Issuu on Google+

Section 1 Welcome – from Angela Monaghan, Chair and Mike Potts, Chief Executive Welcome to our annual report for 2011/12. This has been a momentous year for the NHS nationally, and no less for us here in Kirklees. Just as the year ended the Health and Social Care Act 2012 passed into statute, marking the culmination of a process which has already seen huge organisational change. Business as usual for local people We have worked hard to ensure that the NHS locally is in good shape to adapt to the requirements of the new Act and, despite the undoubted upheaval of the changes, we are delighted to report that it is still business as usual for local people. If you dip into some of the stories later in this report, you will see that we are continuing to extend access to GP services, we are still committed to helping local people lead healthier lives, and we are actively working to secure the long term future of clinical services both in hospital and in the community. Calderdale, Kirklees and Wakefield District – working together Perhaps the most significant change during the year has been our joining together with NHS Calderdale and NHS Wakefield District, as a cluster of primary care trusts. The cluster is led by one Board, with one Chair and one Chief Executive. Supporting the Board in Kirklees is a Chief Operating Officer, Carol McKenna, who is responsible for the day to day running of the PCT. However, while coming together under one board, the three PCTs have not merged and we each continue as a statutory body in our own right until abolition of the PCTs at the end of March 2013. We are not alone in making these arrangements: across the country, 152 PCTs have moved into 50 clusters. The benefits have been huge, enabling us to secure resilience during transition, helping us to make efficiency savings and, crucially, allowing us to provide robust support for the emerging clinical commissioning groups as they prepare to take over the commissioning reins in April 2013. Quality, improvement, productivity and prevention (QIPP) NHS Kirklees, like NHS organisations across the country, faces a huge challenge – the „QIPP‟ challenge - to work more efficiently and to contribute to the £20bn savings which the NHS has to achieve by 2015. As you read on in this report, you will find out more about some of the ways in which we are making our contribution. DRAFT NHS Kirklees Annual Report

Page 1


More importantly, however, you will see how we are working together across the local health and social care system to ensure not only that the local NHS is financially sustainable, but that healthcare itself is transformed. Our aim is to ensure we transform services so that patients can rely on safe, high quality care that delivers outcomes comparable with the best in the country. Community services We also want to mark another major shift that has affected us here in NHS Kirklees. We have always been proud of the staff who provide services out in the community, from district nurses to therapists, and from health visitors to stop smoking experts. Under the previous governmentâ€&#x;s Transforming Community Services agenda we were required to separate our commissioning activities from our service provision, which meant that these crucial local services moved out of PCT management. At the beginning of October 2011 we reached the end of this long process, with the launch of Locala Community Partnerships, a social enterprise. Although patients will see no immediate difference from these moves, from a staff point of view this has been a time of significant upheaval. We thank them for their hard work in making the change so smooth, for their continued commitment to providing the best possible care for their patientsand we wish them all well for the future. Our commitment So, change and challenge have been the backdrop to all the achievements of the year and it is a tribute to both the commitment of our staff and the constructive support of our partners in the public, private and voluntary sectors that we have continued to see improvements in services and care. We remain determined that local people should have confidence in local health services, and that people who currently have some of the poorest health outlooks in the country, should have a healthier future. Angela Monaghan Chair

DRAFT NHS Kirklees Annual Report

Mike Potts Chief Executive

Page 2


DRAFT NHS Kirklees Annual Report

Page 3


Section 2 The changing face of the NHS Throughout this report you will read references to different organisations which are coming into being as a result of the reforms embodied in the Health and Social Care Act 2012. These include clinical commissioning groups, the National Commissioning Board, Health and Wellbeing Boards as well as arrangements for the transition of public health responsibilities to local authorities. Here you will find a guide to the key elements of these changes: GP practices have come together into Clinical Commissioning Groups (CCGs) and from April 2013 they will take over the majority of the commissioning responsibilities currently carried out by the PCT. Other health professionals and lay members are included on the Boards of the CCGs. Within NHS Kirklees , we have two clinical commissioning groups, NHS Greater Huddersfield CCG and NHS North Kirklees CCG. Both of our CCGs are leading and implementing the business plan and operating plan for 2012-13, including leading all QIPP schemes and agreeing their own commissioning intentions. Each CCG has also been formally established as a sub-committee of the Cluster Board called a Clinical Commissioning Executive (CCE) and has been delegated 100% of the appropriate commissioning budget. Strategic Health Authorities (SHAs) will be abolished in March 2013. Primary Care Trusts (PCTs) will be abolished at the end of March 2013. The majority of the PCTâ€&#x;s public health responsibilities will be transferred to Kirklees Council. The PCT has been working with the Council and the CCGs to ensure that plans are in place for an effective transition of staff and programmes. Commissioning Support Services (CSS). These organisations are being set up to provide specialist commissioning support which is available to CCGs if required. The Cluster approach to developing commissioning support has been to work in partnership with our CCGs to understand what they will need and whether they will want to build their own capacity, buy it in or share with other organisations. A key decision has been to develop a CSS across West Yorkshire that will cover our Cluster, and the neighbouring Cluster of NHS Airedale, Bradford and Leeds. This will offer support services to CCGs covering a population of 2.3 million. The new year (2012-13) has opened with the appointment of Alison Hughes as interim Managing Director to lead this organisation through the process of authorisation. Local Involvement Networks (LINKs) will be transformed into HealthWatch and will ensure that the views and feedback from patients DRAFT NHS Kirklees Annual Report

Page 4


and carers is an integral part of local commissioning across health and social care. Health and Wellbeing Boards will bring together key decision makers to set a clear direction for the commissioning of health care, social care and public health, and to drive the integration of services across communities. CCG representatives are members of these Boards, and each is already working in shadow form building on existing mature relationships and developing their joint agenda. There will also be a number of new national bodies which will set the direction for local services, including the NHS Commissioning Board, Public Health England and HealthWatch England.

Insert as ‘feature’ Our local Clinical Commissioning Groups (CCGs) In our area we have two CCGs, NHS Greater Huddersfield CCG and NHS Kirklees CCG, each serving a distinct part of the Kirklees area. NHS Greater Huddersfield CCG NHS Greater Huddersfield CCG has 40 member practices, representing 238,000 patients in Huddersfield and the Valleys. The CCG is chaired by Dr Steve Ollerton, a practising GP based in Skelmanthorpe. The CCG has a clear vision: by being informed by their local population and clinicians, it will drive the improvement of healthcare services through leadership, innovation and excellence. Its priorities are to ensure: improved patient outcomes, improved consistency and quality of care improved patient experience improved patient safety empowered patients; putting the patient at the centre through better integration with social care, provision of good quality care, improvements in mortality, morbidity, quality of life, staying healthier for longer, listening to patients, focusing on prevention and self care. NHS Greater Huddersfield CCG is passionate about making a difference to the health of the people in the area. It is committed to achieving this through commissioning high quality, accessible services that make a real difference to patients and the population.

NHS North Kirklees CCG

DRAFT NHS Kirklees Annual Report

Page 5


Enabling the population of North Kirklees to live longer, healthier and happier lives is the vision of NHS North Kirklees Clinical Commissioning Group. Chaired by Dr David Kelly, NHS North Kirklees CCG draws its membership from 31 GP practices - representing 185,000 patients - in the Mirfield, Spen, Batley, Birstall, Birkenshaw and Dewsbury areas. NHS North Kirklees CCG, along with CCGs nationally, has been set a series of priorities to work towards:     

Keeping People Safe Preventing Premature Death Improving quality of life for people with long term conditions Supporting recovery from injury and illness Creating a positive patient experience

Within that priority framework, there are some significant challenges. Already, one in three adults living in the area has a long term health condition such as diabetes and asthma. On top of this, by 2030, at least one fifth of the population will be over 65 years of age. Infant Death Rates are declining locally, but are still too high. NHS North Kirklees CCG believes that tackling obesity and lack of physical activity - especially amongst children – as well as encouraging more people to give up smoking will help to prevent life limiting conditions as patients grow older. This ambition is set against a backdrop of increasingly stretched NHS resources and challenging budget targets.

For 2012/13 both of the Kirklees CCGs are operating in shadow form, increasingly taking on the responsibilities of the PCT by becoming subcommittees of the Board (the Clinical Commissioning Executives or CCEs) with delegated powers to commission services. Also during the year both CCGs will be going through a national process of authorisation to ensure that they are ready to take on full commissioning responsibilities from April 2013. Given the evidence to date we are confident that as the PCT lays down its responsibilities, the CCGs will be in a strong position to promote the healthcare of local people.

DRAFT NHS Kirklees Annual Report

Page 6


Section 3: Our priorities Our strategic decision-making is driven by both national priorities and by the characteristics and needs of local people. The assessment of local needs is carried out jointly by us and our partners in Kirklees Council. The resulting report – our Joint Strategic Needs Assessment (JSNA) - takes a snapshot look at the health of the population. It uses this information to map trends which show what health problems might look like in the future. On this basis we are able to plan future service provision that can best meet the changing needs of the district. If you would like to see the current JSNA for our district, it can be found at: www.wakefield.gov.uk/HealthAndSocialCare/HealthServices/JPHU/StrategicNeeds

Our strategic goals We are committed to three overarching strategic goals:

By putting the programmes in place that support these goals, we believe that in the coming year we will deliver measurable differences: ÂŁ9.5m of QIPP initiatives) 50% of savings over the next three years being transformational, and a sound basis for further transformation across our health economy authorised Clinical Commissioning Groups (CCGs) successful public health transition safe transfer of functions to the NHS Commissioning Board.

DRAFT NHS Kirklees Annual Report

Page 7


You can read more about how we intend to meet our objectives in the NHS Calderdale, Kirklees and Wakefield District Cluster Operating Plan for 201215. Link to website. Delivering quality, improvement, productivity and prevention We have a strong record of managing within our financial resources, and of meeting our targets for savings which also transform services. Although the PCT itself will not be here after the current year, the imperative for transformational change will remain and will require more than a few months to implement and embed. To ensure that improvements continue into the future, we have worked with our clinical commissioners to agree five transformational QIPP programmes for 2012-15: Preventing unplanned admissions and managing long term conditions Changing planned care pathways Strengthening mental health and learning disability provision Introducing assistive technology and risk stratification Alternative community services. These choices have been made on the basis of local need, understanding of best practice and in response to local people who have told us clearly that they want to see the best outcomes, even where that might mean doing things differently. They want more joined up care and they want to see as much care as possible as close to home. As clinicians, partners and patients work together on the service redesign that will bring about these changes, we are confident that the future of local healthcare is in good hands.

DRAFT NHS Kirklees Annual Report

Page 8


Section 4 Working in partnership Transforming the system Making a real difference in the long tem, both financially and in improved outcomes, will take new ways of thinking and concerted effort by commissioners, providers and recipients of services alike. During the year we brought our planning together into two overarching health and social care transformation programmes, one covering Calderdale and Huddersfield and one covering North Kirklees and Wakefield District. A process of engagement has been developed so that provider organisations, and in particular their clinical leadership, are equal partners in designing how changes can be developed. Local authorities have also played a central role in shaping the transformation agenda. In NHS Kirklees we have a stake in both of the major transformation programmes.

Wakefield District and North Kirklees health and social care transformation Our health and social care partnership programme focuses on the big programmes of work which will put the health and social care economy into a stronger position to be financially sustainable, improve performance and also help one of our local hospital providers, The Mid Yorkshire Hospitals NHS Trust to achieve Foundation Trust status. (Dewsbury and District Hospital is part of The Mid Yorkshire Hospitals.) The programme covers: Mid Yorkshireâ€&#x;s clinical services strategy: NHS Kirklees , NHS North Kirklees CCG and other relevant stakeholders are all engaged in testing DRAFT NHS Kirklees Annual Report

Page 9


and challenging the Trust‟s options for service reconfiguration to ensure that they are clinically effective, financially sound, and will provide the services that patients want urgent care – ensuring that effective, integrated services sit behind the 111 telephone number which is being introduced nationally in 2013 for patients who need healthcare in a hurry care outside hospital - promoting joined up care between community services and the local authority‟s services to keep people out of hospital, or to help them to be fit to return home after a stay in hospital improving quality and access to primary care, building on what has already been achieved and helping to keep patients with long term conditions out of hospital by identifying their risks and monitoring their condition. Calderdale and Huddersfield health and social care transformation There has been a long-standing Transformational Board operating across this geographical footprint bringing together partners from across the local health and social care economy to drive change. Its main areas of focus have been delivery of system change in planned and unplanned care. Whilst this work has enabled both commissioners and providers to deliver their financial aspirations, it is recognised that, in order to meet the challenges going forward, we need to again review the current configuration of services. This work started back in 2005, when the health community set out its five year vision. The work to refresh this vision has been agreed with all parties, including NHS Greater Huddersfield CCG, and will be commissioner-led. The aims of the work are consistent with our aspirations, in that they will: ensure a strategy for the next five years to deliver high quality care in the most appropriate setting ensure care will be delivered in a system which is in the top 10% nationally for safe, reliable, patient-centred care – maximising technology to deliver and support care maximise the advantages of the NHS reformsand respond to demographic changes focus on meeting the needs of people living with long-term conditions create an affordable and sustainable model of service, where local leaders are recognised for their approach to partnerships and integrating care. The timeline for this work is being agreed at the time of writing, but it is anticipated that public consultation will begin in November 2012, and that, final decisions on any significant change will be taken in Spring 2013.

Section 5 DRAFT NHS Kirklees Annual Report 10

Page


Improving services, improving health Health care is changing with the focus switching from hospitals to the community. Not many years ago, even the simplest diagnostic tests meant a trip to a hospital clinic. Now, many screening services are offered at your local GP surgery or somewhere much closer to your home. There‟s also a greater emphasis on keeping people well and helping them to manage long term conditions such as diabetes, so they don‟t need to be rushed to hospital as an emergency. We also encourage people to „Choose Well‟ and help them to understand the options when someone needs to get medical help quickly out of surgery hours – a trip to A&E should be the last resort, not the first. We‟ve already laid good foundations during 2011-12, and here are just some of the examples of where we‟re improving services and improving health.

Seeing a GP – getting better Measuring the quality of your GP services 100% of GP practices within Kirklees are signed up to the new local GP contract, which contains key performance targets to make sure patients receive the highest quality care at their GP surgery. This is fully operational, with practices in Kirklees measured on how easy it is for patients to get appointments, care for patients with long term conditions and childhood vaccinations/immunisations. And all our GP practices take part in the Quality Outcomes Framework (QOF) which covers a range of clinical and non-clinical topics to make sure that patients with a wide range of conditions are identified and monitored.

Caring for your eyes Eyecare goes ‘PEAR’ shaped A new Primary Eyecare Assessment Referral System (PEARS) has been set up in Kirklees, meaning that patients with sudden eye problems can be seen in local opticians rather than having to be referred to hospital clinics. As well as offering a more convenient service for patients, this is preventing waits and providing a fast referral to hospital for those who really need it. The service is committed to achieving the following outcomes: to improve access by delivering care closer to home at high street opticians to treat patients within the primary care setting, where appropriate, reducing the number of A&E attendances and in some cases first outpatient attendances DRAFT NHS Kirklees Annual Report 11

Page


to ensure patients are directed to the correct patient pathway with the appropriate urgency of the initial diagnosis, reducing potential consultant to consultant referrals and any delays in treatment (where onward referral is required) to clearly signpost patients to other appropriate services e.g. pharmacists.

Taking your medicine Electronic Prescription Service release 2 (EPSr2) Technology is improving all the time and our pharmacies are about to embrace a new electronic prescription system which can generate, receive and process prescriptions electronically (EPSr2). This will get rid of the bulk of the paper administration associated with prescribing and dispensing. We have been described as one of the few exemplar PCTs in the introduction of EPS. Electronic prescribing delivers huge cash saving across the NHS which issues around 1.5 million paper prescriptions every working day in England – and that figures is rising by around five percent each year. Patients can now choose the most convenient pharmacy to collect their prescriptions from and, as an extra benefit, by seeing patients on a regular basis, pharmacists will have a good understanding of which medicines patients are taking. New Medicine Service (NMS) Patients newly diagnosed with long term conditions, such as asthma and Chronic Obstructive Pulmonary Disease (COPD), Type 2 diabetes, and high blood pressure are benefiting from the New Medicine Service (NMS). Through NMS, a pharmacist will help people to get maximum impact from their medicine. The idea came from research which showed that advice from a pharmacist can help to improve the uptake and use of medicines which is a vital part of the patientâ€&#x;s self-care regime. If patients use their medicines wisely they are more likely to manage their condition well and less likely to need emergency hospital support.

Open wide Making it easier to see a dentist We have continued to work with local providers across the district to create access to high quality dental care and have put extra money into buying more capacity so it is easier for people to get an appointment or treatment with an NHS dentist.

DRAFT NHS Kirklees Annual Report 12

Page


Patients can now contact their nearest dental surgery to register, or if the practice has reached its full capacity, West Yorkshire Urgent Care Services will help patients to find another suitable dentist close by.

Living with illness Better care for Kirklees people with diabetes Patients with diabetes are being looked after by a primary care team whichis bringing changes to way their condition is being managed. Patients can now review their own results before attending their annual care planning review meeting. They can make an appointment to get all the necessary pre-review tests done and receive the results by post a week or so before the review meeting. The annual review meeting gives each patient the chance to share information with their healthcare team about: any issues and concerns, including clinical issues their experience of living with diabetes help the patient needs to access other services and support Each patient then agrees the priorities or goals for the next year and the actions that need to be taken with their healthcare professional. „The diabetes self care handbookâ€&#x; has been developed which includes basic information about diabetes, self care options available in Kirklees and care planning. We are now extending the care planning training and supporting resources to include cardiovascular disease.

Putting patients in control of their pain A pioneering health programme which has helped hundreds of people in Kirklees manage their long term health conditions has been extended until August 2012. It initially focused on chronic musculo-skeletal pain but because of its success has recently been expanded to cover chronic obstructive pulmonary disease (COPD) and chronic chest problems. Funded by the Health Foundation, NHS Kirklees, NHS Calderdale and the Calderdale and Huddersfield NHS Foundation Trust were one of only eight sites chosen nationally to take part in the Co-creating Health Programme. It helps people develop the skills, knowledge and confidence to manage their long term conditions with the support of a specially trained team of clinicians and tutors. DRAFT NHS Kirklees Annual Report 13

Page


The programme does not just help people with long term conditions, but also helps NHS staff improve the support they are able to provide through training.

Specialist advice to support primary care diabetes teams GP practices using the SystmOne clinical system are now able to gain specialist diabetes advice on-line from the diabetes specialist team at Dewsbury and District Hospital. Rather than referring patients with non-urgent diabetes problems to hospital, practice teamsâ€&#x; patients can be asked if they want to resolve their clinical issue through an e-consultation with the specialist team. This new way of working not only allows patients with diabetes to be managed closer to home, but builds on the strong relationship between primary and secondary care. This enhances the knowledge of the primary care diabetes team and avoids unnecessary referrals. Early indicators are showing a 75% reduction in referrals. An added bonus is that both teams now use , SystmOne record consultations which greatly improves communication with patients and primary care as well as reducing the risk of prescribing errors. . SystmOne also allows secondary care consultants to access to GP records This has reduced duplication and improved the quality of care as well as making clinics more proactive because there is more time to spend with patients promoting self care. The e-consultation service will be extended to support care for other patients with long-term conditions. Improvements in avoiding infant death The number of babies dying within the first year of their life has reduced in Kirklees. But although the number is falling, it is still higher than the national average. During the year we published a report together with Kirklees Council which showed that effective support services are needed to help people to change the behaviours that might lead to their babies dying unnecessarily. These include improving community engagement work, currently directed through the Auntie Pamâ€&#x;s pregnancy peer support service based in Dewsbury. More women are being helped to access maternity services and are being encouraged to reduce smoking, drinking and maintain a healthy body weight by eating healthily and doing more physical activity. The report highlights the need to improve genetic awareness among Pakistani communities and in depth training has been provided to relevant health and social care professionals within these communities. DRAFT NHS Kirklees Annual Report 14

Page


To read the report in full visit www.kirklees.gov.uk/infantmortality

Bowel cancer campaign supported by local residents To save lives and help raise awareness of the signs and symptoms of bowel cancer for the over 50s, residents of Kirklees (community champions) took part in a new campaign in October 2011. They helped to communicate the importance of early diagnosis and educated others about the signs and symptoms of bowel cancer. The earlier the disease is found, the better the Through this campaign NHS Kirklees, along with the Yorkshire Cancer Network, helped to break down the barriers that stop people from going to see their GP. For further information on bowel cancer, visit www.nhs.uk/bowelcancer

Section 6 Quality counts A strong focus on quality and safety is the driving force that underpins all our commissioning: we constantly seek assurance about the safety of services and we proactively seek opportunities to improve the quality of the services provided. Quality and safety is the first item considered at every Board meeting, and it is a standing item for our Clinical Commissioning Executive. We monitor a vast array of information that helps us understand exactly what is happening about the things that matter to patients, including waiting times, infection rates, same sex hospital accommodation and many others. DRAFT NHS Kirklees Annual Report 15

Page


Here are some of the highlights from the past year: Target Patient Safety Reduction in healthcare associated infection, including a reduction in numbers (maximum of 13 cases) of MRSA 2-week urgent referrals: cancer 93% of possible cancer patients are to wait no longer than two weeks from an urgent referral to a first outpatient appointment. Stroke The national standard states that 80% of people who have had a stroke should spend at least 90% of their time in hospital on a stroke unit. Diabetes 100% of people with diabetes are to be offered Diabetic Retinopothy Screening Mental Health A minimum of 64 cases to be served by early intervention services Choose and Book Giving patients more choice about „How, When and Where‟ they receive treatment with access to a named consultant given to a minimum of 70% of people End of Life Care To provide all adults nearing the end of life, regardless of diagnosis, access to high quality palliative care, giving more people the choice to die at home, including in a care home.

Achieved

      

Source: Cluster Board Routine Performance Report 2011/12 Learning from experience We aim to make sure that people in Kirklees receive the highest possible standards of care. It‟s important that all patients have confidence in local health services and that people know how they can make a comment on the health services they receive. Sometimes things don‟t go as they should, however, and we ensure that any complaints we receive are thoroughly investigated to achieve the best possible outcome. We encourage a culture that seeks and then uses people‟s experiences to make services more effective, personal and safe. During 2011/12 our Customer Liaison Service received 993 enquiries and the Information Governance Team received 314 requestsfor information under the Freedom of Information Act. In the same period we received and responded to 179 complaints.

DRAFT NHS Kirklees Annual Report 16

Page


We also supported GPs, pharmacists, dentists and opticians to respond thoroughly to the complaints they received. We received the following number of complaints about independent contractors: GP: 54 Dental: 24 Pharmaceutical: 2 Optical: 1

Between 1 April and 30 September 2011, Kirklees Community Healthcare Services received 18 enquiries and 16 complaints. Some of the lessons we have learned from the complaints we received resulted in improvements to patient care are: service improvement fostering a more open and transparent culture assisting service users when encountering access or service problems To contact our Customer Liaison Service call 01484 464464.

Managing the risks The way we manage risk is a key element of how we aim to ensure safety and quality. Our risk management systems enable us to monitor and test how health services are provided, including the performance of our commissioned services against government targets and best practice standards such as treatment times and control of infection in hospitals. Effective incident reporting, complaints and public involvement all contribute to our risk management by adding to our knowledge of what is happening with our services and how the public receive and perceive NHS services. Internal systems of control and communication ensure that serious issues are raised in a timely and relevant way within the organisation, from specialist team meetings through to Board meetings where appropriate. In January 2012 we aligned our risk register and risk reporting proceduresusing a live database system and timeline across the three PCTs. Our risk management teams report incidents nationally to the National Patient Safety Agency and to the Counter Fraud and Security Management Service. This helps us compare ourselves with other organisations and learn lessons to prevent similar incidents from happening in our area. DRAFT NHS Kirklees Annual Report 17

Page


Risk Management forms part of our integrated governance arrangements and evidence shows that well- managed organisations have better outcomes, including: safe and clinically effective services for patients maintenance of core services in times of emergency better value in our use of resources better health outcomes for our population. In other words good governance can save lives.

DRAFT NHS Kirklees Annual Report 18

Page


Section 7 Involving patients and the public Listening to what people tell us about the local NHS services, instead of relying on existing knowledge and assumptions helps us to meet people‟s needs better. We can develop high quality, more responsive services when we involve and listen to people already using services and those who might use them in the future. We also make sure people understand and comment about our plans and why some services need to be changed. The Department of Health introduced a new duty to inform the public about our engagement and consultation activities. To show how we met this duty in 2010/11, we published a detailed Patient and Public Involvement Annual Report which is available at http://www.wakefielddistrict.nhs.uk/YourZone/GetInvolved/ The report for 2011/12 will be published by September 2012 which will provide more detailed information about the engagement exercises and consultations that are given here. Your experience of Urgent healthcare services within Calderdale, Kirklees and Wakefield „Urgent care‟ describes the NHS services you use when you need advice or treatment immediately, but which is not an emergency or life-threatening. We set up a new urgent care system in 2008 called the West Yorkshire Urgent Care Service. The contract for this service is coming to an end soon and we wanted your views on what a new service should look like and to hear about your experiences of the current service. During a three month engagement project people told us that they valued the service. However, there did seem to be a lack of awareness about urgent care services. Further information about this engagement exercise is available at (URL to come) More patient choice on community services Residents living in Calderdale, Kirklees and Wakefield District are soon to have more choice in when, where and who provides some community based services. The initiative is part of the Government‟s commitment to allow patients who are referred for a particular service, to be able to choose from a list of qualified providers (providers who meet NHS standards for quality, care and value for money) DRAFT NHS Kirklees Annual Report 19

Page


During September and October 2011, we asked local patients, patient groups, members of the public and other stakeholders for their views on which services they would like to see more choice of providers in. Based on the response to the survey and further prioritisation and benefits appraisal carried out by NHS Kirklees in partnership with our emerging Clinical Commissioning Groups (CCGs) , the following services will now be opened up to any qualified provider in 2012/13: Adult hearing services in the community (Wakefield District, North Kirklees, Greater Huddersfield, Calderdale CCGs) Diagnostic tests closer to home (Wakefield District, North Kirklees, Greater Huddersfield, Calderdale CCGs) Primary care psychological therapies (adults) (Calderdale CCG) Mid Yorkshire Clinical Services Strategy The NHS in Mid Yorkshire wants local people to help shape the future of hospital services. NHS Kirklees, along with Mid Yorkshire and other partners, is developing plans and proposals for future hospital services. These plans are being developed based on information gained from engagement with service users and staff from October to December 2011 which is likely to lead to further public consultation. For details on how to get involved and for further information visit www.wakefielddistrict.nhs.uk/YourZone/ Care home support consultation NHS Kirklees is proposing to offer a new service to all individuals living in care homes. This service is planned to be in place by September 2012. The proposed service will offer each individual a health review up to three times a year and will support care home staff and other health providers in meeting the changing health needs of individuals. One of the aims of the service is to prevent unnecessary hospital admissions by facilitating timely access to the appropriate health advice and interventions. The Care Home Support Team may include a number of different health professionals such as a pharmacist, a GP, an advanced nurse practitioner and a physiotherapist. The Engagement Team developed an Engagement and Communications plan which was agreed by the Care Home Support Service Specification Group which comprises of representatives from both Clinical Commissioning Groups and NHS Kirklees.

As part of the plan a questionnaire was designed to gain feedback from Care Home managers, Care Home staff, provider organisations, healthcare providers and voluntary and community sector organisations on the proposal. DRAFT NHS Kirklees Annual Report 20

Page


The questionnaire invited them to have their say in shaping the initial proposals and consider what this new service might additionally offer.

DRAFT NHS Kirklees Annual Report 21

Page


Section 8 Valuing our staff Ensuring that healthcare continues to meet the needs of local people requires motivated, capable and committed staff. It has undoubtedly been a challenging year for staff as the pace of change has continued to increase. Despite this, and at a time of great uncertainty, staff have continued to work hard to ensure that patients receive the best possible services and that we use resources in the best possible way. Support during organisational change In order to support our staff colleagues through this time we have organised a range of supportive initiatives: organisational change briefings pensions advice sessions financial planning sessions career management workshops human resources drop-in sessions

Staff survey To help us monitor the views and opinions of our staff, we take part in the national NHS staff survey. This helps us to understand where we need to concentrate our efforts and improve as an employing organisation. 79% of our staff completed the staff survey in 2011, which was a 17% increase on last year‟s figure of 62%. Our top three highest scores showed that our staff: feel that there are still good opportunities to develop their potential at work feel satisfied with the quality of work they are able to deliver believe the PCT has a good commitment to work-life balance We scored less well for the percentage of staff receiving health and safety training in the past 12 months but in 31 areas out of 38, NHS Kirklees was average or above average compared with other PCTs nationally. In 14 of those areas we scored in the top 20% of PCTs in the country. We are also once more in the top 20% of PCTs nationally for honouring the NHS Constitution pledge to „develop and support staff‟, something of which we are very proud. Monitoring We continue to monitor sickness data and provide relevant support to staff according to their needs. During this year our sickness rate was 2.5%, which was exactly in line with our target.

DRAFT NHS Kirklees Annual Report 22

Page


We also take our responsibilities for equality and diversity very seriously and comply with our duty to monitor our workforce on key employment indicators by ethnicity, disability status, age and gender. We try to ensure that our workforce represents our local communities and that all employees are treated fairly and equally.

Our staff Gender Commissioning PCT Male Female

Count 46 201

% 19 81

Count 207 10 30

% 84 4 12

Count 6 62 80 73 26

% 2 25 32 30 11

Count 1 486 58 2

% 0.4 75 23 0.8

Disability Commissioning PCT No Yes Not Declared

Age Commissioning PCT Under 25 25 - 34 35- 44 45 - 54 55+

Sexual Orientation Commissioning PCT Gay Heterosexual Not Declared Lesbian

Ethnicity Commissioning PCT White - British White - Irish White - Any other White background Mixed - White & Black Caribbean Mixed - White & Asian DRAFT NHS Kirklees Annual Report 23

Count 218 3 2 1 1

% 88 1.2 0.8 0.4 0.4 Page


Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Any other Asian background Black or Black British - Caribbean Any Other Ethnic Group

8 9 2

3.2 3.6 0.8

1 1 1

0.4 0.4 0.4

Count 28 1 124 67 12 12 2

% 11.3 0.4 50 27 4.9 4.9 0.8

Religion Commissioning PCT Atheism Buddhism Christianity I do not wish to disclose my religion/belief Islam Other Sikhism

Community services Until the end of September 2011, Kirklees Community Healthcare Services (KCHS) was part of our organisation. In October 2011,the service re-launched as a social enterprise called Locala.. For the period April to September the sickness rate for KCHS staff was 4.2%, and below you can see how the community workforce was made up: Gender

Male Female

Count 80 1165

% 6% 94%

Count 1041 35 169

% 84% 3% 14%

Count 22 230 361 440 192

% 2% 18% 29% 35% 15%

Disabled

No Yes Not Declared Age group

Under 25 25-34 35-44 45-54 55+ Sexual Orientation DRAFT NHS Kirklees Annual Report 24

Page


Bisexual Gay Heterosexual I do not wish to disclose my sexual orientation Lesbian

Count 1 2 830

% 0% 0% 67%

407 5

33% 0%

Ethnic Origin

A White - British B White - Irish C White - Any other White background D Mixed - White & Black Caribbean E Mixed - White & Black African F Mixed - White & Asian G Mixed - Any other mixed background H Asian or Asian British - Indian J Asian or Asian British - Pakistani K Asian or Asian British - Bangladeshi L Asian or Asian British - Any other Asian background M Black or Black British - Caribbean N Black or Black British - African P Black or Black British - Any other Black background R Chinese S Any Other Ethnic Group Z Not Stated

Count 1120 13 9 5 2 2 1 30 30 1

% 90% 1% 1% 0% 0% 0% 0% 2% 2% 0%

2 15 5

0% 1% 0%

1 1 3 5

0% 0% 0% 0%

Religious Belief

Atheism Christianity Hinduism I do not wish to disclose my religion/belief Islam Judaism Other Sikhism

DRAFT NHS Kirklees Annual Report 25

Count 90 672 7

% 7% 54% 1%

374 45 3 49 5

30% 4% 0% 4% 0%

Page


Section 9 Lean and green We encourage staff, patients and visitors to think lean and green when it comes to the environment. Wherever we can we are asking people to take opportunities to reduce waste and use of utilities and minimise any negative impact on the environment. Within our own properties we do everything we can to reduce energy consumption: Shaw Cross has been fully refurbished including new boilers and windows and a new, better insulated roof. New boilers and heating controls have been fitted at health centres in Slaithwaite, Skelmanthorpe, Liversedge, Marsden and Fartown. New double glazed windows have been installed at health centres in Marsden, Liversedge and Skelmanthorpe. Three redundant sites at Almondbury, Savile Town and Crosland Moor have been disposed of, reducing our energy consumption and revenue costs. Holme Valley Memorial Hospital has had an extensive programme of refurbishment including the replacement of the central boiler plant, modern boilers, double glazing, increased insulation and low energy lighting, significantly reducing the carbon footprint of the site.

A recycling scheme at the NHS Kirklees headquarters at Broad Lea House has seen a reduction in our carbon footprint of CO2 by more than 10 tonnes. Special bins have been placed around the building so that staff can throw away a range of waste from paper and cardboard to plastic bottles and cans and know they will be recycled. NHS Kirklees has also put a green travel plan in place and we estimate that car sharing and our staff shuttle bus service means we have saved more than 13 tonnes of CO2 a year. We have a group of staff who swapped four wheels for two by taking advantage of a cycle to work scheme. Sixteen people got themselves a new bike and in turn saved themselves some money, improved their health and fitness and reduced the number of cars on the road.

DRAFT NHS Kirklees Annual Report 26

Page


Section 10: Planning for an emergency Emergency planning is all about being prepared and ready to provide a rapid, effective response to major incidents which may happen in our area, responding to patient need and helping protect the health of local people. Our emergency plans have been tested at local, national and regional level with staff taking part in a number of emergency planning exercises including a major event in November 2011. This was designed to test how the NHS in West Yorkshire would cope if there were an incident with mass casualties. We continually update and change our plans in light of the lessons learned from these exercises, providing further training for staff to update their skills and knowledge.

Section 11: Equality and diversity We take our responsibilities for equality and diversity very seriously. We consider what our local communities need and how those needs can best be met by the services we commission. We are determined to reduce health inequalities through understanding the health needs of local communities and making the services we commission inclusive and accessible. Equality is for everyone and we strive to design services that are equally available, making sure that: services are open when they are needed people understand the information they are given people understand what to do if things don't go well. This ensures that we do the best for all our population and also ensures that we meet our legal responsibilities, which are carried out through the NHS Equality Delivery System. By implementing this system communities help us determine how well we are doing and what we could do differently or better in the future. Further information about the NHS Equality Delivery System can be found at: http://www.kirklees.nhs.uk/public-information/equality-and-diversity/

DRAFT NHS Kirklees Annual Report 27

Page


Section 12 Director of Finance commentary I am pleased to report that NHS Kirklees has once again achieved all the financial duties set for it by the Government. 2011/12 Performance We received two separate allocations of money from the Department of Health for 2011/12. A revenue allocation of £692 million which we use 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 £2.2 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 2011/12 and those that face us in the coming years.

Revenue Allocation We delivered the planned surplus of £8.2 million (1.2%) against our revenue allocation. This will be carried forward to support investments in services in 2012/13. By properly managing our finances we delivered our planned efficiency programme of just over £13.3m, on top of the £15m delivered in 2010/11. We did this by putting community services in place to reduce unnecessary hospital admissions and stays, improving the efficiency of primary care prescribing, reducing administration expenditure, ensuring we get the best value from contracts with independent providers such as dentists and GPsand increasing the efficiency of community services. We spend our money with a range of organisations. 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 well-being, such as helping people to stop smoking, promoting healthy lifestyles and encouraging access to screening services. During the year we established a new Community Interest Company, Locala, and transferred the range of community services which we previously provided ourselves to this new organisation in line with government policy. These services include district and school nursing services, health visiting DRAFT NHS Kirklees Annual Report 28

Page


services, community dental services and a range of other prevention and treatment services. More information about Locala can be found on its web site www.locala.org.uk. . The following chart provides a summary of how we spend your money.

Capital Allocation During the year we have invested £2.2 million in improving infrastructure, equipment and information technology. The main areas where we have invested are: £900k to improve a number of GP premises to support the delivery of primary and community health services £350k on a new West Yorkshire Rape Crisis Centre £500k on improved information technology and communications infrastructure to support enhanced working arrangements £400k on routine maintenance of buildings and initial works on the improvement of day surgery and dental facilities at the Home Valley Memorial Hospital which will be completed in 2012/13. We have also made grants of around £250k to a number of GPs to help them make infection prevention improvements and to improve access to their premises. DRAFT NHS Kirklees Annual Report 29

Page


Looking Forward 2012/13 is the last year of NHS Kirklees, and our commissioning responsibilities will be transferred to other organisations by April 2013. We are working hard to ensure that we hand over a stable financial position to these organisations. This is a challenging agenda and in line with all other areas of the public sector, we are working within tight financial constraints. We are working to improve our efficiency by continuing to reduce management and running costs, working jointly with other PCTs, and focusing on those things which help us to make the biggest improvements to the health services available to the people of Kirklees. During 2011/12 we significantly reduced our running cost by around ÂŁ4m or 20% of the total. We will continue to work with partners across West Yorkshire to deliver cost effective commissioning support services that allow the new GP commissioners to concentrate on making improvements to services for patients.

We are also working hand in hand with NHS hospitals, GPs, Dentists, and other partners to ensure that the services they provide are done so in a cost effective way. The two shadow Clinical Commissioning Groups for Kirklees have been in existence for a year and we are working with them to hand over responsibility for commissioning and financial management in the lead up to April 2013 when they will become new statutory accountable bodies. We are also working with other bodies, such as the local authority and NHS Commissioning Board to ensure that we successfully hand over responsibility for Public Health and Primary Care commissioning to them. We have also clustered with neighbouring PCTs covering Wakefield and Calderdale. This combined body is responsible for overseeing the successful implementation of the new arrangements and ensuring the proper and orderly closure of the PCT at the end of 2012/13. NHS Kirklees takes its 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 PCTâ€&#x;s accounts, the Audit Commission also provide a number of other reports that help us achieve value for money.

Summary Financial Statements The Summary Financial Statements that accompany this report are taken from the Annual Accounts for 2011/12.

DRAFT NHS Kirklees Annual Report 30

Page


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 Annual Governance statement please contact:

Director of Finance NHS Kirklees Broad Lea House Bradley Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Telephone: 01484 464000 e-mail: financepa@kirklees.nhs.uk

DRAFT NHS Kirklees Annual Report 31

Page


Financial performance targets 2012 This shows that we have delivered our planned revenue surplus of £8.2m against our revenue allocation. This will be carried forward to support investments in services in 2012/13.

The PCT’s performance for the year ended 31 March 2012 is as follows: Net Operating Cost for the Financial Year Revenue Resource Limit Under/(Over)spend Against Revenue Resource Limit (RRL)

2011-12 £000

2010-11 £000

683,351 691,590

660,654 668,554

8,239

7,900

Statement of Comprehensive Net Expenditure for year ended 31 March 2012 This shows a summary of how we spent our money and is split between employee benefits, other costs, and income. 2011-12 £000

2010-11 £000

Administration Costs and Programme Expenditure Gross employee benefits Other costs Income Net operating costs before interest Finance costs Net operating costs for the financial year

30,408 670,145 (18,536) 682,017 1,334 683,351

47,702 635,103 (23,334) 659,471 1,183 660,654

Other Comprehensive Net Expenditure Impairments and reversals put to the revaluation reserve Net (gain)/loss on revaluation of property, plant & equipment Total comprehensive net expenditure for the year

3,717 (3,965) 683,103

87 (734) 660,007

DRAFT NHS Kirklees Annual Report 32

Page


Statement of Financial Position as at 31 March 2012 This shows our assets and liabilities. The non-current assets include health centres, GP premises, administrative buildings, and IT and other equipment which are either used to deliver services or allow us to commission them effectively. The current assets include stock, mainly equipment to help people live at home, and 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 Better Payment Practice Code below. 31 March 2012

31 March 2011

ÂŁ000

ÂŁ000

33,499

32,445

Intangible assets

0

21

Trade and other receivables

0

0

33,499

32,466

258

236

3,000

4,583

1

1

3,259

4,820

801

801

4,060

5,621

37,559

38,087

(40,556)

(44,653)

(5,169)

(967)

(712)

(712)

(46,437)

(46,332)

(8,878)

(8,245)

0

(9)

(1,065)

(1,180)

Borrowings

(24,815)

(25,581)

Total non-current liabilities

(25,880)

(26,770)

Total Assets Employed:

(34,758)

(35,015)

(37,289)

(37,343)

2,531

2,328 Page

Non-current assets: Property, plant and equipment

Total non-current assets Current assets: Inventories Trade and other receivables Cash and cash equivalents Total current assets Non-current assets 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

Financed by taxpayers' equity: General fund Revaluation reserve DRAFT NHS Kirklees Annual Report 33


Total taxpayers' equity:

DRAFT NHS Kirklees Annual Report 34

(34,758)

(35,015)

Page


Cash flow statement for the year ended 31 March 2012 This shows that we 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.

Cash Flows from Operating Activities Net Operating Cost Before Interest Depreciation and Amortisation Impairments and Reversals Interest Paid (Increase)/Decrease in Inventories (Increase)/Decrease in Trade and Other Receivables Increase/(Decrease) in Trade and Other Payables Provisions Utilised Increase/(Decrease) in Provisions Net Cash Inflow/(Outflow) from Operating Activities Cash flows from investing activities (Payments) for Property, Plant and Equipment Net Cash Inflow/(Outflow) from Investing Activities Net cash inflow/(outflow) before financing Cash flows from financing activities Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI and LIFT Net Parliamentary Funding Net Cash Inflow/(Outflow) from Financing Activities Net increase/(decrease) in cash and cash equivalents Cash and Cash Equivalents ( and Bank Overdraft) at Beginning of the Period Cash and Cash Equivalents (and Bank Overdraft) at year end

DRAFT NHS Kirklees Annual Report 35

2011-12 ÂŁ000

2010-11 ÂŁ000

(682,017) 1,622 (265) (1,305) (22) 1,583 (4,199) (410) 4,468 (680,545)

(659,471) 2,538 (1,241) (1,187) 34 1,104 366 (252) 404 (657,705)

(2,049) (2,049) (682,594)

(1,001) (1,001) (658,706)

(766) 683,360 682,594

(727) 659,336 658,609

0

(97)

1

98

1

1

Page


Statement of changes in tax payers’ equity for the year ended 31 March 2012 This shows the movements in taxpayer‟s equity for the year and how these are reflected in the reserves of the PCT. It also shows the funding received from parliament by the PCT in the year.

Balance at 1 April 2011 Net operating cost for the year Net gain on revaluation of property, plant, equipment Impairments and reversals Transfers between reserves Total recognised income & expense 2011-12 Net Parliamentary funding Balance at 31 March 2012

General Fund

Revaluation Reserve

Total Reserves

£000 (37,343) (683,351)

£000 2,328

£000 (35,015) (683,351) 3,965

3,965

45 (683,306) 683,360 (37,289)

(3,717) (45) 203 2,531

(3,717) 0 (683,103) 683,360 (34,758)

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

2011-12

2010-11

£000

£000

Purchase of Primary Health Care GMS / PMS/ APMS / PCTMS Prescribing costs Contractor led GDS & PDS General Ophthalmic Services New Pharmacy Contract Non-GMS Services from GPs Total Primary Healthcare purchased

54,923 64,550 27,509 4,257 17,717 2,528 171,484

53,945 65,213 25,796 4,101 16,758 1,901 167,714

Purchase of Secondary Healthcare Learning Difficulties Mental Illness Maternity General and Acute Accident and emergency Community Health Services Other Contractual Total Secondary Healthcare Purchased Total Healthcare Purchased by PCT

17,527 59,770 23,614 282,178 37,202 71,530 231 492,052 663,536

15,702 63,858 23,994 274,329 36,768 67,873 511 483,035 650,749

DRAFT NHS Kirklees Annual Report 36

Page


Staff This shows the number of staff we employ (based on whole time equivalent numbers) and the areas in which they work. The reduction in numbers of staff is partly due to the transfer of community services to Locala on the 1 October 2011, and partly due to reducing staff numbers in administration and estates as we make reductions in our running costs.

Average Staff Numbers 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 2010-11 Total staff numbers

DRAFT NHS Kirklees Annual Report 37

Total Number

2011-12 Permanently Employed Number

Other Number

13 319 74 237 64 8 715 1,207

12 303 61 230 61 6 673 1,193

1 16 13 7 3 2 42 14

Page


Staff Sickness Absence This shows the number of days lost through staff sickness and expresses this as an average number of working days lost per staff year.

Total Days Lost Total Staff Years Average working Days Lost

2011-12 Number 8,138 980 8.30

2010-11 Number 12,251 1,205 10.17

Running Costs This shows the staff and non-staff costs incurred by the PCT in managing its work, and shows the reductions in running costs made during the year. 2011-12 Commissioning Public services health Running costs (£000s) Weighted population (number in units) Running costs per head of population (£ per head)

Running costs (£000s) Weighted population (number in units) Running costs per head of population (£ per head)

DRAFT NHS Kirklees Annual Report 38

Total

14,350 401,821 35.71

2,280 401,821 5.67

16,630 401,821 41.39

Commissioning services

2011-12 Public health

Total

17,769 401,282 44.28

2,600 401,282 6.48

20,369 401,282 50.76

Page


Better Payment Practice Code 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 NHS Kirklees has sent a clear signal to its customers and suppliers that it is 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 summary financial statements below.

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 performance

2011-12 Number

2011-12 ÂŁ000

23,371 22,186 95% 96%

113,721 106,351 94% 94%

Audit services 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 PCT and the adequacy of its financial arrangements. 5.1 Analysis of operating costs: Audit Fees Other Auditors Remuneration Total Audit Fees

2011-12 221 0 221

2010-11 279 0 279

Related party transactions Kirklees Primary Care Trust 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 PCT.

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 7.4 in the annual accounts and the remuneration report, see page XX.

DRAFT NHS Kirklees Annual Report 39

Page


Section 13: 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) prior to the creation of the CKW cluster comprised the Chairman (Rob Napier) and three non-executive directors: (Mehboob Khan, Imran Patel and Vanessa Stirum). After clustering, the RTSC comprised Ann Liston (Chair) Cluster NED, Mehboob Khan, Cluster NED, Roger Grasby, Cluster NED, Mike Potts, Cluster Chief Executive, June Goodson-Moore, Exec Director of Workforce & Corporate Development, Ian Currell, Cluster Director of Finance & Efficiency. The non-executive director who chairs the Audit Committee does not attend in order to make sure separation of duties. The Chief Executive is in attendance (except when his own terms and conditions are considered). 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.

DRAFT NHS Kirklees Annual Report

Page 40


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 PCTs. 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 the 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 2011/12 All payments are disclosed in the table on pages XX-XX. Salary and pension entitlements of senior managers for 2011/12

DRAFT NHS Kirklees Annual Report

Page 41


See table on page XX.

DRAFT NHS Kirklees Annual Report

Page 42


Clinical Executive Committee - salaries and allowances [Audited] 2011-12

Name and title

David Anderson Jim Lee

Ajit Mehrotra Anil Aggarwal Anuj Handa Dawn Gordon Bert Jindal Liz Clough Carl Chapman

DRAFT NHS Kirklees Annual Report

2010-11

Salary

Other Remuneration

Benefits in kind

Salary

Other Remuneration

(bands of £5,000)

(bands of £5,000)

(Rounded to the nearest £00)

(bands of £5,000)

(bands of £5,000)

0 - 5,000 3 months 0 - 5,000

15,000- 20,000 20,000 25,000 10 Months 5,000 - 10,000

2 months 0 - 5,000 2 months 0 - 5,000 2 months 0 - 5,000 2 months 0 - 5,000 2 months 0 - 5,000 2 months 0 - 5,000 2 months 0 - 5,000 2 months

5,000 - 10,000 5,000 - 10,000 9 Months 5,000 - 10,000 5,000 - 10,000 9 Months 5,000 - 10,000 9 Months 5,000 - 10,000 9 Months

Page 43

Benefits in kind (Rounded to the nearest £00)


The Clinical Executive Committee was abolished during the year when we introduced shadow Clinical Commissioning Groups (CCGs) in June 2011. These are transitional arrangements in preparation for the handover of commissioning responsibilities to these Clinical Commissioning Groups when they become new statutory bodies on the 1 st April 2013. In Kirklees we have two shadow CCGs, one covering Greater Huddersfield and one covering North Kirklees. A number of GPs, Nurses, and Practice Managers sit on these shadow groups. We reimburse their employing GP practices, to allow them to free up these individuals to attend shadow board, commissioning, and other meetings and to carry out the significant amount of work required in the lead up to formal handover of commissioning responsibilities in April 2013. This funding allows the practices to make arrangements to cover clinical commitments of the GPs to avoid any reduction in the clinical care they provide to their patients. In 2011/12 the aggregate amount of funding used to support this important work was: For Greater Huddersfield we spent ÂŁ365,000, which allowed 8 individuals to be released by their practices. For North Kirklees we spent ÂŁ290,000, which allowed 8 individuals to be released by their practices. This funding is from the amount which the Department of Health has required PCTs to make available to support the development of Clinical Commissioning Groups.

DRAFT NHS Kirklees Annual Report

Page 44


Director – salaries and allowances During the year we entered into a clustering arrangement with NHS Calderdale and NHS Wakefield. This is one of the transitional working arrangements to support the introduction of CCGs in April 2013. The new Calderdale, Kirklees, and Wakefield NHS Cluster (CKW Cluster) is responsible for ensuring the establishment of CCGs and the orderly transfer of commissioning responsibilities to them. This clustering arrangement commenced in June 2011, and was completed in October 2011. In June the 3 PCTs agreed to have a single team of executive directors. In October 2011 the 3 PCTs agreed to have a single team of Nonexecutive directors. The first 2 tables below show the remuneration of all those non-executive and executive directors who have held a post in year as a director of NHS Kirklees before and after this clustering arrangement came into being. The 3 rd table shows the full remuneration of those directors who have held a cluster post during the year. Where directors have held a cluster post, their remuneration in these roles has been split across the CKW cluster based on the relative populations served by the constituent PCTs. NHS Kirklees picked up 44% of the cluster remuneration, and this share is reflected in the first 2 tables where appropriate.

DRAFT NHS Kirklees Annual Report

Page 45


Non-executive directors [Audited] 2011-12

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

£

Rob Napier Chairman - NHS Kirklees Angela Monahan Chairman - CKW Cluster T Gerrard NHS Kirklees & CKW Cluster M Khan NHS Kirklees & CKW Cluster K Wright CKW Cluster A Liston CKW Cluster R Coldwell CKW Cluster

DRAFT NHS Kirklees Annual Report

2010 - 11

Other Remuneration

Benefits in kind

(bands of £5,000)

(Rounded to the nearest £00) nearest

£

£00)

15,000 20,000 6 months 5,000 10,000 6 months 5,000 10,000 12 months 5,000 10,000 12 months 0 - 5,000 6 months 0 - 5,000 6 months 0 - 5,000 6 months

Salary (bands of £5,000)

£

35,000 40,000

10,000 15,000 5,000 10,000

Page 46

Other Remuneration

Benefits in kind

(bands of £5,000)

(Rounded to the nearest £00) nearest

£

£00)


S Cheseldine CKW Cluster R Grasby CKW Cluster I Patel

0 - 5,000 6 months 5,000 10,000 6 months 0 - 5,000

NHS Kirklees V Aguirregoicoa

6 months 0 - 5,000

NHS Kirklees V Stirum

6 months 0 - 5,000

NHS Kirklees R Millington

6 months 0 - 5,000

NHS Kirklees

6 months

DRAFT NHS Kirklees Annual Report

200

5,000 10,000 5,000 10,000 5,000 10,000 5,000 10,000

Page 47


Executive Directors [Audited] 2011-12

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

Mike Potts Chief Executive Bryan Machin Director of Finance Andy Leary Director of Finance Jonathan Molyneux Director of Finance Matt Walsh Medical Director

DRAFT NHS Kirklees Annual Report

Other Remuneration

Bonus

Benefits in kind

(bands of £5,000)

(bands of £5,000)

(Rounded to the nearest £00)

5,000 10,000

5,000

125,000 130,000

5,000

800

100,000 105,000

5,000

70,000 75,000 12 Months 10,000 15,000 2 months 15,000 20,000 4 months 60,000 65,000 6 months 35,000 40,000 10 months

2010 - 11

1,700

5,000 10,000

Page 48

Salary (bands of £5,000)

Other Remuneration

Bonus

Benefits in kind

(bands of £5,000)

(bands of £5,000)

(Rounded to the nearest £00)


Judith Hooper

Director of Public Health

Helena Corder Director of Corporate Services Carol McKenna Director of Comm & Strat Development Ann Ballarini Cluster Director of Comm & Serv Development Peter Flynn Director of Performance Sue Cannon Director of Quality & Governance Sheila Dilks Director of Patient Care

DRAFT NHS Kirklees Annual Report

125,000 130,000 12 Months 15,000 20,000 3 months 10,000 15,000 2 months 30,000 35,000 10 months 45,000 50,000 12 Months 30,000 35,000 10 months 10,000 15,000 2 months

120,000 125,000

70,000 75,000

1,000

185,000 190,000

80,000 85,000

5,000

85,000 90,000

5,000

1,100

5,000

165,000 170,000

80,000 85,000

Page 49

05,000


35,000 04,200 80,000 5,000 40,000 5,000 85,000 10 months 40,000 2,500 80,000 05,000 Robert Flack 45,000 85,000 5,000 6 Director of Provider Services months *1 For the last 2 months of the year the post of Director of HR was held by June Goodson-Moore. She is employed by the Airedale, Bradford, and Leeds NHS Cluster and her full salary costs are disclosed in their Annual Report. Sue Ellis Director of Human Resources *1

CKW Cluster Remuneration [Audited]

Name

Title

Dates

Executive Directors Mike Potts Jonathan Molyneux Andy Leary Ann Ballarini Peter Flynn Sue Ellis June

Full Costs

BIK

Other

(Rounded to the nearest £00) 4,200

(Bands of £5,000) -

5,800

Cluster Chief Executive

01.04.11 to 31.3.12

(Bands of £5,000) 135,000-140,000

Cluster Director Of Finance Cluster Director of Finance Cluster Director of Commissioning and Service Development Cluster Director of Performance and Commissioning Development Cluster Director of HR and Organisational Development Cluster Director of HR and Organisational Development

10.10.11 to 31.3.12 01.04.11 to 02.10.12

140,000-145,000 55,000-60,000

01.06.11 to 31.3.12 01.06.11 to 31.3.12 01.06.11 to 22.01.12 23.01.12 to 31.3.12

DRAFT NHS Kirklees Annual Report

Page 50

-

-

75,000-80,000

2,400

-

70,000-75,000 50,000-55,000 See note a

4,200 3,500

-


Goodson Moore Matt Walsh Sue Cannon Angela Monaghan Keith Wright Ann Liston Roy Coldwell Mehboob Khan Tony Gerrard Sandra Cheseldine Roger Grasby

Cluster Medical Director Cluster Director of Quality and Governance (Nursing)

01.06.11 to 31.3.12 01.06.11 to 31.3.12

85,000-90,000 70,000-75,000

Cluster Chair Cluster Non Executive Cluster Non Executive

01.10.11 to 31.03.12 01.10.11 to 31.03.12 01.10.11 to 31.03.12

15,000-20,000 5,000-10,000 0-5,000

Cluster Non Executive

01.10.11 to 31.03.12

0-5,000

Cluster Non Executive

01.10.11 to 31.03.12

0-5,000

Cluster Non Executive

01.10.11 to 31.03.12

5,000-10,000

PCT Non Executive/Cluster Non Executive

01.10.11 to 31.03.12

5,000-10,000

PCT Chair/Cluster Non Executive

01.10.11 to 31.03.12

5,000-10,000

-

10,000-15,000

800

This table shows the full cost of each named individual for the period stated. *1 For the last 2 months of the year the post of Director of HR was held by June Goodson-Moore. She is employed by the Airedale, Bradford, and Leeds NHS Cluster and her full salary costs are disclosed in their Annual Report.

DRAFT NHS Kirklees Annual Report

Page 51


Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation‟s workforce. The banded remuneration of the highest paid director in NHS Kirklees in the financial year 2011-12 was £125,000-£130,000 (201011, £130,000-£135,000). This was 4.6 times (2010-11, 4.9 times) the median remuneration of the workforce, which was £27.6k (2010-11, £26.5k). In 2011-12, no (2010-11, non) employees received remuneration in excess of the highest-paid director. Remuneration ranged from £14k to £130k rounded up to the nearest £1k, (2010-11 £5k to £135k). In 2010-11 we employed a number of apprentices which is reflected in the lower pay range for that year. In calculating the highest paid director, total remuneration includes salary, non-consolidated performance-related pay, benefits-inkind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. We have used our share of cluster directors remuneration only in calculating the highest paid director. The highest paid Director in 2011/2012 received a payment for termination benefits. Although this was the highest value, it was not used to calculate the pay multiples as this director was not employed in a management role in the PCT. In calculating the median remuneration we have based this on the salary costs only, as this is more reflective of the true median remuneration costs of our workforce. In calculating the median remuneration we have grossed up part time staff to their equivalent full time remuneration.

DRAFT NHS Kirklees Annual Report

Page 52


Pension benefits [Audited] Name and title

Real Real increas increas e in e in pensio pensio n at n lump age 60 sum at aged 60

(bands of £2,500) 5 - 7.5

(bands of £2,500) 15 17.5

Lump Cash sum at Equivale age 60 nt related Transfer to Value at accrue 31 March d 2012 pensio n at 31 March 2012 (bands (bands of of £5,000) £5,000) 65 - 70 195 1440 200

0 - 2.5

0 - 2.5

35 - 40

105 110

625

517

92

0 - 2.5

5 - 7.5

50 - 55

150 155

1084

962

92

-2.5 - 0

-2.5 - 0

20 - 25

70 - 75

0

405

-418

Mike Potts Chief Executive

Total accrue d pensio n at age 60 at 31 March 2012

Bryan Machin Director of Finance Judith Hooper Director of Public Health Helena Corder Director of Corporate Services

DRAFT NHS Kirklees Annual Report

Page 53

Cash Equivale nt Transfer Value at 31 March 2011

Real increase in Cash Equivale nt Transfer Value

1234

168

Employer’ s contributi on to stakehold er pension


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

0 - 2.5

0 - 2.5

20 - 25

60 - 65

318

253

57

0 - 2.5

2.5 - 5

15 - 20

55 - 60

393

335

47

0 - 2.5

0 - 2.5

20 - 25

65 - 70

0

464

-478

0 - 2.5

0 - 2.5

30 - 35

100 105

659

585

56

0 - 2.5

5 - 7.5

10 - 15

30 - 35

134

99

32

2.5-5

12.5-15

40-45

130135

751

569

164

2.5-5

7.5-10

40-45

125130

883

761

98

0-2.5

0-2.5

25-30

85-90

628

573

37

0-2.5

2.5-5

40-45

130135

829

714

57

M Walsh Medical Director S Cannon Director of Quality & Governance A Ballarini Cluster Director of Comm & Serv Development A Leary

Note 1 Director of Finance The table shows the pensions information for directors who were employed by NHS Kirklees during the year, either directly or as part of the CKW Clustering arrangements. The remuneration for J Molyneux was not pensionable and therefore no information is available to disclose.

DRAFT NHS Kirklees Annual Report

Page 54


Note 1 - This is the real increase for the proportion of time in post Mixture of full given names and initials needs reconciling Cash Equivalent Transfer Values 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 memberâ€&#x;s accrued benefits and any contingent spouseâ€&#x;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. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses market valuation factors for the start and end of the period as notified by the Government Actuaries Department.

DRAFT NHS Kirklees Annual Report

Page 55


Exit Package Information 2011-12

Exit package cost band (including any special payment element) Lees than £10,000 £10,001-£25,000 £25,001-£50,000 £50,001-£100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000 Total number of exit packages by type (total cost

Total resource cost

2010-11

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages by cost band

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages by cost band

Number 0 0 0 0 0 0 0

Number 1 2 6 0 0 1 0

Number 1 2 6 0 0 1 0

Number 0 0 0 0 0 0 0

Number 4 8 6 12 4 1 0

Number 4 8 6 12 4 1 0

0

10

10

0

35

35

£000s

£000s

£000s

£000s

£000s

£000s

0

391

391

0

1,642

1,642

Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Terms and Conditions. Where the PCT has agreed early retirements, the additional costs are met by the PCT and not by the NHS pensions scheme. Illhealth retirement costs are met by the NHS pensions scheme and are not included in the table. This disclosure reports the number and value of exit packages agreed in the year. Note: The departures of staff may take place in a future period.

DRAFT NHS Kirklees Annual Report

Page 56


The disclosure for 2011/12 does not include the provision made for future departures of ÂŁ2,582k. For 2010-11 the comparators have been amended to also exclude the provision made for future departures of ÂŁ404k.

DRAFT NHS Kirklees Annual Report

Page 57


APPENDICES Statement of the Chief Executive’s responsibilities as the Accountable Officer of the Primary Care Trust The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that:

there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; value for money is achieved from the resources available to the primary care trust; the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; effective and sound financial management systems are in place; and annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains 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.

Date....................................................... Signed..................................................................................... Mike Potts, Chief Executive

DRAFT NHS Kirklees Annual Report 58

Page


CLUSTER BOARD DECLARATIONS OF INTEREST REGISTER 2011/12 Board Member Angela Monaghan Sandra Cheseldine

Role Chair Non Executive Director

Roy Coldwell

Non Executive Director

Tony Gerrard Roger Grasby

Non Executive Director Non Executive Director

Ann Liston

Non Executive Director

Keith Wright.

Non Executive Director

Mike Potts

Chief Executive

DRAFT NHS Kirklees Annual Report

Interests Declared None Chair of the Trustees Board for Wakefield District Citizens Advice Bureau. Trustee and Company Secretary of Catalyst Science Discovery Centre. Director of RS Clare and Company Lubricants manufacturer. Non-Executive Director PICME-Business Improvement Consultancy. Risk Management Consultant – HFL Risk Services. Director of Tony Gerrard Associates Ltd. Independent Member – West Yorkshire Police Authority. Justice of the Peace – Wakefield/Pontefract Bench. Non-legal member – Employment Tribunal. Chair/Director, Spectrum Community Health CIC Ltd. Independent Member of West Yorkshire Police Authority. Counsellor and external training manager Leeds Counselling. Treasurer, Hope Baptist Church, Hebden Bridge. Director of ICATs Ltd. (a dormant company). NHS consultancy support to NHS organisations. None

Page 59


Ann Ballarini Sue Cannon Sue Ellis (until January 2012)

Peter Flynn Dr Andrew Furber

Gill Galdins June Goodson Moore (from January 2012) Dr Judith Hooper

Julie Lawreniuk Carol McKenna Jonathan Molyneux Graham Wardman Matt Walsh

DRAFT NHS Kirklees Annual Report

Executive Director of Commissioning and Service Development Executive Director of Quality and Governance (Nursing) Director of Human Resources and Organisational Development

Director of Performance and Commissioning Intelligence Executive Director of Public Health – NHS Wakefield District Chief Operating Officer – NHS Wakefield District Executive Director of Public Health – NHS Kirklees

Chief Operating Officer - NHS Calderdale Chief Operating Officer – NHS Kirklees Interim Executive Director of Finance and Efficiency Executive Director of Public Health – NHS Calderdale Medical Director

Page 60

None None Spouse is an Employee at Gilthwaites First School, Denby Dale. Church Council Secretary and worship leader Denby Dale Methodist Church. None Trustee – North to North Health Partnership. Honorary Senior Clinical Lecturer – Sheffield University. None Employed by GP contractor to CKW PCT – GP assistant Meltham Road Surgery. Partner provides services under contract to CKW via Bradford Hospital Trust – Tier 2 Pain Service South Kirklees. None None None Ownership of a 2/7 share of premises at Thornton Medical Centre, Bradford (a PMS practice with a Bradford contract) Spouse is an employee of Calderdale and Huddersfield Foundation Trust.


Find out more You can find out more about us on our website www.kirklees.nhs.uk

Twitter @NHS Kirklees

Or search on Facebook for NHS Kirklees

If you have any questions about local health services, you can call Customer Liaison Service on

. Or by email toenquiries@kirklees.nhs.uk

If you require this report in another format such as large print, audio tape or other language, please contact The Communications Team on 01484 464000.

DRAFT NHS Kirklees Annual Report

Page 61


/CKWCB-12-140d_Annual_report_-_K