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ME/GA/SA/HC-AnnualReview-110608 Margaret Edwards, Chief Executive 0113 295 2105

Mike Potts, Chief Executive Kirklees PCT St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH

Blenheim House West One Duncombe Street Leeds LS1 4PL Tel: 0113 295 2000 Fax: 0113 295 2222

11 June 2008 Dear Mike Kirklees Primary Care Trust Annual Review Thank you to you and your Director colleagues for the preparation that you put in for the Annual Review meeting held on 22 April 2008. The purpose of the meeting was to look back at last year’s performance and identify the challenges for this year. In addition the focus was also on strategic development, including the PCT’s readiness to become a World Class Commissioning organisation. This letter reflects the discussions held and captures the key messages for 2008/09. Operating Framework performance issues 2007/08 In terms of operational performance for 2007/08, you achieved the following performance targets: • • •

18 Weeks March milestones (we jointly agreed that the delivery process had been very difficult particularly in relation to Mid Yorkshire NHS Trust); GUM Access 48 hours; 4 Week Smoking Quitters.

You failed to deliver: • • • •

Category A Ambulance; MRSA; A&E; 6 Weeks Diagnostics.

You stated the control total for 2007/08 had been achieved. We recognised that this was a significant achievement by you and your colleagues particularly in light of the constraints posed through resolving the financial challenges at Mid Yorkshire Hospitals NHS Trust (MYHT). We welcomed the corporate support given last year by the PCT to sign-off the new hospital development at MYHT, which will deliver benefits to the wider health economy. We also welcomed the significant corporate role the PCT has played in the ongoing development of the Mid Yorkshire Service Strategy, engaging positively with key partner organisations. 1

Vital Signs and Performance in 2008/09 The key risks we identified for the Vital Signs target are as follows: •

18 Weeks - You stated that sustaining 18 Weeks is a key challenge particularly with reference to MYHT and that performance is expected to deteriorate from May-June. You confirmed that plans are in place to ensure improvement in performance and to deliver the September 2008 targets.

A&E - You recognised the pressures at MYHT and as a consequence have developed a recovery plan to ensure that the A&E target is delivered.

Ambulance targets - The performance in respect of the ambulance service needs to be addressed across the region as a matter of urgency. You confirmed that your PCT will play its full part in this. We expect that collectively the PCTs will deliver this target.

Cancer targets - You gave assurance that the targets would be delivered; and the PCT would work closely with the Leeds Commissioning Consortia to address issues at Leeds Teaching Hospitals.

A number of further issues were identified for which the PCT provided assurance of delivery: •

Health Inequalities - You have published a report on the high Infant Mortality rates and advised that a number of interventions have been developed such as introducing a clinic and social needs assessment when booking in for maternity services. In addition to this you informed us that a social marketing programme is being developed with the Local Authority on a range of issues including smoking in pregnancy.

Under doctored area - We confirmed that Kirklees PCT has been identified as an under doctored area and we are assured by your response that the affected areas such as Dewsbury will in the very near future have the appropriate service in place. You commented that extended opening hours will be achieved in Kirklees, however further focused work on patient views would be carried out to ensure that opening hours reflect the needs of the local population. You confirmed that the requirements of the Operating Framework regarding primary care access will be met.

Better Care Better Value - We queried the low prescribing of statins. You advised that an incentive schemes was in place and therefore expected this to improve.

Emergency Planning - Assurance was given by you that PCT plans were in place.

Serious Untoward Incidents (SUIs) - Your PCT has recently taken over the performance management of the SUIs reported by Calderdale and Huddersfield NHS Foundation Trust (CHFT). We raised with you concerns about low reporting, however you have assured us that this has been addressed with CHFT. You commented that further work is being undertaken with practices to improve 2

reporting. In addition to this a SUIs clinical governance review is shortly going to be undertaken with MYHT and South West Yorkshire Mental Health Trust. •

Equality and Diversity - You confirmed that the PCT is compliant with the Equality and Diversity legislation and stated that further work would be done on the Gender strand.

The European Working Time Directive (EWTD) - Compliance level with the EWDT was discussed in relation to MYHT. We agreed to share further information to help you address the relevant issues with Wakefield PCT and MYHT.

NHS Users Survey - We reported that NHS users are less confident than non NHS users about the future of the NHS in Kirklees. You stated that you would need to look at the survey information and will respond accordingly.

PCT Provider Development - You advised that a Service Level Agreement is in place with the PCT Provider. You confirmed that the Operating Framework expectations in terms of Provider Development would be met.

Financial Plans - At the annual review meeting you stated that you were only 50% confident of achieving your financial control total in 2008/09 due to the uncertainties associated with your contribution to the outcome of the financially challenged Trust review at MYHT. Further to this issue being resolved, you have now confirmed 80% confidence (and expect it to improve through this financial year) in delivering your 2008/09 financial control total.

The Mid Yorkshire Hospital Development Plan (HDP) - This is a significant risk area. To achieve the planning and capacity assumptions agreed, community services need to be in place and clinical care pathways revised. It is crucial that a year on year improvement towards the planned levels of activity and capacity of service is achieved to give a seamless transfer of services to the new hospitals. You provided assurance that plans and investment are in place to ensure activity levels are brought in line with the HDP. The focus of the investment plans are on Long Term Conditions, delivering a reduction of emergency admissions; both of which will be supported by strong community services such as District Nursing and Rapid Response Teams.

The SHA expects to sign off the majority of financial plans for 2008/09 over the next few weeks. A further meeting will be arranged with your Finance Director to review your financial plan in more detail. In some cases third party verification or further detailed SHA scrutiny may be required before the plan can be signed off. We will be in touch with your Finance Director shortly to make the necessary arrangements.

Strategic Development We discussed your medium term plans for your PCT area – noting that our formal assessment of your strategic plans will take place in the autumn, as part of the national assurance framework for World Class Commissioning. We were particularly keen to understand: •

How you are identifying the strategic priorities for the PCT; 3

• •

The big differences that you will have made in 3-5 years time; Key workforce and public perception issues.

We raised a number of questions particularly in terms of implementing the strategy whilst working in an economy with a diverse range of commissioners and providers and also the ongoing HDP work at MYHT. You clarified that the local NHS organisation as well as the Local Authority will play a key part in shaping the implementation process. Promoting the local NHS is a challenge for the PCT which you recognised and have already identified key clinical champions who will be able to drive this forward with the relevant training. Given that there is to be this autumn assessment of your strategic plans we are not giving you more detailed feedback on existing plans – but we did want to highlight some our key expectations going forwards. Your strategic plan should include: •

Your assessment of where you are locally against the recommendations contained in “Healthy Ambitions” (the regional report on the outcome of the Next Stage Review in Y&H) together with an analysis of the ways in which these have been prioritised and will be delivered locally;

Rigorous analysis of the needs and perceptions of your local population, which demonstrably link with your strategic priorities;

Clarity about the activity, financial and workforce implications of your proposals;

Clarity about the ways in which you will develop the market for healthcare in your area.

We discussed your plans around system management and how you will deliver your system management role. Going forward the key tasks for the PCT will be to: •

Introduce greater transparency into decision making processes, as set out in recent DH publications. In particular the PCT needs to develop processes and policy around the approach to procurement of new services.

Build a deeper understanding of the provider landscape and how patient flows will change as a result of choice.

To conclude, the strategic plan should set out a compelling narrative about the differences your PCT will make over the medium term, with clear reference to “Healthy Ambitions”. This should be widely understood and owned both in the local health economy and by the broader population. World Class Commissioning At the meeting, we discussed the window of opportunity you have over the next 4- 5 months to take action on the development of key competencies; we would encourage you to focus on this before the formal assurance process in the autumn. Our expectation is that PCT Boards take leadership and determine where the gaps and development needs are, and take appropriate action. 4

In the meeting, you told us about a planned Senior Management Team time out where you were to carry out an early self-diagnostic against the World Class Commissioning competencies and governance. This takes account of organisational development initiatives already underway in the PCT, e.g. clinical leadership, review of governance arrangements. We would urge that you roll this out into the organisation as soon as possible in order to establish your development needs. In order to understand your priorities for development, we would like a copy of your early development plan for world class commissioning by the end of June 2008. We will contact you about this in the next two weeks, both to support your planning and to understand where we may need to provide additional development regionally. Summary You have clearly set out a direction of travel for strategic development with the key focus on the seven Kirklees localities. There are some key performance challenges, nevertheless there are real opportunities within Kirklees to significantly improve health outcomes and we will be keen to see early results in this area. We acknowledge the corporate role the PCT plays in its local health economy and the region as a whole. There are ongoing complexities on a number of different levels (which I have described in this letter) within your local health community and with this in mind we will hold a formal mid year review with you. I enclose a table outlining the PCT’s 2007/08 performance and also the PCT Planning Timetable for 2008/09. I hope that you feel that this is an accurate reflection of our meeting, should you wish to discuss any aspects of this letter please feel free to contact me.

Yours sincerely

Margaret Edwards Chief Executive C.C.: Rob Napier, Chair, Kirklees PCT