NHS Doncaster 2011 Annual Report by PepperTree Creative

Annual Review 2010/2011

Contents About us What do we do? Our journey through the year Highlights of the year How we performed Financial Review Summary Financial Statement

3 4 5 16 31 46 49

About us

Area we cover

We are Doncaster’s local leader for health, guardian of public health and custodian of the borough’s multi-million pound NHS budget. In 2010/11 we operated with a resource allocation of £575 million, which works out at around £1,866 for every one of our 308,000 registered patients. Our role is to make sure health services are available to our patients when and where they are needed. During 2010/11, the Trust comprised of two separate functions: A commissioning function of around 400 employees, which is responsible for identifying and buying health services for our patients and making sure those services are of high quality and perform well. An arms length provider services – Doncaster Community Healthcare – which has some 1,400 employees working across key hospital and community-based services like school and district nursing, health visiting, rehabilitation and drug treatment. The majority of staff working in the commissioning side of the organisation are based at headquarters buildings near Doncaster town centre. The headquarters of Doncaster Community Healthcare is Park Lodge, on the former St Catherine’s Hospital site at Balby. Front-line clinical staff operate from more than 50 bases in health centres, family doctor surgeries and other community buildings.

We cover healthcare for people in the same operational boundary as Doncaster Council and work closely with local NHS organisations and other public and private sector partners to ensure our patients receive the best possible healthcare from a wide choice of providers. We fund the wide range of health services needed by everybody who lives in the Doncaster area. In addition, Doncaster Community Healthcare provides a range of services based in the community.

Thorne & Moorends Askern Town Centre

Hatfield & Stainforth

Adwick le Street Bentley Armthorpe Intake & Wheatley Edlington Mexborough

Conisbrough

Bessacarr & Cantley

Balby & Hexthorpe

Rossington

Bawtry & Tickhill

Hyde Park & Belle Vue

What do we do?

Our strategic vision is to:

We are responsible for buying – in the NHS we call it commissioning – the health services our patients need. This includes everything from bandages to open heart surgery. We purchase those services from health care providers, such as local hospital Trusts and ambulance services, and also from the private and voluntary sectors. We also have to ensure that all our patients have access to primary care services. These are services provided by local family doctors, dentists, pharmacists and optometrists. Our aim is to provide services locally where possible and centrally where necessary. Many of the specialist services we commission, such as kidney transplants, have to be carried out at bigger treatment centres based in places like Sheffield and Leeds. As well as commissioning services from health care providers we also monitor the performance of those contracts to ensure the healthcare delivered is of a high quality that meets patients’ needs. Our key challenge this year has been to balance our books whilst meeting the ever rising expectations of our patients. We have to determine which areas of health to invest in whilst acknowledging that we do have a finite financial resource to spend each year.

Promote public health and reduce inequalities through prevention, investment, partnerships and the commissioning of high quality, accessible services. To ensure the vision is achieved we have in place the following strategic objectives that were our core focus for 2010/11:

Within the Doncaster area there are 44 family doctor practices, 45 dental practices, 73 community pharmacies, and 35 optometry (opticians) practices. These are the independent contractors that NHS Doncaster contracted with during the year. 4

For our population Address/invest in health inequalities by targeting the areas with greatest need I mplement health improvement plans with clearly defined sustainable quality outcomes For our patients Commission and provide high quality, evidence based, accessible services closest to the patient’s home Design/invest in safe care pathways For our workforce Value and develop our people through leadership, training and investment Encourage research and development For our partners Promote joint working to maintain high performance and continuous improvement and, S eek engagement to maximise potential from joint resources.

Our journey through the year

By Roger Greenwood, Chairman

Annette Laban, Chief Executive

Dr Alastair Graves, Chair, Professional Executive Committee We are pleased to present the Trust’s fifth annual review, completing what has been a very challenging but rewarding year for the organisation. Following our toughest financial year to date, that experts tell us will last for a number of years, it is particularly satisfying for us to announce that we have met our statutory financial obligations. This is an outcome that has been the result of extremely hard work and dedication of our staff and contractors, especially when set against the challenging change and economic climate we continue to face.

Looking back, although we have experienced the most difficult year in our history, we have met our key performance targets and had many key highlights that are outlined further in this review. However, we feel it is important to mention a few of them in a look at our journey this year. Supporting family doctors, nurses and other health professional colleagues is one way in which we have driven forward improvements to the services provided to patients. A key landmark during the year was the launch of the new Government’s White Paper – Liberating the NHS – in June that will see dramatic changes for our organisation over the next couple of years, as local doctors become more involved in shaping health services. In Doncaster we are one of the first areas to put in place a Clinical Commissioning Group - having developed positive relationships and high levels of involvement with our clinicians - who will be responsible for buying healthcare after April 2013. As part of the transition of the NHS in our area we will come together with colleagues in South Yorkshire and Bassetlaw Primary Care Trusts (PCTs) to form a ‘cluster’ that will make the very best use of existing systems, processes and relationships across the region to help to plan for the future of the local NHS. We have worked effectively with our many partners to narrow the health gap between our affluent and poorer communities and are continually strengthening our links with Doncaster Council, benefiting from a Joint Director of Public Health. A key joint objective of all statutory agencies across Doncaster is to ensure the safety of our vulnerable adults, children and young people. We cannot emphasise 5

During 2010/11 we continued to work with our local doctors, patients, the public and health Trust partners across Doncaster and Bassetlaw on a clinical services review. This is looking at hospital based services to see how we can make them more efficient for patients and ensure they deliver the best health outcomes.

enough the importance we and the Trust Board place on keeping our patients safe, underlined by our membership of the Children’s Improvement Board – scrutinising the performance and delivery of services for children - and both the Children’s and Adults Safeguarding Boards. Over the year assurance mechanisms have been implemented in line with national legislation and local guidance to provide a consistent high quality safe service to all our patients. We also played a pivotal role in the recent Care Quality Commission inspection of Children’s Service in Doncaster with an outcome report due in the coming months. During 2010/11 we continued to work with our local doctors, patients, the public and health Trust partners across Doncaster and Bassetlaw on a clinical services review. This is looking at hospital based services to see how we can make them more efficient for patients and ensure they deliver the best health outcomes. One of our top achievements has been the successful transfer of our provider services at Doncaster Community Healthcare (DCH) to new providers. In October 2010 we announced the local organisations who will take over the management of our front-line services from 1st April 2011 in line with the Government requirements under the Transforming Community Services initiative. We are satisfied that our front line services are transferring to high performing local organisations that will ensure they continue to deliver excellent services in the community. In taking these decisions, the Board sought to ensure that the changes will enhance even further the current level of high quality services provided for the people of Doncaster.

Details of where services will be provided in the future are discussed in the highlights of the year section. Proud of what we do We have around 1,400 members of staff in DCH, who have been working at arms length since 2009, and they have continued to perform outstandingly throughout the difficult and uncertain times for them. We would like to say a big thank you to all our staff for the excellent work they have done during the year. We would also like to thank the 400 staff in the commissioning arm of the organisation for their hard work. In fact, their dedication was rewarded in this year’s Healthcare 100 poll, run by Health Service Journal, that ranked us as the third best commissioner only PCT, 13th out of all the NHS organisations that took part in the survey. We strongly believe that our staff are our biggest asset and they are at the forefront of improvements we are making in services for patients, thanks to their dedication and high standards of work. We value our people highly and are proud to be an employer of choice. Despite an eventful winter and difficult adverse weather conditions that meant some patients were seen outside the four hour waiting target for accidents and emergencies, we have worked very closely with our partners across Doncaster to make sure that we are back on track to meet our year end target. The excellent work we’ve carried out across our unplanned care network has allowed us to maintain a high level of service to patients in the firstof-its-kind Unplanned Care Centre at Doncaster Royal Infirmary. 7

We remain dedicated to improving the health of our patients and public and have proved once again that we are not only leaders of the NHS in Doncaster but a driver for excellence on the national stage. Our stroke services are amongst the best in the country with a report by Government health watchdog the Care Quality Commission rating Doncaster as equal fifth best in England when it comes to providing services for people who have had a stroke and their carers. Fewer Doncaster people are having a stroke, thanks to improving prevention techniques, and those who do suffer one receive some of the best aftercare in the country. We were also one of only 20 areas across the country to launch a pilot of Personal Health Budgets, which gives people the freedom to choose and pay for the support services they want. So far 66 patients and service users of continuing care and mental health services have benefited from the pilot that has progressed very well and will be evaluated at the end of March 2012. During the year we organised two competitions asking local people to come up with creative names for our latest state-of-the-art health centres in the town centre and Conisbrough. The Flying Scotsman Centre, which will open St Sepulchre Gate in Doncaster town centre at the end of 2011, draws on Doncaster’s historical links with the railways for inspiration, whilst Conisbrough’s name also reflects its history with The Stone Castle Centre and will open to patients in the summer. These will be striking new buildings which symbolise the NHS at its best – delivering quality care and helping to regenerate our communities. However, we regret that 8

we cannot take forward two new build proposals in Mexborough and Bentley due to the financial situation we face but our board were unanimous in agreeing that we will improve health care premises in these areas as a priority. We have agreed to work with our partners to make the best use of the existing premises by making improvements to them. It was extremely pleasing to be recognised as ‘performing strongly’ in the counter fraud arena. We have been one of only 11 PCTs in England to be awarded Level 4 (the highest rating available) in the Counter Fraud Service Quality Assurance Programme Assessment. We feel this again demonstrates the commitment of our staff to embrace fraud activity and innovation in their everyday work. The future The year ahead brings many more challenges as we move ahead with changes to the health system. We will work as part of the South Yorkshire and Bassetlaw cluster to help the local Clinical Commissioning Group (CCG) through the transition period, ensuring that we, as the accountable organisation, are able to maintain the quality of patient care whilst reducing our costs. Money and resources will be tighter as we continue the journey of continually improving services for patients. In the coming months we will be working with patients, the public and clinicians in Mexborough as we review the hospital based services provided in the area. This and other elements of the Clinical Services Review will remain a top priority for us as we work with the CCG to make sure services are safe, high quality and fit-for-purpose.

The year ahead brings many more challenges as we move ahead with changes to the health system.

We will continue to embed QIPP (Quality, Innovation, Productivity and Prevention) within our organisation and across the health community to help achieve more from less as it becomes part of the everyday business for health professionals. We are proud of what NHS Doncaster has achieved and are confident that we will continue to provide high quality services for our people by striving to be the best. The following pages give you a flavour of our achievements during 2010/11.

Organisational structure The day-to-day running of the organisation is shared across the Chief Executiveâ&#x20AC;&#x2122;s Office and six directorates. Each directorate is headed by a director who has responsibility for a portfolio of functions: Directorate of Strategic Commissioning and Finance Reviews, plans and develops a wide range of high quality, responsive and efficient health care services. This includes working jointly on a number of services with Doncaster Council and also works closely with General Practice Commissioners. The directorate also ensures that robust financial controls exist that enables NHS Doncaster to meet our statutory responsibilities, including achieving financial balance. Directorate of Organisational Development and Corporate Affairs Ensures NHS Doncaster has rigorous corporate governance and complies with relevant guidance and legislation. Also oversees the strategic human resources, equality and 10

diversity, organisational development and communications and engagement functions. The Director of Organisational Development and Corporate Affairs is the Senior Information Risk Owner. Directorate of Performance and Information Manages performance systems and processes for NHS Doncaster against key national and local targets and evaluates the performance of our organisation and its directorates. Leads the implementation of the National Programme for Information Technology. The Director of Performance and Information is also our knowledge management lead and chief information officer. Directorate of Public Health Influences the commissioning of services to ensure they improve local health and reduce health inequalities. The directorate ensures that we have sound health protection arrangements and leads on emergency planning. Manages health promotion messages to ensure the public are aware of key health issues in Doncaster. The Director of Public Health is a joint appointment across NHS Doncaster and Doncaster Council. Directorate of Quality and Clinical Assurance Provides professional advice, leads the re-design of primary care services and acts as clinical governance watchdog for NHS Doncaster. Also responsible for primary care contracts, infection control and prevention, and child and adult protection. Also responsible for governing the prescribing and use of medicines. The Acting Director of Quality is also NHS Doncasterâ&#x20AC;&#x2122;s Caldicott Guardian. Doncaster Community Healthcare

Doncaster Community Healthcare Is responsible for around 1,400 staff to deliver the community based services that directly report into NHS Doncaster. Also provided out-of-hours dental and general practice services in the year.

Whoâ&#x20AC;&#x2122;s who NHS Doncaster Trust Board NHS Doncaster Trust Board meets every month in public and is responsible for agreeing the strategic direction of the organisation, ensuring that performance and delivery levels meet the targets set out by the board and making high level decisions. Membership comprises the Chairman and six non-executive directors, together with the Chief Executive, five executive directors and the Medical Director/ Clinical Leadership Executive Chairman.

The Chairman and non-executive directors are members of the public selected for their wide range of skills and experience. They have been appointed by the Appointments Commission, which also determines the length of time they serve. 11

Non Executive Directors and Directors Register of Interests 2010/11

Name

Appointment

Declaration

Roger Greenwood

Chairman

None

Ann Gilbert

Non Executive Director

None

Pam Horner

Non Executive Director

None

Tony Humphries

Non Executive Director

None

Jill Morris

Non Executive Director

None

Les Ranson

Non Executive Director

Chair of Governors Wadworth Primary School

Albert Schofield

Non Executive Director

None

Annette Laban

Chief Executive

Consultancy work for Janssen Pharmaceuticals and Novartis Pharmaceutical Company

Helen Beard

Executive Director of Performance and Information

Partner Governor Rotherham, Doncaster and South Humber Mental Health Trust Director, Charlesworth 24 7 Ltd (from 1st Dec 2010)

Tony Baxter

Executive Director of Public Health

Parent Governor and Vice Chair of Board of Governors at Doncaster School for the Deaf

Julie Bolus

Executive Director of Quality and Clinical Assurance None until 5th April 2010

Debbie Hilditch

Director of Organisational Development and Corporate Affairs â&#x20AC;&#x201C; in attendance at Board meetings Acting Executive Director of Organisational Development and Corporate Affairs

Partner Governor Don Valley High School (from 1st June 2010)

Carole Donaldson

Managing Director, Service Provision – in attendance at Board meetings Managing Director, Service Provision/ Strategic Nurse (to 1st August 2010)

None

Linda Kellett

Managing Director, Service Provision in attendance at Board meetings (from 1st August 2010)

None

Chris Stainforth

Executive Director of Finance and Commissioning

None

Alastair Graves

Medical Director/Clinical Leader Executive Chairman

Partner Saint Vincent Practice Glenthorne Medical Doncaster Commissioning Consortium Director Hallcross Medical Services Ltd

Jon Cooke

Associate Director of Finance – in attendance at Board meetings

Partner Governor of Doncaster and Bassetlaw Hospitals Foundation Trust Director of Doncaster Community Solutions

Jackie Pederson

Associate Director of Commissioning – in attendance at Board meetings

None

Heather Marsh

Associate Director of Primary Care and Quality in attendance at Board meetings (from 5 April 2010) Acting Director of Primary Care and Quality in attendance at Board meetings (from 1st August 2010)

None

Pension Liabilities NHS Doncaster follows the NHS Pension Scheme which is open to all its employees. Details of how pension liabilities are treated within NHS Doncaster can found in note 1 Accounting Policies in the statement of accounts.

Clinical Representatives

Clinical Leadership Executive (CLE) The Clinical Leadership Executive replaced the Professional Executive Committee and comprises health professionals working in the community, with the chair being appointed by the Chairman. Other members include designated directors and a senior officer from Doncaster Council representing social care. Its role includes preparing development and strategy proposals for the NHS Doncaster Trust Board, supervising sub-groups and sub-committees, reflecting views of clinical professionals.

CLE register of interests 2010/11

Name

Appointment

Declaration

Alastair Graves

Clinical Executive Chairman. Medical Director (from June 2010)

Partner Saint Vincent Practice Glenthorne Medical Doncaster Commissioning Consortium Director Hallcross Medical Services Ltd

Eric Kelly

Partner in GP Practice Member of Local Medical Committee DCC Board member

Nick Tupper

Co-owner of Glenthorne via Kingthorne Group Practice Clinical Director for DSSHC Director of Hallcross Medical Services Ltd Part owner of Rutland Educational Centre

Lis Rodgers

GP Principal, Member of the PBC Commissioning Group Husband is a partner in Clayton Rodgers Architect and Design Partnership

Rumit Shah

Member of Local Medical Committee and Doncaster Commissioning Consortium

Andy Oakford

Member of Doncaster Commissioning Consortium

Julie Mouncher

Allied Health Professional Member.

Vice Chair Dial Doncaster

Chris Prewett

Nurse Member

None

Geoff Lord

Ophthalmic Practitioner

Member of Doncaster Local Optical Committee

Richard Allott

Dental Practitioner

Part-ownership of Nostell Place Dental Practice Local Dental Committee member

Julie Hall

Nurse Member

None

Richard Wells

Pharmacy (from 1st June 2010)

None

Greg Connor

GP (from 1st June 2010)

Partner Park View Surgery Shareholder Danum Medical Services Ltd Member of Local Medical Committee Chair Doncaster Commissioning Consortium West Constituency Representative DCC Board

Doncaster Council Representatives CLE register of interests 2010/11

Name

Appointment

Declaration

Joan Beck

Doncaster Council

Director of Adult Services â&#x20AC;&#x201C; Doncaster Council Director of Social Care Association Local Authority Interests

NHS Doncaster Executive Directors and directors are also members of the committee. 15

Highlights of the year Personalised Health Budgets launched in Doncaster

DONCASTER paratrooper Ben Parkinson gave his backing to a ground-breaking NHS scheme that aims to provide individual budgets for people who want to have more choice and control over how money is spent on their health care. Ben, who four years ago lost part of both legs and received serious head and other injuries in a bomb blast whilst on patrol in Afghanistan, was joined by fellow Doncaster residents Ally Vuli and Debbie Lichfield at a launch event in the town, where they related their own stories to a 100-strong audience.

Personal health budgets give people freedom to choose the support services they want and pay for them. The Primary Care Trust is one of only 20 areas across the country chosen to pilot the initiative which runs until the end of March 2012 when it will be evaluated by a team led by the University of Kent ahead of a possible national roll-out. Over the next three years NHS Doncaster plans to recruit people who need on-going mental health and continuing care support and allow them to choose who provides their health care from a range of suppliers. The scheme involves assessing their individual needs and then drawing up a budgeted care plan. Since it started in April 2010, Doncaster’s pilot, which covers Continuing Health Care and Mental Health, has been progressing extremely well and patients’ and carers’ feedback has been very positive. So far 66 patients and service users have signed up to receive a Personal Health Budget. We have worked closely with Doncaster Council social care colleagues to try and integrate as many of our systems and processes with theirs as possible. The voluntary and community sector are also involved in delivering the pilot. We have discussed with our partners within the NHS, local authority and voluntary/community sector about rolling out the personal health budgets to more patients once we have reached the target numbers within mental health and continuing health care.

NHS Doncaster among top UK healthcare employers NHS DONCASTER has been named one of the best healthcare organisations to work for in the United Kingdom, according to the Healthcare 100 poll. We were named the 34th best employer in the prestigious Healthcare 100 Awards, run by the Health Service Journal (HSJ), the Nursing Times and sponsored by NHS Employers. The Trust was third best commissioner only PCT and was ranked 13th out of all the NHS organisations that took part in the survey. The influential list, researched by IPSOS MORI, is based on the results of an exclusive poll of the employees of registering organisations. The awards attracted entries from more than 225 healthcare organisations drawn from across the NHS and charitable and independent sectors. What makes this achievement special is that the results are based on the views of our employees, describing their experience of work. Our ranking reinforces our excellent results in the National Staff Survey.

Doncaster stroke services amongst best in the country FEWER Doncaster people are having a stroke, thanks to improving prevention techniques, and those who do suffer one receive some of the best aftercare in the country. A report published in January 2011 by Government health watchdog the Care Quality Commission rated the NHS Doncaster area equal fifth best in England when it comes to providing services for people who have had a stroke and their carers. The Commission examined 15 different aspects of stroke care, from how NHS staff managed all the elements around transferring a patient from hospital to home, to the quality and range of information provided to help people manage their condition, and the report’s authors also reviewed the services provided for carers. The report’s findings came in the wake of figures showing that Doncaster is turning the tide on the number of people having a stroke each year as local doctors and nurses get 18

better at preventing them happening in the first place. A number of initiatives have helped in the war against stroke, including a new one-stop clinic at Doncaster Royal Infirmary (DRI) for people who have had a TIA (Transient Ischemic Attack), or ‘mini stroke’. Patients attending the clinic are prescribed medication to prevent them having a full blown stroke and also have a scan of their carotid artery to see if there’s a blockage. Narrowing of this artery is a big cause of stroke and anyone with a blockage of more than 50 per cent sees an on-duty vascular surgeon then and there to determine the best treatment. Retired former teacher Chris Bowes, 65, from Thorne, had a stroke in December 2009 but quick action by paramedics and local health care teams have helped him make an almost full recovery, and he’s now busy restoring a vintage van. Chris, who taught design technology and other sciencebased subjects at Finningley’s Hayfield School for 27 years, said: “Fortunately I had seen the TV adverts explaining the symptoms of stroke so knew something was wrong straight away. I rang 999, an ambulance took me to DRI where a scan quickly revealed that I had a massive clot in a main artery. I was given clot busting drugs, which worked like magic and within one and a half hours of the stroke I was feeling much better. “The aftercare I received when I went home was marvellous. I was keen to get back to my hobby of making electrical circuits, which involves using power tools, and so an occupational therapist came and assessed that I was fine to work with them in my workshop.

Local women name Doncaster’s latest two health centres

The Stone Castle Centre, Conisbrough

The Flying Scotsman Centre, Town Centre

TWO Doncaster women with a flair for words have won prizes for naming the Borough’s latest health centres. NHS Doncaster organised two competitions asking people to come up with creative names for the multi-millionpound centres which are currently under construction at Conisbrough and Doncaster town centre. Leanne Thomas, from Mexborough, earned £50 in vouchers after a panel of local judges thought her suggestion, The Stone Castle Centre, was an excellent name for the new centre which is well underway at Gardens Lane, Conisbrough. Leanne, 31, a receptionist with the Conisbrough Group Practice which is currently based in adjacent temporary buildings, will move into the building she has named when it opens in autumn next year. And Pamela Crich, 54, from Balby, drew on Doncaster’s historical links with the railways as her inspiration for The Flying Scotsman Centre, which is being built at St Sepulchre Gate in Doncaster town centre. A panel of judges from the local community liked the idea and awarded her the prize of £50 in vouchers. Pamela, whose husband Robin started out as an apprentice at the former plant railway works at nearby Hexthorpe where the Flying Scotsman bas built, said: “The building is really taking shape and its name will be a great way of reminding people of Doncaster’s fantastic railway heritage.” 19

Veraâ&#x20AC;&#x2122;s new hi-tech housemate is a healthy helping hand VERA Maddisonâ&#x20AC;&#x2122;s hi-tech housemate has been keeping the Doncaster gran in daily contact with local nursing staff and helping her stay out of hospital. She is one of 110 people with long-term conditions across Doncaster who has benefited from a Telehealth service launched in March 2010. The compact little computer, which is about the same size as a small paperback book, lets Vera, 82, monitor her vital signs at home rather than having to go to her family doctor practice or needing a nurse to visit.

Vera, who has serious chest problems and needs a round-the-clock supply of oxygen supplied from portable cylinders, is one of the first to benefit from a new £400,000 telehealth programme being rolled out by NHS Doncaster. The scheme uses state-of-the art technology to keep a closer check on patients whose on-going conditions can be controlled by medication and other therapies. Every weekday she listens to a pre-recorded voice on the computer, which is activated at a time pre-set to suit her. The voice prompts Cantley-based Vera to carry out a series of self checks of her blood pressure, temperature and oxygen saturation level. She said: “It’s so easy and a man with a lovely sounding voice talks me through the whole process and tells me exactly what to do. He asks me questions like ‘Is my breathing any worse today than normal?’ and I then press the yes or no button depending on my answer. It’s reassuring to know that the NHS is keeping an eye on me to prevent anything going wrong.” After carrying out the checks she simply touches a button and the results are wirelessly sent to NHS premises in Doncaster. The daily ‘MOTs’ of Vera and patients with a variety of incurable conditions are then checked by health workers using a secure web link and password. The system provides an early warning of potential changes in a patient’s condition so action can be taken to avoid an emergency hospital admission. Over the next three years, around 180 of the £1,500 apiece units will be installed in the homes of some the borough’s most vulnerable patients.

Long term conditions like COPD, epilepsy, diabetes and stroke account for most of the emergency hospital admissions in Doncaster. Improving the management of these illnesses in the community is helping to avoid this happening. Telehealth has received positive staff and patient feedback, with patients saying they felt more confident in managing their condition. The evaluation also showed a reduction in emergency hospital admissions for patients using the service.

Minor Ailments Clinics for Doncaster residents A NETWORK of high street clinics for minor health problems have been just the tonic for Doncaster patients who need expert advice at short notice. In 2010, NHS Doncaster joined forces with local

pharmacies to launch whatâ&#x20AC;&#x2122;s thought to be a first of their kind range of Minor Ailments Clinics (MACs) at over 30 pharmacies across the borough. Patients using the participating pharmacies have been able to request a confidential consultation in a private room where they can discuss the treatment and management of 22 common ailments, including acne, mouth ulcers and cold sores. Anyone who is registered with a family doctor practice in the Doncaster borough area, plus homeless people and travellers, can access the service on either a walk-in or prebooked appointment basis. The MAC service was designed to offer patient choice, support the work of local doctor surgeries, allowing family doctors more time to deal with complex health problems. Patients receive the same medication and advice for their condition from the pharmacist as they would if they saw their doctor.

Patients experience high quality services at Doncaster pharmacies PATIENTS in Doncaster received high quality, satisfactory services from community pharmacies during the year thanks to a local award winning scheme. NHS Doncaster and the Local Pharmaceutical Committee (LPC) worked closely to improve the quality of pharmacy services through a locally developed Quality and Outcome Framework (QOF), increasing patient satisfaction and loyalty.

The scheme was awarded Pharmacy Innovation of the year in the 2010 awards run by leading weekly magazine for retail pharmacists Chemist + Druggist (C+D), for its original and innovative way of producing real benefits to both patients and the businesses. Doncaster is the only area in the country currently improving the quality of community pharmacy services through the framework with the LPC. Judges said of the entry â&#x20AC;&#x153;shows how careful planning and excellent partnership working can transform a potentially bureaucratic national standard setting and monitoring tool into a real driver for improving practice and the quality of services.â&#x20AC;? We were the first Primary Care Trust to develop a QOF for both dentistry and pharmacy, aimed at supporting our independent contractors to improve the quality of services they provide and improve patient experience.

Forum gives voice to people with dementia THE Doncaster Dementia Forum was launched ahead of Dementia Awareness Week in July 2010. The forum, was launched by Councillor Patricia Schofield backed by excarer Eileen Harrington and Scawthorpe resident Dennis Jubb, who received an MBE for services to people with dementia in this year’s Queen’s birthday honours. Dennis, aged 68, was diagnosed with dementia in 2000 and has campaigned relentlessly for other people with young onset dementia in Doncaster ever since. He sees the creation of the Doncaster Dementia Forum as an important step towards influencing the future of dementia care for people in Doncaster. It is been estimated that there are around 3,300 people with dementia in Doncaster, with this figure predicted to increase in line with the borough’s ageing population. NHS Doncaster continue to deliver on its Dementia action plan and there will be an increased focus on four key areas within 11/12; Early Diagnosis, Better Care at Home, Better Care in Acute hospitals, and Better Care in Care Homes. NHS Doncaster is also signed up to the National Dementia Declaration involving local partnerships to be involved with the implementation of the National Dementia Strategy – living well with dementia. The Doncaster Dementia Forum ensures that service users and carers are given a strong and influential voice and their views are listened to, guaranteeing that services are centred around their needs. This meets objectives of both the Doncaster Carers’ Strategy, which is currently under development by DMBC, and the objectives within the Doncaster Dementia Action Plan. 24

Transfer of front-line services to new providers NHS DONCASTER’s Trust Board announced in October 2010 the local organisations that were to take over management of the community services from Doncaster Community Healthcare from 1st April 2011 following Government direction to transfer all front-line services to a new provider. NHS Doncaster placed the services provided by Doncaster Community Healthcare into five themed groups – called pathways - and invited local public sector organisations to register their interest in managing them or where it is sensible to do so transfer these services to local NHS organisations. The five pathways are: Long term conditions – including district nursing, stroke outreach team and St John’s Hospice Children and families – including contraception and sexual health services, children’s centres, safeguarding nurses and health visitors Health and well-being – including New Beginnings, Drug Intervention Programme and psychological therapies Planned health – podiatric surgery Primary care – including dental access centre and dental out of hours The contract value of the five pathways is £46 million where Doncaster Community Healthcare staff will be transferred.

Following an evaluation process the following organisations were the preferred providers for the five pathways: Pathway

Preferred Provider

Long term conditions

Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) in partnership with Doncaster Council

Children and families

Rotherham Doncaster and South Humber NHS Foundation Trust in partnership with Doncaster Council

Health and well-being

Rotherham Doncaster and South Humber NHS Foundation Trust

Planned care Podiatric surgery

Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBH)

Primary care:

The Dental Access Centre, dental out of hours service will transfer to Rotherham NHS Foundation Trust

Dental Access Centre and Dental out of hours service Integrated Call Handling and Triage (ICHAT) service

Those employed with the ICHAT service will be employed by DBH as part of the newly redesigned unplanned care centre at Doncaster Royal Infirmary.

Pharmaceutical services reviewed A PHARMACEUTICAL Needs Assessment (PNA) for Doncaster was published in February 2011, reviewing the services provided by 72 local community pharmacies. The Health Act, 2009 placed a duty on all Primary Care Trusts to develop and publish a Pharmaceutical Needs Assessment (PNA) that identifies current service provision and reflects the local health needs of the Doncaster population. Following extensive work and consultation with patients, the public and the Local Pharmaceutical Committee (LPC) - to help us understand how people use pharmacies and what they’d like in the future – the needs assessment concluded that: – Doncaster has adequate provision of essential pharmaceutical services for the current population and future planned developments – Doncaster is reliant on the current 100 hour pharmacies to provide a network of pharmacy services available outside of normal hours. However, there were potential gaps in the provision of some enhanced services indentified, which will be taken into consideration when commissioning services in the future.

Businesses sign up for ‘Breastfeeding Welcome’ programme A WELL-KNOWN high street store became the first business to sign up to an NHS scheme that supports breastfeeding mothers in Doncaster. Debenhams was recruited to the Breastfeeding Welcome programme, launched by NHS Doncaster to help mothers identify breastfeeding friendly premises in the borough. The free-to-join scheme ensures that every member of staff working for an organisation that has signed up to the programme is trained to welcome breastfeeding mothers and their families. Breastfeeding is acceptable in all areas of the premises that are open to the general public and mothers will not be asked to stop feeding their child or move on. Those businesses that are part of the scheme clearly display the programme’s window sticker and certificate to show that breastfeeding is supported on the premises. The name of each business also appear in Doncaster’s Breastfeeding Directory, which is available to all new mothers and their families. Lizzie Ette, Breastfeeding Coordinator for NHS Doncaster, said: “Breastfeeding is good for both mums and babies alike. Breastfed babies are less likely to be obese, which means they are less likely to develop type two diabetes and other illnesses in later life. For mums it lowers the risk of getting breast and ovarian cancer. “In Doncaster nearly seven out of 10 women begin breastfeeding their babies but quickly stop because they

feel there is a lack of support, particularly when they want to feed their baby away from home.” This year we also received a UNICEF Baby Friendly award for our commitment to improving breastfeeding rates in the borough. During the year we were awarded a Certificate of Commitment in our first step towards gaining international recognition from the UNICEF Baby Friendly Initiative. Just 69 per cent of Doncaster mums breastfeed their babies at birth and many stop soon after. NHS Doncaster has been at the forefront of a number of initiatives throughout the borough aimed at increasing rates, growing a healthier community and helping mums to have a positive breastfeeding experience.

Askern, in the grounds of the construction site. Artwork by local schools was put on permanent display in the reception area and consultations were held to reduce vandalism. There was also input from Askern Historical Society regarding artefacts found during construction. The items found, which include a deer antler from the Bronze Age, are now displayed in a special cabinet in the centre.

More people visiting NHS dentists White Wings Centre triumphs at LIFT awards ONE of NHS Doncasterâ&#x20AC;&#x2122;s multimillion-pound super surgeries was recognised at a national awards ceremony celebrating the cream of local healthcare services across the country. NHS Doncaster, alongside public-private partnership Doncaster Community Solutions (DCS), scooped first prize in the Community Engagement and User Experience category of the Local Improvement Finance Trust (LIFT) Awards for its work on the White Wings Centre in Askern. The award focused on the links made with the wider community in the planning and design of the building and the impact it had on user experience after the centre opened. The local community was regularly consulted and updated on the development of the health centre, which was commissioned by NHS Doncaster. Engagement of young people included the planting of a time capsule by pupils from Moss Road Infants School, in

THE percentage of people in Doncaster who have seen an NHS dentist is the highest in Yorkshire and the Humber. A report, from The NHS Information Centre, showed that 73.2 per cent of people in the NHS Doncaster area had seen an NHS dentist in a two year period ending in June 2010. This is the second highest of all Primary Care Trusts in the country. NHS dentists saw a total of 213,547 people in the borough during this period â&#x20AC;&#x201C; an 11.1 per cent increase on figures previously recorded for a two year period ending in March 2006. Some 162,149 adult patients visited an NHS dentist throughout this period (a 12.9 per cent increase) and 51,398 children (a 5.7 per cent increase) were seen during this time. The statistics also showed that people in Doncaster are three times as likely to see an NHS dentist as their counterparts in Kensington and Chelsea. NHS Doncaster has worked closely with local dentists over the last three years and has funded additional dentists in eight established practices in the borough.

24-hour cyclathon boosts funds for charity WORKERS and clients from a Doncaster drugs treatment centre saddled up for a 24-hour cyclathon to raise money for charity. The cyclists from New Beginnings, a project run by NHS Doncaster’s front-line services organisation, raised several hundred pounds for local breast cancer charity the Aurora Centre after riding 750 miles around Manvers Lake, Wath-on-Dearne. Teams of three took it in turns to see how many times they could cycle the 3.5 kilometres around the lake in two hour sessions. Some 16 cyclists took part in the event including clients who have received help from the Balby-based drug treatment and rehabilitation centre and members of Dream, a peer support group for ex-drug users.

Healthy school meals prove recipe for success THE proportion of children enjoying healthy school dinners in Doncaster has been rated among the highest in the country, latest figures have shown. Data from the School Food Trust shows that 60.8 per cent of primary school pupils in the borough ate school meals between April 2009 and March 2010. This is well above the national average of 41.4 per cent. NHS Doncaster works closely with Doncaster Council’s School Catering Service, which produces meals that

meet strict nutritional standards but remain affordable for thousands of local families. The organisation provides meals to 102 primary, infant and junior schools and 50 per cent of the secondary schools in the Borough. It uses fresh, high quality produce from, whenever possible, local suppliers to support the regional economy and reduce the number of “food miles” run up in deliveries. Menus are drawn up with the help of expert dieticians to make sure they meet the Government’s stringent diet and nutritional standards as well as appeal to hungry youngsters. Copies of the healthy menus are available at schools for parents, guardians and pupils to inspect. While primary schools in some areas of the country saw the number of pupils eating school meals drop, Doncaster’s take-up rose by 2.6 per cent. In secondary schools Doncaster’s take up was 46.6 per cent compared to the national average of 35.8 per cent.

New look website PEOPLE in Doncaster have been given a simple way to find information on local health services and get advice on healthy living thanks to NHS Doncaster’s easy-touse new look website – www.doncaster.nhs.uk. Users can search for local healthcare services, pick up medical advice delivered directly from the national NHS Choices website, watch latest health videos and find out how to see a dentist. The site is focussed on being interactive with residents having the opportunity to have their say on local health issues by voting in surveys and commenting on regularly updated blogs. Web users with accessibility issues have a number of options available to them so that they can pick up the information they need. The options include a Browsealoud reader that reads out text and the ability to change text size and colour schemes.

Three- year plan for Doncaster’s Alcohol Strategy DONCASTER’S new alcohol strategy set out how NHS, local authority and police organisations will work together under the ‘umbrella’ of the Safer Doncaster Partnership initiative to focus on three key theme areas – treatment and care services, children and young people; and crime and disorder. Dr Tony Baxter, Doncaster’s Director of Public Health, said: “The aim of the three year strategy is to minimise the health harm, violence and anti-social behaviour associated with alcohol abuse, whilst letting people enjoy responsible drinking.” The town’s public sector partners are determined to take forward the ‘drink safely’ message to bring about local improvements in a number of areas, including health, child protection, personal safety and crime reduction. The alcohol related statistics for Doncaster are stark, with researchers believing that drinking is adversely affecting the lives of more than 63,000 residents. They estimate that around 43,000 of the problem drinkers have a habit that is hazardous to their health; a further 13,000 are consuming booze to a level that is causing harm to them; and an additional 7,000 are alcohol dependent. 29

A year of success for the Emergency Care Practitioners DONCASTER’s Emergency Care Practitioners (ECPs), highly skilled health workers responding to urgent calls, experienced a month on month increase in the patient referrals in their first year of operation in the Borough. One of their key roles is to make sure patients don’t have unnecessary journeys to hospital for treatment they can receive on the spot. They are qualified to carry out assessing, diagnosing, treating and discharging patients in local community settings, contributing to a reduction in avoidable 999 ambulance trips. Since the start of the project, they have received 2,963 referrals mainly from nursing and residential homes. Eighty per cent of the patients treated were seen face-toface with the remaining helped over the telephone. 54 per cent of patients have been treated without requiring further treatment, 25 per cent of patients were referred to another community service, 13 per cent were referred to secondary care and a small number required a 999 ambulance. Following a patient survey, 78 per cent were happy to

receive treatment in their own home, the same number were happy with the quality of care received and 89 per cent would be happy to be seen by an ECP again. All carers who were contacted in a similar survey had no problems contacting the team and were happy with the quality of care and the outcome for the patient. A Doncaster carer from a local care home commented: “I think this is a brilliant service which has benefited our residents immensely thank you for your help”

New intermediate care services model A NEW model for intermediate care services – providing care at the right time, in the right place by the right people - in Doncaster was agreed by commissioners from NHS Doncaster, Doncaster Council and DCCG in summer 2010. Patients are being kept independent and in their homes or close to home for as long as possible through a comprehensive health and social assessment and rehabilitation service. The Community Intermediate Care Team (CICT) provides a 24/7care service so patients are able to remain at home or return home earlier from hospital and be cared for. The service is accessed through a single point of telephone contact. We have designated services with places available for people who need short term care but do not need to be in hospital. These services are available not only to prevent hospital admissions but to enable a speedy discharge from hospital also.

How we performed During the year we have worked towards achieving the national targets set by Government, working closely with our partners. Some examples of the targets we have worked towards and how we performed during the year are highlighted below. Improving access to health services in Doncaster is key to improving the health of the population NHS Doncaster exceeded the national target for the number of patients who were admitted to hospital being seen within 18 weeks from referral from their GP, up to the end of December 2010. Also during the same period, plastic surgery was the only specialty that fell below the 90 per cent target. 102.00% 100.00%

As at March 2011 we had exceeded the national target for the number of patients who were not admitted but seen at a hospital within 18 weeks of the GP referral but not admitted into hospital. Discussions are progressing with the hospitals to further improve the delivery of satellite clinics which will improve performance in all areas, including plastic surgery. Over 205,000 patients have been seen in A&E since 1st April 2010. The percentage seen within four hours in A&E from arrival to admission, transfer or discharge fell during December and January. At the end of March 2011 97.16 per cent of patients had a maximum wait of four hours. During December and January there was an increase in the numbers of patients due to the adverse weather conditions resulted in more attendances and affects on staff from illnesses such as flu, adding to the pressures felt in the A&E departments during the winter period.

98.00%

100.00%

96.00%

99.00%

94.00%

98.00%

92.00%

97.00%

90.00%

96.00%

88.00%

95.00%

86.00%

94.00%

84.00%

93.00%

82.00% 80.00%

92.00% Qtr 1

Qtr 2

Qtr 3

Qtr 4

All Specialities – Admitted

All Specialities – Non-Admitted

Trajectory – Admitted

Trajectory Non – Admitted

Percentage of patients seen within 18 Weeks for Admitted and Non Admitted Pathways 2010/2011

91.00%

Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

4 hour maximum wait in A&E from arrival to admission, transfer or discharge Traj 4 hour maximum wait in A&E from arrival to admission, transfer or discharge Act Mth 4 hour maximum wait in A&E from arrival to admission, transfer or discharge Cum Mth 4 Hour maximum wait in A&E from arrival to admission, transfer or discharge 2010/11

This resulted in our main provider Doncaster and Bassetlaw Hospitals NHS Foundation Trust falling short of the 95 per cent target in January 2011. PCTs in other areas of the Yorkshire and the Humber region also experienced the same problems. However, overall the 95 per cent four hour waiting target has been exceeded for 2010/11. The Doncaster health community has worked hard to increase the opportunity for patients to choose which hospital they are referred to through Choose and Book. GPs are able to book an appointment directly into a clinic of your choice. In January 2011 we saw an improvement for all referrals to all services and NHS Doncaster was the fourth best performer in Yorkshire and the Humber. Work is progressing to utilise additional functions of the Choose and Book system which will for instance enable GPs to book their patients to see a named consultant.

This is another area that we are providing a high quality service to our patients in an intermediate care setting.

Patient Environment Action Team assessment

120.00%

All hospitals throughout the country are assessed every year and a score given â&#x20AC;&#x201C; ranging from excellent to poor for environment, food and privacy and dignity. The table below shows that in 2010/11 services provided by Doncaster Community Healthcare at our Tickhill Road site scored highly in each of the categories. Site Name

Environment Food Score Score

Privacy and Dignity Score

Tickhill Road Hospital

Good

Excellent

Improving access to screening helps reduce cancer mortality Our main targets for cancer screening are for bowel, breast and cervical cancers. We carry out extensive work with our partners to increase the amount of people screened for these types of cancer with the aim of reducing cancer mortality in Doncaster. Over the year the number of women receiving their cervical screening results within two weeks steadily increased to a level of 93.90 per cent in March 2011. Doncaster is an early implementer for offering HPV testing at the same time as cervical screens. This does increase the length of reporting results, however by only two days over the period. 100.00% 80.00% 60.00% 40.00% 20.00% 0.00%

Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

Proportion of women receiving cervical cancer screening test results within two weeks Act Mth Proportion of women receiving cervical cancer screening test results within two weeks Traj Proportion of women receiving cervical cancer screening test results within 2 weeks 2010/11

Our bowel cancer screening programme measures the percentage of people who have been invited for a bowel screening from those who are eligible. At the end of March 2011 70.99 per cent of the eligable population had been invited for screening. Evidence suggests that bowel cancer mortality should reduce by around 16 per cent in those people screened. It has been agreed at the North Trent Cancer Network that this screening programme will be extended helping to improve the performance further in the future. 80.00% 70.00%

The national cancer reform strategy highlights breast cancer screening as a key area and we have worked hard in Doncaster to raise breast screening rate for women aged 53 to 70 to over 79 per cent.

50.00% 40.00% 30.00% 20.00%

81.00%

10.00%

80.00%

0.00%

79.00% 78.00%

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Bowel Cancer Screening Programme to men and women aged 70 up to 75th birthday (Invited) Act

77.00%

Bowel Cancer Screening Programme to men and women aged 70 up to 75th birthday (Invited) Traj

76.00% 75.00%

Bowel Cancer Screening Programme to men and woman Aged 70 up to 75th Birthday 2010/11

74.00% 73.00% 72.00%

60.00%

Qtr 1

Qtr 2

Qtr 3

Breast Cancer Screening for women 53 to 70 Qtr Breast Cancer Screening for women 53 to 70 Mth Breast Cancer Screening for women 53 to 70 Traj Breast Cancer Screening for 53 to 70 2010/11

Qtr 4

Between February and April 2011 we worked with the NHS Centre of Information to develop a campaign focusing on earlier presentation/diagnosis in bowel, breast and lung cancers. It is hoped that this will be reflected in our performance early in the 2011/12. 33

160 140 120 100 80 60 40 20 Mar-11

Jan-11

Feb-11

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10

Feb-10

Dec-09

Oct-09

Nov-09

Sept-09

Jul-09

Aug-09

MRSA number of infections

Jun-09

0 Apr-09

Infection control has been a high priority for the Trust and we have worked hard to ensure that at March 2011 there were only five MRSA cases attributed to NHS Doncaster compared to the 12 cases at the same point in 2009/10. The following graphs demonstrate the year on year reduction in infection cases.

180

May-09

Improving infection control in acute care and the community

Clostridium Difficile Cum All PCT Patients

Clostridium Difficile Traj

Continued delivery of robust education plans and the early detection of infections brought into hospitals via the community have helped in the reduction of the infections.

14 12 10 8

Reducing the number of over 16s who quit smoking

6 4 2 Mar-11

Jan-11

Feb-11

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10

Feb-10

Dec-09

Oct-09

Nov-09

Sept-09

Jul-09

Aug-09

Jun-09

Apr-09

May-09

MRSA numbers of infections Cum Mth MRSA numbers of infections Traj (Donc/PCO) Clostridium Difficile

Also at March there were 80 cases of Clostridium Difficile infections compared to over 106 infections at the same point in 2009/10.

NHS Doncaster has undertaken significant work to increase the number people in Doncaster who quit smoking. We had managed to help 2,451 people to stop smoking by the end of March. If you would like to stop smoking you can contact the stop smoking service on 01302 640064 or the national helpline on 0800 0169 169.

Listening, Responding, Improving Complaints 1 April 2010 - 31 March 2011 The complaints received by NHS Doncaster, as the lead commissioner for Doncaster healthcare services, including those related to primary care services (doctors, dentists, pharmacists, optometrists) and our actions and processes as a commissioner of healthcare services across Doncaster. The figures below reflect the written complaints we received from 1 April 2010 to 31 March 2011. The arrangements for improving the handling of complaints created a single complaints process across health and adult social care. Through the complaints process NHS Doncaster aims to improve the quality of peoplesâ&#x20AC;&#x2122; experience of services through a more flexible approach based upon dialogue with the complainant to agree the type of investigation and the outcome required. If local resolution fails, there is a one-stage review process by the Parliamentary and Health Service Ombudsman for the NHS.

Services complained about:

Service

2010-11

General Practice Health Services

NHS Doncaster actions

Prison Healthcare

Doncaster Community Healthcare

Total

188

Complaints regarding prison healthcare have been captured better following the introduction within the Prisons and Immigration Removal Centre of the NHS complaints procedure. The main issues are predominantly related to pharmacy and dentistry services. Nottingham Healthcare NHS Trust commenced their provision of health services in August 2010. The management of prison complaints transferred over to Nottingham Healthcare NHS Trust in October 2010. Analysis of general practice health services complaints

Category GP Health Services

2010-11

Clinical

Practice Administration

*Practice Management

Communication/Attitude

**Total

* Note: Relates to decisions made by the practice about the operation of services, such as access to individual practitioners, appointment systems, triage systems. ** Note: The totals for categories do not match total complaints received as a complaint may contain more than one category. 35

The most common themes in the past year for general practice health services complaints were related to clinical care and the attitude of staff.

Requests to the Health Service Ombudsman (HSO) for an independent review

Analysis of complaints about NHS Doncaster

Thirteen (five for Doncaster Community Healthcare) requests for a review were made to the Health Service Ombudsman during the year. One of these was withdrawn and the HSO concluded that eight of these would not be investigated. Two complainants opted to go for conciliation after speaking to the HSO and these were then resolved. Two are still under consideration.

Category

Nature of incident

Total

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

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

III

Insecure disposal of inadequately protected electronic equipment, devices or paper documents

Unauthorised disclosure

177*

Other

* We process a significantly large amount of patient and personal data. However, we make sure we fully investigate and record all potential incidents relating to this type of data. Throughout the year we have worked to make sure lessons are learnt from all incidents involving personal data. As a result we had a 50 per cent reduction from the first to the second six months of the year in the number of incidents of potential unauthorised disclosure.

NHS Doncaster has complied with Treasury Guidance on setting charges for processing of information.

onitoring compliance with Standing Orders and M Standing Financial Instructions

Being prepared for an emergency

ndertakes self-assessment to demonstrate that U is meets all the requirements set out in the Audit Committee Handbook 2005.

We have a Major Incident Plan that is fully compliant with the requirements of the NHS Emergency Planning Guidance 2005 and all associated guidance. During the year, our emergency planning staff attended major incident training exercises.

Audit Committee

The committee is chaired by Albert Schofield OBE and includes fellow non-executive directors Ann Gilbert, Jill Morris and Dr Les Ranson. The directors of Commissioning and Finance and Organisational Development and Corporate Affairs also attend, together with representatives from internal and external audit.

As a committee of the Trust Board, the Audit Committee is responsible for: Reviewing the establishment and maintenance of an effective system of governance, risk management and internal control, across the whole of the organisationâ&#x20AC;&#x2122;s activities â&#x20AC;&#x201C; both clinical and non-clinical - that supports the achievement of the organisationâ&#x20AC;&#x2122;s objectives. Monitoring the implementation of agreed control improvements, largely through the work of external and internal audit, both of which are represented at committee meetings. Ensuring there is an effective internal and external audit function. Reviewing the accounting policies of NHS Doncaster and the draft annual financial statements prior to submission to the Board.

Integrated Governance Committee (IGC) As a committee of the Trust Board, IGC is responsible for ensuring that appropriate systems and processes are in place to achieve and maintain the highest standards of governance and public accountability across the whole spectrum of NHS Doncaster’s work. One of the prime governance tasks of NHS Doncaster is ensuring effective management of risk. This covers key areas such as clinical, litigation, financial, information, research, Care Quality Commission standard, the risk register and assurance framework. Non-executive director Dr Les Ranson sits on the committee.

Remuneration report Remuneration and Terms of Service Committee

As a committee of the Trust Board the committee is responsible for advising the NHS Doncaster Board about the appropriate remuneration and terms of service for the Chief Executive, executive directors and other senior managers, as well as monitoring and evaluating their performance. The committee consists of Chairman Roger Greenwood and non-executive directors, Tony Humphries and Pam Horner. For the purpose of this report senior managers are defined as: ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the Trust. This means those who influence the decisions of the organisation as a whole rather than the decisions of individual directorates or departments.’ 44

The salaries and relevant pension details of the most senior managers, and the Non-Executive members of the Board, who had control over the major activities of the Primary Care Trust in 20010/11 can be found in the Summary Financial Statement. There were no early termination issues for senior officers to report in the year. Statement of Internal Control

The Board is accountable for internal control. As Accountable Officer, and 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. The context for risk management surrounding my role include establishing processes to ensure effective partnership working across a network of key stakeholders including the local community of public and patients, elected representatives, the Local Authority, other NHS Trusts, the Strategic Health Authority, local Independent Contractors and Voluntary Sector organisations. I believe that NHS Doncaster has a generally sound system of internal control that supports the achievement of its policies, aims and objectives. Annette Laban on behalf of Andy Buck, Chief Executive, South Yorkshire and Bassetlaw Cluster

The partnership arrangements include the following: SHA

We have formal performance targets reviews and annual reviews with the Strategic Health Authority (SHA) and Chief Executive meetings hosted by the SHA. We have positive liaison with the Department of Health through the SHA.

Providers

We hold annual Board to Board meetings with our main local Providers and have regular Doncaster Chief Officers Meetings. We schedule regular Commissioning Forums and additional Performance Meetings with our Providers with whom we have legally binding contracts or Service Level Agreements to ensure delivery of both activity and quality targets.

Local health and social care economy

We have a prominent role within the Doncaster Together Local Strategic Partnership and the Chair of the Healthier Doncaster Partnership Board where partnership risks are identified, addressed and monitored. We have membership of the Doncaster Safeguarding Children Board and Doncaster Safeguarding Adults Board. We also regularly seek feedback on service developments and risks through the Healthier Communities and Vulnerable People Overview and Scrutiny Committee. Our Joint Strategic Needs Assessment is developed jointly with the Local Authority and includes the patient â&#x20AC;&#x153;voiceâ&#x20AC;?. We have a risk on our Assurance Framework which specifically relates to the impact of partner decisions on NHS Doncaster.

Patients and the public

We have a positive and close working relationship with the Doncaster Local Involvement Network (LINk). We lead the Doncaster Equalities and Human Rights Network and have a robust and internally audited system of Equality Impact Assessment alongside an Equality Strategy and Single Equality Scheme. We strive for public and patient engagement in service redesigns and service changes such as our current Clinical Services Review and this serves to highlight risks.

Internal mechanisms

Our Trust Board endorses our Risk Management Strategy, Policy and Procedure to ensure that NHS Doncaster critically examines and effectively manages risks arising from all types of activity, thereby safeguarding the interests of all stakeholders. Internal Audits and clinical audits inform the risk management context. Our Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions sit alongside our Code of Conduct and Accountability for NHS Boards.

External mechanisms

We receive reviews and reports from external assurance sources including the Audit Commission, the Care Quality Commission, the Health and Safety Executive and the Environment Agency.

Financial Review The accounts and summary financial statements included within this annual report reflect the financial performance of NHS Doncaster for the 12 month period ending 31 March 2011. These summary financial statements show an overview of this performance. A full copy of the annual accounts and the full Statement on Internal Control can be obtained from the PCT offices or via the NHS Doncaster website (www.doncasterpct.nhs.uk). The PCT has again delivered against its financial duties. Performance against financial duties Delivered a revenue surplus of £2,691,000 against a total resource limit £575 million in line with the PCT control total; aintained capital expenditure with the PCT M capital resource limit of £978,000 anagement of cash within the limit set ending M the financial year with a bank balance of £1,150

2010/11 has however been a challenging financial year for the PCT. Lower levels of growth coupled with increasing demands on healthcare services resulted in pressures against many PCT budgets including secondary care contracts and continuing health care packages. The PCT has worked hard to manage expenditure and deliver efficiencies to secure performance within the agreed control total. Overall the PCT spent £572,843,000 in 2010/11 which equates to an average of £1,860 per person for the residents of Doncaster. The chart below provides an analysis of where these resources have been spent. 6.5% 4.7%

6.5% 11.8%

7.4%

3.7% 0.5%

3.6%

4.4%

95.0 per cent of invoices (96.70 per cent of the value of invoices) paid within 30 days in line with the Better Payment Code

In previous financial years NHS Doncaster has lodged resources within a Strategic Investment Fund within NHS Yorkshire and the Humber. In delivering the financial duties above the PCT has utilised additional non recurrent resources of £7.1 million. NHS Doncaster targeted these resources at non recurrent expenditure programmes ensuring that recurrent financial balance was maintained.

11.8%

36.7%

GP Services Prescribing and Pharmacy Services Dental Services Ophthalmic Services Learning Difficulties

2.3%

Mental Illness Maternity General and Acute Services Accident and Emergency

Community Health Services Other Health Care Other Costs including Administration

Looking Forward Although the NHS is not facing real term cuts in resources, rising costs and demand for healthcare will result in a financially challenging period over the next few years. Nationally, the NHS needs to deliver efficiencies totalling £20 billion by 2014/15 during a period of significant organisational change. NHS Doncaster is committed to delivering its own share of these efficiencies whilst securing a robust financial position to hand over to future healthcare commissioners. The PCT has developed a medium term financial strategy that delivers 18 per cent savings over four years through a combination of management savings, provider contracts and transformational commissioning efficiency. Recognising the need to secure a robust financial position these efficiencies will be delivered whilst maintaining some key underlying financial principles. Financial Principles Achievement of all statutory and administrative financial duties; o year in recurrent deficit assured through N the on recurrent commitment of 2 per cent of recurrent allocations; elivery of at least 0.5 per cent surplus in each D financial year; ngagement of budget holders and GP E Commissioners in delivery of the financial plan.

Chris Stainforth on behalf of Steve Hackett Director of Finance, South Yorkshire and Bassetlaw Cluster

Independent Auditor’s report to the Directors of Doncaster PCT I have examined the summary financial statement for the year ended 31 March 2011 set out on pages 49 to 59. This report is made solely to the Board of Directors of Doncaster PCT 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 “The auditor’s statement on the summary financial statement in the United Kingdom” 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 the Doncaster PCT 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. John Prentice Officer of the Audit Commission 3 City Leeds Office Park Holbeck Leeds LS11 5BD July 2011

Summary Financial Statement Statement of comprehensive net expenditure

Net operating costs:

Commissioning

2010/11 £000 526,782

2009/10 £000 495,068

Provider

44,476

48,099

Net operating costs before finance costs

571,258

543,167

Finance costs

1,585

1,548

Net operating costs for the year

572,843

544,715

Other comprehensive net expenditure

(2,071)

2,704

Total comprehensive net expenditure for the year

570,772

547,419

2010/11 £000

2009/10 £000

Total Net Operating Cost

572,843

544,715

Non-Discretionary Expenditure

2,923

Operating Costs less Non-Discretionary Expenditure

572,843

541,792

Revenue Resource Limit

575,534

545,969

Under/(over) Spend against Resource Limit

2,691

4,177

Unplanned Resource Brokerage Received

Operational Financial Balance

2,691

4,177

Financial performance targets The PCT’s performance for 2010/2011 is as follows:

Statement of financial position

Non Current Assets

As at 31 March 2011 £000 £000 33,801

As at 31 March 2010 £000 £000 32,466

Current Assets

5,606

8,143

Current Liabilities

(40,834)

(40,023)

Net Current Assets/(Liabilities)

(35,228)

(31,880)

Non Current Assets Plus /Less net Current Assets/ Liabilities

(1.427)

586

Non Current Liabilities: Amounts falling due after more than 1 year

(18,321)

(18,972)

Total Assets Employed

(19,748)

(18,386)

General Fund

(24,979)

(21,069)

Revaluation Reserve

2,974

685

Donated Asset Reserve

Government Grant Reserve

2,253

1,993

Total Taxpayers' Equity

(19,748)

(18,386)

Financed by:

Statement of changes in taxpayers’ equity Changes in taxpayers’ equity for 2010-11

Govt. Grant Reserve £000

Balance at 1 April 2010

For the year end March 2011 General Revaluation Donated Fund Reserve Asset Reserve £000 £000 £000 (21,069) 685 5

1,993

£000 (18,386)

Net operating cost for the year

(572,843)

Net gain on revaluation of property, plant, equipment

2,000

150

2,150

Receipt of donated or government granted assets

Release of reserves to SoCNE

(1)

(86)

(87)

Transfers between reserves

(477)

289

188

Total recognised income and expense for 2010-11

(573,320)

2,289

(1)

260

(570,772)

Total Reserves

260

Net Parliamentary funding

569,410

Balance at 31 March 2011

(24,979)

2,974

2,253

(19,748)

Provider full cost recovery duty

Provider Gross Operating Cost

2010/11 £000 52,704

2009/10 £000 56,884

Less: Miscellaneous income relating to provider functions

(8,228)

(8,785)

Net Operating Costs

44,476

48,099

Costs met from PCT's own allocation

44,662

48,646

Under/(over) Recovery of Costs

(186)

(547)

2010/11 £000

2009/10 £000

(568,155)

(541,033)

(607)

(859)

Net Cash inflow/(outflow) from financing

568,754

541,863

Net increase (decrease) in Cash and cash equivalents

(8)

(29)

Cash and cash equivalents at the beginning of the financial year

Cash and cash equivalents at the end of the financial year

The PCT is required to recover full costs in relation to its provider functions. The performance for 2010/2011 is as follows:

Statement of cash flows Operating Activities Net Cash Outflow from operating activities Investing Activities Net Cash inflow/(outflow) from investing activities Financing Activities

Capital resource limit The PCT is required to keep within its Capital Resource Limit

2010/11 £000 1,273

2009/10 £000 1,130

(356)

(275)

Charge against the Capital Resource Limit

917

855

Capital Resource Limit

978

(Over)/Underspend against Capital Resource Limit

123

Gross Capital Expenditure Add : Loss in respect of disposals of donated assets Less: Net Book Value of non current assets disposed of Less: Capital Grant Less: Donations

The audit commission has provided external audit services to the pct as follows: Financing Activities For the statutory audit

£231,349

Further assistance services

£0

Other services

£0

Better Payment Practice Code The Better Payment Practice Code requires the PCT to ensure that creditors are paid within 30 days of the receipt of goods or a valid invoice whichever is the later. The target is 95% compliance and the PCT achieved 95.00% for non-NHS and 90.90% for NHS based on the number and 96.70% for non-NHS and 98.70% for NHS based on the value of invoices paid. There was no interest payable arising from claims made under the Late Payment of Commercial Debts (Interest) Act 1998.

Total bills paid in year

2010/11 Number 28,927

£000 128,142

2009/10 Number 32,132

£000 115,666

Total bills paid within target

27,475

123,860

30,560

113,782

Percentage of bills paid within target

95.00%

96.70%

95.11%

98.37%

Total bills paid in year

2010/11 Number 3,884

£000 330,912

2009/10 Number 3,457

£000 309,108

Total bills paid within target

3,530

326,735

3,150

307,202

Percentage of bills paid within target

90.90%

98.70%

91.12%

99.38%

Non-NHS

NHS

Management costs

Management Costs (£000s)

2010/11 £000 13,888

2009/10 £000 15,874

Weighted Population (number)

345,691

343,708

Management Cost per Head of Weighted Population £

40.17

46.00

Relevant business interests Doncaster Primary Care Trust is a body corporate established by order of the Secretary of State for Health. Doncaster Primary Care Trust has undertaken transactions for funding General Medical Services or Primary Medical Services with all GP practices within it’s area. This includes the following practices in which GP Executive and Board members are parties.

Dr A Graves (Dr Inman & Partners) Dr A Graves (Glenthorne Medical Services Ltd)

Payments to Related Party 2010/11 2009/10 £ £ 1,523,305 1,454,040

Amounts owed to Related Party 2010/11 2009/10 £ £ 0 0

13,891

21,989

300

1,835

Dr A Graves (Hallcross Medical Services Ltd)

648,727

898,823

6,280

75,899

R Allott (Nostell Place Dental Practice)

351,000

347,000

28,900

Dr L Rodgers

236,093

223,542

Dr N Tupper (Kingthorne Group Practice)

960,571

888,141

Dr E Kelly (Dr Fox & Partners) Dr Shah (Dr Simmonite & Partners)

724,899 660,419 944,800 1,150,377

0 0

G Lord

11,806

43,760

The Department of Health is regarded as a related party. During the year Doncaster Primary Care Trust 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. These entities are listed below; Payments to Related Party

Doncaster and Bassetlaw Hospitals NHS Foundation Trust

2010/11 2009/10 2010/11 2009/10 £ £ £ £ 190,199 184,909 3,865 3,617

Rotherham Doncaster and South Humber NHS Foundation Trust

46,543

46,190

652

Sheffield Teaching Hospitals NHS Foundation Trust

15,366

15,981

168

Sheffield Children's Hospital Foundation NHS Trust

4,685

4,669

250

178

The Rotherham NHS Foundation Trust

6,382

5,787

482

Leeds Teaching Hospitals NHS Trust

798

1,440

126

Mid Yorkshire Hospitals NHS Trust

562

657

Nottinghamshire Healthcare NHS Trust

4,406

518

389

Northern Lincolnshire and Goole Hospitals FT

1,418

1,369

Barnsley Hospital NHS Foundation Trust

335

444

Yorkshire Ambulance Service NHS Trust

9,472

8,195

251

41,880

41,505

1,524

1,459

159

322

Barnsley Primary Care Trust Rotherham Primary Care Trust

Amounts owed to Related Party

In addition, the Primary Care Trust has had a significant number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with Doncaster Council in respect of joint healthcare provision. Payments to Related Party 2010/11 £ NHS Direct NHS Business Services Authority (including NHS Supply Chain) NHS Pensions Agency Doncaster Council

Amounts owed to Related Party

2009/10 2010/11 2009/10 £ £ £ 0 71 0 0

638

670

108

7,716

6,822

37,473

17,813

634

475

Financial Assets: The LIFT Company was established in September 2005 when the Doncaster PCTs reached financial close on three schemes in the first tranche. LIFTco is now categorised as a related party. The Doncaster PCTs made an investment in this company in 2007/08 of £321,000 bringing the total investment to £508,000. A further investment was made in 2009-10 of £393,000 relating to LIFT Tranche 2 bringing the total investment to £901,000 which is disclosed under Note 29. There has been no further investment in 2010-11. Charitable Funds: The PCT is a significant recipient of funds from Doncaster PCT Charitable Fund. Grants received in year from this charity amounted to £215,244 (2009-10 £125,768). Certain of the Trustees of the Charitable Trust from which the PCT has received grants are members of the PCT Board.

Salary and Pension entitlements of senior managers 1 April 2010 to 31 March 2011 Salaries and allowances

2010/11

2009/10

Salary (Bands of £5000)

Other Remuneration (Bands of £5000

Benefit in Kind (Rounded to the nearest £00)

Salary (Bands of £5000)

Other Remuneration (Bands of £5000)

Benefit in Kind (Rounded to the nearest £00)

£000

£00

£000

£00

Roger Greenwood

Trust Board Chairman

35-40

Ann Gilbert

Non Exec Director

5-10

Pamela Horner

Non Exec Director

5-10

Anthony Humphries

Non Exec Director

5-10

Jill Morris

Non Exec Director

5-10

Dr Leslie Ranson

Non Exec Director

5-10

Albert Schofield

Non Exec Director & Chair of Audit Committee

10-15

Tony Baxter

Executive Director

125-130

Helen Beard

Executive Director

80-85

Julie Bolus

Executive Director

Heather Marsh

Acting Director of Quality and Clinical Insurance 1st April

80-85

Annette Laban

Chief Executive From 1 June 2009

140-145

Jackie Pederson

Acting Director Of Commissioning & Strategic Development to 24 April 09

Jackie Pederson

Associate Director Of Commissioning 80-85 & Strategic Development from 1st April 2010

Chris Stainforth

Director of Commissioning from 27 Apr 2009 to 31 Mar 10

Chris Stainforth

Director of Finance & Commissioning 105-110 from 1st April 10

Debbie Hilditch

Executive Director

125-130 80-85

85-90

29-30

110-115

91-92

5-10

85-90

75-80

53-54

75-80

60-65

Salary and Pension entitlements of senior managers 1 April 2010 to 31 March 2011 Salaries and allowances

2010-11

2009-10

Salary (Bands of £5000)

Other Remuneration (Bands of £5000

Benefit in Kind (Rounded to the nearest £00)

Salary (Bands of £5000)

Other Remuneration (Bands of £5000)

Benefit in Kind (Rounded to the nearest £00)

£000

£00

£000

£00

Sheenagh Powell

Executive Director (to 28 Feb '09) & Acting Chief Executive (from 1 March '09 to 31 May 09)

75-80

Jon Cooke

Acting Director of Finance & Procurement (from 1 March '09 to 31 May 09 & 15 Feb 10 to 31st March 10)

25-30

Jon Cooke

Associate Director of Finance & Procurement 1st April

85-90

Carole Donaldson

Director (from 1 March '09 to July 10)

30-35

Linda Kellet

Managing Director DCH (from Aug 10)

80-85

Dr Alastair Graves

PEC Chair

35-40

Richard Allott

PEC Member

10-15

Geoffrey Lord

PEC Member

10-15

45-50

90-95 170-175 36

50-55

46-47 0-5

Julie Mouncher

PEC Member

0-5

55-60

0-5

50-55

Christine Prewett

PEC Member

0-5

45-50

0-5

40-45

Dr Lis Rodgers

PEC Member

25-30

30-35

10-15

35-40

Dr Nick Tupper

PEC Member

5-10

Julie Hall

PEC Member

5-10

45-50

5-10

Dr Eric Kelly

PEC Member

5-10

40-45

5-10

Dr Rumit Shah

PEC Member

10-15

40-45

Salary and Pension entitlements of senior managers 1 April 2010 to 31 March 2011 Real increase in pension at age 60 (bands of £2,500)

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

Total accrued pension at age 60 at 31st March 2011 (bands of £5,000)

Lump sum at age 60 related to accrued pension as at 31st March 2011 (bands of £5,000)

Cash equivalent transfer value at 31st March 2011

Cash equivalent transfer value at 31st March 2010

Real increase in cash equivalent transfer value

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

£000

£00

J Pederson

Associate Director Of Commissioning & Strategic Development from

2.5-5

12.5-15

20-25

65-70

240

231

A Laban

Chief Executive

5-7.5

15-17.5

55-60

170-175

1093

1074

S Powell

Acting Chief Executive from 1 March 09 to 31 May 2009

859

J Cooke

Acting Executive Director of Finance & Procurement from

2.5-5

10-12.5

15-20

55-60

229

216

H Beard

Executive Director of Performance & Information

0-2.5

2.5-5

10-15

40-45

185

197

-12

AP Baxter

Executive Director of Public Health

0-2.5

2.5-5

40-45

120-125

731

784

-53

J Bolus

Executive Director of Quality & Clinical Assurance

2.5-5

10-12.5

25-30

80-85

397

D Hilditch

Director of OD & Corporate Affairs

0-2.5

5-7.5

25-30

85-90

460

486

-26

Chris Stainforth Director of Finance & Commissioning from

2.5-5

10-12.5

20-25

70-75

359

343

A Graves

Medical Director and Chair of CLE

45-50

140-145

799

H Marsh

Acting Director of Quality and Primary Care 0

25-30

80-85

397

C Donaldson

Managing Director of Service Provision

2.5-5

10-12.5

35-40

110-115

669

676

-7

L Kellet

Managing Director of Service Provision

25-30

75-80

426

J Hall

Executive Committee Member

0-2.5

2.5-5

15-20

50-54

289

292

-3

J Mouncher

Executive Committee Member

0-2.5

2.5-5

20-25

60-65

341

353

-12

C Prewett

Executive Committee Member

0-2.5

2.5-5

10-15

30-35

218

210

As Non-Executive members do not receive pensionable remuneration there are no entries in respect of pensions for Non-Executive members. 61

Feedback Thank you for your interest in NHS Doncaster. We hope you have enjoyed reading this report and that it has provided you with an insight into our work in serving the local community over the last year. We value feedback and would welcome any comments you may have regarding this report. Please contact the Communications and Engagement team at the address below. If you require a response, please include your name and contact details. NHS Doncaster White Rose House Ten Pound Walk Doncaster DN4 5DJ Telephone 01302 565656 or please email: enquiries@doncasterpct.nhs.uk If you would like any part of this document in large print, braille, audio tape or translated into your own language please ring the Communications and Engagement team on 01302 565656

www.doncaster.nhs.uk

Published: September 2011