Ambitions for a Healthy Kirklees
Organisational Development Plan 2009/10
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Contents
Section 1
Chief Executive’s Introduction
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Background Information 1.1 Introduction to NHS Kirklees and our approach to organisational development 1.2 Strategic challenges 1.3 Organisational vision and values 1.4 Goals 1.5 Delivering our vision 1.6 Equality and diversity
6 6 6 7 8 8 9
Section 2
How the PCT is Organised 2.1 Organisation structure 2.2 PCT Board 2.3 Governance structures 2.4 PCT Directorate structure
9 9 10 10 10
Section 3
Organisational Development 3.1 PCT current position 3.2 Current Organisational Development Needs 3.3 Organisational Development Self Assessment Initiatives 3.4 Partnership working 3.5 Employer of choice 3.6 Leadership development 3.7 National programme for IT (NPfIT)
13 13 13 15 15 15 17 17
Section 4
Organisational Development Overview 4.1 Objectives for the current year 4.2 Achieving our objectives 4.3 Risk 4.4 Finance
18 18 20 20 21
Section 5
Conclusion
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Appendices 1 McKinsey’s 7-S Model 2 Vision and values chart 3 Kirklees PCT directorate structures 5 PCT Organisational Development – WCC Competency Plan Trajectory 4 WCC outcome of first assessment 6 Kirklees organisational development action plan
22 22 23 24 34 35 45
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Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Chief Executive’s Introduction NHS Kirklees 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.
that the panel only felt it appropriate to alter two of our scores which resulted in the Year 1 WCC scoring process achieving 3 scores at 3, 23 scores at 2, and 4 at 1, with 2 greens and 1 amber for our Strategic Plans, placing us in a good place in comparison with the best PCT’s in the country.
We 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 work 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). This has provided us with a wealth of information on the needs of the people in the seven localities that make up the borough of Kirklees. The NHS Kirklees Strategic Plan reflects these needs in the outcomes we have identified as a priority, and also how we will measure progress over the years.
Feedback from the panel was felt to be fair and good ’the panel developed an overall impression of the organisation which is that the PCT has good foundations in place (systems, processes, resources, partnerships) the PCT has identified its significant challenges and now is the time to deliver the vision’.
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 engaged very positively with the World Class Commissioning (WCC) 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
Looking forward to 2009/10, we will drive towards the outcomes we have identified and in this 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 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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Section 1
Background Information 1.1
Introduction to NHS Kirklees and our Approach to Organisational Development (OD) The NHS Kirklees Organisational Development Plan builds on our existing work and is designed to ensure the delivery of both world class commissioning standards and the PCT’s Strategic Plan. The plan has been developed as a result of several multi-disciplinary workshops attended by the PCT Board, PEC, PCT senior managers, local authority representatives, local clinicians and Public and Patient Involvement (PPI) representatives. Diagnosis of our development to date and our future needs has been identified using McKinsey’s 7-S Model (Appendix 1). This model has been shared amongst the senior management team and will be adopted as our approach for future development. It has allowed the PCT as a whole to look at the multi-dimensional areas that need to be considered to ensure the organisational development plan is realised. In November 2008 the PCT commissioned KPMG to work with the Board to identify future needs and deliver an ongoing development programme to meet the needs identified. This work, including Board Development, review of Governance, development of Provider Services has contributed to the priorities identified in this plan. A key part of developing provider services is ensuring that Kirklees Community Healthcare Services (KCHS), the PCT provider arm, is fit for purpose as outlined in Transforming Community Services.
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A Strategic Organisational Development Group has been established to oversee the delivery of the Organisational Development Plan for the forthcoming year. It is chaired by the Director of Human Resources and Organisational Development with members from the Director Group, and output from the group will report to the Chief Executive and Senior Management Team and ultimately the Board. The OD plan is a live document and will be further refined and updated as the PCT continues its development towards achieving world class commissioning status.
1.2 Strategic Challenges To date, a number of key external strategic challenges have been identified that will impact on the PCT’s ability to meet its goals. These have been identified as part of our work with Kirklees Council and our partners through the Kirklees Partnership. The Kirklees Partnership has identified national and international trends that will have a local impact and to which Kirklees needs to respond: • Climate change – tackling our contribution to and planning to adapt to the impact of climate change. • Ageing population – a growing ageing population with long term conditions, many with co-morbidities • Changing economic context In addition, factors specific to Kirklees must also be addressed. To create a more sustainable Kirklees and achieve our 2020 vision we must narrow the gaps inherent in: • Infant mortality and other health inequalities, including a life expectancy below the national average
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
• Educational attainment • A low skill, low wage economy • Lack of confidence in some of our towns (particularly in North Kirklees – Dewsbury, Batley) • Community relations These challenges are identified within the Joint Strategic Needs Assessment developed in partnership with Kirklees Council. The PCT Strategic Plan identifies the actions required to address them, the expected output from these actions and how this will be measured. The Strategic Plan was developed with our key partners enabling a comprehensive, joint approach to tackling these issues. The organisational development plan is designed to ensure that the PCT has the culture, capabilities and capacity to deliver this.
1.3 Organisational 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 were signed off by the Board in 2007. In 2008, we reviewed our vision, values and goals in light of world class commissioning, Healthy Ambitions and our strategic priorities.
Some services are provided by our own staff and we commission services from others, including GPs, dentists, pharmacists, optometrists, voluntary organisations and hospitals. Our ambition is to further develop our partnership working with these groups for the benefit of people in Kirklees. Values Our vision is underpinned by our values. These are to: • recognise that people are at the heart of everything we do; • support people in taking responsibility for their own health and well-being; • encourage innovation and continuous improvement and celebrate the contribution made by our staff; • encourage open, clear and honest communication; • value diversity and challenge discrimination; • show understanding, dignity and respect for all our clients, partners and staff; and • be accountable for the decisions we make, the work we do, the resources we use and our impact on the environment.
Our vision is:
Working together to achieve the best health and wellbeing for all the people of Kirklees This means that NHS Kirklees works together - with ourselves and with our partners - to achieve the best health and well-being for all the people of Kirklees.
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1.4 Goals To achieve our vision, we are driven by clearly defined goals. These goals have been reviewed in the light of Healthy Ambitions and reflect both the key national drivers and our local priorities. For these reasons, our goals will form a ‘golden thread’ running through our plans, and will underpin our approach to our priority health programmes. Our goals are to: • To place the person at the centre of everything we do. • To improve health and reduce health inequalities. • To improve quality and promote safety. • To promote choice and accessibility. • To work well in partnership with communities, individuals and their families, staff and organisations. • To promote local sensitivity through effective commissioning. • To promote strong clinical leadership • To drive service redesign and innovation. • To be a visibly credible organisation, operating to the highest standards.
1.5 Delivering our vision We have been working with local partners, stakeholders and our own staff to put in place a range of programmes designed to align the local NHS and related system to deliver the goals described above. These programmes form the key strategic priorities within the PCT and have been rigorously assessed to ensure delivery against both the PCT’s goals and our underpinning vision and values. An example of a successful programme includes the Population Centric Workforce Planning Programme undertaken
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(Organisational Development Services) in the field of obesity. This programme has led to the development of a obesity service specification, which has in turn influenced the work of Yorkshire and Humber on the DARZI obesity workforce development. Results of this work include, informing the commissioning of the Public Health (PH) Continuing Professional Development (CPD) programme for teaching public health network. We have developed and increased capacity and capability within Kirklees. To date we have run 26 specific PH Courses with 211 people trained in motivation interviewing and brief interventions up to December 2008 A number of enablers have been identified which will underpin delivery against these programmes and these are identified within the Strategic Plan and will further be clarified by the Programme Delivery Strategy. This organisational development plan includes key enablers, but also focuses more broadly on world class commissioning and delivery of the PCT’s Strategic Plan. Our organisational development goals have been developed to ensure that the PCT’s values are integral to the way we conduct our business, from our practice based commissioning process and associated business planning through to the way we engage with our community and clinicians and lead our staff. The organisational development plan is one of the strategies identified as being integral to the delivery of the PCT’s goals. For example, we have invested in a comprehensive personal development review (appraisal) process to ensure that all staff are well trained, understand our priorities and are motivated to deliver them. We will measure this through our new performance management framework; the
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
NHS Staff Survey; and achievement of the Investors in People standard, towards which we are currently working. Appendix 2 shows our vision and value chart, which has been communicated to staff and stakeholders alike.
1.6 Equality and diversity We are committed, to equality and diversity underpinning everything we do, and this is reflected in both our vision and values and 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 directed where most needed. Internally a multi directorate steering group is leading the implementation of the equality duties across the commissioning side of the organisation. A substantive appointment to a diversity manager post has been agreed which replaces the fixed term contract previously in place. An initial stock take of our organisational position on equality and diversity has been led by the steering group and an action plan prepared. The PCT also strives to ensure that its workforce reflects our diverse community and its employment policies and procedures follow best practice. All policies, including those of human resources, are required to undertake an equality impact assessment as part of their review, development and followed through in their implementation. In addition, basic awareness of equality and diversity is featured in everyone’s Knowledge and Skills Framework (KSF) and is provided as part of our statutory training support.
Section 2
How the PCT is Organised 2.1 Organisation Structure Kirklees PCT was established in October 2006 from the three former PCTs in Huddersfield and North Kirklees. We have the same boundaries as Kirklees Council (KC) and organise our work across the same seven localities. We serve a population of some 400,000 people which is expected to grow by a further 33,000 by 20181. 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 and safe. As the custodian of NHS services in the local area we are known as ‘NHS Kirklees’. Kirklees’ seven localities are shown on the map below. Each locality has a locality plan, which specifically identifies needs and development within that area. The locality plans are overseen by a locality board.
ONS 2006-based population forecasts (whereas the Kirklees Joint Strategic Needs Assessment, published in February 2008, uses ONS 2004-based forecasts). 1
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NHS Kirklees Boundary Batley, Birstall and Birkenshaw Spen
Dewsbury and Mirfield
Huddersfield North Huddersfield South
The Valleys
Denby Dale and Kirkburton
2.2 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 Professional Executive Committee (PEC) Chair and others, including PCT Directors, a PEC member, and a member of our Local Involvement Network (LINks) Forum.
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2.3 Governance Structures There are nine Board committees who progress and oversee delivery of the PCT strategy. These are: • Remuneration and Terms of Service Committee • Audit Committee • Communications and Public Relations • Provider Board • Strategic Service Development • Specialist Commissioning Group • Governance Committee • Professional Executive Committee (PEC) • Finance and Performance Committee
2.4 PCT Directorate Structure When the PCT was established in 2006, eight directorates were created: six in the commissioning arm and two in the provider arm. The PCT has been working closely with its Provider Arm to oversee and support it in preparation for delivery of Transforming Community Services. Several individual and joint workshops have been held to discuss the implications of the split and the actions necessary to accomplish it. The PCT Workforce Risk Assessment Plan for 2008 identified that a potential risk for both the Commissioning and Provider arms of the PCT over the forthcoming year is the capability and capacity issues arising from a formal split of the commissioning and provider functions. A review of workforce capability and capacity is currently underway and output from this will inform the restructuring process required which is being planned.
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Commissioning functions are carried out within six directorates and in April 2009 we are reviewing the effectiveness of these arrangements and split across directorate portfolios in the light of the provider separation and WCC feedback and development required. • 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. • 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 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. • Corporate Services (CS) 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. The provider arm of the PCT includes two directorates: • Human Resources and Organisational Development (HR/OD) 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. • 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. The Board and senior management team are responsible for the delivery of the PCT’s goals and priorities and these are shared and delivered through the directorate structure. Key commissioning activity is undertaken by the Commissioning and Strategic Development Directorate. Its work is informed and supported by the work of the other directorates across the commissioning arm of the PCT, who all have responsibility for ensuring the commissioning function of the PCT is delivered.
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Chief Executive
Chief Executive Office
Kirklees Community Healthcare Services (KCHS)
Human Resources and Organisational Development (HR/OD)
Public Health (PH)
Commissioning and Strategic Development (CSD)
Cross-directorate working is carried out informally, through organised development events and Director, Deputy and Assistant Director Meetings which are held monthly. There is potential for strengthening and development in cross-directorate working and matrix working is currently being explored as an option for delivering this. To maximise the opportunities for integrated ways of working between health and social care and other partner organisations, we have established a number of Health Improvement Teams (HITs). These teams are made up of members of our commissioning staff, clinical leads and representatives from our partners and stakeholders. Each HIT is responsible for tackling a health priority programme, identified within the Strategic Plan. Each HIT creates a clear commissioning plan and performance manages its implementation and ongoing activity. We have also appointed several people to the new role of ‘clinical leads’. The purpose of the clinical lead is to act as a clinical champion for their area and facilitate joint working between the Professional Executive Committee (PEC) (either as a direct member or through their GP representative) and practice based commissioners (PBC). The PEC is responsible for clinical governance of all business planning activities undertaken by HITs.
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Corporate Services (CS)
Care and Professions (PCP)
Performance and Information (PI)
Finance
An innovation within the PCT is the establishment of a Commissioning College which has been established to facilitate discussion among all the key stakeholders mentioned above. Meeting monthly before the PEC, this assembly allows stakeholders to be informed and inform decisions regarding the PCTs commissioning agenda. Feedback from the Commissioning College informs the clinical decisions taken by the PEC who retain their statutory responsibilities. The Director of Corporate Services has undertaken a review of the roles and statutory responsibilities of the PEC and the Commissioning College. Responsibilities have been clarified and communicated appropriately across relevant members. This model of working has allowed us to develop more integrated working with our strategic partners across both health and social care. A review of our governance structures is currently underway. The PCT has commissioned KPMG to support the PCT with this work. Our aim is to ensure they are fit for the future and provide assurance on the quality, safety and delivery of the services we commission and provide. Appendix 3 shows the Kirklees PCT directorate structures.
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Section 3
Organisational Development 3.1 Our Journey to Date As a result of the Fitness for Purpose Review, NHS Kirklees developed a comprehensive development plan that was, in effect, an organisational development plan. The action plan was overseen by the PCT Board and delivery against key outcomes has been achieved. Where development objectives are ongoing, some have been streamlined into the PCT’s performance framework and some are incorporated into our world class commissioning development plans. The key development areas addressed during this period include: • Public and service user engagement – an expansion of the PPI and communications team capacity. • Business planning process and prioritisation – establishment of a process with HIT teams putting forward business cases against that process. • Development of roles and capacity in the PCT in commissioning, finance and information directorates with an emphasis on informing commissioning, contracting and procurement (for example engaging with the advanced commissioning programme).
3.2
Current Organisational Development Needs During the past ten months the PCT has been building on the development needs identified from the Fitness for Purpose process. Throughout 2007 and 2008, we have been working to develop and align our structures and systems to ensure delivery of our goals, the development of our staff, organisational culture and ethos as identified in our vision and values. This has resulted in a clear performance development framework through Performance Accelerator that monitors development and delivery of outcomes. Needs and gaps are swiftly identified and reported to the Board for further action as appropriate. As part of our commitment to our ongoing organisational development needs, the PCT has engaged in diagnostic work including fitness for purpose, links with Local Authority Assessments, our Investors in People preparation and latterly WCC assessments, aimed at continuously improving our performance in order to improve our reputation as the ’local leader of the NHS’. A number of events have been held to explain the WCC Strategy and its impact. In addition, the PCT utilised a number of diagnostic tools, including SWOT and PEST analysis to identify needs in NHS Kirklees. This was followed through with a cross directorate analysis of the WCC Competencies, using the strategic goals and priorities as a baseline of activity required in future.
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WCC Assessment 2008 Feedback Feedback from the WCC Assessment Process identified 5 major areas for consideration by the PCT at this stage on its journey: The panel acknowledges the journey the PCT is on to improve clinical engagement Recommendation: The PCT’s ‘commissioning college’ is an innovative solution to bring together PBC, PEC and HITS. However the panel recommends that the PCT be aware of the challenges and risks that this presents. The PCT will need to be clear about the continuing statutory role of the PEC. The PCT should work to improve the quality of information it provides to support the management of the primary care contract and variances in practices The panel observed the PCT’s strong partnership working Recommendation: The panel recommend that the PCT should use this strong partnership to drive delivery forward and as a means to keep a focus on the vision during some challenging times ahead. The PCT is well placed to tackle future challenges constructively and provide mutual support to the LA The panel observed there were some key risks facing the PCT Recommendation: The panel recommends that the Board reflects on how it prioritises the efforts of the organisation and the focus of the Board. This includes how the PCT prioritises its investments. The PCT should not underestimate the challenges for staff of programme management of a broad range of initiatives
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The panel noted that the culture of the PCT is beginning to change from turnaround to investment Recommendation: The PCT should consider how it readies its staff and teams to think more about investing in work that will clearly provide value for money and benefit more quickly, without losing the strength of the turnaround disciplines. The panel noted that PCT could benefit from more clearly articulating its strategy Recommendation: The panel recommends that the PCT considers how it communicates its strategy. The PCT should reflect on the flow, structure, order and clarity of the document with a view to amending the presentation of the Strategic Plan as part of the work to refresh the document over the coming weeks. In order to deliver the necessary progress we have grouped actions into the following areas, in addition to those identified in the earlier Organisational Development Plan, which will continue to allow the PCT to grow and achieve the development objectives identified to meet the trajectories (Appendix 4). • improve the quality of information it provides to support the management of the primary care contract and variances in practices – A review of the PCT internet and intranet is underway. From March 2009 a link will be established for Primary Care, it will communicate key information to primary care contractors including discussion and output from the commissioning college. • Culture Change – Supported by a move to a centralised Headquarters for all Commissioning Staff where
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
consistent practices are achieved. Underpinning the culture change is a comprehensive leadership programme for all those with leadership responsibility and shared objectives through team development and PDR for all staff • System and Process Development – Systems and processes are being reviewed to ensure a clear strategic commissioning process from business case to implementation and monitoring. In addition, clarity on what our goals will specifically achieve and how these will be measured, including, links to uality outcomes framework (QOF), programme budgeting • A refresh of the Strategic Plan is being conducted for the end of March 09.
3.3
Organisational Development Self Assessment Initiatives In addition to the competency self assessment, the PCT has conducted a training needs analysis with representatives from our commissioning community to assess further details of the key development needs to deliver the WCC competencies. A Leadership Programme will be procured in the next two months for those involved in the commissioning process. This will not only address capability issues but will support the PCT to develop the culture and commitment necessary to delivery our Strategic Plan, including to further support relationship building between clinicians and managers. In addition to the training needs analysis the PCT is working with the Peter Spurgeon from the NHS Institute as part of a pilot into improving medical engagement. One
of three PCTs throughout the UK to become involved in the project, the feedback will enable us to put in place steps to continue to improve how we actively work with our colleagues in primary care.
3.4 Partnership Working A key priority for the PCT is the establishment and further development of partnership relationships, for example, with Kirklees Council and practice based commissioners. Over the past twelve months, we have implemented structures and systems to improve our relationship with our partners and have held a number of development events to support this. Our key organisational development challenges for partnership include: • Enhancing clinical engagement and collaboration through the development and establishment of the Commissioning College (see 2.4) • Building a leadership community with Kirklees Council though joint learning events both at Directorate and senior manager levels. • Developing joint approaches to business planning through clinical leads, HITs, and the Commissioning College
3.5 Employer of Choice To meet our commitment to our staff, achieve our values and goals, and continue to work towards achieving employer of choice status, we have formally committed to working towards Investors in People accreditation. This work is being led by a range of employees from each directorate and is chaired by a Non Executive Director.
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A review against the standard was undertaken in 2007. The results have been included in an organisational action plan being implemented by the IIP Group. This group has also worked with directors to address the needs identified in the 2007 staff survey. Some of the staff support initiatives developed include: • Chief Executive Talk Time • Celebration events to recognise and reward staff • Information events to support the transfer to the PCTs new Headquarters • Refocus and support to the PCT’s Personal Development Review process • Improved communication networks, to include improvements to the PCT website. • Implementation of stress at work guidance and development programme for managers • Review of information and development for new starters, including the Induction process and Employee Handbook • Employee development initiative to encourage all staff to achieve a NVQ Level 2 as a minimum As well as using the information received from our staff survey, we have held a number of focus groups to establish progress against the development actions arising out of the previous year’s survey and to identify future development. The focus groups highlighted that much progress has been made. However, further development is needed in the following areas: • Communication and establishing a clearer feedback loop • Job satisfaction and how this is affected by change in the PCT • To ensure the quality of personal development reviews (PDR) are
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improved. • Improved access to mentoring and job shadowing for all staff • Improved cross-directorate and interteam communication Initial feedback from the 2008 survey indicates a positive improvement across all the areas identified above and action plans are currently being developed to improve this further and address development areas identified in the current survey. The PCT is considering assessment against the Investors in People Standard in 2009. NHS Kirklees’ workforce planning activity is closely linked with its intention to be an employer of choice, and is underpinned by the organisation’s new workforce scorecard. This allows the organisation to more effectively monitor and improve key elements related to the workforce, including sickness, agency spend and staff well-being. The PCT has increased its capacity for analysing workforce data and recruitment activity through the appointment of a workforce analyst who will enable the PCT to review how well we are achieving our desire to be an employer of choice. Our key organisational development challenges for our role as an employer include: • Ensuring appraisal/personal development review (PDR) is conducted consistently and to a high quality • Creating a learning environment throughout the PCT effectively – the Learning and Development Strategy has formally been presented to the Governance Committee • Managing change and risk arising from formal split of commissioning
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
and provider functions • To support recruitment of new staff from those communities who are less represented within NHS Kirklees, an example would be the slivers of time project being rolled out across the PCT.
3.6 Leadership Development The Board has committed to an ongoing development programme commissioned from KPMG that builds on the previous work with both Finnamore Management Consultants and the Audit Commission. The diagnosis reports from these development activities identify that the Board is a well performing team, that has a clear understanding of priorities and how these will be achieved. Relationships are well formed and appropriate levels of challenge are achieved. This was further confirmed in feedback from our recent WCC Board observation event. Our most recent Board diagnostic undertaken by KPMG includes Board observation, one to one interviews, review of personal development reviews and a review of governance information. A Board Development Programme is currently being planned for delivery over the forthcoming 18 months. The PCT signed off its Leadership Strategy in November 2007 and funding for delivery was secured in early 2008. During June and July, the Board undertook an assessment using the PCT world class commissioning self assessment tool (Appendix 5). We will continue to assess our progress against this and continue to adapt our OD plan as our needs develop.
Our key organisational development challenges for leadership include: • To embed a consistent approach to using our vision and values in how we work • To consider issues of talent management and succession planning in future leadership investment • To further develop business planning and project management skills Plans are currently underway to deliver a range of development programmes in support of our clinical and commissioning leaders; including • Leadership programme for PCT managers and stakeholders with responsibility for commissioning • Development programme for Commissioning College • Development of the DDAD (Director, Deputy Director and Assistant Director) Network • Talent management and selection of staff to regional leadership programmes, including Aspiring Directors, National Middle Management Development Programme and Advanced Commissioner Programme
3.7
National Programme for IT (NpfIT) NHS Kirklees will support its programme under the National Programme for IT (NpfIT) through: • its existing capacity/capability • the procurement of additional capacity from its main IT services provider, The Health Informatics Service (THIS) and from external agencies, such as The Phoenix Partnership (TPP)
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Our key organisational development challenges for IT include: • achieving good project management skills; • employing sufficient high quality information specialists; and • planning for the ongoing support of an increasingly IT-dependent workforce. Sufficient specific funds have been identified in the forward resource plan to enable these issues to be addressed. As part of this work, we will ensure: • that basic IT training is included in all mandatory training for staff; and • we have enough specialist IT staff to support the sustainable use of IT and Information systems. In designing the existing PCT structure we have already expanded capacity to lead this through the Performance & Information directorate, which was created as the PCT came into being in late 2006.
Section 4
Organisational Development Overview 4.1 Objectives for the Current Year In developing our Strategic Plan, we have identified a range of enablers, which will support the PCT to deliver its goals and priorities. These enablers are integral within the PCT and reviews show that there are strengths in both capacity and capability within these enablers. We have also undergone a rigorous self assessment process against the WCC competencies, engaging with stakeholders including PBC and Kirklees Council to give balance in this self assessment Arising from this process we have identified the following specific weaknesses (where we scored ourselves at 1) in our current capability: • dissemination of information to support clinical decision making • knowledge of current and future provider capacity • creation of effective choices for service users • creation of robust contracts based on outcomes In addition, to the above, the PCT has considered through its strategic development a number of key strategic documents, including NHS Quality Care for All, Health Ambitions, NHS Next Stage Review, as well as local strategies and documents such as the Joint Strategic Needs Assessment. Some of the PCT’s organisational development objectives will have a direct
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Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
impact on the working of the PCT’s core role on an ongoing basis, while others are more externally focused and will have a longer time frame for delivery. Our strategic organisational development objectives have been updated to: • Ensure that NHS Kirklees as a brand is recognised as a leader of the NHS within Kirklees. As set out in the communications strategy, this means enhancing our profile with stakeholders and the public. We will also continue to work with our partners for the specific benefit of the people of Kirklees. • Provide the local lead for the NHS in Kirklees, ensuring that all leaders within the PCT understand their role and can deliver our strategic goals. We have developed our shared values and improved internal communication to ensure clarity for all staff and this is delivered though regular PDR and use by all of the Knowledge and Skills Framework (KSF). • Develop our clinical leadership and Improve our clinical engagement in collaboration with our clinicians to commission and prioritise with greater focus on outcomes. • Develop greater knowledge of provider capacity and consequences for service user choice. • Continually improve the quality of services that we commission, ensuring that these are evidence based, cost effective, and where possible delivered closer to people’s homes. A number of strategies are currently being formalised and signed off or are in development. For example,the Value
for Money Strategy was agreed at the February 2009 PCT Board and is currently being implemented This is influenced by our need to build our information skills. • Increase and improve our service user and public involvement so that they may be actively engaged in an ongoing basis in the development and delivery of our services. The PCT can demonstrate engagement and involvement activity in the development and commissioning/ procurement of care pathways and services. • 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 have set targets through the workforce scorecard and will demonstrate ongoing commitment through showcasing work in celebrating success and annual staff awards • Ensure that our governance arrangements are fit for purpose and will support the delivery of our strategic goals. We need to embed stronger governance, performance management and following use of the external Audit Commission board diagnostic tool have initiated a further review These overarching PCT organisational development objectives will be communicated to staff and partners as part of our communication strategy for world class commissioning and our Strategic Plan.
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4.2 Achieving Our Objectives NHS Kirklees has a strong foundation on which to continue to develop the PCT. The PCT has a strong Board and relationships between the Board and PEC are good with clear lines of accountability and understanding of roles. In our recent analysis against the WCC competencies we identified additional strengths as follows: • Our people • Leadership/Chief Executive • Our partnerships and the way we develop relationships • Joint working to influence commissioning decisions across organisations to maximise benefits for the people of Kirklees. • Our culture (open and reflective) • Understanding the health needs of the population (JSNA) • Our systems and how the PCT works • Ever improving use of information to support commissioning decisions. We wish to consolidate our position on the competencies and steadily progress to becoming world class. Our detailed PCT draft trajectories are incorporated into this OD plan as Appendix 4, which is subject to Board discussion in March 2009.
4.3 Risks 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: • The organisation must be able to recruit and retain high quality staff in the face of competition from significantly larger local and neighbouring organisations • Small teams are vulnerable to capacity
20
•
•
•
•
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 In driving forward our investment in project management this may increase the marketability and retention issues with our own staff The potential of our newly formed commissioning college may not be realised.
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, which would include recruitment selection and development of future and current staff
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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 is comprehensive and coordinated in its approach, accessing external capacity only as appropriate. The organisational development action plan shown in appendix 6 identifies the range of high level actions that have been identified to ensure that the PCT achieves world class commissioning status.
Section 5
Conclusion We are confident that our plans will help us achieve the growth and development required to ensure we become a World Class Commissioning organisation and also deliver better healthcare for the people of Kirklees as outlined in our Vision, Values and Goals.
4.4 Finance In the year 2007/2008 significant investment has been made in increasing our PCT capacity within a number of directorates; the further diagnostic work will assist us in assessing whether additional resources are being appropriately utilised or need to be redirected internally. We have also made non recurrent investment in training needs analysis and leadership which in forthcoming years will be mainly sustained using internal OD capacity. The strategic and financial plans recognise the need for limited further investment in capacity and capability. Workforce changes as a result of changes in service delivery will be accommodated within workforce plans in the HITs. Workforce planning is identified as a critical component in our development and initial workforce risk assessments have been completed. It is acknowledged that we have yet to identify costs and return from the specific initiatives identified in the OD action plan, such as key finance and performance metrics (for example uptake of mandatory training, employee days per head on development etc). This detail will enhance the content of our workforce scorecard in due course.
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22
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 1
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
NHS Kirklees Vision and Values
Appendix 2
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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24
Kirklees PCT Directorate Structures as at October 2008
Appendix 3
NHS Kirklees Directorate of Patient Care and Professions
NHS Kirklees Human Resources/Organisational Development Shared Service Structure
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
25
26
NHS Kirklees Performance and Information Directorate
NHS Kirklees Finance & Estates Directorate
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
27
28
NHS Kirklees Corporate Services Directorate
NHS Kirklees Commissioning & Strategic Development Directorate
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
29
30
NHS Kirklees Public Health Directorate
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
PBC Forum
Pharmacy Strategy Committee
Exceptions Committee
PEC PCT - LOC Interface
PCT - LMC Interface
PCT - PDC Interface
PCT - LPC Interface
Professional Advisory Group
Strategic Emergency Planning Group (Operational Emergency Planning Group)
Pharmacy Panel Primary Care panel
Records Management Group
Governance Committee Commissioning / Provider Split
Medicines Management Committee
Information Governance Group
Operational Clinical Governance Group
Operational Risk Management Group
(Area Prescribing Committee)
31
PEC Finance & Performance Committee
Audit Committee
Specialist Commissioning Group
Provider Board TRUST BOARD
Strategic Development Group
Remuneration & Terms of Service Committee Communications & Public Relations Committee
Governance Committee
Finance and Performance Committee
Productivity and Efficiency Group
32
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Equality and Diversity Group
Communications and Public Relations Committee
Any section 11 consultation group
Internal Communications Group
33
Appendix 4
PCT Organisational Development - WCC Competency Plan Trajectory Current Score
Expected Score Yr 2
Reputation as local leader of the NHS
2
3
Reputation as change leader of local organisations
2
3
Position as the local healthcare employer of choice
2
3
Creation of Local Area Agreement based on joint needs
3
3
Ability to conduct effective partnerships
3
3
Reputation as an active and effective partner
2
3
Influence on local health opinions and aspirations
2
3
Public and patient engagement
2
3
Improvement of patient experience
2
3
Clinical engagement
3
3
Dissemination of information to support clinical decision making
1
2
Reputation as leader of clinical engagement
2
3
Analytical skills & insights
2
3
Understanding of health needs trends
2
3
Use of health needs benchmarks
2
3
Predictive modelling skills and insights
2
3
Prioritisation of investment to improve population’s health
2
3
Incorporation of priorities into strategic investment plan
2
3
Knowledge of current and future provider capacity and capability
1
2
Alignment of provider capacity with health needs projections
2
3
Creation of effective choices for patients
1
2
Identification of improvement opportunities
2
3
Implementation of improvement initiatives
2
3
Collection of quality and outcome information
2
3
Understanding of providers economics
2
3
Negotiation of contracts around defined variables
2
3
Creation of robust contracts based on outcomes
1
2
Use of real time performance information
2
3
Implementation of regular provider performance discussions
2
3
Resolution of ongoing contractual issues
2
3
Competency 1
2
3
4
5
6
7
8
9
10
34
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Appendix 5
WCC outcome of first assessment Competency 1: Self assessment Competency Are recognised as the local leader of the NHS
Level Level Level Level 1 2 3 4
Measure • Reputation as the ‘local leader of the NHS’ • Reputation as a change leader for local organisations • Position as the local healthcare employer of choice
NHS Kirklees leads the health agenda in Kirklees. We are core members of the Local Strategic Partnership. We have strong working relationships with Kirklees Council (KC), working on the health elements of the Local Area Agreement (LAA). We have strong & effective relationships & partnerships with other providers in primary care, secondary care, mental health & are developing this with the voluntary sector. This has enabled the PCT to drive forward health issues & strategy across organisational boundaries for the benefit of our public & patients. We developed our relationships with the public through such forums as the LiNKs & partnership forums & listening events. The PCT uses Social Marketing techniques, for example in commissioning urgent care services, to allow us to get to the core of what people need. In conjunction with the JSNA this gives the PCT a clear awareness & direction for developing & improving its relationship with the public we serve.
The PCT has led on a number of events with partners that cut across a variety of organisations & allows strategy to be set that influences health care. An example of this is joint events with KMC ‘A Picture of Kirklees’. In addition the PCT has led on health economy events focusing on 18 week delivery with secondary & primary care clinicians to enable cross organisation pathway development. The PCT has a strong focus on developing its staff with a variety of opportunities to maximise individual potential, for example participation in the Advanced Commissioning Programme. The PCT is proud of its staff & as such invests in celebrating its success. Several individuals & groups have been recognised regionally & nationally. In addition the PCT holds its own award events to congratulate staff for the work they do.
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Competency 2: Self assessment Competency Work collaboratively with community partners to commission services that optimise health gains & reduce health inequalities
• Creation of Local Area Agreement based on joint needs • Ability to conduct constructive partnerships • Reputation as an active & effective partner
The JSNA was developed with the PCT partners, principally KC. The PCT works closely with Local Strategic Partnership (LSP) to develop & agree the LAA. The LAA reflects the JSNA & clearly demonstrates what is to be delivered either in partnership or by specific organisations with key milestones, for which the PCT has a history of delivering. The PCT plays a key role in ensuring that the LAA priorities reflect the JSNA & the needs of localities. For example the Children’s & Young people’s plan has been informed by the JSNA & monitored through the LAA. The PCT has an active role in shaping & influencing locality working with KC. The PCT has a clear approach to the delivery of its element of the LAA, working closely with partners in health & social care & also statutory services, such as the Police & the voluntary sector. NHS Kirklees & KC share posts include the joint DPH & commissioning managers for Children, Older People & Physical & Sensory Impairment. This has allowed greater integration with the functions & cultures of the PCT & KC. The partnership posts have 36
Level Level Level Level 1 2 3 4
Measure
allowed for the development of pathways of care, for example in older people, to support health & social care delivery. In addition there are clear & effective governance arrangements for these posts. There are clear structures in both the PCT & KC where the partnership posts influence & deliver on commissioning intensions jointly to enable delivery of the LAA, optimise health gains & reduce health inequalities. The JSNA & LAA, together with PBC local knowledge, allow PBC consortia commissioning plans to be set. The PCT works closely with PBC & encourages the production of practice plans that outline specific actions to address local need to be implemented.
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Competency 3: Self assessment Competency Proactively build continuous & meaningful engagement with the public & patients to shape services & improve health
Level Level Level Level 1 2 3 4
Measure • Influence on local health opinions & aspirations • Public & patient engagement
• Delivery of patient satisfaction
NHS Kirklees communication & patient & public involvement (PPI) strategies focus on ensuring a meaningful & rich relationship with the public & the PCT. We have consistently sought to offer different ways of addressing improved communication either through literature or public events, such as ‘A Picture of Kirklees’ & formal consultation sessions on service strategy have enabled the public to work in partnership with us & to influence commissioning decisions. We actively involve patients in developing services that promote independence, health, wellbeing & personalisation. The ‘Year of Care’ work in diabetes, the Co-creating health programme for Musculoskeletal as well as self care for Long Term Conditions follow the principles of care of Long Term Condition management & actively involve patients in the design & development of these services. The expert patient programme has been recognised nationally & encourages people to maximise their potential. Our approach to patient & public involvement has ensured that there is a tangible influence on how services are
commissioned. Social Marketing techniques have been used to influence how Urgent Care Services are designed & commissioned, & is being used in a wide range of issues, for example in safeguarding children & asking about their attitudes to alcohol, obesity, infection control. The PCT, with KC, has partnership forums; the Working In Partnership team that hold consultation sessions with the public. These are opportunities to share information & have two way dialogue with people who use services & allow commissioning intension to be influenced. Involving Young Citizens equally with children & parent involvement further demonstrates our approach as does the redesign of speech & language therapies involving parents. PALs are an integral link between us & the public, receiving issues & complaints that are analysed & reported to the Board, as well as influencing commissioning decisions.
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Competency 4: Self assessment Competency Lead continuous & meaningful engagement of all clinicians to inform strategy & drive quality, service design & resource utilisation
• Clinical engagement • Dissemination of information to support clinical decision making • Reputation as an active & effective partner
The PCT’s structure & PBC arrangements strengths are that it generates strong clinical engagement. The PEC & PBC participate in a joint commissioning forum with the PCT which strengthens integration & clinical engagement in our commissioning functions. All clinicians, GPs & others, are actively involved in the PCT planning forums, such as Health Improvement Teams (HITs), the Long Term Conditions Board & redesign groups with regular PEC attendance. We are actively engaged with PBC consortia to ensure joint development of commissioning plans based on the needs of patients, using the JSNA & broader planning documents such as Healthy Ambitions, whilst maintaining a local focus. PBC consortia have the delegated responsibility to drive improvement in health & wellbeing through their commissioning plans. To support PBC, resource utilisation packs have been developed & regularly discussed with practices. The intention is that these give an accurate picture of how services & resources are being used. Clinicians are encouraged to submit commissioning plans & business cases to 38
Level Level Level Level 1 2 3 4
Measure
improve health gains. Clinical engagement in redesign is seen as paramount in the successful development & implementation of pathways. Primary and 2º care clinicians work with the PCT on pathway redesign of which the PCT actively facilitates & leads joint working. Our success in our approach to clinical engagement for 18 weeks was recognised nationally as excellent. Clinical engagement is embedded in other areas of development, Urgent care, Health visiting, Intermediate Care, all using pathways of care as the basis of improving services for patients. The PCT is currently establishing a commissioning development programme with clinicians supported by a training needs analysis, that will further enhance clinical & management partnerships in Kirklees.
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Competency 5: Self assessment Competency Manage knowledge & undertake robust & regular needs assessments that establish a full understanding of current & future local health needs & requirements
Level Level Level Level 1 2 3 4
Measure • Analytical skills & insights • Understanding of health needs trends • Use of health needs benchmarks
The JSNA is comprehensive & refreshed on an annual basis & takes into account information from public involvement & clinical opinion. PBC annual plans are based on the JSNA & allow commissioning of services at a local level through consortia & practice plans. Other data is used & analysed to support commissioning decisions; secondary care activity referral rates for example. This information is used as part of predictive modelling. In conjunction with the JSNA gaps in service provision are recognised & addressed. The Strategic Development Plan provides a framework for commissioning that gives a priority to the major health needs of Kirklees. The JSNA identifies clear priorities for local population by locality, children, young people & adults. The JSNA identifies risk factors for disease, current & future, & focuses on these allowing subsequent commissioning decisions to be made. There is also trend data for mortality of major health issues. The CLIK & YPHS major surveys have contributed significantly to the JSNA.
Part of the JSNA focuses on benchmarking Kirklees nationally & further work on benchmarking against local PCTs is being developed. The PCT benchmarks itself against other PCTs in a number of other areas, e.g. delivery of the 18 week standard & the PCT’s position against this regionally is measured & used as a tool to drive performance & influence commissioning decisions. Health Care Commission reports benchmark the PCT performance against all PCTs & from these come action plans supported by commissioning plans to improve performance. PBC use resource utilisations packs that demonstrate patterns of activity at practice level across the PCT where it is used through peer development, to drive forward improvements through focused redesign work & changed commissioning plans. Further needs assessments are undertaken as appropriate; for example children with disabilities, cardiovascular disease, obesity, health behaviours of women of child bearing age.
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Competency 6: Self assessment Competency Prioritise investment according to local needs, service requirements & the values of the NHS
Level Level Level Level 1 2 3 4
Measure • Predictive modelling skills & insights • Prioritisation of investment to improve population’s health • Incorporation of priorities into strategic investment plan
NHS Kirklees uses predictive modelling across a range of its functions. Notably the Service Strategy with Mid Yorkshire Hospital Trust as part of forecasting commissioning intention for service provision in the new hospitals. This long term model, at specialty level, has been developed across primary & secondary care incorporating demographic & health needs based data. Redesign of services at Calderdale & Huddersfield Foundation Trust has used predictive modelling to inform commissioning intensions at specialty level.
outcome from HITs. There are HITs for all of the PCTs key strategic areas & fit with delivery of policy, for example ‘healthy ambitions’. Business plans have defined criteria & fit with the vision & values as well as the goals of the PCT & highlight where improvements will be made. In addition, the composition of the HITs incorporates clinicians as well as managers & other stakeholders ensuring the commissioning cycle & business planning process is receptive to local need, clinicians & stakeholders.
Specialty level modelling is used annually for capacity & demand planning with acute trusts. As part of this process where changes in service delivery are made, from secondary to primary care for example, this is incorporated. An example of this is in Long term Conditions where disinvestment in secondary care & investment in primary care is planned.
Through locality working & the use of the JSNA the PCT has been able to focus investment & develop services where the need is greatest. The equitable access centre will be in Dewsbury, this is an area with a lower patient to GP ratio. The same approach has been used to invest in dentistry. These being agreed in consultation with key stakeholders including GPs & other clinicians.
These changes are progressed through the business planning & commissioning cycle. The business planning process is an 40
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Competency 7: Self assessment Competency Effectively stimulate the market to meet dem& & secure required clinical & health & wellbeing outcomes
Level Level Level Level 1 2 3 4
Measure • Knowledge of current & future provider capacity • Alignment of provider capacity with health needs projections • Creation of effective choices for patients
NHS Kirklees understands the local market for health services & jointly commissioned services with social care. We have used competitive processes to procure services. The equitable access procurement sourced a number of providers to enable delivery of this initiative. Urgent care procurement for Out of Hours care & the development of urgent care services has stimulated the market & attracted a variety of potential providers for this service. As part of the urgent care procurement public consultation & social marketing techniques have been used to ensure that patients’ views & opinions are included in the specification. In addition the inclusion of patients & clinicians in the procurement process has been vital. There has been analysis of the providers ability to deliver the service at a defined minimum level of quality & within a specific budgetary envelope. This is representative of the PCT approach to procurement & sourcing providers.
To further develop our approach to increasing the supply market we have developed a procurement policy ensuring future procurement is robust in its assessment of a wide range of providers using competitive approaches. The PCT uses demand & capacity analysis tools in conjunction with secondary care providers to plan specialty based activity forecasts incorporating local need determined by the JSNA. Review is on a monthly basis, any gaps in service provision are commissioned accordingly. An example of this is Audiology where capacity in local services was not available in order to reduce waiting times. An independent sector provider, sourced through a procurement process, was secured to deliver the activity & reduce waits to acceptable levels. Patients will be offered Choice by their GP. Where it becomes apparent that there is a lack of services & Choice then the PCT ensures GPs are aware alternative providers.
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Competency 8: Self assessment Competency Promote & specify continuous improvements in quality & outcomes through clinical & provider innovation & configuration
• Identification of improvement opportunities • Implementation of improvement initiatives • Collection of real time quality & outcome information
The PCT incorporates benchmarking into service improvement. This is demonstrated both in our performance management processes where current performance in some areas is benchmarked against national & local levels. In addition GP performance is benchmarked locally, for example in referral rates, so that there can be an analysis of extreme high & low referrers & any changes made accordingly. Developing commissioned services through joint working and innovation is essential & the PCT has a track record of this. Clinical pathway improvement has been seen in a number of areas, Musculoskeletal Care, Gynaecology, Cardiology, Diabetes amongst others. Within pathway development the whole patient journey is considered highlighting key areas where improvement & changes can be made. For example Long Term Conditions pathway focuses on self care & all 3 levels of prevention including how patients can be cared for in a primary care setting as the norm, not admission to secondary care, a specific example being, the ‘Year of Care’ programme, involving 42
Level Level Level Level 1 2 3 4
Measure
patients & clinicians, considers how patients can improve self care & with clinicians improve outcomes. PBC are core to pathway development. The PCT has a ‘planned care’ HIT with PBC involvement. PBC are also involved with secondary care to develop integrated care pathways. As part of 18 weeks, clinicians & patients reviewed pathways under development. This formed a strong basis of ensuring pathway implementation fits with patients need & is clinically driven. Pathways are developed against a series expected outcomes which are then measured. Quality boards have been established with MYHT, CHFT & SWYMT. The PCT is improving its process of incorporating quality metric & benefit realisation techniques into it improvement work. The PCT holds regular monitoring sessions with providers, in areas where there is ongoing improvement, for example urgent care, this is weekly, for other areas this is monthly.
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
Competency 9: Self assessment Competency Secure procurement skills that ensure robust & viable contracts
Level Level Level Level 1 2 3 4
Measure • Understanding of providers economics • Negotiation of contracts around defined variables • Creation of robust contracts based on outcomes
Through the PCT relationship with its providers & broader intelligence the PCT has good understanding of provider economics & market dynamics. NHS Kirklees has an robust and mutually respectful relationship with its major acute providers & mental health providers. The contract unit meet with providers to discuss capacity constraints, activity & financial positions against plan on a monthly basis & includes feedback on patient experience. All of this information is documented & reported on at weekly internal contracts meetings. These meetings also ensure that the strategic direction of providers is in line with commissioning intentions. Finance & Commissioning Directors lead contract negotiation in line with the PCTs procurement strategy supported by the contract team where variables such as cost & quality are identified. A more systematic approach to quality is being developed with quality metrics integrated into contracts & new Quality Boards being integrated into contract management structures. However there is a
requirement for further improvement in incorporating patients experience into the contracting & reporting process. Where there are variables for example, referral rates or variance of activity against plan, these are discussed & solutions agreed at regular, at least monthly, contract team meetings. Contracts are based on outcomes. Recently developed contracts for Equitable Access & Urgent care for example, are outcome based & include quality metrics that are monitored through key performance indicators. Contracts with major acute provides are standard & legally binding including details of arbitration & break clauses. The PCT has risk sharing arrangements for specialist commissioning & chairs the Specialist Commissioning Group (SCG). Through the SCG a number of specialties & provided services have been improved through clear common performance indicators & robust specifications.
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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
• Use of real time performance information • Implementation of regular provider performance discussions • Resolution of ongoing contractual issues
The PCT has a dedicated information team that analyses & validates data & presents in usable formats to ensure that information is provided in a such a way that is easily understood by commissioning staff & stakeholders as appropriate. Where there is a need for validation or to challenge information provided this is done. The information is then used to support contracting meetings, provide evidence for pathway development & support performance management. This is particularly important where there are variances against plan & actions required to be taken. The performance data & minutes from contract & performance discussion with main providers is used internally by the contract team to assimilate all provider performance & take coordinated actions accordingly. In addition where there are specific areas of monitoring required on a weekly basis the information is provided in a format to allow decisions to be made to influences key programme areas, for example 18 weeks & A&E performance. 44
Level Level Level Level 1 2 3 4
Measure
Performance is shared with PBC consortia who have opportunities through commissioning forums to reflect on performance & play an active role in commissioning decisions. The PCT also produces & disseminates daily real time information relating to access to community based services & any provided service issues through SITREP reports. A corporate performance report is produced monthly & reported to the board & is public information. The board takes a keen interest in performance & have influence over key decisions relating interventions required with providers particularly if performance varies significantly or consistently from the plan. Further interrogation is through the Finance & Performance committee, reporting to the board. There are monthly bespoke performance reports for key areas to support specific development work including 18 weeks, cancer waits & A&E four hour target. Reports are shared with providers on a regular basis.
Organisational Development Objective
To ensure that NHS Kirklees as a brand is recognised as a leader of the NHS within Kirklees
World Class Commissioning Competency
Locally Lead the NHS
Strategy
Pathway redesign events planned involving a range of partners
A plan is developed which identifies how to build on existing relationships with the LA and to ensure that strategies and activities are aligned in order to drive forwards improvements in health outcomes
Clear programme management and action plans for LAA programmes
Pathway redesign process achieved in partnership
Chief Executive
Ongoing
Strategy and Plans delivered and monitored by the Finance and Performance Committee
Partnering and joint commissioning strategy is defined
Using strong partnership with the LA , drive delivery and development forward and as a means to keep a focus on the vision during some challenging times ahead Programme Delivery Strategy will be developed that will identify how programmes will be delivered both by NHS Kirklees and jointly with the LA.
All Directors
Executive Lead
Ongoing
Timescale
WCC partner feedback assessment Benchmark partnership working eg. HAD/LGA Guidance
Measures
Improved health outcomes Five year revised strategy to include WCC, LAA and vital signs
Outcomes
To align our strategies, as appropriate, with those of Kirklees Council on an ongoing basis
Actions Required
Organisational Development Action Plan 2008/9
Appendix 6
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
45
46
Locally Lead the NHS
To ensure that NHS Kirklees as a brand is recognised as a leader of the NHS within Kirklees
To embed the NHS Kirklees vision, brand values and identity within the PCT and Kirklees as a whole
To ensure that the leadership community within the PCT understand key strategic goals and priorities and work to deliver these within the PCT and with out partners
To embed the NHS Kirklees vision, brand values and identity within the PCT and Kirklees as a whole
That the people of Kirklees, as well as our partners, understand the leadership role of the PCT
Development programme to support whole scale change across Kirklees that is multi-disciplinary
Ongoing joint development programmes organised with key partners eg Medical Engagement Project
Engagement through the Commissioning College
World class commissioning development programme developed
That the people of Kirklees as well as our partners understand the leadership role of the PCT
A methodology for tracking outcomes and inequality improvements against the 12 elements of the LAA is developed
Stakeholder survey and feedback, WCC partner feedback assessments, Public perception polls
Staff surveys Improved health outcomes Medical Engagement Project
Staff survey, WCC partner feedback assessments WCC assessments
March 2009
2008/2009
March 2009
Director of Corporate Services
Director of HR/OD
Director of Corporate Services
To improve the prioritization of resources
Prioritise Investment
Organisational Development Objective
To improve the quality of information it provides to support the management of the primary care contract and variances in practice
World Class Commissioning Competency
Collaborate with Clinicians
Systems and infrastructure
To improve our clinical engagement and collaboration with our clinicians
Collaborate with Clinicians
June 2009
Feedback from the Medical Engagement Survey and ongoing process
Robust contract management of the Primary Care contract is embedded into our Commissioning Cycle Heat map established A reduction in variation of Primary Care performance based on the actions initiated from the examination of this overall information
Identify and rationalize the high quality information we have/need in order to manage the primary care contract? Reduce the variations in primary care health inequalities by developing a systematic and transparent approach
Review of contracts to determine impact
Commissioning College Feedback
Intranet link established Feedback from
Timescale
June 2009
November 2008
Measures
Strategies produced, shared and embedded within the organisation using the Commissioning College and Leadership Programme
Output from the clinical engagement tool
Feedback through the PBC Executive on levels of clinical engagement
Development programme to meet needs identified in TNA
Outcomes
Actions Required
Develop a benchmarking strategy
Develop a divestment strategy
To ensure that the Commissioning College is an integral part of NHSK, informing clinical decisions and PEC action
To improve clinical engagement through collaboration with our clinicians
The Board reflects on how it prioritises the efforts of the organisation and the Board
Training Needs Analysis undertaken which identifies key engagement issues
To develop clinical leadership and engagement across Kirklees
Director of Performance and Information
Executive Lead
Director of Finance
PEC Chair
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
47
48
Engage with Public and Patients
Develop a robust strategy for public engagement and understand the key local issues that will ensure that NHSK taps into the hard to reach part of its population Explore the concept of a membership council type of model to support the patient and public involvement agenda
Develop a toolkit for sustained public engagement
Understanding key themes surrounding successful public engagement
Use the Commissioning College to solicit and disseminate quality improvement ideas from clinicians
To develop the contractual framework to trigger performance monitoring and “Event� milestones
to Primary Care using a heat map of underperformance
Cross directorate working enable sharing of information on patient experience, complaints and PALS to show how this has improved quality
Toolkit embedded throughout NHSK
All business cases identify the range of public engagement and involvement undertaken
Demonstrable engagement and involvement activity in the development and procurement of care pathways and services
July 2009
Director of Corporate Services
Manage knowledge and assess need
To ensure that our governance arrangements are fit for purpose and will support the delivery of our strategic goals
To continually improve the quality of services that we deliver, ensuring that these are evidence based, cost effective, and where possible delivered closer to people’s homes
To ensure that the PCT reviews systems and process to ensure that they are fit for purpose and meet requirements of WCC
To embed systems and process which underpin our clinical engagement and allow us to identify best practice and analyse impact and outcomes
Information at locality level
Implement the Health Dialogue risk stratification system.
To align the planning process between practice based commissioners and health improvement teams, ensuring there is a consistent process for all new service development
Governance review planned for 2008.
Greater understanding of the business planning approach
Improved alignment, operation and communication among PBC, PEC, Board and HITs
Build in health inequalities to planning – via HIT leads but part of the HWB Inequalities Strategy
To develop a range of quality indicators in collaboration with colleagues in Yorkshire and Humber
Implement and embed the PCT Quality and Clinical Governance Strategic Framework
WCC assessment Internal review of sub committee process
Financial spend review
Commissioning process is aligned more closely to business planning process
Improved Health Outcomes
Information Strategy embedded
PCT plans have been shared with our Commissioners through the Commissioning College
Quality indicators developed and embedded within the PCT performance development framework and review of programme management conducted
January 2009
November 2009
March 2009
Director of Performance & Information
Director of Corporate Services
PEC Chair
Director of Commissioning and Strategic Development
Director of Patient Care and Professions
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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Organisational Development Objective
To continue to work with our partners to use beneficial impact of improved relationships for the people of Kirklees
World Class Commissioning Competency
Work with Community Partners
Shared Vision and Values
To enhance our work with our partners in delivering our individual and joint strategies
Actions Required
To extend partnership working at all levels of the PCT. This will include partnership with public, private and voluntary sector organisations by implementing the actions identified in the Communications Strategy
To strengthen our relationship with our key providers and identify additional potential providers of services
To align systems and processes with our partners so that streamlined services can be delivered
To review the outcomes of the CAA pilot and implement changes
Outcomes
Ongoing
All Directors
PCT Board
Ongoing
WCC partner assessment Improved health outcomes
As above Feedback through our formal and information communication links
Executive Lead
Timescale
Measures
Work with Community Partners
To ensure that PMO becomes a core way of working throughout NHSK
To increase and improve our service user and public involvement so that they may be actively engaged in an ongoing basis with the development and delivery of our services
Development of a methodology that can be used and adopted throughout NHSK on a consistent basis
Understanding key themes surrounding successful programme management what a PMO function can do for NHSK
Using the knowledge within NHSK to share knowledge and develop protocol and new systems and processes using PMO
A number of key staff has already undertaken PM training and plans are underway to extend this training.
Explore the concept of a membership council
Understand when to use
Deliver measurable improvements for our investments and how these can be monitored and tracked
A toolkit for sustained public engagement is developed
Understanding by staff of key themes surrounding successful public engagement
Develop a robust strategy for public engagement Develop a strategy and resource bank for social marketing initiatives and engage with social marketers
To increase our levels of partnership with our service users and public in Kirklees
To enhance our work with our service users and the public in Kirklees
PMO becomes an embedded way of working throughout NHSK
Improved satisfaction in service user and public opinion surveys Improved quality indicator performance as assessed through our contracts with our key providers
Communications Strategy Implemented
June 2009
December 2009
Director of Public Health
Director of Corporate Services
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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Actions Required To enhance analytical skills and ability to undertake cost/benefit analysis. To review capacity and resource capability across the PCT and bring in expertise as required
Understand what successful strategic sourcing looks like Develop understanding around contract management, negotiation and legal issues Development of key business risks understanding of how these can be managed Broad understanding of financial risk management, trajectories, balance sheet and P&L issues
Organisational Development Objective
To ensure that PCT has the right capacity and capability to meet demand and secure required clinical and health and well being outcomes
To develop key aspects of procurement, contract management, business risks and finance
World Class Commissioning Competency
Effectively Stimulate the Market
Secure Procurement Skills
Staff and Skills
NHSK has a good understanding and application of procurement contract management and business risks at appropriate levels from the Board throughout. A risk register/plan is implemented at NHSK Board to Board learning with high performing (corporate) boards
HITs increase focus on measuring demand and capacity, with process for identifying gaps embedded
Choice principles are embedded across the PCT Annual review of demand and supply that produces clear gap analysis and proposed actions.
Outcomes
May 2009
May 2009
Systems in place to measure and count non-mandated activity.
Feedback from Board Development Process Successful implementation of Leadership Programme Patient experience data regularly reviewed in contract meetings Benchmarked information in SLA performance reports (be produced on quarterly basis)
Timescale
Measures
Director of Commissioning and Strategic Development
Director of Commissioning and Strategic Development
Executive Lead
Promote Innovation and Change
To consider issues of talent management and succession planning in targeting future leadership investment
To 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
The KSF project lead to continue to work with KSF champions to ensure adoption of the KSF process
Identify areas where turnover or additional capacity is an issue
To delivery the PCT Learning and Development Strategy
To build integration of JSNA into commiss’ing decisions & prioritisation
To continue to embed the PCT Personal Development Review Process (PDR) To ensure that PPI ‘insights’ to be built into prioritisation
A talent and succession plan ensures the PCT is equipped to deliver its objectives
Linking personal development to the business of the PCT as well as career development Ensuring that all staff have the appropriate knowledge, skills and behaviours to deliver their roles
Greater understanding of the PCT strategic objectives and priorities by all staff and how they support their delivery. To embed a value for money mindset and culture throughout NHSK
2009/10
March 2009
100% of staff have current KSF outline 100% of staff recording development plans on e-KSF Annual training plan derived from e-KSF
July 2009
Targets on workforce scorecard. Workforce and market analysis
100% achievement of PDRs across the PCT as outlined in the PCT workforce scorecard Improved staff survey results on the quality of appraisals All staff within the PCT having a KSF outline To ensure that the eKSF is adopted PCT wide Achievement of Investors in People standard
Director of HR&OD
Director of HR/OD
Director of HR&OD
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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To ensure the output from the WCC training needs analysis is identified as part of the PCT annual training plan
To ensure that the business planning process identifies potential development needs necessary to deliver the plan
To ensure that the PCT Training and Development Strategy is aligned to the PCT Strategic Framework
To ensure future capability needs are identified across the PCT in a timely manner
A programme of activity will be developed for all those involved in delivering world class commissioning arising from the outcomes of the training needs analysis
A completed WCC training needs analysis report
To ensure there is a closed loop between business planning and training and development requirements
To update business planning process so that development needs are required to be identified as part of the process
Review of PCT training and development strategy to ensure fitness for purpose
World class commissioning training programme delivered
Revised business process
NHS staff survey Achievement of the IIP standard PDR process Updated training and development strategy
December 2009
March 2009
Director of Performance & Information
Director of Performance & Information
Director of Patient Care and Profession
The Board (Non Executives and Executives hold the organisation and each other to account based on the initiatives The Board track and performance manage key areas and outcomes Understand how measurement and benefits tracking together with robust milestones and delivery timelines can lead to successful implementations Staff have the competencies needed to implement change and lead on significant programmes of service design.
Key deliverable as part of the Board Development Programme planned with KPMG
To ensure that programme management programmes are provided to across Directorates using PDR as a mechanism All programmes managed effectively and milestones reviewed through performance accelerator
To further develop the Board to performance manage key areas and outcomes
Develop consistent methodology around programme management using industry best practice
Staff understand at appropriate levels how VFM Strategy (signed off by the Board in February) and ethos fits with the commissioning cycle, market management, use of resources and partnering strategy. Understanding of key strategies, including the Programme Delivery Strategy
Secure Procurement Skills/Manage Local Health System
To embed a VFM culture using a range of tools
Understand how we enable systematic prioritization of commissioning activity
Staff understand tools such as programme budgeting and predictive modelling and how these can inform decision making
To improve the prioritization of resources
Prioritise Investment
Roll out of Programme Management Programme Clarity among staff re the role of the Programme Management Office and how their role contributes to this
Board Development Programme Delivered and Development Plans reviewed as part of the PDR process
The WCC Leadership Programme integrates fit with the commissioning cycle, market management, use of resources and partnering strategy. Understanding how measurement and benefits tracking together with robust milestones and delivery timelines can lead to successful implementations
May 2009
June 2009
May 2009
Director of Patient Care and Professions
PCT Board
Director of Finance
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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World Class Commissioning Competency
Structure
Organisational Development Objective
To improve crossdirectorate working, learning and understanding of roles and responsibilities
Comprehensive and consistent plans and strategies that are understood and built into all relevant directorate, team and individual plans
To identify how we can address our goals and impact on the well-being of the people of Kirklees through proactive recruitment practices
Action plan required to address any gaps, identifying where and what skills, knowledge will be required in future
NHS staff survey Review of the business planning approach Outcomes of the Strategic Plan
Regional workforce development conference work placements, slivers of time career fairs
Clear plan will be produced re the workforce gaps in terms of capacity and capability, to include for example, basic IT training as a mandatory programme for all staff
Current workforce analysis currently undertaken, highlighting potential gaps across PCT
To ensure that the PCT has sufficient capacity and capability in the longer term Plans currently being developed to identify where staff will be based, and on what time proportion once the commissioner and provider arms separate.
Measures
Outcomes
Actions Required
March 2009
March 2009
Timescale
All Directors
Director of HR & OD
Director of Finance
Executive Lead
Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10
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Further information about the PCT can be found on the PCT’s website (www.kirklees-pct.nhs.uk) or by contacting the PCT at: Kirklees Primary Care Trust St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH Tel: 01484 466000