Annual Report 2010/11 by NHS Medway

Delivering Health Together NHS Medway Annual Report and Operating Financial Review 2010/11

www.medwaypct.nhs.uk1

Feedback to this document Itâ&#x20AC;&#x;s your NHS, and we would very much like to hear your views on our annual report. To comment on it, get a copy in an alternative format, or get involved with helping NHS Medway shape health services for people in Medway, please email itsyournhsmedway@nhs.net; visit our website www.medwaypct.nhs.uk or call us on 01634 335173. 2

Contents Introduction

4 - 7

Our context

8 - 11

How we work

- 21

Making sure the right care is there when you need it - how we did in 2010/11

- 45

Medway Community Healthcare

- 54

Our staff

- 57

Making experiences count

- 58

Our environmental impact

- 59

NHS Medway Board and committees

- 62

NHS Medway Performance 2010/11

- 64

Statements of accountability, directorsâ&#x20AC;&#x; responsibilities and internal control

- 77

Summary financial statements 2010/11

- 91

Auditorâ&#x20AC;&#x;s opinion

- 92

Introduction Welcome to the annual report for 2010/11 for NHS Medway, the body which plans and pays for NHS healthcare for everyone who lives in Medway. This was a year which saw publication of the NHS White Paper, Equity and excellence: Liberating the NHS, and the Health and Social Care Bill 2011, which set out plans for changes to the way that health and healthcare services in England are commissioned for local people. As the primary care trust (PCT) for Medway, we are working closely with GPs and other clinicians in Medway and Medway Council as they develop new structures in preparation for the transfer of commissioning responsibilities from the PCT, expected by April 2013. We have been doing all we can towards the transition, supporting those who will take on new responsibilities. We intend to leave a legacy of high quality performance, clinical ownership of the local health economy, sound financial stewardship, and strong local health and social care partnerships. Our budget for 2010/11 was £448million. We are responsible for using that money in the best possible way for the 268,400 people we serve – those who live within our boundary, plus others just over the border who are registered with Medway GPs. During 2010/11, we faced significant financial challenges, including a requirement to plan for management cost savings of 46 per cent by the end of March 2014. Of course, managing change on this scale requires considerable energy, commitment and focus. But we have not allowed that to distract us from our day-today business, and we are pleased to say we have been able to continue improving services for patients. Achievements by NHS Medway in conjunction with our partners in 2010/11 included: A Better Medway, a wide-reaching campaign to encourage people living and working in Medway to make changes to improve their physical and mental health improved care for people suffering the most serious type of heart attack, provided by a new award-winning primary angioplasty service at William Harvey Hospital in Ashford working in close co-ordination with South East Coast Ambulance Service continued improvement in infection control, with just two cases of a bloodstream MRSA (meticillin-resistant Staphylococcus aureus) infection in Medway patients, compared to eight last year sustained improvements to care for people having a stroke, with 94 per cent having a brain scan within 24 hours the launch of Live It Well, Kent and Medway’s mental health commissioning strategy for 2010-15, developed with extensive input from people who use 4

services, carers, and health and social care professionals, which now underpins local commissioning of mental health services being the only PCT in the country where every GP practice offers patients aged 40-74 an NHS Health Check every five years, to assess their individual risk of developing heart disease, Type 2 diabetes, kidney disease and stroke the establishment of a Delivering Health Together in Medway programme, with the other key organisations in health and social care in Medway, to ensure a successful whole-system approach to strategic change and create a slimmer, more effective NHS being considered in the top third of PCTs in the country for World Class Commissioning the launch of a lung cancer awareness and early diagnosis initiative, to help more people recognise the symptoms of lung cancer and seek help from their GP much greater involvement by the public and by health and social care professionals in shaping services and much better communication with the public and health professionals the opening of our new healthy living centre at Balmoral Gardens in Gillingham sustaining a strong financial position, including delivering our year-end target for 2010/11 of staying within budget, at a time of intense pressure on the NHS successful completion of the NHS Carbon Management Programme and the development of a five year plan to reduce our carbon emissions which is being used as an exemplar by the Carbon Trust In addition, in 2010/11 we, with the three practice-based commissioning locality groups in Medway, spent a significant amount of time developing the commissioning skills of GPs and practices, in readiness for clinical commissioning which is at the heart of the governmentâ&#x20AC;&#x;s reforms of the NHS and is subject to parliamentary approval. Medway Community Healthcare Community Interest Company In line with national guidance on Transforming Community Services, NHS Medway â&#x20AC;&#x201C; along with other primary care trusts that provided services directly â&#x20AC;&#x201C; has been preparing in recent years for the separation of its provider arm from the commissioning part of the PCT. The aim is to raise the quality of care provided by NHS community services and to increase their accountability to local people. This came to fruition on 1 April 2011 with the launch of Medway Community Healthcare, formerly the provider arm of the PCT, as an independent community interest company, or social enterprise.

It followed rigorous scrutiny by the NHS Medway Board and South East Coast Strategic Health Authority of the new organisation‟s integrated business plan and financial model. They were satisfied that its plans would enable it to continue to provide high quality community services and stay within budget. Changes at the top In October 2010, our Chief Executive Marion Dinwoodie was seconded to NHS West Kent, whose own Chief Executive had moved to work for the South East Coast Strategic Health Authority. Deputy Chief Executive Helen Buckingham became Acting Chief Executive. To sustain resilience at a time of change, NHS Medway joined the other Kent primary care trusts to form a Kent and Medway cluster from April 2011 with a single Executive Team and Board, led by Chairman Colin Tomson and Chief Executive Ann Sutton. Helen Buckingham became Director of Whole System Commissioning and Deputy Chief Executive for the cluster, retaining a strategic leadership role for Medway. Aims for 2011/12 In line with the NHS nationally, we are focusing on becoming a slimmer, more effective service which involves patients at every stage of their care, so there is “No decision about me, without me”. We are continuing to work with GPs and other clinicians in Medway and Medway Council to ensure a smooth transition for the roles and responsibilities of the PCT. Everyone involved in this process is determined to ensure that the change is seamless for people in Medway. We are passing on the knowledge and expertise built up within the PCT, to ensure that commissioning arrangements in the future benefit from this bank of experience, as well as from the knowledge and expertise of clinicians and Medway Council. This will help future health and healthcare commissioning in Medway to be even more effective, making sure the right services are there when people need them. GPs in Medway decided overwhelmingly to form a single commissioning group, called Medway Commissioning Group, to take over the commissioning of healthcare services locally. This closely mirrors Medway Council boundaries, with significant advantages for local people as it makes it easier for health and social care staff to offer integrated care. The group represents all GPs in Medway and has appointed 10 GPs to serve on its board and lead the work of establishing the new organisation. Following the “listening exercise” into the government‟s reforms the membership of the board was widened to include other clinicians and patient representatives. Unscheduled care and referral management – making sure patients get the right care, in the right place, at the right time, first time – are two areas where GPs are already playing the leading role. Medway Commissioning Group is operating in shadow form alongside NHS Medway until it is ready and has approval to take over full responsibility for commissioning 6

healthcare in Medway. We expect this to be from April 2013, subject to parliamentary approval. The council is working with NHS Medway to develop a Health and Wellbeing Board which will set the strategic direction for health and wellbeing services in Medway and will encourage improved coordination of NHS, social care, public health and childrenâ&#x20AC;&#x;s services. It is expected that this Board will be advised by the Director of Public Health for Medway, who will lead health improvement work from within Medway Council from April 2013. With our partners, the PCT continues to focus on improving the health and life expectancy of everyone in Medway, and on making sure that help and support are there for the people who need them the most, improving their chances of leading long and healthy lives. As ever, we would like to thank staff, partner organisations, our patients, our volunteers, and everyone else involved in improving health and healthcare in Medway, for all that you do. Denise Harker Chairman, NHS Medway (until 31 March 2011) Helen Buckingham Acting Chief Executive, NHS Medway (until 31 March 2011) Dr Peter Green Professional Advisory Committee Chairman and NHS Medway Medical Director

Our context Health in Medway Compared to the average for the rest of England, the population of Medway is: younger more likely to be overweight less likely to eat five helpings of fruit and vegetables likely to die younger Medway has 22 electoral wards. Three of them (Gillingham North, Chatham Central, and Luton and Wayfield) are in the 20 per cent most deprived wards in England. People living in these areas have the shortest life expectancy in Medway. Two of the electoral wards in Medway (Rainham Central, and Hempstead and Wigmore) are in the 20 per cent least deprived in the country. With Cuxton and Halling, they make up the areas where people in Medway have the longest life expectancy. People living in Cuxton and Halling (the area with the longest life expectancy) live on average for 5.7 years longer than people living in Gillingham North (the area with the shortest life expectancy). The major causes of death in Medway are heart disease, stroke, cancer, and respiratory disease.1 Forecast By 2021, it is expected that there will be 5.2 per cent more people living in Medway than in 2011, including 6.1 per cent more children under 15. The population is ageing: by 2021, 17.4 per cent of the population will be over 65 (up from 14.4 per cent in 2011), and 2.3 per cent over 85. However, the proportion of older people will still be lower than the national average. Our planning takes these, and other predicted changes into account.

(Source: Joint Strategic Needs Assessment 2008 carried out by NHS Medway and Medway Council, and Public Health Mortality File, 2006-2010, South East Public Health Observatory) 8

Our budget and financial context NHS Medway has three statutory financial targets to achieve each year: revenue resource limits – to maintain revenue expenditure within the limits set capital resource limits – similarly, capital spending must be contained within prescribed limits cash limit - each primary care trust has a statutory duty to remain within the cash limit set by the Department of Health We achieved all three targets in 2010/11: Your money We had £448million to spend on healthcare between 1 April 2010 and 31 March 2011: this means that for each man, woman and child in Medway, we spent £1,673. The chart below illustrates how, of every £100: £48 was spent on acute hospitals (of which £29 went on services provided by Medway NHS Foundation Trust) £12 was spent on community health services (mostly on services provided by Medway Community Healthcare) £12 was spent on primary care (GPs, pharmacies, dentistry, optometry) £11 was spent on mental health and learning disability services (of which £6 went on services provided by Kent and Medway NHS and Social Care Partnership Trust) £11 was spent on medicines £1 was spent on our public health team and healthy living services £2 was spent on ambulance services £3 was spent on operational and management costs of the commissioning arm of NHS Medway NHS Medway Expenditure 2010/11 Ambulance services Public health

Operational management

Medicines

Mental health and learning disability services

Acute hospitals

Primary care Community health services

NHS Medway continues to monitor expenditure in all these areas. The main differences between what we expected to spend and what we actually spent were the result of: more patients than expected being treated in acute hospitals such as Medway Maritime Hospital, and some of these treatments are becoming more complex and expensive prescribing costs rising savings arising from the reduction in running the organisation, which allowed additional investment in frontline services In total, we spent £444million of our revenue budget, giving a surplus of £4.3million. We also spent £6million on capital costs, including: £5.1million on building and equipping the new healthy living centre at Balmoral Gardens, Gillingham £700,000 on grants to GP and dental practices for equipment £300,000 on grants to GP and dental practices for premises improvements Looking forward, the PCT has received a small increase in its revenue resource limit for 2011/12. It is therefore looking at how it can use its funding most effectively, and it has prepared a Quality, Innovation, Productivity and Prevention (QIPP) programme, designed to ensure that each pound spent is used to bring maximum benefit and quality of care to patients. Total savings of £18million per year are planned for reinvestment in patient care by supporting frontline staff, funding innovative treatments and giving patients more choice. Principal risks and uncertainties We have assessed the principal risks and uncertainties that may affect NHS Medway over the next two years as we hand over our functions to our successor organisations as being: financial risks: NHS budgets will not be reduced but with demand for NHS services increasing annually, along with the range of services the NHS can offer (such as new drugs and technologies), we have to be very careful about getting value for money. Growth in the PCT‟s allocation for 2011/12 is 2.2 per cent, which is at the lower end of PCTs in England health of our population: growing need for services, falling capacity within the NHS, or an increased focus on Kent-wide services, could result in NHS Medway being unable to meet the specific health needs of our local population transition risks: at this time of organisational change, there is a risk of key people leaving, resulting in over-stretched systems failing to deliver the NHS Medway vision whole system risks: different parts of the NHS and social care, in Medway and beyond, could fail to co-ordinate in every aspect needed to deliver necessary improvements to quality, innovation, productivity and prevention 10

enabling risks: in an era of transformational change, our staff need far greater capacity and flexibility from estates and information technology to support skills which enable that transformation The plans we have put in place for 2011/12 and future years are designed to address these risks and to ensure that the health service in Medway continues to respond to the needs of our population and to deliver value for money to taxpayers.

How we work Our plans are framed by the national and regional vision for the NHS, set out in documents such as the NHS White Paper, Equity and excellence: Liberating the NHS, the emerging Health and Social Care Bill, the NHS Outcomes Framework, the Public Health White Paper, the NHS Operating Framework 2011-12, the NHS Constitution and the Sustainable Healthcare Route Map. Growing Healthier, our Operational Plan, sets out the detailed work we will be carrying out in 2011/12 to fulfill our vision, values and strategic goals. Vision and values Like Medway Council, our vision is: Medway – a great place to live, work and thrive. We want to see a healthy, safe and productive population in Medway where: people are empowered to take control of their own wellbeing individuals and communities have access to the very best quality healthcare Our values include: respect and dignity commitment to quality of care compassion improving lives working together for patients everyone counts These are the values set out in the NHS Constitution. Our strategic goals are: improving health and wellbeing targeting killer diseases improving care and choice for patients supporting future generations promoting independence and better quality of life improving mental health Right care starts with the promotion of positive well being and the prevention of ill health, and that is our first priority. However, inevitably people will experience injury or ill-health at some point in their lives, and so our second priority is to equip people, as far as possible, with the skills to manage their own care, whether that is through effective self management of self limiting illness or the „expert patient‟ approach to people with long term conditions. However good we are at that, there will be people who need to seek treatment for their injury or ill-health, and so our third priority is to make it as simple as possible for 12

them to access the right care for their condition through developing „single point of access‟ and „case management‟ approaches. Behind that, our fourth priority is to ensure that the interventions we commission/provide are as high quality and costeffective as possible and delivered as close to home as possible. These principles also enable delivery of sustainable healthcare which makes best use of resources and reduces our environmental footprint. In NHS Medway, we recognise that sustainable development must be embedded into our management and governance processes, and have established the Sustainability Group to ensure that this happens. How commissioning works To improve health services for people in Medway, commissioners, including GPs as practice-based commissioners, assess needs and requirements, before working with clinicians, patients and others to draw up plans for change, and developing specifications and contracts to underpin the improved service. This is the work that will in future be overseen by Medway‟s clinical commissioning group and Medway‟s Health and Wellbeing Board. Medway clinical commissioning will build on the strengths already developed by practice-based commissioning locally, which has seen GPs lead work with clinical colleagues from a range of providers to identify and bring about improvements for patients. In 2010/11 practice-based commissioning led, among other things, improvements to services for sudden eye problems, blood-taking and people with skin conditions. In these years of transition the Health Secretary has set four new tests for all reconfigurations of services, which must demonstrate: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base and consistency with current and prospective patient choice How we work with local people We systematically ask local residents to get involved when we are reviewing or planning a service so we make sure we learn from their expertise. In 2010/11, we talked to people about a range of different services, including bloodtaking (phlebotomy), pharmacy services (for NHS Medway‟s Pharmaceutical Needs Assessment), care for children with disabilities and for children and young people with mental health needs, and services for people with a learning disability. Commissioners used the information gathered by this process to improve services. People told us, for instance, that they wanted more clinics and shorter waiting times for blood-taking (phlebotomy) services. As a result, NHS Medway invested in phlebotomy services in GP practices, and it is now possible for people to get their 13

blood taken at many more locations and to choose whether they want to book an appointment or use a drop-in service. In 2010/11, we also held a series of meetings with different groups and communities so we could take account of peopleâ&#x20AC;&#x;s experiences of the NHS and ideas for improvement as we refreshed our Strategic Commissioning Plan. This culminated in the Medway Health Debate in October 2010, an event that we held jointly with Medway Local Involvement Network (Medway LINk). More than 150 local people joined us to review healthcare in Medway and set priorities for the future. Although Medway LINk ceased to have statutory status and funding at the end of March 2011, the LINk continued to exist, and to work hard to help people influence and change the way NHS and social care services are delivered in Medway. We continue to work with them and will do so until their role is taken on by HealthWatch from April 2012. We had a good working relationship with the Medway LINk and are committed to working closely with HealthWatch in the future. The NHS is required by law to consult local Overview and Scrutiny Committees about any planned substantial health service variations or developments. We work with both the Health and Adult Social Care Overview and Scrutiny Committee and the Children and Adults Overview and Scrutiny Committee of Medway Council on this. Working in partnership Partnerships are core to the way that NHS Medway works. They allow us to use public money in the most effective way and to ensure that services for people in Medway are joined-up and patient-centred. As responsibility for commissioning health and healthcare transfers from the PCT to its successor organisations, partnerships are even more important, to ensure a smooth transition. We play a full part in the Medway Partnership Network (see diagram on next page) which brings together all the key organisations in Medway and has set the following priorities for the wellbeing of local people: working towards a safe and strong Medway; promoting healthier communities and the needs of older people; supporting children, young people and families; regeneration, including housing, the environment and culture; developing the local economy, transport and skills.

In 2010/11, the key organisations in health and social care in Medway set up a Delivering Health Together in Medway programme, to ensure a successful wholesystem approach to strategic change and create a slimmer, more effective NHS. The programme is resourced by key organisations across the health economy, and is overseen by a Medway Delivering Health Together Board. There are six priority strategic change areas within the overall programme: choosing health, planned care, urgent care, mental health, older people and end of life. Each contains a number of strategic change initiatives. Emergency planning Emergency planning is a further area where we work in partnership. Under the Civil Contingencies Act 2004, we have a legal responsibility to prepare for emergencies such as flooding or flu pandemic to ensure that peopleâ&#x20AC;&#x;s health needs will be met with minimal disruption. We are a Category 1 responder which means we are at the core of any emergency response and subject to the full set of civil protection duties. We lead NHS emergency planning in Medway, and have a robust major incident plan which is compliant with the requirements of the NHS Emergency Guidance 2005 and all associated guidance. It is regularly updated and published on our website. We are responsible for the performance management of emergency planning of all NHS organisations in Medway. We work closely with emergency services, other NHS trusts, Medway Council and other partners on the Kent Resilience Forum, including carrying out joint exercises. During 2010/11, we participated in a major live exercise with partners across Medway and Kent to test our plans in tandem.

Who we commission from Primary care 216 GPs (165 full time equivalent) in 61 practices 34 dental practices, one specialist orthodontic practice, one home-visiting dentist, the emergency out of hours dental service DentaLine and special needs dentistry through five dental clinics based in Medway 50 community pharmacies 20 optometrists (opticians) Community care Medway Community Healthcare (38 services including district nursing, health visiting, speech and language therapy, podiatry, occupational therapy, nutrition and dietetics, physiotherapy, continence, blood tests, help with breathing

problems, diabetes, heart or stroke problems, assessing difficulties with muscles or bones, end-of-life care and equipment loans) Kent Community Health (newborn hearing screening, care management and secure placement services for people with learning disabilities, plus contraception and sexual health services) Kent and Medway NHS and Social Care Partnership Trust (wheelchair services) Health improvement Joint NHS Medway / Medway Council Directorate (Stop Smoking support, healthy weight advice and programmes, co-ordination of infant feeding strategy, sexual health advice, Chlamydia testing, co-ordination of teenage pregnancy strategy, tobacco control programme, and alcohol strategy). Sunlight Development Trust (Health and Lifestyle Team) Acute care Any hospital of people‟s choice for most treatments so long as it offers care to NHS standards for NHS prices. (Mental health services, urgent care and very specialised care are excluded). In practice, most people choose to have their care in Medway or at other providers in Kent – including at Medway Maritime Hospital (run by Medway NHS Foundation Trust), the Will Adams NHS Treatment Centre and the Spire Alexandra Hospital. Mental health Kent and Medway NHS and Social Care Partnership Trust Independent organisations offering provision from psychological therapies to secure accommodation Prisons GP, dental, optical and pharmacy services for offenders at Rochester and Cookham Wood Young Offenders‟ Institutions Mental health services including Child and Adolescent Mental Health Services and substance misuse services Nurses and pharmacists working in the institutions are employed by the prison service. We also commission pharmacy services for all ten prisons in Kent and Medway.

How we make sure you get good care We have detailed contracts with hospitals, GPs and the other providers from whom we commission most care. We carefully monitor their performance against a range of measures which include patient experience, patient safety and clinical effectiveness. The Commissioning for Quality and Innovation (CQUIN) payment framework ties part of providers' income to quality and innovation requirements. These requirements - known as CQUINs - cover a whole range of areas, including training to ensure that staff get the updates they need and patient surveys, looking at patient experience and satisfaction. Single-sex accommodation Medway NHS Foundation Trust, Kent and Medway NHS and Social Care Partnership Trust, and Medway Community Healthcare declared compliance with requirements to eliminate mixed-sex accommodation by April 2011. More information is available on their websites. From 1 April 2011, NHS Medway can fine provider trusts for breaches of single-sex accommodation. Healthcare associated infections Through a rigorous approach to reducing risk factors, backed up by surveillance and training for NHS staff across Medway, in 2010/11 Medway achieved its best ever performance on infection control. Medway NHS Foundation Trust was singled out for praise as ”outstanding” by the South East Coast Strategic Health Authority after achieving more than 12 months without a single patient developing an MRSA bacteraemia. There were only two cases of MRSA affecting a Medway patient in any care commissioned by NHS Medway during 2010/11. Achievement on Clostridium difficile, although good, showed a slight deterioration on 2009/10, particularly in the final months of the year. Targets for Medway are even tighter in 2011/12 and it will be essential for all services to remain fiercely focused on infection control and avoidance of risk factors where possible (such as prescription of high-risk antibiotics) to achieve them. NHS Medway‟s aim is to eliminate avoidable healthcare associated infections. Working towards equality for all We are committed to ensuring that everyone in Medway can access the care they need and is treated with dignity and respect.

To help us meet the needs for health and healthcare of everyone in Medway, including those who are from seldom-heard groups, we: reach out into different communities in innovative ways recommended by those communities target our health promotion initiatives at the people who need them most are gaining a better understanding of the cultural needs of people in Medway and any barriers that exist to achieving better health carry out equality impact assessments which look at the impact on different communities of NHS Medway policies and commissioning decisions, so that we can take corrective action if necessary We provide opportunities for people, including patients and our staff, to observe the rituals of their faith or belief. Ministers of different religions are welcome in our buildings and we have an arrangement with the Church of England to provide chaplaincy services. We participate in groups such as the Kent and South East Coast equalities networks. Supporting this work is NHS Medwayâ&#x20AC;&#x;s single equality scheme covering race, gender, disability, age, sexual orientation and religion and belief. NHS Medwayâ&#x20AC;&#x;s Equality and Diversity Steering Group monitors the success of the implementation of the scheme and identifies priority actions which have included: mandatory equality and diversity training for all commissioning staff to support them to promote equality through all aspects of the commissioning process the accreditation of NHS Medway under the Government's Positive about Disability scheme - Two Ticks an equality impact assessment tool and plan for critical aspects of organisational policy and service development How we make sure information about you is kept safe NHS Medway and all NHS providers work to a set of standards outlining how we handle, store and transmit all patient information, entitled the National Care Record Guarantee. The full document can be obtained from NHS Medway, or can be downloaded from http://www.nigb.nhs.uk/guarantee/crs_guarantee.pdf In NHS Medway, we comply with the guarantee by: ensuring staff and contractor contracts are clear about the duty of confidentiality ensuring that all staff have training in data protection and information governance at their induction and annually thereafter ensuring that we have a strong Registration Authority. This ID-checks and registers staff, with pin-protected smartcards, to enable appropriate role-related access to patient information on general practice, pharmacy and community information systems, based on the job role they do ensuring we have clear guidelines governing access to NHS systems 18

ensuring that all our systems can identify who has viewed and accessed information ensuring we have nominated officers who will investigate any unauthorised access to records (Caldicott Guardian and Privacy Officer) complying with our NHS Information Governance Statement of Compliance encouraging and supporting general practice to undertake the Information Governance Statement of Compliance, and let their patients know when they have attained it through publicity in practice leaflets encrypting all mobile IT equipment and prohibiting the use of unencrypted memory sticks and removable data storage (digital camera memory, smartphones etc) ensuring that all electronic data in transit is audited to ensure that it needs to be transferred and is transferred using secure methods only. We comply with Treasury guidance on charging for information, such as Freedom of Information requests, in line with the policy that much information about public services should be made available either free or at low cost, in the public interest. Information risks 2010/11 Information Commissionerâ&#x20AC;&#x2122;s Office No personal-related data incidents were reported to the Information Commissionerâ&#x20AC;&#x;s Office in 2010/11. Other personal data related incidents in 2010/11 Summary of other personal data related incidents in 2010/11

Category

Nature of Incident

Total

Loss of electronic equipment, devices or paper documents from secured NHS premises

Loss of electronic equipment, devices or paper documents from outside secured NHS premises.

III

Insecure disposal of electronic equipment, devices or paper documents.

Unauthorised disclosure

Other*

2 19

* Incorrect name was put onto a set of x-rays. * An email containing a patientâ&#x20AC;&#x;s details was not transmitted using NHS.net How we are doing During 2010/11, the system for monitoring the performance of primary care trusts changed. There are no longer Annual Health Checks, World Class Commissioning Assurance ratings or Comprehensive Area Assessments. We continue to be rated by the Audit Commission on how well we are using our resources to deliver value for money and outcomes for local people. This assessment has three elements: managing finances, governing the business and managing resources. A four point scale from 1 to 4 is used, with 4 being the highest. We scored consistently in our 2010 Use of Resources assessment and were able to demonstrate improvements in several of the key lines of enquiry and sustainability in the remainder. The 2009/2010 assessment included a new key line of enquiry for managing natural resources (3.1). In line with the majority of PCTs throughout England, NHS Medway was assessed to need some improvement in its practices to make better and more effective use of its natural resources. A cross organisation working group has been created to take this work forward. NHS Medwayâ&#x20AC;&#x;s final scores were: Key Line of Enquiry Managing finances 1.1 Financial planning/financial health 1.2 Understanding costs/performance 1.3 Financial reporting Governing the business 2.2 Data quality to support decision making 2.3 Good governance 2.4 Systems of internal control Managing resources 3.1 Natural resources 3.3 Workforce

2009 score 3 3

2010 score 3 3

3 2 2

2 2 2 2

3 2 2 1 2

As a PCT, we continue to monitor our effectiveness at improving the quality of care and of peopleâ&#x20AC;&#x;s health. During 2010/11 we compared our performance in key areas with how we have performed in the past, and also with the performance of other primary care trusts. 20

This helped identify areas where we are focusing our efforts, such as tackling heart disease and stroke mortality and reducing childhood obesity. It also demonstrated that we perform well compared to our peers in key areas such as cancer waiting times, stroke care, smoking quitters and child immunisation. (See p63-64 for tables of performance information). We are using the new NHS Outcomes Framework, which will be a key part of how the performance of clinical commissioning group is monitored from 2012/3, to guide us. It focuses on five key goals: Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill health or injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Indicators for each of these are part of the framework.

Making sure the right care is there when you need it - how we did in 2010/11 1.

Maternity and newborn

Good maternal health and maternity care are important factors in ensuring that all children get a good start in life, improving the life chances and development of babies, children and their mothers. Our main focus in 2010/11 continued to be delivering safe, accessible, high-quality care to women and their families, and increasing the choices that women have in pregnancy and beyond. This is in line with Maternity Matters, the national plan for maternity care. Achievements in 2010/11 include: launch of a specialist Mother and Infant Mental Health Service, provided by Kent and Medway NHS and Social Care Partnership Trust, to support GPs and health visitors in caring for mothers with postnatal depression launch of an infant feeding strategy by public health, in conjunction with Medway NHS Foundation Trust and Medway Community Healthcare, to ensure that all new mothers receive the information and support that they need to breastfeed, both in hospital and at home, from midwives, health visitors, GPs and peer supporters (women who breastfed their own babies who are given training to support other new mothers) preparations for a Safer Sleeping campaign (launched in April 2011) with Medway Safeguarding Children Board to raise awareness of the causes of cot death and remind parents to put babies to sleep on their backs In 2011/12 we plan to build on all of this and: continue to work with Medway NHS Foundation Trust on the new midwifery led unit, offering women a homely environment to give birth, at Medway Maritime Hospital. The unit is due to open in autumn 2011 continue to work with Medway NHS Foundation Trust and Medway Community Healthcare to develop the maternity workforce to ensure high quality care for women and their families throughout pregnancy and beyond introduce foetal fibronectin testing to help in early detection of mothers at risk of going into labour prematurely with colleagues across Kent and Medway, develop a service specification for maternity services provided out of hospital It is important for mothers to breastfeed if they can because it is better for them and better for their baby. Research shows breastfeeding protects women against breast and ovarian cancer. It improves babiesâ&#x20AC;&#x; immunity and makes them less likely to be obese as children or adults.

Children and young people

The Medway Children‟s Trust (part of the Local Strategic Partnership) is the body which sets the strategic direction for children and young people‟s services in Medway, and makes sure that the priorities in the Medway Children and Young People‟s Plan are being delivered. It brings together health, children‟s social services, housing, education, the police, probation, the voluntary sector and the independent sector to ensure Medway children get the care and support they need to: be healthy stay safe enjoy and achieve make a positive contribution achieve economic wellbeing These are the outcomes set out by the national “Every Child Matters” programme. The Medway Children‟s Trust has six sub-groups which co-ordinate and commission different aspects of children‟s services. Achievements by NHS Medway with partners during 2010/11 include: Emotional wellbeing and mental health evaluation of the single point of access for Child and Adolescent Mental Health Service (CAMHS), resulting in recommendations to further improve access and care funding for support for children and young people‟s emotional wellbeing with the Place2Be and the NSPCC a training programme for schools to enable early identification of low emotional wellbeing and mental health issues, and parent training for Children‟s Centre staff by the Place2Be introduction of a multi-agency triage arrangement and better performance management to help reduce waiting times for children and young people who need tier 32 mental health services successful appointment of a new provider for urgent and high level mental health care for children and young people in Kent and Medway

The purpose of the tier 3 (specialist) CAMHS service is to provide assessment and treatment for children, young people and their families up to the age of 18, who are presenting with signs and symptoms of severe, complex and enduring mental illness. Under the Mental Health Act (2007), examples of clinically recognised mental disorders include mental illnesses such as schizophrenia, bipolar disorder, anxiety or depression, as well as personality disorders, eating disorders, autistic spectrum disorders and learning disabilities.

redesign, with Kent, of urgent care emotional wellbeing pathways for children and young people implementation and evaluation of preventative and early intervention projects to tackle persistent health and wellbeing challenges, using the Innovations Fund Services for children with disabilities increased provision of short breaks for families with children with disabilities and implementation of the Aiming High programme development of transition protocols and processes to support young people with disabilities, and young people with mental health needs, moving into adult services development of proposals to enhance palliative care for children and young people locally, in partnership with Kent engagement with parents, carers, children and young people and health professionals about the relocation of the Children‟s Therapy and Disability Service undertaking a strategic review of all services for disabled children Other achievements completing a comprehensive needs analysis for children and families across all areas of activity, to support and inform the Joint Strategic Needs Assessment review of the Children and Young People‟s Plan and development of a new partnership plan to take forward the priorities identified in the needs assessment. involvement of children and young people in service development and planning through the young commissioners group review by young inspectors of a cross section of services for children and families development of a comprehensive Child Health Action Plan to track progress on implementing the national healthy child agenda increased use by community health services of integrated processes to support multi-agency working, including the Common Assessment Framework, information sharing protocols and lead professional role public health campaigns on early intervention and prevention through the Children‟s Trust partnership launch of locality working pilot to improve coordination and allocation of resources working for children and families in one of the most deprived communities in Medway (Luton and Wayfield) development of a Parenting Framework to guide local practice and activity to support parents and develop their parenting skills introduction of guidance for assessing the needs of children with continuing care needs support for services to acquire accreditation of „You‟re Welcome‟ quality standards

In 2011/12 we plan to: Emotional wellbeing and mental health implement the CAMHS improvement action plan to reduce waiting times for tier 3 services and enhance preventative interventions ensure that specialist CAMHS services are addressing the needs of vulnerable groups extend the age range for young people currently accessing CAMHS services from their 17th to their 18th birthday, in line with the National Support Team recommendations and NICE guidance bridge the gap in service provision for newly presenting 17 year olds at CAMHS tier 3 via a 12 month pilot improve the out-of-hours service between CAMHS tier 3 and tier 4 develop effective transition arrangements with adult mental health commissioners for children and young people requiring ongoing mental health support re-commission the CAMHS tier 3 service, expand the scope of service provision for tier 2 provider, the Child and Adolescent Support Team and introduce online referrals develop services to support children and young people with symptoms of Attention Deficiency Hyperactivity Disorder and Autistic Spectrum Disorder develop services to support children and young people who have a high level of learning disability develop a specification for community paediatric services to support more effective CAMHS and support for disabled children Services for children with disabilities complete the relocation of the Childrenâ&#x20AC;&#x;s Therapy and Disability Service to an integrated site in Medway in consultation with key stakeholders, develop a plan to implement the recommendations of the strategic review of services for children with disabilities in Medway implement the sustainability plan for short breaks for children with disabilities and their families complete the re-tender process for the provision of wheelchairs develop and expand the use of personalised budgets for children with disabilities review provision of short breaks for high level needs by Medway NHS Foundation Trust Other planned work ensure the expansion in health visitors is planned and managed in line with national guidance further expand the use of integrated processes in health services, to ensure a seamless service from health and social care for children and young people with additional needs implement the Parenting and Family Support framework 25

implement a new specification and contract for speech and language that supports early intervention, particularly in deprived areas review maternity and postnatal services in Medway implement priorities for ill-health prevention, including reviewing acute care pathways and payments implement and develop the use of the new continuing care guidance double the number of family nurses, who support teenage parents and their babies

Staying healthy

Supporting people to improve their health, preventing ill health and reducing health inequalities, benefits the people involved, their families, the wider community, and the NHS. It improves the quality and length of people‟s lives, and reduces the demand on services. A Better Medway 2010 was the year of A Better Medway, a year-long campaign to encourage people living and working in Medway to make small but significant changes, with a particular focus on eating healthily, getting active, drinking sensibly, quitting smoking and managing stress. People were encouraged to make and keep pledges. A cookbook, with healthy recipes sent in by local people, was compiled as part of the campaign and proved enormously popular. It was distributed at libraries, children‟s centres, and markets in Medway. In November, Combating Stress Week encouraged people to build five ways to wellbeing into their lives – evidence-based actions that improve wellbeing and protect mental health. One of the outcomes of the campaign was an increase in calls from Medway to the Mental Health Matters helpline which offers confidential emotional support. Evaluation after the campaign finished found more than a third of a sample of people questioned were aware of A Better Medway, and around eight per cent were actively involved. Achievements in 2010/11 include: launch of a public awareness campaign to increase knowledge of signs and symptoms of lung cancer, so that more people seek help from their GP at an earlier stage development of a Health and Wellbeing Strategy for Medway, which was commended by experts from the Department of Health‟s health inequalities national support team as one of the best they had seen implementation of the Medway infant-feeding strategy for preventing obesity, focusing on pre-conception and antenatal care, breastfeeding and infant nutrition launch of a new network of breastfeeding peer supporters – experienced mothers who are trained to support other women in breastfeeding introduction of a physical activity referral scheme which offers a guided exercise programme for people wanting to become more active, or who have a medical condition 26

further seven MEND (Mind, Exercise, Nutrition, Do It!) programmes for children aged 7-13 and eight Mini MEND programmes for families with children aged 2-4, to encourage physical activity and healthy eating further reduction in teenage pregnancy rates in Medway, which however, remain above the regional average social marketing research to help Stop Smoking Services ensure they are effective at reaching people who need support recruitment of community champions to become stop smoking advisors work with St Georgeâ&#x20AC;&#x;s Hospital, London on a LEAP (London Exercise and Pregnancy) trial to identify if exercise helps pregnant women to stop smoking making teaching resources available on the Medway Stop Smoking website for staff to download and use in the classroom helping 2,260 people to quit smoking work with other agencies to set up alcohol and tobacco control partnerships across Medway development of identification and brief advice interventions in a range of settings for minimising harm caused by alcohol increased uptake of HPV immunisations which are offered to girls to protect them against cervical cancer in later life continued participation in the national breast screening age extension project, with women aged 47-49 or 71-73 being offered screening, depending on randomisation protocols In 2011/12, we have already: improved access to long-acting reversible contraception for women under 25 though a project with College Health changed to a specialist provider, Kent Eye Screening Service, to provide retinal screening for people with diabetes, with screening available in community settings as well as at Medway Maritime Hospital And we are continuing our campaign to increase awareness and improve early diagnosis of cancer, particularly lung cancer. We also plan to: develop Healthy Weight interventions for five to seven-year-olds and 13 to 17year-olds reduce the number of people who are frequently admitted to hospital for alcohol misuse develop a framework for promoting mental health in Medway and deliver training to relevant agencies in mental health promotion and suicide prevention tackle health inequalities by implementing the priorities set out in the Health and Wellbeing Strategy and the recommendations from the visit of the Health Inequalities National Support Team. These include analysing and reducing the variation in primary care, developing an integrated health and housing winter warmth project, targeting hard to reach groups for NHS Health Checks and developing place-based initiatives for more deprived areas 27

evaluate a project in the Stop Smoking service to increase earlier diagnosis of people who may have COPD (chronic obstructive pulmonary disease) Screening In 2010/11: 6,406 people aged 40-74 in Medway had an NHS Health Check at their GP practice or at a community outreach service (for instance onboard the SOS Bus at Job Centre Plus in Chatham) to assess their individual risk of developing heart disease, diabetes, stroke and kidney disease. Following their health check, 139 people were diagnosed with hypertension, 39 with diabetes, 39 with chronic kidney disease, 21 with impaired glucose tolerance and 242 were prescribed medication for prevention of hypercholesterolemia. In addition, 295 people were referred to healthy living services to lose weight, increase activity levels, reduce alcohol levels or stop smoking. The aim is for everyone within the age group to be invited by their GP or through community outreach services over the next five years to have an NHS Health Check 21,131 women were screened for breast cancer in 2010 8,395 young people (aged 15-24) were screened for Chlamydia in 2010/11 In 2011/12, we plan to: extend the current Bowel Screening Programme to men and women aged between 70 and 75, once the rounds for people in their 60s have been successfully completed implement HPV testing for women with mild or borderline results from cervical screening, so that womenâ&#x20AC;&#x;s risk of developing cervical cancer can be more accurately identified offer antenatal screening for Sickle Cell Disease and Thalassaemia to all pregnant women

Primary care

Primary care is provided by GPs, dentists, optometrists, pharmacists, and the healthcare staff who work in the practices with them.

4a. GPs Our main focus in 2010/11 was working with GPs to focus on driving up quality in relation to data, access, service provision, with the ultimate goal of improving patient care and experience.

Achievements in 2010/11 include: introduction of Audit+ software into practices. It assists GPs in their work and enables improved targeting of interventions for smoking, obesity and alcohol as well as screening for a range of conditions, including chronic obstructive pulmonary disease (COPD), cancer and heart failure review of GP lists â&#x20AC;&#x201C; writing to patients who are not known to have used NHS services recently to check that they are still at the same address and registered with the same GP practice, to ensure that NHS Medway has an accurate picture of its population and that payments to practices are accurate review of local service agreements with practices to ensure they are delivering improved care for patients and value for money improved local service for minor surgery, to ensure that patients across the whole of Medway can access a minor surgery service, even if their own GP does not offer the service introduction of a new local service for Zoladex and Decapeptyl injections used in a range of treatments, principally endometriosis, fibroids, prostate cancer, and breast cancer, which can also be accessed by patients across the whole of Medway updated accreditation process focused on ensuring care provision that is fit for purpose. It includes suitability of premises, infection control arrangements, and competence of clinicians. publication of balanced scorecards which give patients information about how their GP practice is performing on a range of measures (available at www.medwaypct.nhs.uk/gpscorecards) delivery of flu vaccination and care for flu patients, during a challenging season improved communications with practices, through a dedicated part of the NHS Medway website and a new monthly e-bulletin In 2011/12 we plan to: review all practices in line with our Quality Development Framework ensure all 12 nursing homes in Medway are able to access dedicated GP care develop a local approach to GP opening hours which results in a more responsive service Balmoral Gardens The new ÂŁ5.1 million healthy living centre for Balmoral Gardens, in the centre of Gillingham, opened to patients in August 2010, and had a formal opening in March 2011. It has three GP practices, a pharmacy, health promotion services, and clinics run by Medway Community Healthcare, Medway NHS Foundation Trust and Kent and Medway NHS and Social Care Partnership Trust. The land around the building was also redeveloped, to offer play space for children and a pleasant place for people to sit in the centre of Gillingham. The partners in the project are NHS Medway which is funding services at the centre, Medway Community Estates which has built and will maintain it, and Medway Council, which made available the land on which the new centre has been built. 29

Your emergency care summary In April 2011, letters were sent to the remaining people in Medway who had not yet been offered a summary care record, which is a secure way for the NHS to share information about patientsâ&#x20AC;&#x; allergies, medication and previous bad reactions to treatment. It helps those who do not know you to provide better care and avoids the risk of you getting medicine or care that is known to cause you problems. It is known as â&#x20AC;&#x153;your emergency care summaryâ&#x20AC;?. People have the opportunity to refuse a summary care record, and can opt out at any time by speaking to their GP practice. Fewer than one per cent of patients in Medway have chosen to opt out of the scheme so far. The aim is for summary care records to be created by Christmas 2012 for all those who do not opt out. Quality and Outcomes Framework The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, which resources and rewards good practice. QOF results for GP practices by primary care trust area are published annually by the NHS Information Centre in October. The most recent results are for 2009/10, a challenging year which saw a fall in overall QOF achievement at national, regional, and local level, as well as across the cluster of similar PCTs which is used by NHS Medway for benchmarking. However, having risen from140th out of 152 in 2007/08 to 102nd in 2008/9, Medway again improved its ranking, reaching 87th in 2009/10. Early indications are that we have improved further in 2010/11. QOF aims for 2011/12 are to assist practices with understanding and implementation of new and revised QOF indicators and to continue to support and develop practices in improving patient care and data quality.

4b. Dentistry Achievements in 2010/11 include: more urgent access sessions during the day extended hours - many practices now open in the evenings and some on Saturdays two smaller practices merged to enable them to meet the new decontamination standards required of primary care dentists by the Care Quality Commission grants awarded to 31 practices to contribute towards improving decontamination standards 30 out of 35 practices now have dedicated decontamination rooms continuation of the three-year cycle of inspections of dental premises to ensure compliance with service regulations all our dental practices applied for registration with the Care Quality Commission 30

In 2011/12 we plan to: start a new minor oral surgery service in primary care review specialist services currently provided in secondary care (orthodontics, endodontics and periodontology) to establish if they would be better provided in primary care. Dentistry in Medway 33 out of 35 dental practices in Medway are able to see new NHS patients. 65.5 per cent of people in Medway receive NHS dental care compared to 56 per cent nationally.

4c. Pharmacy / support to GPs as prescribers Achievements in 2010/11 include: support for GP practices to manage prescribing in the most cost-effective way while maintaining high quality care for patients completion and publication of NHS Medway‟s Pharmaceutical Needs Assessment which will guide commissioning of pharmacy services in the future increase in the number of pharmacies offering emergency contraception, chlamydia screening, C-Card services and minor ailment scheme awareness raising campaign for members of the public and healthcare professionals to reduce waste of medicines continued position as one of the lowest prescribers of “high risk” antibiotics in Kent, Surrey and Sussex project with our GPs to reduce antipsychotic prescribing in primary care, as recommended by the Bannerjee report. This is being used by the Department of Health as an example of good practice. Secretary of State approval for the roll-out of Electronic Prescriptions Services (EPS) release 2 in Medway. pilot for procurement of dressings via a computerised ordering system from March 2011 In 2011/12 we plan to establish support to residential and nursing homes in Medway by experienced pharmacists to review medications that residents are taking, ensuring they are taking the right medicine in the right way at the right time, and ensure that residents and nursing staff understand the treatment plans work collaboratively on the production of Kent and Medway Prescribing Guidelines for gluten free foods, stoma and incontinence products work on areas highlighted in the Pharmaceutical Needs Assessment as requiring action repeat our medicines waste campaign with an additional focus on care homes provide support through community pharmacies to Medway public health campaigns, such as the campaign to raise awareness of lung cancer symptoms. 31

monitor pharmacies for compliance with Information Governance standards and provide support as required. introduce a Green Bag scheme to support patients in taking all their medication into hospital with them, to help improve patient safety and satisfaction further develop the Message in a Bottle project for people reaching the end of life complete a business case for transferring the supply of HIV drugs from Medway NHS Foundation Trust to a homecare organisation revise the 28 day prescribing policy to minimise waste, including a statement on seven day prescriptions.

4d. Optometry Achievements in 2010/11 include: extension of the Primary Eyecare Acute Referral Scheme (PEARS) provided by high street optometrists for people experiencing sudden eye problems to the whole of Medway, following successful pilots in Rochester and Strood development of a cataract referral scheme relocation of one optical practice into larger premises to improve patient experience a rolling programme of inspections of optical practices to ensure compliance with service regulations and record-keeping In 2011/12 we plan to: roll out a glaucoma refinement scheme to reduce the number of patients being referred to secondary care for further tests to establish if they have glaucoma roll out a cataract follow up service in primary care. Optometry in Medway There are 20 optical practices providing NHS sight tests, of which: 7 practices have contracts to provide the PEARS service 10 practices have contracts to provide the cataract referral service 5.

Planned care

Planned or elective care is care arranged ahead of time when immediate, urgent treatment is not needed. In 2010/11 we continued to meet the national target of 18 weeks for referral to treatment. More than 60 per cent of referrals to hospitals continued to be made via the computerised system, Choose and Book. While there are increases in some specialty areas, the overall numbers of referrals to hospitals have stayed at the same levels as in 2009/10. This is particularly encouraging as a number of other PCTs have seen referrals increase. We clarified referral and threshold criteria for a number of conditions through implementation of the Kent and Medway Referral and Treatment Criteria, which are based on best clinical practice and guidance. They were introduced in spring 2010 32

following clinical review and discussion. We audited referrals in some of these areas during 2010/11. Through Practice Based Commissioning (PBC) a peer review of referrals for six speciality areas was completed with both primary and secondary care clinical input. Achievements in 2010/11 include: improved access to phlebotomy (blood-taking) services introduction of enhanced recovery services (which optimise patientsâ&#x20AC;&#x; preparation for surgery and treatment) at Medway Maritime Hospital improved access to diagnostic tests more patients being successfully treated for lower back pain by their GP practice or Medway Community Healthcare patients having vasectomies at a GP practice in Medway, rather than in hospital In 2011/12 we have already: introduced a finger-prick anticoagulation service, improving the quality of care (from April 2011) introduced a community lymphoedema service extended the number of skin conditions that can be seen and treated by the community dermatology service Since April this year, patients referred for an outpatient appointment have been able to choose which team, led by which named consultant, they want to be treated by. In 2011/12 we plan to: continue to ensure that referral to treatment times are met offer greater choice in diagnostic testing and post-diagnosis care finish reviewing prison health services review further services to ensure they are delivering the best and most effective care for patients recommission a local Pain Management Programme for people living with persistent pain

5b. Cancer Over the last ten years the incidence of cancers in Medway has remained steady and similar to the incidence rates in the South East and England as a whole. There is a downward trend in mortality for all cancers in Medway (1997 â&#x20AC;&#x201C; 2008) although cancer death rates in Medway have remained higher than the South East and England averages. NHS Medway hosts the Kent Cancer Network, which supports the commissioning of cancer care for the whole of Kent and Medway.

We continue to work closely with all key stakeholders on the delivery of the Cancer Reform Strategy. This year we will refocus our plans to deliver the new Improving Outcomes Strategy for Cancer, with the overarching aim to achieve cancer survival rates in line with the European average, and the ambition to achieve cancer survival rates among the best in Europe. Monitoring cancer targets remains a high priority as well as working with the cancer network on implementation of NICE Improving Outcome Guidance. We are also raising awareness of the signs and symptoms of cancer and ensuring early diagnosis to improve outcomes. Achievements in 2010/11 include: Medway NHS Foundation Trust maintained all the existing national cancer waiting time targets as well as achieving new targets for breast symptom referrals and cervical screening The new Macmillan Chemotherapy Unit at Medway Maritime Hospital now offers local access to treatment for most types of cancer Advanced radiotherapy technology was commissioned and delivered at the Kent Oncology centre in the form of Intensity Modulated Radiotherapy Information for people living with and beyond cancer has been improved thanks to a new Macmillan Information Centre within the Macmillan Chemotherapy Unit at Medway Maritime Hospital the launch of a cancer welfare benefits service, a joint project between NHS Medway, Macmillan Cancer support and Medway Council, to improve access to advice and support for people with cancer timely access to the newly implemented interim cancer drugs fund the launch of a campaign to raise awareness of the signs and symptoms of lung cancer, delivered by Health and Lifestyle Trainers who work within communities, and supported by marketing material In 2011/12 we plan to complete the review of haematology services across Kent and Medway currently underway to understand the different approaches taken in different parts of the county. The aim is to commission a best practice service that offers improved outcomes for patients and value for money work with Medway NHS Foundation Trust to develop an acute oncology service so that people, who go to the emergency department with cancer, see the right medical professional promptly review primary care access to diagnostics including chest x-rays (for lung cancer), non-obstetric ultrasound (for ovarian cancer), flexible sigmoidoscopy/ colonoscopy (for colorectal cancer) and MRI brain scans (for brain tumours) to support earlier diagnosis of cancer continue to work with the Kent and Medway Cancer Network and key stakeholders to improve surveillance and support rapid access back into services, if required continue to develop services that address the holistic needs of the increasing number of people living with and beyond cancer 34

continue to raise awareness of the signs and symptoms of cancer and increase earlier diagnosis support the implementation of the cancer drugs fund support introduction of information prescriptions at Medway Maritime Hospital

Urgent care

The focus of urgent or emergency care is on providing high quality, safe and responsive care, at the right time and in the right place. Most urgent care for people from Medway is provided by the emergency department at Medway Maritime Hospital, GPs including Medway On Call Care (MedOCC) and Medway NHS Healthcare Centre which provides walk-in care, minor injuries units in Eastern and Coastal Kent, and the South East Coast Ambulance Service. Kent and Medway NHS and Social Care Partnership Trust provides urgent care for people in a mental health crisis. NHS Medway works with providers and Medway Council in a whole-system approach to identify and deal with issues in urgent care. Achievements in 2010/11 include: an innovative pilot scheme under which MedOCC co-ordinates the care of patients who call an ambulance but are assessed by South East Coast Ambulance Service staff as not needing treatment at the emergency department. Ambulance staff discuss the needs of the patient with MedOCC who arrange the right treatment (such as an appointment with a GP or a referral to the respiratory team). This improves care for patients and value for money the introduction by South East Coast Ambulance Service of paramedic practitioners (more highly skilled ambulance staff) in Medway. They assess patients and signpost them to alternatives to the emergency department, where appropriate introduction of an Emergency Department liaison team of psychiatric nurses at Medway Maritime Hospital to improve care for people with mental health needs attending the department and reduce avoidable admissions continued multi-media communications to patients about alternatives to the Emergency Department, though a biannual magazine distributed to all households in Medway, a mailshot to businesses, takeaways and hairdressers, widespread information in community newsletters and for specific communities (such as students), and joined-up consistent messaging by public sector partners implementation of changes to patient transfers and discharges, following a review by a whole system delayed transfer of care group which identified improvements that could help people avoid admission to hospital where appropriate, and be discharged swiftly when they are ready improved care for stroke patients, including seven-day-a-week scans, faster admissions, reduced waiting times for rehabilitation, reduced lengths of stay on acute stroke unit, and introduction of health and social care reviews, six and 12 months after discharge by the Stroke Services Team 35

introduction of a seven-day-a-week Transient Ischaemic Attack (TIA) service for patients suspected of having a mini stroke development of a plan covering care management and admission avoidance for people with a high rate of re-admission development, by a whole system falls group, of a multi-agency proactive and responsive service for patients at risk of falling, to improve prevention and management of falls in older people, and reduce their risk of hip fracture development of a whole system capacity model to help shape and inform future demand and capacity requirements within urgent care In 2011/12 we plan to raise public awareness of the steps people can take to reduce their risk of falling and increase referrals into the falls service implement telemedicine at Medway NHS Foundation Trust to support 24/7 thrombolysis for appropriate stroke patients. Primary angioplasty This new service for patients suffering the most severe form of heart attack as a consequence of a blockage in an artery, started for patients from Kent and Medway in April 2010. Angioplasty is a procedure to unblock an artery carrying blood to the heart. Under local anaesthetic, a small balloon is inserted via an artery in the groin or arm and guided to the blockage. The key element is that the procedure is carried out as soon as possible after the heart attack. This is why people are taken straight to the specialist centre, William Harvey Hospital in Ashford. During the first six months of the service in 2010/11, 63 patients from Medway had a primary angioplasty, resulting in saved lives and reduced disability.

Learning disability

People with a learning disability generally have poorer health than their non-disabled peers, differences that are, to an extent, avoidable. The Local Authority Care Director Register currently has approximately 700 people with a learning disability with â&#x20AC;&#x17E;critical or substantialâ&#x20AC;&#x; needs accessing social care services. Our aim is to develop a whole system health and social care strategy that will drive changes and improve the outcomes for people who have a learning disability (LD). The outcomes will be focused on accessibility, equality and independence for people who have a learning disability.

In 2010/11 we, jointly with Medway Council: appointed a specialist manager to advise all areas of commissioning on how to ensure that people with a learning disability receive healthcare that is as accessible and as good as for the population as a whole worked with Kent and Medway NHS and Social Care Partnership Trust to improve mental health services for people with a learning disability carried out a further “Big Health Check” to review how good health services are at meeting the needs of people with a learning disability improved uptake of annual health checks offered by GPs for people with a learning disability from 51 per cent in 2009/10 to 61 per cent In 2011/12 we plan to improve the way the Community Learning Disabilities Team works further improve the uptake and quality of annual health checks offered by GPs for people with a learning disability improve transition planning for young people moving to the care of adult services focus on the key areas of health, housing and employment for people with a learning disability in line with national guidance and the requirements of Valuing People Now. carry out year three of the “Big Health Check” to ensure that health services for people with a learning disability are continuing to improve

Mental health

There is no health without mental health. Mental health problems create high levels of personal suffering, isolation and financial hardship. They are also closely linked to physical illness and can result in more admissions to hospital, investigations and treatment. NHS Medway hosts the directorate which commissions adult mental health services for the whole of Kent and Medway, which has a population of over 1.6million. During 2010/11 it consulted on a vision and strategy for improving mental health and wellbeing in Kent and Medway. The final version of the five year strategy, Live It Well, was published on 10 October 2010 - World Mental Health Day. A suicide prevention strategy was also developed as part of the wider work carried out by mental health commissioners on behalf of Kent and Medway. In Medway, as in wider Kent, our main focus is on recovery, wellbeing and inclusion for people with mental health needs. Achievements in 2010/11 include significant improvements in community mental health services in Medway. Scope for these was identified as a result of the ongoing review and redesign of acute mental health services for people in Medway and Swale being led by NHS Medway. Improvements include: direct access to the crisis team for people already using mental health services, their carers and GPs 37

a relaunch of Medway Assessment and Short Term Treatment Team (MASTT), as Medway Access Team, which provides the gateway to services for people experiencing serious mental health difficulties, with a focus on enabling more people to be treated within primary care investment in the Early Intervention in Psychosis Service (EIS), which assesses, treats and supports people aged 14 to 35 in the early stages of a psychotic illness, resulting in the recruitment of more care coordinators the launch of a dedicated Assertive Outreach Team (AOT) for Medway, which works with an identified client group of adults with mental illness and complex needs who do not engage effectively with mental health services. (The service was previously provided by dedicated staff within the community mental health teams.) the launch of the Emergency Department liaison team at Medway Maritime Hospital - psychiatric nurses who carry out assessments, where appropriate, of patients with mental health needs Suicide prevention pilot November 2010 saw the launch of a suicide prevention pilot in Medway, to enable the police to manage and refer people at risk of suicide, using an objective and systematic approach. Almost 200 police officers in Medway are now trained in risk assessment of potential suicides, using a process developed by Kent Police with Oxford University. The approach is tiered according to risk and gives officers the option of consulting 24/7 with the mental health crisis team from Kent and Medway NHS and Social Care Partnership Trust when they are considering detaining someone under the Mental Health Act. Officers involved in the pilot also carry details of appropriate services for people who are at low risk, such as the Mental Health Matters helpline. For 2011-12 the focus will be on continuing to deliver commitments within Live It Well, our strategy for mental health, and ensuring that services are more focused on recovery and more cost-effective. We plan to: redesign community mental health services develop more community support so that fewer people need to be admitted as inpatients, and they can go home sooner continue to prepare for â&#x20AC;&#x153;payment by resultsâ&#x20AC;? which will be part of mental health contracts from April 2012 improve mental health services for those with learning disabilities reduce antipsychotic prescribing and costs improve the physical healthcare of those with serious mental health conditions change pathways for those with mental health problems who are taken to or admitted to acute general hospitals, often as emergencies (A&E diversion / liaison psychiatry services) improve specialist services (focusing on those with eating disorders, complex rehabilitation needs, Attention Deficiency Hyperactivity Disorder and Aspergerâ&#x20AC;&#x;s Syndrome) 38

improve services for offenders and also secure services employ a mental health promotion specialist and roll out mental health first aid training to relevant groups, to promote mental health and wellbeing and lessen stigma and discrimination

Long term conditions

Long term conditions are those that people have to live with and manage on a day to day basis, such as diabetes or asthma. Our focus is on supporting people with long term conditions to take control of their own health and wellbeing, so they stay as well and as independent as possible. For all long term conditions, we will continue to develop personalised care planning, improving the care we give to people and helping them to better manage their own conditions. Achievements in 2010/11 include: work to raise awareness of coronary heart disease within Medway in line with the British Heart Foundation campaign a new Medway Community Arrhythmia Service to improve identification and treatment of people with an irregular heartbeat, which increases the risk of stroke a pilot project to increase collaborative working between coronary heart disease services initial implementation of the new national COPD (chronic obstructive pulmonary disorder) and Asthma Strategy, including two pilot projects to improve management of COPD in GP practices and improve identification and diagnosis of COPD in smokers work with GPs, MedOCC, the ambulance service and the community respiratory team to reduce emergency admissions to hospital a review of care for interstitial lung and neurological respiratory diseases continued education for patients, public and healthcare professionals about the prevention and management of diabetes a review of how current services can most effectively manage the increasing number of people living with diabetes work with the county Chronic Fatigue Syndrome Service to redesign services and improve productivity In 2011/12 we have already: begun to offer Natalizumab infusions to people with multiple sclerosis at Medway Maritime Hospital. This is a significant improvement for patients who previously had to travel to London every four weeks We also plan to: implement Intensive Case Management for people with complex long term conditions to improve their care investigate using cardiac imaging as an alternative to invasive procedures for cardiovascular patients improve heart failure and cardiac rehabilitation services 39

improve the availability of ECGs (electrocardiograms) in the community support primary care staff to offer appropriate interventions to adults who are at increased risk of cardiovascular conditions ensure implementation of NICE guidelines on the management of hypertension in adults in primary care work to diagnose those patients with possible Familial Hypercholesterolemia (high cholesterol that runs in the family) work to increase early identification of people with COPD work to improve management of respiratory disease through education on inhaler technique in primary care and pharmacies increase access to pulmonary rehabilitation for people with severe COPD commission a local Home Non Invasive Ventilation Service for complex respiratory disease invest in specialist Chronic Fatigue Syndrome services to further reduce waiting times commit to continuing to fund Parkinson‟s Disease Nurse Specialists in Medway ensure people with diabetes are supported by services as close to home as possible with our neighbouring PCTs in Kent, recommission the wheelchair service for Kent and Medway

More choice and control Personalised healthcare gives people greater control and choice over how their health needs are met – one of the key elements of the vision for NHS patients of “No decision about me, without me”. In social care, people receiving personal budgets have felt they have more choice and control over their care needs. We were delighted to be chosen by the Department of Health as a pilot site to test personal health budgets to see if the same is true for health. In 2010/11, we started looking for 150 people to contribute to this study who have a neurological condition, dementia, or COPD. This process is continuing in 2011/12. Different elements that we will be evaluating include: Health, wellbeing, experience and access Variation by condition and background Financial impact and cost-effectiveness Effect on NHS services Practical issues – what works, what doesn‟t Impact on staff We are working with Medway Council and will look at integrating services where this would be beneficial to individuals.

9b. NHS continuing healthcare and NHS funded nursing care NHS continuing healthcare is a package of care arranged and solely funded by the NHS. People are eligible for NHS continuing healthcare if their primary need is for healthcare, as opposed to social care. NHS continuing healthcare can be delivered in a variety of settings and locations, such as at home or in a nursing, or residential care home. NHS funded nursing care is the payment made by the NHS for individuals in registered nursing care homes, who are not eligible for NHS continuing healthcare but who have registered nursing care needs. This payment is set by the Department of Health and for 2010/11 it was ÂŁ108.70 a week. It remains the same for 2011/12. In 2010/11 NHS Medwayâ&#x20AC;&#x;s Continuing and Funded Nursing Care Team: received the following new requests for assessment for eligibility for NHS continuing healthcare for the period April 2010 â&#x20AC;&#x201C; March 2011. Number of applications received 450 (19 per cent more than in 2009/10)

Number assessed as eligible for NHS continuing healthcare 361

Number assessed as not eligible or referred to an alternative service 89

undertook over 1700 assessments as part of the NHS Continuing and Funded Nursing Care process in conjunction with colleagues from Medway Council Social Care, provided training to 73 health and social care staff to develop their understanding of the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care, and to increase their assessment skills continued working with care providers to ensure quality, needs-focused, value for money, care packages/placement options and choice for patients and their families created with Medway Council combined health and social care panels to provide a more seamless process for decision making participated in a systems wide audit of pressure relieving care/ equipment in Medway nursing homes and supplied, on temporary loan, more than 300 pieces of dynamic pressure relieving equipment to assist in the care of patients with compromised skin integrity In 2011/12 we plan to: offer nurses working in care homes training in using the tools in the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care, to ensure that they refer appropriate people for consideration of eligibility for NHS Continuing Healthcare further develop relationships with new care providers in the Medway Towns, to ensure that we continue to develop person centred care packages and 41

placements, so patients have increased choice over how and where their healthcare needs are met in collaboration with colleagues, develop and encourage access to personal healthcare budgets for patients assessed as eligible for NHS Continuing Healthcare continue to deliver NHS continuing healthcare and NHS funded nursing care for the population of Medway at a time of organisational change

10. Older people NHS Medway and Medway Council have taken a joined-up approach to health and social care commissioning for older people and for carers, based on joint strategies developed with local stakeholders, including older people themselves and their carers. Our joint vision is to create a society where people have choice and control in their lives, independence is retained and when they require support, individual needs are met through a range of responsive services. Achievements in 2010/11 include: development with Medway Council of a strategic plan and a joint health and social care commissioning strategy for older people participation in a national demonstrator programme for Dementia Advisers amalgamation of two helplines to provide a single point of access for carers needing support progress on developing innovative respite breaks and improved information for carers through the Carers Partnership Board development, with clinicians and local providers, of a care pathway for older people at risk of falling, to ensure they access preventative advice and support from Medway Community Healthcareâ&#x20AC;&#x;s falls prevention service review of all bed based provision and start of a redesign programme to provide a variety of community bed-based and non bed-based services development, with our partners in Kent, of a range of information, advice and support services for people with dementia and their carers. In 2011/12 we plan to: work with our voluntary sector organisations to support more people with dementia by establishing peer support and advice services. invite tenders from voluntary organisations to run the peer support and advice services. develop the dementia pathway across Kent and Medway to reduce acute hospital usage, long term nursing and residential placements and develop a full range of flexible community services that offer the right support, in the right place at the right time. work with our partner organisations to develop a range of flexible respite breaks for carers 42

review intermediate care and rehabilitation services to ensure they are flexible and can meet the different needs of older people, focusing on re-ablement back to home. establish a Medway and West Kent acute liaison service for people with mental health needs including dementia, to cover Medway Maritime Hospital and Darent Valley Hospital continue to develop our community services so that when older people experience illness or they have to spend time in hospital, they access local support that aids their recovery and maintains their independence work with our care providers to upskill the workforce in the management of older people with dementia work with Medway Council to develop a variety of flexible initiatives to promote independence and wellbeing

11. End of life care End of life care offers support and palliative treatment for both patients and their families through the last phase of life and into bereavement. Our main focus for end of life care continues to be supporting people to achieve their preferred place of care as they approach the end of their life. This is in line with the national End of Life Care Strategy. Achievements in 2010/11 include: development of training for community staff on end of life, across Kent and Medway purchase of software to support an end of life register in GP practices an audit of deaths in hospital of people aged 65 plus, to identify factors that led to people being admitted an audit of crisis phone calls to community teams to understand the level of crisis demand and what support was needed introduction in March 2011 of a single point of access phone number, to make it easier for patients and carers to get advice, support and response to a crisis, 24/7 launch of a standard set of principles for a â&#x20AC;&#x153;Do Not Attempt to Resuscitateâ&#x20AC;? policy across Kent, Surrey and Sussex an event for patients and professionals in Medway to increase knowledge, skills and awareness on end of life issues upgrading and improvement of facilities for the newly bereaved at Medway Maritime Hospital continued support for GP practices in implementing the principles of the gold standards framework by a Macmillan GP facilitator recruitment of a care homes end of life facilitator, to support care homes to develop their knowledge and skills in caring for patients at the end of life In 2011/12 we and our partners plan to: explore options for a sustainable bereavement service to support people affected by death, no matter what the cause 43

review the capacity and skills of community teams to support patients being cared for in the place that they prefer ensure that the Liverpool Care pathway is adopted within all relevant wards at Medway Maritime Hospital and that hospital staff develop their knowledge and skills â&#x20AC;&#x201C; work to be led by a newly recruited End of Life matron introduce a standard syringe driver across the Medway community to increase access and improve quality of care roll out End of Life care training for all key community staff introduce the My Wishes register across Medway, to give health professionals access to key patient information and preferred places of care introduce advanced care planning documentation fully roll out the single point of access scheme

Medway Community Healthcare Medway Community Healthcare provides the majority of community health services used by patients in Medway. In line with the Government‟s NHS reforms, from 1 April 2011 Medway Community Healthcare became a social enterprise Community Interest Company, independent of NHS Medway. Medway Community Healthcare has a separate Board, which remained accountable to the main NHS Medway Board until formal separation on 1 April 2011. The new Medway Community Healthcare Board is now in place.

Healthcare services for local people Medway Community Healthcare provides a wide range of high quality community health services for Medway residents; from health visitors and community nurses to speech and language therapists and out of hours and urgent care.

Children’s services Children’s services are delivered by: three integrated teams of health visitors, community nurses and nursery nurses an integrated children‟s therapy team which cares for children with complex and special needs a youth offending team in partnership with police officers, social workers, probation and education staff the young parents‟ integrated team, which supports teenage parents the Family Nurse Partnership team, which supports teenage parents the child and adolescent support team which focuses on emotional wellbeing Achievements in 2010/2011 include: significant reductions in waiting times for speech and language therapy services children‟s therapy services continued to be delivered from a range of locations and significant progress was made in securing a new site for a children‟s therapy centre the Family Nurse Partnership programme made a positive impact on the lives of teenage parents across Medway and was well received by those enrolled onto the programme. Many of the young parents attended a celebration event, held in July 2010

Adult services Community healthcare services for adults are delivered by: St Bartholomewâ&#x20AC;&#x;s Hospital, Rochester, a nurse-led rehabilitation centre providing rehabilitation care and treatment, which helps patients of all ages recovering from a variety of illnesses or injuries, ranging from a stroke to a motorcycle accident, return to living independently the Walter Brice Rehabilitation Centre, Hoo, which provides day rehabilitation to help adults recovering from an illness or injury or with a progressive condition to achieve and maintain confidence and independence. The team includes a physiotherapist, rehabilitation nurse and occupational therapist six integrated health and social care teams offering care, support and advice for people in their own homes, including community nurses, care managers, social workers, occupational therapists and physiotherapists the rapid response team, which provides intensive short-term health and social care support to people recovering from an illness or injury a community equipment service which supplies beds, hoists, walking aids and similar equipment to patients being cared for at home a continence care service which supports, treats and manages people with bowel or bladder dysfunction, and offers advice and guidance for patients, carers and healthcare professionals speech and language therapists who offer assessment and advice to adults with swallowing and/or communication difficulties resulting from for example, a stroke or head injury, and conditions such as multiple sclerosis, Parkinsonâ&#x20AC;&#x;s disease, motor neurone disease, dementia or head and neck cancer the dietetics team which provides advice and support to individual patients with special dietary needs and people with conditions such as diabetes and heart disease, as well as information and training for healthcare professionals an orthopaedic clinical assessment service, which consists of an orthopaedic physician (a GP with a special interest in orthopaedic conditions); consultant physiotherapist; orthopaedic physiotherapy practitioners; extended scope practitioners in physiotherapy; occupational therapy and podiatry. The team will assess patients to diagnose problems and can arrange x-rays and magnetic resonance imaging (MRI) or give injections if necessary. Conditions treated by the team include hip, knee, shoulder and other joint problems, arthritis, lower back pain a physiotherapy team, which provides clinics as a number of venues across Medway for physiotherapy assessments, treatments and advice for adults with musculoskeletal problems. Conditions seen may be caused by injury, overuse or be age related and include low back pain, joint problems, whiplash, broken bones and rheumatoid arthritis. Treatments include manipulation, exercise programmes, group education session and electrotherapy - including ultrasound and TENS and acupuncture a podiatry service offering assessments, treatment and preventative care for problems affecting the legs and feet including those caused by diabetes, arthritis and age-related conditions

occupational therapists who provide specialist assessment, advice, treatment and education to people with a range of different conditions and help patients get the equipment they need to be independent a phlebotomy (blood taking) team, which runs sessions at Rainham, Lordswood, Parkwood and Twydall an advanced clinical assessment team of advanced clinical practitioners who support people in their own homes and care homes. The support and care provided by team helps patients avoid going into hospital or a nursing home before they need to and also supports them to return home from hospital as soon as they are able to Achievements in 2010/2011 include: 100 per cent of inpatients were cared for in same sex environments publication by the Community Equipment Loan Service of an equipment catalogue for use by prescribers review of the service provided for patients with long term neurological conditions including rehabilitation care at the Walter Brice Rehabilitation Centre introduction of a dietetics nutritional support team, which supports patients being fed by tube and those who are malnourished. This improves health outcomes and helps to reduce hospital admissions and inappropriate prescribing of nutritional supplements

Specialist services Specialist community healthcare services delivered by Medway Community Healthcare are: DentaLine, the out-of-hours emergency dental service for Medway and Kent a community dental service, which provides dental care for vulnerable people and those with special needs in Medway and West Kent, as well as oral health promotion work in schools and care homes Darland House in Gillingham â&#x20AC;&#x201C; a 40-bed specialist nursing home for people over the age of 65 with mental health needs, including dementia Wisdom Hospice in Rochester, which has 15 beds and provides a day hospice as well as advice and support for patients and carers. The hospice team includes palliative care nurses who provide care for people in their own homes and a specialist team of social workers who offer psychosocial and family support the community respiratory team, which provides assessment, breathing tests, rehabilitation, advice and support to people in Medway and Swale with chronic lung disease a community cardiology team and heart failure team which carries out both nonurgent tests for diagnosing heart conditions and offers rehabilitation support, including exercise classes the stroke service, which cares for everyone registered with a Medway or Swale GP who has recently had a stroke a specialist diabetes service which gives advice and support to adults with diabetes and the professionals caring for them 47

the tissue viability service, which offers wound care for people with chronic wounds or recovering from surgery or an injury plus advice and support the falls prevention team, which offers older people who have fallen a full assessment and works with them to prevent a recurrence. Achievements in 2010/11 include: Darland House opened a shop, based within the house, to provide everyday goods for residents and visitors and an opportunity for residents to work in the shop the day hospice service at the Wisdom Hospice was expanded, giving more people a chance to benefit from a dedicated six week programme tailormade for them, before being reviewed for support by the community team Goodyer House at the Wisdom Hospice, purchased by the Friends of the Wisdom, opened for staff and bereavement counselling sessions provision of the new arrhythmia service for diagnosing and treating patients with an abnormal alteration in the rhythm of their heartbeat the TIA (transient ischaemic attack) service provided by members of the Medway Community Healthcare stroke team based at Medway Maritime Hospital was extended from five days a week to seven days a week

Urgent care Medway On Call Care (MedOCC) provides a service for people needing urgent GP and nurse appointments. MedOCC never closes but is open 24/7, every day of the year. Residents of Medway and visitors to the area can access MedOCC when GP surgeries are closed during the evenings, at weekends and on Bank Holidays. MedOCC will also see patients during the day Monday to Friday if they need an urgent appointment which their own surgery cannot provide. In these cases, their surgery refers them. Most patients who get in touch with MedOCC need urgent care. Others contact the service because they have not registered with a GP locally. Out-of-hours, MedOCC also dispenses urgently required medication prescribed by its GPs, such as pain relief and antibiotics. Achievements in 2010/11 include: more than 54,000 patients were seen at one of MedOCCâ&#x20AC;&#x;s clinics, at Quayside House, Chatham, Rochester Healthy Living Centre and alongside the Emergency Department at Medway Maritime Hospital, Gillingham; a further 37,000 patients received telephone advice and around 8,000 patients received a home visit introduction of a new referral system where MedOCC can arrange for patients to go into St Bartholomewâ&#x20AC;&#x;s Hospital, rather than Medway Maritime Hospital, if they need very short term nursing care. In 2010/11, 32 patients benefited from this scheme. 48

Single sex accommodation and privacy and dignity Medway Community Healthcare staff have developed a number of projects to support the Department of Health‟s targets to virtually eliminate mixed sex accommodation for patients. The Privacy and Dignity Policy has been revised to incorporate the escalation process if a case of mixing occurs. Medway Community Healthcare is pleased to confirm that mixed sex accommodation has been virtually eliminated in all its inpatient areas, except where it is in the best interest of patients or reflects their personal choices and that there have been no breaches of the policy. Within Medway Community Healthcare, peer to peer reviews (by other healthcare organisations) were successfully conducted during 2011/2011 to assess privacy and dignity and single sex accommodation in all inpatient areas. These reviews found outstanding standards of privacy and dignity at all three inpatient sites (St Bartholomew‟s Hospital, Darland House and Wisdom Hospice). Results from our patient surveys show excellent inpatient satisfaction with privacy and dignity.

Safeguarding children The Children Act 20043 places a duty on health organisations to safeguard the welfare of all children. Medway Community Healthcare is committed to protecting children and has in place a safeguarding children team who provide professional safeguarding and child protection advice and support to staff whose work brings them into contact with children and adults who are parents or carers, however minimal. Working in partnership the team are members of: Medway Safeguarding Children‟s Board sub-groups. Multi Agency Risk Assessment Conference (High level domestic abuse cases) Children‟s Trust Child Death Process Achievements in 2010/11 include: appointment in 2010 of a specialist domestic abuse nurse to raise awareness of domestic abuse and its impact on children and adults continued supervision for all staff whose caseload includes children who are subject to a child protection plan production of a revised training strategy and safeguarding children procedures, in line with national guidance preparation for a high profile safer babies campaign in partnership with the Medway Safeguarding Children Board (MSCB) greater awareness of the team has seen an increased number of GPs and other health professionals attending training and seeking advice 3

Children Act 2004 section 11. London HMSO 49

Safeguarding adults Medway Community Healthcare is committed to ensuring that adults live free from abuse. To support staff, safeguarding adult training has been redesigned to allow not only an understanding of the theory but also to have the opportunity to discuss issues related to patient care during clinical supervision. To raise awareness of abuse, each service area has a designated safeguarding link who is able to reinforce the importance of prompt recognition of and action on abuse with colleagues. The link representative also ensures that staff are aware of the support available to them from the safeguarding adults team. The Mental Capacity Act (2005) is legislation which affects the care delivered by all staff; it is mandatory for all clinical staff to attend basic awareness training. Staff at St Bartholomewâ&#x20AC;&#x;s Hospital, the Wisdom Hospice and Darland House have regular contact with the safeguarding adult team to ensure that patients are not unlawfully deprived of their liberty and care is delivered in their best interests. The safeguarding adults team works in collaboration with council colleagues to ensure that joint procedures are followed and that lessons learnt are implemented robustly. Achievements in 2010/11 include: provision of safeguarding supervision across adult services to ensure practitioners learn and develop their practice 100 per cent attendance at supervision sessions, following focused training around safeguarding adults and the Mental Capacity Act a 61 per cent rise in professionals recognising safeguarding issues and contacting the team for advice and support

Infection control Medway Community Healthcare aims to provide care in environments that ensure the prevention and control of infection. All staff with patient contact are required to attend annual infection control and hand hygiene training, while non clinical staff have two yearly training. Robust cleaning schedules are displayed in all areas identifying what is cleaned and how frequently. We use single use instruments in most areas and centralised sterile supplies provision in podiatry. We monitor cleaning standards and the environment, staff compliance with hand hygiene, and other clinical procedures, through a comprehensive audit programme. Patient experience surveys seek assurance from patients that they feel cared for in clean and appropriate environments as well as asking if the clinical staff were seen to wash their hands or use alcohol gel. Feedback from patients is acted upon at each service level. 50

We continue to promote the cleanyourhands and Essential Steps national campaigns across all our services. The infection control team continues to support nursing care homes in all aspects of infection control. The homes have representation on the infection control link practitioner network. Work continues with our Medway health colleagues to drive down serious infections such as MRSA and Clostridium difficile. There were no incidents of MRSA blood infections or Clostridium difficile infection within our services in 2010/11. Medway Community Healthcare Patient Environment Action Team Assessments (PEAT) 2010 PEAT is an annual assessment of inpatient healthcare sites with more than ten beds which aims to ensure improvements are made in the non-clinical aspects of patient care, such as cleanliness, food and infection control. Assessments are carried out by NHS staff (nurses, matrons, doctors, catering and domestic service managers, executive and non-executive directors, dieticians and estates directors). Patients, patient representatives and members of the public are also part of this assessment process. The assessment results help to highlight areas for improvement and share best practice across healthcare organisations in England. The results for Medway Community Healthcare for 2011 are:

Site Name Darland House Nursing Home St Bartholomew's Hospital Wisdom Hospice

Environment Food Score Score Good Acceptable Good

Excellent Good Excellent

Privacy & Dignity Score Excellent Excellent Excellent

Our staff Medway Community Healthcare has 1258 staff (1020 full time equivalent). Medway Community Healthcare is keen to be seen as an employer of choice to ensure it attracts the best staff to drive forward the organisational goals. Workforce plans have been developed, aligned to service plans, to underpin high quality, innovative, patient care that will support Medway Community Healthcare as an autonomous organisation. Appropriate skill mix ensures the most effective use of time and resource and is providing new development opportunities for the current workforce, with investment in foundation degree progression routes into the associate practitioner role. Additionally, an increased number of apprenticeships for offer an alternative entrance and progression route into clinical roles for young people leaving school. 51

Increased use of electronic staff records helps the organisation to accurately monitor the employee journey, whilst tracking any trends that may be of local or national interest. Sickness absence In 2010/11, the average sickness rate for Medway Community Healthcare was 4.4 per cent, a reduction on the previous year. This equates to 11 days of sickness absence for each full time equivalent post in Medway Community Healthcare. More than 400 staff had no sickness absence in the year. Equal opportunities Following consultation with staff and the local community, Medway Community Healthcare published its first Single Equality Scheme in partnership with NHS Medway. This sets out how equality and diversity issues are considered and ensures continued development of a more accessible and fair service. This is based around three strategic themes: promoting equality through commissioning, contracting and procurement; improving patient experience and workforce. Medway Community Healthcare is committed to tackling discrimination of any kind, promoting equality and diversity and protecting and promoting human rights. These principles are at the very heart of the NHS and everyone has a role to play in achieving them. Staff engagement and development Staff engagement is paramount to Medway Community Healthcare and 2010/11 saw increased involvement and opportunities for staff to have a real voice in the future of the organisation. In addition to the formal consultation on the transfer to the new organisation under the Transfer of Undertakings (Protection of Employment) Regulations (TUPE) and the staff consultation on the proposed restructure, our established â&#x20AC;&#x17E;Working together for our futureâ&#x20AC;&#x; staff focus groups generated many ideas and suggestions. Topics included the people strategy, organisational values and creating a meaningful employee voice. Comments from staff involved in the programme show that they found it informative and thought provoking.

“Very clear objectives that demonstrate how important it is that all staff have a say for the new organisation.” “It made me think about the role of the organisation and how my actions form part of this.” Working together for our future staff focus groups, 2010-11 An organisational change group, comprising staff from across the services, was instrumental in driving the transition as Medway Community Healthcare prepared to separate from NHS Medway and become a social enterprise. Staff are preparing to become co-owners of the new organisation. Elections will be held for a staff representative group who will be a direct channel of communication and engagement between staff and the Medway Community Healthcare Board. Personal and professional development is ongoing and a particular theme has been the increased use of self-service to access electronic staff records, record appraisal activity, check compliance with mandatory training, book training or undertake elearning. Valuing our staff Medway Community Healthcare held three events in July and September to celebrate the long service – of 25 years or more within the NHS – of 83 members of staff. The events, funded through charitable funds, were held at the historic Commissioner‟s House at Chatham Dockyard and hosted by members of the executive team and board. Staff and their guests were treated to a guided tour of the ropery or one of the historic warships before enjoying a buffet and collecting their award – a signed limited edition print of a Medway landscape. The health and wellbeing of staff has been a continued focus with a series of lunchtime health check events and a number of initiatives including holistic therapies to combat stress and evening zumba dance exercise classes. Working in partnership with Medway Council and NHS Medway, joint initiatives were taken forward, including a community allotment and organised lunchtime walks. Clinical specialists from within the services have been involved in providing some of these events, including a referral scheme for staff suffering from back or musculoskeletal problems.

Voluntary services The national emphasis on volunteering outlined in the Government vision of the „big society‟ has led to high demand for placing volunteers within the healthcare sector.

Medway Community Healthcare has provided a service on behalf of NHS Medway both locally and to other neighbouring health trusts to ensure safe and appropriate opportunities which benefit both volunteers and patients, whilst enhancing service provision. During 2010/11, more than 750 volunteers were placed, giving nearly 100,000 hours of volunteer service, enhancing the experience of patients and local people.

Compliments and complaints to Medway Community Healthcare During 2010/11, a total of 671 compliments were received by Medway Community Healthcareâ&#x20AC;&#x;s customer care team - an increase of 31 per cent over the previous year. This excludes positive feedback from surveys carried out by many services. It is likely that the actual number of compliments received was even higher; services sometimes omit to forward compliments which they receive directly. In total, 169 complaints were received by Medway Community Healthcare - a reduction of 35 per cent from the previous year. Of these, 38 were joint complaints with other trusts. One complaint was passed to the Care Quality Commission (CQC) who found no fault with the way the complaint had been handled. Three complaints were passed to the ombudsman and were closed with no further action required.

Our staff NHS Medway has 389 staff, (319 full time equivalent). This includes the staff of the Kent and Medway Cancer Network as well as staff who work in the many roles within the PCT. Sickness absence In 2010/11, the average sickness absence rate for NHS Medway was 2.9 per cent. The average sickness absence rate for the NHS in England was 3.97 per cent between July and September 2010. The average absence rate for the South East Coast Health Authority was 3.6 per cent for the same period. More than a quarter of staff had no sickness absence. The average number of days lost to sickness for staff working for NHS Medway and Medway Community Healthcare during 2010/11 was 9.66, compared to 9.27 days in 2009/10.

Equal opportunities NHS Medway believes that every employee should be treated with equal respect and dignity. We value the rich diversity and creative potential of people with differing backgrounds and abilities and encourage a culture of equal opportunities in which personal success depends on personal merit and performance. We are fully committed to a programme of action to ensure the promotion of equal opportunity for all and the elimination of discrimination in all aspects of employment. Our policy on equal opportunities and disabled employees is set out in our Single Equality Scheme, which complies with current law and codes of practice. Staff engagement and development - NHS Medway In 2010/11 we: embedded a new approach to staff engagement, via our Staff Engagement Group, with representatives from all directorates sitting alongside trade union representatives. It meets monthly to identify and tackle issues and provide a mechanism for two-way feedback between staff and senior managers developed our Transitional People Strategy, outlining our commitments to staff under the themes of health and wellbeing, managing the transition, and learning and development developed NHS Medwayâ&#x20AC;&#x;s Health and Wellbeing Strategy continued to offer equality and diversity training to all staff, continued to encourage staff to hold lunchtime celebrations of cultural and religious festivals and monitored equality and diversity outcomes via our Equality and Diversity steering group became a Mindful Employer and started a partnership with Royal British Legion employment solutions, to support existing and prospective staff with disabilities and long term health conditions 55

set up a health and wellbeing sub-group of the Staff Engagement Group, which hosted NHS Medway‟s first staff health and wellbeing event in July 2010 carried out a Training Needs Analysis for programmes to benefit NHS Medway‟s managers and staff in bands 1-6 refreshed and re-launched our sickness policy and reporting process launched a completely modernised intranet made substantial improvements to the Electronic Staff Record to help the organisation understand the demographics of the workforce, and enable updating of records by managers and staff worked closely with South East Coast HR colleagues to provide support and redeployment opportunities via the newly set up South East Coast Clearing House held a staff conference in January 2011 to reflect on our achievements and plan for the future In 2011/12 we have already: hosted a second staff health and wellbeing event in May 2011 launched a learning and development programme for managers, incorporating mandatory modules on managing attendance, appraisal, capability, disciplinary action and managing change launched a new learning and development programme for band 1-6 staff, informed by the feedback from the white paper and health bill 1-2-1s and personal development plans launched a new appraisal policy and process, accompanied by manager and staff workshops. The executive team have agreed to a target of 100 per cent completion rates which will be incorporated into their individual key performance indicators We also plan to: continue to deliver on the commitments made in our Transitional People and Health and Wellbeing strategies continue to review our human resources policies with our cluster counterparts to ensure consistency and equity across Kent and Medway primary care trusts Pensions Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsba.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies allowed, under the direction of the Secretary of State, in England and Wales. Details of the scheme‟s valuation are available in NHS Medway‟s Annual Accounts, published separately.

Workforce planning NHS Medway has a leadership, developmental and assurance role in workforce planning and education commissioning across the health community. We recognise that the whole healthcare system in Medway needs to have the right workforce, with the right skills, at the right time, in the right place and at the right cost. Over 70 per cent of all NHS expenditure is on staff. In the current economic climate it is even more essential that workforce plans are comprehensive and integrated with financial plans. In 2010/11 we: worked with all our main provider organisations to ensure that their workforce and education plans are continually updated to support future service delivery undertook quarterly workforce assurance meetings with all our main providers in conjunction with Medway GPs, created a development programme for them to ensure they have the skills they will need to become commissioners of healthcare, and make the clinical commissioning group sustainable provided training in workforce planning for commissioners and managers across Kent and Medway updated the local health community education plan that sets out the future workforce that we anticipate will be required in the next three to five years In 2011/12 we plan to: continue to provide leadership in workforce planning and education commissioning across the local health community work across NHS Kent and Medway and social care partners to align and integrate workforce planning and education commissioning contribute to the development of provider skills networks to lead workforce planning, education and training. contribute to the development of a framework for managing large scale workforce change across Kent and Medway

Making experiences count NHS Medway works hard to ensure errors or accidents do not happen. However, sometimes mistakes are made, and in these cases we follow the principles of good practice with regard to remedying the problem. As set out in the NHS complaints procedure, Making Experiences Count, we aim to resolve concerns as quickly as possible and to the patientâ&#x20AC;&#x;s satisfaction. Complaints are reported to the NHS Medway Board and service directors receive quarterly reports of complaints received, including trend analysis. These reports also go to the Clinical Governance, Patient Experience and Clinical Risk Groups Complaints received by NHS Medway include concerns about the commissioning or funding of NHS services or procedures in Medway and concerns regarding NHS initiatives. Patients who are not happy with the service they receive from independent practitioners (GPs, dentists, pharmacists and optometrists) can also choose to complain to NHS Medway rather than directly to the individual or practice involved. People can choose what form they want the response to their complaint to take (such as a meeting, a letter or a phone call) and the timescale in which the investigations should be completed and a response sent. In 2010/11, there were 171 formal complaints and 95 informal complaints to NHS Medway. Any complainant who is not satisfied with the local response can ask the Parliamentary and Health Service Ombudsman to get involved. In 2010/11, four NHS Medway complaints were passed to the ombudsman. None was upheld. PALS Throughout 2010/11, NHS Medwayâ&#x20AC;&#x;s Patient Advice and Liaison Service (PALS) continued to support patients by assisting them with advice and answering queries. The service received 1,110 enquiries during 2010/11. Feedback and concerns are encouraged in a positive way as they help towards changing and improving services. This allows services to act immediately to put matters right, review working practice, apologise where at fault and provide an explanation.

Our environmental impact The NHS is one of the largest organisations in the UK, and is the biggest contributor to the public sectorâ&#x20AC;&#x;s carbon footprint. Climate change is predicted to have major harmful impacts on human health, making it even more vital that the NHS commits to tackling the problem. In England, the NHS is committed to reducing carbon emissions by 80 per cent by 2050. To build on the initiatives already in place in Medway and to identify further energy saving opportunities, NHS Medway successfully completed the NHS Carbon Management Programme in March 2011. We now have in place robust plans to reduce carbon emissions by at least 25 per cent by 2015. These plans will be further developed to lay the framework for achieving the 80 per cent reduction by 2050. We have continued to engage staff in this, and have an awareness programme in place to encourage staff to take simple steps that have an immediate impact, including recycling, shutting down computers, lights and electronic devices as much as possible to save energy and adopting a carbon aware approach to travelling to work and meetings.

NHS Medway Board The board sets the strategy and direction of NHS Medway, monitors its performance and makes financial and policy decisions. On 1 May 2011, the NHS Medway Board delegated many of its functions to a Board for the Kent and Medway PCT cluster. Medway Community Healthcare C.I.C. has its own Board, following its launch as a social enterprise. Details of the cluster Board are at www.medwaypct.nhs.uk/about and details of the Medway Community Healthcare Board are at www.medwaycommunityhealthcare.nhs.uk/about-us/ From 1 April 2010 to 31 March 2011, the NHS Medway Board consisted of: Non Executive Directors Chairman: Denise Harker Trevor Cooper Glyn Griffiths David Mayes Stephen Gee Graham Mayes – Chairman of the Audit, Assurance and Risk committee Gillian Wells Saba Sadiq Executive Directors Marion Dinwoodie, Chief Executive – until 30 September 2010 Helen Buckingham, Acting Chief Executive – from 1 October 2010 Dr Alison Barnett, Director of Public Health Jonathan Bates, Director of Finance and Assurance Dr Peter Green, Professional Advisory Committee Chair Dr Nathan Nathan, Professional Advisory Committee – from November 2010 Other members of the executive team Pippa Barber, Director of Clinical Performance / Executive Nurse – voting member of the Board from September 2010 Helen Buckingham, Director of Commissioning and Performance – until 30 September 2010 Natalie Davies, Company Secretary Wendy Head, Director of Organisational Development and Workforce Planning Nurse – voting member of the Board from September 2010 Lauretta Kavanagh, Director of Commissioning for Mental Health and Substance Misuse, Kent and Medway Martin Riley, Managing Director of Medway Community Healthcare Practice Based Commissioning locality clinical leads Rochester and Strood: Dr Dudley Hubbard Chatham: Dr Nathan Nathan Gillingham and Rainham: Dr Subramaniyam Selvan

Membership of major committees Professional Advisory Committee Dr Peter Green, GP, Chair Dr Chid Balachander, GP Dr Gill Fargher, GP Dr Dudley Hubbard, GP (as PBC lead for Rochester and Strood) Dr Nathan Nathan, GP (as PBC lead for Chatham) Dr Subramaniyam Selvan, GP (as PBC lead for Gillingham and Rainham) Dr Chau Shum, GP (until 30 June 2010) Dr Olurotimi Adesanya, dentist Mary Kirk, Cardiology Nurse Consultant Marion Dinwoodie, NHS Medway Chief Executive â&#x20AC;&#x201C; until 30 September 2010 Pippa Barber, Director of Clinical Performance / Executive Nurse Dr Alison Barnett, Director of Public Health Jonathan Bates, NHS Medway Director of Finance and Assurance Helen Buckingham, NHS Medway Director of Commissioning and Performance/ Acting Chief Executive David Quirke-Thornton, Assistant Director Adult Services, Medway Council Clinical quality committee Gillian Wells, Chairman Graham Mayes Stephen Gee Dr Peter Green, PAC Chair and Medical Director Mary Kirk, PAC member Pippa Barber, NHS Medway Director of Clinical Performance / Executive Nurse Dr Alison Barnett, NHS Medway Director of Public Health Helen Buckingham, NHS Medway Director of Commissioning and Performance/ Acting Chief Executive Natalie Davies, NHS Medway Company Secretary Jane Wiltshire, NHS Medway Mental Health Lead Commissioner Julie Steele, NHS Medway Head of Patient Safety Justin Chisnall, NHS Medway Assistant Director for Information and Performance Eng-Choo Hitchcock, NHS Medway Assistant Director of Infection Prevention and Control Audit, Assurance and Risk Committee Graham Mayes, Chairman Stephen Gee Saba Sadiq Trevor Cooper Remuneration Committee The members of the Remuneration Committee for 2010/11 were all the non executive directors of NHS Medway. The committee was chaired by the NHS Medway Chairman.

Finance Committee David Mayes, Chairman Stephen Gee Graham Mayes Marion Dinwoodie, NHS Medway Chief Executive – until 30 September 2010 Helen Buckingham, as Director of Commissioning and Performance until 30 September 2010, and as Acting Chief Executive – from 1 October 2010 Jonathan Bates, Director of Finance and Assurance Dr Peter Green, as Director of Commissioning and Performance – from 1 October 2010 Human Resources Committee Saba Sadiq, Chairman Denise Harker Glyn Griffiths Wendy Head, Director of Organisational Development and Workforce Planning During 2010/11, the NHS Medway Board held six meetings in public at NHS Medway‘s HQ at Fifty Pembroke Court, Chatham. The Board is supported by a number of sub committees, many of which are chaired by non executive directors.

Note: The Decision Making Group takes actions where concerns have been raised about performance or contractual issues regarding independent contractors.

NHS Medway performance 2010/11 This table sets out our performance against Quality of Services Indicators, which are set by the Department of Health to ensure the NHS delivers high standards of healthcare. It features the national priority (Vital Signs) and existing commitment indicators. More information about the definition, calculation method, purpose, source of underlying data and changes to these key purpose indicators is available on request from NHS Medway, using the contact details provided on page 2 of this annual report. NHS MEDWAY PCT KEY PERFORMANCE INDICATORS 2010/11 Data period

PCT

SHA

England

Data period

PCT

Number of MRSA bloodstream infections

2009-10

174

1,898

2010-11

Number of incidences of Clostridium difficile

2009-10

1,839

25,604

2010-11

2009-10

95.58%

94.5%

2010-11

94.70%

94.90%

Quarter 4 2009-10

94.9%

90.4%

2010-11

96.50%

91.80%

2009-10

98.8%

97.7%

2010-11

98.30%

98.10%

2009-10

99.5%

99.7%

99.5%

2010-11

100%

100.00%

2009-10

97.7%

96.7%

96.3%

2010-11

96.00%

97.60%

2009-10

88.7%

83.5%

2010-11

87.80%

86.70%

2009-10

100.0%

92.2%

2010-11

98.00%

92.30%

Proportion of people admitted to hospital following a stroke who spend at least 90% of their time on a stroke unit

2009-10

71.3%

58.6%

58.9%

2010-11

79.68%

Proportion of Transient Ischaemic Attack (TIA) cases - with a higher risk of stroke who are treated within 24 hours

2009-10

56.4%

56.5%

51.0%

2010-11

66.00%

2008

759.30

614.10

679.60

2009

715.49

609.64

652.28

2008

518.13

447.14

486.60

2009

493.67

426.71

459.71

SHA

England

INFECTION CONTROL

WAITING TIMES FOR CANCER SERVICES Proportion of patients first seen by a specialist within two weeks (14 days) when urgently referred by their GP or dentist with suspected cancer Proportion of patients with breast symptoms referred to a specialist who are seen within two weeks of referral Proportion of patients receiving their first definitive treatment within one month (31 days) of a decision to treat Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (drug treatments) Proportion of patients waiting no more than 31 days for second or subsequent cancer treatment (surgery treatments) Proportion of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer Proportion of patients receiving first definitive treatment within 62 days following referral from an NHS cancer screening service during a given period

92.0%

STROKE CARE

MORTALITY RATES Mortality rate per 100,000 (directly age standardised) of male population from all causes at all ages Mortality rate per 100,000 (directly age standardised) of female population from all causes at all ages

NHS MEDWAY PCT KEY PERFORMANCE INDICATORS 2010/11 Data period

PCT

SHA

England

Data period

PCT

SHA

England

2008

77.45

57.59

70.99

2009

69.25

55.56

66.1

2008

115.36

103.92

112.22

2009

125.28

103.75

110.36

NHS Stop Smoking Services: Smoking quitters per 100,000 population aged 16 and over

2009-10

1110

726

895

2010-11

1110

455 (by end Q3)

583 (by end Q3)

Number of conceptions to under-18 year olds

2008

238

2,763

38,783

2009

227

2515

35966

Rate of conception per 1000 population aged 15 to 17

2008

44.1

33.7

40.5

2009

43.0

30.9

38.2

Percentage of children in reception with height and weight recorded who are obese

2008-09

11.7%

8.6%

9.6%

2009-10

10.5%

8.4%

9.8%

Percentage of children in Reception with height and weight recorded

2008-09

88.2%

89.9%

91.2%

2009-10

89.4%

92.9%

Percentage of children in Year 6 with height and weight recorded who are obese

2008-09

19.4%

16.0%

18.3%

2009-10

20.2%

16.7%

18.7%

Percentage of children in Year 6 with height and weight recorded.

2008-09

89.6%

88.3%

89.1%

2009-10

89.5%

90.2%

89.9%

Immunisation rate for children age 1 who have completed immunisation for diptheria, tetanus, polio, pertussis, Haemophilus influenzae type b (Hib) i.e. all 3 doses of DTaP/IPV/Hib

2009-10

96.50%

92.80%

93.60%

Quarter 3 2010-11

94.50%

92.20%

93.90%

2009-10

93.20%

87.50%

87.60%

Quarter 3 2010-11

94.10%

87.10%

89.00%

2009-10

94.40%

85.70%

90.00%

Quarter 3 2010-11

96.70%

89.90%

91.30%

2009-10

93.90%

87.50%

88.20%

Quarter 3 2010-11

93.80%

87.30%

88.90%

2009-10

93.20%

85.10%

84.80%

Quarter 3 2010-11

93.50%

83.00%

85.60%

2009-10

88.40%

80.80%

82.70%

Quarter 3 2010-11

90.40%

80.00%

84.00%

2009-10

71%

74%

80%

School year 2010-11

76.71%

Percentage of infants breastfed at 6-8 weeks

Quarter 4 2009-10

36.2%

45.2%

Quarter 4 2010-11

41.7%

45.2%

Percentage of the population aged 15 24 screened or tested for Chlamydia

2009-10

23.7%

17.1%

22.1%

2010/11

24.4%

19.1%

25.2%

Mortality rate per 100,000 (directly age standardised) population from heart disease, stroke and related diseases in people aged under 75 Mortality rate per 100,000 (directly age standardised) population from cancer in people aged under 75 HEALTH OF THE POPULATION

Immunisation rate for children age 2 who have completed immunisation for pneumococcal infection - i.e. received Pneumococcal booster (PVC) Immunisation rate for children age 2 who have completed immunisation for Haemophilus influenzae type b (Hib) and meningitis C (MenC) - i.e. received Hib/MenC booster Immunisation rate for children age 2 who have completed immunisation for measles, mumps and rubella (MMR) i.e. 2 doses of MMR Immunisation rate for children aged 5 who have completed immunisation for diptheria, tetanus, polio and pertussis (DTaP/IPV) - i.e. all 4 doses Immunisation rate for children age 5 who have completed immunisation for measles, mumps and rubella (MMR) i.e. 2 doses of MMR Immunisation rate for girls aged around 12-13 years who have completed immunisation for human papillomavirus vaccine (HPV) - i.e. all 3 doses

Statement of the Chief Executiveâ&#x20AC;&#x2122;s responsibilities as the Accountable Officer of the Primary Care Trust

The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: - there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; - value for money is achieved from the resources available to the primary care trust; - the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; - effective and sound financial management systems are in place; and - annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Signed............................................................. Ann Sutton Chief Executive NHS Medway

7 June 2011

Statement of directorsâ&#x20AC;&#x2122; responsibilities in respect of the accounts The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the primary care trust and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts, directors are required to: apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; make judgments and estimates which are reasonable and prudent; state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the primary care trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the primary care trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts. By order of the Board.

7 June 2011

Ann Sutton Chief Executive

Jonathan Bates Director of Finance and Assurance

So far as each director is aware, there is no relevant audit information of which the PCTâ&#x20AC;&#x;s auditors are unaware. Each director has taken all the steps which he/she ought to have taken as a director to order to make him/herself aware of any relevant audit information and to establish that the NHS bodyâ&#x20AC;&#x;s auditors are aware of that information. 66

Medway Primary Care Trust Statement of Internal Control 2010/2011 1.

Scope of responsibility

The Board is accountable for internal control. As Accountable Officer, and Acting Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation‟s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation‟s assets for which I am personally responsible as set out in the Accountable Officer Memorandum. In particular, I am responsible for: The propriety and regularity of NHS finances. The keeping of proper accounting books and records. Prudent, efficient and effective administration. The avoidance of waste and extravagance. The efficient and effective use of all resources in my charge. Ensuring managers at all levels have a clear view of their objectives, the means to assess achievement against those objectives, and the information and training to exercise their responsibilities effectively. I also have responsibility for developing and maintaining the following key relationships: With local communities through public meetings and the publishing of annual reports and accounts. With patients through the PCT‟s Local Involvement Networks (LINks) and the Customer Care Team. With the South East Coast Strategic Health Authority through a range of regular meetings and forums. With other partners through the Delivering Health Together in Medway Board and through a range of service and care specific committees and working groups. The context in which risk within the organisation is managed takes into consideration the stakeholders listed above. My responsibilities are fulfilled and monitored through a range of committees, groups, and actions as follows: Regular reporting to the Board and Professional Advisory Committee (PAC) by both clinical and operational management teams. The Audit, Assurance and Risk Committee. 67

The implementation of a Risk Management Policy/Strategy agreed by the Board which clearly defines roles and responsibilities in relation to Risk Management at all levels from the Chief Executive to front line staff and addresses both clinical and non clinical risk. The Health and Safety Committee. The Clinical Quality Board which incorporates Clinical Governance. Regular briefings to the Strategic Health Authority. Internal and External Audit. The use of the Assurance Framework to manage principal risks associated with key objectives together with an exception report on corporate objective performance. 2.

The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to: Identify, rate and prioritise the risks to the achievement of the organisationâ&#x20AC;&#x;s policies, aims and objectives, evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in NHS Medway for the year ended 31 March 2011 and up to the date of approval of the annual report and accounts. 3.

Capacity to handle risk

The following key principles are observed in implementing our risk management strategy: There is Board, PAC and Executive Management Team commitment to, and leadership of the risk management function, with the ultimate responsibility resting with the Chief Executive. The PCT has an Audit, Assurance and Risk Committee charged by the Board with the oversight of the audit and risk management function in the organisation. This process is supported by both Corporate and Directorate Risk registers and assurance reports. The PCT has developed its clinical governance framework to include the formal application of the Risk Management process to clinical practices. There is widespread employee participation and consultation in Risk Management processes. There are risk leads and clinical governance leads in all services which feed into Departmental and Directorate risk registers. There is a mechanism for all incidents and complaints to be immediately reported, categorised by their potential consequences and investigated to determine system failures and lessons learned where appropriate. 68

There are management systems in place that provide safe practices, premises and equipment in the working environment. Systems of work are designed to reduce the likelihood of human error occurring. The Risk Management process is applied to contract management especially when acquiring, expanding or outsourcing services, equipment or facilities. Contracts are reviewed and written to ensure that only reasonable risks are accepted. In all PCT premises, whether owned, shared or leased/licensed, safe systems of work are in place to protect patients, visitors and staff. The PCT maintains an effective system of emergency preparedness, emergency response and contingency planning. The effectiveness of risk management strategies, plans and processes are measured against NHS best practice; where available, as well as through the Information Governance toolkit, internal and external audit and to a degree through the Quality, Innovation, Productivity and Prevention agenda . Where weaknesses are identified, action plans are developed, implemented, monitored and delivered to ensure continued compliance. The PCT provides realistic staffing and financial resources to implement and support effective risk management. It is recognised that failure to manage risk effectively could seriously impact on the above and that every care is taken to ensure that key controls put in place to manage risk do not have a detrimental effect on stakeholders. The organisation has a strong control on fraud and has made great progress in embedding effective counter fraud operations in all its processes and procedures. The organisation is also embedding the recent enhancements to the Bribery Act 2010. The organisation has maintained a Compound Indicator assessment rating of level 3 (out of a maximum 4) as awarded by the Counter Fraud Service. Training: All staff have been trained in both physical and environmental risk assessment of their work areas; assessments have been carried out in year which has fed into the risk registers. All new staff have risk management training as part of their induction to the organisation Work continues to further embed risk awareness into the culture of the organisation as service teams risk rate the effectiveness of internal controls in place to ensure team objectives are met. This involves continuing risk management training and the promotion internally of the Risk Management policy. 4.

The risk and control framework

The risk management process is designed to identify the principal risks to the achievement of the organisationâ&#x20AC;&#x;s objectives; to evaluate the nature and extent of those risks and determine the organisations appetite for those risks; and to manage them efficiently, effectively and economically. The PCTâ&#x20AC;&#x;s risk management system covers four types of risks and controls: 69

Clinical risks â&#x20AC;&#x201C; Covered by the Clinical Quality Committee report to the PCT Board and Audit, Assurance and Risk Committee and recorded in the clinical quality risk register. Executive accountability for clinical risk management resided with the Director of Clinical Performance / Executive Nurse. Organisational risks â&#x20AC;&#x201C; Covered by the annual report on risk management and recorded in the Assurance Framework, and Corporate Objectives report. Executive accountability for organisational risks rests ultimately with the Acting Chief Executive. Financial risks - Covered by the annual report on risk management and recorded in the Assurance Framework and Corporate Objectives report. Financial Risks are also reported in Finance Reports to the PCT Board, Finance Committee and the Audit, Assurance and Risk Committee. Executive accountability for financial risk management rests with the Director of Finance and Assurance. Strategic risks (risks which will impact on the achievement of corporate objectives) â&#x20AC;&#x201C; Covered by the annual report on risk management and the statement of internal control. These risks are also recorded in the Assurance Framework. Risk assessment forms part of all strategic policy decisions. Risks in all these areas are recorded in directorate risk registers and feed into the corporate risk register. Using the reports detailed above, and regular performance update reports, these risk areas are monitored regularly by: The PCT Board The Audit, Assurance and Risk Committee The Finance Committee The Clinical Quality Committee The Executive Team Risk management awareness and the purpose of assessment and monitoring of risk and the organisations appetite for the risk categories are embedded in the activity of the organisation at all levels through: Including risk and residual risk rating in business cases, Board reports/papers relating to all development proposals and all performance reports, corporate and team objectives. The development of Directorate risk registers in all services and sites informed by risk assessments carried out by staff trained and competent to assess both physical and geographical risks posed by location and client group. The development of action plans to address risks identified and monitoring mechanisms to ensure key controls are effective. In line with every PCT during 2010/2011, NHS Medway faced a period of significant financial pressure and instability following the publication of the White Paper Equality and Excellence: Liberating the NHS. These have been closely monitored by the PCT 70

Board and they have taken an active role in guiding the organisation based on the information available. I envisage this will continue until the demise of the PCT in 2013. 4.1.

Quality and Risk Profiles (QRPs)

QRPs are essential tools for providers, commissioners and staff in monitoring compliance with the Care Quality Commission (CQC) defined essential standards of quality and safety. They help in assessing where risks lie and can play a key role in providersâ&#x20AC;&#x; own internal monitoring as well as informing the commissioning of services. After the initial registration process that providers of health and social care have gone or will be going through, NHS Medway will continue to monitor the three main providersâ&#x20AC;&#x; Quality and Risk Profile action plans via quality review groups. The QRPs help do this by drawing in data from a number of sources which the CQC analyse to identify areas of potential non compliance with a provider. 4.2.

Care Quality Commission

NHS Medway has been working with its three main NHS providers to ensure they are registered with the Care Quality Commission (CQC). All non compliant areas had action plans and areas of concern were monitored thorough Quality Review Groups. These providers are now registered without conditions. NHS Medway will in addition work with other providers to ensure they are ready to register with the Care Quality Commission at the appropriate time for their service. CQC Declaration for Medway Community Healthcare CIC The PCT is fully compliant with CQC essential standards of quality and safety. Evidence of this was provided as part of the due diligence process and CQC registration documents were provided to enable the Business Transfer Agreement to be signed. 4.3.

Quality Accounts

A Quality Account is a report about the quality of services provided by an NHS healthcare service. A report is published annually by each NHS healthcare provider and has to be available to the public. The aim of Quality Accounts is to enhance accountability to the public, further engage the leaders of an organisation in their quality improvement agenda as well as providing another level of assurance to a commissioning organisation that a quality service is being delivered. The first statutory Quality Accounts were published by our three main providers (Kent and Medway NHS and Social Care Partnership Trust, Medway NHS Foundation Trust and South East Coast Ambulance Trust) in June 2010 covering activity for 2009/10. Although not required to, the provider arm to NHS Medway (Medway 71

Community Healthcare) also produced a quality account for this period so as to adopt best practice. As part of the quality assurance process the accounts were reviewed and particular attention was paid to any identified priorities for improvement and the quality performance indicators. NHS Medway fed back comments on the content of the accounts before agreeing them with the providers. 4.4.

Information Governance

The Information Governance agenda covers a broad spectrum of subjects that ensures the organisation maintains public confidence in our handling of its information; each carries their own individual risks and controls. Within the year there were no incidents of data loss identified. The system managed through both a dedicated Information Governance Committee as well as through individual and corporate risk registers. For this period the organisation has developed a comprehensive asset register which includes an inventory of the organisations physical records. All data under the direct management of the organisation is tightly monitored and controlled. This period has seen the introduction of a revised Information Governance assessment tool as well as a more robust approach to staff training and Pseudonymisation but we have to continue to score in the top 25% nationally and are the top PCT performer regionally. We are continuing to challenge ourselves with a comprehensive work programme which has been devised to further enhance our processes and protocols and the national and regional figures indicate that we are an organisation to be trusted with handling and using sensitive information correctly. 4.5.

Assurance Framework

The Assurance Framework demonstrates the processes in place to ensure the organisation meets its objectives. The risk associated with failure to deliver against an objective is rated, actions to ensure delivery and monitoring mechanisms are described and each objective is further rated for the residual risk. The framework reports both positive and negative controls as well as identifying control gaps; those with significant risk ratings have action plans. The Assurance Framework has been audited by South East Coast internal audit and they awarded the organisation Significant Assurance for its Assurance Framework. The auditors reported that the Board could place reliance on the Assurance Framework as a tool to monitor progress against corporate objectives To ensure public stakeholder involvement, the Local Involvement Networks (LINks) are kept informed of key risks impacting on service to the public, and the PCT's actions to address them. This information is also communicated through our PAL Service and several PCT public facing publications. The organisation has undertaken a climate change risk assessment and developed an Adaptation Plan, to support its emergency preparedness and civil contingency requirements, as based on the UK Climate Projections 2009 (UKCP09), to ensure that this organisationâ&#x20AC;&#x;s obligations under the Climate Change Act are met. 72

In an effort to achieve control of our physical resources a carbon reduction strategy has been developed and a whole organisation working group has been created to oversee its delivery. This demonstrates a real commitment and determination to make best use of every resource available to us. A cross organisation working group has been created to take this work forward. 4.6.

World Class Commissioning (WCC)

The second year assurance system for WCC began in June 2009 and was completed in May 2010. This however proved to be the last WCC assessment as the new government published its White Paper Equality and Excellence: Liberating the NHS. The White Paper saw the establishment of GP commissioning consortia and a national NHS Commissioning Board, an extended role for local government and the abolition of Primary Care Trusts and Strategic Health Authorities. NHS Medwayâ&#x20AC;&#x;s overall year two ratings (Fig 1) were very encouraging and provided a good level of assurance to the PCT Board. Fig 1. NHS Medway Strategy

Amber

Finance

Green

Board

Green

Unfortunately, the second year World Class Commissioning scores were never calibrated nationally. However, we are able to compare ourselves with our local partners and have shown that we are amongst the best performing PCTs in the South East of England (Fig 2.). Fig 2. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Brighton & Hove

ESDW

ECK

H&R

Medway

Surrey

Wes t Kent

Wes t Sus s ex

Fig.2 demonstrates the comparison of Red, Amber, and Green (RAG) ratings of South East PCTs. The results of the assessment have been used to develop systems further and action plans have been implemented in response. 4.7.

Use of Resources

The Audit Commission considers how well organisations are managing and using their resources to deliver value for money and better and sustainable outcomes for local people. It is structured into three themes: managing finances, governing the business and managing resources. The use of resources assessment also fed into other performance assessment frameworks, such as, Standards for Better Health. A four point scale from 1 to 4 is used, with 4 being the highest. NHS Medway scored consistently in its 2010 Use of Resources assessment and was able to demonstrate improvements in several of the key lines of enquiry (KLOE) and sustainability in the remainder. The 2009/2010 assessment included a new KLOE for managing Natural Resources (3.1). In line with the majority of PCTs throughout England, NHS Medway was assessed to need some improvement in its practices to make better and more effective use of its natural resources. NHS Medwayâ&#x20AC;&#x;s final scores were: Fig.3 Key Line of Enquiry Managing finances 1.1 Financial planning/financial health 1.2 Understanding costs/performance 1.3 Financial reporting Governing the business 2.2 DQ to support decision making 2.3 Good governance 2.4 Systems of internal control Managing resources 3.1 Natural resources 3.3 Workforce 4.8.

2009 score 3 3

2010 final score 3 3

3 2 2

2 2 2 2

3 2 2 1 2

Equality and Diversity

I can confirm that control measures are in place to ensure that all the organisationâ&#x20AC;&#x;s obligations under the equality, diversity and human rights legislation are complied with. A significant amount of work was undertaken by the organisation to training all staff and Board members in equality and diversity. 74

4.9.

Pensions

As an employer with staff entitled to membership of the NHS Pension scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employerâ&#x20AC;&#x;s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. 5.

Review of effectiveness

As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Director of Finance and Assurance provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive directors within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. The final position statements contained within the Assurance Framework, external and internal auditorsâ&#x20AC;&#x; reports on the Assurance Framework and our financial management, our Use of Resources assessment, our information governance toolkit assessment verified by internal audit, clinical audits and good fraud compound indicators. It is on these on which reliance has been placed during the year. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control. A plan to address weaknesses and ensure continuous improvement of the system is in place. These plans will be discussed by the following groups who will take responsibility for maintaining and reviewing the effectiveness of the system of internal control: the Board the Audit, Assurance and Risk Committee the Clinical Quality Committee Executive Management Team Internal Audit Assurance Frameworks, self-assessment declarations and the Comprehensive Area Assessment scores and benchmarked data.

Significant internal control issues Issues identified through the Assurance Framework Plans for driving down costs and increasing quality may not be delivered inline with the funding timetable. This issue was identified in year as a result of close monitoring of the financial position of the PCT and its progress against the savings targets set out by Government. To increase the level of control required to mitigate this issue the Executive Team lead a series of sessions involving a broad spectrum of staff to identify areas to increase quality and drive down cost. The sessions also looked at whether there were any barriers which would prevent savings being realised within the financial year. A Finance Committee, chaired by a Non-Executive Director was also established to oversee the process and hold officers to account. The position facing the organisation was also clear communicated to all staff as was the need to identify and embed change across every facet of the organisation. Several areas, both internally and externally, were identified and combined resulted in the necessary savings being realised. This will be managed through the Delivering Health Together Board, and also by close monitoring of the Quality, Innovation, Productivity and Prevention (QIPP) Programme An extended programme was also produced has been included in the Operational Plan for 2011/2012. A lack of contractual levers will mean the PCT may fail to convince drug prescribing health professionals to reduce the number of wasted prescriptions and use generic medicines (where appropriate), thereby restricting the available resources for other PCT priorities. Without the contractual levers to affect meaningful change a number of alternative levers were identified in year which were under the control of the PCT. Work plans were adjusted and compensatory actions taken. These covered areas such as: a) Wastes management. b) Formulary management. c) Shift to generics. d) Review of pharmacy contract. e) Savings plan linked to incentives. The effect of these compensatory actions has been monitored through the bimonthly Business Objective reports, Assurance Framework, Professional Advisory Committee, Clinical Quality Committee sub groups and the Board were assured that significant control had been achieved to mitigate the perceived risks. 76

It is estimated that next financial year savings equate to £2.2m. However, upward pressures of £3.4m give a net pressure of £1.2m although we accept that drug price changes are outside PCT control. The number and scope of large scale changes being made to the NHS will impact on internal controls, organisational memory, and workforce and staff morale. The NHS is seeing changes on a scale not seen before and a combination of reducing running costs and NHS instability has led to a number of vacancies being withdrawn and several posts being made redundant. This is coupled with the implementation of the Quality, Innovation, Productivity and Prevention agenda mean that staff resources are stretched in the delivery of NHS Medway objectives. As a result risks have been identified and are continually monitored to ensure they are mitigated as far as is possible. Where single points of failure have been identified, the organisation has identified alternative arrangements and an appropriate successor identified. Additionally, the Board, Audit, Assurance and Risk Committee and the Executive Team review the risk registers and exception reports to ensure the internal controls are robust. Going forward, the organisation in conjunction with the Kent and Medway Cluster is producing a Legacy Report for Medway, the purpose of which is to preserve some aspects of the organisational memory. Conclusion This statement sets out the control arrangements and the results of assessments carried out relating to the PCT. It also sets out those areas where there have been lapses in internal control. My review confirms that NHS Medway has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

Signed……………………………………………….. Ann Sutton Chief Executive, NHS Medway (On behalf of the Board) 7 June 2011

NHS Medway summary financial statements 2010/11 The following tables set out the summary financial statements. These financial statements might not contain sufficient information for a full understanding of NHS Medwayâ&#x20AC;&#x;s financial position and performance. The full annual accounts are available from Jonathan Bates, Director of Finance and Assurance. The directors of NHS Medway confirm that all the accounting records of the PCT have been made available to the auditors for the purpose of carrying out their audit. Medway PCT - Annual Accounts 2010/11 Statement of Comprehensive Net Expenditure for year ended 31 March 2011 2010-11 ÂŁ000

2009-10 ÂŁ000

Employee benefits

14,739

15,207

Other costs

410,713

391,547

Income

(30,521)

(28,372)

Employee benefits

40,349

38,406

Other costs

15,759

16,262

Income

(8,623)

(9,299)

PCT net operating costs before interest

442,416

423,751

Investment income

(90)

(74)

Other (Gains)/Losses

Finance costs Net operating costs for the financial year

1,556

1,397

443,882

425,074

(1,945)

(1,288)

Commissioning

Provider

Other Comprehensive Net Expenditure Net (gain) on revaluation of property, plant & equipment Net (gain) on revaluation of intangibles Net (gain) on revaluation of available for sale financial assets Receipt of donated or government granted assets

2010-11 £000

2009-10 £000

(Gain)/loss on other reserves

Impairments and reversals Transfers from donated and government grant reserves Adjustment for nominal cost of capital charge Transfers (to)/from other bodies within the Resource Account Boundary

5,882

(340)

(1)

(6)

Net actuarial (gain)/loss on pension 1

Total comprehensive net expenditure for the year

442,053

429,373

STATEMENT OF FINANCIAL POSITION AS AT 31 March 2011 31 March 2011

31 March 2010

NOTE

£000

Property, plant and equipment

47,985

42,943

Intangible assets

261

369

Other financial assets

630

633

Trade and other receivables

17.1

1,096

2,460

49,972

46,405

Non-current assets:

Total non-current assets

Current assets: Inventories

Trade and other receivables

17.1

10,318

11,626

Other financial assets

Other current assets

Cash and cash equivalents

10,376

11,626

135

Total current assets

10,376

11,761

Total assets

60,348

58,166

Non-current assets held for sale

Current liabilities Trade and other payables

(30,603)

(28,039)

Other liabilities

(85)

Provisions

(657)

(890)

Borrowings

(573)

(459)

Other financial liabilities

Total current liabilities

(31,833)

(29,473)

Non-current assets plus/less net current assets/liabilities

28,515

28,693

Non-current liabilities Trade and other payables

(1,096)

(2,460)

Provisions

(1,721)

(1,981)

Borrowings

(19,907)

(16,247)

Other financial liabilities

Other liabilities

Total non-current liabilities

(22,724)

(20,688)

Total Assets Employed:

5,791

8,005

General fund

(3,844)

(120)

Revaluation reserve

8,343

6,854

Donated asset reserve

1,292

1,271

Government grant reserve

Other reserves

Total Taxpayers' Equity:

5,791

8,005

FINANCED BY: TAXPAYERS' EQUITY

The financial statements were approved by the Board on 6 June 2011 and signed on its behalf by

Signed............................................................. Ann Sutton Chief Executive, NHS Medway 7 June 2011 Property assets were revalued as at 31 March 2011 by the District Valuer. LIFT assets were revalued at fair value; all other assets were revalued on the Modern Equivalent Asset basis.

STATEMENT OF CHANGES IN TAXPAYERS' EQUITY For the year ended 31 March 2011 General Fund

Revaluation Reserve

Donated Asset Reserve

Govt. Grant Reserve

Other Reserves

Total Reserves

Changes in taxpayers’ equity for 2010-11

£000

Balance at 1 April 2010 Net operating cost for the year Net gain on revaluation of property, plant, equipment Net gain on revaluation of intangible assets Net gain on revaluation of financial assets Receipt of donated or government granted assets Movements in other reserves Impairments and reversals Release of reserves to SoCNE Non-cash charges – cost of capital Transfers between reserves Transfers to/(from) other bodies within the Resource Account Boundary Net actuarial gain/(loss) on pension Total recognised income and expense for 2010-11 Net Parliamentary funding

(120)

6,854

1,271

8,005

Balance at 31 March 2011

(3,844)

(443,882)

(443,882) 1,885

1,945

0 0

0 (78)

(78)

(39)

318

(318)

0 (443,563)

1,489

0 1

(442,053)

439,839

439,839 8,343

1,292

5,791

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 March 2011 NOTE Cashflow from operating activities Net operating cost before interest Other cash flow adjustments Movements in Working Capital Provisions utilized Interest paid Net cash outflow from operating activities Cash flows from investing activities Payments to purchase property, plant and equipment Payments to purchase intangible assets Proceeds of disposal of assets held for sale Purchase of financial investments (LIFT) Sale of financial investments (LIFT) Loans made in respect of LIFT Loans repaid in respect of LIFT Payments for other financial assets Proceeds from disposal of other financial assets Interest received Rental Revenue Net cash inflow/(outflow) from investing activities Net cash inflow/(outflow) before financing Cash flows from financing activities Net Parliamentary Funding Other capital receipts surrendered Capital grants received Capital element of payments in respect of finance leases, on-SoFP PFI and LIFT Cash transfers (to)/from other NHS bodies Net cash inflow/(outflow) from financing Net increase/(decrease) in cash and cash equivalents Cash (and) cash equivalents (and bank overdrafts) at the beginning of the financial year Effect of exchange rate changes on the balance of cash held in foreign currencies Cash (and) cash equivalents (and bank overdrafts) at the end of the financial year

39 38 21

2010-11 ÂŁ000

2009-10 ÂŁ000

(442,416) 3,175 4,102 (661) (1,508) (437,308)

(423,751) 6,020 2,173 (682) (1,296) (417,536)

(1,999) (134) 410 0 3 0 0 0

(5,200) (103) 275 (75) 1 0 0 0

0 90 0

0 74 0

(1,630) (438,938)

(5,028) (422,564)

439,839 0 0

423,110 0 0

(839) 0 439,000

(555) 0 422,555

(9)

Related party transactions During the year none of the Department of Health Ministers, trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with Medway Primary Care Trust, nor have they any company directorships or other significant interests where those companies are likely to do business, or are possibly seeking to do business with the NHS where this may conflict with their managerial responsibilities. PAC GPs are members of the following practices: The Dame Sybil Thorndike Healthcare Centre, Rochester Walderslade Village Surgery, Chatham Wouldham Road Surgery Payments to GPs and Practices are determined by the Board following recommendations made by the PAC. GPs are not in the majority on the Board. The Department of Health is regarded as a related party. During the year Medway PCT has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. (See table) Related party transactions

Balances with related Parties 2010/11 ÂŁ000s Creditors Debtors Income

Expenditure

South East Coast Strategic Health Authority

307

862

116

Eastern and Coastal Kent PCT West Kent PCT

2,610 413

2,326 4,794

5,864 20,996

2,657 18,474

Dartford and Gravesham NHS Trust East Kent Hospitals University Foundation Trust Guys and St Thomas' Foundation Trust Kent and Medway NHS and Social Care Partnership Trust Kings Healthcare Foundation Trust Maidstone and Tunbridge Wells NHS Trust Medway NHS Foundation Trust Oxleas NHS Foundation Trust Queen Victoria Foundation Trust South London and Maudsley Foundation Trust University College London Foundation Trust

331 0 0

57 68 1,249

230 0 0

4,057 6,123 11,042

1,513 40 1,099 2,239 0 182 300 69

304 0 6 1,335 102 13 0 0

48 0 53 267 0 56 0 0

26,914 5,653 15,334 130,250 1,398 4,632 1,840 1,524

Medway Council 202 1,730 1,845 12,191 In addition, the PCT has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with the NHS Pensions Agency, HM Revenue and Customs, and the NHS Business Services Authority (Prescription Pricing Authority). Charitable Funds collected by the Medway PCT are invested in the Charitable Funds managed by the Kent and Medway NHS and Social Care Partnership Trust.

Better Payment Practice Code Measure of compliance Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year Total Non-NHS Trade Invoices Paid Within Target Percentage of Non-NHS Trade Invoices Paid Within Target NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid Within Target Percentage of NHS Trade Invoices Paid Within Target

2010-11 Number

2010-11 £000

2009-10 Number

2009-10 £000

22,835 20,305

84,978 75,977

21,898 20,003

76,489 69,561

88.92%

89.41%

91.35%

90.94%

4,455 3,511 78.81%

270,767 263,257 97.23%

4,275 2,914 68.16%

270,989 248,584 91.73%

The Better Payment Practice Code requires the PCT to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The PCT has not yet signed up to the Prompt Payments Code.

PCT Management Costs Management costs (£000s) Weighted population (number) Management cost per weighted head of population (£ per head)

2010/11 7,991 257,384 £31

2009/10 9,408 255,109 £37

Commissioning Management Costs Management costs (£000s) Weighted population (number) Management cost per weighted head of population (£ per head)

5,095 257,384 £20

5,917 255,109 £23

Provider Management Costs Management costs (£000s) Revenue (£000s)

2010/11 2,896 56,770

2009/10 3,491 55,935

Public health 217 257,384 £0.84

Total 13,260 257,384 £51.52

Running Costs 2010/11 Running costs (£000s) Weighted population (number) Running costs per head of population (£ per head) Total Public Health Expenditure 2010/11 Total public health expenditure (£000s)

Commissioning 13,043 257,384 £50.68

19,457

Running costs and public health expenditure separately identified for the first time in 2010-11.

External Audit External Auditors are appointed by the Audit Commission. The auditors appointed to the PCT are PKF (UK) LLP.

External audit fees (excluding VAT) for 2010/11 were: ÂŁ Accounts and Governance

121,000

Use of Resources (including risk based work)

35,500

Review of redundancy cases (required by DH)

14,500

Total

171,000

No non audit work has been carried out by PKF (UK) LLP for this PCT. Value for Money The audit fees for value for money included: . Use of resources assessment (mandatory) . Risk based work

Remuneration Report Name and title

Mrs D Harker Chairman Mr T Cooper, Non Executive Director Mr G Mayes, Non Executive Director Ms G Wells, Non Executive Director Mr G Griffiths, Non Executive Director Mr D Mayes, Non Executive Director Mr S Gee, Non Executive Director Ms S Sadiq, Non Executive Director Ms M Dinwoodie Chief Executive* (until October 2010, but see note below) Mr J Bates, Director of Finance Dr A Barnett, Director of Public Health Ms P Barber, Director of Clinical Performance / Executive Nurse Ms H Buckingham, Director of Commissioning and Performance, and Acting Chief Executive (from October 2010)

Contract of service dated

01.01.10

Date of leaving

2010-11 Other remuneration (bands of £5,000)

Benefits in kind (bands of £100)

Salary (bands of £5,000)

2009-10 Other remuneration (bands of £5,000)

Benefits in kind (bands of £100)

Salary (bands of £5,000)

2008-09 Other remuneration (bands of £5,000)

£000

£00

£000

£00

£000

£00

5 - 10

Benefits in kind (bands of £100)

30 - 35

5 - 10

17.02.03

5 - 10

01.04.10

10 - 15

5 - 10

01.04.10

5 - 10

10 - 15

5 - 10

135 - 140

6-7

01.08.07

31.03.11

Salary (bands of £5,000)

31.03.11

01.03.10 01.03.10

31.03.11

01.04.10

01.10.06

5 - 10

0-5

5 - 10

0-5

31.03.11

130 - 135

5-6

130 - 135

6-7

13.11.06

90 - 95

95 - 100

03.03.08

135 - 140

125 - 130

115 - 120

70 - 75

45 - 50

100 - 105

95 - 100

5 - 10

22.10.07

01.03.09

31.03.11

Mrs W Head, Director of OD and Workforce Planning Ms N Davies, Company Secretary Dr P Green, Medical Director PAC Chair, and Director of Commissioning and Performance (from October 2010) Mr M Riley, Managing Director of Medway Community Healthcare Dr A Adesanya, Dentist PAC Member Dr C Balachander, GP PAC Member Dr G Fargher, GP - PAC Member Ms M Kirk, Nurse - PAC Member Dr N Nathan, GP - PAC Member Dr D Hubbard, GP, PBC PAC Member Mr D Quirke Thornton, Local Authority – PAC Member Dr C Shum, GP - PAC Member

02.11.09

85 - 90

35 - 40

18.02.08

65 - 70

60 - 65

01.09.07

100 - 105

70 - 75

50 - 55

100 - 105

95 - 100

20 - 25

5 - 10

45 - 50

18 - 19

10 - 15

20 - 25

10 - 15

23 - 24

13.11.06

31.03.11

01.06.10

5 - 10

01.04.10

5 - 10

01.09.06

5 - 10

10 - 15

01.05.08

5 - 10

55 - 60

01.05.08

0-5

25 - 30

01.06.10

5 - 10

18 - 19

15 - 20

5 - 10

50 - 55

5 - 10

25 - 30

18 - 19

0 01.09.06

30.06.10

0-5

5 - 10

*Ms Dinwoodie, whilst acting as Chief Executive at West Kent PCT, continued to be paid by Medway PCT, which recharged her salary to West Kent PCT. Since recharges are not shown on this statement, the full cost is shown. Benefits in kind relate to the amount paid by the PCT in respect of expenses claims, which is in excess of the amount nationally agreed by the Inland Revenue. Remuneration waived by directors and allowances paid in lieu £5 - 10,000 (2009/10, £0) remuneration was waived by 1 (2009/10, 0) directors. £0 (2009/10, £0) of allowances were paid in lieu to 0 (2009/10, 0) directors.

2010/11 Pension entitlements Name and title

Ms M Dinwoodie, Chief Executive Mr J Bates, Director of Finance Dr A Barnett, Director of Public Health Ms P Barber, Director of Clinical Performance / Executive Nurse Ms H Buckingham, Director of Commissioning and Performance Ms N Davies, Company Secretary Dr P Green, Medical Director Mrs W Head, Director of OD and Workforce Planning Mr M Riley, Managing Director of Medway Community Healthcare

Real increase in pension at age 60 (bands of £2,500)

Real increase in lump sum at age 60 (bands of £2,500)

Total accrued pension at age 60 at 31 March 2010 (bands of £5,000)

Lump sum at age 60 related to accrued pension at 31 March 2010 (bands of £5,000)

Cash Equivalent Transfer Value at 31 March 2010

Cash Equivalent Transfer Value at 31 March 2009

Real increase in Cash Equivalent Transfer Value

Employer's contribution to stakeholder pension (rounded to nearest £00)

£000

2.5 - 5

10 - 12.5

60 - 65

185 - 190

1381

1353

-2

0 - 2.5

15 - 20

55 - 60

332

348

-24

2.5 - 5

7.5 - 10

35 - 40

105 - 110

601

593

-5

0 - 2.5

2.5 - 5

20 - 25

60 - 65

297

316

-27

2.5 - 5

10 - 12.5

20 - 25

70 - 75

267

-6

0 - 2.5

2.5 - 5

10 - 15

30 - 35

108

116

-11

0 - 2.5

5 - 7.5

50 - 55

160 - 165

899

959

-82

0 - 2.5

15 - 20

55 - 60

263

290

-33

* Mrs Head is no longer a member of the NHS Pension Scheme As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members

Cash Equivalent Transfer Value at 31 March 2010 A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the members' accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefit accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figure, and from 2004-05 the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Self-employed GPs who are members of the Professional Advisory Committee (PAC) have pension entitlements. However, the proportion of those entitlements that relates to their membership of the PAC is not significant compared to the proportion that relates to their work as practitioners independent of the PCT. It is not, therefore, appropriate to disclose their pension entitlements. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of period. Policy on the Remuneration of Senior Managers The VSM Pay Framework introduces new arrangements that were implemented in 2006/07. The total reward package for very senior managers includes: Basic Pay: A spot rate for the post Additional payments where appropriate An Annual performance bonus scheme No performance bonuses were given to Executive Directors in the last financial year. All Senior Managers are on permanent contracts and the notice periods do not exceed six months.

Signed………………………………. Ann Sutton Chief Executive, NHS Medway 7 July 2011 90

2010/11 Reporting of other compensation schemes - exit packages Exit package cost band (including any special payment element)

Number of compulsory redundancies

<£20,001 £20,001 - £40,000 £40,001 - 100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000 Total number of exit packages by type (total cost)

9 2 3 1

15 (£474,000)

Number of other departures agreed

Total number of exit packages by cost band (total cost)

Number of departures in (b) and (c) where special payments have been made (special payment element (totaled)

9 (£87,000) 1 (£23,000) 4 (£267,000) 1 (£132,000)

0 0 0 0

1 (£62,000)

Total number (and cost) of exit packages 16 (£536,000)

0 Total number of special payments (and total cost of special payment element) 0

Independent auditorsâ&#x20AC;&#x2122; report to the Board of Directors of Medway Primary Care Trust I have examined the summary financial statement for the year ended 31 March 2011 which comprises the Operating Cost Statement, Statement of Financial Position, Statement of Changes in Equity, Statement of Cash Flows, Related Party Transactions, Better Practice Payment Code, Management Costs, Audit costs and Remuneration Report set out on pages 78 to 91. This report is made solely to the Board of Directors of Medway Primary Care Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010. Respective responsibilities of directors and auditor The directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement. I conducted my work in accordance with Bulletin 2008/03 â&#x20AC;&#x153;The auditor's statement on the summary financial statement in the United Kingdomâ&#x20AC;? issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of my opinion on those financial statements. Opinion In my opinion the summary financial statement is consistent with the statutory financial statements of Medway Primary Care Trust for the year ended 31 March 2011. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements (9 June 2011) and the date of this statement.

Robert Grant Partner, on behalf of PKF (UK) LLP London, UK 7 July 2011

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