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Panel Report Kirklees PCT 19 December 2008


Overview The panel thanks Kirklees PCT for participating in this round of assessments for World Class Commissioning, and for making us so welcome on the panel day and engaging with the panel in an open and constructive way. The panel asks the PCT to accept this report in the spirit in which it is intended: a support tool on the journey to world class commissioning and as a considered perception of the organisation’s strengths and weaknesses based on the insight the PCT itself gave the panel into its commissioning approach. With regard to the competencies, the panel feels that the results from the self-assessments almost totally matched the panel’s perceptions during the assurance test. During our review of Kirklees, the panel developed an overall impression of the organisation, which is that the PCT has good foundations in place (systems, processes, resources, partnerships). The PCT has identified its significant challenges and now is the time to deliver the vision. The panel identified 5 over-arching recommendations that the PCT will need to consider as the PCT positions itself to drive transformation of health and healthcare in Kirklees. These are set out at the beginning of this report. The report also contains the world class commissioning scorecard, a commentary on the PCT’s potential for improvement, observations and recommendations on the outcomes chosen by the PCT, and the panel scores/ratings and recommendations for the 10 world class commissioning competencies and PCT governance. Adding life to years and years to life 2


Commentary The panel identifies 5 major areas for consideration by the PCT at this stage on its journey: 1. The panel acknowledge the journey the PCT is on to improve clinical engagement Observation: The panel observed that the PCT is on a journey to improve its clinical engagement. The PCT has made an impressive start and is making good headway but with more to do in some areas. The PCT has a good multidisciplinary PEC and has made good efforts to engage PBC and is starting to improve relationships. The PCT has also involved social care through their HITS. The panel noted the PCT’s novel concept of a ‘commissioning college’ to bring together PBC, PEC and HITS. The panel observed that the PCT still has work to do on information quality especially to support the management of the primary care contract and variances in practices. Recommendation: The PCT’s ‘commissioning college’ is an innovative solution to bring together PBC, PEC and HITS. However the panel recommend that the PCT be aware of the challenges and risks that this presents. The PCT will need to be clear about the continuing statutory role of the PEC. The PCT should work to improve the quality of information it provides to support the management of the primary care contract and variances in practices. 2. The panel observed the PCT’s strong partnership working Observation: The panel was impressed by the sensitive reciprocal partnership working it has seen with the LA. Its breath and depth is impressive, from the front line to the most senior levels. The PCT clearly appreciate that this relationship is critical to success in achieving its vision. This enables a sensitive local approach to meeting community needs, and the panel heard some excellent examples of how this is working for Kirklees. Recommendation: The panel recommend that the PCT should use this strong partnership to drive delivery forward and as a means to keep a focus on the vision during some challenging times ahead. The PCT is well placed to tackle future challenges constructively and provide mutual support to the LA.

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Commentary 3. The panel observed there were some key risks facing the PCT Observation: The panel want to reflect back some of the key risks that the PCT is already aware of in delivering its strategy: • MYHT - The PCT is likely to face ongoing challenges with managing the performance, finances and future developments at MYHT. As system managers, the PCT will need to keep alert and aligned to the risks it may present • Locality working – The PCT is clear why it is doing this, but this will require sensitive and sophisticated handling to ensure all stakeholders are and remain on board with this strategy • Focus – The PCT has lots of initiatives underway and planned and it will be important for the Board to determine how to prioritise these initiatives and the related investment, and provide the appropriate oversight to ensure their successful delivery. Recommendation: The panel recommend that the Board reflects on how it prioritises the efforts of the organisation and the focus of the Board. This includes how the PCT prioritises its investments. The PCT should not underestimate the challenges for staff of programme management of a broad range of initiatives. 4. The panel noted that the culture of the PCT is beginning to change from turnaround to investment Observation: The panel noted that the culture of the PCT is beginning to change from turnaround to investment. Culture change is always difficult and the planned move to a new headquarters building and the additional resources the PCT has to spend will mean further change. Recommendation: The PCT should consider how it readies its staff and teams to think more about investing in work that will clearly provide value for money and benefit more quickly, without losing the strength of the turnaround disciplines.

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Commentary 5. The panel noted that PCT could benefit from more clearly articulating its strategy Observation: It became clear to the panel what the PCT’s strategy was through the Chief Executive’s ‘pitch on the patch’ and through the interview sessions. Through these the panel were able to pick up the passion of the team, the importance of partnerships as well as the other good work being done by the PCT. However it was the panel’s view that the current strategy document, as written, did not put this across as effectively as it could and could sell the PCT and its vision short. Recommendation: The panel recommend that the PCT considers how it communicates its strategy. The PCT should reflect on the flow, structure, order and clarity of the document with a view to amending the presentation of the strategic plan as part of the work to refresh the document over the coming weeks.

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Current

Previous

Upper Quartile

COMPETENCIES

KIRKLEES PCT HEALTH OUTCOMES AND QUALITY

GOVERNANCE

Outcomes Selection Date: Sep-Oct 2008 0

Strategic Priority

National

1. Life expectancy

Worst Value Indicator

73

National Median

100

th percentile

Level 4

Best PCT Rate of Value Change

87

M

0.4%

Time period

CY 2004/06

Level 1 Local leader of NHS

Strategy

F 0.5% 2. Health Inequalities

48

8

3. Smoking during pregnancy

38

4

4. Smoking quitters

85

2051

5. Percentage of stroke admissions given a brain scan within 24 hours

16

81

6. Rate of hospital admissions per 100,000 for alcohol related harm

2683

545

7. CHD controlled blood pressure

86

92

NA

NA CY 2007

NA

NA FY 2006/07

49.0%

FY 2007/08

A

Collaborates with partners Patient and public engagement Clinical leadership Finance Assess needs

CY 2006

6.4%

FY 2006/07

Prioritisation

0.2%

FY 2007/08

Stimulates provision

G

Local

-17.1%

8. Childhood obesity

9. Emotional health of children

10. People with LTC supported

NA

NA

NA

NA

NA

NA

Innovation Procurement and contracting

Board G

Performance management

M = Male F = Female CY = Calendar Year FY = Financial Year

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Potential for Improvement Commentary

PCT trajectory • The PCT has strong foundations across the breadth of its work. It has some robust business processes and innovative ideas. There is clear aligned leadership. • However, it also has a challenging context, both in terms of service challenges and in the huge diversity of needs of its communities. This means that the PCT will need to be alert to how its environment changes, and look to deploy its management effort and capabilities to tackle these significant challenges. Areas for organisational development • The panel recommend that the PCT revisit the written strategy to ensure it conveys the full strength of its ambitions, and the initiatives it has in place to deliver it. The PCT should consider whether it has the skills in place to manage such a wide number of programmes; the panel believe the PCT has set itself an ambitious task in this regard. • The PCT will need to strengthen some parts of its clinical engagement. The PCT should also look to build up its market management capability.

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Outcomes Outcomes chosen

1. Smoking during pregnancy 2. Smoking quitters 3. Percentage of stroke admissions given a brain scan within 24 hours 4. Rate of hospital admission per 100,000 for alcohol related harm 5. CHD controlled blood pressure 6. Childhood obesity (locally defined) 7. Emotional health of children (locally defined) 8. People with LTC supported (locally defined)

Panel observations on outcomes: • The outcomes were selected to have a strong read through to the JSNA, LAA, Healthy Ambitions and the PCT’s vision and values. • The PCT wanted a breadth of outcome metrics and ones that they could act on locally that would have a big impact on health and also can be robustly measured. • The Board discussed and challenged the selection of the outcome metrics. The metrics were also discussed by the PEC, and taken through PBC and their fora. • The metrics chosen were partly to reflect partnership priorities. The PCT already has rigorous performance monitoring of outcomes so those areas where the PCT is currently underperforming will already be managed through this process. • The PCT also wanted to ensure that delivery against the outcomes is focused on the localities within Kirklees to make a difference on health inequalities. • In terms of the specific metrics selected: – Infant mortality was important but not selected because of the small numbers involved. The PCT instead looked to the risk factors e.g. smoking during pregnancy, which would have wider health benefits. – The council run an annual ‘Tell Us’ survey through schools using school nurses to understand the needs of children. This directly influenced the choice of emotional health of children as a metric. – The LTC metric involves a range of measures such as reduction in length of stay, percentage of people dying at home, etc. • The PCT acknowledges that it still has some work to do to determine the interim milestones for some of the outcomes.

Recommendations: • The PCT should be clear about interim milestones for delivery against the outcomes. • The PCT should consider how it will benchmark its locally defined metrics nationally. Adding life to years and years to life 8


PCT's Self Assessment

Overview - Competencies

panel assessment

PCT Self-Assessment Competency

Level Level Level 1 2 3

Level 4

1. Locally lead the NHS 2. Work with community partners 3. Engage with public and patients 4. Collaborate with clinicians 5. Manage knowledge and assess needs

Topline introduction •

The panel agreed with 28 of the PCT’s 30 self-assessment ratings. However, the panel found it necessary to adjust the remaining ratings.

•

The panel acknowledges that in the few areas where it has adjusted self-assessment ratings, the PCT has made inroads into achieving sub-elements of the competencies.

6. Prioritise investment 7. Stimulate market 8. Promote improvement and innovation 9. Secure procurement skills 10. Manage the local health system Adding life to years and years to life 9


PCT's Self Assessment

Competency 1: Panel assessment Competency

Measure

Are recognised as the local leader of the NHS

Reputation as the ‘local leader of the NHS’

Reputation as a change leader for local organisations

Position as the local healthcare employer of choice

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT has a communication engagement strategy. Health issues are regularly included in the council’s news-letters to the public. The PCT has just delivered its first newsletter (‘Health Talk’) to the public. The PCT commissioned Leeds Metropolitan University to understand the effectiveness of this communication (60% of recipients read it and it did change their perception positively) . • The panel heard how the PCT has become more sophisticated in its communication, for example in its ongoing communication around the Mid Yorkshire Trust’s Service Strategy. • Press coverage for June – Sept ‘08 was more positive than negative. • In the public perception survey 61% of people agree that the PCT improves services for people like them, compared to the regional average of 67%. • The PCT works well with its Local Authority, and used the JSNA to lead the health agenda with all its partners. The PCT works closely with neighbouring PCTs, as evidenced by its participation in a number of Boards. • The workforce survey suggests the PCT has a fairly high turn-over rate (above SHA average but inline with the national average). Staff satisfaction was near average. The PCT is based across split sites which does not help staff satisfaction but the PCT is moving into a new headquarters in 2010. The PCT links staff development very explicitly to the 8 goals of the organisation. Recommendations going forward: The panel recommends the PCT should: • Act on the findings of the Leeds Metropolitan University research to improve its public-facing communications. • Build on its work with partners to establish a stronger brand with the public. • Be clear about the benefits of working at NHS Kirklees for commissioning staff. Adding life to years and years to life 10


PCT's Self Assessment

Competency 2: Panel assessment Competency Work collaboratively with community partners to commission services that optimise health gains and reduce health inequalities

Measure •

Creation of Local Area Agreement based on joint needs

Ability to conduct constructive partnerships

Reputation as an active and effective partner

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The LAA was identified by Government Office as a good example nationally. The LA is a 4 star rated organisation. • The Kirklees Partnership Executive (which includes the PCT) worked closely to develop the 35 priorities for the LAA. The PCT takes leadership of several of the cross cutting themes (e.g. the alcohol agenda including resources from the DAT, adult services and the police). Delivery responsibilities for each of the targets was clear e.g. the PCT produced an alcohol strategy that has 5 areas with milestones. • The PCT has several joint posts beyond the DPH. The joint posts report back into the LSP Boards. The PCT and LA also have pooled spending on MH and LD. • The PCT and LA have commissioning teams aligned with the 4 LSP Partnership Boards. • The PBC consortia have signed off commissioning plans with the PCT. • The PCT has a track record of delivery in partnerships in line with planned milestones.

Recommendations going forward: The panel recommends the PCT should: • Develop clear clinical and PBC leadership and engagement in the LAA as it is refreshed. • Consolidate work with a wide range of partners to increase its effectiveness as a partner.

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PCT's Self Assessment

Competency 3: Panel assessment Competency

Measure

Proactively build continuous and meaningful engagement with the public and patients to shape services and improve health

Influence on local health opinions and aspirations

Public and patient engagement

Improvement of patient experience

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT has a communication strategy which segments its key stakeholders. The PCT uses a range of media including specialist radio stations to reach target groups. The PCT is also currently revamping its website to make it more user friendly. • The PCT uses its regular survey of adults and children to shape its priorities. For example on physical activity, the survey led them to set targets to increase activity amongst young people. • The PCT has conducted multiple consultations with the public, e.g. ‘Looking to the Future’, urgent care consultation, the future of Liversedge and Slaithwaite Health Centres. The PCT also has a Readers Panel to ensure information and leaflets are easy to read and understand. • The PCT could give some comprehensive examples of where patient engagement was driving improvement for e.g. ‘Diabetes Year of Care’ Programmes and urgent care. The PCT is now working with partners to do this more systematically. • The PCT noted that they receive a relatively low level of complaints, and so it is difficult to spot trends, but the PCT is using queries to its PALS service (e.g. podiatry and dentistry) and other sources to help do this. The PCT has made changes as a result, for e.g. with access to dentistry where, in response to feedback through PALS, the PCT set up an information helpline to direct the public to the right place.

Recommendations going forward: The panel recommends the PCT should: • Build on the research evidence of effective communication techniques to reach seldom heard and different segments of the local communities. • Review the PCT website in terms of making it more patient-public friendly. • Build on the opportunities of joint work with the LA to feedback how patient and public views have influenced commissioning of care for local communities.

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PCT's Self Assessment

Competency 4: Panel assessment Competency Lead continuous and meaningful engagement of all clinicians to inform strategy and drive quality, service design and resource utilisation

Measure •

Clinical engagement

Dissemination of information to support clinical decision making Reputation as a leader of clinical engagement

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT is planning to set up a ‘commissioning college’ to pull together the PEC, PBC and HIT teams. This was kicked off at an event with 60 clinicians. The PEC will remain as a statutory body. • The PCT involves a range of clinicians in all its improvement work, for example, the PCT involved clinicians from across the patch in driving the changes in urgent care. The PCT used ‘Route to Solution’ to pull together clinicians from primary and secondary care for which the PCT won an award. • Clinical leadership appears embedded within the business of the PCT (e.g. HITS) and influences strategic planning and service design. There is also local social care representation on a number of the HITS. • The PBC survey shows that satisfaction with the quality, format and frequency of PCT information supplied for PBC is broadly considered to be inline with the SHA average. • Quality performance data for primary care is still at a development stage. The PCT has a good information system with a web based system that clinicians can access, although the PCT was concerned over the variability in access to quality data. The PCT recognised that there are inconsistencies across the patch from the history of 3 PCTs but has plans in place to resolve these issues. Recommendations going forward: The panel recommends the PCT should: • Move towards the model of a ‘commissioning college’ which will move clinical leadership and engagement even further in influencing commissioning and clinical “buy-in” to delivery of the strategic plan. • Further develop the quality data set to support PBC commissioning and also the performance management of primary care contractors.

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PCT's Self Assessment

Competency 5: Panel assessment Competency

Measure

Manage knowledge and undertake robust and regular needs assessments that establish a full under-standing of current and future local health needs and requirements

panel assessment

Level 1 •

Analytical skills and insights

Understanding of health needs trends

Use of health needs benchmarks

Level 2

Level 3

Level 4

Rationale for scoring: • In the JSNA, the PCT has outlined a detailed assessment examining the most current local health needs. Prior to this year’s assessment, a range of smaller scale assessments and survey had been carried out. • The PCT is working through a refresh of its JSNA and is trying to carry out more modelling work to understand future needs (e.g. dementia) • The JSNA provides a fact-based understanding of local outcomes for most major diseases and establishes links with other relevant diseases and conditions in each case. Data for the 7 localities within Kirklees is also compared against the Kirklees average and the national average on indicators for all major health needs (e.g. infant mortality, suicide, premature deaths from CHD, etc.). • The PCT has presented tailored findings of the JNSA to providers, PCT provider arm and PBC. • The infant mortality issue was identified to the public through the use of benchmark data and it was communicated sensitively through community groups and the media. • The LA has a bimonthly news-letter to all households which includes a health section. The LA also has good results on its LSPA targets including those related to health and these are also benchmarked.

Recommendations going forward: The panel recommends the PCT should: • Continue work to identify unmet future needs in Kirklees in order to reduce gaps. • Develop plans to systematically improve performance to health needs through use of stretch targets and benchmarking.

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PCT's Self Assessment

Competency 6: Panel assessment Competency Prioritise investment according to local needs, service requirements and the values of the NHS

Measure

panel assessment

Level 1

Predictive modelling skills and insights

Prioritisation of investment to improve population’s health

Incorporation of priorities into strategic investment plan

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT has demonstrated risk modelling through its work with MYHT structures for the new hospital in Wakefield. Services were redesigned based on modelling done in pathway work. • Acute care contracts are not just for activity, but include age, locality and time modelling as well. • The PCT demonstrated its use of best and worse case scenarios (e.g. in their long term conditions work). • The PCT has a relatively rigorous business case process and the Board challenges and approves business cases as they are presented. All business cases are required to have clear criteria which requires mapping to vision, locality, strategic objectives and input from all appropriate stakeholders. Outcomes are a standard part of their internal process and are a required element as well as detail regarding investments and disinvestments.

Recommendations going forward: The panel recommends the PCT should: • Continue to refine its prioritisation process, as data from local providers and public become more timely and actionable. • More clearly demonstrate in their planning the links between individual investments and overall programmes. • Develop a more robust criteria weighting system to assist in prioritising business cases.

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PCT's Self Assessment

Competency 7: Panel assessment Competency Effectively stimulate the market to meet demand and secure required clinical and health and wellbeing outcomes

Measure •

Knowledge of current and future provider capacity

Alignment of provider capacity with health needs projections

Creation of effective choices for patients

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT acknowledged that it had yet to systematically analyse the market to identify the full range of providers, or to assess their relative costs and quality although some analysis had been carried out in relation to priority areas e.g. MH with the LA. • The PCT acknowledged that they had more work to do on soliciting patient feedback. • The PCT was testing market capacity through its tendering exercises. • Work on projections had identified capacity gaps in the areas of plastics and neurology and further work was under way with the SCG in relation to neurology. • The PCT has focussed on ensuring effective “Choose and Book” services. Local campaigns have been conducted on raising the awareness of choice. More work is required on ensuring patient choice around the content and style of services.

Recommendations going forward: The panel recommends the PCT should: • Carry out further analysis of the market to identify the full range of providers and their relative costs and quality. • Continue to expand the depth and breadth of the work to obtain patient feedback on services. • Further develop the PCT’s strategy relating to patient choice.

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PCT's Self Assessment

Competency 8: Panel assessment Competency Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration

Measure

panel assessment

Level 1

Identification of improvement opportunities

Implementation of improvement initiatives

Collection of real time quality and outcome information

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT clearly demonstrated the use of a common pathway design model used by new improvements (LTC was given as an example). • The PCT has identified a process map listing the specific interventions that are required at each point in the LTC pathway including prevention work as the first step in the process. • PBC is clearly engaged in pathway work and local and national benchmarks have been used (e.g. in community nursing) • The PCT found that the MSK triage service did not have the projected impact in the orthopaedic pathway, so more work was carried out through root cause analysis to provide solutions in the processes. • The PCT has monitoring in place for most providers; some have very frequent meetings and reporting if issues have been identified, less regular for others (e.g. twice yearly for GP practices). • PBC does not see the full impact of pathway redesign and commissioning as yet at locality level. • The PCT is currently developing provider based systems to more fully understand activity and outcomes.

Recommendations going forward: The panel recommends the PCT should: • Continue to work on improved data from GP practices which will inform the pathway redesign process. • Strengthen systematic input into redesign as changes are made to clinical pathways. • Conduct more regular and more frequent meetings with primary practices as they develop more robust provider specific information.

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PCT's Self Assessment

Competency 9: Panel assessment Competency Secure procurement skills that ensure robust and viable contracts

Measure •

Understanding of providers economics

Negotiation of contracts around defined variables

Creation of robust contracts based on outcomes

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • A considerable amount of work has gone into understanding the economics and market dynamics of MYHT and the PCT is working through similar issues with SWYMHT. The procurement work on urgent care and equitable access to primary care had also helped the PCT to understand provider economics and market analysis. • Patient data relating to providers was obtained via SLAs and as part of the equitable access scheme. • The PCT has a procurement strategy. • The PCT has an agreed negotiation process both for its lead role as a commissioner and as an associate commissioner. Roles have been agreed internally and the key negotiation variables have been agreed, e.g. standard negotiations approach with set, clear expectations across the negotiation team, including cost, quality and information variables. • The PCT has set out the outcome measures in the new SLAs for urgent care, equitable access and the third sector although the existing SLAs have not all got clearly specified outcomes. • The PCT’s contracts have defined break clauses linked to performance variables.

Recommendations going forward: The panel recommends the PCT should: • Ensure that existing contracts are reviewed with a view to including clearly specified outcomes and quality metrics. • Embed the recently adopted procurement strategy across the PCT.

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PCT's Self Assessment

Competency 10: Panel assessment Competency Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvement in quality and outcomes and value for money

Measure •

Use of real time performance information

Implementation of regular provider performance discussions

Resolution of ongoing contractual issues

panel assessment

Level 1

Level 2

Level 3

Level 4

Rationale for scoring: • The PCT’s performance monitoring of its main providers is monthly, with specific areas reviewed by exception (e.g. A&E performance). • The PCT appears to have a good understanding of contract terms and conditions and its contracts are managed efficiently (e.g. coding compliance). • The performance information is worked through with PBC consortia on a speciality basis. • The PCT holds regular performance meetings with its main providers (e.g. meets with CHFT fortnightly). • The PCT has a track record of using the contractual process to engineer service improvement (e.g. SWYMHT crisis resolution). Chair and Chief Executive, executive to executive director meetings, patch meetings, Board to Board meetings and performance notices have all been used to resolve contractual issues.

Recommendations going forward: The panel recommends the PCT should: • Ensure contract performance notices are used to strengthen performance improvement processes. • Integrate primary and secondary care information flows, i.e. understand and measure care pathway improvements.

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panel assessment

Governance: Panel assessment on Strategy

Overall recommendation on governance: The PCT Board will need to focus on clarifying the link between the vision and the initiatives and conveying this to partners. The Board should also continue to focus on managing its key risks, e.g. MYHT Assessment

A

Measure •

Vision and objectives

Initiatives to ensure delivery of strategic objectives

Consistency of financial plan with the strategy

Board challenge and ownership of the strategic plan

Achievement of milestones to date

Red

Amber

Green

Rationale for rating: • The panel believe that the strategy, as written, does not sufficiently convey how the initiatives and HITS will deliver the overarching vision and objectives. The panel found this much easier to understand from its visit to the PCT, so believes that this is predominantly a matter of style rather than substance. However, it is for this reason that the panel have scored the strategy section amber. • Further work is also needed to clarify the timelines for investment and strengthen the link between finance and health outcomes. • There is evidence that the Board provided regular and robust challenge of the strategic plan, and their input was sufficiently incorporated into the end product. The panel heard of the establishment of a new committee to oversee the delivery of the new initiatives and it will be important that this committee is clear about the information it needs to fulfil its role. • The PCT went through a successful turnaround from 2006/07.

Recommendations going forward: The panel recommend the PCT should: • Articulate the strategic plan so that there is a clear relationship between the PCT’s vision, goals and initiatives. • Ensure that the Board is clear how it will track the progress of strategic initiatives and the impact of those on health outcomes.

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panel assessment

Governance: Panel assessment on Finance Assessment

G

Measure •

Sustainable financial position

Historical financial management

Robustness of planning assumptions

Red

Amber

Green

Rationale for rating: • • • •

The PCT is projecting a surplus in every year over the next 5 year period which is in line with SHA expectations. In 2006/07 the PCT forecast a deficit, but a small surplus was achieved. The PCT have robust financial monitoring processes in place. The PCT’s assumptions for inflation, incidence, activity and population rates are credible with a convincing rationale articulated. The plan is granular, building incidence assumptions up by disease group. The PCT may need to review its assumptions around MYHT in the medium to long term. The PCT’s capacity management appears to be in line with activity projections.

Recommendations going forward: • The PCT needs to develop a community wide financial strategy which includes Wakefield District PCT regarding the MYHT service and financial strategy.

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panel assessment

Governance: Panel assessment on Board Assessment

G

Measure • • • • • •

Red

Amber

Green

Organisation Risk Information Performance Delegation Board interaction

Rationale for rating: • The PCT has a clear and well defined organisational structure which is well understood by the Board. The roles and accountabilities are clearly articulated and delineated. The PCT has outlined capability gaps which are aligned with those identified in the self assessment and has clear robust actions with timelines to address these gaps. The PCT has clearly articulated values that have been communicated consistently to stakeholders. The PCT’s OD plan outlines actions to be taken in response to the staff survey. • The ALE score for internal control = 2. • The PCT’s provider Board reports and provider performance reports provide consistent and actionable data of a timely and accurate nature. • The PCT tracks clinical and operational performance of its providers on a monthly basis. The PCT reports to its Board on clinical, service and financial performance indicators. The Board plays and active role in acting to address disparities in performance (e.g. A&E). • The PCT has described the process for delegation and management of the PBC consortia. • The entire PCT Board including executives and non-executive directors played an active role in shaping the PCT’s strategy.

Recommendations going forward: • The Board should reflect on how it focuses its effort and oversight in terms of prioritising and the timing of investments. Adding life to years and years to life 22


Glossary A&E

Accident & Emergency

PCT

Primary Care Trust

ALE

Auditors' Local Evaluation

PEC

Professional Executive Committee

CHD

Coronary Heart Disease

PPI

Patient and Public Involvement

CHFT

Calderdale Hospital Foundation Trust

SCG

Specialist Commissioning Group

DAT

Drugs Action Team

SCP

Strategic Care Partnership

DPH

Director of Public Health

SLA

Service Level Agreement

HITS / HIT

Health Improvement Team

SWYMHT

South West Yorkshire Mental Health Trust

JSNA

Joint Strategic Needs Assessment

WCC

World Class Commissioning

LA

Local Authority

LAA

Local Area Agreement

LD

Learning Disabilities

LSP

Local Strategic Partnership

LTC

Long Term Condition

MH

Mental Health

MRSA

Methicillin Resistant Staphyloccns Anrens

MSK

Musculoskeletal Service

MYHT

Mid Yorkshire Hospital Trust

OD

Organisational Development

PALS

Patient Advise and Liaison Service

PBC

Practice Based Commissioning Adding life to years and years to life 23


http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/KPCT-09-30_WCC_Final_report_Kirklees-1