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Community Health Services Annual Report 09/10


Introduction and welcome Welcome to our Annual Report for 2009 – 2010. Community Health Services (CHS) is the provider arm of NHS Halton and St Helens. We deliver a wide range of healthcare services to the population of Halton and St Helens. Community Health Services aims to provide excellent care close to, or at home, which is integrated to deliver a positive patient experience, promote independence and improve health outcomes. We place a great emphasis on involving patients and the public in designing our services, and we are dedicated to providing dependable, caring, safe and respectful healthcare to local people. Our services have delivered a number of recent success stories, including reduced waiting times, improved access to care and the opening of new state-of-the-art facilities. We have also enjoyed success at regional and national award ceremonies, highlighting our forwardthinking approach to improving the health of our local community. This report is an ideal opportunity to recognise our staff, the work they do and acknowledge the pride we have in delivering high class services to our local population. The document also highlights the range of different services we offer, as well as an insight into our people, our finances and our future direction of travel. We hope you find this useful and welcome any comments. John Jones Chief of Operations Heather Greaves Chair


CHS Annual Report 09/10

“Our services have delivered a number of recent success stories, including reduced waiting times, improved access to care and the opening of new state-of-the-art facilities.� 3


Community Health Services CHS offers a wide range of services from local venues such as clinics, GP practices, Walk-in-Centres and Access Centres as well as out in the community. Services currently delivered by CHS include: Acute Care (Closer to Home) –– District Nursing –– District Nursing Out of Hours Service –– Treatment Rooms –– Tissue Viability –– Community Phlebotomy Service – St Helens –– Continence Promotion Service –– Intravenous Therapy –– Halton Integrated Community Equipment Service –– Wheelchair Service - Halton –– Halton Podiatry Service –– Falls Prevention Service –– Access Centres –– Walk-in-Centres –– Rapid Access and Rehabilitation Service –– Halton Integrated Therapy Services –– Primary Care Orthopaedic Service –– Community Dental –– St Helens Intermediate Care Assessment Team –– St Helens Intermediate Care Services


CHS Annual Report 09/10

Children and Families –– Safeguarding Children Service –– Health Visiting –– Community Midwifery –– School Nursing –– Paediatric Speech and Language Therapy Service – Halton –– Children’s Disability Services –– Audiology –– Primary Child and Adolescent Mental Health Service –– Sure Start Parr –– Sure Start Phoenix End of Life –– Macmillan Nurses

Health and Wellbeing –– Wellbeing Team – Mental Health –– Lifestyle Team – Alcohol –– Lifestyle Team – Harm Reduction –– Lifestyle Team – Homeless Health –– Teen Advice Zone (TAZ) / Choices –– Community Sexual Health –– Specialist Weight Management Service –– Fresh Start –– Health Trainers –– GO Men’s Health Programme –– Health Improvement Team –– Smoking Cessation –– Older People’s Services –– Workplace Health and Wellbeing (Workwell) Long Term Conditions –– Integrated Cancer Care Programme –– Community Matrons –– Diabetic Retinopathy –– Respiratory Counsellor –– Community Stroke Service –– Newton Community Hospital –– Healthy Heart Service – Cardiac Nurse –– Healthy Heart Service – Heart Failure Nurses

Mental Health –– Primary Care Psychological Therapies – Halton –– Psychosexual Counselling –– Erectile Dysfunction –– Single Point of Access for Mental Health Rehabilitation and Neurological Conditions –– Occupational Therapy for Assistive Technology –– Halton Neurological Rehabilitation Service –– Adult Speech and Language Therapy Service –– Chronic Pain Rehabilitation Service Further information on some of the services provided by CHS, as well as recent successes and achievements can be found on the pages that follow.



2009 – 2010 highlights and achievements Sexual Health Social Marketing Project The Health Improvement Team developed a sexual health social marketing intervention aimed at local young people aged 20-25 which ran during the summer of 2009. The campaign aimed to increase condom use and was delivered in conjunction with the pubs and bars in Halton and St Helens. The project has been extremely well received and has achieved strong results. Pre and post-campaign analysis reflected a positive shift in condom usage (18% increase) and awareness against protection of sexually transmitted infections (11% increase). Feedback from the venues involved in the campaign has been excellent and strong working relationships have been established which can now be built on in future.


CHS Annual Report 09/10

Telehealth Telehealth delivers remote health monitoring for patients with long-term conditions in their home setting. CHS has funding for 60 units which have been distributed to patients throughout Halton and St Helens with chronic obstructive pulmonary disease (COPD) hypertension. Telehealth technology is also being used by the Outreach Team from Newton Hospital as part of an early discharge facilitation programme. The initial findings claim the initial implementation has been extremely positive and early indications are showing a reduction in visit levels required by community staff. Halton Intermediate Care Assessment Team Halton Intermediate Care Assessment Team is a dedicated integrated assessment team of health and social care staff within the Rapid Access and Rehabilitation Service. The Team provides a single point of access for Intermediate Care in Halton and works with patients being discharged from hospital and in the local community. Following an individual assessment the team provides a range of treatments and advice to enable the patient to be discharged earlier, undertake ongoing rehabilitation in a dedicated unit or remain in their own home. Since beginning in June 2009 the number of referrals has increased by 62%, with 82% being seen within 24 hours of referral. Local hospitals, community services and service users experience the speed of response and the approach of the team to enable patients to receive the best possible services to support discharge home and prevent unnecessary hospital admission. The Service has been commended by the Local Partnership Board and Halton Borough Council’s Health Overview and Scrutiny Committee. Chronic Pain Rehabilitation Service The delivery of the Chronic Pain Rehabilitation Service has been restructured to offer a new service in the Kingsway Leisure Centre in Halton. This has been part of the ongoing strategy of increasing the delivery of pain management services in ‘non-health’ settings, commensurate with promoting increased self-management, independent coping and healthy lifestyle promotion. The new approach has brought about the following benefits: –– –– –– ––

Increased overall service capacity Reduced pressure on clinical space Increased the quality of care through greater exercise opportunities Enhanced the “normality” of this very common long-term health problem by using a non-clinical environment –– Provided direct opportunities and encouragement for patients to engage in positive health behaviours Patient quotes (taken from formal feedback): “The gym sessions were the most helpful and will continue to be helpful in the future” “I think the course is an excellent idea as it shows you that no matter how much pain you are in you can still do exercise.” “…now I can go forward knowing that although the pain won’t go away I am not likely to wake in the morning totally paralysed. This has been my biggest fear over the years.” 7


Macmillan Palliative Care Service Macmillan is a Specialist Palliative Care Nursing Service working within the community of Widnes and Runcorn. The Service supports patients, family and carers living with cancer and other life threatening illness from the point of diagnosis, through the palliative phase and for some end of life and with bereavement care. Patients are able to be involved in the decision making process and spend their final days in their place of choice due to the integrated team working together. Specialist Palliative Care and close workings with the Community Nursing Team means patients are as comfortable as possible in their own home environment. The Team is based at Halton Haven Hospice, and visits patients in their own homes and on occasion at other venues agreed with patients. The Service’s aim is to help people make informed decisions about their personal treatment and offer guidance. District Nursing District Nursing offers high quality nursing care and support for the diverse health needs of those living in Halton and St Helens. Haydock Health Centre recently opened a private space called Wayne’s Room. This is a facility in which families can meet with a District Nurse outside the home environment to discuss concerns, receive counselling and support away from the patient. Wayne’s Room came about following the death of a young man from cancer. The patient’s family wished to make a donation to the nursing team for a space where bereaved families, as well as in-house staff, could go during difficult times. A room was identified within Haydock Health Centre which was not being used to its full potential. The family purchased furniture, pictures, a music system as well as arranging for the facility to be painted.

Wayne’xs Room


CHS Annual Report 09/10

Community Midwifery Halton Community Midwifery provides care including antenatal, intrapartum (home birth) and postnatal, and is the only midwifery service based within a Primary Care Trust in the North West. The service was recognised in 2009 by NHS Innovations North West for implementing a Grandparent Information Group in the Halton area. In addition to this service, parenting information groups specifically targeting fathers were also launched in 2009. This enabled fathers to support their partners through pregnancy and childbirth as well as preparing them for the challenges and responsibilities of parenthood. Both of these groups are run out of hours by the midwives to increase accessibility and attendance. A breastfeeding support team has also been established this year in partnership with Public Health and Health Improvement. The Team has already noted a 6% rise in breastfeeding rates in the Halton area, exceeding the national expected rise of 2% per year. School Nursing School Nursing addresses health and wellbeing issues with school children and young people (including nursery infants and those attending special schools). This is seen as an important link between education, health and home. With a focus on preventative health care and health promotion, School Nursing provides effective community based responses to the needs of children and young people across Halton and St Helens. In January 2010, Halton School Health Nursing Service launched a new and extended confidential drop-in service for pupils attending Halton High School in Runcorn. Members of the School Health Team have worked closely with the school, parents, governors, pupils, other partner agencies and the Borough Council to ensure the service meets the wider needs of those attending the school. The holistic drop-in, named Ace Space (RmZ) by pupils, offers support and advice on a wide range of health issues including: healthy eating, safer lifestyle choice and emotional wellbeing. On-site sexual health services are also available for pupils in years 9 and above. Members of the School Health Nursing Team have all completed additional training during 2009 and 2010 to ensure that they have the skills and knowledge to provide this extended support to pupils. Paediatric Speech and Language Based on feedback from a pilot in 2006, a new model of service delivery has been rolled out across Speech and Language Therapy. Halton is one of the few areas in the country that has modernised its service to this extent, based on local evaluation. The model was presented at a national conference when in its infancy and has since been featured in national strategies. It has also attracted interest from regional advisors from ICAN (the charity working for children with speech language difficulties) and Together for Children. Following a service redesign, Paediatric Speech and Language now provide a choice to families on where they wish to be seen. The introduction of this option has seen the rate of non-attendance at appointments reduce from 30% to 5%.



Halton Integrated Community Equipment Service The Halton Integrated Community Equipment Service launched new storage and decontamination facilities during 2009, enabling the PCT to meet the decontamination guidance set out by the Health and Safety Executive. More equipment can be recycled as a result, thus reducing the number of items being condemned which has had a positive effect on the overall budget. Get checked Campaign – Health Improvement Team The Get checked campaign is a social marketing intervention that increases knowledge of the symptoms of breast, bowel and lung cancer in Halton and St Helens – and encourages people to visit a GP if they have them. The project is delivered in the local community by volunteers from the area, who engage with their peers to increase awareness and action. The campaign has brought about significant increases in the presentation of breast, bowel and lung cancer symptoms in the most deprived areas of Halton and St Helens. The results included urgent two-week referrals rising by 82% for bowel cancer, 19% for breast cancer and 16% for lung cancer. Get checked has been developed ‘in-house’ by the Health Improvement Team, with support only brought in for focus groups and the design and print of materials. This has ensured excellent value for money throughout. The project was successful at several regional and national award ceremonies in 2009, including second place at the National NHS Communications Awards for ‘Best Campaign’.


CHS Annual Report 09/10

Additional Successes –– 100% of patients attending our Minor Injury Treatment Centres are seen within 4 hours. –– CHS fully met all Healthcare Commission/Care Quality Commission core standards. –– The Health Improvement Team gained national and international recognition for provision of high quality social marketing and early detection services – including awards at the Health and Social Care Awards, NHS Communications Awards and a nomination at the Health Service Journal Awards. –– The Midwifery Team achieved national recognition for providing support for young, first time parents and their babies. –– CHS contributed significantly to improving the health of our local population. 5,616 people accessed support to stop smoking with 2,798 being recorded as having quit. This comfortably exceeded our local target of 2,500 quitters. –– The Health Improvement Team and St Basil’s Primary School in Widnes won a National Award for Healthy Schools and Innovation. –– The Healthy Schools Programme also became one of only a few in the country to achieve a 100% sign up rate from local schools. –– Primary Mental Health Workers won a National Award for their work in children’s services. –– Patient feedback for Adult Speech and Language Therapy reported that Widnes patients wanted to be seen as outpatients in Widnes rather than travelling over to Runcorn. As a result two treatment room sessions were put on at the Health Care Resource Centre in Widnes to accommodate this request.



Our people The Transitional Community Services Subcommittee (TCS Sub Committee) The TCS Sub Committee has been established to be responsible for the strategic leadership and operational delivery of all services provided by the Primary Care Trust’s provider arm. The TCS Subcommittee is accountable to the PCT Board as a formal Sub Committee. The TCS Sub C ommittee is responsible for ensuring a governance structure is in place which gives it assurance that CHS is being managed safely, effectively and efficiently within its scheme of delegation and statutory obligations. Heather Greaves Heather Greaves has lived most of her life in the Runcorn area and has recently retired from the position of European Human Resources Manager for a large global chemical company. A Fellow of the Chartered Institute of Personnel and Development, Heather has over 30 years’ experience in private industry operating at senior management level throughout Europe in rapidly changing environments. Heather is not politically active and does not hold any ministerial appointments. Suzanne Knight Suzanne Knight was elected as a Member of St Helens Council in 1991 and has held the position of Deputy Leader with responsibility for Adult Social Care and Health since 2006. She is Chair of governors at St Aelred’s Catholic Technology College in Newton-le-Willows, a position she has held for ten years, and also sits on a primary school governing body. Suzanne also sits on the management board of three community centres in Newton and is a founder member of the Newton Community Partnership Group. She chairs St Helens Healthier Communities Partnership Board and is a Magistrate on the St Helens Bench.


CHS Annual Report 09/10

Sally Yeoman After graduating in 1995 with a BSc (Hons) in Sociology, Sally Yeoman spent time working in services for adults and children with learning disabilities. She joined Voluntary Action Epping Forest in 1999 as Older People’s Services Co-ordinator and was appointed Chief Officer in August 2002. There she chaired the Essex Association of Council for Voluntary Service and the Essex, Southend and Thurrock Change Up Consortium. She played a key role in the development of Essex Local Area Agreement (LAA) and with colleagues led the voluntary sector input. In August 2006 she was appointed as the Chief Executive Officer at St Helens CVS. Sally is currently a Board member at the Community Foundation for Merseyside and is the Merseyside CVS representative on the Merseyside Sports Partnership. She is an Institute of Directors (IOD) certified Company Director and was recently accredited by the Improvement & Development Agency as a Partnership Peer. John Davies John Davies is an experienced strategic manager and consultant with a successful track record of over twenty years at director level in metropolitan local government including Liverpool, St Helens and Leeds following an early career in operational management. His last post in Leeds until 2007 was as Director of Learning and Leisure and Acting Director of Adult Social Services. He has worked in a wide range of partnership settings involving public, private, voluntary and community sector organisations and is adept at working in complex political environments to deliver results and improvement. His extensive experience especially in leisure and culture, health and wellbeing and children and young people’s services, has equipped him to support public sector organisations with self improvement, partnership development, strategic commissioning, performance management, leadership and transformational change-areas in which he has undertaken consultancy projects since April 2007. John has also served as a Board Member or Chair of a number of national, regional and local bodies. He has lived in Rainford for the last 22 years. Peter Stevens Peter Stevens has lived in St Helens since 1991 and retired in 2008 from a high street banking and insurance company. He has over 38 years’ financial industry experience, a wide business background and extensive experience in organisational change. Since retiring he has also developed a broad involvement with third sector organisations. Peter has no political affiliations or other public sector appointments. Ann Gerrard Ann Gerrard has lived all of her life in Widnes. After working in mental health for 10 years, she has been an Elected Member of Halton Borough Council for 9 years and Executive Board Member (with responsibility for the Health and Social Care Portfolio) for the past 3 years. During this time services have undergone radical transformations, with continuing challenges.



John Jones Chief of Operations John commenced his career in the NHS over 30 years ago. Initially focussing on finance he progressed into wider general management taking on the role of Fund Holding Lead for South Mersey Regional Health Authority. With a change in government policy he was appointed to Chief Executive of Widnes Primary Care Group. This post was job shared, one of the very few job shares in the country to operate at this level. Together with his job share partner he was appointed to the Project Director post to establish Halton PCT. They successfully created the PCT and he became the new Trust’s Assistant Chief Executive/ Director of Corporate Services. With the direction of travel from the centre to join larger PCTs, Halton PCT worked with St Helens PCT to form one new single Trust. During this transition period he took on the role of Deputy Chief Executive for Halton PCT. With Halton and St Helens PCT formed he became the Director of Corporate Services. With Provider Arms starting to became more autonomous with PCTs he was appointed to the role of Chief of Operations. Having operated at Board level for over 15 years he is passionate about what the NHS can and does do. Carl Powner Deputy Chief of Operations/Head of Service Development Carl’s career in the National Health Service has spanned over 19 years, following 12 years supporting reforms in Education. He is well grounded in Primary Care having driven and embedded key NHS reforms in this sector and has an excellent track record in partnership working including the delivery of health and social care innovations. Carl has considerable experience and expertise in the areas of performance management and governance. He is well versed in driving change throughout organisational reform and feels that the key to success is being consistent and passionate about staff and patient involvement. Joan Pickett Director of Newton Community Hospital Joan has had a career in the NHS for 45 years. Following her nurse training at Whiston Hospital she progressed through additional training and development to ward management. Joining the Community Services in 1975 she worked for many years as a District Nursing Sister moving into management roles in the early 1990’s. A series of development roles and training led to an appointment of Deputy Director of Service Provision helping to shape the future role of provider services to achieve autonomy from Primary Care Trusts. In 2008 a further career change led to the role of Director of Newton Community Hospital, working with an excellent team to shape Newton Community Hospital to play a key role in Intermediate Care and Sub Acute Medical Care services. Joan officially retired in May 2010, but will continue to move the transitional agenda forward at Newton Community Hospital until March 2011.


CHS Annual Report 09/10

Paula Woods Head of HR Paula’s introduction to Human Resources came about during her time at GlaxoSmithKline (Beechams). She moved from the Payroll Department into Human Resources in 1992. On closure of the site in 1994, she continued with her HR career in a local Housing Association. Whilst employed there, Paula studied for her qualifications and subsequently became a Graduate of the Chartered Institute of Personnel & Development (CIPD) in 1998. After 10 years in the Housing Sector, she embarked upon a career change which would further her HR experience whilst still enabling her to work for an organisation that was responsible for making a difference in the community. In 2004, Paula commenced work in the NHS and continues to contribute to delivering services to help improve the lives of the population she serves. During this time, her experience and continued professional development have enabled her to apply for and be upgraded to the highest grade of membership attainable with her professional body – Chartered Fellow of the CIPD. Dorothy Keates Head of Clinical Leadership & Professional Development Dorothy has worked in the NHS for 30 years as a registered nurse. In addition to the role of practice nursing, she was part of a dynamic practice nurse development team, developing competences and clinical pathways within general practice. She supported the development of the Practice Nurse Career pathways in conjunction with the local universities. She also undertook a teaching certificate, and was involved in an asthma training centre both developing and delivering training packages aligned to university certification. She worked as primary care advisor for the Royal College of Nursing (RCN) in the North West. Dorothy moved into Governance, progressing to the Head of Clinical Governance. These roles have allowed Dorothy to analyse and be involved in developing robust governance structures within the organisation. Recently Dorothy has also taken on-board the additional responsibilities for the portfolio of Clinical and Professional Leadership within Community Health Services. John Morris Head of Finance John has worked in NHS finance for over 25 years, starting at Preston Health Authority, then Bolton Health Authority before progressing onto West Lancashire NHS Trust and then Southport and Ormskirk NHS Trust. In these organisations he worked in a number of finance roles including financial services, management accounts, contracting and corporate performance. John joined St Helens PCT as Deputy Director of Finance in March 2003 and latterly continued this role within the reconfigured Halton and St Helens PCT, until joining the CHS management team in November 2008. Mike Ore Head of Service Delivery Mike joined the PCT in January 2008 as a Business Manager and is now the Head of Service Delivery. Prior to joining the NHS he was the Operational Director for a national sports body delivering social and wellbeing sports initiatives for children across the UK. Prior to this Mike had 15 years with the private sector healthcare markets including Primary Care, Optometry, Social Care, Dentistry, Renal PFI and a contract manager with the NHS including a secondment with the Virgin Group.



The Community Health Services workforce Our overall vision is to provide an organisation which is valued by everyone who works within it, making a major contribution to its ongoing development and success. This includes helping to generate a working environment that is supporting and enabling to staff. It is recognised that to deliver the ambitions set out in our strategy and plans, we must review and develop our existing capacity and capability. In this new environment, our contribution to the wellbeing of the people we serve in Halton and St Helens is to enable them to have the best possible health and healthcare. This section gives you an insight into the Human Resources and Organisational Development Directorate, its aims and objectives and more importantly, its achievements. Our top 5 priorities were: 1. Employee attendance, health and wellbeing and improving working lives 2. Staff satisfaction and engagement 3. Equality and diversity 4. Organisational development 5. Innovation

World Class HR Practice Working Towards ‘World Class’ Human Resources and Organisational Development in the North West


CHS Annual Report 09/10

Create value

Aligns & integrates with the business

Added value

Achieves desired results for the business

Value for money

Gets the Basics right

Source: IES, 2008

Proactively leads the people agenda


Has a compelling employee proposition

Supports people management

Sustainable innovation

Continuous improvement

Customer focus

“In this new environment, our contribution to the wellbeing of the people we serve in Halton and St Helens is to enable them to have the best possible health and healthcare. � 17


Introduction In the PCT’s 2008-09 Annual Report a new project was introduced a new project that had been commissioned by the NHS North West (Strategic Health Authority) – Working Towards World Class HR and Organisational Development. The Institute for Employment Studies (IES), an independent centre of research and consultancy in public employment policy and organisational human resource issues undertook the study. The aim was to seek feedback from those we provide services to, about World Class HR and OD. This was done by way of an on-line survey. There are seven factors within the World Class HR and OD model – the attainment of which is conceptualised as a series of building elements. The factors are: 1. Getting the basics right. 2. Supporting people management. 3. Achieving desired results for the business. 4. Having a compelling employee proposition. 5. Aligning and integrating with the business. 6. Proactively leading the people agenda. 7. Creating value, innovating and demonstrating impact. 2009 Activities The information gathered from the survey was analysed and action plans were put into place in order to address our areas for development and maintain our strength areas. A fundamental part of the process took place in the form of a peer review. A HR professional from another Trust visited us to review the work that had taken place. This involved: –– –– –– –– ––

Reviewing a portfolio of evidence provided by the Trust Observation of the Wellbeing Steering Group Group interview with Senior HR Team Focus group with wider HR Team Focus group with front-line staff, managers and a member of staff side

The key improvement areas were: –– –– –– –– –– ––


CHS Annual Report 09/10

Improved communication Staff Attendance, Health and Wellbeing Majority of HR Policies ratified HR Skills Programme for Managers Take up of Personal Development Reviews (PDRs) Robust absence management framework

Future Plans The World Class HR and OD project is a continuous one and we will continue to work on the feedback that we have from our staff. The project is ongoing with another on-line survey conducted in January 2010. Once again, staff were invited to take part. We hope that the work that has taken place in 2009 will be evidenced by improvements in the 2010 survey feedback which is due in April 2010. Organisational Development The organisational development programme, Best in Class, has to date focused on the values and behaviours required by our workforce in our strives to provide quality outcomes for the residents of Halton and St Helens. In response to Lord Darzi’s report on ‘High Quality of Care for All’ and to ensure our staff are equipped to work within the current economic climate, our focus has aligned to the QIPP (Quality, Innovation, Productivity and Prevention) agenda which is now the driver for all organisational development activity. We have 7 work programme areas as part of our approach to organisational development: –– Supporting delivery of the Commissioning Strategic Plan –– Achieving financial balance through implementation of the Better Care, Better Value tool –– Supporting delivery of the QIPP action plan –– Developing our approach to innovation –– Reframing our values and behaviours –– Developing our approach to engaging with our patients and the local population –– Strengthening transformational leadership for commissioning. Our approach to organisational development encompasses service improvement methodology and we have trained a cohort of staff within the PCT in change management principles, tools and techniques that will enable us to eradicate non-valuable activity, and increase the quality of service provision for our patients. Organisational development has continued to support team development, and facilitated support to individuals and work programme areas to ensure effective working across boundaries. Learning and Development The Learning and Development Team has led a programme of improvement during 2009/10 around the uptake of PDRs (Personal Development Reviews) for staff. This has resulted in 81% of our workforce participating in a PDR with their line Manager, a significant increase on the previous year’s activity. PDR is based on the principles of good people management, incorporating two different processes. Appraisal which focuses on the individual’s performance in their job role and development, which focuses on supporting staff to gain the necessary development, to be effective in their jobs and committed to developing and maintaining high quality services for the public.



Key Achievements, Accreditations and Awards The PCT Annual Awards Ceremony and AGM was an opportunity to showcase some of the teams/individuals who, each day, are making a difference to health and wellbeing of the communities they serve. The winners this year were: –– Clinical Team of the Year – The Widnes Walk-in-Centre in Centre –– Improving the Patient Experience – The Health Improvement Team: Get checked –– Innovation of the Year – Pam Worrall and the Health Improvement Team: Healthy Schools Programme –– Leadership for Improvement – Lorraine Downey and the Haydock District Nursing Team –– Non-Clinical Team of the Year – The Admin, Clerical and Porter Security Team at Newton Hospital –– Star of the Year – Karen Worthington, Pre-School Services Manager –– Award for Improving Staff Resources – Steve Devine, Taskforce Engineer Key Achievements –– Development of a staff engagement framework, including the launch of ‘Listening to You’ (L2U) –– A strategic workforce plan and the launch of an organisation wide workforce planning framework –– Electronic Staff Record ‘ESR’ – Implementation of the Manager Self Service Project and improved absence reporting and management/ workforce information –– Organisational Development Plans for the respective Commissioning and Community Health Services arms of the organisation –– The design, development and implementation of an essential skills training programme –– The development and ratification of key HR policies –– The design, development and implementation of an in-house HR skills programme –– Promotion of attendance, health and wellbeing initiatives and services for staff, including the publication of a ‘Mental Health and Wellbeing Booklet’ –– Personal Development Reviews (PDRs) - 81% take up –– Our second annual awards ceremony recognising staff achievements ‘Positive About Disabled People’ Symbol User This is awarded annually by Jobcentre Plus to organisations which can demonstrate progress against five key commitments in relation to employing and retaining disabled people. ‘Age Positive Employer Champion’ Symbol User This is awarded to employers who employ people regardless of their age.


CHS Annual Report 09/10

‘Improving Working Lives’ Practice Plus Status The PCT has achieved IWL ‘Practice Plus’ Status which requires good practice in seven areas: –– –– –– –– –– –– ––

Human Resources Strategy and Management Equality and Diversity Staff Communication and Involvement Flexible Working Healthy Workplace Training and Development Flexible Retirement, Childcare and Support for Carers

Our work in relation to IWL is continuing via the Trust’s Staff Matters Group as we strive to be a ‘model employer – an employer of choice’. The IWL Framework 2009 has been adopted by the Trust and the Group are selfassessing the organisation against the standards. NHS Employers Equality and Diversity Partner Site Awarded by NHS Employers to NHS organisations which have demonstrated evidence of commitment and progress against key equality and diversity themes. This is the third year running the Trust has achieved the status, and is one of only 20 Trusts to do so. Listening to our Staff – Staff Engagement Activities Staff satisfaction and engagement was one of the five NHS priorities for 2008/9. This remained for 2009/10. A staff engagement framework was ratified in 2008 and rolled out during 2009 onwards. Listening to You! Putting Staff at the Centre of Change As part of our staff engagement framework we launched the ‘Listening to You’ approach to staff engagement as a vehicle to engage with staff at all levels, with the aim of delivering better outcomes for patients and increasing levels of staff satisfaction. The staff engagement framework also includes The NHS Constitution – the staff pledges and responsibilities within. The NHS Constitution has been developed through a wide process of consultation and is based on research into what matters to the public, patients and staff. Taking into consideration the views of over 9,000 employees, it has specific focus on areas of interest for staff. All those providing NHS services are to take account of it. The NHS Constitution has a number of pledges to staff in relation to their roles, working environment and conditions. Furthermore, it outlines what staff can expect from the NHS, their duties to it and vice versa. Consultation on the Staff Guide ended on 17th October 2008. The final version was published in January 2009.

“The NHS Constitution has a number of pledges to staff in relation to their roles, working environment and conditions.”



NHS Staff Survey Results 2009 and Action Plans Staff were once again given the opportunity to share their views and opinions with us by completing the annual Staff Survey. An action plan was devised drawing on the survey with the aim of continuously improving and addressing areas requiring further development identified within the results. Based on the feedback we received from the 2008 staff survey results we introduced the following during 2009/10: –– The Trust sourced an external training provider to conduct training around equality and diversity. Equality and diversity also forms part of the Management Development Programme –– Health and Safety – A “REPORT THAT INCIDENT” poster campaign has been launched –– A leaflet sent to all staff introducing and explaining new incident reporting arrangements –– A ‘smart card’ is to be sent to all staff detailing the procedure to follow to report an incident –– Safe Working Environment - A learning brief is being implemented throughout the PCT –– Extensive work has gone into rolling out more training courses to ensure maximum accessibility to staff –– Introduction and implementation of ‘Listening to You’ …… ‘You said, We Did…Are Doing….campaign to ensure feedback is two-way –– Comprehensive HR skills programme in progress for managers –– Roll out of ‘1 Hour Briefings’. These are aimed at highlighting key HR processes and policies that help managers to manage their teams more effectively –– A project group was established to further improve the coverage of personal development reviews (PDRs) and personal development plans (PDPs) –– A system to capture PDR activity has been developed and revised paperwork will enable more robust training needs analysis. PDR activity is monitored and is reported to the Chief Executive –– We are raising awareness of the standards of conduct and behaviour expected in the workplace, our values and beliefs. We have designed and developed bullying and harassment training for managers and staff alike. The training is being rolled-out Trust wide –– A bullying and harassment “Pulse” survey was carried out and the results were analysed and communicated to staff –– An internal ‘mediation’ scheme has been launched. Mediation is a means of sorting out disagreements or disputes. A neutral third person works with those in disagreement or dispute to help them reach an agreement that will sort out their problems. It encourages discussion between the individuals involved. In conjunction with ACAS (Advisory, Conciliation and Arbitration Service) we trained a number of employees to become mediators –– A wellbeing policy (stress management) has been developed and ratified in conjunction with our health and safety colleagues. This was rolled-out Trust wide and supported by a comprehensive training package, which will include a ‘stress risk assessment’ approach –– A ‘stress survey’ using the Health and Safety Executive Standards/ Tool. The results of this will be analysed and communicated during 2010 The results from the survey and our action plans are widely shared with staff ensuring that they are aware their views are being listened to and acted upon.


CHS Annual Report 09/10

Relationships with Trade Unions – Joint Staff Group (JSG) We continue to have a strong and positive relationship with our Trade Union staff-side colleagues. The strength of this level of partnership has had real benefits for our staff and we are working together to ensure that effective partnership working is further developed from this sound basis. Staff-side representation has been a feature of a number of working groups to ensure that partnership working is applied to everything we do. The Trust recognises several Trade Unions as the collective consultation and negotiating representatives of staff. The PCT has a Joint Staff Group (JSG) which meets formally. We will continue to promote and support the benefits of Trade Union membership and the JSG Representatives will continue to play an essential role in promoting good employee relations, supporting effective change management, the learning and development agenda, the negotiation of terms and conditions and developing best practice in employment. Partnership Approaches – Staff Working Groups We have a number of groups in operation. These are run in partnership with the Trade Unions. Our Staff are kept informed on developments by way of Newsletters, Trust Times, Team Brief and the Intranet. Our ‘Staff Matters’ Group We have achieved IWL ‘Practice Plus’ status which required good practice in seven areas: human resources strategy and management, equality and diversity, staff communication and involvement, flexible working, healthy workplace, training and development, flexible retirement, childcare and support for carers. We continue to demonstrate excellent progress in these areas as we embed and engrain the 2009 ‘Improving Working Lives’ Framework. The group’s remit is to support a culture that develops and retains high calibre people committed to providing the best possible healthcare. Building on the achievements of IWL Practice Plus status, we are ensuring that we continue to build an organisation that truly values people and uses a culture of staff engagement and involvement, ensuring that we have honest, two way and meaningful communications. In addition to health and wellbeing initiatives and staff benefits, we have extensive family friendly provisions by way of a dedicated working family advisory service with employees who provide advice, guidance and support to staff to assist them in balancing their work and home lives. As in previous years, The ‘Staff Matters’ Group: –– Promotes initiatives which support and encourage staff to achieve a reasonable work/life balance –– Continues to embed IWL as we strive to become a ‘model employer’ and ‘employer of choice’, taking into consideration standards for 2009 –– Analyses staff survey results and incorporates them into action plans, highlighting the positives and identifying areas for development to be improved upon, further gathering staff views and their input –– Promotes ‘family friendly and flexible working’ policies, practices and procedures –– Continues to raise awareness of staff benefits and widen the pool of benefits available to staff –– Captures, shares and publicises areas of good practice, staff achievements and successes –– Engages staff with regard to ‘innovation’ and ‘ideas’, taking this forward for further development and recognition 23


Our Wellbeing Steering Group The organisation delivers its health and wellbeing agenda, in partnership, through a wellbeing steering group and its members consider a wide range of issues and suggest appropriate actions/ interventions. The organisation is committed not only to improving performance in health and wellbeing; it is also committed to health promotion by encouraging the adoption of healthier lifestyles for our staff. The philosophy which underpins this commitment is one of self help and individual responsibility within a corporate framework, promoting and supporting good practice to comply with legislation, addressing key workplace risks to health and wellbeing and encouraging a healthier lifestyle culture. It is our aim to create a culture where negative wellbeing issues are identified, minimised and managed before they affect the wellbeing of staff. To that end, we promote the positive aspects and initiatives associated with health and wellbeing at work by: –– Promoting good practice in both physical and mental health and wellbeing and sharing successes across the organisation –– Providing training for managers in good management practices –– Identifying those circumstances that may contribute to inappropriate levels of work related stress and conducting risk assessments to eliminate or control the risk from such stress. These circumstances and risk assessments will be kept under regular review –– Engaging and involving staff on all proposed actions relating to staff wellbeing –– Providing occupational health services and confidential counselling for staff whose wellbeing is affected by work or external factors –– Working towards the mindful employer charter which is awarded to organisations for showing a positive and enabling attitude to employees and job applicants with mental ill health The group’s key priorities for 2010/11 include: –– Development and implementation of a Trust health and wellbeing strategy –– Action plans taking forward the ‘NHS Health and Wellbeing Review; Final Boorman Report December 2009 –– Specific action plans to reduce absence attributed to stress and musculo- skeletal which are the Trust’s most common reasons for absence –– Further development around management accountability framework regarding reducing absence; action plans and exception reporting –– Evaluation of current health and wellbeing interventions i.e. complementary therapies, mediation and health checks to ensure effectiveness. Continuous improvement cycles will be put in place to ensure services meet the needs of the organisation –– Exploration of in-house physiotherapy on a sessional basis –– Further development of health and wellbeing initiatives in line with the ‘key health priorities’ for NHS Employers as taken from the Boorman report, which include physical activity, reductions in smoking, reduction in numbers of adults who drink too much, healthy eating and mental health and wellbeing


CHS Annual Report 09/10

Employee Attendance, Health and Wellbeing ‘Working Towards Positive Mental Health’ This is a Charter that employers sign up to who are positive about Mental Health and is a tangible display of commitment to improving the working lives of staff. The Charter recognises that policies and good practice are not necessarily currently in place – it is a set of aims: something to work towards. Work has already commenced to achieve the aims below via a robust action plan. Managing Attendance, Health and Wellbeing in the Workplace The organisation encourages a positive culture of attendance supported by a commitment to wellbeing throughout the organisation. We aim to provide healthy, safe working environments that support staff in their wellbeing. Despite the work of the wellbeing steering group staff absence has been increasing in 2009 and the cumulative sickness absence figure as of December 2009 was 6.19%. This was an increase compared to a December 2008 figure of 5.23%. With effect from October 2009, the organisation set an absence target of 3.3% to be achieved within an 18 month timeframe. A ‘management accountability framework’ has been put in place from November 2009. This is to ensure line managers refer to occupational health immediately if absence is attributed to stress or musculoskeletal or for other sickness absence after 28 days, trigger points are implemented in line with the ‘managing attendance policy’ and that return to work interviews are conducted for every person following every period of sickness absence. As an organisation we recognise the responsibility of ensuring managers have the right skills and knowledge to prevent unnecessary absences within their department and to pro-actively support and manage staff who have unavoidable periods of sickness absence. Therefore ‘managing absence’ and ‘wellbeing’ training is now considered essential training for managers. In addition to this a number of ‘mental health awareness’ training sessions are running to provide managers with the skills and confidence in recognising and supporting an employee that has mental health issues.

“As an organisation we recognise the responsibility of ensuring managers have the right skills and knowledge to prevent unnecessary absences.”



A number of recommendations were approved by the Board during 2009 as follows: –– Absence management training is now regarded as ‘essential training’ for all managers and the programme is endorsed at board and senior management level. –– A business case to fund a training programme on staff mental health and wellbeing. Surveys have been sent out to assist in this training being relevant and targeted to need. –– Endorsement for return to work interviews to be conducted following every period of sickness absence. –– Directors are responsible for reducing absence levels in their work areas against the agreed target of 3.3%. –– Random audits will be carried out on stress risk assessments (via the health and safety department) and on return to work interviews (via the human resources department). The focus being on departments whose absence levels are high. Support will be offered to pinpointing areas of concern and action plans will be developed accordingly. –– Staff can self refer to occupational health services (Mediscreen). –– A Trust health and wellbeing strategy will be developed, following the publication of the final “Boorman Review” report (containing 20 recommendations in relation to the health and wellbeing of NHS workers). –– Christine Samosa, Director of Workforce Strategy and Organisational Development is the Executive Lead for attendance, health and wellbeing. Christine will ensure the effective implementation of the health and wellbeing programme at a strategic level in keeping with the recommendations of Dr Boorman’s Report. Absence Management Since March 2010, a ‘Red Amber Green’ rating has been applied to Departmental absence data and it is now presented and cascaded to Senior Managers on a monthly basis in what we refer to as ‘absence league tables’. The ratings are as follows: 1. Red The teams with unacceptable absence rates over 5% who require both action plans and exception reports 2. Amber The teams with absence rates from 3.3% to 5% who require action plans to reduce absence levels 3. Green The teams with absence rates lower that the PCT target of 3.3% who are to be commended A “Performance Framework” that will include an action plan and exception reporting facility has been in place from March 2010. All line managers whose departmental sickness rates are currently ranked ‘RED’ have been asked to present at/after the performance committee to account for their teams’ sickness levels and to provide detailed action plans to ensure absence is minimised wherever possible. Previously absence has been reported two months in arrears. This has made it difficult to acknowledge reductions in absence rates to the ‘as is’ position. In that respect, ESR Manager Self Service has been rolled out in April 2010 to enable ‘as is’ absence reporting and assist in a more pro-active approach to managing sickness absence.


CHS Annual Report 09/10

Working Families Advisory Service The organisation is committed to assisting its workforce to achieve where possible a suitable work life balance which not only benefits the employee but also the organisation: –– –– –– –– –– –– –– –– –– ––

Carers and Childcare Issues. Finding appropriate, affordable quality childcare Information on Childcare Vouchers and other initiatives Maternity, Paternity and Adoption Leave Family and Child Tax Credits Flexible Working Options Family Friendly Policies Staff Benefits and Discounts School Holiday Childcare Subsidies Carers Subsidies

The Working Families Advisory Service also provides a variety of workshops and events in order to support the employees including: –– –– –– –– ––

Bumps and Babies Events Stress Buster Workshops Reiki Training for Carers Carers Pamper Days Yearly Pantomime



Equality and Diversity The Trust is committed to an environment that promotes equality, diversity and human rights within the workforce and both in commissioning of services and services provided. The equality, diversity and human rights agenda plays a more significant role than ever before for the Trust and this has been progressed during the last year with several key work areas: There are two equality and diversity sub groups, one for Commissioning and one for Community Health Services. Both are chaired by the equality and diversity manager, and have representative membership of each structure at operational/service level manager and above. Both groups report to the Governance Assurance Committee, which assures the Board of legal compliance. We work with key local partners to ensure that diversity is represented in our workforce. Around 65% of our workforce is from the local boroughs. Action plans are being agreed to ensure that the workforce is as reflective as possible at all levels of the Trust. Given that the majority of the workforce is ‘local’, we also work with the Local Strategic Partnerships of each borough to ensure that social inclusion and health indicators are progressed within the workforce as this will influence the population as a whole. The Trust seeks to engage with third sector and community groups and has established links with the Local Authorities and its partners. The views of the local community are important to us and with this in mind we are seeking to obtain feedback on Trust initiatives on the equality and diversity agenda. Equality Impact Assessment (EqIA) is the process by which organisations examine their activities in order to minimise the potential for discrimination. The Trust carries out the EqIA process on an annual basis across all services. During 2009, the organisation adopted the North West SHA’s 5 year Equality and Diversity Strategy – “Narrowing the Gaps”. The strategy has a number of goals within whereby you develop, achieve and/or are excellent. We are at a ‘developmental’ stage with plans to be achieving during 2010/11.


CHS Annual Report 09/10

Social and Community Responsibilities as a Local Employer We continue to take forward initiatives to promote the organisation as a local employer and to reduce worklessness in the local area. The average figure for both Boroughs for those seeking Jobseekers Allowance in January 2010 was 5.9%, with a comparative North West regional figure of 4.9%. The Recruitment Team continue to work in partnership with a range of agencies in supporting local people into employment by facilitating opportunities for pre-employment work placements, Modern Apprenticeships, student placements via the local colleges to complement formal qualifications and studies being undertaken, voluntary work and local outreach work with schools to support school leavers entering the workplace. Going forward, the Recruitment Team will be working to incorporate actions from the Single Equality Scheme Action Plan to encourage applications from its Equality Target Groups. A key part of this will include continuing to promote the Trust as an organisation which welcomes applications from disabled candidates through the ‘Two Ticks’ Positive about Disabled People Scheme, and by promoting the ‘Access to Work’ Scheme to disabled applicants for support with securing employment. It has been and will continue to develop working towards the ‘Mindful Employer’ Charter in showing a positive and enabling attitude towards job applicants with mental health issues, and has been working towards application of the principles of Valuing People Now: A New Three Year Strategy for People with Learning Disabilities, in seeking to develop flexible support systems designed to help people with Learning Disabilities into employment. ‘Pennies from Heaven’ A scheme that enables staff to donate to a chosen Charity directly from their monthly pay. We are committed to assisting charities within the communities we serve. A charity is voted for by staff on an annual basis. The chosen charity for 2009/10 was Halton Haven Hospice in Runcorn.

“Going forward, the Recruitment Team will be working to incorporate actions from the Single Equality Scheme Action Plan to encourage applications from its Equality Target Groups.”



Financial overview 2009 - 2010 The Primary Care Trust reported a financial surplus of £0.3m for the financial year 2009 - 2010 against an overall budget of £579m; within these corporate figures Community Health Services contributed a surplus position of £1.4m against a contractual value with the PCT of £43.3m. Included within CHS’ headline figures is the successful achievement of a 3% efficiency programme and a real increase in income of £2m. These results have been delivered in a year where there has been a number of significant operational challenges facing budget holders, e.g. flu pandemic, winter weather conditions, to name just a couple. Thanks on behalf of the finance team to all staff who have contributed through their management of resources to deliver this financial surplus. Other financial headlines reported by the PCT include £2m investment in capital projects, a balanced cash position and 85.6% of all trade invoices paid within 30 days. Total turnover including income from other sources, together with CHS’ share of corporate overheads shows an in year increase of £3.5m to £61m and reflects the increased service provision provided to PCTs and organisations within the local economy. Nearly £42m (69%) of this income figure has been spent on pay costs with the balance of £19m (31%) spent on non pay and sub contractual arrangements with other organisations. The outlook for 2010 - 2011 is extremely challenging as the NHS as a whole looks to review costs in order to meet national targets. All organisations will be required to realise efficiency savings in line with QIPP (Quality, Innovation, Productivity, Prevention) plans in order to achieve the 2010 - 2011 financial targets. Effective cost management and resource utilisation will be fundamental in ensuring that organisations achieve their financial targets.


CHS Annual Report 09/10

“The outlook for 2010 - 2011 is extremely challenging as the NHS as a whole looks to review costs in order to meet national targets.� 31


Future direction of travel The 2010 - 2011 NHS Operating Framework, issued by the Department of Health in December 2009, required all Primary Care Trusts to make a decision regarding the future organisational form of local community services by March 2010. In order to be in a position to make the best decision for the people of Halton and St Helens, an engagement process took place during February 2010 in order to inform the Board’s decision. The process adopted was to invite potential local providers to “pitch” for services and describe how services and health outcomes would be improved for the populations of Halton and St Helens. A number of providers presented their ideas resulting in the NHS Halton and St Helens Board holding an extraordinary meeting on 8th March 2010 to consider the various options presented by potential providers. The Board fully appreciated the overall strength of the providers, but additionally recognised that they have differing relative strengths. The Board also recognised the value of strong community services and in particular the contribution that the Trust’s own provider arm of Community Health Services has made to developing and delivering high quality services. The Board wish to maintain and build on this commitment by staff whilst unlocking the potential benefits to both patients and the system as a whole that an integrated approach to service delivery along patient pathways brings. It was therefore agreed that the option with the greatest potential for transformational change and significantly improving quality, effectiveness and productivity would be a pathway specific allocation of services. Please see the table on the following page. This option is most closely aligned to the Department of Health and Strategic Health Authority guidance. However, the Board accepted that this would not be the case for all 68 services currently provided by Community Health Services and therefore some excluded services will be dealt with separately on a case by case basis. This means CHS will no longer be a stand-alone provider, and that community services will be delivered instead by other health and Local Authority providers. This process of change is expected to be implemented by March 2011.


CHS Annual Report 09/10

TCS Pathway


Health and Wellbeing

Halton Borough Council (HBC) &

Children and Families

HBC & SHBC (except community midwifery, community paediatrice and audiology which would integrate better

Acute Care Closer to Home

Secondary Providers (St Helens and Knowsley NHS Trust and Warrington and Halton FT) (will be required to work closely with primary care providers to integrate

Rehab and LTNC


Long Term Conditions

Secondary Providers (will be required to work closely with primary care providers to integrate

End of Life Care

Hospices (Halton Haven and willow-

Mental Health

5 Boroughs Partnership

Third Sector The panel recognised the strength and added value of the third sector locally. In recognition of this it was agreed that the lead contractors identified as the first preference will be required to ensure that an agreed percentage of the contract value will be delivered by local third sector providers.

The service specifications for the pathways will be refined ahead of March 2011 and will ensure that, where applicable, patient choice is strengthened and the GP gatekeeper function maintained. Next steps Communication plan It is necessary to ensure that there is a robust and effective communications plan with staff, patients, public, stakeholders, MPs and all other relevant parties. This communication plan will be in effect for the entire period leading up to implementation of the final definitive model in March 2011. NHS North West Following approval from the Board on the preferred option, this was submitted to NHS North West in March 2010. The Strategic Health Authority (SHA) will then evaluate the proposals to ensure that they satisfy the assurance tests set by the Department of Health. NHS North West is responsible for ensuring proposals, for transactions that are reviewable under the Principles and Rules for Co-operation and Competition (PRCC), benefit patients and taxpayers. Once the SHA has undertaken the assurance process in order to ascertain that this is the case, the Co-operation and Competition Panel (CCP) will asses the consistency of the transaction with the merger and vertical integration provisions in the PRCC.



Co-operation and Competition Panel and Transactions Board As the Trust’s proposals include vertical integration models with the acute sector and horizontal integration with Practice Based Commissioning (PBC) and Local Authority, it will be necessary for the CCP to formally review the proposals before the PCT is able to progress any transaction. The CCP will undertake a review to ensure that the proposals are compliant with the PRCC (specifically principle 9 which deals with horizontal mergers and principle 10 which deals with vertical integration). Vertical integration is permissible under the PRCC when demonstrated to be in patient and taxpayers’ best interests and protects the primacy of the GP gatekeeper function; and there remains sufficient choice and competition to ensure high quality standards of care and value for money. Duty to consult Mergers always require consultation and as the proposals represent a significant change in who will be providing services it will be necessary to ensure that our obligations under Section 242 are discharged. Overview and Scrutiny Committees We have a legal obligation to consult with our local Overview and Scrutiny Committees when there are to be significant changes to the provision or commissioning of services. St Helens Overview and Scrutiny Committee (OSC) received a presentation on the options available on 5th March 2010. The Halton OSC received a presentation on 9th March which indicated the Board’s approved proposal. NHS Constitution It is also essential that the Trust has regard for the NHS Constitution in all it does both in terms of its duty to the public and to the staff currently employed. Other checks There will be a range of checks that the PCT will be required to undertake, including, but not limited to: –– Monitor (the Foundation Trusts regulator) to provide assurance that proposals are permissible within the Terms of Authorisation for Foundation Trusts –– NHS Litigation Authority to be notified of staffing and service changes as part of 2011- 2012 contributions –– Information Technology and data transfer compliance with Data Protection and Caldicott


CHS Annual Report 09/10

Detailed specifications As the consultation exercises progress, the PCT will develop robust service specifications so that the public can be assured that these proposals will result in improved, measurable health outcomes through seamless pathways of care. The specifications will be developed and approved by the Clinical Executive Committee which will be responsible for ensuring that the specifications take account of Quality, Innovation, Prevention and Productivity. It is also necessary to ensure that the quality and safety of patient services is not compromised in any way during the transitional period. Principle 10 of the PRCC which deals with vertical integration requires commissioners to ensure that there are sufficient safeguards in the contract to mitigate against inappropriate referrals. Before agreeing to any vertical integration activity, commissioners should also consider the degree of patient choice that will be present after the change is made. As specifications are being developed a performance framework will be established and the preferred providers will be fully appraised of the Trust’s expectations throughout the transitional period and prior to the final sign off of any contracts. Successful completion of contract negotiations The proposals engage the provisions of Clause 49 of the NHS Contract regarding change in control and also Clause 53 in respect of Conflicts of Interest. No transaction can take place until the due diligence process has been completed and the Competition Panel agree that the Trust can formally proceed. If during the due diligence process on the preferred option the Trust is unable to agree the necessary quality and productivity standards for a particular service or group of services with its preferred provider then the Trust will revert to a competitive process for those services. Capable of realising this by March 2011 The PCT will regularly review progress on implementation to ensure that the proposals are deliverable within the required timeframe. The PCT will ensure that the proposals remain deliverable under a range of financial scenarios. A transitional plan will be developed which will take account of the absolute imperative to deliver the change (or make significant progress towards it) by March 2011. Other issues Work is progressing on the rationalisation of the workforce required to support the commissioning function. It will be necessary to consider the options for the continued employment of practice nurses, salaried GPs and other members of staff for whom employment by a clinical provider will be most beneficial to the patient. The PCT is also working with the Local Improvement Finance Trust (LIFT) partners to develop an estates strategy for implementing these changes based on the requirements of the Commissioners’ Investment and Asset Management Strategy (CIAMS). This will identify opportunities for the local health economy and wider public sector to maximise estates utilisation. The Community Health Services management team and Commissioners will work jointly during the transition period to ensure we support staff in this time of significant change. We have excellent staff in the CHS, who are committed, highly skilled and who we know will continue to deliver the high quality services to the people of Halton and St Helens. This is one of the most significant changes that has been proposed for community services and we need to ensure that we involve all stakeholders fully throughout the process. 35

Community Health Services NHS Halton and St Helens Cowley Hill Lane St Helens Merseyside WA10 2AP (01744) 457 221

This leaflet can be produced in alternative languages or formats upon request. Please contact us on the number above to arrange this.


CHS Annual Report 09/10

Community Health Services_Annual Report_09/10  

Annual Report