Realising our Ambition
Organisational Development Plan 2010/15
Realising our Ambition Organisational Development Plan 2010/15
Contents
Section 1
Chief Executive’s Introduction
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Background Information
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1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13
Section 2
Section 3
About Kirklees NHS Kirklees NHS Kirklees Vision and Values NHS Kirklees Strategic Goals NHS Kirklees Outcomes Reducing Health Inequalities Joint Strategic Needs Assessment Equality and Diversity Quality Improvement Finance Management Costs Risk Organisation Structure
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Our current position
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2.1 2.2 2.3
21 22 24
Our Journey to Date Organisational Review Organisational Development Activity 2009/10
Organisational Development
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3.1 3.2 3.3
33 34 36
How we identified our Organisational Development Priorities Organisational Strengths Organisational Development Needs
Appendices 1 2 3 4 5 6 7
Kirklees Way Commissioning Programme Overview Organisational Development Action Plan Committee Structure to the Board NHS Kirklees Organisational Structure 7 S Model World Class Commissioning Self Assessment Competencies Equality Impact Assessment
38 38 51 52 59 60 64
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Realising our Ambition Organisational Development Plan 2010/15
Chief Executive’s Introduction NHS Kirklees (NHSK) has made much progress over the past eighteen months and is in a strong position to meet future challenges. During this time we have focused on strengthening our commissioning capability to ensure that we spend public money in the most efficient way to achieve the best possible health for all the people of Kirklees. The Care Quality Commission in their 2008/09 assessment rated NHS Kirklees as “Good” for both Quality of Services and Financial Management an improvement from the previous “Fair” rating in both areas.
Executive Committee which will form part of the Commissioning College but also provide clinical leadership within NHS Kirklees.
We have continued to strengthen working relationships with our key partners across the health economy. This has been particularly so with Kirklees Council where we have worked jointly across a number of agenda’s and have a number of joint posts, including the Director of Public Health. As part of our working with the council we have completed a Joint Strategic Needs Assessment (JSNA) which is now used extensively across key partner organisations to drive investment and priority setting to reduce the health inequalities that exist within our communities. The NHS Kirklees Strategic plan reflects these needs in the outcomes we have identified as priorities, and also how we will measure progress over the years.
We engaged very positively with the World Class Commissioning assessment process in the period October to December 2008, seizing this as a supportive opportunity to identify required development of our commissioning role. Careful consideration was given to our self assessment of the current position against WCC competencies, and we were pleased that the process identified us in a good place in comparison to the best PCT’s in the country.
We recognise the need to continue to engage and build stronger partnerships with both our local clinicians and the people of Kirklees as they play a central role in influencing the way we commission services. We have undertaken a review of our Commissioning College and are planning the development of a Clinical
The past year has provided specific challenges, including swine flu and adverse weather which has enabled us to introduce new processes such as business continuity and command and control systems. We were asked to lead regional emergency planning on an interim basis and were pleased to be confirmed as lead PCT for Emergency Planning in West Yorkshire.
A key challenge over the forthcoming period is the need to improve quality and productivity whilst making efficiency savings so that NHS Kirklees can meet our financial targets. We are currently exploring options for reducing our management costs, but recognise our challenge is to ensure that efficiencies are delivered whilst ensuring improvements in quality. There are a number of high priority initiatives, presented to NHS Kirklees by programme leads, which have been identified as a major financial challenge. Many of these schemes have already commenced and require a commitment for recurrent investment. These initiatives are deemed to 5
be critical in terms of our ability to achieve our strategic goals and world class commissioning outcomes. Looking to the future we will drive towards the outcomes we have identified and continue to tackle the issues affecting our local community, including obesity, tobacco control, mental health and sexual health. We will continue to improve access and choice for service users that reflect our diverse communities and deliver services closer to people’s homes where it is safe to do so. These key priorities are outlined in the PCT’s Strategic plan. This plan clearly sets out how we intend to achieve our goals by working proactively with partner organisations and engaging with clinicians, the public and service users within Kirklees.
Mike Potts Chief Executive
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Realising our Ambition Organisational Development Plan 2010/15
Section 1
Background Information 1.1 About Kirklees Kirklees comprises both urban and rural communities with a total population of nearly 425,000 (FHS 2006), of whom 1 in 4 are aged under 19 and nearly 1 in 4 aged over 65 years. By 2025, the population is predicted to increase by 7%. This is mainly in those aged over 65 years. The towns and valleys of Kirklees have their own strong and distinct identities and contain a rich and diverse mixture of cultures and faiths. This diversity, coupled with our complex links to major regional centres, creates unique opportunities and challenges for our district. Kirklees has pockets of relative deprivation for both children and older people, but is not classified as a Spearhead area i.e. in the lowest 20% of deprivation for all areas. It is however amongst the worst 50 districts for both income and employment deprivation and this has worsened since 2004, as has Educational Skills and Training and Income. In contrast, for Barriers to Services and Crime Kirklees had improved. 1 in 6 of the population are income deprived. Areas of deprivation are concentrated in and around Huddersfield town and Dewsbury in particular. Across Kirklees 27% of children aged 0 -15 years were classed as living in poverty and 21% of those aged over 65 years. Kirklees has a diverse ethnic mix, with a higher proportion of our population from ethnic minorities than for England as a whole. Ethnicities present in Kirklees include those of Pakistani origin, Indian origin and African-Caribbean origin but the largest group remains of white origin.
1.2 NHS Kirklees NHS Kirklees was established in 2006 from 3 former PCTs in Huddersfield and North Kirklees. We have the same boundaries as Kirklees Council and organise our work across the same 7 localities which are shown on the map below. Working on a geographical basis we are together with our partners using the context of Place to tackle the particular issues of that area, where needs are identified for that locality from the JSNA and local intelligence as well as for other communities of interest e.g. those with certain disease, disability or at risk of significant ill health. Directors and senior PCT staff are members of the leadership groups within these areas. In common with other PCTs, we have three main functions: • engaging with our local population to improve health and well-being; • commissioning a comprehensive and equitable range of high quality, responsive and efficient services within allocated resources, across all service sectors; and • directly providing high quality, responsive and efficient services where this gives best value. As a PCT, we are responsible for making sure that NHS services are in place to meet the needs of local people. The PCT is accountable for ensuring that these services are accessible, high quality, provide value for money and safe. As the custodian of NHS services in the local area we are known as ‘NHS Kirklees’.
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Batley, Birstall and Birkenshaw Spen
NHS Kirklees Boundary • Dewsbury and Mirfield
Huddersfield North Huddersfield South
The Valleys
1.3
•
Denby Dale and Kirkburton
NHS Kirklees Vision and Values
Vision The PCT vision and values were originally developed in collaboration with staff and our partners through a series of workshops and communication events and signed off by the Board in 2007. In 2009, we reviewed our vision, values and goals in light of world class commissioning, Healthy Ambitions and our strategic priorities. The vision and values underpin all key organisational development activity within NHS Kirklees. All initiatives are considered in light of the vision and values to assess how they help us meet them. Our vision and values are:
“Working together to achieve the best health and well-being 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
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•
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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.
1.4 NHS Kirklees Strategic Goals In selecting our strategic goals, NHS Kirklees has addressed those areas of health needs across our community where our focus needs to be strongest and where we need to demonstrate not only improved health outcomes for those localities where this is currently the poorest, but also in raising the quality of the services which we commission and achieving real value for money in everything we do. The goals represent a life-cycle approach, starting with life expectancy, through childhood, health inequalities, and people with long term conditions. Each of our goals are underpinned by both hard and soft measures and have been mapped against real and measurable targets as defined our World Class Commissioning Outcome Aspirations, and this is presented within our strategic plan. A process of consultation has taken place over the last six months both internally with our Board, Senior Management Team (SMT) and Programme Leads (as part of our Health Improvement Teams (HITs), as well as externally with our partners, to ensure that our new Goals were representative of our community and also to ensure that our initiatives, and outcomes, can be mapped against them.
Realising our Ambition Organisational Development Plan 2010/15
GOAL 1
Improve health outcomes for children and young people, working in partnership to improve life chances and safeguard children.
GOAL 4
GOAL 3
Raise male and female life expectancy at birth so that it is not significantly below the national average in any part of Kirklees
GOAL 2
Strategic Goals The strategic goals for NHS Kirklees are:
Target individuals and populations to tackle health and well being inequalities, focusing on the priority issues identified locally. Provide advice, support and care to these individuals, families and communities, in the form of high quality targeted interventions known to work, to increase the control they have over their own health and wellbeing.
Empower those people in Kirklees with a long term condition to exercise control over their own lives and be central to the decision making about their own care, so preventing problems arising or worsening and enabling them to independently manage their own health and well being.
In addition to our Goals, NHS Kirklees have a wider shared ambition with Kirklees Council and other partners that by 2020 Kirklees will: • Be recognised in West Yorkshire and beyond as an area of major success; • Have a strong economy supported by an attractive, high quality environment, offering the best of rural and urban living; • Place a high value on creativity and learning; • comprise communities who are proud of their past, but enjoy diversity, are outward looking and face the future with optimism;
• be a safe, healthy and supportive place to live and work for both young and old people, with a clear commitment that all should share in this success. Our achievement against these will be monitored through our JSNA and joint forums including the Kirklees Partnership.
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The Kirklees Partnership Our wider work with the Kirklees Partnership has enabled the delivery of a joint Sustainable Community Strategy which covers the period 2009 – 2012. This sets out the strategic direction and long term vision for Kirklees. It is a strategy to promote the social, economic, environmental well-being of the area. The overarching vision for this strategy is: “By 2020 Kirklees is recognised in West Yorkshire and beyond as an area of major success. Its strong economy is supported by an attractive, high quality environment, offering the best of rural and urban living. Creativity and learning are highly valued. Communities are proud of their past, but enjoy diversity, are outward looking and face the future with optimism. Both young and old find it a safe, healthy and supportive place, where there is clear commitment that all should share in this success”. Within the strategy, the “Picture of Kirklees” gives a clear focus on the current issues facing our population in terms of their health and socio-economic needs, education and skills, housing and crime, and thus identifies the priorities we need to focus on to be able to close these gaps, and by working in partnership with Kirklees Council and other strategic partners we will help to reduce inequalities. The JSNA provides key data informing the development of the Sustainable Community Strategy. The NHS Kirklees Five Year Strategic Plan is closely aligned to the Kirklees Partnership Strategy, and thus four out of the nine identified shared priorities in the strategy have direct links with our own World Class
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Commissioning Outcome aspirations and our strategic programmes. These are outlined in the strategic plan. The above represents and reflects the close working relationships and degree of collaboration that has been established between NHS Kirklees and Kirklees Council. There is a strong joint commitment to work together to improve the lives of the people of Kirklees. This is based on the recognition that health inequalities is a shared priority.
1.5 NHS Kirklees Outcomes In light of the above, the NHS Kirklees Board has discussed the outcomes which should be adopted and these are outlined within the strategic plan. Outcome aspirations have also been agreed as a result of a robust process with our programme leads and are aligned to the strategic plan and requirements of the WCC process. The local health priorities of Kirklees are directly linked to the chosen outcomes, in line with the JSNA. These are closely aligned to both NHS Kirklees vision and NHS Next Stage Review.
1.6 Reducing Health Inequalities Health Inequalities are health differences between people which can be changed. Change depends on the control that people feel they have over factors that prevent ill health, as well as the opportunities they feel they have to control such factors. If we are to make a difference and narrow the Health Inequalities gap, we need to: • Be person centred, focusing on equality of outcomes; • Involve local people in creating and delivering solutions; • Work closely with partners to ensure
Realising our Ambition Organisational Development Plan 2010/15
• •
•
•
current needs are met and there is adequate provision for the future; Target our actions more effectively to ensure we reach those most in need; Establish clear programmes which support older people and those with long term conditions to address the challenge of more people living longer; Target our resources to reduce inappropriate variations in investment across the area, particularly where lower investment sits alongside poorer health outcomes; and Use our commissioning function and opportunities in the new primary care contracts to tailor services to meet the needs of the practice and locality populations.
NHS Kirklees Strategic Plan identifies the actions that we are taking to ensure the above are met. The organisational development initiatives are designed to address the areas identified above through the development of improved public and patient involvement, collaboration with Kirklees Council but also wider across other organisations who have responsibility for commissioning services on behalf of the people of Kirklees. This will require working in a way that is person centred. Involving other parties in identifying issues and creating solutions, focusing on those in most need. Our need is to ensure that given the financial constraints, we work in a way where we develop targeted interventions. To ensure we tackle the local challenges to health and well being inequalities that have the most significant impact, as identified by the JSNA. This will require much greater collaboration across the system, to ensure that: • quality can be improved, whilst
increasing value for money, • a reduction in duplication is avoided. The impact of the financial challenges will require us to work with reduced resources which will mean we have to not only prioritise but work innovatively to deliver this. Our action plan identifies how we plan to build on the foundations already established.
1.7
Joint Strategic Needs Assessment (JSNA) In our second JSNA, published jointly with Kirklees Council in June 2009, 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 overall purpose of the JSNA is to identify the avoidable gaps in health and well-being for Kirklees people, i.e. inequalities that must be tackled. The JSNA uses national and local data to identify issues, together with results from local health and well being surveys of over 18 year olds, most recently carried out in 2008 and of 14 year olds, most recently carried out in 2007. This gives richness to the routine data available and intelligence derived provides a clear locality focus of who to target to narrow inequalities. The key health and well-being issues identified within the JSNA have an important role in developing our programme objectives. Our planning is evolving to incorporate the priorities identified and this is now reflected in specific programmes and objectives. It is essential to ensure that the information provided by the JSNA is integrated throughout the work of the PCT and its
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partners. How HITs currently use the JSNA and recognising its further potential is captured within the Kirklees Way commissioning programme.
1.8 Equality and Diversity Our commitment, to ensure that equality and diversity is embedded in everything we do, is reflected in both our vision and values and is set out in our goals and strategic plan. It is an integral part of the programme approach. Our JSNA clearly identifies the needs of our diverse communities and our commissioning strategies are designed to ensure that not only the programmes but resources are targeted at those most in need. The PCT has established links with many community groups and their contribution is explicit within the JSNA. As such, any decisions taken regarding disinvestment are underpinned by the JSNA and will be subject to an equality impact assessment, which will help to ensure that those in the greatest need do not experience further disadvantage. To sustain our approach to equality and diversity the PCT has appointed a part time Equality and Diversity Manager. A key role for the post holder will be to lead a review of the Single Equality Scheme. In addition, a review of the current equality impact assessment framework will be carried out. Over the past year we have explored how we can link our workforce development targets with our knowledge of health inequality within the community. The NHS Kirklees Workforce Scorecard monitors the ethnic composition of our employees with a view to achieving an initial target of >15% of the workforce from black, asian and ethnic minority groups. We reached 17.2% at March 2009 and expect to continue to further exceed this target by March 2012. 12
We will achieve this through promotion of careers within the NHS – the PCTs Annual Careers Event calendar ensures that the NHS is represented at school and community career events. We have introduced a new NHS Kirklees work experience programme and a new apprenticeship scheme has led to seven people joining NHS Kirklees over the next year.
1.9 Quality Improvement NHS Kirklees is committed to commissioning services that are safe, of high quality and that continuously improve patient experiences. Essential to this is being able to provide assurances that we make best use of public money for the benefit of the people we serve. We recognise the need to ensure that commissioning and decommissioning decisions demonstrate sound methodology and are based on the best available evidence of safety, effectiveness, patient experience and value. In order for this to be delivered the PCT will need to demonstrate a clear model of quality improvement which is well understood by staff throughout each directorate. Quality improvement methods such as clinical audit, effectiveness, evaluation, research, patient safety initiatives and patient reported experiences must be rigorous in order to demonstrable beneficial outcomes for patients, staff and the organisation e.g. improved safety and quality, clinical and cost effectiveness, better access, and lifestyle choices of those most at risk. Equally staff will need to be capable or enabled to apply the most appropriate quality improvement techniques to achieve the above outcomes. As commissioners we will be expected to seek assurances from all
Realising our Ambition Organisational Development Plan 2010/15
the providers we commission services from that they are applying the most sound quality improvement techniques to achieve the best outcomes for patients and provide value for money. NHS Kirklees has in place the foundations to ensure the quality agenda is embedded, we have in place a dedicated Quality Improvement Team who work with other directorates to drive quality improvements and meet the requirements of external regulators such as the Care Quality Commission. However, there is further work to be done to ensure all NHS Kirklees staff understand and fully engage with this agenda and our organisational development action plan highlights the developments that will be undertaken to achieve this. 1.10 Finance The strategic plan recognises the challenging financial climate in which NHS Kirklees is working and outlines the actions that are being taken to address this. In order to deliver financial sustainability, the PCT has to generate significant levels of efficiency savings over the next 4 years. The requirement in 2010/11 is around £20m, with a further £23m over the following 3 years. Work to address these efficiencies has been conducted with our Board, partners, stakeholders, colleagues and staff. We have focused on the need for a greater emphasis on delivering cost efficiencies than there has been in recent years. . As a result of these development events and one to one work the PCT has well advanced plans in place to deliver the savings required in 2010/11. The plan for 2010/11 has been developed by:
improvement leads which are a combination of: - existing work on pathway re-design - identification of new work on pathway re-design - identification of other efficiencies in areas such as improved contracting and procurement arrangements • Identifying organisational level ‘top down’ initiatives through a combination of: - Use of high level benchmarking information such as programme budgeting and Better Care Better Value indicators - The StHA QUIP information pack - Partnerships with other health and social care organisations. Productivity and efficiency are key strands running through “Kirklees Way” our commissioning development programme. In fact, we have ensured that an outcome of the programme should be several projects which deliver efficiencies through improvements and innovation in the way we work or deliver our business. Appendix One outlines the key modules of the programme and how this will support the development of knowledge, behaviour and skills to meet the WCC Competencies.
1.11 Management Costs Information shared regionally shows NHS Kirklees management costs are slightly above mid range when compared to other organisations. Indeed, our workforce metrics indicate there are some areas within the organisation which have slightly higher grades compared to others outside the PCT. This is a reflection of the complexity of the commissioning agenda across NHS Kirklees.
• Identifying ‘bottom up’ efficiencies from programmes and health
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However, we continue to work to reduce these costs, in line with the Operating Framework. We recognise 10/11 is a pivotal year in the current financial environment to work more efficiently and productively. Organisational development activity in this area includes: • Further development of our single commissioning agenda with our partners will increase savings, productivity and value for money including rationalising support and back office functions on which we already have a good track record • Using our leadership framework to adapt our current working arrangements to more of a matrix style of working, and review our directorate and leadership structure as this develops • To review our use of existing and future people as a resource to deliver our strategic plan. We will achieve this through the continuation of our vacancy control so that external appointments are only made to key posts where skill gaps can not be met by internal flexibility. In addition, we will revisit job roles in light of the strategic plan - using performance tools including pdr and ksf competencies. • To capitalize on the centralization of commissioning directorates so that we maximize opportunities for working more effectively to co-incide with the move to Bradley Park (our new HQ). This includes introduction of LEAN methodology, home working and use of new technology into the way we currently work. A review of ways of working to increase personal responsibility and decision making across the organisation will be adopted. Our move will increase current management capacity as 14
working over two sites has impacted on down time due to travel across bases. Any spare capacity will be used to fill any void from the non replacement of key vacancies. • We are proactive in talent management; we currently have three NHS Graduates working across NHS Kirklees. Our involvement in the scheme allows short term project work to be delivered on top of that by our permanent workforce. We intend to continue to access the best workforce through leadership programmes such as NHS Graduate Scheme, Aspiring Director Programmes and our recruitment processes. • We will start to explore with our staff side a variety of employment terms that may deliver improvements in management costs whilst supporting opportunities for employees. This includes issues such as reduced use of agency and bank staffing, inviting all staff to consider a contracted hours reduction and unpaid career breaks in 2010/11 and potentially other schemes across the wider NHS. • We recognize that reducing our management costs may have an impact on levels of staff motivation. We intend to ensure delivery on the NHS constitution staff pledges, for example have ensured that throughout our plans for moving to Bradley we have actively engaged our workforce in designing and developing working practices for when we move. We have recently developed a leadership framework which clearly sets out our expectations of leaders. All leaders are currently undertaking our commissioning leader’s programme where one of the modules focuses on the leadership skills required to deliver change.
Realising our Ambition Organisational Development Plan 2010/15
1.12 Risks NHS Kirklees system of risk management is based on an integrated approach to the assessment and management of risk at all levels across the organisation. To support this approach, the PCT utilises a software application tool supported by policies, procedures and staff qualified to manage risk. The current areas of greatest risk concerns the PCTs ability to design a way of working that will allow it to delivery the strategic and financial plan. Some of the thinking regarding future working arrangements will be informed by discussions which are planned across the Chief Executives Future Group. Targets will be agreed on a regional basis that will need to be complied with. There are service risks including ambulance response times, cancer, stroke, smoking at the time of delivery in the Dewsbury & Batley areas, chlamydia and teenage conceptions. All of these targets are integral to the programme plans aligned to the priorities and strategy of NHS Kirklees. In order to achieve our ambitions we will need to address the following capacity and capability gaps. These include the following risks, which have an action plan to address them: • NHS Kirklees has had a recruitment review in place for the last six months. This process has ensured that each vacancy is discussed in turn in light of other options to deliver service. During the current climate and as a result of the operational plan it will be necessary to review how we deliver our work and how we use our resources more creatively to deliver our agenda. This is set out in section 1.11.
• Small teams are vulnerable to capacity problems if individuals leave or are incapacitated for any reason • There is a limited labour pool for employees with high quality specialist skills • There are skill/capacity gaps within various teams that need to be addressed There will be a level of upheaval as we move to new premises and adopt new ways of working – this culture change will take time to embed. There is further work to be done before workforce planning is fully integrated with the organisation’s standard business processes, though there are plans to address this; and the workforce planning relationship between commissioner and provider is still evolving. However, NHS Kirklees is pleased with its progress to date and continues to make positive steps in the right direction. A further area for development is how the PCT addresses the issues of health inequalities and the capability of staff within the PCT to address this agenda. There are two levels of action required to achieve improvements in health inequalities and well-being for all the people of Kirklees: • a systematic cultural change across the whole public sector system which includes real partnership working; and • specific targeted programmes. The PCT is in a fortunate position in that it has already invested resources in developing internal organisational development capacity. Therefore, our programme of development which is identified within our action plan for the forthcoming period is comprehensive and co-ordinated in its approach, accessing external capacity only
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as essential as resources will be limited. The organisational development priorities are longer term, the action plan shown in Appendix Two identifies the range of high level actions that have been identified for the forthcoming twelve months to ensure that the PCT achieves world class commissioning status.
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Organisation Structure
Governance Structures PCT Board The PCT Board is responsible for agreeing the strategic direction, policy and performance of the PCT. It is also responsible for making sure the key requirements of governance are in place. The Board consists of: • • • •
Chair, Rob Napier Chief Executive Mike Potts Six Non Executive Directors Four Executive Directors
Board meetings are also attended by the PEC Chair and others, including PCT Directors, a PEC member, and a member of our Local Involvement Network (LINks) Forum. PCT Board Committees There are nine Board committees who progress and oversee delivery of the PCT strategy (Appendix Three). These are: • Remuneration and Terms of Service Committee • Audit Committee • Communications and Public Relations • Provider Board • Strategic Development Committee
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• Specialist Commissioning Group • Governance Committee • Professional Executive Committee (PEC) • Finance and Performance Committee In early 2009 the Director of Corporate Services commissioned KPMG to conduct a review of our governance structures and as a result an action plan was developed. The review focused on four key areas of governance: • • • •
Organisational capacity and capability Performance management Risk management and controls Information technology and data systems
An overview of some of the key development identified and addressed are listed in Section Two. The delivery of the actions is overseen by the Governance Committee and Senior Management Team. To date the majority of the actions have been met and the remainder are within the timescale set for completion. Clinical Leadership At the beginning of 2009, as a result of a conference held with our PBC community it was agreed that we would establish a Commissioning College. The Commissioning College meets monthly and is an open forum for all those involved in the delivery of our strategic plan or direct commissioning of healthcare within Kirklees. It includes membership from the PCT Director and Senior Management Team, PBC Community, HIT programme leads and Local Authority. The purpose of the college is to ensure that clinicians are proactively involved in the commissioning agenda, either through the presentations they give as part of their involvement as clinical leads on HIT’s or as contributors to
Realising our Ambition Organisational Development Plan 2010/15
commissioning issues which will be presented to them. • The Commissioning College has evolved over the past year and a recent Commissioning College conference has been undertaken to identify how clinical leadership through both the PEC and Commissioning College can be further improved. The development of the Commissioning College, the progress of practice based commissioning; the formation of the Strategic Development Committee, the prospect of Transforming Community Services means we need to refocus and restructure how the PEC operates. A SWOT analysis of the PEC was undertaken by members of the Commissioning College; new roles and membership were developed and shared and gained broad support. This has resulted in the formation of a Clinical Executive to replace the present PEC. The Clinical Executive will strengthen the involvement of clinical leaders in the commissioning decisions the PCT takes and ensure greater collaboration of clinicians in partnership working. The current PEC Chair has expressed a wish to step back from this role and so a recruitment process is currently being devised for his replacement. A new Clinical Executive Chair who will also be the Responsible Officer for the PCT will replace the PEC Chair. This has now been accepted by the Board as an appropriate way forward and will be implemented from April 2010. We have defined the role of the Clinical Executive in the following way: • As a sub-committee of the Board, provide co-ordinated comprehensive clinical advice to the Board. • Enable a co-ordinated clinical
•
•
• •
•
• •
perspective to PCT, e.g. in relation to 5 year Strategic Plan Ensure effective clinical leadership within all 11 PCT programme areas. Provide advice on the commissioning of high cost, low volume new interventions, e.g. arising from Individual Funding Request process that is out with the 11 programme commissioning work. Ensure effective clinical leadership of the Individual Funding Requests system. Ensuring effective clinical partnerships with providers and other networks. Ensuring effective development of skills and competencies of clinical leaders in commissioning. Provide clinical leadership and support to the Commissioning College and PBC Consortia Approve clinical care pathways Provide a scrutiny function: - Ensure QUIP is embedded into the 11 programme areas and can be delivered - Enable and approve care pathways to ensure they have a comprehensive clinical focus, in line with PCT 5 Year Strategic Plan
PCT Directorate Structure When the PCT was established in 2006, eight directorates were created: six in the commissioning arm, one in the provider arm and one as a shared service. Appendix Four provides an overview of the PCT Directorates, including key posts. Commissioning functions are carried out within six directorates which are listed below, with three directorates, Commissioning and Strategic Development, Public Health and Patient Care and Professions taking responsibility for undertaking the commissioning of services. This approach is unusual across PCTs,
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however, it results in greater understanding of the commissioning agenda and how it is delivered both across the NHS and wider social care system. As an approach it supports our partnership working as many of the joint posts across both NHSK and Kirklees Council sit within our Public Health Directorate.
of its strategic programmes. The Programme Office will set out, implement and monitor adherence to minimum standards for project management, project governance and prioritisation based on factors such as alignment with the strategic priorities and goals, project budget, risk and costs of failure.
Over the past year our PCT structure has benefited from the establishment and recruitment of a number of key positions and developments. These posts have arisen as a result of needs identified through our previous WCC assessment and strategic and organisational development plans. The developments include:
This will give an organisational overview of programme progress, will identify linkages to offset risks, maximise benefits and inform investment / resource savings through better and more efficient management of the whole programme as opposed to individual projects. The Head of Programmes will report the above to the Strategic Commissioning Development group who oversees delivery of the Strategic Plan. The diagram below clearly sets out the role of the programme office.
• Senior procurement specialist • Senior Information Analyst • Head of Programme Management Office • Equality and Diversity Manager • Temporary Organisational Development Specialist There has been an increase in the number of joint commissioning posts with Kirklees Council and we have also appointed several people to the role of ‘clinical leads’. The purpose of the clinical lead is to act as a clinical champion for their programme area and facilitate joint working between the Commissioning College, Professional Executive Committee (PEC) (either as a direct member or through their GP representative) and practice based commissioners (PBC). We have established a clinical lead network to ensure there is peer group support across this role.
NHS Kirklees has recently established a Head of Programme Management Office as a clear commitment to following a rigorous programme approach in the management
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In February 2010 the PCT will move to new Head Quarters and discussions are currently underway to explore opportunities for more innovative environmental and efficient ways of working (as outlined in section 1.11).
Realising our Ambition Organisational Development Plan 2010/15
Commissioning Process Stages
Project Board
Metrics on performance of process and outcomes
Start up PID
Commissioning Process Stages
Deploy Contract
Post Deploy
Results: Strategic objectives
Evaluation
Programme Office
Programme Office drives performance but is not responsible for governance • compares projects (e.g. stage by stage; benchmarks, satisfaction surveys ) • analyses productivity (cycle time, including hand-offs between stages) • compare plans/forecast vs actual and strategic outcomes
Key Roles and Accountabilities Commissioning Directorates • Commissioning and Strategic Development (CSD) Reviews, plans and develops a wide range of high quality, responsive and efficient health care services. It also supports practice based commissioners and manages the local delivery plan and Local Area Agreement • Public Health (PH) Delivers key public health goals, working in partnership with the local authority. It influences the commissioning of services to make sure they improve health locally and reduce health inequalities. Health protection including emergency planning and communicable disease control is a further key responsibility. • Patient Care and Professions (PCP) Provides professional advice, leads on
the redesign of primary care services and oversees clinical governance of the PCT. It is also responsible for professional development and education. • Performance and Information (PI) Manages performance systems and processes for the PCT so that it can measure its performance against national and local targets. It also evaluates the performance of our primary care services against national and local targets. This directorate also leads on the National Programme for Information Technology • Finance and Deputy Chief Executives Office Ensures robust financial controls are in place so that the PCT can meet its statutory duties and achieve financial balance. It also supports managers and staff in ensuring that the services commissioned are value for money.
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The Programme Office will set out, implement and monitor adherence to minimum standards for project management, project governance and prioritisation based on factors such as alignment with the strategic priorities and goals, project budget, risk and costs of failure. • Corporate Services Responsible for enabling and supporting the PCT’s corporate agenda. It works across all directorates, contributes to the strategic priorities and makes sure statutory duties and legislation are complied with. It leads on communications and engagement for the PCT and risk management.
Shared Services Human Resources and Organisational Development (HR/OD) The Human Resources and Organisational Development Service is provided as part of a shared service across the 2 PCTs of NHS Kirklees and NHS Calderdale. The service will be reshaped in 20101/11 in response to workforce impact of provider destiny. Opportunities are being explored by NHS organisations across WY regarding wider efficiencies arising from potential sharing and/ or strategic partnerships of HR and OD services. The HROD Shared Service leads on human resources and organisational development for Kirklees and Calderdale PCTs, both on the commissioning and provider arms. This directorate also provides support for workforce planning and development. Estates Shared Service The difficulty in providing high quality estates services across the NHS due to a
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scarcity of the capacity and capability of resources is well recognised. In the last twelve months NHS Kirklees has agreed to enhance its current Estates team and develop a shared service that serves NHS Calderdale, NHS Wakefield in addition to NHS Kirklees. Both the HROD Service and the Estates Service are hosted by NHS Kirklees. Provider Arm The provider arm of the PCT includes: • Kirklees Community Healthcare Services (KCHS) Provides a range of primary care and community services, including health visiting, school nursing, therapy services and community dental services.
Realising our Ambition Organisational Development Plan 2010/15
Section 2 • Director of Human Resources and Organisational Development (Chair) • Director of Commissioning and Strategic Development • Director of Corporate Services • Director of Public Health • Director of Patient Care and Professions • Assistant Director of Organisational Development • Assistant Director Strategic Development Adults (WCC Project Lead) • Head of Programme Office
Our Current Position 2.1 Our Journey to Date A key ambition in our 2009/10 organisational development plan was to ensure that we developed a strong organisational foundation in which to lead as a world class commissioner. Developing both an internal and external focus has ensured that organisationally all employees understood the transition required to become world class commissioners. We have continued to use the 7 S Model (see Appendix Five) to review our organisational development progress but also to plan future development. The model below shows how the model has become integral into our approach to commissioning.
The group reports to the Chief Executive and Senior Management Team with regular updates presented to NHS Kirklees Board and to the Strategic Development Committee which oversees achievement of the Strategic Plan. The organisational development plan is a live document and will be further refined and updated as the PCT continues its development towards achieving world class commissioning status
A Strategic Organisational Development Group has been established to performance manage the delivery of the Organisational Development Plan. It’s members include:
Commissioning and 7S Style Structure Skills
Commissioning cycle
Kirklees Shared Values
Providers
Systems
Enablers Staff
Strategy
OUTCOMES
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2.2 Organisational Review We have used the feedback from a number of internal and external reviews and assessments to inform our analysis of our current organisational development position. These include: • WCC Assessment 2008 Feedback • NHS Staff Survey 2008 • Investors in People Assessment July 2008 • KPMG Review of Governance • Organisational review of WCC Competencies • KPMG Review of Board The output of these assessments is outlined below:
WCC Assessment 2008 Feedback Feedback from the WCC Assessment Process identified 5 major areas for consideration by the PCT: • The panel acknowledges the journey the PCT is on to improve clinical engagement • The panel observed the PCT’s strong partnership working • The panel observed there were some key risks facing the PCT • The panel noted that the culture of the PCT is beginning to change from turnaround to investment • The panel noted that PCT could benefit from more clearly articulating its strategy
NHS Staff Survey The PCT return rate for the 2008 survey was 66%, which is above average for PCTs in England. This is comparable with our 2007 response rate of 69%.
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In 2008, NHS Kirklees was in the best 20% of PCTs in England in the following areas: • staff feeling satisfied with the quality of work and patient care they are able to deliver • fewer staff reported feeling the pressure of their work • staff working in a well structured team environment • commitment to work-life balance • fewer staff reporting suffering from work related stress. • fewer staff witnessing potentially harmful errors, near misses or incidents in the last month • fewer staff intend to leave their job • staff recommending the trust as a place to work. The HCC report also highlighted four key findings for which the PCT compared most unfavourably with other PCTs in England, namely: • fewer staff reported receiving jobrelevant training, learning or development in the last 12 months (NHS Kirklees = 80%, 2008 national PCT average = 83%) • fewer staff agree that their role makes a difference to patients (NHS Kirklees = 89%, 2008 national PCT average = 90%) • fewer staff received well structured appraisals in the last 12 months (NHS Kirklees = 26%, 2008 national PCT average = 29%). • less availability of hand washing materials (1 representing no availability and 5 representing full availability) (NHS Kirklees = 4.43, 2008 national PCT average = 4.48). The four key findings, highlighted above, formed the basis of the NHS Kirklees organisational action plan.
Realising our Ambition Organisational Development Plan 2010/15
In addition to the organisational action plan, all directors shared their directorate staff survey findings with their teams and formulated directorate action plans to address their specific issues. These action plans are owned by directorate teams and are overseen by the Investors in People Champions
Investors in People (IiP) Assessment Kirklees PCT (as it was then) committed to the IiP Standard in 2006 and made a commitment to undertake the IiP Assessment Process in 2009. The IiP Assessment was undertaken during July 2009 with a follow-up in December. Both NHS Kirklees and KCHS were awarded the Standard as a result of these assessments in December 2009. The national Investors in People Standard defines 10 elements (‘10 IiP Indicators’) of an organisation’s people management climate which produce high performing organisations. These have been regularly researched for validity over the 18 year lifetime of the national IiP Standard. The initial assessment in July highlighted many areas of strength and most indicators were already met. In his report, the assessor stated he found: • extensive scope of personalised healthcare services that were being offered by the PCT and enjoyed hearing many accounts which confirmed the existence of a highly motivated and committed group of staff within NHS Kirklees. • clarity of direction, and communication about this, was a strong feature in the PCT. A number of road shows have been held
throughout 2009 and the assessor found that these had been particularly welcomed, with staff feeling that their leaders communicated in an accessible way which positively facilitated the management of change. • the overall learning and development culture within the PCT was strong. Equity of opportunity was found to be strong and constituted in performance into the extended IiP framework • reward and recognition were described as having been strengthened over the past year with many public opportunities for recognizing the achievements of staff having been made available. A recommendation was provided from the assesment process regarding the consistency of a single leadership approach. As a result, a leadership framework was developed and shared with staff in November 2009. In December 2009 a review was undertaken of the Leadership Framework developed and its initial impact within the organisation. The IIP Assessor found that there was comprehensive and convincing support from NHS Kirklees staff that the process of consultation undertaken had resulted in there being good ownership of the leadership framework. He also found that staff have a firm belief that the leadership framework is a really useful addition in clarifying what leaders and managers are expected to do in our organisation. Over the forthcoming month an Investors in People Continuous Improvement Plan will be produced. This will be aligned to the organisational development plan and will form part of our external assessment of progress against key elements of the plan.
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KPMG Governance Review Organisational development activity occurring as a result of this work includes: • Programme of Board Development including developing WCC Board Behaviours • Review of Commissioning College with discussion of the development of a clinical executive committee • Review of management structures in light of new commissioning structure • Review of contracts and contract negotiation arrangements • Development of the systems and processes to support Provider separation • Review of key Board sub committees so that there is clarity over the relative responsibilities for delivering key agenda items
Organisational Review of Competencies NHS Kirklees has developed a cross directorate working group to oversee the delivery of the World Class Commissioning Competencies. Reporting to the Senior Management Team the working group have worked closely to identify how the trajectories, which were reviewed as part of a Board workshop would be delivered. Each competency has an organisational lead who has responsibility for ensuring appropriate transformational actions are taken to support our development to the next competency. In addition, the group works cohesively to ensure that there is overall change as a result of the individual actions undertaken. Our self assessment against the World Class Commissioning Competencies is outlined in Appendix Six.
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KPMG Board Review A consortium of KMPG, Manchester University and representatives from Dr Foster have worked closely with the Board to consolidate and improve there performance as a world class commissioning board. The board has undertaken a range of diagnostic activity, including observation, individual questionnaires and one to ones. As a result a range of development events have been held to address the outcomes of the diagnostic.
2.3
Organisational Development Activity 2009/10 Over the past year NHS Kirklees has undertaken ongoing development across the organisation. Much of this has been organised in response to the 2009 Organisational Development Plan, however, other parts are in response to feedback received during assessments undertaken, which are highlighted above.
Leadership Leadership is identified both as a WCC competency as well as one of the nine dimensions which help address key areas of organisational health. Good leadership is defined as that which ensures that leaders shape and inspire the actions of other organisational members to drive better performance. NHS Kirklees is committed to ensuring that there is appropriate leadership development at all levels across the organisation. • Kirklees Board has committed to an ongoing development programme commissioned from KPMG. As part of the Board Development programme KPMG undertook a diagnostic which included Board observation, one to
Realising our Ambition Organisational Development Plan 2010/15
•
• •
•
•
•
•
one interviews, review of personal development reviews and a review of governance information. As a result of this a Board Development Programme is currently being delivered to meet the identified needs over the forthcoming 18 months. Board involvement in the development of PCT strategy, but also in the framework for disinvestment NHS Kirklees goals have been revised as part of our Strategic Plan review Joint Review of JSNA with NHS Kirklees and Kirklees Council to ensure that it is fit for purpose and informs commissioning decisions Two organisational events have been held and attended by all commissioning employees to ensure there is broader understanding of the role of the organisation as a WCC and how our vision, values and goals help us to achieve this The success of both the Commissioning College and DDAD Forums have helped ensure that there is a high level understanding and collaboration in how we develop our strategic priorities and work together to deliver these as leaders. HIT Programmes and clinical lead involvement both at the Commissioning College but also at our annual conference has led to greater understanding and ownership of not just individual areas of work but broader aspects of the PCTs commissioning agenda. Organisational Leadership Framework developed through our clinical and managerial forums.
The developments above have resulted in a more concrete and explicit demonstration of both clinical and managerial leadership throughout NHS Kirklees. The impact of
this has resulted in a greater clarity regarding purpose and direction which has enhanced our ability to continue to build partnerships and focus on the actions which will deliver real change for the people of Kirklees. Our IIP assessment process highlighted many organisational strengths, which are highlighted in Section 2.2 which are as a direct result of the leadership across the PCT. The development of joint documents such as Kirklees Community Strategy reflects the strength of collaborative leadership across the Kirklees area.
Improving Quality The Government set out its commitment to delivering services in England that met the highest quality standards . They set out this vision in High quality care for all – NHS Next Stage Review Final Report (DH 2008). NHS Kirklees is committed to achieving this vision and aspires to deliver health care that is of a consistent high standard and quality . To ensure we are leading the way in the delivery of this vision we have put in place systems and processes to set and monitor quality standards across the health economy, and as leaders of the local NHS we are delivering continuous quality improvement through world class commissioning. To deliver world class high quality services, it is necessary to focus on the central tenants of Lord Darzi’s report which are , patient experience , patient safety and clinical effectiveness. Over the last two years NHS Kirklees has been working both regionally and locally to develop metrics , working in partnership with providers and partners , to drive up standards and to review and improve the quality of care through formal quality boards. As a result of this work NHS
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Kirklees has made significant process over the last 12 month to improve the quality of our commissioned services. • As leaders of the local NHS we have worked with providers of services to build a culture that supports continuous quality improvement. Through the clinical quality boards we have held organisations to account for the quality standards in their organisations. • We have seen significant reductions in health care acquired infections and worked in partnership to deliver single sex accommodation . • We have used incentives to improve the time spent on face to face contact with patients, through the releasing time to care initiative, and have played a leading role in the delivery of the regional CQUINs programme . • All contracts and service specifications now include quality indicators which are monitored through contract boards, with any variations in quality performance reported through to the clinical quality board.
This gives us the platform to focus on quality and improve services for the population of Kirklees , reducing variation in the quality of care, providing more information and choice for the public . In the turbulent times ahead we must have synergy between performance, finance, innovation and quality which will underpin the QUIP agenda. Throughout the next period our intention is to strengthen the framework so that we incentivise real improvements in quality and to support our local priorities for improvement. The model below is the framework for the delivery of quality improvement that underpins the ethos of the board and is based on The Next Stage Review (DH2008) and the Yorkshire and Humber Strategy High Quality Care for All (2008).
Model for Quality Improvement
Involving people in service design
Improving patient experience
Focus on clinical effectiveness and evidence based practice
Setting standards for patient safety
Leading change and innovation through Quality Improvement
Partnership working
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Clinical Leadership and engagement
World Class Commissioning
Realising our Ambition Organisational Development Plan 2010/15
Clinical Engagement Improving the levels and quality of clinical engagement has been a key organisational development objective within the PCT. This has been achieved through direct involvement of our clinicians on several levels. PEC/Commissioning College The Commissioning College has met monthly over the past year and all key strategies and Health Improvement Programmes have been presented to the commissioning college for debate, feedback and suggestions. Information and decisions from the Commissioning College are considered at the PEC which meets after the Commissioning College. Clarity has been provided regarding the statutory role of the PEC. In April a new Clinical Executive of the Commissioning College will be established. LINK Intranet Service A new intranet service has been developed for practices called LINK. This provides all practices with relevant, up to date information regarding strategy development, HIT progress, minutes and outcomes of key organisational committees. It is the PCT intention to extend the LINK to all primary care providers over the forthcoming year.
“Kirklees Way� Commissioning Development Programme A new Commissioning Development Programme has been commissioned and commenced in January 2010. Delivered by Tribal Newchurch the programme is based on the output of a training needs analysis conducted with PCT managers and primary care providers. The programme will be delivered to key individuals involved in the commissioning process. This includes, HIT Clinical Leads, Practice Based Commissioning Leads, NHS Kirklees senior managers and Kirklees Council representatives. In addition, the programme will meet a range of needs identified through the WCC competency assessment. Part taught and part project based the programme format is designed to enhance not only partnership working, but also help deliver against our QUIP agenda This has been designed to ensure closer working relationships among commissioners and is aimed at ensuring we develop a universal approach to commissioning across healthcare. Medical Engagement Questionnaire A number of clinicians have responded to the Medical Engagement Questionnaire distributed in the last year. In December Dr Peter Spurgeon presented initial findings which will be presented to the Commissioning College. The findings will be further enhanced through the development of broader research. Once the further research is conducted a formal report comparing NHS Kirklees to other PCTs will be provided. A small working group will be identified to show how we use the results to further consolidate clinical engagement across the patch.
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Development of New Commissioning Executives The PCT supported a PBC Consortium to establish a development programme that allowed potential commissioners to work as apprentices, thereby giving them experience of the role of a commissioning executive and a useful grounding. An evaluation of the scheme demonstrated that once in post the apprentice Commissioning Executives assumed the role more rapidly and successfully. To improve the quality of information it provides to support the management of the primary care contract and variances in practice HIT/Clinical Leads Our Health Improvement Teams include clinical leads who work within the 11 broad programmes, with Choosing Health and Long Term Conditions subdivided further into specific areas of work. All our HITs work within a cultural framework which is comprised of our visions and values, and our strategic goals as a “golden thread” running through each specific programmes objective and influencing ultimate outcomes.
Public and Patient Involvement NHS Kirklees has developed a robust strategy for public engagement and we have developed a Public and Patient Involvement Toolkit to support broader organisational involvement. As such, we have increased and improved our service user, public involvement and engagement on an ongoing basis in the development and delivery of our service development. Examples of where we have successfully used this strategy into the development of care pathways include, pain management, intermediate care and diabetes.
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Through partnership with the local authority the PCT has developed how it utilises LINK to engage and communicate with a range of stakeholders and partners including those across the voluntary sector. Our public health department have excellent links with hard to reach parts of our population and have ensured that their input is a key part of the JSNA. A Camper Van approach ensured that feedback was received from the public across Kirklees, both on services and NHS Kirklees. The concept of a membership council was explored and evaluated. However, it was felt that this was not a cost effective approach once an option appraisal had been carried out. Events have been held internally to ensure our employees understanding what the purpose of the PCT is as a WCC and leader of healthcare. Both of these have been supported through both the Leadership Framework and TCDP. The Mental Health Partnership Board has service users on it. This group were involved in a consultation for the “New Horizons” document which will inform the work of our Trust. As the PCT pursues the quality and productivity agenda it is essential that stakeholders and public are involved and consulted on any ways they may be impacted upon. The training provided through the past year will support competencies to do this.
Realising our Ambition Organisational Development Plan 2010/15
Programme Management The PCT has committed to implementing a programme management approach – a number of internal managers have been trained and are adopting a programme management approach in the delivery of service development through the HITS. A programme office has been established to support a more integrated working approach among HITs and oversee delivery of priorities (see page 14).
Performance and Information Two key strategies have been approved by the Strategic Development Committee and Board - Information and Health Intelligence Strategy and Performance Improvement Strategy. These set the direction of travel and the initial steps required to develop an information and performance culture through improved use of technology. They set out the changes that are required to ensure performance and information become integral to all leaders roles in NHS Kirklees. Further work is required and is identified within the organisational development action plan. Project management support is commissioned through The Health Informatics Service – work has occurred inyear to develop detailed contract/SLA to ensure standards are clearly defined. In addition, we have invested in both equipment and basic IT training to upskill our workforce. There will have been 11 GP system upgrades to TPP System One, the strategic system of choice by 31st March 2010. Capacity/work priorities withinTHIS has been reviewed as part of the 2009/10 contract negotiations. NHS Kirklees has invested in the predictive
risk tool which will give commissioners and providers information which will allow them to target new interventions and levels of support health provision. Over the last twelve months we have identified resources and purchased the predictive risk tool. Through our engagement with clinicians regarding the benefits of the tool we have doubled the number of required patient information input into the system, thereby increasing its usefulness. Our next step is to ensure organisational role out and transfer of knowledge to staff and this is being actioned through the roll out programme.
Quality and Productivity In August 2009, a report was presented to the NHS Kirklees Board on our approach to efficiency. This was tied to regional and national strategy around Quality, Innovation, Productivity and Prevention (QUIP). Since this time NHS Kirklees has worked to implement and put in place a number of policies, procedures and actions that are aimed at ensuring we meet the approaches set out to the Board. This includes: • Value for Money Strategy • Framework for Prioritising Investment and Disinvestment • Programme Budgeting • Cost efficiency programmes Our approach to 2010/11 has been a tactical one. The PCT has developed a Framework for Prioritising Investment and Disinvestment Issues. This has been shared with commissioning colleagues and one to one’s have been held with all programme leads to share both the framework and the PCT approach to programme budgeting. Our HIT leads are currently using a quadrant analysis model to identify where potential efficiency savings can be made. In addition
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to identify how longer term the programmes will operate more effectively to deliver radical service redesign. The Commissioning College Meeting in December 2009 was devoted to sharing the Investment and Disinvestment Framework and engaging clinicians in identifying opportunities for system improvement and proposals to meet the QUIP agenda. The PCT has commenced more robust contract management processes which will be further developed over the forthcoming year.
Partnership Working Partnership working is identified as an area of strength across the PCT. We are proactive members of a number of partnership forums, including Kirklees Partnership, Kirklees Health Marketing Board, Whole Systems Assurance Group. Over the past year we have also taken a lead in working more closely with the Boards of our partner PCTs and joint commissioners. This reflects recognition that health inequalities will only be addressed and success of our strategic plan achieved through increasing our continued work and joint collaboration with our partners across the system.
Employer of Choice Both the Investors in People Assessment Process and the results of the NHS Staff Survey show that NHS Kirklees has much to celebrate as an employer. Both assessments showed that NHS Kirklees is a good place to work and is one where our values are being delivered as an employer on a day by day basis. All of the actions below directly help us to ensure that people at all levels are
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aligned around the organisations vision, strategy, culture and values. The NHS Survey shows that we have a well motivated workforce, who are clear on what is expected from them within their role and that they have the right set of skills to deliver this agenda. Over the past year we have strengthened this position by: World Class Commissioning Conference We have held two conferences for all employees. The conferences, which were both extremely well attended set out our Strategy and explained how this would help us achieve our ambitions as a world class commissioner, identifying how this would help us improve health care for the people of Kirklees and meet the needs identified in our JSNA. The second conference encouraged staff in identifying how their work plays a central role in delivering the commissioning agenda and explained both the culture we are currently building and the pressures and risks that we will face as an organisation. Celebrating the Talents Each year we invite teams to an organisational event where they present areas of innovative practice. Sharing best practice and recognising the impact from the flow of ideas on change so that the organisation can sustain itself over time. Our current organisational development plan recognises that part of our longer term plans to deliver QUIP will require more radical service redesign and as such we need to ensure that appropriate levels of service redesign tools and change management programmes, potentially through using the Five Frames, are embedded.
Realising our Ambition Organisational Development Plan 2010/15
Staff Awards Our annual awards event which is attended by both NHS Kirklees and our provider arm Kirklees Community Healthcare Services was attended by three hundred people. Fifteen awards were given over a range of subject areas including Innovation and Patient Care Award, Working in Partnership Award, Engagement and Involvement Award, Leadership Award. Celebrating with our staff at both the Celebrating the Talent and Staff Awards events help to recognise their contribution is an example of how we are building a culture of innovation and shared learning. Personal Development Reviews NHS Kirklees doubled the number of people receiving a PDR between 2007 and 2008. We recognise there is work to do and have put in place an action plan to further address not only the quantity of PDRs completed but also the quality. The action plan also identifies how employees can use their KSF outlines to plan their development and careers within NHS Kirklees and the NHS. Currently, all employees have an up to date KSF outline. High quality PDR’s against ksf outlines are integral to ensuring that we have the right capacity and capability in our staff to deliver the WCC agenda. Ensuring that the requisite internal skills and talent exists to support the organisations strategy is one of the nine dimensions identified as necessary for addressing organisational health in the WCC Assurance Handbook.
Workforce Planning The primary objective to date of NHS Kirklees’ workforce planning approach to date has been to “get the basics right”: • to improve the workforce information available to NHS Kirklees, ensuring this is aligned to finance plans • to identify key workforce risks associated with commissioning strategies • to develop constructive workforce planning relationships with Providers • to deliver viable 5 year workforce projections Critical steps in our workforce planning journey since January 2008 can be briefly summarised as follows: • Launch of Workforce Planning Framework • Introduction of monthly Workforce Scorecard • Improvements in quality and presentation of workforce information • Links developed with key external partners: Kirklees Council, CHFT, SWYFT, YAS, Mid Yorkshire • Development of workforce planning capability for Kirklees Community Healthcare Services Managers • Inclusion of Workforce sections in standard business planning documentation • Delivery of 2008/2009 workforce risk assessments and projections to the SHA (with excellent feedback received from the SHA) • Training and awareness raising activities internally and externally, including multi-organisation “Our Future Workforce” event with key speakers from DH and SHA This progress in workforce planning has
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been recognised by the Department of Health, who approached NHS Kirklees in June 2009 for a case study to include in an imminent Good Practice guide for Commissioners. Whilst we projected a flat line in our workforce development plan, the Human Resources and Organisational Development Team are working closely with the Finance Team and will make adjustments as appropriate. Improved Employee Engagement The IiP assessment highlighted that there are excellent levels of communication throughout NHS Kirklees. We have improved our communication to our teams on a team and individual level through formalised newsletters and the PDR process. We have revised our Induction Process to ensure that everyone who works for the PCT receives both a corporate and local induction. We have held cross directorate events to ensure there is a greater degree of cross functional working. We expect that communication and greater cross directorate working will be achieved when the PCT moves to it’s new purpose built accommodating in the early part of 2010. Our ambition is to ensure that we create a learning environment throughout the PCT, where innovation is valued and recognised and staff capacity and capability are key to the delivery of our services. We are exploring with our staff new ways of working as we move to our new HQ. The Human Resources and Organisational Development Strategy is underpinned by a number of key documents including both the NHS Constitution and WCC competencies. The strategy identifies the impact of these on NHS Kirklees and the associated business plan identifies a range
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of HR and OD actions to deliver progress. Transforming Community Services The Board has agreed the Community Services Commissioning Strategy which was developed in close consultation with Local Authority and is now being implemented. There is an approved Procurement Policy that is designed to ensure that NHS Kirklees’ procurement and contracting will be in proportion to risk and will be used to support clinical priorities, health and wellbeing outcomes and wider PCT objectives. Assessment of relative quality of key providers using performance reports has been embedded. We have developed an economic database of providers for all sectors (acute, community, primary, mental health, ambulance) being populated in priority order and showing relative importance of and influence over different contracts NHS Kirklees Information Strategy will ensure there is improved performance information regarding community services activity which in turn will continue to inform demand and capacity modelling. Over the next 12 months we will develop a PCT Marketing Strategy which will supersede the existing PCT Procurement Strategy.
Realising our Ambition Organisational Development Plan 2010/15
Section 3
PCT Organisational Development Priorities 3.1
How we identified our Organisational Development Priorities The priorities identified below arise from both our assessments over the past year and the needs identified to deliver the programme of activity identified within the NHS Kirklees Strategic Plan. The organisational development priorities are designed to allow us to deliver cultural transformation and change which reflect the pressures that will be experienced throughout the system if we are to deliver intelligent commissioning of primary care services which are supported by the use of good quality clinical and public health data. The 7 S Model has been used as a practical tool in the implementation of key strategies and is still applicable from an organisational perspective in that it helps identify and align the changes that will be required both in terms of hard and soft skills. Through the development of our strategic plan our programme leads have been asked to identify gaps and capacity issues that may hinder the delivery of their plans. In addition, the WCC Project Group has conducted a review of the skills required and available to deliver the specific competencies and the broad areas identified are contained within the action plan. Through our involvement in regional developments, for example, the Prevention and Lifestyle Behaviour Change Competence Framework and Commercial Professional Network we can identify gaps but also new opportunities and ways of working that will enhance our commissioning capabilities and capacity.
The developments undertaken since establishment provide a strong platform on which to work. Indeed, it is likely that in some areas, such as our collaboration with other PCT commissioners or Kirklees Council the drive for closer working is dramatically increased. Leaders will need to build teams who have the drive and impetus to improve quality and efficiency through transition. In order to do this, they need to continue to develop a flexible skill set that includes identifying and learning from innovative best practice. We will use our talent management process to identify critical posts and link these to those identified as showing potential. It is likely that the organisational structure will need to change to accommodate the above as resource will be reduced and so keeping teams focused and motivated during potentially difficult times will be an essential skill for leaders. “Kirklees Way� the Commissioning Development Programme will provide a key part of our leadership development programme, not only for our internal employees but also for those member clinicians who ensure we achieve our ambition to become one commissioning organisation. We will access the Organisational Diagnostic which is being used in the Yorkshire and Humber region. This process, which has been developed using international benchmarks, will allow us to assesses the organisations capacity and capability against WCC competencies. It enables identification of what the organisation needs to do holistically to address these competencies. We will continue to use both internal and external assessment frameworks to measure our progress and benchmark us against
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national standards. For example, the Investors in People process has changed so that organisations can tailor assessment against unique business needs. NHS Kirklees will ensure that the IIP Action Plan is aligned to our organisational development plan so that we can use the assessment to track progress.
3.2 Organisational Strengths A key strength within NHS Kirklees is the relationships and level of partnership working both locally and regionally. Over the past year we have continued to build strong working relationships with our partners and collaborative commissioners. This has been achieved through the Commissioning College but also through organised events with our collaborative commissioners. Proactive engagement with our partners underpins our approach to the delivery of our strategy. The latter have been designed to ensure that there is an understanding of joint agenda’s and clarity regarding the needs and expectations of strategy delivery. We have a clear sense of purpose and clarity regarding our role as an NHS Leader within Kirklees. We have achieved this through development events which have been held with our stakeholders, commissioning college, Board, HIT Leads and staff to identify and ensure that the strategic plan and identified programmes deliver the PCT vision, goals and outcomes. The output of this work has been integral to the development of the strategic plan and organisational development objectives. Our systems and structures have been changed so that new areas of strategic development are led by each of the HIT or PBC leads with full collaboration and support from enabling functions such as performance and information, finance, procurement ,
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workforce, organisational development and medicines management. This has been strengthened by the development of a consistent programme management approach using MSP and in house tool, which is also reflected in our partnership working. For each of the 11 Programmes there is a detailed action plan developed and managed by the HITs identifying objectives, actions and outcomes. These plans include short term and long term outcomes and therefore provide a key link between the 5 year strategic plan and the annual operational plan. There is a public sector wide focus on inequalities which has brought together senior managers from the PCT and Council to improve links across the priority programmes and ensure inequalities are being tackled. This remains a significant area for further organisational development. NHS Kirklees organisational structure is clearly established with a good emphasis and commitment to cross directorate and cross organisational working. There are several working groups which facilitate a high level commitment to the broad strategies and agenda’s which help deliver the PCT goals. For example, the Commissioning College, Director, Deputy and Assistant Deputies Group, World Class Commissioning Project Group. The output of these groups include great cohesiveness and organisational commitment to delivery of the goals identified within the strategic plan and the organisational development plan. An example of these working arrangements was demonstrated through our approach in managing through the Swine Flu pandemic which was supported by cross directorate working groups. NHS Kirklees provided a lead both across our
Realising our Ambition Organisational Development Plan 2010/15
patch and more regionally offering advice and establishing a Strategic Control Group supported by Operational Command and Control. This process has demonstrated first hand the high level of generic management and administrative skills across the organisation which has given additional confidence in abilities at an individual, team and organisational level. We have held reviews and opportunities for learning from the management of this process and the new ways of working which were adopted as a result of this. We have a positive background of improvement and evidence of past delivery. We achieved an improvement in the Care Quality Commission rating from average to good. Achieving the range of development priorities identified below allows NHS Kirklees to continue to build on this foundation so that our longer term ambition as a key partner in Kirklees that improves the health of people in our area is achieved. Our longer term ambition is to achieve more integrated commissioning and working with Kirklees Council.
embraces change, is committed to innovative practice, not just from our providers but in the way we work and deliver our service. Our focus will be towards improvement and learning which will allow us to drive up the quality of what we do and what we commission. The organisational objectives listed below contain both wider cultural change objectives as well as specific objectives. Our ambition at the end of the organisational development plan is one where we deliver our agenda through a programme approach that is underpinned by a formal organisational structure that reflects a matrix style of working. Clinical input will be integral throughout all the programme areas and PCT work. Commissioning decisions will be based on areas identified as most in need and funding will flow from this. Decisions will be evidenced by outcomes using performance and information confidently across the organisation.
Our organisational assessments show we have a motivated and skilled workforce who are well placed to respond flexibly to the challenging and stimulating healthcare environment. This has been effectively demonstrated during 2009 and early 2010 through our workforce’s swift and effective response to the Swine Flu pandemic. We are confident that our staff will continue to demonstrate similar innovation and flexibility in their response to future challenges. Where there were skills gaps we have taken action through reorganisation, recruitment and retraining to ensure that people with the right skills are in place to deliver our strategy. We are recognised as an organisation that
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3.3
Organisational Development Objectives The following identify our overarching development objectives. The actions required to deliver these are contained within the organisational action plan for 2010/11.
Strategy • To ensure that all organisational strategies are aligned to the NHS Kirklees Strategic Plan and therefore support its delivery • To ensure that the NHS Kirklees Strategy is embedded and appropriately understood
Structure • Programme Office is established and functioning • A new approach to working is established in which the Programme Office supports the commissioning functions such as HIT teams, and helps drive performance through matrix working • To create a new Clinical Executive Committee for the Commissioning College
System • To undertake a whole system review to identify how different systems support each other and critically, how continuous improvement feedback serves to strengthen the whole system • To identify systems and processes which support delivery of the Marketing Strategy
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• To ensure that predictive modelling is successfully implemented and integrated by practices and clusters so that interventions can be targeted more appropriately to those most at risk • Predictive modelling provides the most accurate and comprehensive approach to risk stratification. This method systematically assesses the entire population, identifying patients along the continuum of risk. Which will enables each practice or cluster to target interventions based on individual patient’s risk and to tailor these interventions to deliver the right amount of support at the right time.
Style • To continue to build strong clinical involvement in the Kirklees commissioning agenda • To continue to build and foster the strong partnerships that already exist both within the NHS and with our Kirklees Council colleagues • To embed the NHS Kirklees Leadership Framework (e.g. including in PDRs) • A Leadership Framework has been developed and will be used to underpin Kirklees Way and to ensure that all leaders in NHS Kirklees receive appropriate feedback on their performance and development within this area. Some of the key organisational challenges identified within the 2009/10 survey and met include: - To embed a consistent approach to using our vision and values in how
Realising our Ambition Organisational Development Plan 2010/15
we work - To consider issues of talent management and succession planning in future leadership investment - To further develop business planning and project management skills
Skills • To develop a range of core commissioning skills among our commissioning community and ensure we develop further a joined up approach between our PCT Managers and Clinicians in commissioning decisions
• To develop a learning culture where innovation and improvements in performance are recognised and developed
• To ensure HIT Programme Leads have the appropriate competencies to deliver the objectives identified in both the strategic plan and QUIP Framework
Staff • To ensure that NHS Kirklees adopts people management practices that reflect Model Employer Status and ensures we more than meet the requirements of the NHS Constitution
• To continue to increase the range and depth of commissioning skills required to become WCC
• To develop new ways of working which are aligned to our move to new Headquarters and which demonstrate a more efficient way of working through increased collaboration and reduced duplication. • Use the KSF to identify core competencies which support the delivery of the strategic plan and world class commissioning competencies
• To increase commercial skills, first by undertaking the development needs analysis and then through involvement on the regional development programme • To ensure that staff are fully aware of the need to apply the most appropriate quality improvement techniques to achieve quality of service and value for money whilst delivering outcomes outlined in the strategic plan.
• To ensure that key organisational skills are identified and addressed through recruitment, selection or development
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Understanding the local health system
Measuring & improving provider performance & contracts mgt
Managing your demand and supply
Commissioning case & investment portfolio
Service specification & design
Programme development
Developing strategic objectives & setting priorities
Commissioning needs assessment
Building evidence base, sources of information
Understanding your local health economy
Civic engagement for health
Policy context
COMPETENCIES Manage knowledge and assess needs
Collaborate with Clinicians
Engage with public & patients
Work with Community Partners
Locally Lead the NHS
Prioritise of all spend
Kirklees Way - Delivering World Class Commissioning Competencies
Appendix 1
MODULE 1
MODULE 2
MODULE 3
MODULE 4
Promote and improve innovation
Manage the local health system
Secure procurement skills
Stimulate the market
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Efficiency and effectiveness of spend
The NHSK Strategy is embedded and appropriately understood
All organisational strategies are aligned to the NHSK Strategic Plan and therefore support its delivery
Development Objective
STRATEGY
Discussion of the Plan at NHSK staff events
Use of Personal Development Review Process to ensure that appropriate employees recognise how delivery of the plan effects their role
Communication of plan to all internal staff and our partners. Ensuring that key messages regarding the QUIPP agenda are given and understood, especially in relation to the delivery of our programmes areas
To continue to develop ongoing relationships with our partner organisations and commissioning colleagues so that priorities are continually addressed and development action taken as required
To move from having a procurement strategy to an organisational market management strategy – that will help understand, strengths and weaknesses of current, potential providers
To ensure that strategies reflect not just the direction of travel for NHSK but also take into account the work being undertaken by the Yorks and Humber SCG
Using internal communication mechanisms to promote the strategy. To ensure that key targets within the strategy are built through internal performance mechanisms
Partners have been involved throughout the development of the strategy. The final NHSK Strategy will be formally shared with our partners.
Plans are already underway to deliver this both internally and as a patch wide initiative
Sharing information through NHSK formal networks
The 7 s model is used to identify development and implementation implications of organisational strategies.
Process for development and delivery of strategic initiatives are linked
Options for Delivery (Buy, Share, Build)
Actions Required
Organisational Development Priorities
Appendix 2
Head of Programme Office/Assistant Director of Organisational Development
Head of Programme Office
Deputy Director of Commissioning
Assistant Director of Organisational Development
Organisational Lead
March 2010
March 2010
Ongoing
Ongoing
Timescale for completion
Realising our Ambition Organisational Development Plan 2010/15
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A new Executive Committee for the Commissioning College is created
A new approach to working is established with the Programme Office supporting HIT and others through matrix working.
Programme Office is established and functioning
Development Objective
STRUCTURE
To recruitment and develop new members of the Committee
To clarify the role and responsibility of the Executive Committee and its members
To achieve greater clarity between commissioning and enabling roles with a higher degree of understanding of who delivers what (through SLA’s if necessary)
To embed chosen approach and ensure all employees are signed up to this and understand the implications for our new way of working
To explore both formal networking or matrix working as an organisational approach to how the PCT delivers it’s business
Supported through internal consultancy provided by the HROD Shared Service
The Assistant Director of Organisational Development is exploring opportunities for working as part of our leadership development approach
The Head of Progamme Office will ensure there organisational understanding of the programme office and programme planning framework
Role and responsibilities of the Programme Office are identified and understood across the organisation
Programme Planning Framework is developed so that there is enhanced project and programme methodologies with clear stages, timelines, milestones and deliverables.
Options for Delivery (Buy, Share, Build)
Actions Required
Senior Management Team
Assistant Director of Organisational Development
HIT Leads
Head of Programme Office
Organisational Lead
May 2010
April 2010
March 2010
Timescale for completion
To identify systems and processes which support delivery of the Marketing Strategy
To undertake a whole system review to identify how different systems support each other and critically, how continuous improvement feedback serves to strengthen the whole system
Transforming Community Services
Development Objective
SYSTEM
Internally through the Strategic Commissioning Directorate
Taking forward service reviews identified as priorities within our Commissioning Strategy for Community Services
The tool has been purchased and implementation is being supported through Medicines Management
To embed Script switch across Kirklees
The development of systems and processes which will be delivered with guidance and supported by templates for example those that allow the formalization of contracts etc which will support an increased commercial approach to commissioning, for example programme budgeting
To ensure that systems are kept as simple as possible to reduce duplication and increase transparency
Through a joint approach of internal development, for example, Kirklees Way, but through Y&H workshops on innovation and efficiency
To identify greater effectiveness and efficiency and to shorten cycle times
To agree an appropriate organisational structure for all community services currently provided by the PCT’s provider arm - Kirklees Community Healthcare Services (KCHS)
Options for Delivery (Buy, Share, Build)
Actions Required
Deputy Director of Commissioning
Director of Patient Care and Professions
Assistant Director of Organisational Development/Dep uty Director of Commissioning
Deputy Director of Commissioning
Organisational Lead
December 2010
Ongoing
July 2010
Ongoing
Timescale for completion
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Predictive modelling is successfully implemented and integrated by practices and clusters so that interventions can be targeted more appropriately to those most at risk
Development Objective
SYSTEM Continued...
Additional resource has been allocated to this work but it is time limited. There is potential to extend this resource on a short term basis
Delivering the Knowledge Exchange Programme by assisting GPs and Community Matrons to understand the information available and to review the way in which they target services.
Conduct a review which shows how the tool can support the efficient and effective commissioning and design of services and review this for changes and impact
Review success against the implementation plan, evaluate success and identify learning and impact for the identification of those with highest risk
Explore the opportunity of extending the model into social care and mental health through our current partnership arrangements
Continue with the implementation plan developed to embed the predictive risk process.
Options for Delivery (Buy, Share, Build)
Actions Required Director of Patient Care and Professions
Organisational Lead July 2010
Timescale for completion
Continue to build and foster the strong partnerships that already exist both within the NHS and with our Kirklees Council colleagues
Development Objective
STYLE
Building on current arrangements and using this basis as an opportunity to explore further opportunities across the Yorkshire and Humber patch
To identify further opportunities for joint appointments and economies of scale both across Kirklees and wider within West Yorkshire
To continue to explore with our partners how we work collaboratively to increase service user and public involvement in our work. The NHSK Communications Plan identifies the further work required to engage with the public.
To continue to explore opportunities for system wide working arrangements which support a person centred approach and partnership working across the whole organisation and which enhances delivery of the QIPP agenda.
To explore opportunities for development which offer increased joint working and understanding of different organisational cultures
To continue to explore how through partnership and collaboration we can learn how to manage increasingly complex contractual relationships with a diverse range of providers
Options for Delivery (Buy, Share, Build)
Actions Required Senior Management Team
Organisational Lead Ongoing
Timescale for completion
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To embed the NHSK Leadership Framework
Strong clinical involvement in the Kirklees commissioning agenda is embedded
Development Objective
STYLE Continued...
Internal mechanisms, including induction and PDR will be used to identify future development needs and arrange specific development to meet these, for example, Kirklees Way The Leadership Framework will be embedded internally but externally assessed through the Investors in People Assessment Process which will need to be bought into the PCT
To improve understanding and relationships between PCT staff and clinical staff through ongoing joint working initiatives
To ensure that the organisational action plan for delivery is implemented The Leadership Framework is embedded through “Kirklees Way�
To assess impact of the Leadership Framework as part of the PCTs ongoing commitment to the Investors in People Standard
To use the analysis from the leadership framework to identify talent management and succession planning
To undertake assessment of leaders using the framework. To identify development needs which recognise the importance of this role and fulfil responsibilities accordingly
To ensure that the Leadership Framework is used as additional support to the recruitment process especially for senior posts and those for the Clinical Executive Committee
To support initiatives such as the PBC Development Programme for practices
The IIP Process is a three year assessment cycle with the potential for in year
Initial discussion through Directors, Deputy and Assistant Directors Forum
The Commissioning College is facilitated using internal consultancy. A conference and review are held annually
To continue to review and renew the commissioning college
To develop a new clinical executive committee
Options for Delivery (Buy, Share, Build)
Actions Required
Director of HROD
Director of HROD
Assistant Director of OD
Director of HROD
Director of HROD
Assistant Director of Organisational Development/PEC Chair
Clinical Executive
Organisational Lead
December 2010
April 2010
April 2010
March 2010
December 2010
June 2010
October 2010
Timescale for completion
To develop a learning culture where innovation and improvements in performance are recognised and developed
Development Objective
STYLE Continued...
To ensure that data information is used in a way to facilitate learning, development and decision making. For example, use of tools such as the predictive risk will become embedded into the ongoing culture and working ethos across the PCT
To develop a culture where people are empowered and supported to improve performance across all aspects of PCT business through an approach of continuous improvement
To recognise and utilise a range of alternative (to course attendance) development opportunities, including coaching, mentoring, job shadowing and on the job learning
Actions Required
Yorkshire & Humber Coaching & Mentoring Resource Internal resources
assessments which will incur costs for the PCT if this approach is adopted
Options for Delivery (Buy, Share, Build)
Director of Patient Care and Professions
Director of HROD
Organisational Lead
September 2010
Timescale for completion
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The HROD Shared Service have a clearly defined SLA and business plan which is monitored as part of a governance arrangement
Deliver the NHSK HR Strategy and business plan which identifies a range of actions to address this objective
Assistant Director of HR and Workforce Development
A KSF Project Group exists to ensure implementation and appropriate use of the KSF
HITs/ WCC Project Group identify gaps as part of its ongoing review of the competencies. Feedback is provided through SMT
To undertake a review of current working arrangements and explore opportunities for more effective and efficient ways of working
Use the KSF to map key competencies at the different levels within the PCT and ensure that outlines are updated to build in the key competencies identified. Current areas include: • Information technology and the use of information • Public and patient involvement • Contract management • Performance information and analysis
Current organisational gaps include: High quality information specialists
Use the KSF to identify core competencies which support the delivery of the strategic plan and world class commissioning competencies
To ensure that key organisational skills are identified and addressed through recruitment, selection or development
To develop new ways of working which are aligned to our move to new Headquarters
Member of HR/OD Team identified to undertake training Programme
To address development needs identified from the 2009 survey when they are released
To develop a continuous improvement plan against the Investors in People Standard which we have recently achieved.
Options for Delivery (Buy, Share, Build)
Actions Required
To explore and implement a LEAN approach to working
To ensure that NHSK adopts people management practices that reflect Model Employer Status and ensures we meet the requirements of the NHS Constitution
Development Objective
STAFF
Senior Management Team
Assistant Director of Organisational Development
Director of HR/OD
Senior Management Team
IIP Champions Group
Director of HROD
Organisational Lead
Ongoing
September 2010
December 2010
April 2010
May 2011
March 2011
Timescale for completion
Public Health Service Observatory and Tribal Newchurch Consultancy appointed to deliver “Kirklees Way” commissioning Development Programme
A Commissioning Development Programme has been commissioned which includes a range of modules that cover: • Health needs assessment • Social Marketing • Commissioning Cycle • Equality and Diversity including Equality Impact Assessments • Short term projects which focus on addressing specific commissioning issues within the PCT • Leading the Commissioning Agenda • Knowledge and practical application of change management
To ensure all HIT Leads have the level of skills to enable them to: • Conduct service reviews using access to a range of national and internal information as a best practice guide • Identify opportunities for radical service improvement • Conduct root cause analysis and analytical ability • Develop a gap analysis on the changes required using a range of data analytical skills • Manage and deliver changes identified both on a service level but also for patients delivering personal behaviour change • Use of performance information (including programme budgeting) and management systems to measure outcomes • To work using a programme management approach underpinned by MSP principles • To create a shift in focus from business case skills to developing appropriate service redesign,
To develop a range of core commissioning skills among our commissioning community and ensure we develop further a joined up approach between our PCT Managers and Clinicians in commissioning decisions
To ensure HIT Programme Leads and Clinical Leads have the appropriate competencies to deliver the objectives identified in both the strategic plan and QUIP Framework
April 2010
March 2010
Deputy Director of Commissioning/ Assistant Director of Organisational Development
Head of Programme Office
Commercial Skills Development Programme
September 2010
January to September 2010
Timescale for completion
Organisational Development Group
Organisational Development Group
Organisational Lead
Public Health Service Observatory and Tribal Newchurch Consultancy appointed to deliver “Kirklees Way” commissioning Development Programme
Additional training may be required to deliver some skills development, but this will be identified on an ongoing basis through the use of PDR
Options for Delivery (Buy, Share, Build)
Development Objective
Actions Required
SKILLS
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To continue to increase the range of commissioning skills required to become WCC
Development Objective
SKILLS Continued...
Current gap analysis in addition to the above includes: Scenario planning Health Dialogue Risk and Stratification System
contracting and relationship management • Ongoing development of forecasting skills (budgetary management, workforce development, training and education needs of future workforce) • To develop skills that will enable the introduction and development of personalised care planning. • Identify any training or education needs of service users for successful implementation of personalised care planning • To introduce the Behaviour Change Competence Framework across the PCT which will enable commissioners to assess the impact of commissioning decisions on health and wellbeing through changes in behaviours and also to ensure that our provider employees have the levels of competence identified within the Behaviour Change Competence Framework
Actions Required
HITs/WCC Project Group to identify gaps and needs through identified organisational processes and feed this back through SMT
Behaviour Change Framework Programme
Options for Delivery (Buy, Share, Build)
Senior Management Team
Assistant Director of Public Health
Organisational Lead
Ongoing
Ongoing
Timescale for completion
To ensure that staff are fully aware of the need to apply the most appropriate quality improvement techniques to achieve quality of service and value for money whilst delivering outcomes outlined in the strategic plan.
To undertake the training needs analysis to identify development of commercial skills
Development Objective
SKILLS Continued...
Commissioning and decommissioning decisions demonstrate sound methodology throughout the whole commissioning cycle
A credible and valued resource is provided to clinicians and commissioners to support high quality clinical audit, effectiveness, evaluation, research, patient safety initiatives and mechanisms to measure patient experiences.
Audit, effectiveness, evaluation and research capability and capacity is strengthened, streamlined and aligned with other quality priorities e.g. WCC, PbC, patient safety, patient experience initiatives (including PROMs and PREMs), accreditation, appraisal and revalidation.
Relevant staff to be identified to take part in the DNA Access to programme Internal Resource through strengthening and focusing of priorities within the Quality and Clinical Governance Team
Deputy Director of Commissioning is leading this development within the PCT with the Assistant Director of Organisational Development. Funded through the Y&H Collaborative
NHSK has signed up to a work-plan being delivered by the Commercial Professional Network. The work plan forms the activities that are being done collaboratively across PCTs, within the commissioning side of the Commercial Support Unit. A range of activities are underway which will equip us in addressing WCC competencies, particularly 7,9 and 10 with a particular focus on the up-skilling of the commercial population (this will be provided for specific staff in addition to our own internal programme
Development Needs Analysis to be organised by Y&H PCT Collaborative
Options for Delivery (Buy, Share, Build)
Actions Required
Assistant Director of Quality and Clinical Governance
Deputy Director of Commissioning
Organisational Lead
December 2010
April 2010
Timescale for completion
Realising our Ambition Organisational Development Plan 2010/15
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Development Objective
SKILLS Continued...
Assurance that all the services we commission and provide are compliant with local and national standards and quality indicators including CQC essential standards for registration, national standards relating to research, clinical audit, NICE, patient safety
Greater volume of primary care led research that attracts funding, benefits patients and results in positive reputation and accreditation
Assurances and evidence are provided that service users and patients directly benefit from quality improvement activities
Each project is quality and risk assessed and prioritised to ensure patient focus, costs are considered and projects are aligned with other local and national priorities e.g. reducing health inequalities, LTC, compliance with NICE and other national standards
PROMS and PREMS are used to shape service developments, commissioning and decommissioning decisions
Innovations, quality improvements and commissioning decisions are explicitly patient outcome focused and evidence based
Quality outcome measures are rigorously developed, embedded into clinical practice and commissioning processes and routinely measured
Actions Required Options for Delivery (Buy, Share, Build) Organisational Lead
Timescale for completion
PEC
Audit Committee
Provider Board
Finance & Performance Committee
Committee Structure to the Board
Appendix 3
Private
Remuneration & Terms of Service Committee
Board
Communications and Public Relations Committee
Strategic Development Committee
Specialist Commissioning Group
NHS Kirklees Directorate of Patient Care and Professions
Governance Committee
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NHS Kirklees Organisational Structure
Appendix 4
NHS Kirklees Directorate of Patient Care and Professions
NHS Kirklees Human Resources/Organisational Development Shared Service Structure
Realising our Ambition Organisational Development Plan 2010/15
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NHS Kirklees Performance and Information Directorate
NHS Kirklees Finance & Estates Directorate
Realising our Ambition Organisational Development Plan 2010/15
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NHS Kirklees Corporate Services Directorate
NHS Kirklees Commissioning & Strategic Development Directorate
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NHS Kirklees Public Health Directorate
Systems
Soft Elements
Shared Values Skills Style Staff
Hard Elements
Strategy Structure Systems
Capabilities possessed by the organisation as a whole as distinct from those of individuals
The processes and procedures through which things get done from day to day
The organisation chart and accompanying information that shows who reports to whom and how tasks are both divided up and integrated
7 - S Model (McKinsey)
Appendix 5
Shared Values
Staff
Strategy
The overarching purpose and belief of the organisation – they imply a trust about common goals and beliefs which is often the glue holding the organisation together
Skills
Structure
The people in the organisation – their demographics, socialisation into organisation (formal & informal), rewards, training, promotion, peer pressure, rewards, folklore. All these are powerful levers for change
Style
The way managers collectively behave with respect to use of time, attention and symbolic actions
A plan to allocate resources over time to achieve identified goals – sets direction
Realising our Ambition Organisational Development Plan 2010/15
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Appendix 6
World Class Commissioning Self Assessment Competencies Competency 1: Self assessment Competency Are recognised as the local leader of the NHS
Measure
Level Level Level Level 1 2 3 4
• Reputation as the ‘local leader of the NHS’ • Reputation as a change leader for local organisations • Position as the local healthcare employer of choice
Competency 2: Self assessment Competency Work collaboratively with community partners to commission services that optimise health gains & reduce health inequalities
Measure
Level Level Level Level 1 2 3 4
• Creation of LAA based on joint needs • Ability to conduct constructive partnerships • Reputation as an active & effective partner
Competency 3: Self assessment Competency Proactively build continuous & meaningful engagement with the public & patients to shape services & improve health
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Measure • Influence on local health opinions & aspirations • Public & patient engagement
• Improvement in patient experience
Level Level Level Level 1 2 3 4
Realising our Ambition Organisational Development Plan 2010/15
Competency 4: Self assessment Competency Lead continuous & meaningful engagement of a broad range of clinicians to inform strategy & drive quality, service design & efficient & effective use of resources
Measure
Level Level Level Level 1 2 3 4
• Clinical engagement • Dissemination of information to support clinical decision making • Reputation as leader of clinical engagement
Competency 5: Self assessment Competency Manage knowledge & undertake robust & regular needs assessments that establish a full understanding of current & future local health needs & requirements
Measure
Level Level Level Level 1 2 3 4
• Analytical skills & insights • Understanding of health needs trends • Use of health needs benchmarks
Competency 6: Self assessment Competency Prioritise investment of all spend in line with different financial scenarios & according to local needs, service requirements & the values of the NHS
Measure •
Predictive modelling skills & insights to understand impact of changing needs on demand
•
Prioritisation of investment & disinvestment to improve population’s health
•
Incorporation of priorities into strategic investment plan to reflect different financial scenarios
Level Level Level Level 1 2 3 4
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Competency 7: Self assessment Competency Effectively stimulate the market to meet demand & secure required clinical & health & well-being outcomes
Measure
Level Level Level Level 1 2 3 4
• Knowledge of current & future provider capacity & capability • Alignment of provider capacity with health needs projections • Creation of effective choices for patients
Competency 8: Self assessment Competency Promote & specify continuous improvements in quality (e.g. CQUIN, IQI) & outcomes through clinical & provider innovation & configuration
Measure
Level Level Level Level 1 2 3 4
• Identification of improvement opportunities • Implementation of improvement initiatives • Collection of quality & outcome information
Competency 9: Self assessment Competency Secure procurement skills that ensure robust & viable contracts
Measure • Understanding of provider economics • Negotiation of contracts around defined variables • Creation of robust contracts based on outcomes
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Level Level Level Level 1 2 3 4
Realising our Ambition Organisational Development Plan 2010/15
Competency 10: Self assessment Competency Effectively manage systems & work in partnership with providers to ensure contract compliance & continuous improvement in quality & outcomes & value for money
Measure
Level Level Level Level 1 2 3 4
• Use of performance measures • Implementation of regular provider performance discussions • Resolution of ongoing contractual issues
Competency 11: Self assessment Competency Ensuring efficiency & effectiveness of spend
Measure
Level Level Level Level 1 2 3 4
• Measuring & understanding efficiency & effectiveness of spend • Identifying opportunities to maximise efficiency & effectiveness of spend • Delivering sustainable efficiency & effectiveness of spend
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Appendix 7
Equality Impact Assessment 1
What is being Equality Impact Assessed? The NHS Kirklees Organisational Development Plan.
2
Description of the function being Equality Impact Assessed: The purpose of the Organisational Development Plan is to identify the developments which need to take place to support delivery of the NHSK Strategic Plan. These developments may be internal or external but usually relate to the organisational capacity and capabilities required to deliver the priorities identified. The actions therefore concentrate on the directly employed staff of the organisation although there are obviously much wider impacts. Equality and diversity are integral across the employment practices of NHSK. Our HR Strategy identifies how we continue to support the implementation of equal opportunities in our day to day work. Our explicit approach as an employer will be more important as we approach the changes which are set out within the operating framework regarding management costs.
3
Lead contact person for the Equality Impact Assessment: Karen Gallagher, Assistant Director of Organisational Development
4
Who else is involved in undertaking this Equality Impact Assessment: Sources of information obtained which inform this EIA include workforce information, NHSK Workforce Strategy, NHSK Strategic Plan, NHSK Finance Plan
5
Sources of information used to identify barriers etc
What does your research tell you about the impact your proposal will have on the following equality groups? BME Groups: NHSK collects, monitors and publishes race data. This is monitored via the corporate performance framework. The organisation is broadly reflective of the population but there are differences between roles and grades.
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Realising our Ambition Organisational Development Plan 2010/15
Our workforce data shows that our workforce is not representative of the community in which we serve. The purpose of the organisational development plan is to ensure that as an organisation we achieve such representation within our workforce, through our human resource policies, including recruitment and development. In addition, we are also identifying specific action through our talent planning to identify leaders from BME groups who may be able to access the specialist leadership programmes that are available within the region. The document aims to increase the representation of BME groups in the PCT workforce to reflect the ethnic diversity of the local population. This is likely to include targeted recruitment activity towards BME groups. Minority ethnic achievement in Kirklees is complex. Overall, students from the largest minority ethnic group, Pakistani origin, performed below the Kirklees average at KS1, 2 and 3. This persisted up to KS4 where students of Pakistani origin were least likely to achieve the 5+ GCSEs at grade A*-C, and therefore programmes of work which encompass children and young people will ensure that these factors are considered. Access to employment, rather than to Higher Education, is the issue for the local Pakistani population. The PCT has employed apprenticeships and works with local schools share information about careers and opportunities within the health service. Work is on-going to support individuals into work who are likely to include disproportionate numbers of BME staff – apprenticeships, the Future Jobs Fund
Disability Groups: Disability data is collected for employees but response rates do not reflect the numbers reported through the staff survey (The national staff survey data is monitored by staff declaring a disability.) The organisation provides support for staff with health problems through its ill health policy – there are occupational health and counselling available. Recruitment processes are DDA compliant (see draft EqIA of this policy). A number of senior staff have agreed to act as mentors for BME staff through a regional programme. The organisation has achieved the 2-ticks disability symbol and is signed up to the Mindful Employer initiative. A number of staff have been trained through the Mental Health First Aid programme. We work with employees on an ongoing basis to review working arrangements to ensure our workplace is appropriate to the needs of our employees. Work is ongoing to support individuals into work who are likely to include disproportionate
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numbers of disabled staff – apprenticeships, the Future Jobs Fund, encouraging managers to consider “job carving” Within our HR Strategy we are looking to ensure that we proactively support health workplaces for all employees.
Gender: The organisation collects, monitors and published data on gender. This information is complete. The organisation is predominantly female although this difference moves more towards parity in the most senior posts. The national staff survey data is monitored by gender. The organisation employs no declared transgender staff. NHSK is a predominantly female workforce. However, whilst we have good representation locally of women in senior management positions, we recognise this is not always reflected across the broader NHS. We are actively involved in identifying employees who can access specific development programmes designed to redress this balance. We offer flexible opportunities both for working and for learning so that those with carer responsibilities are not hindered from accessing the opportunities presented within the plan.
Age: Age profiles are monitored for employed staff. The national staff survey is monitored by age. Workforce plans identify age related recruitment issues will impact on the PCT at a national level. This is less of an issue for Commissioning staff (the primary focus of the WCC agenda) but will impact significantly on many provider staff. The organisation does not control entry into the market for health care professionals The Organisational Development Plan focuses on talent management and succession planning linked to the ageing workforce of the NHS and the ageing local population. Our HR Strategy highlights positive action being taken, including efforts to retain more experienced workers, for example through flexible retirement, and efforts to recruit more younger workers, for example through an Apprenticeship Scheme.
Sexual Orientation: The organisation has very little data on the sexual orientation of its workforce and applicants for posts as people generally choose not to reveal these. HR casework is monitored – there have been no grievances/bullying issues related to this. Through our close partnership arrangements with Kirklees Council we have discussed opportunities to join groups that exist for example, gay and lesbian employee support groups
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Realising our Ambition Organisational Development Plan 2010/15
Religion & Belief: As part of our plans to move to a new HQ we have discussed the need for quiet areas which can be used for prayer. Employees are supported to practice their beliefs within their work for NHSK.
6
Consultation: New or Previous: Consultation was held through our formal processes, including the WCC project group, senior management team and NHSK Board. The OD Plan has not been shared externally to the organisation, however, it is formed from the NHSK Strategy which has been widely consulted upon.
7
Assessment and Actions needed
Location of Organisational Barriers
Assumption of normality / description of barrier
Geographical location Built environment
Action needed Responsibility Deadline N/A
Our new premises are purpose built and provide a modern working environement
Information and communication
N/A
Timing
N/A
Involvement in Planning
Costs of the service
Consultation has occurred through the development of the Strategic Plan which the Organisational Development Plan underpins. The Plan has been shared across key personnel within the organisation N/A
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Customer Care and Staff training
The Organisational Development Plan identifies a range of development programmes that staff can access. Attendance on these programmes will be monitored and access through the PCT study leave and PDR process
Stereotypes and Assumptions
N/A
Involvement in Planning
N/A
Specific Issues/ Barriers
N/A
9
Methods of Monitoring progress on Actions Many of the actions taken are integrated within the general employment practices across the PCT. These are currently monitored through various means including the Workforce Scorecard
10
Publishing the Equality Impact Assessment The EIA will be published as part of the Organisational Development Plan which will be published on the NHSK Website.
11
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Signing off Equality Impact Assessment:
Realising our Ambition Organisational Development Plan 2010/15
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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 Broad Lea House, Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Tel: 01484 464000