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Contents Welcome

2

All about us

3

NHS Kirklees - a commissioning organisation

4

Working with our partners

6

Improving health for all

6

Improving our services

8

Listening to you

10

Risk management

14

Emergency planning

14

Primary care developments

15

Valuing our staff

16

Our new headquarters – a positive impact on the environment

18

Our directorates and the Board

19

Director of Finance’s report

20

Remuneration report

26

Declarations of interest

29

Statements

30

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NHS KIRKLEES annual report and summary financial statements 2009|10

Welcome Welcome to the fourth annual report for NHS Kirklees. Since the Primary Care Trust was formed in October 2006 we have made measurable progress in improving the performance of the local NHS here in Kirklees and in 2008/09 the quality of services as assessed by the Care Quality Commission were judged to be ‘good’. Our role is to ensure that high quality, safe and responsive health services are provided for local people when they need them and to improve the health of our local population by supporting people to adopt healthy lifestyles and reduce the health inequalities that exist across Kirklees. In 2008/09 we published our first five year strategic plan which sets out our plans and priorities up to 2014. During 2009/10 we have continued to make good progress in delivering these plans and we are pleased to share some of these achievements in this report. There are many factors that affect people’s health and we know that we cannot deliver all of this on our own. We continue to enjoy strong and productive partnerships with Kirklees Council, our main provider organisations, other public sector organisations, the voluntary sector and the business community. Another key factor in our success is the close working relationship we have with local doctors, nurses and other health care professionals which has contributed to our success. It is important we listen and respond to what local people are telling us and later in this report there are some examples of how we have involved you in evaluating and changing services. Our achievements have only been made possible by our dedicated staff who work hard to ensure that we use the resources provided to us in the best possible way and that what we do makes a difference. We are proud of our achievements and pleased to report these to you.

Rob Napier Chairman

Mike Potts Chief Executive

David Anderson Chair Professional Executive Committee

Our achievements have only been possible by our dedicated staff who work hard to ensure that we use the resources provided to us in the best possible way and that what we do makes a difference.


All about us

NHS Kirklees covers a population of both urban and rural communities with a total population of nearly 425,000 (Family Health Services, 2006). Of that population a quarter are aged under 19 and a quarter are aged over 65 years. By 2025, the population is predicted to increase by 7%. This is mainly in those aged over 65 years. Kirklees has pockets of relative deprivation for both children and older people. This is generally concentrated in and around Huddersfield town centre and Dewsbury in particular. Across Kirklees 27% of children aged 0 -15 years were classed as living in poverty and 21% of those aged over 65 years. Kirklees has a diverse ethnic mix, with a higher proportion of the population coming from ethnic minorities than for England as a whole. Ethnicities

present in Kirklees include those of Pakistani origin, Indian origin and African-Caribbean origin but the largest group remains of white origin. Many of the people living within our boundaries identify closely with the locality in which they live, rather than with Kirklees as a whole. Together with Kirklees Council, we recognise this by working in partnership in the seven distinct localities that make up the district. These localities are: • The Valleys • Huddersfield North • Huddersfield South • Denby Dale and Kirkburton • Dewsbury and Mirfield • Spenborough • Batley, Birstall and Birkenshaw.

Cleckheaton Batley Heckmondwike

Dewsbury Mirfield Ravensthorpe

Huddersfield Kirkburton

Slaithwaite Honley

Marsden Meltham

Holmfirth

Denby Dale

We are committed to working in partnership because we know that this is the way to achieve real success for Kirklees. In particular, we have a strong relationship with Kirklees Council, including a joint Director of Public Health and other shared posts.

This partnership is helping us to focus our attention on improving health and reducing health inequalities that exist across Kirklees. We also work with other key stakeholders such as Calderdale and Huddersfield NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust and the South West Yorkshire Partnership NHS Foundation Trust, as well as the community and voluntary sectors.

Our vision and values

Working together to achieve the best health and well-being for all the people of Kirklees. • Recognising that people are at the heart of everything we do; • Supporting people in taking responsibility for their own health and well-being; • Encouraging innovation and continuous improvement and celebrate the contribution made by our staff; • Encouraging open, clear and honest communication; • Valuing diversity and challenge discrimination; • Showing understanding, dignity and respect for all our clients, partners and staff; and • Being accountable for the decisions we make, the work we do, the resources we use and our impact on the environment. NHS KIRKLEES annual report and summary financial statements 2009|10

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NHS Kirklees

A commissioning organisation

NHS Kirklees is responsible for improving the health and well being of local people and making sure that services are in place to meet your needs. We commission services from others, including GPs, dentists, pharmacists, opticians, voluntary organisations and local and specialist hospitals. We are accountable for making sure that these services are accessible, high quality and safe. So that we understand your needs we need to: • have a good understanding of public expectations and political drivers • have active engagement with local people • involve clinical leaders in assessing local needs and shaping priorities. Other key factors which drive our strategic decision making are the national and local priorities, local population characteristics and needs as shown in the Joint Strategic Needs Assessment (JSNA). The process for developing the JSNA has enabled us to identify key issues for specific populations such as people with disabilities, women of child bearing age and older people. It also looks at conditions such as heart disease, stroke, obesity, diabetes and dementia as well as wider living and working factors including employment, housing and educational attainment and personal behaviours such as smoking, alcohol, food and nutrition. We are proud of our achievements and can demonstrate how we have made and are continuing to make progress against the priorities identified last year. We have commissioned a range of new services to respond to the needs of our population for example:

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• an adult weight management service • a range of services to address the growing problem of alcohol misuse, ranging from services in primary care to specialist alcohol treatment services • services to support people with long term conditions, including the introduction of a new primary care based system that will let us identify those people most at risk of worsening health in the future so we can take action to support them • further developments in telehealth and telecare that will improve our ability to deliver services and support people in their own homes and to let them take more control over managing their own care. In addition to these new services, we have reviewed and improved existing services, for example, services for people with breathing problems and mental health services for children and young people. However, there still remains more to do. In particular we face significant challenges around managing our money and meeting increasing performance targets. To address these, we will focus on commissioning services to meet our four strategic goals, which are:

NHS KIRKLEES annual report and summary financial statements 2009|10

Goal 1

Goal 3

Raise male and female life expectancy at birth so that it is not significantly below the national average in any part of Kirklees.

Target individuals and populations to tackle health and well being inequalities, focusing on the priority issues identified locally. Provide advice, support and care to these individuals, families and communities, in the form of high quality targeted interventions known to work, to increase the control they have over their own health and wellbeing.

Goal 2 Improve health outcomes for children and young people, working in partnership to improve life chances and safeguard children.


Kirklees Community Healthcare Services Kirklees Community Healthcare Services (KCHS) is the part of NHS Kirklees responsible for providing services directly to patients. In common with the rest of the country the provider and commissioning arms are separating to increase transparency and accountability. KCHS is now in a contractual relationship with NHS Kirklees. KCHS provide community services such as district nursing, health visiting, school nursing, therapy services, chlamydia screening and stop smoking support across Kirklees. The majority of care takes place in patient’s homes, with services able to respond to each persons unique circumstances. Services provided by KCHS extend to include the provision of ward based care in Holme Valley Hospital and intermediate care in partnership with nursing homes throughout Kirklees. Minor surgical procedures are also carried out in Holme Valley Hospital, Dewsbury Health Centre and Moorfields Primary Care Centre.

Goal 4 Empower those people in Kirklees with a long term condition to exercise control over their own lives and be central to the decision making about their own care, so preventing problems arising or worsening and enabling them to independently manage their own health and well being.

As a new and vibrant organisation, KCHS has concentrated on providing the best quality care, whilst using technology to allow it to be as efficient and productive as possible. KCHS has tried to capture its very essence by choosing ‘Caring for you, locally’ as its motto. These words describe the strengths: experience in delivering first class healthcare and vast local knowledge.

Over the last year KCHS has concentrated on delivering the following: • making sure that the organisation constantly improves services and that safety and quality are at the centre of everything we do. • rolling out an ambitious programme of mobile technology to allow front line services to have immediate access to all their clinical records in patient’s homes. This is one of the largest uses of this technology in the country. • working very closely with partners, in particular in social care, to make sure a seamless service is provided, reducing duplication and improving efficiency. • empowering service and clinical leaders to take more decisions based on the health needs they are dealing with, making sure the interests of the patient are best served. The pace of change for community services continues, and by making sure the patient remains at the centre of everything, KCHS will be well placed to provide the best and most cost effective services.

KCHS has tried to capture its very essence by choosing ‘Caring for you, locally’ as its motto. These words describe the strengths: experience in delivering first class healthcare and vast local knowledge.

NHS KIRKLEES annual report and summary financial statements 2009|10

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Working with our partners Our work with the Kirklees Partnership has enabled the delivery of a joint Sustainable Community Strategy which covers the period 2009 – 2012. This sets out the strategic direction and long term vision for Kirklees. The aim is to promote the social, economic and environmental well-being of the area. The overarching vision for this strategy is: By 2020 Kirklees is recognised in West Yorkshire and beyond as an area of major success. Its strong economy is supported by an attractive, high quality environment, offering the best of rural and urban living. Partners such as the council, the NHS, the police and others need to focus on the following five themes: • educational attainment • low skills and low wage economy

• low confidence in some of our towns

Improving health for all Health inequalities is how we describe the differences in health and life expectancy between different groups of people in Kirklees. These have the potential to be changed and one of the main aims of NHS Kirklees is to reduce these differences. For example: • if you are a man in Dewsbury you are likely to live 4.9 years less than a man in Holme Valley • if you are a woman in Batley you are likely to live 4.1 years less than a woman in Holme Valley • seven in ten of people with heart disease or pain were overweight compared to three in ten people who did not have these problems. This is far worse than it was in 2005

• one in three of people aged 18-24 smoke compared with one in nine of those aged over 65 • six in ten of new local cases of lung cancer were in women aged under 65 which is higher than the national figure • People with a physical disability were seven times more likely to feel cut off from others than adults overall.

• community relations.

• infant mortality and health inequalities The Local Area Agreement (LAA) focuses partnership working on those priorities which matter most to Kirklees and the partnership. These are grouped into the four themes of partnership working:

1 2

children and young people safer stronger communities

3 4

healthier communities and adults economic development and the environment.

We also have joint commissioning strategies in place for mental health, learning disabilities, older people and long term conditions, as well as health inequalities and health behaviours.

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NHS KIRKLEES annual report and summary financial statements 2009|10

NHS Kirklees and Kirklees Council has used this type of information to develop our Joint Strategic Needs Assessment that tells us what different health needs are across Kirklees

www.kirklees.nhs.uk/fileadmin/ documents/About_Us/FINAL_Report_ JSNA.pdf This is available as either a summary or full version.


Rates of death from all cancers have improved and remain better than the national rate.

NHS Kirklees works with partners such as hospitals, community services, the council, the police and voluntary sectors to improve our health priorities. Examples of this include: Stroke We are trying to reduce the impact of stroke on local people by: • increasing widespread awareness of the signs of stroke

The table below shows our priorities for improving health locally: For adults Who are our target groups?

• Young adults (18-44), particularly women • Older people • People with disabilities • Improving emotional well-being Being healthy – • Reducing obesity what areas of health are we trying • Helping people to reduce and mange their pain to improve? • Dementia • Reducing the rates of heart disease and stroke • Reducing the rates of diabetes Personal behaviours • Improve our diet so we eat healthily • Reduce our alcohol intake – what do we do • Stop smoking that can help improve our health • Be more physically active

Living and working – what are the other factors that we know affect health

For children and young people • People with learning disabilities

• making sure that care is delivered promptly in the right place so it is effective in reducing the impact of a stroke • preventing a stroke by identifying and supporting people who have risk factors and helping people to learn how to control them.

Women of child bearing age • Reducing the rates of infant mortality • Improving emotional well-being • Reducing obesity

• working with women of child bearing age who smoke, particularly in Batley and Dewsbury localities • providing early support in pregnancy for clinical, health and social issues • action to support good nutrition for women before, during and after pregnancy. These activities are crucial in reducing infant deaths, improving infant and family health and reducing smoking related disease in women.

• • • •

• • Housing affordability and adequacy – • being able to have a home • • Employment and income – having a job and money • • Isolation and social networks – having friends and support • Educational attainment and skills – having qualifications and skills that help you to find a job

Improve our diet so we eat healthily Stop smoking Be more physically active Reduce the number of teenage pregnancies Improve sexual health Improving educational attainment Being unhappy and not having friends and family Making children safe and protecting them from harm - safeguarding (child protection)

In this report you will be able to read about these and other issues and the ways in which we are working to improve the health of local people.

Some of the health improvements we have seen since 2008/09 include: • rates of death from all cancers have improved and remain better than the national rate • over 2,000 people in Kirklees have successfully stopped smoking • Kirklees schools all participate in the National Healthy Schools programme with 77% achieving the status by December 2009.

NHS KIRKLEES annual report and summary financial statements 2009|10

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Improving our services

Long term conditions and intermediate care “The Department of Health strategy for long term conditions aims to put people with long term conditions at the centre of decision making about their own care. In this way, they will personalise the services they need so they are truly supported to live life as they want” Department of Health, 2010 We are committed to delivering high quality services for people with long term conditions (LTC). In the last year we have built upon our 2008/09 achievements and continue to improve services for the people of Kirklees.

NHS Kirklees is committed to continually improving the quality of services we provide for you. We work with all of our providers to give you more information and choice about the services we offer.

What we have achieved

Quality boards have been formed with all our main providers so that we can be confident that we are commissioning and delivering safe and effective services for you. The boards are led by, for example, medical and nursing directors from each organisation and clinical representatives from primary care.

We have re-designed existing long term conditions services and further developed a number of these to provide care which is more suitable for people’s individual needs. These include:

• set priorities for continuous quality improvement

• a new discharge service for people with chronic obstructive pulmonary disease (COPD - that causes breathing problems) which lets people go home from hospital early has been introduced. This will provide people with specialist support at home for up to 14 days

• monitor the delivery of national quality standards.

• family and carers support service for people and their carers following a stroke

The aims of the boards are to: • identify quality priorities • make sure regional quality indicators are achieved • identify and monitor core quality standards

NHS Kirklees has made significant progress over the last 12 months to improve the quality of our commissioned services. Some of our achievements are opposite.

• round the clock staff who provide support for health or social care needs • registered health or social care staff to help stop people having to go into hospital and, where they do, make sure they can come home as early as possible • assistive technology – this is new equipment that helps health care professionals and their patients share information. It monitors health to improve care and helps people care for themselves better. One hundred of these devices have been issued across Kirklees • the introduction of a tool which can predict the risk of future hospital admissions and provides data on the use of current services. This will help us to make valuable decisions about the services and support that local people need • improvement of service quality and safety for patients in Kirklees which will focus on the prevention of hospital admissions, enabling people to be cared for out of hospital, and the improvement of self care • make sure that the services we commission are what patients want and receive. We will provide individual care plans which help people to reach their full potential and meet their personal goals.

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NHS KIRKLEES annual report and summary financial statements 2009|10


Intermediate care services Intermediate care is what we call a range of integrated services that: • promote faster recovery from illness • prevent you from going in to hospital unnecessarily • support timely discharge when you do go into hospital • maximise independent living. These services are mostly, but not solely, used by older people. The idea behind them is that they bridge the gap between hospital and home so that you recover faster and can cope on your own more easily.

What we have achieved: • A single point of contact has been established: one telephone number that clinicians can ring to gain access to support and advice about services available. There is a clinical lead who deals with all requests as well as delivering more individual assessments to make sure the correct package of care is delivered for each person • During the year, working in partnership with Kirklees Council, the South West Yorkshire Partnership Foundation Trust, Dementia UK and the Alzheimer’s Society has meant that Kirklees will have its first ever admiral nurses - specialist nurses who will support individuals with dementia and their carers • The development of the Kirklees Dementia Strategy and implementation plan to make sure that our health and social care services are ready for future challenges. This recognises the importance of carers and raising levels of awareness amongst the wider population of the major role carers play in the lives of their loved ones • Linked with carers and so many other areas of work across both health and social care is the developing End of Life Care Strategy. Most importantly, the strategy recognises the fact that we have only one chance to get things right at the end of life and this must be the ambition we strive to achieve.

Learning disabilities We have worked with both our specialist health service, and social care providers to improve our learning disability services.

What we have achieved During 2009/10 NHS Kirklees has commissioned new service developments, including: • learning disability health action plans • vulnerable In-Patient (VIP) cards • specialist respite services • enhanced primary care services • new low secure service provision. We have also improved our learning disability low secure forensic services for local people by reviewing existing services, criteria, working practices, referral patterns, average lengths of stay and revised Department of Health forensic guidance.

Mental health NHS Kirklees has worked with partner agencies to find ways of working together to achieve better outcomes for our patients. Existing partnerships such as those with Kirklees Council and specialist mental health providers have remained strong. We have also explored other forms of partnership working such as those involving the independent and not for profit sectors.

What we have achieved During 2009/10 we have developed our mental health services to make sure they are appropriate for local people whatever their age. We have also commissioned a number of new service developments, including: • community service for adults with attention deficit and hyperactivity disorder (ADHD)

More information about our future plans can be found in the Joint Mental Health Commissioning Strategy 2008-2011 www.kirklees.nhs.uk/fileadmin/documents/ publications/Kirklees_Joint_Mental_Health_ Commissioning_Strategy_-_2008.pdf which is based on both national guidance and the local needs assessment.

• community eating disorder service • primary care mental health service. NHS KIRKLEES annual report and summary financial statements 2009|10

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Listening to you

Public consultations During 2009/10 NHS Kirklees consulted on:

Holme Valley Memorial Hospital (HVMH)

The Mid Yorkshire Service Strategy Proposals for changes to services in Mid Yorkshire stemmed from the best clinical evidence, feedback and views previously gained from local people, new national guidelines and information from the national NHS review led by Lord Darzi. The changes proposed were to ensure that the three hospitals that make up The Mid Yorkshire Hospital’s NHS Trust functioned in the best possible way, to provide the best possible care for patients and to help us respond to the changes that we expect to see in healthcare over the coming years.

As the local leader of the NHS we want to make sure that all NHS services used by you are of the best possible quality. By working together we make sure that everyone benefits from improved healthcare. It means putting patients at the centre of all we do in the health service. This includes involving patients and the public in:

Following the outcome of the public consultation, the partnership board has supported the development of dedicated specialist centres for neonatal intensive care, children’s inpatient surgery and inpatient orthopaedic trauma. These will open at the new Pinderfields Hospital, when it fully opens in 2011. A consultation on developing specialist hospital services for mid Yorkshire Summary document NHS Kirklees

The Mid Yorkshire Hospitals

• sharing your ideas and experiences

NHS Trust

NHS Wakefield District

August 2009

• identifying what you want from services • making sure you understand our plans, and why services need to be changed, so that we make the best use of our resources. 10

NHS KIRKLEES annual report and summary financial statements 2009|10

Proposals to improve the facilities at HVMH are part of NHS Kirklees’ aim to provide patient centred care closer to home. Proposals to improve the facilities and range of services at HVMH include: • a ward with 20 beds for patients who have to stay in hospital * • facilities for minor surgical procedures • physiotherapy • podiatry

Shaping services

at Holme Valley Memorial Hospital

• outpatients appointments • diagnostic tests and imaging including x-ray, ultrasound, electrocardiogram (ECG) and blood tests • intravenous therapies such as chemotherapy • specialist community dental services for clients who are unable to access regular dental services. * these services are already provided at Holme Valley Memorial Hospital. Consultation events took place over the summer months and we are developing the business case to secure funding to take this project forward. By making these changes we will get the best possible clinical outcomes for our patients.

By working together we make sure that everyone benefits from improved healthcare. It means putting patients at the centre of all we do in the health service.


Patient experience In 2009/10 NHS Kirklees looked at new ways to get information and work with local people to find out what they thought about us as an organisation and what they thought about health services in the area. The Comments Campervan is a mobile diary room where people can go to give their comments on the services provided by NHS Kirklees. The van attended several public events in 2009 so that we could get the opinions of Kirklees residents to improve your understanding of our role in improving local services. We also held a number of patient discussion groups with: • people who had had a hip replacement in the previous three to six months. They had the opportunity to share experiences of their journey, including before surgery, the referral, surgery and recovery • people who experience persistent pain conditions i.e. lasting longer than three to six months and who are not responding to standard treatment. These activities have given us greater understanding of patient’s experiences of services. The information has been used to improve care services for patients suffering from long term pain.

How we used what you told us Attention deficit hyperactivity disorders (ADHD) service You said Through consultation with parents, carers, children and young people we found out that they wanted well-timed and up-to-date information about ADHD, quick and easy access to services, parenting support, practical advice and coping strategies, an out of hours crisis contact number covering weekends and clarity about the roles and responsibilities of the different team members and agencies involved in ADHD service provision. Children and young people wanted to be listened to and their views about ADHD and the treatment options to be taken into account. They wanted school staff to have training on how to support pupils with ADHD, and to receive appointments via SMS text or email with reminders about appointments. They wanted follow up or contact sessions to be carried out over the phone where appropriate and a young persons support group where they could meet with other young people experiencing ADHD. Parents and carers requested coordinated and organised care plans for the child/young person which incorporated school and home based interventions, to be listened to, be encouraged for getting things right, and the service delivered in community locations closer to home.

We did We have re-designed the ADHD service to include the things children, young people and families told us they wanted. We developed our service specification so that: • services are delivered close to home in local children’s centres • a range of parenting programmes will be offered to all parents and carers • a training programme will be rolled out so that schools and others will be more informed and able to manage children and young people with ADHD • a twice weekly drop-in session for families needing crisis support • appointments are co-ordinated around the lives of children, young people and their families • all children and young people will receive a comprehensive assessment and treatment service.

NHS KIRKLEES annual report and summary financial statements 2009|10

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Kirklees Drug and Alcohol Action Team

Adult weight management service You said We consulted with health practitioners, adult service users and our adult target group about weight management and found the following:

Health practitioners:

Pilot diabetes expert patient programme A health needs assessment conducted in the Birkby and Fartown areas of the Huddersfield North locality identified a high prevalence of diabetes among the South Asian community. Further consultation with community individuals and local health care professionals identified a lack of understanding about diabetes prevention, management and the services available to support self care.

You said You wanted more support to increase your understanding of diabetes and what you can do to improve our health.

We did We set up a project to increase awareness of diabetes and improve self care skills. Part of this project involved piloting a diabetes specific expert patient programme aimed at the South Asian community.

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• men feel uncomfortable talking about the issue and taking action • patients are more likely to use weight management programmes if they can afford to • health care workers or peers may be better placed to motivate patients • people are not aware of all of the services that exist and different ways in which people can manage their weight.

Adult service users: • most often use commercial weight management programmes such as Weight Watchers, Slimming World and other methods of self help

• were turned off by attending hospital based weight management services as it felt impersonal • men perceive weight management services as inappropriate and wanted materials targeted at them.

We did We identified and approached key stakeholders to form an Expert Reference Group to shape the redesign of weight management provision. Throughout the process there was full clinical engagement. This group used the insight received from health practitioners, adult service users and our adult target group as a starting point for the review and re-design process. A ‘Healthy Weight 4 Kirklees’ public website was introduced, providing the people of Kirklees with a one stop shop of information about the Kirklees Adult Weight Management Service, what’s new, other local services, and where to get more information for themselves and their children.

You said Alcohol misuse and associated problems are a significant issue in Kirklees where over a third of Kirklees adults drink at levels that are placing their health at risk. Consultation with patients and the public identified that they want an alcohol treatment service that is easily accessible and separate from drug services.

We did NHS Kirklees secured Neighbourhood Renewal Funding that went on to fund two specialist alcohol workers and an alcohol nurse. The funding also supported the Kirklees Partnership to develop the Kirklees Alcohol Strategy (2007 – 2010).

• their awareness of NHS services was low but there was a very high demand for programmes offered through the NHS • a lack of time and the cost of attending formal weight management activities are major barriers to attempting to lose weight.

The adult target group: • were put off services by the humiliation of the ‘weigh-in’ and the people attending who were not seen as very overweight • found cost was a barrier to them attending weight management programmes

NHS KIRKLEES annual report and summary financial statements 2009|10

For further and more detailed information on public consultations and patient experience, please refer to the Patient and Public Involvement Annual Report 2009/10 at www.kirklees.nhs.uk/get-involved/ patient-public-involvement/


What happens when you have problems NHS Kirklees welcomes and values any comments or suggestions on your healthcare services. We can learn from these and make improvements for you.

NHS Kirklees

We will respond to any complaints we may receive with the aim of making system or service changes to improve your experiences. We have a dedicated Patient Advice and Liaison Service (PALS) who help and advise on resolving any difficulties you may have.

Exceptional case funding requests

In 2009/10 NHS Kirklees handled 61 complaints. The table shows a breakdown of these complaints:

Antiviral collection service during the swine flu outbreak Commissioning Diabetic screening Freedom of information Health centre parking Immunisations

1 6 3 2 2 1 1

Kirklees Community Health Services (KCHS) Contraception and sexual health Community dentistry District nursing Health visiting and school nursing Podiatry Phlebotomy Therapy services Walk-in centre

5 14 5 6 2 2 8 3

We always try to learn and improve as a result, so all comments, complaints and compliments give us useful feedback on services to change things for the future. Here are a few examples where we have done this: • Kirklees Community Health Services have reviewed all baby assessment centres • NHS Kirklees have reviewed parking policies with a view to increasing availability for patient parking at Cleckheaton Health Centre • continuing healthcare and care planning training is to be given to staff and service users • within community dental services, clinics must now to notify patients of cancellations both in writing and by telephone.

We aim to learn from complaints and improve those services. When looking into complaints raised by individuals, NHS Kirklees is committed to following the ‘principles for good administration’ and ‘principles for remedy’. From 1 April 2009 there has been a single approach to dealing with complaints across health and social care. It also encourages a culture that seeks and then uses people’s experiences to make services more effective, personal and safe.

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Emergency planning

Risk management This is the process that NHS Kirklees uses to make sure that it works efficiently and effectively. It means we try to anticipate problems that can happen and take action to prevent them. We aim to make sure that any problems have as little impact as possible on patients, staff and services.

policies that have an impact on data security and undertaken work to make sure all our computers and memory sticks are encrypted to protect any information that is held by NHS Kirklees. However we have had one data security incident this year which was reported as a serious untoward incident. This was investigated and successfully resolved with no adverse effect on patients.

All staff have regular training in health and safety, fire, infection control and how to manage aggressive situations. We also have an incident reporting system in place which helps monitor any trends in accidents or incidents and take action to minimise the likelihood or prevent such things happening again.

We have made sure that our new headquarters building has good security systems in place to protect staff and visitors.

Our risk management team report incidents nationally to the National Patient Safety Agency and to the Counter Fraud and Security Management Service so that we can see how we perform compared with other similar organisations.

During 2009/10 we have developed our Patient Safety Strategy to make sure that patient safety is seen as everyone’s responsibility.

An important area which we have been working on in 2009/10 is data security. We have reviewed all our 14

NHS Kirklees has maintained its Royal Society for the Prevention of Accidents bronze award and this year received the silver award.

The Governance Committee is the board sub committee that oversees these key risk areas and reports to NHS Kirklees Board.

NHS KIRKLEES annual report and summary financial statements 2009|10

In 2009 NHS Kirklees and its partner agencies were faced with the global swine flu pandemic and our experience gained from years of emergency planning, preparation and training, helped us to respond effectively to this emergency.

NHS Kirklees is not complacent. Planning and testing of emergency preparedness will continue to make sure we respond effectively to future threats or other pandemic viruses.

We led a highly successful local multi-agency response to pandemic flu (H1N1) to lessen the local impact of this pandemic across Kirklees. This included managing a complex outbreak in Dewsbury involving different groups of people and settings.

Having established effective control systems to address the initial impact of the pandemic, NHS Kirklees mobilised staff and resources to undertake a complex vaccination programme of people most at risk from swine flu. This included essential frontline staff from health and social care. NHS Kirklees achieved the highest uptake in healthcare workers for a primary care organisation regionally at 53.6%. This was due to visible senior leadership, effective communication and a dedicated core immunisation team that was flexible in timing and the administering of the programme. NHS Kirklees is not complacent. Planning and testing of emergency preparedness will continue to make sure we respond effectively to future threats or other pandemic viruses. During the year NHS Kirklees took on the role of lead Primary Care Trust, responsible for co-ordinating emergency planning across West Yorkshire, ensuring that the NHS works effectively with other key players, for example, the police, fire and rescue service, local authorities, through the West Yorkshire Resilience Forum.


Primary care developments Nationally and locally, the NHS is changing to provide world class healthcare that is easy to access and meets the needs of each person, especially the most vulnerable and those in greatest need. Improving access to primary care is really important – so you can see a health professional at the time and place of your choice, knowing that you are receiving the best care for you and your family’s needs.

Improving access to GP services

GP and dental training practices

More than 83% of GP practices in Kirklees now offer extended hours in addition to their normal opening hours.

NHS Kirklees, NHS Yorkshire and the Humber; the Strategic Health Authority and the Yorkshire Deanery have invested a total of £800,000 to support nine GP practices and five dental practices in extending their premises to allow them to accommodate additional vocational trainees.

Last year NHS Kirklees opened a new GP practice in Dewsbury Health Centre that anyone can use offering services from 8.00am to 8.00pm each day of the year.

Access to dental services Access to emergency dental treatment out of normal working hours is available following assessment through the West Yorkshire Urgent Care Service. Patients without a dentist can access this service and receive in-hours emergency appointments at dental practices across Kirklees.

More than 83% of GP practices in Kirklees now offer extended hours in addition to their normal opening hours.

These GPs and dental vocational trainees will work with established and qualified GPs and dentists as part of their training programme. From experience it is known that many trainees when qualified remain in the area and this will help us retain newly qualified practitioners.

Quality and Outcome Framework The Quality and Outcome Framework (QOF) was introduced in April 2004 to improve patient care by rewarding GPs for quality rather than quantity of work. Since 2004 achievements in QOF points have increased and in 2008/09 the average QOF points for GP practices in Kirklees are 954.5 points with four practices achieving the full 1000 points available.

NHS KIRKLEES annual report and summary financial statements 2009|10

15


Valuing our staff As at 31 March 2010, NHS Kirklees employed 1,574 staff, of which 1,201 worked for Kirklees Community Health Care Services (KCHS). NHS Kirklees has now successfully met the criteria for Investors in People, the UK’s leading people management standard, which was awarded on 13 January 2010. Around 150 staff from across NHS Kirklees and KCHS took part in the assessment process, which included both in-depth one-to-one and group interviews. The evidence gathered was used to establish whether the aims and ambitions of senior managers are understood and being implemented by those throughout the organisation. Following the last NHS staff survey for NHS Kirklees, greater emphasis has been placed on people development through new initiatives and strengthening those already in place. This includes revising the mandatory training programme and personal development reviews. A leadership framework is also being put in place to make sure every member of staff knows what is expected of them and has the skills and support to deliver objectives.

Equality and diversity As a public sector body, NHS Kirklees has a duty to monitor its workforce on key employment indicators by ethnicity, disability status, age and gender to make sure that there is no discrimination against any of these groups. NHS Kirklees has decided to extend this to include data on sexual orientation and religion or belief. NHS Kirklees’ Diversity and Equal Opportunities in Employment Policy/ Procedure, which includes information about our disability policy can be found at

www.kirklees.nhs.uk/public-information/policies-andprocedures/employment-policies/

16

NHS KIRKLEES annual report and summary financial statements 2009|10

The equality data for employed staff as at 31 March 2010 is outlined as follows: Gender

Count

%

Male Female

138 1,436

8.8% 91.2%

Age

Count

%

Under 25 25-34 35-44 45-54 55-64 65+

52 3.3% 307 19.5% 480 30.5% 525 33.35% 198 12.58% 12 0.76%

Disability

Count

%

Yes No Not declared Undefined

52 1,291 228 3

3.3% 82% 14.5% 0.2%

Ethnicity

Count

%

White 1,428 Mixed 15 Asian/Asian 95 British Black/ Black 24 British Chinese or other 7 ethnic group Undefined 5

90.7% 0.95% 6% 1.5% 0.45% 0.3%

Sexual orientation

Count

%

Bisexual Heterosexual Gay Lesbian Not declared Undefined

1 0.06% 1,027 65.25% 2 0.13% 5 0.32% 538 34.18% 1 0.06%

Religion/belief Atheism Buddism Christianity Hinduism Islam Judaism Sikhism Other Not Declared Undefined

Count

%

108 6.86% 2 0.13% 831 52.8% 10 0.64% 57 3.62% 1 0.06% 8 0.51% 58 3.68% 498 31.64% 1 0.06%

N.B: Not declared means people would not say. Undefined means that people did not answer the question.


Sickness information From 1 April 2009 to 31 March 2010 the sickness rate for NHS Kirklees was 3.98%. This is below our target rate of 4.9% and the national NHS average of 4.4%. The Human Resources/ Organisational Development shared service works with managers to manage sickness and submit regular workforce scorecard reports to the Governance Committee. The total cost of sickness absence for 2009/10 was £1.7million.

Queen’s garden party Two lucky members of staff enjoyed a visit to Buckingham Palace after being invited to attend one of this summers royal garden parties.

NHS long service award winners

Barbara Cruddas, Receptionist at Broad Lea House, was nominated by her line manager Pat Patrice in recognition of her commitment to the organisation. Pat explained, ‘Barbara always goes beyond what she has to do – she is helpful and I don’t think people realise the hard work that she does.’

Annual staff awards 2009 The annual NHS Kirklees staff awards took place in October 2009. Over 300 staff attended the event to celebrate the long service, achievements and dedication of our colleagues across NHS Kirklees. For the first time separate awards were presented to both the commissioning and provider parts of the organisation as well as 27 members of staff who were presented with long service awards and vouchers in recognition of 25 years service to the NHS.

Sheila Dilks, Director of Patient Care and Professions, was nominated to attend the garden party in recognition of her long service to the NHS. Her career, which began in nursing has spanned 35 years during which she has worked as a midwife and health visitor as well as a national role with the Department of Health.

Jenny Scholefield, winner of the Top Hat award for NHS Kirklees

Following the last NHS staff survey for NHS Kirklees, greater emphasis has been placed on people development through new initiatives and strengthening those already in place.

Huddersfield North School Nurses, winners of the Top Hat award for KCHS

NHS KIRKLEES annual report and summary financial statements 2009|10

17


There will be an annual saving of a minimum of £98,000 on headquarters running costs so nearly £1million over 10 years.

This change was intended not only to provide an improved working environment for our staff but to have a positive impact on our carbon footprint. NHS Kirklees has approved an environmental strategy www.kirklees.nhs.

uk/fileadmin/documents/publications/Kirklees_PCT_Environmental_ strategy_V5_13.05.10.pdf in line with the overall NHS strategy ‘Saving Carbon, Improving Health’ and to show how we are working to meet our vision and values for Kirklees. It sets out how we aim to minimise the environmental impact of our services and explains our sustainability objectives. The aim of it is to make sure that environmentally responsible practices and procedures are used to reduce the overall impact on your health. The landscaping on the new site has seen planting of trees which is supporting the natural environment and wildlife in the surrounding area.

Our new headquarters A positive impact on the environment 18

The building was designed by low carbon consulting engineers incorporating measures such as high efficiency glazing and better building insulation. The lighting used is high efficiency throughout and the building incorporates an automatic reading system to determine where energy is being expended to allow us to review our energy use within the building and make changes to reduce energy consumption. The building has been registered under the Building Research Establishment’s Environmental Assessment Method (BREEAM) at a rating of very good. This represents an energy efficient design through the careful selection of sustainable materials and environmentally friendly mechanical and electrical installations.

In February 2010 NHS Kirklees moved into a new headquarters. This is a key change for staff at NHS Kirklees and has enabled all commissioning staff to move into one building at Bradley Business Park. This was prompted by the planned closure of the St Luke’s site.

This change also means that staff travel between sites will be reduced which also enables us to reduce our CO2 emissions.

Advice was sought from the district valuer to confirm that the plans represented value for money. There will be an annual saving of a minimum of £98,000 on headquarters running costs so nearly £1million over 10 years.

We are also planning to pilot a recycling scheme at Broad Lea House to see how we can maximise what we recycle and reduce overall waste and waste disposal costs.

NHS KIRKLEES annual report and summary financial statements 2009|10

As well as the building change we have also introduced other initiatives such as home working and a cycle to work scheme. These not only have a positive impact on the environment but also on staff wellbeing.


Our directorates and the Board Rob Napier Chairman*

Valerie Aguirregoicoa Non-executive director*

Tony Gerrard Non-executive director*

Mehboob Khan Non-executive director*

Rob Millington Non-executive director*

Imran Patel Non-executive director*

Vanessa Stirum Non-executive director*

Sheila Dilks Executive Director of Patient Care and Professions*

Dr Peter Flynn Director of Performance and Information

Dr Judith Hooper Executive Director of Public Health*

Sarah Brackwell Health Visitor

PEC representatives

Mike Potts Chief Executive*

Helena Corder Director of Corporate Services

Dr David Anderson GP/PEC Chair*

Bryan Machin Executive Director of Finance*

Carol McKenna Executive Director of Commissioning and Strategic Development*

Sue Ellis Director of Human Resources and Organisational Development

N.B. Sarah Brackwell was a PEC representative until August 2009.

* Voting members of the Board

NHS KIRKLEES annual report and summary financial statements 2009|10

19


Bryan Machin Executive Director of Finance

Director of Finance’ s report

I am pleased to report that NHS Kirklees has once again achieved all the financial duties set for it by the Government.

2009/10 performance NHS Kirklees received two separate allocations of money from the Department of Health. For 2009/10, our allocation was split two ways and included: • a revenue allocation of £645 million which we used to commission and provide health services for the population of Kirklees, many of which you can read about elsewhere in this Annual Report • a capital allocation of £4.4 million which we used for improvements to buildings, equipment, and information technology. This report summarises how we have invested this money to deliver and improve health care and services for Kirklees residents. It also highlights some of the key challenges that we have addressed during 2009/10 and those that face us in the coming years.

Revenue allocation We delivered the planned surplus of £2.9 million (0.4%) against our revenue allocation. This will be carried forward to support investments in services in 2010/11. We received a 5.6% recurrent increase in our revenue allocation for 2009/10 of £31 million. After meeting the costs of inflation we were able to make significant investments in improving access to health services,

improving the quality of services, improving the environment and safety in doctors’ and dentists’ surgeries and improving community services. For example we have invested: • £5 million in hospital services to meet increased demand and ensure that the local population is able to access services in a timely manner for inpatient, outpatient, A&E and cancer services

These include NHS and non-NHS hospitals, community organisations, GPs (including prescription costs), dentists, optometrists, and pharmacists. We also spend our money helping people to improve their health and wellbeing, such as helping people to stop smoking, promoting healthy lifestyles and encouraging access to screening services. We provide a range of community services ourselves, including district and school nursing services through our provider arm, Kirklees Community Health Services.

The following chart provides a summary of how we spend your money: Spend £millions

• £0.8 million in extending services to treat age related macular degeneration

A&E £33

Community Health Services £55 Other £1

• £5.8 million in specialist regional services such as cancer treatments and drugs

GPs £57

• £4 million in continuing care to meet increased demand due to the ageing population and changes in regulations clarifying when people are eligible for free health care • £1.2 million in services for people with long term conditions such as stroke and breathing difficulties • £0.2 million in intermediate care services to promote faster recovery from illness and prevent people going in to hospital

Prescribing £70

General and acute £276

Dentists £25 Opticians £4 Learning difficulties £12

• £1.5 million in services provided by Kirklees Community Health Services • £0.6 million in services to help prevent people becoming ill such as making vitamin supplements available to those who most need them and to help people improve their lifestyles by changing damaging habits relating to alcohol, drugs, and obesity. We spend our money with a range of organisations.

20 NHS KIRKLEES annual report and summary financial statements 2009|10

Mental illness £62 Maternity £25


During the year we managed our money flexibly to meet changing circumstances. In particular, we faced higher in costs due to rises in the number and costs of people receiving treatment in hospital. We were able to fund this from our available resources by working closely with local NHS trusts and NHS foundation trusts, identifying efficiencies from within the organisations own expenditure and the fact that some new investments took longer to implement than anticipated. We have also had the benefit of money we placed in a Strategic Investment Fund held on our behalf by the Yorkshire and the Humber Strategic Health Authority (SHA). Over the course of the year we have withdrawn and used £11 million. This leaves £4 million in the fund which we are planning to spend in 2010/11.

Capital allocation During the year we have invested £4.6 million in improving infrastructure, equipment and information technology. The main areas where we have invested are: • £900k in completing the upgrade of the Hawthorne Ward at the Home Valley Memorial Hospital. This was a scheme which started in the previous year, and in total we have now invested nearly £3 million on improving facilities at the ward • £275k on portable ‘tough book’ computers for district nurses to improve the quality and efficiency of services they deliver • £250k on a number of small schemes to improve GP premises • £2 million on a new headquarters building for the organisation, enabling it to bring all of its commissioning functions and staff together on one site for the first time since it was formed in 2006. This move was necessary after the owners of our previous headquarters at St Luke’s Hospital advised us of their intention to sell the site. The move will have important benefits and improve our efficiency and effectiveness. It was funded from additional capital funds made available by the Strategic Health Authority • £600k on improving information technology and equipment for NHS Kirklees and for GP practices. We have also made grants of around £1.5 million to a number of GPs and dentists to help them improve their premises, mainly to support vocational training of new clinicians and to improve infection control arrangements.

Looking forward NHS Kirklees will again see its revenue allocations increase by 5.6% in 2010/11. After this, increases are anticipated to be much lower at around 1%. We recently published our Five Year Strategic Plan, Realising our Ambition, and this explains how we will continue to work to improve the quality of health and healthcare services for the people of Kirklees in this more difficult economic climate. Although things will be more financially challenging, our history of strong financial performance means that we are in a good position to deal with this effectively. We are planning to improve our efficiency by reducing management and agency costs, joint working with other primary care trusts, and focusing on those things which help us to make the biggest improvements to the health services available to people locally. We are also working with hospitals, GPs, dentists, and other partners to make sure they continue to provide services that are good quality, effective and efficient. We take our responsibilities for safeguarding public money and achieving value for money very seriously. On behalf of the Board, the Audit Committee considers financial governance. The members of the Committee receive regular reports from our external auditors, the Audit Commission, and from our internal auditors. In addition to their statutory audit of the organisation’s accounts, the Audit Commission also provide a number of other reports that help us achieve value for money. NHS KIRKLEES annual report and summary financial statements 2009|10

21


Summary financial statements The Summary Financial Statements that accompany this report are taken from the Annual Accounts for 2009/10. These accounts are the first that we have produced under International Financial Reporting Standards (IFRS). These are the set of rules which we are required to follow by the Treasury and they mean that some additional information is now disclosed in the accounts. The main implication of IFRS for NHS Kirklees has been in the accounting treatment of five health centres constructed under a Private Finance Initiative around five years ago. Under the previous accounting rules these were not included as assets within our accounts. They are now included as ‘assets in’ and shown in the Statement of Financial Position (previously called the Balance Sheet). The previous year’s comparative figures in the Summary Financial Statements below have been restated on an IFRS basis to allow meaningful comparisons to be drawn between years. The Summary Financial Statements are intended to highlight and summarise the key financial information contained in the Annual Accounts. If you would like to receive a full set of the accounts or a copy of our Statement on Internal Control (SIC) please contact:

Director of Finance NHS Kirklees Broad Lea House Bradley Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Telephone: 01484 464031 Email: financepa@kirklees.nhs.uk 22 NHS KIRKLEES annual report and summary financial statements 2009|10

Financial performance targets This shows that NHS Kirklees have delivered our planned revenue surplus of £2.9 million against our revenue allocation. This will be carried forward to support investments in services in 2010/11. Note that the figures for 2008/09 are on a UK Generally Accepted Accounting Procedures (GAAP) basis as that is the basis on which the targets were set for that year.

NHS Kirklees’ performance for the year ended 31 March 2010 is as follows:

Total net operating cost for the financial year Non-discretionary expenditure

Net operating cost less non discretionary expenditure Revenue resource limit

Under/(over)spend against revenue resource limit (RRL)

2009/10 £000 646,478 3,999 642,479

2008/09 £000 585,103 3,575 581,528

645,407 2,928

584,315 2,787

2009/10 £000

2008/09 £000

Operating cost statement for the year ended 31 March 2010 This shows how we spent our money and is split between: • our commissioning spend which is what we spend buying services from other organisations such as hospitals, GPs, dentists, non-NHS organisations and on drugs prescribed by GPs. This is as well as the costs of running the organisation • our in house provider spend which is what we spend on community services we deliver such as district nursing:

Commissioning Employee benefits Other costs Income

Commissioning net operating costs Provider Employee benefits Other costs Income

Provider net operating costs NHS Kirklees net operating costs before interest Investment income Other (gains/losses) Finance costs

Net operating costs for the financial year

13,904 15,083 600,044 651,285 (12,200) (120,057) 602,927 545,132

31,916 15,372 (4,906) 42,382 645,309 0 (7) 1,176 646,478

28,353 15,430 (4,770) 39,013 584,145 0 633 1,225 586,003


Statement of financial position as at 31 March 2010 This shows NHS Kirklees’ assets and liabilities. The non-current assets include health centres, GP premises, administrative buildings, IT and other equipment which are either used to deliver services or allow us to commission them effectively. The current assets include stock and receivables. Stock is mainly equipment to help people live at home, and receivables is money owed to us by NHS and other organisations. The current liabilities are amounts we owe to other bodies for the provision of services. We try to ensure that we pay other bodies promptly and our performance in doing so is shown in the following Better Payment Practice Code:

31 March 31 March 2010 2009 £000 £000 Non-current assets: Property, plant and equipment Intangible assets

Total non-current assets Current assets: Inventories Trade and other receivables Cash and cash equivalents Non-current assets classified "Held for Sale"

Total current assets Total assets Current liabilities Trade and other payables Provisions Borrowings

Total current liabilities Non-current assets plus/less net current assets/ liabilities Non-current liabilities Trade and other payables Provisions Borrowings

Total non-current liabilities Total assets employed: Financed by: Taxpayer’s equity General fund Revaluation reserve

Total taxpayers' equity:

32,744 41 32,785

44,626 91 44,717

270 5,687 98 6,055 0 6,055 38,840

566 6,207 90 6,863 243 7,106 51,823

(44,152) (588) (712) (45,452) (6,612)

(39,887) (334) (696) (40,917) 10,906

(13) (1,414) (26,305) (27,732) (34,344)

(3,620) (1,642) (27,017) (32,279) (21,373)

(36,086) 1,742 (34,344)

(25,649) 4,276 (21,373)

Cash flow statement for the year ended 31 March 2010 This shows that NHS Kirklees have been available to fund expenditure on services from within our available cash. This means that we stayed within our cash limit, which is the amount of cash given to us by the government each year:

2009/10 £000

2008/09 £000

Cash flow from operating activities Net operating cost before interest Other cash flow adjustments Movements in working capital Provisions utilised Interest paid

Net cash outflow from operating activities Cash flows from investing activities Payments to purchase property, plant and equipment (PPE) Payments to purchase intangible assets Proceeds of disposal PPE and intangible assets

Net cash inflow/(outflow) from investing activities Net cash inflow/(outflow) before financing Cash flows from financing activities

(645,309) (584,145) 1,958 13,306 7,288 1,522 (350) (238) (1,182) (1,137) (631,856) (576,431) (4,568)

(2,928)

(27) 250 (4,345)

(19) 0 (2,947)

(636,201) (579,378)

Net parliamentary funding Capital element of payments in respect of finance leases, on-statement of financial position, private finance initiative

636,905 (696)

579,585 (676)

Net cash inflow/(outflow) from financing Net increase/(decrease) in cash and cash equivalents

636,209 8

578,909 (469)

Cash (and) cash equivalents (and bank overdrafts) at the beginning of the financial year

90

559

Cash (and) cash equivalents (and bank overdrafts) at the end of the financial year

98

90

NHS KIRKLEES annual report and summary financial statements 2009|10 23


Statement of changes in taxpayers’ equity for the year ended 31 March 2010

Services commissioned

This shows the movements in taxpayer’s equity for the year and how these are reflected in the reserves of NHS Kirklees. It also shows the funding received from parliament in the year:

Balance at 1 April 2009 Net operating cost for the year

General Revaluation Fund Reserve £000 £000 (25,649) 4,276

Total Reserves £000 (21,373)

(646,478)

0

(646,478)

Net gain on revaluation of property, plant, equipment

0

871

871

Impairments and reversals

0

(3,294)

(3,294)

Non-cash charges – cost of capital

(975)

0

(975)

Transfers between reserves

111

(111)

0

(647,342)

(2,534)

(649,876)

Net parliamentary funding

636,905

0

636,905

Balance at 31 March 2010

(36,086)

1,742

(34,344)

Total recognised income and expense for 2009/10

24 NHS KIRKLEES annual report and summary financial statements 2009|10

This shows how we invest our money in providing a range of services for the population of Kirklees:

2009/10 £000

2009/10 %

56,837 70,090 25,101 3,999

9.2% 11.3% 4.0% 0.6%

Total primary healthcare purchased Purchase of secondary healthcare

156,027

25.2%

Learning difficulties Mental illness Maternity General and acute Accident and emergency Community health services Other contractual

12,246 61,746 25,131 275,091 33,379 54,988 1,315

2.0% 10.0% 4.1% 44.4% 5.4% 8.9% 0.2%

Total secondary healthcare purchased Total

463,896 619,923

74.8% 100.0%

Purchase of primary healthcare General Practice (GPs) Prescribing costs and payments to pharmacists Dental services Opticians services

During the year we managed our money flexibly to meet changing circumstances. In particular, we faced higher in costs due to rises in the number and costs of people receiving treatment in hospital.


Staff

Better Payment Practice Code

This shows the number of staff we employ (based on whole time equivalent numbers) and the areas in which they work:

NHS Kirklees is signed up to the Better Payment Practice Code and aims to pay all its valid invoices by the due date or within 30 days receipt of a valid invoice, whichever is later. By agreeing to these terms we have sent a clear signal to our customers and suppliers that we are committed to good credit management and paying on time. Details of compliance with the code are included within annual accounts note 6.1 and also within the following summary financial statements:

2009/10 Total Permanently Employed Medical and dental Administration and estates Healthcare assistants and other support staff Nursing, midwifery and health visiting staff Scientific, therapeutic and technical staff Other

Total staff numbers

Other

27 526 145

26 495 140

1 31 5

475

474

1

129

128

1

1

0

1

1,303

1,263

40

Non-NHS payables Total non-NHS trade invoices paid in the year Total non-NHS trade invoices paid within target Percentage of non-NHS trade invoices paid within target

2009/10 Number

2009/10 £000

32,309 30,752 95%

85,085 79,127 93%

We are working towards further reducing the time it takes us to pay bills. Where possible we are trying to pay local suppliers within 10 working days, but there is more hard work to do to achieve this.

Management costs

Audit services

This shows how much money we spend on managing the work of NHS Kirklees and is based on a set of criteria set out by the Department of Health. This year these costs are also shown for the commissioning and provider functions of the organisation separately:

This shows what we spent in year on audit fees with our external auditors. Our auditors are appointed by the Audit Commission. The audit fee is based on the size of the primary care trust and the adequacy of its financial arrangements:

Total management costs

2009/10

2008/09

Analysis of operating costs:

2009/10

2008/09

Management costs (£000s) Weighted population (number in units) Management cost per weighted head of population (£ per head)

10,801 398,534 27.10

9,594 378,145 25.37

Audit fees Other auditors remuneration

298 0

296 0

Total audit fees

298

296

NHS Kirklees commissioning services management costs

2009/10

Management costs (£000s) Weighted population (number in units) Management cost per weighted head of population (£ per head)

7,839 398,534

NHS Kirklees provider services management costs

2009/10

Management costs (£000s) Provider services income Management costs as a percentage of income

Related party transactions NHS Kirklees is a body corporate established by the Secretary of State for Health. During the year none of the Board members or members of the key management staff or parties related to them has undertaken any material transactions with the primary care trust.

Pension liabilities Details of how pension liabilities are treated in the accounts and a reference to the statements of the relevant pension scheme are included in accounting policies note 7.5 in the annual accounts and the remuneration report - please see page 26.

19.67

2,962 47,357

6.25% NHS KIRKLEES annual report and summary financial statements 2009|10 25


Remuneration report About the remuneration report Section 234B and Schedule 7A of the Companies Act, as interpreted for the public sector, require NHS bodies to prepare a remuneration report containing information about the remuneration of directors. In the NHS, the report will cover those senior managers “having authority or responsibility for directing or controlling the major activities of the NHS body”. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments.”

Membership of the Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee (RTSC) comprises the Chairman, Rob Napier and three non-executive directors: Mehboob Khan, Imran Patel and Vanessa Stirum. The non-executive director who chairs the Audit Committee does not attend in order to make sure of separation of duties. The Chief Executive is in attendance (except when his own terms and conditions are considered). The committee is supported by the Directorate of Human Resources and Organisational Development.

The role of the Remuneration and Terms of Service Committee The role of the RTSC is to make decisions about appropriate remuneration and terms of service for the Chief Executive, directors, Clinical Executive members’ allowances and in exceptional circumstances individual issues arising for staff on Agenda for Change terms. This includes the determination of basic pay for the Chief Executive and other directors, together with any annual uplifts and performance bonuses.

Statement of the policy on remuneration of higher paid employees for current and future financial years NHS Kirklees works within the Pay Framework for Very Senior Managers in Strategic and Special Health Authorities, Primary Care Trusts and Ambulance Trusts as set out by the Department of Health and which became operable from 1 April 2007. This helps to make sure that NHS Kirklees is able to recruit, retain and motivate high calibre staff and is consistent, competitive and comparable to other primary care trusts.

26 NHS KIRKLEES annual report and summary financial statements 2009|10

Explanation of methods used to assess whether performance conditions were met and why those methods were chosen The RTSC reviews appropriate levels of pay for the Chief Executive and other directors under the Very Senior Managers Framework. In line with best employment practice, where performance should be assessed by the line manager, the Chief Executive conducts the performance assessments for the directors. The Chairman assesses the performance of the Chief Executive. Assessments are conducted using established appraisal and personal development review processes, which include clearly defined responsibilities with measurable objectives. The discretionary element of pay is covered by performance bonus arrangements as referred to above in the section on statement of the remuneration of higher paid employees.

Explanation of relative importance of the relevant proportions of remuneration which are, and which are not, subject to performance conditions Please refer to information on the role of the Remuneration and Terms of Service Committee.

Summary and explanation of policy on the duration of contracts, notice periods and termination payments Chief Executive and director appointments are made on a substantive basis, with notice provisions normally six months clearly identified and articulated in the contract.

Significant awards made to past senior managers during 2009/2010 All payments are disclosed in the table on pages 27.

Salary and pension entitlements of senior managers for 2009/2010 See table on page 27-28.


Salaries and allowances Name and title Salary (bands of £5,000)

2009-10 Other Benefits in kind Expenses remuneration (rounded to the rounded to the (bands of £5,000) nearest £00) nearest £00)

Salary (bands of £5,000)

2008-09 Other Benefits in kind remuneration (rounded to the (bands of £5,000) nearest £00)

Professional Executive Committee David Anderson David Wood Ajit Mehrotra Anil Aggarwal Angela Ladocha Sarah Brackwell Dawn Gordon

45,000 - 50,000 10,000 - 15,000 10,000 - 15,000 10,000 - 15,000 10,000 - 15,000 5,000 - 10,000

45,000 10,000 10,000 10,000 10,000

-

50,000 15,000 15,000 15,000 15,000

10,000 - 15,000

5 months worked

10,000 - 15,000

10,000 - 15,000

Non-executive directors Rob Napier, Chairman V Aguirregoicoa T Gerrard M Khan I Miya-Mohammed Patel V Stirum R Millington

35,000 - 40,000 5,000 - 10,000 10,000 - 15,000 5,000 - 10,000 5,000 - 10,000 5,000 - 10,000 5,000 - 10,000

400 500 1,100 200 600 700 600

35,000 - 40,000 5,000 - 10,000 10,000 - 15,000 5,000 - 10,000 5,000 - 10,000 5,000 - 10,000 5,000 - 10,000

5,000

800

125,000 - 130,000

5,000

700

100,000 - 105,000

2,200

110,000 - 115,000

600

70,000 - 75,000

5,000

500

80,000 - 85,000

5,000

800

85,000 - 90,000

700

80,000 - 85,000

5,000

600

80,000 - 85,000

5,000

500

80,000 - 85,000

Directors Mike Potts, Chief Executive 130,000 - 135,000 Bryan Machin, 100,000 - 105,000 Director of Finance Judith Hooper, 110,000 - 115,000 Director of Public Health Helena Corder, Director of 70,000 - 75,000 Corporate Services Carol McKenna, Director of 85,000 - 90,000 Comm & Strat Dev Peter Flynn, 85,000 - 90,000 Director of Performance Sheila Dilks, 85,000 - 90,000 Director of Patient Care Sue Ellis, Director of Human 85,000 - 90,000 Resources Robert Flack, 85,000 - 90,000 Director of Provider Services

The information disclosed for 2009/10 includes expenses paid to non-executive directors and executive directors. These relate to the reimbursement of travel expenses in relation to business journeys undertaken in order to fulfil the duties required of their roles.

NHS KIRKLEES annual report and summary financial statements 2009|10 27


Pension benefits Name and title

Mike Potts, Chief Executive Bryan Machin, Director of Finance Judith Hooper, Director of Public Health Helena Corder, Director of Corporate Services Carol McKenna, Director of Comm & Strat Dev Peter Flynn, Director of Performance Sheila Dilks, Director of Patient Care Sue Ellis, Director of HR Robert Flack, Director of Provider Services

Real increase in Real increase in Total accrued Lump sum at age pension at age 60 pension lump sum pension at age 60 60 related to at aged 60 at 31 March 2010 accrued pension at 31 March 2010 (bands of £2,500) (bands of £2,500) (bands of £5,000) (bands of £5,000) £000 £000 £000 £000

Cash equivalent transfer value at 31 March 2010

Cash equivalent transfer value at 31 March 2009

Real increase in cash equivalent transfer value

Employer’s contribution to stakeholder pension

£000

£000

£000

£000

0 - 2.5

0 - 2.5

55 - 60

170 - 175

1303

1196

33

0 - 2.5

0 - 2.5

30 - 35

90 - 95

540

486

21

0 - 2.5

0 - 2.5

40 - 45

125 - 130

962

872

33

0 - 2.5

0 - 2.5

20 - 25

65 - 70

434

389

18

0 - 2.5

0 - 2.5

15 - 20

55 - 60

283

251

14

0 - 2.5

2.5 - 5

15 - 20

45 - 50

326

272

28

0 - 2.5

0 - 2.5

15 - 20

55- 60

460

408

22

0 - 2.5

0 - 2.5

30 - 35

90 - 95

617

554

24

0 - 2.5

0 - 2.5

5 - 10

25 - 30

108

89

10

Cash Equivalent Transfer Values

Real Increase in CETV

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

28 NHS KIRKLEES annual report and summary financial statements 2009|10


Declarations of interest Name and position held Mike Potts, Chief Executive Helena Corder Director of Corporate Services Sheila Dilks Director of Patient Care and Professions Carol McKenna Director of Commissioning and Strategic Development Bryan Machin Director of Finance Dr Judith Hooper Director of Public Health Robert Flack Director of Kirklees Community Healthcare Services

Type of interest None None

Detail

Programme advisor External assessor health foundation registered charity None

Advise on programmes Review, assess and advise on funding allocation for special project.

None

Imran M Patel, Non executive Director

Related parties

David Wood PEC member

Partner, clinical Lead for NHS Kirklees and provides self care training and musculoskeletal services Membership of sports York Cricket Club - Captain club committee Membership of sports MCC area representative with endorsing rights club committee Related parties Spouse works for North Yorkshire and York Primary Care Trust as Physiotherapist and Manager Shared post with NHS Post at Board level shared with Calderdale Calderdale

Susan M Ellis Director of Human Resources and Organisational Development Peter Flynn Director of None Performance and Information Rob Napier, Chairman Related parties Vanessa Stirum Non Executive Director

Rob Millington Non Executive Director

Valerie Aguirregoicoa Non Executive Director

Name and position held Tony Gerrard Non Executive Director Mehboob Khan Non Executive Director

Spouse is a Non Executive Director on Barnsley Foundation Trust School governor King James School, Almondbury, Huddersfield Trustee King James Foundation Non Executive Director Kirklees Community Healthcare Services and Chair Non Executive Director Kirklees Community Healthcare Services Board member Local Public Service Board – Regeneration and Sustainability Share holdings Astra Zeneca and various Independent member West Yorkshire Police Authority Company Secretary / Aguirregoicoa Ltd Executive Director Related parties Sister is employee at the Mid Yorkshire Hospitals NHS Trust

Type of interest Commercial interest

Detail Director of Tony Gerrard Associates Ltd

Political Schools Public bodies

Dawn Gordon District Nurse Team Leader Dr A. K. Aggarwal GP (PEC member)

Councillor of Kirklees Governor of Greenhead Member of West Yorkshire Fire Authority Board member of the Standards Board of England Board member of Local Government Association Council of Europe Private company Shareholder in Excol Consulting Ltd Parent governor Park Road Junior, Infant and Nursery School Batley Local Authority Officer City Of Bradford Metropolitan Borough Council Primary Care Trust sub Proprietor of Woods Dental Practice, Mirfield. contractor Other trusts Honorary contracts with Mid Yorks Hospital Trust and Leeds Teaching Hospitals Trust Local Dental Member of the Local Dental Committee Committee Clinical Tutor Clinical Tutor at the University of Leeds None Partner Executive Member Secretary

Dr David Anderson PEC Chairman Sarah Brackwell Health Visitor Team Leader (PEC Member) Angela Ladocha PEC Member/ Clinical Lead Dr A P Mehrotra GP PEC Member, Urgent Care Lead

GP Principal Related parties Company Secretary Director None Registered Personal Medical Services (PMS) GP Chairman Kirklees Local Medical Committee

Partner at Meltham Road Surgery, Lockwood, Huddersfield Executive Member of the Three Valleys Commissioning Consortium Secretary, Huddersfield Friends Group of Martin House GP Principal at Grange Group Practice Spouse works for KCHS as a Health Visitor Brackwell Consultancy Services (self employment vehicle for husband) Termsol Ltd (Partners Company)

Windsor Medical Centre, 2 William Street, Leeds Road, Dewsbury Forrest Burlinson Accountants, Owl Lane, Shaw Cross, Dewsbury

NHS KIRKLEES annual report and summary financial statements 2009|10 29


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

9 June 2010 Date.......................................................

Signed................................................................ Chief Executive

Statement of directors’ responsibilities in respect of the accounts The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the organisation and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts, Directors are required to: i. apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; ii. make judgements and estimates which are reasonable and prudent; iii. state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

30

NHS KIRKLEES annual report and summary financial statements 2009|10


Independent auditor’s report to the Board of Directors of Kirklees PCT I have examined the summary financial statement for the year ended 31 March 2010 set out on pages 22 to 25. This report is made solely to the Board of Directors of Kirklees PCT in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission.

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.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the organisation and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the health authority and hence for taking reasonable steps for the prevention of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the financial statements. By order of the board.

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 Kirklees PCT for the year ended 31 March 2010. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements (10 June 2010) and the date of this statement.

Paul Lundy – Officer of the Audit Commission

11 August 2010

Audit Commission, 3 Leeds City Office Park, Holbeck, Leeds, West Yorkshire, LS11 5BD

9 June 2010 Signed................................................ Chief Executive Date...................... 9 June 2010 Signed............................................. Finance Director Date......................

NHS KIRKLEES annual report and summary financial statements 2009|10

31


NHS Kirklees Broad Lea House Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Tel: 01484 464000 www.kirklees.nhs.uk

This information can be made available in other formats including large print and other languages. 32 NHS KIRKLEES annual report and summary financial statements 2009|10

Reference: SL3705 Date of publication: Aug 10 Š Kirklees Primary Care Trust

www.kirklees.nhs.uk

http://www.kirklees.nhs.uk/fileadmin/documents/publications/annual_reports/Annual_Report_2009-10  

http://www.kirklees.nhs.uk/fileadmin/documents/publications/annual_reports/Annual_Report_2009-10.pdf