on women of child-bearing age to ensure they do not drink during pregnancy

GP Engagement

Decrease in number of people in unemployment due to recession

Monitor number of referrals GP and health professional referrals

LAA 173

Number of health and safety training courses delivered

Number of businesses engaged with

Monitor number of referrals

2% reduction by 2010/11 of WOCBA drinking over safe/sensible limits (baseline 28.7% in 2008)â&#x20AC;?.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

An agreed local care pathway developed and implemented.

Increase weight management provision to meet identified gaps and the needs of target population.

3000 adults will be referred per year who will be supported via a personalised weight management interventions to manage their weight.

Service in place 2009/10

Commission weight management provision for children and adults.

Obesity

85% of those referred to the service will show at least a 5% reduction in body weight

Number of employers engaged and number of employees involved

Employer engagement

Reduced sickness absence

3.5 year project commencing Spring 2009

Improve emotional well-being at work through training, Occupational Health and policy assistance to businesses

Better Health at Work

Weight management services in place, performance monitored. Quarterly monitoring figures provided by provider of service.

Number of employers engaged and number of employees involved

Employer engagement

To engage with large local employers to develop employee health and well-being programmes

3.5 year project commencing Spring 2009

To improve health of WOCBA in workplace setting. To include WOCBA specific health & safety assistance to businesses

Better Health at Work

Initial contract: 3 year period

Number of employers engaged and number of employees involved

Employer engagement

To engage with large local employers to develop employee health and well-being programmes

Project to be evaluated July 2009

To develop and implement a healthy workplace strategy for businesses in Kirklees

Better Health at Work

Performance Management

Risks

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

Implement routine feedback to parents to provide results from the National Child Measurement Programme and signpost to services.

Develop and implement a local weight management care pathway

Improve data collection and recording through the National Child Measurement Programme and BMI recording by health professionals

Obesity

This will be measured using the National Child Measurement Programme and BMI recording by health professionals. Success will result in:

Ongoing

56% of adults attending GP practice have BMI recorded and referred to services as appropriate.

95% of reception and 91% of year 6 pupils being measured and parents informed of the results.

A local care pathway will be implemented and adopted by primary health care professionals ensuring that obese patients are referred to appropriate weight management services.

This will be measured using the National Child Measurement Programme. Success will result in 95% of reception and 91% of year 6 pupils being measured and parents informed of the results.

Ongoing

Routine feedback implemented by 2010

Ongoing.

To improve access to weight management services for target groups

Increase in uptake of weight management services

Number of obese children and adults referred to weight management services.

% of adults with a BMI recorded.

% of reception and year 6 pupils measured

Number of obese adults referred into weight management services.

Number of front line staff trained to use.

Number of obese children and young people attending weight management programmes.

% of reception and year 6 pupils measured.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

2009/10

Each care home to have a protocol to ensure all residents with an oral health care need are identified and have access to appropriate services.

Dental

All residential care homes to have an oral health policy and protocol to ensure best care of patients.

Number of care home staff receiving training monitored. (existing performance measure)

Number of care home managers applying new policy monitored.

Monitor & evaluate uptake of programme within target areas. Existing performance indicator

2009/10

Maintain and increase access to Brushing is fun programme.

Dental

All targeted schools in North Kirklees delivering brushing is fun. Targeting occurs through the results of the BASCD Survey results.

2009/10

Maintain access to Brushing for life programme.

Dental

Number of packs distributed by health visitors. Existing performance indicator

Improvement in tooth decay levels for children as measured in BASCD survey.

Success will see a reduction of 0.5 dmft by 2017 in five year olds to aspire to the same rate as the national average currently. All health visitors distributing tooth brushing packs at every Childs 7 month visit.

No. of population receiving fluoridated water

Implementation of Water Fluoridation scheme in Kirklees by 2012/13.

By the end of 2009

PCT has asked SHA to carry out a technical feasibility study

Performance Management

Dental

Risks

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

Brief intervention/advice to be given by a clinician, supported by written material to individuals followed by referral to The Physical Activity and Leisure Scheme (PALS).

Marketing plan for physical activity including a range of campaigns

Care pathway developed for primary care professionals

Develop a range of activity opportunities for children and young people

Physical Activity

Ongoing

March 2010

Annual plan to be agreed

June 2009

PHCTs not using /supporting pathway

Effective care pathway in place with all PHCTs signposting patients appropriately A range of quality evidence based activity programmes in place to support children and young people to be active at the recommended level to improve health .

Finance to support campaigns (currently available for 2 years)

Failure to ensure current information

Number of targeted marketing campaigns

Local people able to access information and therefore increase knowledge and awareness to be able to make informed choices.

To increase knowledge and awareness of the key messages about physical activity to enable people to make choices that will improve their health.

Increase the number of high school aged children and young people taking part in the recommended

Increase the number of children and young people participating in 2 hours in high quality PE and Sport 08/09 – 81% 09/10 – 85% 10/11 – 88% (LAA).

Agreed care pathway in place

Number of physical activity campaigns

Number of website hits

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Physical Activity

Develop a range of activity opportunities for older people

Initiative / Action

Ongoing

Timeline

Choosing Health (Staying Healthy) (continued)

A range of quality evidence based activity programmes in place to support older people to be active at the recommended level to improve health

Outcomes

Risks

Reduce the number of adults aged 18-64 on

Increase adult participation in sport and active recreation on 3 occasions /week By 1% year on year 08/09 – 21% (LAA – Active people Survey .

A series of process /project indicators to be agreed and monitored via performance accelerator

Increase the number of young people ie 13/14 year olds, participation of at least 30 minutes doing sport or activity every day 08/09-84.6% 10/11 – 86.8% (LAA ) .( Year 9 survey)

level of physical activity by 1% year on year . 08/09 – 62% (Year 9 Survey).

Performance Management

Physical Activity

Develop a range of activity opportunities for people at risk of /with Long Term Conditions

Ongoing

A range of quality evidence based activity programmes in place to support people at risk of and with long term conditions to be active at the recommended level to improve health

A series of process /project indicators to be agreed and monitored via performance accelerator

Reduce the number of people with long term conditions who are sedentary by 0.5% year on year 08/09 – 15.5% (CLIK )

A series of process /project indicators to be agreed and monitored via performance accelerator

Reduce the number of adults over 65 who are sedentary by 0.5% year on year 08/09 – 25.6 % 10/11 – 24.6 % (CLIK).

low incomes who are sedentary 08/09 -17% 11/12 -15.5% (LAA – CLIK).

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Develop a range of activity opportunities for women of childbearing age

Annual training programme developed for activity leaders/coaches/instructors

Physical Activity

Initiative / Action A range of quality evidence based activity programmes in place to support women of chid bearing age to be active at the recommended level to improve health

Target populations are provided with motivation and support to increase their levels of physical activity.

Ongoing

Annual

An activity workforce better able to support target populations to be more active

Outcomes

Timeline

Choosing Health (Staying Healthy) (continued) Risks

Number of leaders/coaches/ instructors trained

A series of process /project indicators to be agreed and monitored via performance accelerator

Increase the girls aged 13/14 taking part in the recommended level of physical activity by 1% year on year 08/09 -57.5% (Year 9 Survey).

Reduce the number of women of child bearing age who are sedentary (CLIK).

Performance Management

Training programme offered for health and social care professionals

Train and support volunteer activity leaders as appropriate

Ensure individuals are able to make informed choices to manage their self care needs

Professionals are trained in selfcare skills at the appropriate level. Common core principles of selfcare are part of service delivery and job specs.

A wide range of resources are available for different conditions that are quality assessed And are approved by experts and patients.

Physical Activity

Self Care and Expert Patient Programme

Self Care and Expert Patient Programme Ongoing

Ongoing

Annual

People can access a wide range of information in different formats for different needs.

Professionals are trained to support people to self-care

All patients have a care plan and access to support and resources.

A volunteer workforce better able to support target populations to be more active ie someone like me

A health and social care workforce better able to support target populations to be more active

Information resources are available to all eg: toolkit.

Lack of awareness of types of resources that are available.

Training is not taken up by professionals. The training element is part of the blueprint for each LTC.

Lack of choice promoted. Embed all self-care approaches in LTC blueprint.

Monitoring figures for libraries Up to date directories Number of information prescriptions prescribed/dispensed

A range of self-care training is available. Evaluation of training

Number of EPP courses, patients completing courses, health trainer consultations, care plans, patient satisfaction with health.

Number of volunteers trained

Number of health and social care professionals trained

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Develop a range of activity opportunities for women of childbearing age

Annual training programme developed for activity leaders/coaches/instructors

Physical Activity

Initiative / Action

Annual

Ongoing

Timeline

Choosing Health (Staying Healthy) (continued)

An activity workforce better able to support target populations to be more active

Target populations are provided with motivation and support to increase their levels of physical activity.

A range of quality evidence based activity programmes in place to support women of chid bearing age to be active at the recommended level to improve health

Outcomes

Risks

Number of leaders/coaches/ instructors trained

A series of process /project indicators to be agreed and monitored via performance accelerator

Increase the girls aged 13/14 taking part in the recommended level of physical activity by 1% year on year 08/09 -57.5% (Year 9 Survey).

Reduce the number of women of child bearing age who are sedentary (CLIK).

Performance Management

Training programme offered for health and social care professionals

Train and support volunteer activity leaders as appropriate

Ensure individuals are able to make informed choices to manage their self care needs

Professionals are trained in selfcare skills at the appropriate level. Common core principles of selfcare are part of service delivery and job specs.

A wide range of resources are available for different conditions that are quality assessed And are approved by experts and patients.

Physical Activity

Self Care and Expert Patient Programme

Self Care and Expert Patient Programme Ongoing

Ongoing

Annual

People can access a wide range of information in different formats for different needs.

Professionals are trained to support people to self-care

All patients have a care plan and access to support and resources.

A volunteer workforce better able to support target populations to be more active ie someone like me

A health and social care workforce better able to support target populations to be more active

Information resources are available to all eg: toolkit.

Lack of awareness of types of resources that are available.

Training is not taken up by professionals. The training element is part of the blueprint for each LTC.

Lack of choice promoted. Embed all self-care approaches in LTC blueprint.

Monitoring figures for libraries Up to date directories Number of information prescriptions prescribed/dispensed

A range of self-care training is available. Evaluation of training

Number of EPP courses, patients completing courses, health trainer consultations, care plans, patient satisfaction with health.

Number of volunteers trained

Number of health and social care professionals trained

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Ongoing

Support and enable individuals to develop skills in self care â&#x20AC;&#x201C; Getting Sorted Expert Patient Programme.

Support and enable individuals to develop skills in self care and to use technology to support self care.

Advise individuals how to access support networks and participate in the planning, development and evaluation of services.

A range of self-care choices is available for people.

Self Care and Expert Patient Programme

Self Care and Expert Patient Programme Ongoing

Ongoing

09/10

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

People with a LTC are aware of the choices they have around their care.

People have a range of support options to choose from

People can access information about the things they want to know about in a format useful to them. Support is available to help them understand this and ask questions.

A rolling programme of EPP courses is available and used by all people with a LTC

Outcomes

Relevant communication

Failing to inform the public about services/ information and how to access these.

Lack of partnership working

Develop services fit for purpose in Kirklees Evaluate well and commission new services based on evidence

Lack of consistent sign up to both services.

Increase capacity of staff and support for volunteers

Lack of capacity to support the delivery.

Risks

Number of services offered as part of the SC programmes Links to Kinfo Integration of self care approaches within all Choosing Health programmes.

Number of people referred to EPP support group No of partner agencies linked to self-care programme Links to KINFO

Support for information on prescription and numbers prescribed/dispensed. Number of staywell questionnaires completed

Increased number and range of EPP programmes. Increased uptake by patients Increased number of tutors.

Performance Management

2010 onwards

Role out of LES for LARC (Long Acting Reversible Contraception)

Increase access to contraception for young people across the district by: maintaining condom distribution scheme, developing “C Card” scheme across the district

Commission a sexual health outreach programme to engage vulnerable young people in positive sexual health promotion, increasing access to sexual health services and Chlamydia screening.

Pilot and subsequently commission stop smoking services that target R & M workers

Sexual Health

Tobacco 2010 onwards

2010 onwards

Increase Chlamydia screening sites across the district working with both Chlamydia screening programmes.

Sexual Health

Ongoing

Professionals and the public know about self-care choices and how to access them. Competence to self-care can be assessed

Self Care and Expert Patient Programme

Reduction in the rate of routine and manual workers smoking

Decrease in teenage conception in the most vulnerable

More young people using condoms and a reduction in the rate of teenage pregnancy

Reduction in the rate of Teenage pregnancy

Reduction in the prevalence of Chlamydia in Kirklees

Professionals have accurate up to date information about selfcare choices. Professionals are trained to support self-care.

Risk of qualified trainers in family planning diploma

Failing to provide directories of information and raise aware of these. Lack of good training programmes for self-care. Self-care toolkit/ info and training programme are being developed.

Four week smoking quitters.

25% of 15 – 24 year olds screened for Chlamydia annually.

Teenage conception rate

Teenage conception rate.

25% of 15 – 24 year olds screened for Chlamydia annually.

Self-care toolkit. Information on prescription and Stay well service are promoted.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Review year on year

Develop and coordinate delivery of social marketing programmes with programme leads.

Social Marketing

Social marketing (SM)embedded within programme plans as a tool tool to support the PCTs strategic goals and health & well-being

Not taking long term approach

Quality check against National Social Marketing (NSMC) Benchmarking criteria

2010 onwards

Development of a directory of services for referrals by frontline workers to key services of relevance to women of childbearing age. This will facilitate referrals and ensure that women are able to gain access points to services.

WOCBA

Increase in uptake of 5 a day

Not embedding social marketing within programme plans

Increased rates of breastfeeding

Increase in physical activity in WOCBA Decrease in smoking and drinking in WOCBA

Early access to maternity services.

More women accessing antenatal care earlier

2010 onwards

Specific pilot projects targeting three key age groups and health priorities. Targeting (a) young women 15-17 years of age to increase uptake of physical activity or continuation of physical activity after leaving school; (b) pregnant women aged 15-25 to increase access to maternity services and provide support, information and referrals through peer supporters and (c) women with children aged 0-10 identified as being in need of input or support with diet, who do not access any existing support services or initiatives

Performance Management

Women of Child Bearing Age (WOCBA)

Risks

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

Social Marketing

Work with Organisational development team to give some consideration to the learning objectives for commissioners and providers. Commission training as required at provider/ commissioner and director level.

Challenge programmes and services to utilise SM approach

Review year on year

Understanding impact of social marketing on taking a people cantered approach to the delivery of service

People know what social marketing is and how people can use social marketing techniques to help support the commissioning and business planning process.

Social marketing approach embedded within strategic planning and health needs assessment, health and well being strategy

Links to individual programme targets

Achievement of behavioural change (through SMART goal setting, monitoring and evaluation)

Robust evidence base â&#x20AC;&#x201C; insight and evaluation

inequalities strategy to: Place the person at the centre of everything we do Improve health and reduce health inequalities

Links with health needs assessment, health and well being strategy

Use within business planning and commissioning process

Monitor understanding and application of social marketing:

Monitor against measurable behavioural goals

Check progress against total planning process model

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Health Trainers

Marketing

Social Marketing Social

Evaluate and improve service

Training and manage health trainers to see clients and record interventions

Market services to health professionals and people with long term conditions

Ongoing communications with NSMC and regional leads

Work closely with Health Intelligence/ PPI and Kirklees Council consultation teams

Lead/participate in SM health networks within Kirklees and at a regional level to share good practice

Annual

Review year on year

Insufficient trained staff mitigated by maintaining spare and flexible capacity in bank service

Failure to achieve referrals, mitigated through close monitoring and appropriate marketing interventions.

2,000 clients will be seen annually almost 1,800 will have set goals and achieved them

Through SLA monitoring referrals, discharges, and outcomes. Reporting monthly and quarterly

Check that intelligence being used as part of planning process

Using intelligence out of context Not using insight/evaluation to drive projects

Check usage of ACE database

Review training needs analysis and commission training as required

Mapping of staff currently involved in SM projects against staff attending training

Performance Management

Duplication of effort across the region.

Capacity within SM programme

Risks

Insight is used to inform interventions/ service development

Storage and access to insight and evaluation of social marketing initiatives locally and regionally

Learning applied

Training sessions attended

Increased understanding of and application of SM across organisation

Review year on year

Identify staff currently working on SM programmes who demonstrate an understanding and positive application of SM

Work with capacity on training needs analysis: identify needs, initiate, develop and provide support and training

Outcomes

Timeline

Initiative / Action

Choosing Health (Staying Healthy) (continued)

Provision of training and development opportunities in behaviour change techniques for wide range of staff

Review of competences required; PDR process in place to ensure gaps are identified and addressed. Multidisciplinary training programme accessible in-house to PCT staff and partner orgs; access to CPD for PH staff

Capacity and Capability

Those working to improve the publicâ&#x20AC;&#x2122;s health use appropriate ways of working to promote health and engage with local communities Successful partnership working using appropriate methodologies will increase local engagement; improve the health of individuals and communities

Bi-annual review;

Rolling programme

The public health workforce are trained and developed in supporting people to make and maintain informed health choices. Success will result in increased numbers of people making and maintaining positive change in health behaviours and reduction in health inequalities

Rolling programme

Poor or wrong advice given, mitigated

Number of staff with completed PDRs: minimum of 90%

Number of staff trained As above for front-line staff

Number of staff trained: from baseline training data March 2008/9 26 PH Courses with at least 267 people trained there will be a 5% increase pa

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Prospective and existing staff attending formal

Academic progression is encouraged and supported by the public health directorate.

Revision of curricula, provision of PH specific components within basic, advanced training for health professionals

On-going

Kirklees PH work with PHWAG to support commissioning of appropriate PH training by training providers

Capacity and Capability Healthy Schools and Colleges

PH staff recruited and retained at levels appropriate for the needs of the population

100% of staff within PH fulfil the CPD requirements as outlined for their role (eg Bands 7 and upwards 100 hours; those in Faculty of PH must complete 50 credits pa)

Career development in public health is supported but expert knowledge is retained and passed on

On-going

Staff are made aware of career development opportunities as they arise; transparent system in place to enable access

Capacity and Capability

Performance Management PH input in SLAs etc

Risks

Health improvement programmes and services are developed in a way that reduces inequalities in health, and underpinned by theoretical models and principles of effective public health practice Programmes and services routinely developed with health inequalities at forefront of design; public health practice develops and changes in line with evidence base

Outcomes

PH staff supported to provide leadership in arenas where they can influence eg HITs; CPD re health improvement, theory and evidence base made available

Timeline

Capacity and Capability

Initiative / Action

Choosing Health (Staying Healthy) (continued)

Ongoing Ongoing

Ongoing

2009

Ongoing 2010

One to one support to schools

Commission work to support schools to improve the health related behaviour of children and young people, particularly in the areas of physical activity, emotional health and wellbeing and food and nutrition

Termly Health in Schools network meetings for North and South Kirklees

Support schools to develop individual Health plans and link to National Healthy Schools Programme

Development of new Kirklees Healthy Schools website

Termly newsletter for all schools

Mapping exercise of services and resources available to schools

Improvement in physical and social environments to improve young peopleâ&#x20AC;&#x2122;s health

Improvement in emotional and psychological wellbeing of young people

training/ongoing professional development within FE/HE receive up to date and relevant PH training

Capacity of team to support this process in all schools across Kirklees

Changes / developments to the National Healthy Schools Programme and associated new National targets

Number of schools signed up and achieving National Healthy Schools Status

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Total planned additional investment is ÂŁ489k

Primary Care

We have responded quickly to the national drive to extend GP opening hours, with a significant number of Kirklees practices offering appointments at evenings or weekends by October 2008. We will continue to review the extended hours offered by practices to ensure they reflect service usersâ&#x20AC;&#x2122; preferences as reflected in surveys.

Increase the number of training practices in Kirklees Present and ongoing

Greater choice and accessibility for patients

Increased number of training practices

Patient survey results

Performance returns on extended opening hours

Workforce census

To achieve average list size of 1750.

Identify practices and localities with highest list size and agree commissioning plans to address.

Agreed set of measures in Primary Care Quality Benchmarking Tool and impact of actions monitored through this.

Improved quality of primary medical services by reducing variations across Kirklees

April 2009 for creation of tool

Establish Primary Care Quality Benchmarking Tool and use to continuous improvement

Performance Management

Outcomes

Timeline

Initiative / Action Risks

The table below sets out progress and actions to deliver against all local action vital signs, SHA requirements and additional local priorities.

Local action

Total planned additional investment is £1,026k

Timeline Ongoing via drugs commissioning strategy

Develop more pathways in and out of treatment, including offering a wider range of primary care based interventions and better access to mental health support, housing, employment and training.

OBCs to be produced for HVMH and Huddersfield Town Centre by June 2009.

Assess if this is a model that could also be commissioned for other parts of Kirklees – September 2010.

Assessment of impact of School House Practice by March 2010.

Initiative / Action

Drugs and alchohol

Improved primary care premises in identified areas

A new GP led 8 – 8 health centre (School House Practice) was commissioned from 1 March 2009 in Dewsbury. We will assess the impact of this service and identify any opportunities to commission such a service elsewhere in Kirklees if considered beneficial.

More people being treated in the community and for shorter periods, 10% less people in specialist services each year combined with improved quality for those remaining

Outcomes

New fit for purpose premises in place or in development and providing a wide range of services

Greater choice and accessibility for patients

Heroin use is declining in Kirklees – impact of recession uncertain but may impact on numbers and therefore levels of need and budgets

Risks

Via National Drug Treatment Monitoring System 2008/09: 200 service users in shared care* 2009/10: 250 2010/11: 300 2011/12: 350 Mental health, housing and employment status measured via TOP

Performance Management

Project plans and timescales to be confirmed for each schemes and monitored.

KPIs in contract for 8 – 8 centre

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

50 service users accessing personal budgets via the social care system and increased choice for vulnerable service users

Ongoing

March 2010 all National Treatment Agency BBV targets exceeded

We will commission services that are increasingly personalised and responsive to individual and community needs. In particular, we will link into personalised budgets and expand access to services via peer education programmes

Develop outcome monitoring via the Treatment Outcome Profile (TOP)

We will develop a preventative approach based on well-being, with improved access to harm reduction services, e.g. blood borne virus and would care

100% of all service users offered Hep B and C testing by April 2009, 90% of all users aware of status by March 2010

Improved user health to be placed at the heart of our integrated treatment system

Coupled with service user feedback we will be able to better direct resources to more popular services and/or disadvantaged groups

200 service users receive peer led support by 2013

Outcomes

Timeline

Initiative / Action

Drugs and alchohol (continued)

Hep C testing is currently invasive and relatively unpopular â&#x20AC;&#x201C; information campaign scheduled for 2009

None

Assessment of incentivisation scheme for providers 2009/10

Assessment of potential uptake due 2009 â&#x20AC;&#x201C; as of Feb 09 uncertain levels of demand for personalised budgets

Risks

100% of all service users offered Hep B and C testing by April 2009, 90% of all users aware of status by March 2010

Quarterly TOP reports will tell us what services are most effective and enable more effective targeting

Number in PE Programmes 2008/09: 100 2009/10: 125 2010/11: 150 2011/12: 175 2012/13: 200

Number of service users accessing individual budgets and direct payments 2008/09: 5 2009/10: 20 2010/11: 30 2011/12: 50

Performance Management

April 2009 and ongoing

Ongoing

Implement national Offender Health Strategy, including delivering effective services for prisoners and others in the criminal justice system

We will continue to develop and review pathways into and out of treatment, particularly for offenders and other hard to reach groups

We will continue, through contract management, to drive service improvement and meet national and local targets, particularly increasing numbers in effective treatment (Vital Signs and LAA target) People staying in treatment for longer and completing treatment results in long term improvements in health and social functioning and less crime (DH, 2008)

Quality to be enshrined in the commissioning process via service review and improved clinical effectiveness, resulting in all NTA/SHA targets being exceeded

Baselines national Better access to services and reduced inequalities for dependent drug and alcohol users and offenders

Improved access from offenders to GPs, dentistry, drugs, alcohol and mental health services.

Improved user health to be placed at the heart of our integrated treatment system

We are planning to reduce numbers in specialist services and increase primary care provision â&#x20AC;&#x201C; however there are still 1,000 drug users outside treatment with uncertain needs

Some hard to reach service users may have higher needs that require long term specialist interventions â&#x20AC;&#x201C; Effective care planning should identify these people

Integrated Offender Management system is under resourced in Kirklees â&#x20AC;&#x201C; Joint Commissioning approach required

Vital Signs 2008/09: 3% 2009/10: 2% 2010/11: 2% Increase in numbers in successful treatment from baseline

NTA 2008/09: 85% in effective treatment 2009/10:87% 2010/11:88% 2011/12:89% 2012/13:90%

Consistency of provision across Kirklees localities will reduce health inequalities and deliver a responsive and more personal service

Improved access from offenders to GPs, dentistry, drugs, alcohol and mental health services. Baselines national

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Timeline Ongoing

New contract April 2010

Ongoing

Initiative / Action

All service users have an appropriate care plan and health care assessment, and clinical audits will occur on an annual basis

Full implementation of new clinical guidance and the creation of a broader clinical team that enshrines clinical leadership in the treatment system

Improved services for children and families of adults in treatment

We will use the levers outlined in World Class Commissioning to deliver integrated and well managed services

Drugs and alchohol (continued)

Using WCC will improve quality and raise our

We will manage the Joint Commissioning agenda for substance misuse through effective partnerships to deliver collaborative advantage and benefit to service users and communities

Families and children, and service users themselves, have stronger outcomes if their needs are integrated into care planning

Improved clinical leadership across drug and alcohol services

Better care planning and effective clinical audit increases outcomes and reduces risk

Outcomes

Safeguarding issues always generate some risk, the task is minimise this through stronger partnerships

Minimal risk as improvements required under new national guidance

Clinical capacity has been a problem but is improving via the 301k business case

Risks

Evidenced via HCC and NTA annual reviews

100% of service users with children assessed for parenting skills and receiving appropriate support

All clinicians receiving supervision according to guidance managed via contract with KCHS

100% of service users with a care plan and receiving health assessment by April 2010, monitored via case file audits and contract monitoring

Performance Management

Ongoing

2009/10

Ongoing

Tender complete April 2010

Our commissioning teams and clinical teams will operate to the highest standards of integrity and effectiveness

We will complete the full tender for Kirklees alcohol services

Deliver expansion of the screening and brief intervention Locally Enhanced Service for alcohol in primary care

We will work with our partners to tender young people’s treatment and prevention services and investigate the need for dedicated services for 16-25 year olds

Improved social functioning and meeting ‘Every Child Matters’ goals and less substance use in vulnerable groups

Early interventions via primary care reduces the need for specialist alcohol services

More people treated and improved health and reduced offending. Community impact to be assessed

Stronger commissioning and clinical leadership will strengthen service user outcomes and choice

game across the agenda and increase the chances of meeting LAA and vital signs targets

Commissioning and delivery systems currently subject to improvement plan

As above – level of alcohol need in Kirklees is high and demand for services will be high and increasing. Integrated alcohol system (stepped care) should mitigate this.

Currently 16,000 dependent drinkers so expanded service will only hit a small percentage (though hopefully the most needy)

2009/10: 20% of young people in treatment from ‘vulnerable’ groups 2010/11: 25% 2011/12: 30% 2012/12: 35%

2008/09: 35% of practices with LES 2009/10: 60% 2010/11: 65% 2011/12: 70% 2012/13 75%

LAA targets for alcohol misuse 2008/09: 450 2009/10: 960 2010/11: 1200 2011/12: 1300 Success monitored via LAA and Vital Signs and NDTMS

Evidenced via HCC and NTA annual reviews

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Total planned additional investment is £1,476k

Poor attendance. Monitored through line manager KSF to inform training.

Induction and training programmes for new staff and ongoing training for existing staff.

Annual mandatory programme.

Support health care workers who are delivering services to individuals by providing them with a clear framework for managing infection prevention and control.

Education and training statistics. Education and Training Department.

Performance monitoring score card. HCAI strategic meetings, KCHS Board, KICC

Key policies and practices not implemented appropriately. Programme of audit.

Appropriate core policies and evidence of adherence via performance monitoring score card.

Monitored monthly at strategic HCAI meetings, Trust Board, KCHS Board and KICC.

Trajectories for MRSA bacteraemia and C. Difficile infections not achieved. Health Economy HCAI action plan.

An element of the annual infection prevention and control work programme.

31 March 2009 Zero avoidable health care associated Annual infections trajectories agreed for 2009/10.

To create a safe environment for service users, visitors and health care workers.

Performance Management

Quarterly monitoring and external evaluation via Healthcare Commission and National Treatment Agency

Performance Management

Risks

Specifying added value and focus on social inclusion and wellbeing is a cultural shift in drug and alcohol services

Risks

To promote best practice through a programme of education and audit to reduce health care associated infections.

Timeline

Initiative / Action Outcomes

Services will understand how they contribute to the ‘triple bottom line’ and we will specify return on investment across all contracts. Savings will be reinvested in treatment provision

2009/10 NEF to review contract provisions, New contract 2010-2013 subject to procurement guidance

Review our Integrated Drug Treatment System and use New Economics Foundation to assess added value inherent on current contracts and to better specify the ‘triple bottom line’ (financial, socio-economic, environmental) impact

Infection Control

Outcomes

Timeline

Initiative / Action

Drugs and alchohol (continued)

Application for registration with Care Quality Commission submitted. Awaiting outcome. Robust RCA process. Action plan developed and monitored. Annual infection prevention and control work programme. Ensure infection prevention and control is included in contracting for services with independent contractors. Ongoing.

Reducing health care associated infections part of legislative framework.

Effective root cause analysis investigation to minimise and manage HCAIs.

When commissioning services the PCT ensures and satisfies itself that contractors have appropriate systems in place to keep service users, staff and visitors safe from health care associated infections. Minimising health care associated infections is embedded in the governance systems of the organisation to strengthen responsibility for health care associated infections.

Communicating with service users and the public about health care associated infections in the health economy and to ensure the information meets the needs of the local population.

No complaints received.

Routinely embedded into practice.

Prevention of all avoidable HCAIs.

Compliance with the Health and Social Care Act 2008

Breaches of hygiene and cleanliness and failure to communicate to patients and the public. Development of a communications strategy.

Failure to include in contracts. Assurances not provided from Contractors.

Failure to implement lessons learned. Action plan and audit.

Failure to meet the legal requirements. Monitoring of ongoing action plan.

Monitored at Governance Committee via PALS complaints.

Monitored at KICC and Contracting Boards.

Monitored at HCAI strategy meetings. KICC.

Infection prevention control strategy monitored at Trust Board, KCHS Board, and KICC.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

High awareness of the possibility of HCAIs in patients and health care workers.

Zero avoidable HCAIs.

Infection prevention and control embedded into everyday practice.

Ongoing.

The Infection Prevention and Control Strategy empowers all staff to follow good practice. A commitment that everyone in the organisation including independent contractors and commissioned services understands their role in preventing infections.

To ensure that infection prevention is an integral part of delivering care.

To change behaviour through consistent leadership at every level and ensure accountability for infection prevention and control is explicit.

Total planned additional investment is ÂŁ367k

Outcomes The vision for Learning Disabilities in Kirklees is to empower and enable individuals with learning disabilities to lead a full and, as far as possible, ordinary life as part of

Timeline December 2008

Initiative / Action

complete a baseline benchmarking exercise of both our current primary care and specialist health service provision

Learning Disabilities

Outcomes

Timeline

Initiative / Action

Drugs and alchohol (continued)

Risks

Baseline mapping completed against all national recommendations

Performance Management

Monitored at HCAI strategic meetings, KCHS Board, Trust Board and KICC.

Monitored at KICC, HCAI strategic meetings, KCHS Board and Trust Board.

Failure to comply with legal requirements. Infection prevention and control strategy.

Failure to comply with policies and guidance. Social marketing to understand why individualâ&#x20AC;&#x2122;s behaviours.

Monitored at KICC.

Performance Management

Not embedded into everyday practice. Annual infection control programme.

Risks

The PCT intends to pursue specialist learning disability pathway redesign.

During 2009/10 & ongoing

Fully integrated pathway for LD service users to access services appropriately with improved quality and outcomes, reduced waits and reduced duplication of services

To improve access to healthcare and provide effective support for families and carers through meaningful involvement

the community with the same hopes and aspirations as everybody else.

Risk – Agreed standards are not met. Mitigating actions – monitor performance closely, increase / decrease activity commissioned from providers to meet demand and standard. Focus service improvement on challenged specialties with programme management and identified benefits for service improvements.

Risks – lack of support for integration by providers; lack of clinical sign up for new pathways. Mitigation – promote and drive whole systems approach; key involvement of clinical lead

Agreed Access related performance standards monitored

Informed by provider contracts, monitored monthly/quarterly

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

People with a learning disability are able to access services and have the same level of patient experience as the rest of the Kirklees population

2009 -11

To increase improved access to appropriate primary care health care & acute services Through planned programme management

Risks

Number of agreed patients receiving annual health checks will be maintained at 76% of the total registered 480 - March 09 1013 - March 10

100% will be in receipt of HAPs / VIP cards

Increase number of patients on LD registers who meet agreed diagnostic criteria 632 - March 09 1332 - March 10

Increase number of practices with agreed LD registers to 82.6% - March 09 to 93.3% - March 10

Improvement from 08 baseline

Performance Management

Trajectories for the Health Ambitions measures will be in place for the financial year 2009/10 and will be delivered by the objectives and actions set out in this plan.

Outcomes

Timeline

Initiative / Action

Learning Disabilities (continued)

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Section 6

Financial planning This Operating Plan is entirely consistent with the financial plan 2009/10 – 2011/12 and they should be read in conjunction with each other. The financial plan supports the delivery of the PCTs prioritised objectives and the resource assumptions identified in section 5 above are fully integrated into NHS Kirklees’ financial planning assumptions. When the PCT was established in October 2006 it inherited a recurrent deficit and an accumulated debt of £6.2m. Actions initiated by the predecessor PCTs and continued by NHS Kirklees, achieved a balanced financial position in 2006/07 (surplus £900k). During 2007/08, the accumulated deficit was repaid whilst delivering a surplus of £4.4m. This surplus was brought forward into 2008/09. Due to its success in turning a recurrent and legacy deficit from its predecessor organisations into a recurrent surplus with no historic debt, the PCT accumulated, at its maximum in 2007/08, a Strategic Investment Fund (SIF) of £19.8m. During 2008/09, the PCT Board agreed to play a full part in an agreement between the Yorkshire and Humber Strategic Health Authority (SHA), Mid Yorkshire Hospitals NHS Trust, Wakefield District PCT and ourselves to provide a solution to the accumulated deficit of MYHT. The PCT has committed £11m of its SIF over the next three years to help provide a sound financial base for one of its major health care providers. £3.3 million of this was utilised in 2008/09.

The PCT achieved the required surplus in 2008/09 which is carried forward in to 2009/10. We begin the year with £14.9m in the Strategic Investment Fund of which £7.7m is committed to the MYHT accumulated deficit. The PCT’s resources in future years include prudent assumptions of recurrent growth in line with guidance from the SHA, the phasing of withdrawals from the SIF and the non recurrent surpluses made available in the year following achievement to fund a contingency budget to help manage risk. The PCT believes that this contingency budget and the level of surplus planned provide sufficient financial risk mitigation. The introduction of HRG4 as the currency for Payment by Results in the NHS offers an improved basis on which the PCT will pay for services provided to its residents. However, it has introduced an additional call on our resources and additional risks which will need careful management across the health economy. Table 5 overleaf shows the additional investment that we expect to receive over the next four years from 2009-10 and the assumptions on the use of these.

Table 2: Additional investment 2009 – 10 to 2013-14 Additional Funds Available

£000

Growth funding- rec

107,600

SIF funding returned

14,600

Non recurrent surpluses

13,800

Efficiency plans

18,000

Total

Use of Resources

154,000

Inflation

69,000

Investment in secondary care

27,000

Initiatives -priority areas

36,000

Contingency – risk reserve

12,000

Additional surplus

2,300

Corporate services

7,700

154,000

The investments planned in secondary care and the priority areas are described in detail within the financial plan. The Board accepts that some of those investments will be disproportionately targeted across the different localities and other communities as the PCT aims to reduce health inequalities.

IM&T

£000

Total

Section 7

The Kirklees Local Health Community (LHC) informatics planning falls under the remit of the Kirklees IM&T Programme Board, Chaired by the Chief executive of NHS Kirklees. The plan is written to ensure the LHC as a whole has developed plans in alignment with the national and local expectations and requirements. There is clear evidence that the IM&T programmes are clearly aligned to support delivery of the priorities outlined in the Operating Plan and the 5 Year Strategy. Robust LHC deployment plans form part of the plan with rigorous performance management and benefits realisation processes in place. “Informatics Planning for 2009/10 Onwards for the NHS in Kirklees” should be read in conjunction with the Operating Plan.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Section 8

Organisational Development, including WCC competency development trajectories Organisational Development Since its establishment in October 2006, NHS Kirklees has made significant progress in establishing itself as a coherent commissioning organisation. We have responded to the challenge of integration of two former PCTs, and created a new structure with strong vision and values, and commissioning capability to deliver best possible health for all the people of Kirklees. We engaged very positively with the World Class Commissioning assessment process in, seizing this as an opportunity to identify further development of our commissioning role. Careful consideration was given to our self assessment against World Class Commissioning competencies and we were pleased that the panel only thought it appropriate to alter 2 of our scores. In response it was felt the feedback from the panel was fair and good and we have revised our Organisation Development plan in the light of this feedback. The results of the Year 1 WCC scoring process showed us achieving 3 scores at 3, 23 scores at 2, and 4 at 1, with 2 greens and 1 amber for our Strategic Plans, placing us in a good place in comparison with the best PCT’s in the country. We wish to consolidate our position on the competencies and steadily progress to becoming world class through a realistic set of aspirations and underpinned by our development plan.

of our capacity and capabilities. We then developed a series of strategic organisational objectives which have now been updated. We present the actions required in keeping with the 7S (McKinsey Model) but also correlated against the World Class Commissioning competencies. A copy of the PCT OD Action Plan for 09/10 is available in the OD strategy documents which accompanies the Annual Operating Plan document. Key themes are as follows: • ensuring that all leaders within the PCT understand their role and can deliver our strategic goals; • developing our clinical leadership and clinical engagement, and collaboration with our clinicians in commissioning and prioritisation, with greater focus on outcomes; • ensuring that NHS Kirklees is recognised as a leader of the NHS within Kirklees, with strong partnerships; • ensuring that our governance arrangements are fit for purpose, and support the delivery of our strategic goals including provider separation; and • using needs assessment and building our information skills to improve the quality of services that we commission, ensuring that these are evidence based, cost effective, and where possible delivered closer to people’s homes. This OD strategy also contains a draft of the competencies development trajectory still to sign off by the PCT Board for submission at the end of March 09.

In determining the draft Organisational Development (OD) Plan for submission in October 2008 we had undertaken a review 87

Workforce NHS Kirklees has also made significant progress in 2008/09 in its approach to workforce planning. In 2009/10 the organisation aims to consolidate and build on this progress, in line with its position as local leader of the NHS. During 2008/09, NHS Kirklees improved its workforce planning structures and capability. The Board approved the organisation’s Workforce Planning Framework, which provides a coherent structure and focus for all workforce planning activity in relation to its own and provider workforces. NHS Kirklees continues to use its Workforce Scorecard, launched in 2008/2009, to monitor and improve its performance in workforce matters, including sickness, turnover and staff wellbeing. More detailed scorecards will be introduced in 2009/2010 for the PCT’s Commissioning Directorates and Kirklees CHS. NHS Kirklees has worked in partnership with its NHS providers to carry out a set of robust workforce risk assessments for 2008 / 2009, and aims to repeat this mutually beneficial process this year. A Strategic Workforce Review was held between the PCT, its main NHS providers, and the Strategic Health Authority in December 2008, where NHS Kirklees’ work in this area received positive feedback. Progress will continue in 2009/2010, with a focus on better integration of workforce planning processes with the organisation’s standard business planning process. Further workforce planning training and development will take place for providers and commissioners, linked to the NHS Kirklees Commissioning College.

In 2009/10 NHS Kirklees will focus on its own workforce as well as those of its providers. With 60% of the NHS’s workforce for the next ten years already in employment, the four pledges made to staff in the NHS Constitution are of paramount importance, to ensure that NHS Kirklees offers a good workplace and rewarding jobs. The NHS Kirklees Workforce Scorecard, Organisational Development Plan and the PCT’s ongoing work to review and act on its annual staff survey results are key elements that will ensure its ongoing support and development of its staff. In addition, the organisation’s ongoing development and embedding of its eKSFbased appraisal process helps to ensure a clear line of sight between organisational, team and individual objectives. Areas for focused workforce planning projects in 2009/2010 include a major piece of work with the Supporting Families (Under 5s) workforce in the community, led by Kirklees Community Healthcare Services, in partnership with Kirklees Council and Midwifery services in secondary care. NHS Kirklees is also working with its main NHS providers to monitor EWTD compliance and implementation plans. This year, the organisation will be developing the use of the contracting process as a scrutiny mechanism to ensure ongoing EWTD compliance.

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

NHS Kirklees continues to work closely with NHS and non-NHS partners to secure and develop the workforce of the future. A successful, health economy-wide event held in November 2008, “Our Future Workforce”, has helped to energise the organisation’s workforce planning partnerships. NHS Kirklees has subsequently formed a Public Sector Workforce Action Group with a range of NHS and non-NHS partners, which will look at mutually beneficial workforce action across Calderdale and Kirklees.

Section 9

Outcomes and trajectories against targets The guiding principle when setting any trajectories in the organisation is lead managers ensuring the deliverability of them and identifying risks at an early stage. Tier 3 indicators selected through the Vital Signs process fit with the strategic priorities of health and social care and focus on the long term conditions agenda. The trajectories to support the monitoring and delivery of Healthy Ambitions are currently being developed and will be in place by the end of March 2009 and be reflective and consistent with the priorities of NHS Kirklees. Rationale for choosing the WCC outcomes The following were used to guide our thinking: • What issues have the biggest impact locally, across Kirklees i.e. at a population level not an individual?; • What issues are most changeable and within our ability to change? • What has the most scope yet to change? i.e. needs considerable development or Kirklees is performing poorly for that indicator; • Focus on outcomes rather than process measures as a proxy, where feasible; • To try and select an outcome from as many of the eight different categories as possible; and • The reliability of the underlying data ie accurate definition, completeness of numerator and denominator in rates, or proposed methods of collecting them.

Avoid indicators • with very small numbers. If a significant issue then to look for those indicators have a major impact on them, e.g. infant mortality is not proposed as is a very small number, but smoking at birth is an outcome that is significantly linked to such deaths; • that measure an extreme of the underlying issue e.g. suicide as an indicator for mental ill health; • that the PCT is being performance managed on anyway; and • that are ambiguous in their definition e.g. self reported experience of patients and carers but about what, clinical care, hotel services, communication? Given the LAA list of indicators has been created using a similar approach, then some of the LAA indicators are proposed to be consistent, especially if they fulfil much of the above.

Section 10

Monitoring arrangements Robust processes exist within the PCT’s governance arrangements for the monitoring and improvement of performance. These are built on the work undertaken throughout 2008/9 in managing and improving performance at all levels of the PCT structure. Routine reports on both finance and performance against targets are presented to the Trust Board on a monthly basis having first been thoroughly scrutinised by the Finance and Performance Committee, a formal sub committee. It can be seen from the actions taken throughout the 2008/09 that NHS Kirklees has a clear view on areas of under performance and has taken actions as appropriate. Examples include the 98% A&E target, Chlamydia screening, cancer services and ambulance service targets. Moving into 2009/10 these risks will continue to be addressed and monitored closely through the existing structures and building on the work to date. The reporting structure is underpinned by a performance culture whereby accountability for delivery of targets and priorities is clearly and transparently owned by both a lead manager and a sponsor, usually a director. This culture will continue to be developed as part of the organisational development outlined in section 8 above and will be a major strand of the developing Performance Strategy, which will be in place as a final draft by the beginning of the financial year. The PCT currently has a software solution, Performance Accelerator, which enables the PCT to monitor performance against Vital Signs, Local Area Agreement, WCC

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Outcomes and Annual Health Check indicators. This will be expanded to cover the Healthy Ambitions trajectories once finalised with the SHA. These have trajectories against which they are monitored routinely. The system also is a fundamental tool to support risk management across the PCT enabling links from all areas of performance to the Board Assurance Framework and Risk Register. The Board Assurance Framework report is generated via the Performance Accelerator system through the same software solution linking into the building of the risk register from across all aspects of PCT business and informed by lead managers. Throughout 2009/10 the roll out of the use of risk tool within the system of Performance Accelerator will help to embed a culture of risk assessment and management integrating further the performance and risk agendas. In addition to the corporate performance reporting the whole system will be performance managed through a number of other routes: • The Operating Framework for 2009/10 has had all actions devolved to Directors for delivery. In turn these will be cascaded to their teams. Performance management of these will integrate into the corporate structures outlined above but also through the personal development review and e-KSF structures and systems. • National targets and priorities are also being built into the schedules for the contracts for services commissioned in secondary care (the main providers being Calderdale and Huddersfield Foundation Trust, Mid Yorkshire Hospitals NHS Trust), mental health service (South West Yorkshire Mental

Health Trust) and community services (Kirklees Community Health Services). • Performance Accelerator will be used to monitor the WCC agenda for each of the 3 strands of governance, competencies and outcomes to facilitate reporting against progress against the development plan. A programme plan will be developed and monitored with activities covering each of the three strands and competency trajectories as outlined through the organisational development plan. The next stage will be around development and embedding of responsibilities, duties and behaviours into the organisation. • Significant programmes such as Choosing Health and Long Term Conditions are also being managed and reported through Performance Accelerator bringing a further level of integration to performance and risk management. • Operational level monitoring is undertaken as a matter of course for key priorities including contract related activities and health care acquired infections. Structures are in place to ensure accurate reporting and appropriate for the management of performance and risk. • As the new performance system, Comprehensive Area Assessment is implemented, Kirklees is well placed to begin monitoring of the Local Area Agreement and the 198 indicators from the National Indicator Set. Work commenced in 2008/09 to bring together the performance reporting systems to ensure consistency across partner organisations. Throughout 2009/10 this work will continue. 91

New business developments Programme leads are invited to submit new business cases on a quarterly planning cycle for development of schemes which fall within our Five Year Strategy. A panel assesses and evaluates cases around the following criteria: • What will be the potential / actual impact if the case is approved? • Is this directly quantifiable – i.e. through cost savings, improvements in performance in this or other parts of the system. A balanced scorecard approach is taken, considering: • Cost savings – potential or actual • Improvement in performance • Improvement in clinical quality • Improvement in outcomes Evaluation will be made against the Joint Strategic Needs Assessment, national priorities (such as the NHS Operating Framework and access targets) and our Five Year Strategic Plan. Schemes should demonstrate: • Value for Money and quantifiable efficiency savings where possible – benefits realisation • Working in partnership • Involving staff and local community • Services are patient focused - close to patient’s homes and delivered safely • Champion innovation in service change • Services are evidence based and cost effective • Promote CPD and motivate staff • Ensure governance is of the highest standard and probity and accountability are maintained at all levels

Following implementation, schemes are monitored so that we have a means of evaluating progress against objectives throughout the year. Questions include: • How will we measure success (or otherwise) of each scheme? What indicators will need to be considered? • How will this be evaluated? • How can we ensure a whole system approach is applied to the evaluation process? • What will be the change mechanism?

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Appendix A

Requirements for PCTs from Operating Framework 2009-10 NHS Kirklees’ assurance around delivery is identified alongside each of the requirements. Operating Framework Section 2 Setting the priorities for 2009-10 • From April 2009, all elective admissions must be screened for MSRA in line with Department of Health guidance. This should be extended to cover emergency admissions as soon as possible and definitely no later than 2011. Included in contracts and performance managed through this route. • 18 Weeks PCTs and providers should plan how they will maintain, and ensure that the patient experience reflects delivery of this standard. Through the NHS performance regime, we shall continue to measure performance against minimum operational standards of 90 per cent (admitted patients) and 95 per cent (nonadmitted patients). Every PCT and trust must strive to achieve this standard across all services and specialties, monitoring waits over 18weeks so that patients do not wait for reasons other than choice or clinical exception. Included in contacts and performance managed through this route. • Reviewing the workforce mix, including the deployment of AHPs,

will support further improvements in the accessibility and experience of services. PCTs will also want to consider how better access to AHP services, such as speech and language therapy or podiatry, will improve health outcomes and reduce health inequalities. Captured through workforce planning. • PCTs will be expected to maintain the reductions in waits for direct access audiology and hearing aid services they planned for delivery in 2008/09, and to support benchmarking of AHP services, referral to treatment data will become mandatory from April 2010. Included in contracts and performance managed through this route. • Timely access also contributes to the quality of primary care. Last year, we asked PCTs to work with GP practices and other partners to improve the responsiveness of primary care services, and in particular to: ensure that at least 50 per cent of their GP practices offer extended opening outside core hours; and secure additional access to GP services through procurement for GP-led health centres (in each PCT) and over 100 new GP practices targeted at poorly served areas. Already delivered through general practice and the new School House Practice in Dewsbury. • Increasing the level, quality and range of services in primary care, particularly in under-provisioned areas, will require further increases in the number of doctors and other clinicians trained in primary care. This will require PCTs to work with GPs and other partners to

upgrade and increase GP premises to add to the number of training practices and places. Addressed through primary care and estates development strategies and includes the School House Practice in Dewsbury. • More than half of practices now have extended opening hours. Every PCT should ensure not only that they achieve and maintain this minimum standard, but also that they make ongoing progress in improving GP services. Already delivered and exceeded through general practice. • GP Led Health Centres During 2009/10, PCTs should ensure that there is timely implementation of these new services, including effective communications with the public, so that patients can benefit as soon as possible from improved access and choice. The School House Practice in Dewsbury saw 132 patients in it’s first week. • PCTs should seek year-on-year improvements in patient satisfaction with GP services, as measured by the GP Patient Survey. The new GP Patient Survey will provide data not only on patient satisfaction with access, but also on their wider experience of the quality of GP services. PCTs should use this broader range of data to identify specific priorities for local improvement. The results are reviewed and actions picked up with specific practices. • Dental Services Reviewing dental commissioning strategies, ensuring open and

transparent procurement for all significant new investments in dental services. Oral Health Strategy in place. • All areas should look to tackle health inequalities through putting them at the centre of service delivery. To sustain this, health inequalities should be at the centre of service delivery, disease prevention and partnership work, particularly with local authorities. Practical guidance has been set out in Systematically addressing health inequalities. Local Area Agreement and Health Improvement Team structure. • Over the next two years, to ensure that those living with a long-term condition receive a high quality service and help to manage their condition, everyone with a long-term condition should be offered a personalised care plan. Long term conditions strategy. • PCTs should work with their local authority partners and publish joint plans on how their combined funding will support breaks for carers, including short breaks, in a personalised way. Joint Carers Strategy in place. • The Cancer Reform Strategy says that patients should not wait more than 31 days for radiotherapy by December 2010. Delivery of this during 2010/11 for all patients needing radiotherapy requires a significant increase in capacity to achieve the level of an average of 40,000 fractions per million population, as recommended by the National Radiotherapy Advisory Group. PCTs should ensure that local

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

capacity plans are put in place to deliver this. Included in contacts and performance managed through this route. Strong links to Yorkshire Cancer Network. • The 2005–08 Local Delivery Plan (LDP) round included six cancer IOGs (implementing outcomes guidance). Where necessary, PCTs and cancer networks should take urgent action to implement recovery plans to ensure full implementation. Fully Implemented. • Driving up standards of care to reduce mortality and morbidity through implementation of the National Stroke Strategy continues to be an important activity for PCTs, supported by their local stroke care networks. Stroke Health Improvement Team and new lead manager dedicated to stroke services. • Maternity and neonatal PCTs will want to demonstrate improvements in the experience of women and their families by developing more responsive services that meet local needs and react to user feedback. This will require ensuring that the workforce has sufficient numbers of maternity staff (including midwives, obstetricians and maternity support workers), neonatal teams and health visitors. Incorporated into workforce plan and Children’s & Young People’s Plan. • All NHS organisations have statutory responsibilities in relation to safeguarding and promoting the welfare of children. PCTs will be expected to keep under review their

arrangements to make sure that they have the policies, skills, competencies, partnership arrangements with other agencies, monitoring and assurance procedures to ensure that their statutory responsibilities are being met. Systems in place and routinely reviewed to ensure in line with statutory responsibilities and guidance. • PCTs will want to review the transparency of their service offer in line with the Child Health Strategy, to be published shortly, and local priorities. These include: - delivering a high quality Healthy Child Programme (formerly the Child Health Promotion Programme); - implementation of the adolescentfriendly ‘You’re Welcome’ standards; - improving the experience of services for children with a disability and their families, including palliative care. To be reviewed once strategy published. PCTs will want to review the transparency of their service offer in line with the Child Health Strategy, to be published shortly, and local priorities. These may include reviewing and evaluating the effectiveness of Child and Adolescent Mental Health Services to ensure that vulnerable children have swift and easy access to services. To be reviewed once strategy published. • Combating child obesity remains a major challenge for us all, and the objective remains to reduce the proportion of overweight and obese

children to 2000 levels by 2020. PCTs should lead this with their local authority and regional partners to support parents and families to make healthier choices. In particular, PCTs should deliver the Change4Life social marketing programme and could include sharing results from the National Child Measurement Programme with parents. Incorporated into Obesity work programme. • All PCTs should be developing effective approaches to promote breastfeeding initiation and support mothers to continue to breastfeed for longer, including implementing the principles of the UNICEF Baby Friendly Initiative in hospitals and community settings. Incorporated into breastfeeding work programme. • SHA strategic workforce plans will need to be developed which deliver improved health outcomes in maternity, neonatal and children’s services and help tackle inequalities. The plans should support the delivery of high quality services as close to home as possible and in a range of settings, for example children’s centres. PCTs will want to consider how their local workforce plans support the local services offer. Incorporated into workforce plan. • The consultation on the NHS Constitution set out four pledges to NHS staff around quality work, wellbeing, learning and development, and involvement and partnership. They reaffirm our commitment that good workplaces and rewarding jobs should exist for all NHS staff. PCTs will want to endorse this commitment as a

prerequisite to the provision of high quality services. The PCT is committed to the NHS Constitution. A Communications Plan has been developed to make sure patients and the public are aware of their rights and responsibilities under the Constitution. • PCTs, together with local partners, were required to produce robust pandemic influenza plans by December 2008. During 2009/10 and beyond, these plans must be tested, reviewed and improved, as appropriate. Plans and systems in place. • The Government’s alcohol strategy, Safe, Sensible, Social: The next steps in the National Alcohol Strategy set out local and national action to reduce alcohol-related ill-health and crime. The recent consultation on possible further action will also be of interest to those PCTs who have included alcohol within their operating plan. PCTs who have not included alcohol within their plan should consider if developments in alcohol services could contribute to other identified priorities. Incorporated in Alcohol Strategy. • PCTs will want to work with local authorities to consider how they could improve dementia services. Incorporated into mental health work programme.

• To deliver the End of Life Care Strategy – promoting high quality care for all adults at the end of life and the local SHA visions, PCTs will want to

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

consider delivering extended and improved service provision with their partners. Incorporated into End of Life work programme. • Mental Health PCTs and providers will want to adopt the principle of providing care in the least restrictive environment and as close to home as possible. Incorporated into mental health work programme. • Plans for mental health and learning disability inpatient services should address the issues above, as well as: ensuring men and women do not share bedrooms or bed bays; and widening the availability of womenonly day areas. Incorporated into mental health work programme.

PCTs are expected to work with their local providers to deliver substantial and meaningful reductions in the number of patients in acute, general or community hospitals who report that they share sleeping or sanitary accommodation with members of the opposite sex. In deciding what constitutes a ‘substantial and meaningful’ improvement, PCTs are expected to take close account of local patient and public expectations. Plan being developed in line with national guidance and timescales. • PCTs are encouraged to promote the use of local intelligence to drive improvement. Operating Framework Chapter 3 A system designed to deliver quality

• In addition, in order to comply with Section 31 of the Mental Health Act 2007, PCTs should ensure that, by April 2010, no 16–17 year-olds are treated on adult psychiatric wards, unless such an admission is in accordance with their needs. Included in contracts and performance managed through this route.

• SHAs and PCTs will also produce talent and leadership plans, in accordance with guidance released early in 2009. This will better equip all new entrants to meet the leadership demands of working in the NHS. Leadership Strategy approved 2007 and being delivered against. Currently looking at improving talent management processes.

• PCTs need to ensure there are effective arrangements for communication and partnership working between primary care and other healthcare providers to improve the overall quality of health care for people with a learning disability. Incorporated into learning disabilities work programme. Funding secured for improvement in learning disability registers held in primary care.

• PCTs will want to assure themselves that NHS providers, other than NHS foundation trusts, have a comprehensive training and development plan that sets out the current requirements and puts in place a programme for the longer term. Clearly linked to OD Plan with current major piece of development being around commissioning skills ad competencies.

• Mixed-sex accommodation

• PCTs should ensure that their operational provider services are fit for purpose and able to perform effectively alongside all other providers. By April 2009, provider services should be in a contractual relationship with their PCT, providing sufficient separation from commissioning roles to avoid potential conflicts of interest. This will be in place. • All NHS organisations will need to demonstrate compliance with information governance standards through the achievement of a minimum of Level 2 performance against key requirements in the Information Governance Toolkit (October 2008). In addition, NHS accounting officers are required to report on the management of information risks in statements on internal controls from 2008/09 and to include details of data loss and confidentiality breach incidents in annual reports. Information governance performance, controls and reporting are subject to audit. Already working towards Information Governance level 2. Operating Framework Chapter 4 Financial framework for 2009-10 • The Department expects all PCT debts caused by previous years’ deficits to be fully resolved, except where there has been specific agreement between the SHAs and the Department. Compliant. • NHS organisations are expected to produce financial plans for 2009/10 that are fully IFRS compliant, and NHS financial planning guidance will reflect

this. Compliant. • Since 2008/09 NHS bodies have been able to choose the frequency and method of their property valuations, within the constraints of the Government’s Financial Reporting Manual (FREM). NHS organisations will need to have carried out a full revaluation of their property assets under the new valuation rules to be reflected no later than the 2009/10 accounts. Compliant. • PCTs are expected to make 0.5 per cent of their contract values (for both tariff and non-tariff services including MFF impact) available and to agree with their providers how this potential additional income for them is linked to quality in 2009/10 contracts. Included in contracts and performance managed through this route (CQUIN). • Both PCTs and NHS trusts will be expected to explore the opportunities identified under the cross-Government Operational Efficiency Programme, where further efficiency savings can be secured from 2010/11. Delivery to be considered alongside Operational Efficiency Programme workstrands launched in July 2008. Operating Framework Chapter 5 Planning and partnership working • PCTs need to ensure that their contracts with NHS trusts, NHS foundation trusts and other service providers allow them to achieve national priorities. PCTs are also a partner in LAAs that will form part of the Comprehensive Area Assessment and be reviewed annually by

Ambitions for a Healthy Kirklees Local Operating Plan 2009/10

Government Offices. Included in contracts and performance managed through this route. LAA in place. • PCTs and SHAs will want to consider how they assure themselves that new and existing services are accessible to those most at risk and that they have met their duty of equality. Equality Impact Assessment process in place. • Every NHS organisation should ensure that it measures and progressively reduces its own carbon footprint. Carbon Footprint Manager appointed. • We expect each PCT to prepare an operating plan for 2009/10. These plans need to ensure that activity, finance and workforce plans are consistent and can be reconciled. Available through intranet. • Financial Plans Each January, all PCTs and NHS trusts must submit to the Department of Health an annual financial plan – a complete set of financial statements – for the year ahead, via the Financial Information Monitoring System. Available through intranet. • Workforce plans PCT commissioners should assure themselves that NHS provider organisations have fully integrated the operating, financial and workforce implications within their business and service plans. A comprehensive assessment of the workforce risks and benefits of any proposals should have the same importance as financial considerations Available through

intranet. • PCT commissioners need to understand fully the strategic workforce implications of their commissioning strategies and service developments for their health economy as a whole. In doing so, they must be prepared to offer constructive challenge to NHS providers about the workforce assumptions in their service plans. They must carry out a robust risk assessment to identify any potential workforce capacity and capability issues, including the need for NHS organisations to comply with the European Working Time Directive. Incorporated into workforce planning. • All NHS organisations must continue to improve the quality of their workforce data to enable effective strategic workforce planning from 2010, when the Electronic Staff Record will be the main source of NHS workforce data. At national and SHA levels, this information will also be used to provide metrics to support workforce planning, education commissioning and, where appropriate, for benchmarking processes. Incorporated into workforce plan. • PCTs should work with their local authorities and other partners through the Local Strategic Partnership to deliver LAAs. Structures and processes in place. • As an active partner in the local Crime and Disorder Reduction Partnership (CDRP), PCTs will have looked at how to prevent crime and support the victims of crime within their local area.

NHS Kirklees represented on Safer, Stronger Communities Partnership Board. • PCTs will work with CDRPs to identify and share information effectively in order to support local action on reducing violent crime – especially knife crime. This will include, wherever possible by March 2009, having local arrangements in place for collecting and sharing with police depersonalised A&E data on victims of violent assault in all nine Tackling Knives Action Programme areas. To be included in contracts once detailed clarity on requirement identified. • Informatics PCT chief executives will continue to lead local health informatics programmes to ensure that informatics underpins the implementation of service transformation. In place. • Community Services PCTs will want to review their community information sources and systems against guidance on information models (to be published in December 2008) and develop clear plans that identify methods to improve their local systems, including migration to NHS National Programme for IT community solutions. Fully migrated and compliant.

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Further information about the PCT can be found on the PCT’s website (www.kirklees.nhs.uk) or by contacting the PCT at: Kirklees Primary Care Trust St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH Tel: 01484 466000