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Ambitions for a Healthy Kirklees

Five year Strategic Plan 2008 - 2013 Revision March 2009


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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Contents Section 1

Foreword by the Chairman and Chief Executive

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Section 2

Ambitions for a Healthy Kirklees – the 5 yr Strategic Plan

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Section 3

Our Vision and Values, Goals and Priority Programme Objectives 3.1 Our Vision and Values 3.2 Our Goals 3.3 Our Priority Programmes

10 10 11 12

Section 4

Needs of our population 4.1 Policy and Planning 4.2 National and Local Priorities 4.2.1 Local Priorities 4.2.2 National Priorities: NHS Next Stage Review – Delivering Healthy Ambitions 4.3 Demographic Overview 4.4 Reducing Health Inequalities 4.5 Joint Strategic Needs Assessment (JSNA) 4.6 Working with Partners and Shared Goals 4.7 Market Analysis of provision 4.8 Health Outcomes – World Class Commissioning

14 14 14 15

Section 5

Our Key Programme Areas and Investment 5.1 Programme Areas 5.2 Delivering Healthy Ambitions 5.3 Kirklees Programme Objectives and Outcomes

23 23 24 26

Section 6

Delivering the Strategy and Plans 6.1 Commissioning Approach 6.2 Clinical Leadership 6.3 Service user and public engagement 6.4 Investment Plans 6.5 Financial Planning 6.6 Risk Management 6.7 Financial Risk 6.7.1 Mitigating Actions 6.8 In year monitoring

37 37 37 39 40 40 41 41 42 42

15 16 16 17 20 20 21

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Section 7

Supporting Activities 7.1 Workforce planning at NHS Kirklees 7.2 Communications and Engagement 7.3 Changes in Technology 7.4 Estates Issues 7.5 Procurement Strategy 7.6 Medicines Management

43 43 44 44 44 44 45

Section 8

Conclusion 8.1 Overall Impact Against Our Strategic Goals

45 45

Section 9

Board Approval 9.1 Declaration of Board Approval 9.2 Formal Sign off of this Plan

47 47 47

List of Tables: Table 1: Kirklees Key Health and Well-being Issues Table 2: Locality Health Inequalities Summary – Children and Young People 2007 Table 3: Locality Health Inequalities Summary – Adults 2007 Table 4: Our Chosen World Class Commissioning Outcomes Table 5: Additional Investment 2009-10 to 20012-13 Table A1: Kirklees Population by Age Group, 2006 and 2018 Projections Table A2: Batley, Birstall, Birkenshaw: Population by Age Group Table A3: Denby Dale and Kirkburton: Population by Age Group Table A4: Dewsbuty and Mirfield: Population by Age Group Table A5: Huddersfield North: Population by Age Group Table A6: Huddersfield South: Population by Age Group Table A7: Spen Valley: Population by Age Group Table A8: The Valleys: Population by Age Group List of Figures: Figure 1: Percentage Investment by Programme Figure A1: The rainbow model of well-being and health Figure A2: Local Area Agreement Priorities Figure A3: A Map of the Seven Localities of Kirklees Figure A4: Batley, Birstall, Birkenshaw: Locality Providers Figure A5: Denby Dale and Kirkburton: Locality Providers Figure A6: Dewsbury and Mirfield: Locality Providers Figure A7: Huddersfield North: Locality Providers Figure A8: Huddersfield South: Locality Providers Figure A9: Spen Valley: Locality Providers Figure A10: The Valleys: Locality Providers

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18 19 19 22 41 48 53 56 58 62 65 68 70

40 49 50 52 55 57 60 63 66 69 71


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Appendices Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9

Needs of Our Population Public Expectations and Political Drivers Provider Landscape Workforce Planning Changes in Technology Commissioning College Equality Impact Assessment References Glossary

48 48 73 74 80 83 85 87 96 97

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Section 1

Foreword by the Chairman and Chief Executive Welcome to our strategic plan – ‘Ambitions for a Healthy Kirklees’ which covers the period 2008/09 – 2013. Kirklees Primary Care Trust – also known as NHS Kirklees – is the leader of the local NHS. We are responsible for improving the health of our population, reducing health inequalities, and ensuring that health services are in place to meet the needs of local people. This plan sets out our aims for the coming five years and the actions we plan to take to improve the health and well-being of all the people in Kirklees. In taking forward our plans, we are driven by the following goals: • To place the person at the centre of everything we do. • To improve health and reduce health inequalities. • To improve quality and promote safety. • To promote choice and accessibility. • To work well in partnership with communities, individuals and their families, staff and organisations. • To promote local sensitivity through effective commissioning. • To promote strong clinical leadership • To drive service redesign and innovation. • To be a visibly credible organisation, operating to the highest standards. We are committed to partnership working as we recognise that this is the only way to achieve real success for Kirklees. In particular, we have a strong relationship

with Kirklees Council, including a Joint Director of Public Health and other shared posts. This partnership is helping us focus our attention on making improvements in health and reducing the health inequalities that exist across Kirklees. Kirklees is an interesting and diverse area. Many of the people living within our boundaries identify closely with the locality in which they live, rather than with Kirklees as a whole. Together with the Council, we recognise this by working in partnership in the seven distinct localities that make up the borough of Kirklees. This plan sets out details of the actions we plan to take at locality level, as well as those focused on Kirklees as a whole. We know that there are health inequalities avoidable gaps in health outcomes experienced by different groups of people within Kirklees. A strong feature of this plan is our commitment to narrow these gaps. Over the next few years, this will mean a stronger targeting of resources to ensure that everyone has access to the opportunities and services they need, to improve equality of outcomes. This plan should be regarded as an initial statement of how we expect services to evolve over the next few years, however we know that we will need to respond to our communities, technological changes, clinical advances and external factors. Therefore, this five year strategic plan will be subject to ongoing review and updated as needed to reflect changes both within Kirklees and externally.

Rob Napier Chairman

Mike Potts Chief Executive NHS Kirklees

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Section 2

Ambitions for a Healthy Kirklees – the 5 year strategic plan Our 5 year strategic plan combines all the elements of work that we undertake into one concise document. The work which we undertake is derived from the needs of the Kirklees community in conjunction with the strategic needs of our partners and stakeholders. The plan is supported and driven by a number of factors as set out below:

Vision and Values within this document

Our Vision and Values

Joint Strategic Needs Assessment Comprehensive Area Assessment Needs of our population Local Area Agreement Yorkshire and Humber “Delivering Healthy Ambitions”

Our Strategic Goals and Programme Objectives

Programme Delivery Strategy Local Operating Plan Organisational Development Plan

Delivering the Strategy and Plans

Medium Term Financial Plan Workforce Development Plan

Estates Strategy Communications and engagement

Supporting activities

Information management and technology

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Section 3

Our Vision and Values, Goals and Priority Programme Objectives Kirklees PCT was established in October 2006 from the three former PCTs in Huddersfield and North Kirklees. We are the custodians of the National Health Service in Kirklees and this is reflected in our name - ‘NHS Kirklees’. We have the same boundaries as Kirklees Council and we both organise our work across the same seven localities. We serve a population of some 400,000 people which is expected to grow by a further 33,000 by 20181. 3.1

Our vision and values

Working together to achieve the best health and wellbeing for all the people of Kirklees • Recognise that people are at the heart of everything we do; • Support people in taking responsibility for their own health and well-being; • Encourage innovation and continuous improvement and celebrate the contribution made by our staff; • Encourage open, clear and honest communication; • Value diversity and challenge discrimination; • Show understanding, dignity and respect for all our clients, partners and staff; and • Be accountable for the decisions we make, the work we do, the resources we use and our impact on the environment. 10

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We are responsible for improving the health and well being of local people and making sure that services are in place to meet their needs. We commission services from others, including GPs, dentists, pharmacists, optometrists, voluntary organisations and local and specialist hospitals. We are accountable for ensuring that these services are accessible, high quality and safe. Medium to Long Term Changes Over the period covered by this plan (and beyond) we want to achieve changes which further our goals. We have a shared ambition with Kirklees Council and other partners that by 2020 Kirklees will: • Be recognised in West Yorkshire and beyond as an area of major success; • Have a strong economy supported by an attractive, high quality environment, offering the best of rural and urban living; • Place a high value on creativity and learning; • comprise communities who are proud of their past, but enjoy diversity, are outward looking and face the future with optimism; • be a safe, healthy and supportive place to live and work for both young and old people, with a clear commitment that all should share in this success.

ONS 2006-based population forecasts (whereas the Kirklees Joint Strategic Needs Assessment, published in February 2008, uses ONS 2004-based forecasts).


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

GOAL 1

Place the person at the centre of everything we do by: • engaging with people to help them understand and take responsibility for their own health • supporting people to feel in control of managing their problems and able to make healthier choices of personal behaviours • providing people with personal choice in accessing help and interventions as ‘close to home’ as feasible • commissioning services which are based on, and responsive to, the person’s needs and preferences, so focus on outcomes • involving local people in creating and delivering solutions.

GOAL 2

Improve health and reduce health inequalities by: • achieving the best possible health outcomes within available resources • commissioning services that encompass prevention, detection, treatment and the consequences of ill health • achieving equality of outcomes through targeting resources to follow needs and so reducing gaps in services and support

GOAL 3

Improve quality and promote safety by: • commissioning services that are delivered safely and to the highest standards and are evidence based around clinical and cost effectiveness • encouraging new and innovative ways of delivering services that are sensitive to the diverse needs of our community, demonstrate improvements in quality and are delivered in an environment that staff and local people can be proud of • developing a learning environment that promotes continuous professional development, motivates people to achieve their full potential and aids recruitment and retention of high calibre staff

GOAL 4

3.2 Our Goals To achieve our vision, we are driven by clearly defined goals and objectives. These goals have been reviewed and now reflect both the key national drivers and our local priorities. For these reasons, our goals form a ‘golden thread’ running through our plans, and underpins our approach to the priority objectives and our 11 health programmes.

Promote choice and accessibility by: • providing people with a choice of a range of services and interventions and ensure that services are accessible, with the principle of ‘closer to home’ being applied as far as possible.

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GOAL 5

Work well in partnership with communities, individuals and their families, staff and organisations by: • achieving real involvement of local people, especially users, staff and our local community in identifying their needs, agreeing priorities for commissioning , creating solutions and taking action

GOAL 6

Promote local sensitivity through effective commissioning by: • setting outcomes and actions that reflect local needs and priorities • acting at the right level, e.g., locally or regionally, depending on the issue or outcome desired.

GOAL 7

Promote strong clinical leadership to drive service re-design and innovation by: • having the skills and capacity to enable effective clinical leadership and engagement in all relevant aspects of the commissioning process

GOAL 8

Be a visibly credible organisation, operating to the highest standards by: • achieving the highest standards of probity and accountability, managing risk and maintaining effective governance arrangements to make sure that the organisation is run efficiently within available resources and in a way that inspires public confidence

3.3 Our Priority Programmes In order to achieve our vision and deliver specific measurable outcomes we have identified 11 priority programme objectives, which are listed in detail in the table in Section 5.3 “Kirklees Programme Objectives and Outcomes”. Successful delivery of our priority programmes will enable us to address our vision, goals and outcomes. Essential to our success is: • the management and delivery of our 11 programmes as supported by our emerging Programme Delivery Strategy, investment plans and financial planning as set out in section 6; and • the supporting activities set out in section 7 .

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

(1)

Planned Care including Cancer & Palliative Care To commission the best standard of care and work with providers to ensure that national standards for access are met.

(2)

Primary Care To commission high quality primary care for all and reduce any variations that exist between different areas in Kirklees.

(3)

Children and Young People To improve the health of and reduce health inequalities amongst children and young people in Kirklees

(4)

Drugs and Alcohol To improve both the numbers of people treated and the personal and community outcomes for people in receipt of drug and alcohol services

(5)

Infection Control Reduce the number of avoidable HCAIs to zero across Kirklees.

(6)

Urgent Care Ensure that people with an urgent care need can access appropriate high quality services in a timely manner and that these services function effectively together

(7)

Healthy Pregnancy and Maternity Place women and families at the centre of their pregnancy journey; listen to and supporting them in identifying their needs and commission effective services and support to meet these needs.

(8)

Long Term Conditions (inc Physical & Sensory Impairment) Embed into our local health and social care community an effective, systematic approach to the care and management of patients with LTC

(9)

Learning Disabilities To empower and enable individuals with learning disabilities to lead a full and, as far as possible, ordinary life as part of the community with the same hopes and aspirations as everybody else.

(10) Mental Health To improve people’s mental health and well-being by commissioning a broad range of services that address people’s needs promptly and effectively. (11) Choosing Health Promote healthy life styles for all and tackle health and well-being inequalities through working in partnership to embed evidence based programmes

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Section 4

Needs of our population 4.1 Policy and Planning context The work of NHS Kirklees is driven by a vast array of political, social and economic drivers. This section sets out the significant factors influencing NHS Kirklees today which form a basis for identifying on which we form our strategic plan and detailed programmes. In order to ensure that the needs of our population are understood, we need to; • have a good understanding of public expectations and political drivers; • have active engagement with local people; and • involve clinical leaders in assessing local needs and shaping priorities. Further details on these areas can be found in Appendix 1. Other key factors which drive our strategic decision making are the national and local priorities, local population demographics, the results of the Joint Strategic Needs Assessment, working with partners, the service provision and the requirements of World Class Commissioning on which further details are provided below.

4.2 National and Local Priorities It is crucial that our strategy and goals reflect and respond to the opportunities and direction of national policy and reform. The priorities for the NHS and direction for the next three-year planning cycle are set out in the annual NHS Operating Framework, in which the emphasis is on shifting from central direction-setting to local priority setting in partnership with local people and communities. The Kirklees Local Area Agreement (LAA) was held up as good practice by the Yorkshire and Humber Government Office, and building on the strength of the partnership working, was agreed ahead of national deadlines. Our strategy reflects the commitment to this approach. NHS Kirklees has already put structures in place to improve health and access to the most appropriate services of the local population. Health Improvement Teams have been established as part of the Commissioning and Business Planning Framework with clinical leadership. Current local performance challenges include hospital and community acquired infections, long waiting times for inpatient care at tertiary providers, mental health targets, and access to A&E. Investment in terms of resource, workforce planning and organisational development over the next five years will support the delivery of the strategic plan and delivery of the national and local priorities. Our choice of outcomes for world class commissioning reflects the above. These, together with our existing priorities, e.g., Vital Signs for the LAA, form the basis of our future performance regime.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

4.2.1 Local Priorities The outcomes identified through a process of consultation as part of world class commissioning have been chosen in line with local priorities as set out in the JSNA. In the majority of cases Kirklees is an outlier for each of the chosen measures. The local health priorities of Kirklees are directly linked to the chosen outcomes and in line with both NHS Kirklees’ vision and the ‘areas of care’ from the NHS Next Stage Review.

The NSR report is accompanied by publication in early July 2008 of the NHS Next Stage Review - Our vision for primary and community care. This sets out the Government’s intended direction for primary and community care in England, where essential standards are ensured and excellence is rewarded. It focuses on personal and responsive health care providing integrated care based around the person, not just their individual symptoms or care needs.

The delivery of the national and local priorities will support the achievement of our goals not only in terms of outcomes but also in terms of ways of working. Through strong clinical leadership and focus on the priorities and performance challenges, NHS Kirklees will be able to commission effectively to improve health and reduce inequalities.

In the Yorkshire and Humber area, ‘Healthy Ambitions’ was published by the Strategic Health Authority (SHA) at the same time as the national reports. This document provides an invaluable benchmark against which to check our own local vision and plans. Healthy Ambitions also stresses the importance of strong primary care to the overall health care system. A strong primary care system leads to lower overall costs, better prescribing, better individual outcomes and higher service user satisfaction. The existing practice registered list based model is central to delivery but must be accompanied by intelligent commissioning of primary care services, supported by use of good quality clinical and public health data.

4.2.2 National Priorities: NHS Next Stage Review – Delivering Healthy Ambitions The results of the national NHS Next Stage Review (NSR) were published in June 2008. The final report of Lord Darzi's review High Quality Care for All, builds on earlier national statements of policy, in particular Our Health Our Care Our Say: a new direction for community services (2006), Choosing Health (2005) which stretch back to The NHS Plan, published in 2000. The NSR sets out a vision to provide people with good quality social care and NHS services in the communities where they live. The NSR report sets out plans that build on progress and how innovation and creativity of staff can further improve services. The report commits the Government to change driven by empowering staff at a local level not through top-down targets.

Taken together, Healthy Ambitions, the national reports and the broader factors discussed earlier provide a reasonable and sound basis on which to build our local vision for services and to plan ahead. Indeed, as we explain below, the direction for the future of health and health care in Yorkshire and the Humber as set out by Healthy Ambitions chimes well with our own existing vision and we are already addressing many of the priorities which it identifies. Examples include the LAA which has set key targets in a number of these

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areas including the promotion of breastfeeding and reducing obesity. Significant progress is also being made on specialist community and mental health services. The information and ambitions set out in this plan establish a clear set of goals for NHS Kirklees and our partners, which in turn sets the direction of travel for investment and service delivery. It also provides a benchmark against which to consider proposals and plans in the interim. The ambition is to build on existing successes and to continue to drive improvements in local health and to reduce inequalities (by the effective targeting of investment) between different Kirklees communities and localities. These will be further developed progressively in successive business and operational plans over the period.

4.3 Demographic Overview Population Kirklees comprises both urban and rural communities with a total population of over 400,000 which is both increasing and ageing. By 2018, the population is predicted to increase by 8%, exceeding the projected increase of 6% forecast within the Joint Strategic Needs Assessment (JSNA). The towns and valleys of Kirklees have their own strong and distinct identities and contain a rich and diverse mixture of cultures and faiths. This diversity, coupled with our complex links to major regional centres, creates unique opportunities and challenges for our district. The population is relatively stable, although there has been some immigration – e.g. Kurdish and Hungarian immigrants mainly based in Dewsbury and Polish immigrants 16

settling in Huddersfield. Often, these immigrant populations have particularly challenging health needs (especially in the case of asylum seekers and refugees) and we need to consider these needs in planning services. Kirklees has a diverse ethnic mix, with a higher proportion of our population from an ethnic minority than for England as a whole. It is difficult to be precise about specific numbers of people across ethnic groups but estimated figures in 2005 indicate that 15.5% of Kirklees’ population is from an ethnic minority, compared to the England average of 10.9%. The biggest such local populations are those with Pakistani (6.9%) or Indian (4.2%) origins.

4.4 Reducing Health Inequalities Health Inequalities are health differences between people which can be changed. Change depends on the control that people felt they have over factors that prevent ill health, as well as the opportunities they feel they have to control such factors. If we are to make a difference and narrow the Health Inequalities gap, we need to: • be person centred, focusing on equality of outcomes; • involve local people in creating and delivering solutions; • work closely with partners to ensure current needs are met and there is adequate provision for the future; • target our actions more effectively to ensure we reach those most in need; • establish clear programmes which support older people and those with long term conditions to address the challenge of a growing ageing population; • target our resources to reduce inappropriate variations in investment


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

across the area, particularly where lower investment sits alongside poorer health outcomes; and • use our commissioning function and opportunities in the new primary care contracts to tailor services to meet the needs of the practice and locality populations. This requires two key sets of actions: 1 A culture shift across organisations, working in partnership with other organisations in order to be person centred. Involving other parties in identifying issues and creating solutions, focusing on those in most need. 2 The development of targeted interventions to tackle the local challenges to health and well-being inequalities that have the most significant impact, as identified by the JSNA.

4.5

Joint Strategic Needs Assessment (JSNA). In our JSNA, published jointly with Kirklees Council in February 2008, we describe the future health and well-being needs of the local population. The JSNA forms the basis for planning, service development and is a key building block for the commissioning process for the next 5 to 20 years. The JSNA is being refreshed in 2009 to reflect the changing health needs of our population, and our planning will therefore evolve with these changes and will be reflected in specific programmes and objectives. This five year strategic plan is a first step on the journey which involves asking ourselves a number of key questions;

• What are the particular issues for the specific population groups we have identified? E.g., older people and young people; • What are the key health challenges our local communities will face as a result of housing, employment, income, transport, communications and climate change? • What are the key themes emerging from our existing mechanisms to give local people a ‘voice’? • What is the future shape of the population, especially in terms of age, ethnicity and migration patterns? • What impact will this have on the major issues we have already identified, and will it throw up others? • How have the key issues we have identified changed over time and how will they change over the next 5/10/15 years? • What are the key challenges involved in supporting people to feel in control in relation to their health and social care issues? E.g., what attitudes do different client and professional groups have to the increasing emphasis on self care? • What are the potential impacts of changes in health and social care technology and care practice? The process for developing the JSNA has enabled us to identify key issues for specific population such as for older people, carers, people with learning disabilities, women of child bearing age and people with physical/sensory impairment. It also looks at key conditions such as heart disease, stroke, diabetes etc; wider living and working factors such as employment, housing etc and personal behaviours such as smoking, alcohol, food and nutrition. These are shown in the table below:

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Table 1: Kirklees Key Health and Well-being Issues

Being healthy – conditions

Areas where our current response is under-developed to meet current or future needs

Areas where action is underway but more effective targeting is needed to address inequalities

Areas which are key issues for children and young people

mental-health & emotional well-being

heart disease & stroke

emotional well-being

diabetes

obesity

food

smoking

food

alcohol

physical activity

alcohol

obesity pain including musculoskeletal dementia Personal behaviours

smoking physical activity Living and working – wider factors

housing condition and options employment isolation and social networks educational attainment

The key health and well-being issues identified within the JSNA have an important role in developing our programme objectives.

The following two tables show health inequalities across the seven locality areas of Kirklees, split by children and young people and adults (2007 data). The breakdown of localities is as follows: Key: BBB – Batley, Birstall and Birkenshaw DDK – Denby Dale and Kirkburton D&M – Dewsbury and Mirfield HN – Huddersfield North HS – Huddersfield South Spen - Spen Valley Vall – The Valleys

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educational attainment


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Table 2: Locality Health Inequalities Summary – Children and Young People 2007 Localities Issues Infant deaths Rotten teeth – 5year olds+ Mums smoking at birth 14 year olds Physically inactive Smoking weekly Happy to smoke* Alcohol weekly* Drink alone Using drugs Teenage conceptions Had sex Felt miserable Felt angry Poor relationships – school staff Unhappy with self Do not have someone to talk to Bullied past 2 months Not 5 GCSEs grade C+

BBB B

BB

DDK DDK

D&M D

M

HN HN

HS HS

Spen Spen

Vall Vall

M

HN HN

HS HS

Spen Spen

Vall Vall

Table 3: Locality Health Inequalities Summary – Adults 2007 Localities Indicator Being Healthy Role functioning Pain problems Depression, anxiety, nervous illness Cancer registration breast Heart disease aged under 65 Heart, stroke deaths aged under 75 High blood pressure Stroke Asthma Diabetes Obesity Cancer deaths aged under 75 Deaths all causes 15-64 Personal Behaviours Smoking Alcohol excess Males Alcohol excess Females Enough physical activity Living and working Low income Housing - overcrowding

BBB B

BB

DDK DDK

D&M D

Shaded boxes show where a locality is significantly worse than the Kirklees average * Of those who smoked or drank + Decayed, missing or filled average number of teeth 19


The Kirklees Partnership, of which NHS Kirklees is a key player, recognises national and international trends that are affecting our area. Major issues are emerging that are holding Kirklees back as an area. To move towards a more sustainable Kirklees and achieve our 2020 vision, we must narrow the gaps inherent in: • infant mortality and other health inequalities including a life expectancy below the national average; • educational attainment; • a low skill, low wage economy; • lack of confidence in some of our towns (particularly in North Kirklees – Dewsbury and Batley); • community relations. Further information on local demographics can be found in Appendix 1.

Working with Partners and Shared Goals Kirklees PCT is committed to working with its partners to deliver shared goals to the Kirklees region (see Appendix 1 for more details). These shared goals are demonstrated in a number of supporting documents including:

4.7 Market Analysis of provision It is our responsibility as a strong commissioning organisation to ensure that we understand what services we need to commission and who is best placed to provide them. We will work with existing service providers to re-design and improve services where we know this will be in the best interests of individuals. We will also assess service gaps or shortfalls, and – with other commissioners where appropriate identify clear strategies to address these shortfalls. Our procurement policy gives us the opportunity to test healthcare markets and bring new providers into Kirklees if this is required. Such new providers may include ‘traditional’ NHS service providers as well as the independent sector, voluntary or not for profit organisations and others. We will ensure that the following drivers underpin our work on market analysis and development:

4.6

• the Kirklees Health and Well-being Inequalities Strategy; • the Local Area Agreement; • the Comprehensive Area Assessment; and • the Safeguarding Strategy

• Increasing choice and diversity of service, giving people more opportunity to define a range of responses to their health and social care needs; • care closer to home where it is safe and effective to do so; • improved access, both in terms of location and timeliness of services • maximising the opportunities available to us from an increasingly diverse market, while at the same time using strong contracts to manage any risks to delivery Details of our current providers at included in Appendix 3. We have assessed current levels of provision for primary care services across our localities and this analysis is contained in Appendix 1. It is clear from this analysis that certain localities face shortfalls certain areas eg numbers of GPs

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

resulting in higher list sizes than elsewhere in Kirklees. We have already started address capacity gaps and test the market through several tendering exercises. For example, • A new 8 -8 GP Led Health Centre which opened on 1 March 2008 and is aimed at increasing GP capacity in Dewsbury. • Our urgent care procurement for GP out of hours services resulted in an extensive market testing exercise and the opportunity to set new quality standards in contracts. • An ongoing procurement for an alcohol treatment service in Kirklees, resulting from new investment by the PCT to identify issues highlighted in our JSNA. During 2009, we will take further actions to understand our healthcare market and respond to identified gaps. These actions will include: • Building on the findings of a market management programme undertaken in collaboration with neighbouring PCTs; • Prioritising areas where a full market analysis is required and assessing current providers in relation to their costs, quality and patient feedback. We need to embed this way of working in our organisation and ensure that our programme leads have the skills necessary to understand and shape healthcare markets. • Strengthening our focus on patient choice. We know from initial patient surveys that location is a major driver in people’s choice of hospital. However, through our broader programmes of work (eg Long Term

Conditions and mental health) we will focus not only on location but on the content and style of services offered. The strengthening of quality standards in contracts and the performance management of these standards will enhance the reputation of the NHS, giving the public confidence that services are of the highest quality.

4.8

Health Outcomes – World Class Commissioning If our vision is to be realised, robust and appropriate delivery mechanisms are essential. World Class Commissioning (WCC) is now the key vehicle for delivering an NHS fit for the 21st century. This applies to primary and community services as much as it does to acute services. WCC is designed to enable the NHS to meet the changing needs of the population and deliver a service which is clinicallydriven, service user-centred and responsive to local needs. This requires us to develop a more strategic, long term and community focused approach to commissioning services, where we and other local commissioners work together with health and social care professionals to deliver improved local health outcomes. WCC is central to achieving the vision of a health and social care system which is fair, person centred, effective and safe. Consistent with WCC we are placing greater emphasis on assessing local needs (e.g. through the JSNA), and prioritising investments to deliver long term improvements in health outcomes through the locality based planning approach. These changes are pivotal in addressing local health inequalities. WCC also supports the shift from treatment and

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Table 4: Our Chosen World Class Commissioning Outcomes Metric

Metric Definition

Kirklees PCT WCC Outcomes

Health Inequalities

Average IMD (deprivation index) score

Reduce health inequalities as measured by the average index of multiple deprivation (IMD) score

Life Expectancy

Life expectancy at time of birth, in Years

Increase life expectancy at birth by at least 2.5 years

Smoking during Pregnancy

Actual percentage of women known to be smokers at the time of delivery

Reduce smoking in pregnancy by 20% of the current baseline.

Smoking quitters

Rate per 100,000 population aged 16 and over

Support a further 10,000 people to stop smoking.

Stroke admissions given a brain scan within 24 hours

Percentage of people admitted with a stroke given a brain scan within 24 hours

Increase the percentage of people given a brain scan within 24 hours following admission for a stroke by 21% - from a baseline of 59% to 80%.2

Alcohol harm

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

Maintain the rate of hospital admissions for alcohol related harm at 10.8 per 100,000 patient population.3

CHD controlled BP

Percentage of people with Coronary Heart Disease in whom the last BP reading was 150/90 or less in the past 15 months

Increase the percentage of people with Coronary Heart Disease (CHD) who have their blood pressure under control by 28%, from a baseline of 52% to 90%.4

Childhood Obesity

Percentage of obesity among primary school age children in Year 6

Reduce the percentage of children in year 6 who are obese at from 18.9% to 17% by 2013.5

Emotional health of children

Baseline to be established through national Tellus Survey in Summer 2008. Targets will be set for 09/10

Improve the emotional health and wellbeing of children to achieve the 5 Every Child Matters outcomes To Be Healthy, Stay Safe, Enjoy and Achieve, make a Positive Contribution and Achieve economic Well-being.

People with LTC supported

People with LTC supported to be independent and in control of their condition, definition to be confirmed by central government

Support more people with Long Term Conditions (LTC) to be in control of their condition by 26%, from a baseline of those surveyed of 54% to 80%.6

Data from Sentinel audit snapshot. Not collected for Vital Signs. 3Data from North West Public Health Observatory figures. 4Actual data – Vital Signs 5Actual data – Vital Signs 6Based on HCC sample survey snapshot data for LAA

2

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

diagnosis to prevention and the promotion of well-being. Under WCC, we are required to choose a number of health outcomes against which our performance will be assessed in future years. We have worked closely with our key partners, in particular Kirklees Council, to identify outcomes and related indicators which both reflect our local health challenges and strategic priorities and are within our ability to influence and change. Please see Tabe 4 for our WCC outcomes.

Section 5

Our Key Programme Areas and Investment 5.1 Programme areas We have worked with local partners, stakeholders and our own staff to put in place a range of programmes designed to align the local NHS and related systems to deliver the goals and programme objectives described above. These programmes are supported by a range of underpinning strategies and supporting activities e.g. the Programme Delivery Strategy and the workforce planning framework. This strategic plan identifies how the PCT’s 11 programmes are used to ensure that work is directed towards achieving our vision and outcomes. The WCC outcomes are an integral part of the Kirklees PCT outcomes as identified in Section 5.3 the Kirklees Programme Objectives and Outcomes. These programmes are aimed at improving the health of local people and reducing health inequalities. Given our local demography, we have a particular focus on long term conditions with specific priorities relating to older people and vulnerable adults. Our Health Improvement Teams (HITs) work within the 11 broad programmes, with Choosing Health and Long Term Conditions subdivided further into specific areas of work. All our HITs work within a cultural framework which is comprised of our visions and values, and our strategic goals as a “golden thread” running through each specific programmes objective and 23


influencing ultimate outcomes. New areas of strategic development are led by each of the HIT or PBC leads with full collaboration and support from enabling functions such as performance and information management teams, finance procurement , workforce and medicines management. For further detail around our business planning process the structure of our HITs and our governance processes around the evaluation and approval of new strategic developments please see the Kirklees Programme Delivery Strategy. For each of the 11 Programmes there is a detailed action plan developed and managed by the HITs identifying objectives, actions and outcomes. These plans include short term and long term outcomes and therefore provide a key link between the 5 year strategic plan and the annual operational plan.

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5.2 Delivering Healthy Ambitions The Yorkshire and the Humber published “Healthy Ambitions� in June 2005 in response to the Next Stage Review, and provides an invaluable benchmark against which we can check our own local vision and plans. Healthy Ambitions also stresses the importance of strong primary care to the overall health care system. The direction for the future of health and health care in Yorkshire and the Humber chimes well with our own existing vision and we are already addressing many of the priorities which it identifies. Examples include the Local Area Agreeement which has set key targets in a number of these areas including the promotion of breastfeeding and reducing obesity. Significant progress is also being made on specialist community and mental health services. The following diagram shows how the Kirklees Programmes support the delivery of Healthy Ambitions.


End of Life

Maternity and Newborn

Planned Care

Acute care

Mental Health

Children’s Health

Long Term Conditions

Staying Healthy

Key priorities from Healthy Ambitions:

Primary care

Planned care/18 weeks

Urgent care

Partnership commissioning

Long Term Conditions

Choosing Health

NHS Kirklees Programme Areas:

11. Primary Care

9. Healthy Pregnancy and Maternity Service Strategy 10. Planned Care including Cancer and Palliative Care

8. Urgent Care

4. Children’s and Young Peoples Strategy 5. Drugs and Alcohol Commissioning Strategy 6. Learning Disabilities 7. Mental Health

3. Long Term Conditions (including Physical and Sensory Disability)

1. Choosing Health 2. Infection control

Kirklees HIT Programmes:

Mapping our Delivery of Healthy Ambitions to our Programme Areas

Coronary Heart Disease

Neurology

Diabetes

Respiratory

Stroke

Cardiovascular disease

Long Term Conditions HIT Programmes

Tobacco

Sexual Health

Patient Programme

Self Care and Expert

Physical Activity

Oral Health

Obesity

Better Health at work

Alcohol

Accident prevention

Food

Choosing Health HIT Programmes

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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Vital Signs Local

Key Actions:

Planned Care: • Redesign pathways to better manage referrals and deliver care in the appropriate setting • Capacity and demand planning • Commission activity to achieve standard • Monitor and react to stretch targets.

Individuals and their families will be at the core of how care is commissioned and delivered.

Palliative care services will be improved. End of life care will be available for everyone with long term conditions.

For cancer care, we will implement the changes required in the cancer reform strategy. This will allow individuals to receive their care in a timely fashion and have a say in how their care is delivered.

Cancer / Palliative Care: • Develop a local Cancer Strategy based on the needs of the local population, incorporating the recommendations of the Cancer Reform Strategy • Commence the National Bowel Cancer Screening Programme • Implement improved breast cancer screening • Monitor Cancer Waiting Times to ensure we are meeting local needs and targets • Develop local Skin Cancer Services • Monitor, review and link with Community End of Life Services to be developed through the recruitment of a facilitator to reduce hospital admissions and improve EOL care in the home. • Develop programmes of education and training.

WCC

New services for people suffering from musculoskeletal services in primary care means that service users have greater choice of provider and that care is delivered closer to home.

The Cancer Reform Strategy

NHS Next Stage Review

• Delivering the NHS NSR targets for Planned Care • A two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals; • A maximum waiting time of one month from diagnosis to treatment for all cancers; • A maximum waiting time of two months from urgent referral to treatment for all cancers; • Increase choice of provider, setting and treatment options

Planned care including Cancer and Palliative Care

We have commissioned services and worked with providers to ensure that the 18 week standard is met.

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Liverpool Pathway

End of Life Gold Standards Framework

Delivering Healthy Ambitions

Local Area Agreement

Joint Strategic Needs Assessment

Primary Care – to improve rapid referral rates and screening

Planned Care programme – delivery of the 18 week target

Quality Improvement – patient experience

Choosing Health Smoking Quitters programme - (WCC Outcome and LAA target)

Linking themes / dependencies

5.3 Kirklees Programme Objectives and Outcomes. Our programme objectives will be delivered through the 11 programme areas. Each programme has a comprehensive action plan which details the objectives, actions, outcomes and financial investment required. The table below identifies the programme objectives and links these to our key outcomes.


Maximise health benefits through personalised medicines management

Ensure that access to community pharmacy is equitable according to need particularly in deprived areas

Improved primary care premises in identified areas

To achieve average list size of 1750 Greater choice and accessibility for patients

Key Actions: • Establish primary care quality benchmarking tool • Identify practices and localities with highest list size and agree commissioning plans to address. • Creation of a balanced scorecard approach to quality in primary care • Continue to review the extended hours offered by practices to ensure they reflect service user’s preferences as reflected in surveys. • Review and strengthen access to dental care • Commission a community based cataracts assessment and referral service • Commission a Primary Eyecare and Referral Service (PEARS) • Ensure that access to community pharmacy is equitable according to need, particularly in deprived areas, ensuring that services users have choice and an assured quality service • Promote the use of community pharmacies as healthy living centres, providing extended services such as minor ailments schemes, long term conditions management and involved in screening and monitoring of conditions such as heart disease and hypertension. • Review and strengthen existing arrangements for commissioning medicines, including High Cost drugs, non NIHCE/ Non Tariff drugs through the use of WCC competencies and frameworks.

Local

Vital Signs

WCC

Delivering Healthy Ambitions

NHS Plan

• Achieve average list size of 1750 by 2013 • An increase in the number of training practices from our current baseline of 11 by 2013 • Commission a new primary care out of hours service from April 2009 • Increasing the number of children receiving immunisations in line with national guidance • Increase primary dental care capacity within the Kirklees area so that by 2011 anyone who needs to see a dentist will be able to do so

Primary Care

Improved quality of primary medical care by reducing variations across Kirklees

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

New Out of Hours service will ensure continuous 24/7 care improving quality and access

Quality Improvement will support service redesign and patient experience

Primary Care will support improved choice options and enhanced services in primary care

Community Hospitals Programme will deliver Care Closer to Home

Linking themes / dependencies

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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Healthy Ambitions Vital Signs Local

Key Actions:

• Develop and agree new specifications for health visiting and school nursing and ensure effective delivery. • Establish effective monitoring systems and ensure evaluation against outcomes. • Ensure implementation of the new CHPP • Ensure the programme is embedded in the roles of service providers and effectively delivered. • Integrate service delivery across children’s centres, general practice and health visiting • For Family Nurse Partnership, establish and maintain Programme Management approach over time period of project. • To implement ‘Aiming High for Disabled Children’ and ‘Standard 8 NSF’. • To implement a comprehensive Emotional Health and Well-being Strategy. To deliver a timely, integrated, high quality multi-disciplinary mental health service. This would ensure effective assessment, treatment and support for children, young people and their families. • Agreeing a service specification and procuring a Yorkshire and Humber wide paediatric and neonatal intensive care transport service.

Improve self-esteem, increase resilience to stressors, improve self efficacy, better relationships, improved emotional literacy, less bullying, increased/improved assertiveness and better access to more effective Mental Health

For Disabled Children, Families/carers have access to a variety of support options and are fully informed about what is available

Reduction in unwanted/unplanned teenage conceptions, better access to more effective services, improved selfesteem, better relationships

Delivery of FNP programme and decision over sustaining the programme after 3 year licence period.

WCC / LAA

WCC

• Reduce percentage of obese children in year 6 from to plateau at 17% by 2011. • Baseline for emotional health of children to be established through national Tellus Survey in Summer 2008 69.8% with targets for 09/10 72.1% and 10/11 74.3% • Reduce the percentage of 16 to 18 year olds who are not in education, employment or training (NEET) from 7.9% (08/09) to 6.5% (10/11) • Reduce the under 18 conception rate to 24.3 by 2011

Children and Young People

We will: Delivery of the new Child Health Promotion Programme

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Breastfeeding Strategy

Children’s National Service Framework

Aiming High for Disabled Children

Every Child Matters

Kirklees Children & Young People Plan

Cancer strategy supports children and young people diagnosed with cancer

Choosing Health Sexual Health programme will target teenage conceptions

Primary care programme will deliver family based services in areas of highest need

Choosing Health Obesity strategy will deliver reduction in childhood obesity

Improved quality of patient experience

Linking themes / dependencies


NTA

• NTA 2008/09: 85% of service users in effective treatment o 2009/10:87% o 2010/11:88% o 2011/12:89% o 2012/13:90% • Number of service users in effective treatment increases from baseline: o 2008/09: 3% (1507) o 2009/10: 2% (1537) o 2010/11: 2% (1568) • Number of service users in shared care increases from 200 (08/09) to 350 (2011/12) • Number of service users accessing individual budgets and direct payments increases from 5 (08/09) to 50 (2011/12)

Key Actions:

Development of a person centred approach that improves user (and by definition community) wellbeing and social inclusion

Develop effective partnerships to deliver collaborative advantage and benefit to service users and wider communities

Quality to be enshrined in the commissioning process via service restructuring and enhanced clinical leadership

• Commission services that are increasingly personalised and responsive to individual needs • Develop more pathways in and out of treatment, including offering a wider range of primary care based services and better access to mental health support, family interventions, housing and employment • Develop a preventative approach based on overall service user well-being, including improved access to harm reduction services, blood borne virus services and counselling services.

Vital Signs/NTA

2008/09: 450 people treated 2009/10: 960 2010/11: 1200 2011/12: 1300

Improve both the numbers of people treated and the personal and community outcomes for people in drug and alcohol services

Improved access to, and successful discharge from drug, alcohol and offender health services

LAA – National Drug Treatment Monitoring System

• Increase numbers in treatment and successful completion rates

Drugs and alcohol

KMC Adult Social Care

Vital Signs/Nation al Treatment Agency

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Putting People First (Social Care improvement agenda)

Darzi and personalisation agenda

LAA

Local Area Agreement Plus Offender Management Agenda

LAA – Choosing Health/Offender Health strategy/Darzi

Linking themes / dependencies

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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• Create a safe environment for service users, visitors and health care workers • Promote best practice through a programme of education and audit to reduce HCAIs. • Support health care workers who are delivering services to individuals by providing them with a clear framework for managing infection prevention and control • Reducing HCAIs part of legislative framework • Effective root cause analysis investigation to minimise and manage HCAIs • When commissioning services the PCT ensures and satisfies itself that contractors have appropriate systems in place to keep service users, staff and visitors safe from HCAIs. Minimising HCAIs is embedded in the governance systems of the organisation to strengthen responsibility for HCAIs. • Communicating with service users and the public about HCAIs in the health economy and to ensure the information meets the needs of the local population • The Infection Prevention and Control Strategy empowers all staff to follow good practice. A commitment that everyone in the organisation including independent contractors and commissioned services understand their role in preventing infections • Ensure that infection prevention is an integral part of delivering care • Change behaviour through consistent leadership at every level and ensure accountability for infection prevention and control is explicit.

Key Actions:

Local

Healthy Ambitions

Vital Signs

LAA

NHS Plan

• Reduce Clostridium difficile infections by 10% by 2010/11. • Maintain a 50% reduction in MRSA bacteraemia cases from the 2003/04 baseline

Infection control

We will: • Reduce the number of avoidable HCAIs to zero across Kirklees. • Adhere to appropriate policies and protocols for the prevention and control of HCAIs • All NHS Kirklees employees will attend mandatory training • Achieve full compliance with the H&SCA 2008 registration with care quality commission. • Embed the effective prevention and control of HCAIs into everyday practice and applied consistently by everyone • Provide suitable and sufficient information to patients and the public • Ensure infection prevention and control central to the delivery of safe cost effective health care.

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Quality Improvement will support service redesign and patient experience

Primary Care will support improved choice options and enhanced services in primary care

Community Hospitals Programme will deliver Care Closer to Home

Linking themes / dependencies


We will continue to work with our communities and partners to improve the quality and accessibility of urgent care services and reduce inequalities of care by continued social marketing and seeking feedback about our services.

• We will develop a full and comprehensive programme for urgent care that will deliver improvement over the next 3 – 5 years. • Urgent care centres will be developed on our main A&E sites to provide a breadth of high quality and access care for service users as outlined in Healthy Ambitions. • We will improve performance in urgent care centres by working closely with our acute providers at MYHT and CHFT. • We will expect our intermediate care teams to work with and visit the main hospital sites to ensure that discharge is timely and delays are minimised • We have integrated GP streaming services into our A&E departments • We will achieve a marked improvement in our YAS performance through joint action planning. • Services that work to deliver urgent care will be fully integrated. This includes OoHs services, A&E departments and ambulance services. These services will also work in tandem with GPs, secondary care and social care services.

Key Actions:

Local

Healthy Ambitions

Vital Signs

Next Stage Review

NHS Plan

• Achieve and maintain 98% A&E 4hr wait standard. • Reduce A&E minor injury and illness attendance by 10% in 2009/10 (by using streaming etc) • Delivering the outcomes of NHS NSR for Acute Care

Urgent Care

We will: • Ensure that urgent care services are integrated and of high quality; • Ensure that high quality standards of care are delivered; • Integrate a new “Access and Assessment service for WY that will provide consistent information for our service users and a central point for their urgent care needs to be addressed;

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Quality Improvement will support service redesign and patient experience

Primary Care will support improved choice options and enhanced services in primary care

Health Care Commission Urgent Care Review 2008

Linking themes / dependencies

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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• Enable women to support each other through peer groups in a range of settings familiar and comfortable to them by piloting a peer led “salon” approach in Dewsbury • Extend insight with pregnant women and practitioners to South Kirklees • Ensure that women and families are supported around their pregnancy and clinical needs, their health and lifestyle needs and their wider social needs including income, housing, domestic violence and substance misuse. • Women and their families will be supported by family support workers, working alongside peer groups, who will help identify and address the range of needs for each family. • Ensure effective capacity of community based midwifery services including using skill mix to free up midwives time. • Establish Maternity Services Liaison committee for Kirklees. • Ensure continued testing of the models and services through social marketing.

Key Actions:

Target 08/09 = 80% 09/10 = 85% 10/11 = 90% Local

Healthy Ambitions

WCC

Vital Signs

Increase the % of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy

Healthy Pregnancy and Maternity

We will: • Place women and families at the centre of their pregnancy journey by listening and supporting them to identify and address their needs • Ensure women have access to effective support to make sustainable lifestyle changes • Develop and implement Care Pathways for pregnancy, addressing complex needs through a multi-agency response • Ensure that services are configured and organised to provide direct access to a midwife, the ability to book as early as 6 weeks of pregnancy, choice of accessing maternity care and choice of type of antenatal care. • Ensure that services offer choice of place of birth.

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Breastfeeding Strategy

Quality Improvement will support service redesign and patient experience

Primary care strategy supports service delivery

Children and Young Peoples programme / Sexual Health Strategy will support delivery of the teenage conception target.

Linking themes / dependencies


Meet the individual requirements of people with long term conditions through high quality personalised care which offers choice and services commissioned to meet the needs as determined by the individual

The LTC programme will: • Embed into our local health and social care community an effective, systematic approach to the care and management of patients with LTC • Reduce the reliance on secondary care services and increase the provision of care in a primary, community or home environment by the redesign and development of intermediate care services

• Commission and implement a risk stratification tool to identify people with LTCs • Development/implementation of a generic care and a self care pathways for LTC • Implementation of intermediate care and falls pathway. • Implement single point of access for health/social care services • Improve our approach to LTC and introduce new pathways of care for service users with a sensory impairment • Develop specialist LTC pathways in line with the standards set out in NSFs, concentrating on bringing care closer to home and developing hospital services that offer rapid access to assessment, diagnostics and treatment. • Address any health inequalities which will require a focus on improving services in those areas where choice is limited and/or traditional services are having little or no impact • Work with localities to commission services that are appropriate to individual communities matching approach to need and improving access

Key Actions:

WCC

• Percentage of stroke admissions given a brain scan within 24 hours increased from 08/09 baseline 59% to 90% 12/13 • Increase the number of patients with CHD in whom the last BP reading was 150/90 or less in the past 15 months • People with LTC supported to be independent and in control of their condition (definition to be confirmed by central government) • Reduction in unplanned hospital admissions for LTCs from 08/09 baseline by 15% • Reduction in emergency bed days from 08/09 baseline by 15% • Reduction in the number of patients admitted to hospital or care home as a result of a fall from 08/09 baseline by 25% • All patients with LTC will have a personalised care plan by 2010

Long Term Conditions (including physical and sensory impairment)

Local

NHS Plan

Vital Signs

Healthy Ambitions

LAA

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Primary Care will support delivery of practice based services

Care Closer to Home will deliver locally based LTC services

Choosing Health programmes will address health inequalities and behaviours eg; smoking, diet and lifestyle Medicines Management will deliver community based services for those with an LTC

Quality Improvement will support service redesign and patient experience

Linking themes / dependencies

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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• In partnership, we will commission a range of services with third sector providers: • Employment service • Self help • Arts • Physical activity • Advice and support • Gender specific • Carers • Advocacy • The partnership work underway will be further developed to deliver better outcomes and economies of scale. The health and social well-being of people who live in Kirklees is a high priority • Ensure existing robust commissioning and contracting relationships are maintained with providers, influence the mental health market through enhancing relationships.

Key Actions:

Local

NHS Plan

Vital Signs

Healthy Ambitions

Vital Signs

• Identify 26 new cases of Psychosis by Dec 09 and 192 new cases by 2013 • 3342 new referrals seen by end March 2010 and 5013 seen by end March 2011 • In line with agreed protocol & criteria – achieve a statistically significant reduction in the number of individuals under sc 136 detained within police cells • Eliminate the requirement for OoA placements • Baseline of 75 adults require transition into adult service • Agreed waiting list backlog will be cleared within financial year 09/10 • Agreed access standards set within national best practice 18 week standard will be achieved & maintained by Sept 09 • To increase the number of adults in contact with mental health services and employed by 1.25% 09/10 and 2.6% 10/11

Mental Health

• Emphasis on the promotion of independence and protection of vulnerable people. • Work on reducing reliance on institutional care • Emphasis on prevention and wellbeing. • Changes in directly provided services along with work to grow the voluntary and ind sector. • Develop and maintain sustainable communities to support and address social exclusion. • Development of need appropriate/ageless services across 3rd sector. • To develop a wide range of services that deliver care for individuals as close to home as possible

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Care Closer to Home will deliver locally based services

Quality Improvement will support service redesign and patient experience

Choosing Health will deliver targeted programmes aimed at improved lifestyle choices through leisure, sports and recreation as well as well as issues affecting patients with MH problems, such as smoking and diet

Primary Care programme will build support

LTC programme will deliver increased quality of care for older people including those suffering from dementia

Linking themes / dependencies


• The PCT intends to pursue specialist learning disability pathway redesign. • To increase improved access to appropriate primary care health care & acute services through planned programme management.

Key Actions:

Local

Healthy Ambitions

Vital Signs

LAA

• Baseline mapping of primary and specialist care completed against all national recommendations • Increase number of practices with agreed LD registers to 82.6% - March 09 to 93.3% - March 10 • Increase number of patients on LD registers who meet agreed diagnostic criteria 632 - March 09 1332 - March 10 • 100% will be in receipt of HAPs / VIP cards • Number of agreed patients receiving annual health checks will be maintained at 76% of the total registered 480 - March 09 1013 - March 10

Learning Disabilities

• The vision for Learning Disabilities in Kirklees is to empower and enable individuals with learning disabilities to lead a full and, as far as possible, ordinary life as part of the community with the same hopes and aspirations as everybody else. • To improve access to healthcare and provide effective support for families and carers through meaningful involvement.

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Care Closer to Home will deliver locally based services

Quality Improvement will support service redesign and patient experience

Linking themes / dependencies

Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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Are covered in the detailed section on the CHIK programmes.

Key Actions:

Accidents o Reduce the number of people killed or seriously injured by 40% in 2010

Alcohol o Improve the availability of and access to relevant and effective treatments for alcohol misuse.

Obesity – o Those with a BMI 30+ and are eligible are referred to Kirklees weight management services – 3000 referrals annually o Increase adult participation in sport and active recreation to 23.1% by 2010/11 o Percentage of infants breastfed at 6-8 weeks

Smoking – o Increase 4 week smoking quitters among people aged 16 or over to 707 per 100,000 population by 2010/11 o Increase 4 week smoking quitters aged 16 or over in routine and manual groups (target to be established)

Infant Mortality – o Reduce the number of women of child bearing age who are hazardous drinkers (target to be established). o Reduce the % of women known to be smoking at birth in Dewsbury and Batley to 18% by 2010/11 o Women of child bearing age accessing a range of physical activity opportunities o To improve maternal and early infant nutrition

LAA

Local

LAA Vital Signs

Local

Vital Signs

Vital Signs/WCC/L AA

Local

Local

LAA

Local target

Vital Signs

• All-age all cause mortality rate per 100,000 population

Choosing Health

The Choosing Health in Kirklees (CHIK) programme will: • Tackle health & well-being inequality priorities through specific programmes • Promote healthy life styles for all through working in partnership to embed evidence based programmes • Work to deliver a cultural change in services to tackle inequalities

Driver

Key Outcome measures (inc. WCC outcomes) and outputs

Programme Objectives

Quality Improvement will support service redesign and patient experience

Commissioning strategies for Children and Young People, Maternity, Drugs / Alcohol and Mental Health

Care Closer to Home

Long Term Conditions Strategy

The Choosing Health Programmes will all contribute to the outcomes described as part of the overall programme objectives

Linking themes / dependencies


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Delivering the strategy and plans

The NHS Kirklees commissioning approach is centred around service planning driven by Health Improvement Teams (HITs), made up of PCT staff, Practice Based Commissioners and other strategic partners.

6.1 Commissioning approach Planning within the NHS is becoming driven by service users, carers, commissioners and staff, rather than national targets and topdown performance management. This is focused on finding ways in which to improve services and develop good practice via outcomes and their associated indicators, not inputs or processes.

We have established a new sub-committee of the Board - our Strategic Development Committee - to oversee the implementation of this Plan. A Programme Delivery Strategy setting out milestone and timelines in each of our programme areas will be finalised in spring 2009.

Section 6

The outcomes and indicators can be combined with other information, such as the JSNA, productivity data, programme budgeting, and other best practice guidance. This is used to identify the local health priorities that require review to commission appropriate service by the PCT, working with the Council, practice based commissioning units and representatives of the population. To achieve this there needs to be a framework within which: • The PCT has a clear understanding of the health priority areas it is focusing on. • There is an identified lead for each area that is supported by, and works coherently with other people within the organisation. Organisational leads are responsible for bringing together the teams of people needed to address their areas of responsibility. • There is an explicit statement from the PCT about the requirements on these leads/teams, and what they need to do within specific timeframes, in order to inform the organisation’s annual planning process. • There is clear accountability within the PCT for the work of these leads/teams.

6.2 Clinical Leadership Local clinicians have a key role in assessing local needs and shaping priorities. Their professional experience of delivering care, combined with their understanding of service users’ needs, will be crucial to designing high-quality, personalised health and care services. In Kirklees, we are fortunate in having a number of clinicians already engaged in commissioning – e.g. as members of the Professional Executive Committee, through practice based commissioning (PBC), and as clinical leaders in their own specialist areas. We are committed to working in partnership with our local clinicians and to supporting their development, in a way that will help drive innovative commissioning. To maximise the potential of this strong clinical engagement, we have created a Kirklees Commissioning College. This newly created forum brings together PBC representatives, clinical leads, PEC members and PCT programme leads and provides a vehicle for clinical debate, input and challenge to the strategic development of our shared commissioning programmes. We see our clinicians as one of our strongest partners and through the Commissioning College will work together 37


to create a strong commissioning system for NHS Kirklees. More details on the Commissioning College are attached as Appendix 6. The PEC plays a key role in ensuring the Board receives appropriate clinical advice and support in undertaking its statutory responsibilities. The involvement of clinicians through Practice Based Commissioning is also vital to our success. They will also play a key supporting role in assessing local needs for the practice and locality populations, helping to decide local priorities, and designing care. Our Practice Based Commissioning (PBC) Strategic Framework underpins the successful development of PBC throughout Kirklees. Taking as a starting point relevant key national guidance and best practice, the aim is to ensure strong PBC as an integral component of a successful commissioning system. The effective development of PBC will contribute significantly to the PCT and its constituent practices becoming world class commissioners. We are already embedding clinical leadership into our commissioning processes. For example, we have: • appointed clinical leads in some of our health priority areas, e.g., mental health, long term conditions and musculo-skeletal services; • demonstrated our commitment to PBC by putting in place the management capacity to support its development and actively promoting joint working between PBC and NHS Kirklees. Wide-ranging programmes are being addressed through our Health Improvement Teams and this commitment is reflected in the positive results reported in successive PBC surveys . These show that most 38

practices are supportive and are actively engaged; • approved a number of proposals for service re-design developed by PBC teams, e.g. the introduction of consultant-led specialist outreach clinics in practice, and new models of care for people with diabetes; and • ensured clinicians are involved in tendering exercises, e.g., for GP out of hours services, the new GP led health centres and intermediate care bed provision. Through the NHS Next Stage Review, GPs and other clinicians from Kirklees contributed to all those work streams in a process managed across Yorkshire and the Humber. A priority for the future is to facilitate the involvement of PBC in our locality working. This approach will further strengthen relationships with key local partners, particularly Kirklees Council, and ensure better links between different aspects of care so that overall care solutions are more personalised and effective. To secure best alignment of local systems we have considered seeking closer convergence between our local PBC structures and the seven localities. In doing so we recognise that PBC consortia are founded in relationships between practices as well as reflecting the local geography and links with the community. We would not want to put these relationships at risk. In addition, we must also acknowledge that practice populations are not always drawn from the population of the locality in which the practice is located. Therefore, we believe that trying to force closer alignment could put at risk the development of PBC and offer fewer benefits than is initially apparent. We shall therefore support PBC


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

in evolving organically, while at the same time supporting the active engagement of PBC in locality working.

6.3

Service user and public engagement As part of World Class Commissioning we are committed to increasing service user and public engagement and greater clinical involvement throughout the commissioning process. Increased clinical and service user input, combined with a more accurate assessment of long term local requirements, ensures services are more closely designed to meet evolving service user needs and provide a good experience of the NHS in Kirklees.

• •

• We will therefore engage actively with local people. We already speak regularly to local people about their health and the sort of services and support they need. We have also started, through a social marketing approach, to help local people have healthier personal behaviours. Examples of this include: • working with groups of people in our localities to develop locality plans; • public consultations on major changes to services, e.g., Looking to the Future (2005/06 and continuing); • public consultations on more local changes to services, e.g., on the future of Liversedge and Slaithwaite Health Centres (early 2007); • urgent care consultation (spring 2007); • service user surveys – whether organised nationally or locally by ourselves or by providers. We work with practices on a regular basis to monitor quality and accessibility. The findings identify needs, show whether services are up to standard and if

individuals are experiencing a good level of care; creation of an Expert Patient Support Group to encourage better health through peer support; Reference groups of service users established for all Long Term Conditions HITs establishment of a Readers’ Panel to ensure that our public information leaflets are easy to read and understand; consultation on the introduction of GP led health centres; a diabetes survey to obtain feedback for action on the care and support which local people with diabetes receive; Patient Public Involvement Forum/ LINks; Specific focussed consultations within communities whether issue or sociodemographic specific; and The local Overview and Scrutiny Committee.

The communications plan reflects and addresses issues arising from our continuing service user and public involvement work. It will also raise new concerns which will require further public engagement and discussion with partner organisations before crystallising into firm service development commitments. We will ensure that this happens. In planning services for the future, we will work closely with our local hospital trusts to ensure that our service users have access to the range of services they need, and that services are easily accessible, safe and of high quality. People should only attend hospital if the care they need cannot be safely provided in a community setting or in their own home.

39


In all cases we will work closely with local communities when we need to review existing services, or are considering proposals for service reconfiguration or investment.

6.4 Investment Plans The following diagram illustrates percentage investment against each of our 11 Programmes and should be considered with table 5 below: Fig 1: Percentage Investment by Programme 8%

12%

11%

26%

11%

5% 6% 8% 3% 2%

8%

Primary care

Mental Health

Planned Care

Learning Disabilities

Long Term Conditions

Urgent care

Children and Young People

Infection Control

Maternity and Healthy

Choosing Health

Pregnancy

Drugs and Alcohol

6.5 Financial planning When the PCT was established in October 2006 it inherited a recurrent deficit and an accumulated debt of £6.2m. Actions initiated by the predecessor PCTs and continued by Kirklees PCT, achieved a balanced financial position in 2006/07 (surplus £900k). During 2007/08, the accumulated deficit was repaid whilst delivering a surplus of £4.4m. This surplus was brought forward into 2008/09. Due to its success in turning a recurrent and legacy deficit from its predecessor organisations into a recurrent surplus with no historic debt, the PCT accumulated, at its maximum in 2007/08, a Strategic Investment Fund (SIF) of £19.8m. During 2008/09, the PCT Board agreed to play a full part in an agreement between the Yorkshire and Humber Strategic Health Authority (SHA), Mid Yorkshire Hospitals NHS Trust, Wakefield District PCT and ourselves to provide a solution to the accumulated deficit of MYHT. The PCT has committed £11m of its SIF over the next three years to help provide a sound financial base for one of its major health care providers. £3.3 million of this was utilised in 2008/09. The PCT achieved the required surplus in 2008/09 which is carried forward in to 2009/10. We begin the year with £14.9m in the Strategic Investment Fund of which £7.7m is committed to the MYHT accumulated deficit. The PCT’s resources in future years include prudent assumptions of recurrent growth in line with guidance from the SHA, the phasing of withdrawals from the SIF and the non recurrent surpluses made available in the year following achievement to fund a contingency budget to help manage risk. The PCT believes that this contingency

40


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

budget and the level of surplus planned provide sufficient financial risk mitigation. The introduction of HRG4 as the currency for Payment by Results in the NHS offers an improved basis on which the PCT will pay for services provided to its residents. However, it has introduced an additional call on our resources and additional risks which will need careful management across the health economy. Table 5 below shows the additional investment that we expect to receive over the next four years from 2009-10 and the assumptions on the use of these. Table 5: Additional investment 2009 – 10 to 2013-14 Additional Funds Available

£000

Growth funding- rec

107,600

SIF funding returned

14,600

Non recurrent surpluses

13,800

Efficiency plans

18,000

Total

Use of Resources

%

154,000

%

Inflation

69,000

45

Investment in secondary care

27,000

18

Initiatives -priority areas

36,000

23

Contingency – risk reserve

12,000

8

Additional surplus

2,300

1

Corporate services

7,700

5

154,000

The Performance Accelerator System take into account information detailed within the Board Assurance Framework, which is based on the PCT’s strategic objectives. This then identifies potential risks that could affect the PCT’s ability to deliver these objectives. All items within the system have a risk tab attached to them, where risk controls and mitigating action are directly quantified. Specific directorate risks can also be added to the system. Risks associated with specific plans are identified in this document, but this is not yet systematic throughout the organisation.

£000

Total

6.6 Risk management Our approach to risk management is based on an integrated approach to the assessment and management of risk. To support this approach, the PCT has procured the Performance Accelerator System tool which is a software application that supports PCT Performance Management across a range of activity.

6.7 Financial Risk We recognise that the ability to deliver our strategic priorities heavily depends on the ability to identify and manage financial risk and respond to unforeseen events. The significant financial risks are identified below: • A continuation of increased referrals and increased inpatient activity in acute secondary care that is not checked by demand management initiatives; • Acute trusts improve PbR coding, resulting in additional costs with no commensurate increase in activity. • Practice based commissioners have

41


several plans which require investment and aim to reduce activity in secondary care, therefore demand may increase to fill the feed up surplus capacity. The community hospitals programme is not deliverable due to the unavailability of strategic capital. The efficiency schemes do not deliver, in particular the long term conditions programme which plans to reduce admissions and length of stay to the value of £4.5m. Prescribing includes an efficiency target of 3% each year and although this is felt reasonable, prescribing is volatile and sometimes unpredictable. The Mid Yorkshire Service Strategy cannot be delivered within PbR tariff over the longer term, a non-recurrent cost is assumed in the plan NIHCE approves more expensive drugs than those currently in the planning assumptions.

6.7.1 Mitigating Actions There are a number of opportunities which need to be pursued in order to mitigate risks identified: • There is scope to reduce length of stay in acute trusts at a greater pace which will result in more efficient use of capacity and a reduction in excess bed day costs. The “Better Care Better Value” indicators show continued savings opportunities for the health economy that are not fully reflected in this financial plan. • This plan includes the financial costs of initiatives. Less well developed in the plan are the savings in secondary care that should result from many of the initiatives.

The risks identified are likely to impact upon the required level of PCT financial commitments and the availability of resources required for the achievement of the PCT’s objectives. In recognition of this, the PCT is planning to hold a 0.5% contingency each year and is planning for an increasing surplus. This means it should have sufficient resource to manage most financial risks over the medium term. Overall, the Board believes that although the scale of the financial impact of some of the risks is large, it is manageable if anticipated and corrective action taken promptly. As the PCT has planned for at least a 0.5% surplus and 0.5% contingency each year, the Board assesses financial risk at green.

6.8 In year monitoring NHS Kirklees has robust systems in place for performance managing key national targets such as Vital Signs and Health Care Commission performance rating targets. These systems are built on the principle of strong accountability and ownership throughout the organisation, including the Trust Board. Routine reporting to various key forums of the PCT ensure that management decisions are taken and acted on to ensure delivery and achievement. The Finance and Performance Committee, sub-committee of the Trust Board, has a key role to play in the delivery of the operating plan and targets. It makes recommendations to the Board on investment decisions resulting from strategic and practice based commissioning business cases for delivery of priorities as well as monitoring progress. The Operating Plan 2009/10 will inform the individual and/or directorate business plans.

42


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

The actions and requirements of the Operating Plan 2008/09 have been included in individual director’s objectives for delivery through their teams. There will be a clear cascade of these from director to individual’s objectives. Through this clear cascade of priorities and targets it is expected that there will be increased accountability and ownership from staff across the entire organisation. Health Improvement Teams, in partnership with PBC colleagues, regularly report on progress of new initiatives via our Business and Financial Planning Committee, a subgroup of our Finance and Performance Committee. All new initiatives are first discussed at the B&FPC, with associated efficiency savings, intended outcomes and performance measures, to ensure strategic fit and effective governance.

Section 7

Supporting activities In order to deliver on our programmes we have a number of supporting activities which are necessary to ensure that we have the resources to deliver out plans. The key activities are: • • • • •

Workforce planning Communications and Engagement Changes In Technology Estates Procurement Medicines Management

These are set out in full detail in the appendices

7.1

Workforce planning at NHS Kirklees The long term aim of our workforce planning activity is to integrate workforce planning with standard financial and business planning processes so that we can attract and retain a motivated workforce with the right skills and competencies to meet the health needs of the populations of Kirklees’ seven localities. In April 2008, the NHS Kirklees Board approved a workforce planning framework for the organisation that aims to fulfil the requirements of paragraph 3.32 of the 2008/2009 NHS Operating Framework and achieve the aim described above. The framework is based on the four pillars described in the NHS Plan (2002). It takes a holistic approach to workforce planning, using the organisation’s goal to be an Employer of Choice as the bedrock for all accompanying plans and actions. The framework recognises that the organisation’s approach to workforce planning is evolving, and will continue to evolve over coming months and years. 43


Further detail can be found in Appendix 5. 7.2

Communications and Engagement Communications needs to be service user focused and centred, so that individuals have the information they need to make informed choices about their care and are able to influence the development of services. We will also seek out ways to work with our partners, such as Kirklees Council, on new social marketing techniques to proactively influence and effect changes in people’s behaviours on public health issues and health choices. A joint Marketing Board now oversees campaigns and social marketing across the PCT and Council. This is covered in detail in our communications plan. NHS Kirklees is committed to actively involving and working in partnership with the public and service users to design, review, monitor and deliver quality services to meet their needs. We have a number of key service change priorities which will continue to benefit from service user, carer and public involvement and engagement, as well as formal consultation processes. We are working to develop a number of key messages for our different stakeholders. For further detail please see the Communications Plan.

7.3 Changes in Technology We will continue to deploy the Connecting for Health sponsored solutions for changes in IT Technology. This will include continued investment in our GP practices, community pharmacists and collaborative use of Data Warehouse. Further detail is provided in appendix 5.

7.4 Estates Issues The provision of high quality services requires premises and equipment which are fit for purpose. Our overarching strategy on facilities may be summarised as being to secure premises which are: • • • •

in the right place; in the right condition; of the right type; and able to respond to future service needs.

Further detail is provided in Appendix 3.

7.5 Procurement Strategy The PCT makes a clear distinction between the process of determining commissioning need, and that of deciding on the appropriate provider. The procurement process starts with the identified need (although the requirements for robust procurement also influence definition of commissioning need, e.g. in producing service specifications that are fit for purpose). NHS Kirklees approved a Procurement Policy in November 2009 and use this policy to underpin our decisions on whether or not to tender for the services we wish to commission. The policy aim to: • Show how we will meet statutory procurement requirements.

44


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

• Set out the transparent process by which we will determine whether Part B services are to be formally tendered. • Contribute to achieving WCC competency around secure procurement skills. • Enable early determination of whether and how services are to be opened to the market, to facilitate open and fair discussion with existing and potential providers.

7.6 Medicines Management Medicines constitute approximately 20% of the total NHS budget. It is therefore crucial to ensure the continued promotion of costeffective and evidence based management of medicines by Health and Social Care professionals, patients and carers to maximize the health benefits medicines can provide. The following are a summary of key areas for development. Please see section 5.3 (primary care) for specific objectives related to this area, and our Programme Delivery Strategy for more detail. • • • • • • • •

Medicines Commissioning Personalised Medicines Management World Class Commissioning Medicines management training and education Non medical prescribing Medicines safety Medicines governance Long Term Conditions and Intermediate Care

Section 8

Conclusion 8.1

Overall Impact Against Our Strategic Goals This plan sets out our ambitions for the services we offer to the people of Kirklees. It establishes a direction of travel from 2009 – 2013, sets objectives for our services and explains how we intend to deliver them. It should be read in conjunction with our: • Organisational Development Plan • Programme Delivery Strategy (available from May 2009) • Communications and Engagement Strategy • Finance Plan • Operating Plan • Joint Strategic Needs Assessment When considered together, this suite of documents provides a clear picture of the key health issues in Kirklees and our strategic goals and objectives. Our goals and priority objectives are central to all our planning activities and form the basis for ongoing strategic development in partnership with all our stakeholders. Our service users are at the very centre of this. To help us raise our game, meet the competencies described in world class commissioning and other local and national systems reform and redesign, our goals are our guiding principles and a consistent means of measuring success throughout the entire system. Planned improvements in quality, health outcomes and inequalities can be measured against the benchmarks we have set ourselves through our “Choosing Health Programmes”, which demonstrate a very clear understanding of the challenges we face, and where our efforts must be 45


focused to meet the needs of our population. We know that service user choice is an issue in some areas, and new investment will include a real increase in primary medical care capacity in the Dewsbury, Huddersfield North and Spen areas to bring the localities closer to the Kirklees and England averages. At the same time, and as in other areas, we need to ensure that services are delivered in premises that are fit for purpose, limit the scope for clinical isolation and ensure continuity of services as existing single handed GPs retire or leave. All this will ensure that we provide people with a choice of services and interventions, and that services are accessible, with the principle of ‘closer to home’ being applied as far as possible. Our commissioning strategies aim to deliver whole scale systems redesign in critical areas such as Long Term Conditions, Mental Health, Children and Young People and supporting planned and urgent care commissioning with our partners in secondary care. These strategies describe improvements in quality and service user safety, by commissioning services which are delivered safely and to the highest standards, and which are evidence based around clinical and cost effectiveness. Genuine partnership working with our stakeholders, in primary, secondary, tertiary care and with Kirklees Council will require setting outcomes which truly reflect local needs and priorities.

46

Effective commissioning will: • ensure that changes in demand and activity can be planned for and managed effectively without adversely affecting our performance, • ensure that we continue to meet and exceed our targets, • allow us to help our partner organisations, particularly those in secondary care, meet their own targets thus enabling whole system improvements. Our investments over the period of this plan have been agreed by the Board to deliver our objectives in our priority areas. These priority areas were guided by our goals. The financial plan over this planning period is both affordable and prudent. It makes use of non-recurrent resources to initiate service changes and provides a contingency for risk. We will deliver all our financial objectives whilst investing for health and well-being. The involvement of our clinical leads and champions, both at a strategic level on our Board and PEC, and also within systems redesign with our Health Improvement Teams, will fulfil our ambition to promote strong clinical leadership to drive service change and innovation. Finally, we aspire to be the best that we can: a world class commissioner of health care and a visibly credible organisation, operating to the highest possible standards and meeting the needs of our local population, and minimising avoidable gaps in health between local people.


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Section 9

Board Approval 9.1 Declaration of Board Approval The Board has been involved in the development of the plan in a number of different ways. Board members are also members of sub committees and other groups, so members have been able to see the development of strategies and ideas from the bottom up as well taking the strategic lead through Board briefing workshops and formal Board discussion. The Board has set out through its approval of the business planning framework, scheme of delegation and practice based commissioning systems and processes the way the PCT will develop its plans.

9.2 Formal Sign Off of this Plan The Board closes the cycle by formal agreement of all plans developed as part of the World Class Commissioning assessment process at a public Board meeting on 25th March 2009. These plans are thus submitted for assessment under the World Class Commissioning Framework.

Rob Napier Chairman

The Professional Executive Committee (PEC) has been a key player in developing clinical pathways through the clinical leadership role of PEC members and service strategy providing advice to the Board on the plans. The links with the council through the Local Public Service Boards on which PCT Board members sit has also enable Board members to make sure that partnership working is a key theme within the plans.

47


Appendix 1

Needs of our population Kirklees comprises both urban and rural communities with a total population of over 400,000. We have a total budget of £550 million in 2008/09 and it is imperative that we invest this, and future budgets in the years to come, wisely to reduce health inequalities and ensure high quality care is available for our population. The towns and valleys of Kirklees have their own strong and distinct identities and contain a rich and diverse mixture of cultures and faiths. This diversity, coupled with our complex links to major regional centres, creates unique opportunities and challenges for our district. Kirklees’ population is both increasing and ageing. (Table 1) By 2018, the population is predicted to increase by 33,000 (8%) - a bigger projected increase than the 25,000 (6%) growth forecast when the JSNA was first published. There are some notable variations across age groups. The projected increase ranges from 5% for the number of

0-20 year olds and 20-64 year olds, to an increase of 26% in over 65s. By 2018, one in four people will be under 20, more than one in two will be aged 20 – 64 and one in six will be aged over 65. This change in local demography will have a major impact on both service delivery and the ability of local health care organisations to attract, train and retain staff. Overall, the numbers of births are static, but increasing among families of South Asian origin. More than one in five young people under 19 are now of South Asian origin, whilst 86% of the total population overall are white. The population is relatively stable, although there has been some immigration – e.g. Kurdish and Hungarian immigrants mainly based in Dewsbury and Polish immigrants settling in Huddersfield. Often, these immigrant populations have particularly challenging health needs (especially in the case of asylum seekers and refugees) and we need to be mindful of these needs in planning services.

Table A1: Kirklees Population by Age Group, 2006 and 2018 Projections7

2006 Total

%

2018 Total

%

Population Difference 2007 to 2018 (000s)

Under 20

105,000

26.2

110,400

25.4

+5,400

+5.1

-0.8

20 – 64 years

236,800

59.1

248,900

57.4

+12,100

+5.1

-1.7

65 – 84 years

51,200

12.8

64,500

14.9

+13,300

+26.0

+2.1

85 years plus

7,600

1.9

9,700

2.2

+2,100

++27.6

+0.3

400,600

100.0

433,300

100.0

+32,700

+8.2

0.0

58,800

14.7

74,200

17.1

+15,400

+26.2

+2.4

Age Group

Total All 65 and over

48

% change in population in age group Change in % 2007 and by age group 2018 2007 to 2018

7

ONS 2006-based sub-national population projections 2006-18


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Fig. A1

Kirklees has a diverse ethnic mix, with a higher proportion of our population from an ethnic minority than for England as a whole. It is difficult to be precise about specific numbers of people across ethnic groups but estimated figures in 20058 indicate that 15.5% of Kirklees’ population is from an ethnic minority, compared to the England average of 10.9%. The biggest such local populations are those with Pakistani (6.9%) or Indian (4.2%) origins. System Alignment - Partnerships and Shared Goals We know we cannot achieve the best health and well-being for local people on our own. In the Kirklees Health and Wellbeing Inequalities Strategy, the Rainbow Model illustrates the broad range of factors that impact on an individual’s health (Fig. 1). As the model indicates, health care services make an important contribution to improved health and well-being - but other factors, not least personal behaviours, are just as important. Inequalities exist between people – both in avoidable gaps in health and in the factors

that profoundly affect health. The Kirklees Partnership is crucial in tackling these inequalities as part of its aim to achieve the health and well-being of local people. We must ensure that those most at risk or in need have real equality of opportunity. The vision for health and well-being inequalities is that people across Kirklees stay as healthy as possible by: • feeling more able to look after themselves, more in control of managing their problems and more able to make healthy choices; • being able to easily choose and access the type of opportunities and help they need, when they need it; • having opportunities for social support and being involved, so participating fully as members of their communities, as defined by them personally; • ensuring those most at risk or vulnerable have opportunities available to them to help reduce their risk or vulnerability and narrow the avoidable gaps in experience; and

Source - Office for National Statistics Experimental Population Estimates by Ethnic Group for Council districts and higher administrative areas in England for 2005. 8

49


• having appropriate access to education, jobs, transport, housing, health care and a decent environment to live and work in.

The Local Area Agreement (LAA) is the main vehicle by which the Partnership wil ensure delivery of local action to tackle these challenges.

We must work closely with our local partner organisations to tackle the health and wellbeing challenges facing Kirklees people and we are actively involved in the leadership and activities of the Kirklees Partnership.

The contribution of NHS Kirklees focuses especially on the two themes of children and young people and healthier communities and older people, but also safer and stronger communities as well as regeneration as the PCT is a significant local employer.

Kirklees Partnership themes are: • economic development and the environment; • safer and stronger communities; • children and young people; and • healthier communities and older people.

In the coming years we will build on established relationships and forge new ones to ensure that our services are of the highest quality and are integrated with or align closely with those of partner organisations. This will be particularly important in ensuring that services are tailored to meet the needs of individuals.

Fig. A2: Local Area Agreement Priorities S AF

ER S

TRONGER COMMUNIT

IES

Crime, anti social behaviour & fear of crime Reducing re-offending

Cohesive Communities

Substance misuse including drugs & alcohol

R H IE

m ic a ll y S tr

o

no

ng

Cohesive Communities

o

CO M

Ec

Older people living independently

LE Healthly minds & bodies Improving the life chances of vulnerable children & young people

CHI

Mental well being

Opportunities for young people to enjoy themselves

LT EA

Reduce worklessness

H

Increase skill levels of the working age population Combating climate change Affordable homes

Grow local businesses

Reduce waste & increase recycling

EC

50

ON

Local transport

OM

IC D EV

V E LOP M ENT & T HE E N

OP & Y O UNG PE

e

rs Dive

Young People

een

Healthy lifestyles

Education attainment & progress

Yo u ng

Maternal Health

Gr

MUNITIES & OLDE

RP

Resident satisfaction with their local area

L DR EN

EO

PL

E

Strong community & vibrant voluntary sector - Volunteering

IR

M ON

EN

T


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Comprehensive Area Assessment (CAA) Comprehensive Area Assessment (CAA) is the new framework for the independent assessment of local public services in England. It is being introduced from April 2009. CAA will focus on how people are being served by their local public services. It will provide constructive challenge and feedback on how well these services, working together, are achieving improvements in outcomes and progressing towards long-term goals, as defined in the Local Area Agreement (LAA). To achieve this, the CAA will draw on the views of local people, people who use local services and other stakeholders, the new National Indicator Set and other information being used to manage public services locally. It will address local priorities and will always include a specific focus on people, including children and young people, who may experience disadvantage in accessing public services or whose personal circumstances make them most vulnerable. CAA will also give government an assurance of how well councils and their public sector partners are working with each other, the private sector, the third sector and other local organisations to: • • • •

Deliver key national and local priorities Provide quality, safe services Provide value for money Be accountable to the public for the quality and impact of these services.

This will strengthen the ability of people to hold elected representatives and those providing local public services to account for their performance and use of public money. It will help people to make informed choices and to influence local decisions.

Safeguarding Strategy NHS Kirklees (NHSK) is committed to working with partner agencies to safeguard and promote the welfare of children, young people and vulnerable adults. Every person has the right to live free from abuse and neglect. This right is underpinned by the duty placed on public agencies under the Human Rights Act (1998) to intervene proportionately to protect the rights of citizens. NHS Kirklees has developed a five-year Safeguarding Strategy which covers: • • • • •

statutory responsibilities; commissioning function; provider function; contracted services function; working with other agencies.

It outlines ongoing work and actions in relation to service and workforce development and details how these actions will be reviewed and monitored. This provides assurances that NHS Kirklees is meeting its statutory responsibilities, commissioning and providing services fit for purpose and achieving equality in outcomes for these vulnerable groups.

It is the intention of CAA to provide clear, impartial information to local people about how well they are being served by their local public services, how that compares with elsewhere, and what the prospects are for the improvement of quality of life in their area. 51


This safeguarding strategy reflects our vision to work together to achieve the best health and well-being for people in Kirklees. It clearly encompasses our strategic priorities by ensuring the work programme for the next five years incorporates: • working in partnership with local people and partner agencies to promote, protect and improve health and reduce inequalities; • involving staff, service users and communities in identifying their needs; • making sure services are available and delivered safely to a high standard; • encouraging new ways of service delivery that offer choice; • ensuring services are evidence based; and • developing a learning environment.

identified where locality specific action is required. See sections 4.4 and 4.6. For much more detail, please refer to our JSNA.

Fig. A3: A Map of the Seven Localities of Kirklees Batley, Birstall and Birkenshaw Spen

Huddersfield South

The Valleys

The Kirklees Localities – Profiles and Priorities for the Future This section sets out a brief profile of the population of each locality, the key health challenges which those populations face, a description of the existing services which we offer and our priorities for future investment in services. Much of the material here is drawn from the JSNA. This is also informed by the development a set of locality plans led by Kirklees Council in partnership with key stakeholders, including NHS Kirklees. As those plans develop, we will review our service priorities for each locality to ensure consistency and to support continued and enhanced partnership working. In this Five Year Strategic Plan, we have set out our priority health initiatives for the next few years. For some of these initiatives, e.g., long term conditions and the Choosing Health Programmes – we have also

52

Dewsbury and Mirfield

Huddersfield North

Denby Dale and Kirkburton


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Batley, Birstall and Birkenshaw This locality lies in the north east of the Kirklees area. Table A1 shows the age profile for the locality. Table A2: Batley, Birstall and Birkenshaw: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

14,920

30,100

6,040

780

51,840

6,820

% of locality

28.8

58.1

11.7

1.5

100.0

13.2

Kirklees %9

26.2

59.2

12.7

1.9

100.00

14.6

N.B. This presentation hides differences between the populations of Batley and of Birstall and Birkenshaw. For this reason the locality is often sub-divided further, as here, into its two major communities of Batley and of Birstall and Birkenshaw.

Batley Population profile The town of Batley has a particularly young profile when compared with the population of Kirklees, with 28% of the population aged under 19 in 2006. Around 12% of the population are aged over 65. Within Batley 32% of the population in 2006 were of South Asian origin. Life expectancy Life expectancy at birth for males in Batley is similar to the Kirklees rate, which in turn is similar to the national rate of 76.6 years. In contrast, life expectancy of females at birth is below the Kirklees rate, which in turn is slightly below the national rate. Overall life expectancy in Batley is 78.5 years and nationally is 80.9 years. Life expectancy at 65 for both men and women in the locality is less than that of Kirklees and for women in particular is two years less than the national rate. Priority health issues The JSNA identified Batley as experiencing much worse health than Kirklees overall and identifies a number of health inequalities. Issues of particular concern include: Children and young people: • nearly twice the national rate of deaths in infants aged under a year and linked to this, one in eight babies were born with a low birth weight; • maternal behaviours affect infant health and in Batley two in five women of child bearing age were overweight or obese and one in three of white women were still

9

Note - Kirklees figures are ONS Mid-Year Estimates 2006

53


smoking at the birth of their child; • five year olds have the poorest teeth across Kirklees and twice the national rate; • more 14 year olds than in the rest of Kirklees were out of control through drinking alcohol weekly or more and one in five were drinking alone; and • asthma is worse than across the rest of Kirklees and can be linked to smoking in the home. Adults: • high rates of diabetes and stroke; • behaviours that contribute to diabetes and stroke, particularly high rates of smoking and drinking alcohol in men; • suffering pain including arthritis is also an issue; and • the town is economically deprived with a lower average household income than in Kirklees as a whole and higher rates of people in receipt of benefits than anywhere else apart from Dewsbury.

Birstall and Birkenshaw Population profile In contrast to Batley, the population of Birstall and Birkenshaw has an older profile when compared to that of Kirklees and particularly when compared to that of Batley. Around 22% of the Birstall and Birkenshaw population are aged under 19 and over 15% of the population are aged over 65. Again in contrast to Batley, 11% of the population were of South Asian origin, similar to the overall Kirklees average. Life expectancy Life expectancy is very similar to the population of Batley. Life expectancy at birth for males is similar to the Kirklees and national rate (76.6 years). Life expectancy for females at birth is below the Kirklees rate which itself is slightly below the national rate. Priority health issues The JSNA identifies a number of health inequalities in Birstall and Birkenshaw. Issues of particular concern include: Children and young people: • maternal behaviours, particularly smoking at birth, although levels were closer to that of Kirklees overall; and • 14 year olds experience the highest rate of bullying in Kirklees and a high rate of those who have bullied. Adults: • overall health functioning was worse than that of Kirklees, particularly for those aged over 65; • high incidence of coronary heart disease, high blood pressure and cancer deaths in those

54


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

aged under 75; • low levels of physical activity; and • alcohol bingeing by men. Current service profile The overall locality is served by eight GP practices (with 30.1 wte GPs and one nurse practitioner delivering an average list size of 1,828 service users per practitioner), five dental practices, and 12 pharmacists.

Fig. A4: Batley, Birstall and Birkenshaw: Locality Providers

Impact on provider landscape New investment will include an increase in primary medical care capacity to bring the locality closer to the Kirklees and England averages. Likewise, we believe that residents from this locality – in particular postcode areas WF17 – have more difficulty than residents elsewhere in Kirklees (with the exception of Dewsbury) in accessing a dentist. This is based on numbers on the dental waiting list in 2008. We will review the impact of recent increases in the commissioning of dental activity and target resources in this area appropriately to ensure local needs are met.

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Denby Dale and Kirkburton This locality lies in the south-east of Kirklees. There is no significant deprivation and generally adults living in the area experience the best health of adults in Kirklees overall. But there are still a number of problems and issues in comparison to national rates. Population The locality is relatively sparsely populated and distance does inhibit access to some services. As table A2 indicates, the area has more people of working age and nearing retirement than other areas in Kirklees. Table A3: Denby Dale and Kirkburton: Population by Age Group (Mid–Year Estimate 2005) Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

7,690

18,790

3,870

580

30,910

4,450

% of locality

24.9

60.8

12.5

1.9

100.0

14.4

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

Age Group Number

The locality has the lowest proportion of its population of South Asian origin, at under 1%. Life expectancy Life expectancy at birth in the locality is the highest in Kirklees but is still three years lower than the best in England. Life expectancy at 65 and at 75 is close to the Kirklees profile. Priority health issues Particular health issues include: Children and young people: • emotional wellbeing of 14 year olds; • early alcohol drinking among 14 year olds; • the highest rates in Kirklees of young people reporting feeling miserable and feeling angry; and • nearly 40% of women of child bearing age were obese or overweight, only a third were physically active enough and over a third binged alcohol in the previous week. Adults: • pain; • high blood pressure and heart disease in older people; and • high rates of pensioners living alone and older people on low incomes.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Current service profile The locality is served by four GP practices (with 14.3 wte GPs and 0.5 nurse practitioners delivering an average list size of 1,787 service users per practitioner), five dental practices and five pharmacists. Fig. A5: Denby Dale and Kirkburton – Locality providers

Impact on provider landscape Large scale change in the primary care provider landscape is not envisaged in this locality, rather we will aim to ensure continuity of service provision and ensure that facilities are up to expected standards.

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Dewsbury and Mirfield The Dewsbury and Mirfield locality lies in the east of the Kirklees area. As table A3 shows the locality population has a relatively young age profile compared to Kirklees as a whole - with a high number of children and young people and fewer older people and of working age. Table A4: Dewsbury and Mirfield: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

21,990

41,960

8,710

1,160

73,810

9,870

% of locality

29.5

56.9

11.8

1.6

100.0

13.4

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

Its population is the largest of the 7 localities and there is widespread deprivation. This shows in health inequalities across a range of conditions, poor personal behaviours and low living and working conditions. Overall, the locality experiences the worst health in Kirklees and this is particularly so in Dewsbury. This area is therefore often sub-divided to consider Dewsbury and Mirfield separately.

Dewsbury Population Dewsbury has 29% of people aged under 19 - the largest proportion across Kirklees. 12% are aged over 65. About 25% of the population is of South Asian origin. Life expectancy Life expectancy at birth for males is the lowest in Kirklees. Life expectancy at 65 and is lower than that of Kirklees and nationally with both men and women having a life expectancy seven years lower than the best area in England. Priority health issues Dewsbury has real health challenges: Children and young people: • babies die in their first year of life at over twice the national rate; • one in nine births are of low birth weight; • maternal behaviours are poor with high rates of obesity, one in three smoking at birth and nearly half of women of child bearing age bingeing in the last week; • tooth decay is common - which may be linked to poor diet; • 14 year olds continue to have emotional well-being issues, particularly self-esteem and isolation;

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

• GCSE attainment is the lowest in Kirklees as a whole; and • the highest proportion of child protection cases and second highest number of looked after children across Kirklees. Adults: • the worst rates of high blood pressure and diabetes across Kirklees; • higher rates for early death from all the major killers; • the highest rate of smoking in Kirklees; • the highest rate of females binge drinking in Kirklees; • one in five adults are obese; • the lowest achievement in Kirklees of five portions of fruit and vegetables; and • the highest rates of people claiming Income Support and Council Tax Benefit.

Mirfield Population Mirfield has an older population profile than both Dewsbury and Kirklees overall. The majority of people are of working age and heading to retirement age. The area has the lowest proportion of people aged under 19 across Kirklees and the highest proportion aged over 65, at 18%. In contrast to Dewsbury, less than 1% of the population are of South Asian origin. Life expectancy Life expectancy at birth is similar to that for Kirklees as a whole. As in Dewsbury, life expectancy at 65 and at 75 is lower than that of Kirklees and nationally with both men and women having a life expectancy seven years lower than the best area in England. Priority health issues Children in Mirfield have better health than the Kirklees profile and noticeably better than children in Dewsbury. Similarly, adults have fewer health issues than those in Dewsbury and this mirrors the Kirklees profile more closely. However: Children and young people: • Women of child bearing age are the highest in drinking over sensible limits per week and amongst the worst in bingeing in a week. Adults: • cancer registrations, particularly for breast, are higher than elsewhere in Kirklees but early death rates from the major killers, apart from suicide, are better than that of Kirklees; and • mean consumption of alcohol in males is the highest in Kirklees and three units over the recommended amount per week.

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Current service profile The locality is served by 14 GP practices (with 31.3 wte GPs and 2.2 wte nurse practitioners delivering an average list size of 2,250 service users per practitioner, nine dental practices and 21 pharmacists. Recent investments in service developments in the locality include new state-of the-art health centres in Dewsbury and Ravensthorpe. In addition, a new NHS walk-in centre (The North Kirklees NHS Walk-in Centre) was opened in 2005 at Dewsbury and District General Hospital. This centre offers nurse-led services primarily to the people of North Kirklees and offers advice and treatment in relation to minor ailments and injuries.

Fig. A6: Dewsbury and Mirfield – Locality providers

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Impact on provider landscape The locality will benefit during 2009 from the new GP-led health centre in Dewsbury. This will offer medical care to local people (registered and unregistered) from 8am until 8pm each day. Once established, we will work with the service provider of this practice, and other local stakeholders, to determine what other services could usefully operate alongside this new GP service. In particular, we will focus on those services and interventions which will best address the specific needs of the people of Dewsbury, and also address the disproportionately high use of the Dewsbury A&E department for minor urgent care needs. Even with the new GP led health centre, it is likely that there may be a need for further primary medical care capacity, but we will review this before March 2010. We will explore with the local community and local providers how best to deliver any increases. The Dewsbury area is also home to a number of smaller GP practices and we will need to ensure that services are delivered in premises that are fit for purpose, limit the scope for clinical isolation and ensure continuity of services as existing single handed GPs retire (or leave). The capacity shortfalls in Dewsbury do not just relate to primary medical services, but to dentistry as well. The dental waiting list continues to grow, despite the additional investment in growth funding and Dewsbury (postcodes WF12 and WF13) is an area of high need and low provision. Historic information suggests that people in the area will not routinely travel very far for their dental treatment and this could be further compromised if public transport is infrequent. One option being considered is an access type centre for dental service users in the Dewsbury area. This area is not only an area of high need but it has a high number of homeless people and asylum seekers. The high level of people who fail to return for treatment following a routine assessment suggests that to open an access service in this area would be the most cost-effective and appropriate way to deal with the high volume of service users.

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Huddersfield North The Huddersfield North locality lies at the middle of our area at the northern edge. It is predominantly urban, comprising in the main northern half of Huddersfield – but includes a semi-rural fringe to the north. The locality experiences broadly similar health to that of Kirklees overall and is the least deprived of the mainly urban localities. Population As table A4 shows, the population profile is similar to that of Kirklees with a slightly lower proportion aged 19 or under. Most are at the younger end of working age. Table A5: Huddersfield North: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

13,190

30,880

7,390

1,020

52,490

8,410

% of locality

25.1

58.8

14.1

1.9

100.0

16.0

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

The area has the most ethnically diverse composition of all the localities in Kirklees, with nearly 14% of South Asian origin and 8% of other origin, mainly Afro Caribbean. Life expectancy Life expectancy at birth, at 65 and at 75, mirrors that of Kirklees as a whole quite closely and for those at 65 and at 75 is close to the national profile. Priority health issues The main health challenges are: Children and young people: • the numbers of 14 year olds drinking alcohol, particularly those drinking alone; • emotional well-being of 14 year olds - a third feel angry and one in four feel miserable; • relationships are also poor; and • women of child bearing age smoke less than in other parts of Kirklees but still experience higher levels of obesity or overweight and bingeing alcohol. Adults: • pain, particularly in older people; • higher rates of diabetes and high blood pressure also in older people; • although deaths from suicide are very small the area experiences nearly twice the national rate; and • less physical activity is undertaken than in most of the localities in Kirklees. Current service profile The locality is served by 17 GP practices (with 37.4 wte GPs – including six single handed

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

practitioners – and 1.9 wte nurse practitioners delivering an average list size of 1,749 service users per practitioner), 16 dental practices and 16 pharmacists. There is also the Princes Royal Community Health Centre (owned by the Calderdale and Huddersfield NHS Foundation Trust) which is the base for a range of community services including community nursing service, health promotion unit, child health clinics, family planning clinics, dental clinic, genito-urinary medicine, speech and language therapy, physiotherapy, and foot health.

Fig. A7: Huddersfield North – Locality Providers

Impact on provider landscape New investment is unlikely to include any substantial increase in primary medical care capacity. However, there are opportunities to improve the way services are delivered through relocation or expansion. We need to ensure that services are delivered in premises that are fit for purpose, limit the scope for clinical isolation and ensure continuity of services as existing single handed GPs retire (or leave). The locality has seen little development in premises in recent years and this now needs to be a

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priority. There are three particular areas of focus – the Acre Mill development; the need to improve health facilities and services in the Ashbrow/Bradley areas; and the future role of the Princess Royal Community Health Centre. The proposed redevelopment of the Acre Mill site, which we will commission, as a third party development, is expected to make a major contribution by providing the opportunity to relocate and co-locate some smaller local practices and to offer community (level 1/2 ) services to a wider population. Further work is required to scope the range of such services which could best be provided from this location and we will work in partnership with the Foundation Trust, local practices and members of the public to do this. The Princess Royal Community Health Centre (PRCHC), which is also owned by the Calderdale and Huddersfield NHS Foundation Trust, has also been identified as a key base for services in the town centre area – just outside the Huddersfield North locality. We regard this site as important to our overall strategic plan for health services in the future and with the Foundation Trust have highlighted the site as a priority for re-development under the banner of our community hospitals programme. While more work is need to define the nature of services that could be delivered from PRCHC into the future, the central nature of the site undoubtedly lends itself to services such as outpatients, ‘one stop’ clinics, advisory and support services such as those for sexual health, substance misuse, alcohol advice as well as other primary care services such as GP surgeries who may offer services at evenings and weekends as well as during the day. During the winter of 2008, we plan to begin discussions with local people and professionals on the options for the Princess Royal Community Health Centre. We will also undertake an options appraisal for establishing a new health centre in the Ashbrow/Bradley area where existing service provision is limited. This too could offer community services and accommodate GP services. It is envisaged that the Fartown Health Centre will become more of a base for community health services into the future, with primary medical care being delivered from either existing or new premises in the area.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Huddersfield South This locality lies at the centre of our area and has the second largest population of the localities in Kirklees. It includes the town centre of Huddersfield and the University campus. Population Table A5 shows the age profile for the locality. It has the largest proportion of people aged 19 – 44 of the localities across Kirklees, a slightly lower proportion of people aged under 19 and a similar proportion of those aged over 65 to that of Kirklees. Table A6: Huddersfield South: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

17,180

40,670

9,680

1,300

68,850

10,980

% of locality

24.9

59.1

14.1

1.9

100.0

16.0

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

11% of the population are of South Asian origin and over 5% of other origin, mainly Afro Caribbean. Life expectancy Life expectancy at all stages is very close to that of Kirklees as a whole. Priority health issues The JSNA identifies the key issues as including: Children and young people: • teenagers have the second highest rate of teenage pregnancies in Kirklees and one of the highest levels of no contraception used in 14 year olds; • relationships at school are amongst the worst in Kirklees; • although those experiencing bullying is low those admitting to being a bully is the highest in Kirklees; and • maternal behaviours are poor with high levels of obesity or overweight, smoking at birth and drinking alcohol particularly bingeing. Adults: • higher rates of long term conditions particularly in older people and especially heart disease, asthma, diabetes and stroke; • people suffering pain, particularly back pain; • nearly one in four people smoke; and • binge drinking is high among both men and women. Current service profile The locality is served by 12 GP practices (with 39.6 wte GPs and 1.9 wte nurse practitioners

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delivering an average list size of 1,796 service users per practitioner), 11 dental practices and 16 pharmacists. In addition, the Moorfields Primary Care Centre opened in 2006 at Crosland Moor. This offers primary care services to people across Kirklees and administrative support to local GPs with a special Interest (GPs who provide services in a particular specialty to individuals on referral by another GP or consultant, as well as providing traditional general practice services to the registered service users of their practice.) Mill Hill Health Centre currently houses a range of community health services serving the Dalton, Rawthorpe and Moldgreen areas.

Fig. A8: Huddersfield South – Locality Providers

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Impact on provider landscape Some new investment will be required in this locality, in particular to bring premises up to standard. Equally, we are aware of areas such as Dalton where there is a lack of a GP presence and we are working with local people and service providers to address this. As part of our plans for the Dalton area we will also work with Kirklees Community Health care Services to ensure that we maximise the potential of the Mill Hill Health Centre to serve as a community services base for the people of the area. In the Crosland Moor and Thornton Lodge area we will explore options for a new health centre or centres to accommodate up to four local practices and potentially community nursing and health visitor services. In addition, we will continue to ensure that the Moorfields Centre is well equipped to deliver services in the immediate future, but will review its longer term future as part of options appraisal for the Princess Royal Community Health Centre. It is possible that some of the services provided from Moorfields may benefit more from a town centre location.

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Spen Spen Valley is located in the northern part of Kirklees, bordering with Bradford. Many residents in the area work in Bradford. This locality most closely reflects Kirklees overall. Population As table A6 shows, the population profile for Spen mirrors that of Kirklees as a whole with slightly more people approaching retirement than in other areas. Table A7: Spen Valley: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

12,470

29,410

6,580

940

49,400

7,520

% of locality

25.2

59.5

13.3

1.9

100.0

15.2

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

6% of the population are of South Asian origin mainly living in the south of the locality. Life expectancy For all ages life expectancy is slightly below that of Kirklees and so slightly below that nationally, particularly for males. Priority health issues The JSNA identifies a range of health challenges: Children and young people: • 14 year olds have higher rates of smoking than elsewhere in Kirklees and a third of them are happy to continue smoking; • one of the highest locality rates of 14 year olds drinking alcohol weekly or more; • teenage pregnancies have increased and the locality has the highest rate of 14 year olds having sexual intercourse with no contraception used; • relationships with family and school staff are poor; and • maternal behaviours are poor with higher rates of obesity/overweight, and drinking alcohol over sensible limits and bingeing in particular. Adults: • pain, both back pain and arthritis are more common than in other localities, particularly in those aged under 65; and • heart attack hospital admissions are also higher than elsewhere in Kirklees. Current service profile The locality is served by nine GP practices (with 24.3 wte GPs and 2.3 wte nurse practitioners delivering an average list size of 1,840), seven dental practices and eight pharmacies. Recent service development investments include a new state-of-the-art Health Centre in Cleckheaton

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

(which opened in 2006), and an intermediate care facility in Liversedge (which also opened in 2006). The Cleckheaton Centre provides a range of services, including physiotherapy treatment, occupational therapy and rehabilitation, eye screening for people with diabetes, ultrasound ante-natal screening and pathology (phlebotomy). The building also provides an audiology cabin for testing hearing, consulting rooms for visiting hospital specialists, a community police officer base and two GP practices. The Eddercliffe Centre in Liversedge centre provides care for people away from hospital to support them back to health after they have experienced a health problem. Fig. A9: Spen Valley – Locality Providers

Impact on provider landscape New investment will include a real increase in primary medical care capacity to bring the locality closer to the Kirklees and England averages. At the same time, and as in other areas, we need to ensure that services are delivered in premises that are fit for purpose, limit the scope for clinical isolation and ensure continuity of services as existing single handed GPs retire (or leave).

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The Valleys The Valleys lies in the western part of Kirklees and geographically is the largest locality, but is very rural. Generally people living in the Valleys have better health than those in Kirklees overall. The Valleys comprises two valleys: the Colne Valley and the Holme Valley which experience slightly different health issues and priorities. Population Table A7 shows the age profile for the Valleys. The area has the largest proportion of adults of working age after Denby Dale and Kirkburton, in Kirklees. In comparison to Kirklees overall, the population under 19 is slightly lower but the population aged over 65 is similar. Table A8: The Valleys: Population by Age Group (Mid–Year Estimate 2005) Age Group

Under 20

20 - 64 Years

65 - 84 Years

85 Years plus

Total

All 65 and over

Number

17,360

41,480

8,510

1,310

66,680

9,820

% of locality

25.3

60.4

12.4

1.9

100.0

14.3

Kirklees %

26.2

59.2

12.7

1.9

100.00

14.6

Around 1% of the population are of South Asian origin. Life expectancy Life expectancy at birth is higher than the Kirklees rate and the national rate with women experiencing the highest life expectancy at birth of all the localities. Priority health issues The JSNA identifies locality health challenges as being: Children and young people – Holme Valley: • 14 year olds drinking alcohol, at the highest rate in Kirklees; • although low, the highest rate of 14 year olds having taken illegal drugs; and • among 14 year olds the rates of feeling angry, lonely and miserable were amongst the highest across Kirklees. Children and young people – Colne Valley: • 14 year olds experiencing the highest rates of bullying across Kirklees. Adults: • unhealthy personal behaviours including obesity, smoking and alcohol use could be addressed.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Current service profile The locality is served by ten GP practices (with 39.1 wte GPS and 2.4 wte nurse practitioners delivering an average list size of 1,551 service users per practitioner), seven dental practices and ten pharmacies. The Holme Valley Memorial Hospital offers acute services traditionally provided in bigger (ie district general) hospitals and inpatient intermediate care beds. The services offered at the Holme Valley Memorial site will be further expanded over the coming years. Fig. A10: The Valleys – Locality providers

Impact on Provider Landscape Substantial new investment in primary medical care capacity is not necessary – existing provision is already well above the Kirklees average and close to that for England. However, there are issues in the Colne Valley part of this locality which need addressing, in particular: • In the Colne Valley we will explore the scope to relocate the existing Golcar Clinic into new premises which could also offer more modern accommodation and facilities to a local GP practice. • In Marsden, Marsden Health Centre is a 1960s former local authority, single storey health clinic. It houses a GP practice (Dr Deacon and Partners) along with some PCT

71


services. The building is of poor quality and grossly undersized for its purpose. We have agreed with the practice the need for them to be based in new premises. Work is ongoing in terms of selecting a suitable site. • In Slaithwaite, the main centres for primary medical care and community service delivery are the Croft House practice and Slaithwaite Health Centre. The Croft House facility in particular has been identified as being unfit for purpose into the future and we will work with service providers in Slaithwaite on an options appraisal for future facilities. In addition to these developments, the locality is home to the Holme Valley Memorial Hospital in Holmfirth. This site, like the Princess Royal Community Health Centre in Huddersfield and Dewsbury Health Centre, has been identified as one of our ‘community hospitals’ – ie a facility offering a broader range of services than a typical health centre, and from which services can be offered to people beyond the boundary of the locality in which it is based. Planning for the HVMH is well underway, with work already started on the redevelopment of Hawthorne Ward. Consultation with local people and service providers is also ongoing. We will refine our plans for the HVMH service model during autumn 2008.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Appendix 2

Public Expectations and Political Drivers Our programmes are formed with public expectations and political drivers in mind. Over time these drivers will changes and consequently we will refresh our programmes to meet existing needs. Public expectations of the NHS – and indeed other public services – continue to rise. Service users and local people are increasingly active rather than passive. This is illustrated through a number of themes: • increased focus on being person centred encourages an expectation that the service user will have a much stronger role in determining how, where and by whom services are delivered; • emphasis on individual choice and the availability of comparative information to support informed decision making; • service user involvement in identifying needs and creating solutions in driving service development or to reward providers who are reinforcing and formalising the strengthened role of the service user; • the role of new technology, e.g., improving communication between service user and professional and enabling remote and/or selfmonitoring of conditions. At the very least this means planning on the basis that more services will be offered and delivered at or closer to people’s homes; more professionals will be based in the community so access is much easier. These developments are evident in Kirklees as elsewhere – e.g., the initial national GP

service user survey in 2007 identified an unmet demand for access to GP services at weekends and especially in the evening. We are ready to meet the challenges which this and other developments present. We also recognise that the period covered by this plan extends beyond established financial planning and political horizons of three and four years respectively. In addition, policy on the delivery of health services is, of course, subject to political change. These political factors make long term planning more difficult. However, there are a number of areas where there appears to be consensus, e.g.: • a shared commitment to the NHS being a publicly funded service which is free at the point of delivery; • person centred support and a greater say for individuals in planning their care; • prevention of ill health and actions to support remaining healthy, as well as prompt detection, treatment and dealing with the consequences of ill health; • supporting people to self care wherever possible; • increased individual choice (from a broad range of providers) and funding following the service user; • a greater focus on quality, safety and improved service user experience; • easy and convenient access; • separation of commissioning and provider functions in the PCT; • localisation of planning and prioritisation in PCTs, local authorities and other commissioners of services; • plurality of provision and a degree of competition among providers; • an increasing shift towards out of hospital provision of services and care closer to home;

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• quality assurance through good commissioning, robust clinical governance, systematic contract and performance management and consistent, transparent and independent external regulation; • integrated, holistic and area-based performance assessment (e.g., through Comprehensive Area Assessment); • key national or local targets; and • primary and community services as the cornerstone of the wider NHS and care systems.

Appendix 3

Provider Landscape Kirklees people receive hospital services largely from two main providers – the Calderdale and Huddersfield NHS Foundation Trust (CHFT) and the Mid Yorkshire Hospitals NHS Trust (MYHT). The South West Yorkshire Mental Health Trust (SWYMHT) provides most of our mental health services. Ambulance services are provided by Yorkshire Ambulance Services (YAS). Community services are provided by Kirklees Community Health Care Services, which operates under the organisation of NHS Kirklees. CHFT has hospitals in both Halifax and Huddersfield, and the MYHT has hospitals in Dewsbury, Wakefield and Pontefract. Hospital services are also commissioned from a wide range of other trusts, including Bradford, Leeds and Sheffield. People needing referral to hospital by their GP can choose which hospital they would like to attend. A small number choose to travel further afield. This may grow in coming years as people become more familiar with the choices which are now available to them. Looking To The Future (LTTF) the integrated service strategy linking primary and secondary care launched in June 2005 and currently being implemented has the explicit aim of providing as much care as possible closer to people’s homes, wherever this is safe and practical, and to provide high quality, specialist services in our hospitals. In short we want to make sure that local people are offered the right care, by the right people, in the right place at the right time.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

For North Kirklees, we are similarly currently working with Mid Yorkshire Hospitals NHS Trust to review service provision across their hospital sites and to explore what services they can deliver in community settings such as our new health centres in North Kirklees. World class commissioning requires us to demonstrate separation in terms of governance arrangements between the commissioning and providing parts of the organisation. This ensures the provider part of the organisation is treated the same as any other provider even though the Board of NHS Kirklees remains accountable for both functions. Primary care services are provided by 74 GP practices, 59 dental practices, 90 pharmacists and 42 optometrists. Out of hours services are currently provided by Local Care Direct under a contract which runs until March 2009. Since 2008, NHS Kirklees has been working with the four other West Yorkshire PCTs to apply a county-wide collaborative approach to the re-design and procurement of urgent care services. As a result of our work with our main local providers, we envisage considerably more services being delivered out of hospital over the next five to ten years than is currently the case. Choice and Diversity of Service NHS Kirklees is committed to make better use of the potential of other service providers to work alongside and complement traditional service providers. We need to ensure that we commission effectively and identify areas where people do not receive an appropriate service for their needs. In some areas, we may not have the range of service providers we need

and we need to use the levers available to us to increase choice and diversity. Examples of this include: • Working more closely with the third sector - Offering organisations such as social enterprises and voluntary organisations the opportunity to provide services and working closer with them to facilitate a level playing field between them and other existing or potential NHS or commercial providers. • Extending the role of the community pharmacist - Community pharmacies are usually located in the heart of communities and are visited frequently. We believe there is great potential for their more effective use to support the prevention of ill health and self care, as well as reducing inappropriate A&E attendance and unnecessary hospital admissions. • Improving oral health - As part of the new contract for dentists from April 2006, the transfer to PCTs of the responsibility for commissioning primary care dental services gives them the opportunity to develop services in a more strategic manner, commissioning dental services where they are most needed and where they will lead to improvements in oral health. • Extending the role of the optometrist There are similar opportunities, to enhance the role of local optometrists and reduce the need for people to visit hospital in relation to certain conditions, e.g., diabetes.

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Estates Issues The provision of high quality services requires premises and equipment which are fit for purpose. Our overarching strategy on facilities may be summarised as being to secure premises which are: • • • •

in the right place; in the right condition; of the right type; and able to respond to future service needs.

The existing estate falls some way short of this ambition. Management of the estate in part reflects the formerly separate PCTs. Our objectives in managing the overall estate are to: • support easy and convenient access to buildings and services by service users, staff and others; • support delivery of the highest quality services to local people; • comply with statutory requirements; • deliver best value for money; and • support delivery of this Five Year Strategic Plan. Care Closer to Home One of our goals is to ensure that services are delivered as close to people’s homes as possible. The underlying principle supporting this goal is that only those services which cannot be provided effectively and safely within a community location should be provided within an acute hospital setting. Future service provision will be shaped around the four tier service model which we have adopted and developed. This balances the aspiration to provide services as close as

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possible to where people live and the continuing imperatives to secure value for money, clinical effectiveness and assured quality. The 4 Tier NHS Service model envisages four levels or tiers of health care service: • • • •

Acute and specialist care Community hospitals Extended primary care services Core primary care

Level 1 - Acute and specialist care Our main acute providers are CHFT, MYHT, and SWYMHT, with people also travelling to hospitals such as Leeds and Sheffield. It is likely that the increased focus on individual choice will result in people travelling to different hospitals, travelling even further afield or using private hospitals as NHS service users. Through the mechanism of our contracts with acute providers, we will focus on securing high quality services that meet the standards which people tell us are most important to them when they stay in hospital, e.g.: • waiting times and choice of appointment time; • cleanliness and a high priority on infection control; • good clinical outcomes and a continued focus on best practice; • personal attention with good communication between service users, their carers and clinicians; and • privacy and dignity. In addition, we will work with our main acute providers to plan how hospital services should be most appropriately configured in future.


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Some of this work has already been done. In June 2005 the PCT (specifically two of the three predecessor PCTS – Huddersfield Central and South) in partnership with Calderdale PCT and CHFT jointly launched the plans for an integrated service strategy which aimed to deliver as much care as possible closer to people’s homes, wherever this is safe and practical, and to provide high quality, specialist services in our hospitals. As a result, some hospital services such as paediatric inpatients, specialist obstetrics and planned surgery have been re-configured across the Calderdale and Huddersfield hospital sites, and a range of new community based services such as community matrons have been introduced. We are now working with MYHT and partners in Wakefield District PCT to review the configuration of services across the three hospital sites in Dewsbury, Pontefract and Wakefield. This work will consider the most appropriate configuration for a range of hospital services in the future and we will consult with the public on options in early 2009. As with the Calderdale and Huddersfield programme, an important aspect of this work will be commissioning community based services that avoid unnecessary admissions to hospital, or increase the numbers of services that can be delivered in community settings such as Dewsbury Health Centre. We will also ensure that we have in place effective commissioning arrangements for specialised services provided in specialist centres to catchment populations of more than one million people. The underlying aim of the arrangements for commissioning specialised services is to ensure fair access to effective, high quality clinical services across our area. User numbers for such services are small and a critical mass of

service users is needed in treatment centres to: • achieve the best outcomes and maintain clinical competence; • sustain the level of training of specialist staff; • ensure cost effectiveness in provision; and • make the best use of scarce resources. Although these services are required by far fewer people than those provided in primary care and local hospitals, they do account for around 10% of total PCT expenditure. To ensure that these services are commissioned effectively, we will continue to commission in partnership with the other PCTs in Yorkshire and the Humber through the Specialist Commissioning Group (SCG) structure. The SCG brings together all PCTs in Yorkshire and the Humber to enable us to make collective decisions on the review, planning, procurement and performance monitoring of specialised services, as well as any other service where an integrated commissioning response/action is beneficial. Current priority areas include: • • • • •

Obesity surgery Cancer reform Cardiac services Children’s services Long term conditions – renal services, neurological conditions and • Mental health Further detail about specific commissioning intentions for each of these areas can be found in Section 5.3.

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Level 2 - Community hospitals If we are to deliver care safely out of hospital, it is vital that we have facilities that are fit for purpose. We believe that a population of the size of Kirklees could support around three larger community sites, from which a range of services could be provided. Our view is that these three key sites are:

Hospital Funding of £6.63m (out of a total of £13.79m awarded jointly to Kirklees and Calderdale PCTs) capital investment over the period 2008/09 – 2011/12). These resources have enabled NHS Kirklees (and Calderdale PCT) to take forward with confidence a broader range of schemes, thereby providing a significant boost to the overall programme.

• Dewsbury Health Centre, Dewsbury • Holme Valley Memorial Hospital, Holmfirth • Princess Royal Community Hospital, Huddersfield Town Centre (this site is owned by the CHFT)

Level 3 - Extended primary care services These are services beyond those offered by all practices – core primary care or level 4 services – which may be offered by some (but not all) practices or by other local providers (e.g. KCHS). Where practices offer such a service or services, the service(s) will be typically offered to a wider population than just the people registered with that practice, usually on referral.

The services that could be delivered from these sites include: • outpatients; • rehabilitation and therapy; • intermediate care (including beds where appropriate); • diagnostics; • minor/day case surgery; • community nursing bases; • sexual health; • primary care mental health services; and • services for people with alcohol problems. Not all services would need to be available from all three community hospital sites – we need to commission them appropriately to ensure they are most effective. We will work with local people and health and social care professionals to plan the most appropriate configuration of services across these sites, taking into account population need, critical mass, and service interdependencies. The strategy is supported by an award from the Department of Health of Community

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These services will include most of those offered by community hospitals (e.g. podiatry and therapeutic services) but an individual provider may well offer only one or two such services. Level 4 - Core primary care These are services provided by the traditional NHS primary care contractor professions which people can expect their GP, dentist, pharmacist or optician to provide as NHS services. E.g., people can expect access to a GP (or nurse) from 8-30am to 6-30pm Monday to Friday, usually through an appointment (and urgent attention in an emergency). The doctor (or nurse practitioner) will also issue prescriptions, offer advice and support in living with a long term condition or refer the person to a specialist doctor, if necessary. The family doctor will also visit people at their homes to provide these services, if appropriate.


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Outside these hours, the practice will facilitate access to the local out of hours service. In addition, many practices are now extending their opening hours by offering appointments in the evening or at weekends. Generally, these services are offered to people who are registered with the practice, but practices will also provide such services to people who are in the Kirklees area temporarily or to anyone in an emergency. Many local practices do, of course, offer a greater range of services (e.g. a range of vaccinations and immunisations or level 3 services, as above). In some cases, practices offer these services to a population wider than its own registered list by referral from another practice under a contract with NHS Kirklees. Similarly, under their NHS contracts, pharmacists dispense NHS prescriptions written by GPs or nurse prescribers, and may also offer a range of other services (e.g. minor ailments schemes) under a local contract with NHS Kirklees. Improving Access We aim to offer Kirklees people responsive, prompt and convenient access to services (including weekends and evenings). This means we need to ensure that there is sufficient service capacity locally and that providers are organising and managing themselves to deliver services which are sensitive to their service users’ needs and preferences. This includes reversing the inverse care law, i.e. where those most in need experience weaker services.

To achieve this, we want to ensure that: • People have the opportunity to access their GP practice during evenings and weekends for routine care and have access to effective care out of hours (overnight, weekends and public holidays). - Some initiatives have begun already, such as procurements of new GP led health centres, commissioning of additional dental services, investment in mental health, and extended GP opening hours with the majority of local practices now offering some additional access. • Urgent care needs can be met away from hospital settings where appropriate, with the service tailored to reflect local needs and factors such as geography and travelling times. - We will be working with partners and local service providers to review urgent care provision and agree a strategy for the future. This work will begin in late 2008. • The services we commission meet national standards such as 18 weeks from referral to treatment, maximum four hour wait in A&E and GP appointments within 48 hours. When resources and capacity allow, we will seek to exceed these national standards. Where necessary, we will address shortfalls in performance.

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Appendix 4

Workforce Planning Introduction A skilled, motivated workforce is critical to the delivery of our strategic goals, and to our Delivering Healthy Ambitions in Yorkshire and Humber and world class commissioning agendas. The changing demographic profile and health needs of our local population mean that NHS Kirklees must take a lead role in workforce planning across the local health economy. This paper describes the approach NHS Kirklees has taken to workforce planning to date and its plans and aspirations for the future. The paper also highlights several of the key identified risks in the Kirklees health care workforce. Full details of all identified risks and accompanying mitigating actions are contained in the Workforce Risk Assessments submitted to the Workforce & Education Directorate of the SHA in late September 2008.

Workforce Planning at NHS Kirklees The long term aim of our workforce planning activity is to integrate workforce planning with standard financial and business planning processes so that we can attract and retain a motivated workforce with the right skills and competencies to meet the health needs of the populations of Kirklees’ seven localities. In April 2008, the NHS Kirklees Board approved a workforce planning framework for the organisation that aims to fulfil the requirements of paragraph 3.32 of the 2008/2009 NHS Operating Framework and achieve the aim described above. The framework is based on the four pillars 80

described in the NHS Plan (2002). It takes an holistic approach to workforce planning, using the organisation’s goal to be an Employer of Choice as the bedrock for all accompanying plans and actions. The framework recognises that the organisation’s approach to workforce planning is evolving, and will continue to evolve over coming months and years.

Achievements in 2008 This year, NHS Kirklees has started with the important fundamentals of workforce planning, focusing on: • Improving workforce information in order to monitor and inform people management practices and plans: The NHS Kirklees Workforce Scorecard, introduced in September 2008, represents a major step in this process. The Workforce Scorecard will enable the organisation to more effectively monitor and improve key elements related to the workforce, including sickness, turnover, agency spend and staff well-being. • Engaging with partner organisations: In line with NHS Kirklees’ strategic goals and Delivering Healthy Ambitions in Yorkshire and Humber, the organisation is building workforce planning partnerships with its key partner and provider organisations, including Kirklees Council, SWYMHT and CHFT. • Improving workforce planning capacity and understanding across the organisation: Information and consultation sessions at Board, Director and Assistant Director meetings and NHS Kirklees Community Health Services workforce


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

sub group meetings have been crucial in raising the profile of workforce planning. Further training sessions are planned before the end of 2008, focusing in particular on operational managers in the provider arm of the PCT. Organisation Development Services (ODS) have been commissioned to provide facilitator training on their SHA-preferred Population Centric™ model before the end of 2008, in order to increase the capacity of NHS Kirklees to carry out workforce planning. • Initiating discrete workforce planning projects: Several projects are underway or in development at NHS Kirklees. The projects are based on the Organisation Development Services (ODS) Population Centric™ model, and are carried out with the full engagement of the staff and partner organisations affected. The projects include: - a major ‘Health in Schools’ service redesign initiative, jointly with local education partners - a small workforce visioning project with a community occupational therapy team - a major project under development in the pre-school Kirklees Community Health Services team, in partnership with the Council, - a significant project planned to review the district nursing workforce in Kirklees • Carrying out workforce risk assessments: NHS Kirklees has taken steps to ensure that it has carried out risk assessments of the local health care workforce, including its own commissioning and provider workforces. It has also carried out;

workforce risk assessments in partnership with its major provider acute trusts, ambulance trust and mental health trust. Identified risks have been mitigated where possible and further action has been planned.

Current Workforce Risks and Priorities Through carrying out workforce risk assessments internally and with partners, NHS Kirklees has identified a series of workforce risks and mitigating actions across its local health economy. Full details are contained in the risk assessments themselves, which will be submitted to the SHA under separate cover; however several of the headline risks are outlined below for illustrative purposes. In addition, work has been carried out with finance colleagues to ensure that our workforce projections reflect the risks and plans identified to date. • Changes in personal support ratio: The Yorkshire Futures study (September 2006) on population projections indicates that the Personal Support Ratio in Kirklees, will decrease significantly between now and 2030 (PSR is the number of the population in the working ages divided by the number in the older ages). This means that by 2030 there will be only 3.08 people of working age to support each person over 65 compared to 4.5 in 2005. NHS Kirklees will need to develop and grow its workforce to deal effectively with the increased longevity of its population. It is likely that it will have to attract employees from sections of its local community that are traditionally economically inactive.

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• World class commissioning competencies: NHS Kirklees aims to become a world class commissioning organisation and as a priority is taking steps to equip its workforce to deliver the world class commissioning agenda and improve its performance against the required competencies. A comprehensive training needs analysis of both PCT employees and PBC partners is underway, following which a training plan will be developed

The Evolution of Workforce Planning at NHS Kirklees It is anticipated that during the coming months and years, further work will take place to improve workforce planning capacity and capability within NHS Kirklees; embed workforce planning into standard business and financial planning processes; and continue to develop joint workforce planning approaches with partner organisations. Specific action planned includes:

• New and extended skills: Delivering Healthy Ambitions in Yorkshire and Humber and work such as 18 Weeks and the Care Closer to Home agenda will require the development of new and extended skills in our health economy workforce. Health improvement skills in primary care and specialist skills in areas such as orthopaedics and radiotherapy are examples of skills areas identified as being in increased demand.

• Health economy dialogue: In line with its intention to be the leader of workforce planning in the local health economy, NHS Kirklees has planned a major health economy workforce planning event in partnership with Wakefield District PCT. The event is scheduled for 21 November 2009 and will bring together partner organisations with a view to developing further shared understanding of workforce requirements and furthering joint projects. Facilitators have been secured from Organisation Development Services (ODS) and the Strategic Health Authority to lead the event.

• Medical recruitment: Medical recruitment in secondary care has been particularly challenging during 2008/2009, with few suitably qualified applicants emerging for advertised posts at all levels, including junior doctor rotations. At CHFT a range of actions have been taken to allow 95% - 100% compliance with European Working Time Directive requirements in 2009. • Age profiles: With significant numbers of community nursing staff approaching retirement, discrete workforce planning projects are scheduled at NHS Kirklees to ensure that succession planning and opportunities for innovative ways of working are fully explored.

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• Improving the workforce planning capacity of commissioners: It is anticipated that the event described above will further NHS Kirklees’ and its partners’ understanding of the commissioner’s role in workforce planning. Subsequently it will be possible to arrange development for key commissioning staff, in particular the Health Improvement Team leads, so they can identify required workforce planning and development activity in partnership with providers.


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

• Integrating workforce planning: NHS Kirklees will continue to work towards its long term goal of integrating workforce planning with its standard business and financial planning processes. Specifically, work will take place within the Business & Financial Planning Committee, to ensure that workforce considerations become embedded into standard procedures. • Building workforce information expertise: NHS Kirklees has approved the recruitment of a workforce analyst, who will play a key role in collating planned workforce expansion and development information as well as leading the continuing improvement of workforce and management information provided to the organisation.

Conclusion NHS Kirklees recognises that 2008 is the beginning of a journey to improve workforce planning in the local health economy for the long term benefit of its local population. There is further work to be done before workforce planning is fully integrated with the organisation’s standard business processes, and the workforce planning relationship between commissioner and provider is still evolving. However, NHS Kirklees is making positive steps in the right direction and will continue to do so. For further detail please see the Organisational Development Plan.

Appendix 5

Changes in Technology We will continue to deploy the Connecting for Health (CfH) sponsored solutions. By the end of 2008 we will have completed the deployment of the TPP SystmOne solution to our Provider Services arm. We will continue to upgrade and refresh the IT equipment in our GP practices and to support their use of a GP Systems of Choice (GPSoC) level 2 clinical system, as a minimum. Many of our GP practices are already based upon TPP SystmOne and others will follow. Therefore, our ability to deploy a virtual full service user record will increase. In parallel with this, we expect the national rollout of the Summary Care Record (SCR) to continue. This will enable increased safety and effectiveness of care, as information is able to flow around the system. This is, of course, always going to be subject to individual choice (for their information to be included) and to appropriate governance. We will continue to support the deployment of the Electronic Prescribing Service (EPS) to our community pharmacists. The planned investment level in CfH solutions is estimated to be £250,000 per annum over each of the next five years. In support of commissioning, we are expecting to use a data warehouse to enable the planning of services and activity levels to be managed effectively. We would anticipate that this will be done collaboratively with other PCTs within Yorkshire and Humber. We have also developed a joint warehouse of health data and information with the Council.

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Our biggest challenge will be with the provision of information to our service users and the public. With the advent of social network websites, such as Facebook, and comparison websites, such as TripAdvisor, we will face an increasing demand from our service users, citizens and staff to interact and share knowledge. We will therefore need to invest in the provision of opinion based sites (such as Patient Opinion) and to further develop our internet and intranet presence to meet this demand. This will include the provision of personal health websites such as HealthSpace. In addition,, we expect that further developments in telehealth and telecare will revolutionise the ability to deliver services and support to people in their own homes. The focus will be on high quality information, supported self care and self management using the latest advances in assistive technology. Working with partners in the Council, we intend to combine our resources and systems to use telehealth and telecare to support vulnerable people in their own homes. In this way we will offer real time access to support for users and carers 24 hours a day.

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Appendix 6

The Kirklees Commissioning College Clinical leadership is essential to strong commissioning. In Kirklees, we have a number of clinicians already playing an active role in commissioning – either as clinical leads, PEC members or through PBC. These clinicians play a key role in our Health Improvement Teams (HITs).

Teams Health Improvement Choosing Health • Alcohol • Food • Tobacco control including smoking cessation • Sexual Health including Chlamydia screening, teenage pregnancy • Physical Activity • Obesity • Oral Health

Urgent Care

Infection Control

Planned Care/18 Weeks • Cancer (including breast, cervical and bowel screening) • Palliative care • Therapy/rehab/intermediate care • Diagnostics • “Pressured pathways” (linked to 18 weeks programme)

Long Term Conditions • CHD • Diabetetes • Respiratory • Self Care

Partnership Commissioning • Children & Young People • Learning disability (adults) • Mental health (adults) • Physical disability (adults) • Older People • Substance misuse

The relationship between the PEC and PBC will be vital for effective delivery. Whilst the PEC is important in supporting the development of a vision and strategic direction for the PCT, PBC will be the main mechanism by which front line innovation and service reconfiguration are delivered. PECs and PBC represent two different but mutually supportive parts of clinical engagement and leadership that will be vital if PCTs are to commission high quality and effective services for patients. It is therefore expected the PEC will set the overarching framework, direction and environment for PBC and link PBC development to the PCT’s overarching commissioning strategy.

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elves rs u o e is n a rg o e w w Ho clinical leadership Trust Board

Provider Arm

Commissioning Arm

Kirklees Community Healthcare Services Provider Board Professional Executive Committee (PEC)

Health Improvement Teams (HITS)

Practice Based Commissioning (PBC)

Clinical Leads Cardiovascular Mental Health Diabetes Respratory Obesity

IM&T Cancer LTC Musculoskeletal

In early 2009, we established a Commissioning College - a clinically led forum that brings together key managers and clinicians on a monthly basis. The Commissioning College will: • Contribute to setting the key strategic objectives and priorities of the Kirklees Primary Care Trust • Lead clinical engagement within the PCT • Facilitate clinical communication within PCT and with partners and stakeholders, including patients and the public. • Support clinical leadership in the implementation of the Quality and Clinical Governance Strategy Framework and Primary Care Quality Indicators and Quality Matrix. • Enable us to work together in a single commissioning system to meet national targets and local priorities. • Encourage effective partnership working and the sharing of commissioning tasks • Promote and support innovation and the sharing of good practice.

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Appendix 7

Equality Impact Assessment 1

What is being Equality Impact Assessed? The NHS Kirklees Five Year Strategic Plan and The NHS Kirklees Operating Plan

2

Description of the function being Equality Impact Assessed: To ensure that all elements of our Five Year Strategic Plan meet the principles around Equality and Diversity, specifically around our commissioning strategy and programme areas.

3

Lead contact person for the Equality Impact Assessment: Samantha J Williamson Head of Strategic Business Planning NHS Kirklees

4

Who else is involved in undertaking this Equality Impact Assessment: The Five Year Strategic Plan is owned by the NHS Kirklees Trust Board who therefore will sign off this piece of work and monitor it’s evaluation and implementation.

5

Sources of information used to identify barriers etc • Individual Programme Commissioning Plans detailing strategic objectives and key outcome measures • Other enabling strategies – e.g. Finance, Organisational Development, Communications and Workforce Planning • Our Joint Strategic Needs Assessment • The Kirklees Local Area Agreement

What does your research tell you about the impact your proposal will have on the following equality groups? BME Groups: Kirklees is comprised of 7 distinct locality areas which enables us to model and focus our strategic planning embracing cultural diversity where relevance to capture the needs of the population. In the Batley locality, a larger proportion of that population are of the South Asian origin than in Kirklees as a whole.

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More than 1 in 5 young people under 19 in Kirklees are now of South Asian origin, whilst overall 86% of the total population are white. The total numbers of births are also increasing amongst families of South Asian origin. Our programme planning therefore represents this particularly where a health issue may be related to ethnic background, for example South Asian people are up to 6 times more likely to have diabetes than White people. Minority ethnic achievement in Kirklees is complex. Overall students from the largest minority ethnic group, Pakistani origin, performed below the Kirklees average at KS1, 2 and 3. This persisted up to KS4 where students of Pakistani origin were least likely to achieve the 5 + GCSEs at grade A*-C, and therefore programmes of work which encompass children and young people will ensure that these factors are considered. Access to employment, rather than to Higher Education is the issue for the local Pakistani population, and again this will be a factor in our planning processes.

Disability Groups: In 2006, 4.3% of children in Kirklees aged 0-18 had some form of learning difficulty, Statement of Educational Needs or some other disability. Total number was approx 4,000. About 3% of students had a statement of educational needs, varying from 4% in Denby Dale & Kirkburton and Huddersfield South to 1.8% in Batley, in 2006. 1 in 5 of the adult population had at least one disability (over 50,000 people). 1 in 20 of the adult population had a serious disability (16,000 people). • 1 in 5 of adults needed help with at least one task of daily living (over 50,000 people). • Most disabled people do not come into contact with Adult Services – they currently provide direct services. There are however 1,836 adults known to Adult Services. Mild and moderate levels of learning disability (LD) affected around 2.5% of the population, approx 10,000 people in Kirklees. Over the past few years Kirklees has been experiencing between 2% and 3% annual increases in adults with severe learning disabilities. Increasingly high proportion of younger adults with LD within our Black and Minority Ethnic communities, especially the South Asian communities. The number of older people with learning disabilities is increasing and we are seeing an increase in the occurrence of early onset dementia. Our Learning Disabilities and Physical and Sensory disabilities programmes, along with Long Terms Conditions management therefore reflect this, and take a proactive approach to ensuring that these service users, and their carers and families, receive the level of care they need.

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Gender: There is a specific programme of work related to Women of Child Bearing Age (WOCBA) which focuses on encouraging increased uptake of positive lifestyle choices to improve the health and wellbeing of Women of Child Bearing Age, specifically around diet, smoking, alcohol, and physical activity and including the effect of emotional well being on those choices. Our Healthy Pregnancy and Maternity Strategy’s principle objective is to “place women at the centre of their pregnancy journey by listening and supporting them to identify and address their needs across health and social care�, and there is extensive work being undertaken to review our maternity strategy during 2009 / 2010 to ensure these needs are addressed. We recognize that men are dying younger than women, and this will be addressed through the Long Term Conditions Programme, specifically for issues such as Coronary Heart Disease and Stroke.

Age: Older People: Population trends for older people in Kirklees reflect those taking place nationally and regionally. Projected growth in the numbers of older people is substantial, particularly for those between 75-79 years and those over 85. By 2015 there is expected to be an additional 14,700 people over 65. By 2025 there will be an additional 26,400 people over 65. Bringing the total population of 65 and over to 85,200 by 2025. This is a 45% increase in the older population, aged over 65. The largest growth will be seen in those aged over 85 years, with a projected growth of 58% equating to an additional 4,400 people (Total 12,000 people over 85 by 2025, 2.7% of the total population). The growth in the numbers of those aged over 85 is significant as they have substantially higher levels of dependency and therefore need for health and social care services. As the highest proportion of those people with a Long Term Condition are elderly, our LTC planning specifically focuses on this age group and aims to meet the individual requirements of people with long term conditions through high quality personalised care which offers choice and services commissioned to meet the needs as determined by the individual. Specific actions during 09/10 will include commisioning and implementing a risk stratification tool to identify people with LTCs, development / implementation of a generic care pathway and a self care pathway for LTC and overall to Improve our approach to LTC and introduce new pathways of care for service users with a sensory impairment.

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Children and Young People: The main health challenges facing children and young people are: • Dying before their first birthday. • Personal unhappiness and social isolation. • Obesity, which is rising year on year. Dewsbury had over twice the national rate of children dying before their first birthday, and there was 3 fold variation across the localities in Kirklees. Maternal malnutrition, whether due to smoking, obesity or poor diet, remains the most significant factor so is the key priority, not infant deaths in itself. During 2009 / 2010 the Kirklees Children and Young People’s strategy will focus on delivery of the new Child Health Promotion Programme, Delivery of FNP programme and ensure a reduction in unwanted/unplanned teenage conceptions, better access to more effective services, improved self-esteem, and better relationships with their families and peers. Specific actions will include: • Develop and agree new specifications for health visiting and school nursing and ensure effective delivery. • Establish effective monitoring systems and ensure evaluation against outcomes. • Ensure implementation of the new CHPP • Ensure the programme is embedded in the roles of service providers and effectively delivered.

Sexual Orientation: The Kirklees Sexual Health Strategy aims to improve people’s knowledge and skills and support them to make choices that will enhance their sexual health and wellbeing, and to reduce the prevalence of undiagnosed HIV and sexually transmitted infections. Specific actions include developing a programme of campaigns to support the promotion of sexual health messages to increase awareness around sexual health issues and services; to continue to develop and evaluate relationship and sexual health courses in schools and colleges across the district to increase relationships and confidences of young people; to commission effective GUM, HIV and services targeting specific groups such as men who have had sex with men and some minority groups; to commission effective HIV family support services; to commission effective services for people affected by HIV and AIDS and to commission research into the local specific health needs of lesbian, gay and bisexual people.

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Religion & Belief: Kirklees is a district with great cultural diversity, representing a number of faiths and beliefs across its entire population. Our strategic goals reflect this, and all our programme objectives represent these principles and deliver services which are culturally sensitive, and “place the person at the centre of everything we do�. This involves commissioning services which, irrespective of cultural background, faith or belief, encompass prevention, detection, treatment and the consequences of ill health, and will achieve equality of outcomes through targeting resources to follow needs. We constantly strive to improve quality and promote safety by encouraging new and innovative ways of delivering services that are sensitive to the diverse needs of our community, promote local sensitivity through effective commissioning by setting outcomes and actions that reflect local needs and priorities.

6

Overall summary: The PCT and its partners are committed to focusing resource on those priority areas where there are health inequalities, to address the differences in health and lifestyles across the Kirklees population. However, we have also identified that there is the potential for adverse impact on those subgroups within targeted areas who may fall outside those otherwise identified within health inequality groups. The PCT will therefore ensure that an individualized approach to planning is part of all programmes of work and that all individuals receive equal access to care and resource whatever their health needs.

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7

Consultation: New or Previous: Service user and public engagement: As part of World Class Commissioning we are committed to increasing service user and public engagement and greater clinical involvement throughout the commissioning process. Increased clinical and service user input, combined with a more accurate assessment of long term local requirements, ensures services are more closely designed to meet evolving service user needs and provide a good experience of the NHS in Kirklees. We will therefore engage actively with local people. We already speak regularly to local people about their health and the sort of services and support they need. We have also started, through a social marketing approach, to help local people have healthier personal behaviours. Examples of this include: • working with groups of people in our localities to develop locality plans; • public consultations on major changes to services, e.g., Looking to the Future (2005/06 and continuing); • public consultations on more local changes to services, e.g., on the future of Liversedge and Slaithwaite Health Centres (early 2007); • urgent care consultation (spring 2007); • service user surveys – whether organised nationally or locally by ourselves or by providers. We work with practices on a regular basis to monitor quality and accessibility. The findings identify needs, show whether services are up to standard and if individuals are experiencing a good level of care; • creation of an Expert Patient Support Group to encourage better health through peer support; • Reference groups of service users established for all Long Term Conditions HITs • establishment of a Readers’ Panel to ensure that our public information leaflets are easy to read and understand; • consultation on the introduction of GP led health centres; • a diabetes survey to obtain feedback for action on the care and support which local people with diabetes receive; • Patient Public Involvement Forum/ LINks; • Specific focussed consultations within communities whether issue or sociodemographic specific; and • The local Overview and Scrutiny Committee. The communications plan reflects and addresses issues arising from our continuing service user and public involvement work. It will also raise new concerns which will require further public engagement and discussion with partner organisations before crystallising into firm service development commitments. We will ensure that this happens.

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In planning services for the future, we will work closely with our local hospital trusts to ensure that our service users have access to the range of services they need, and that services are easily accessible, safe and of high quality. People should only attend hospital if the care they need cannot be safely provided in a community setting or in their own home. In all cases we will work closely with local communities when we need to review existing services, or are considering proposals for service reconfiguration or investment.

Communications: Communications needs to be service user focused and centred, so that individuals have the information they need to make informed choices about their care and are able to influence the development of services. We will also seek out ways to work with our partners, such as Kirklees Council, on new social marketing techniques to proactively influence and effect changes in people’s behaviours on public health issues and health choices. A joint Marketing Board now oversees campaigns and social marketing across the PCT and Council. NHS Kirklees is committed to actively involving and working in partnership with the public and service users to design, review, monitor and deliver quality services to meet their needs. NHS Kirklees has a number of key service change priorities which will continue to benefit from service user, carer and public involvement and engagement ,as well as formal consultation processes. We are working to develop a number of key messages for our different stakeholders. For further detail please see the Communications Plan.

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8

Assessment and Actions needed

Location of Organisational Barriers

Assumption of normality / description of barrier

Action needed

Responsibility

Geographical location

N/A

Built environment

N/A

Deadline

Information and communication

The importance of considering equality and diversity within all areas of work but specifically within strategic planning is communicated to all staff regularly by means of electronic staff updates, surveys, newsletters and within specific work programmes dependent upon the nature of the service area.

Timing

Continuous in line with planning activities.

Involvement in Planning

All staff employed by NHS Kirklees are expected to participate in Equality and Diversity Impact Training, and therefore this is embedded within all planning processes across the entire organization. All programme plans will be individually assessed to ensure consistency and compliance.

Costs of the service Customer Care and Staff training Stereotypes and Assumptions

Specific Issues/ Barriers

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N/A

As above. Our strategic goals would preclude any stereotypes or assumptions being made during the planning process as they embrace cultural diversity None


Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

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Methods of Monitoring progress on Actions All programme areas are subject to regular review at a strategic level, by the newly formed Strategic Development Committee, which is directly accountable to the Trust Board. This group and the Board will ensure that equality impact assessments are carried out and published regularly to reflect changes in environment, service delivery and economy.

10

Publishing the Equality Impact Assessment To be included as part of “Ambitions for a Healthy Kirklees” – our Five Year Strategic Plan.

11

Signing off Equality Impact Assessment: Helena Corder Director of Corporate Services

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Apendix 8

References Kirklees Joint Strategic Needs Assessment http://www.kirklees.nhs.uk/public-information/publications/strategies-and-declarations/

NHS Kirklees Organisational Development Plan http://www.kirklees.nhs.uk/fileadmin/documents/publications/KPCT_Org_Dev_Plan_Web_lowres.pdf

NHS Kirklees Local Operating Plan http://www.kirklees.nhs.uk/fileadmin/documents/publications/KPCT_Local_Operating_Plan_Web_lowre s.pdf

NHS Kirklees Medium Term Financial Plan http://www.kirklees.nhs.uk/fileadmin/documents/publications/KPCT_Finance_Plan_web_lowres.pdf Kirklees Children’s and Young Peoples Strategy http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/Kirklees_Children_and_Young_People_Plan _2008_-_2011.pdf

Kirklees Joint Mental Health Commissioning Strategy http://www.kirklees.nhs.uk/fileadmin/documents/publications/Kirklees_Joint_Mental_Health_Commissi oning_Strategy_-_2008.pdf

NHS Kirklees Estates Strategy http://www.kirklees.nhs.uk/fileadmin/documents/publications/estates/KPCT-07234%20KIRKLEES%20ESTATE%20STRATEGY%20DOC%20v4%20101207.pdf

NHS Kirklees Communications and PPI Strategy http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/KPCT_Com_Engage_web_lowres.pdf

NHS Kirklees Teenage Pregnancy Strategy http://www.kirklees.nhs.uk/fileadmin/documents/publications/teen_preg_strategy_3_.pdf

Kirklees Alcohol Strategy http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/Kirklees_Alcohol_Strategy.pdf

Kirklees LAA (Local Area Agreement) http://www.kirklees.gov.uk/you-kmc/bigpicture/storypdfs/CTI24LAAandLPSB.pdf

Kirklees Local Public Service Boards – Work Programmes 2009 https://www.kirklees.gov.uk/Secure/meetings/pdfs/0309/lpsb05030934720D.pdf

Kirklees CAA (Comprehensive Area Assessment) http://www.audit-commission.gov.uk/reports/NATIONAL-REPORT.asp?CategoryID=&ProdID=63FF7DFAD1DB-46D0-B72E-39DA12AEF9E1&fromREPORTSANDDATA=NATIONAL-REPORT

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Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008 - 2013 : Revision March 2009

Apendix 9

Glossary CHFT – Calderdale & Huddersfield Foundation Trust HIT – Health Improvement Team JSNA – Joint Strategic Needs Assessment KPI’s – Key Performance Indicators LAA – Local Area Agreement LPSB – Local Public Service Boards LTC – Long Term Conditions LTTF – Looking to the Future MYHT – Mid Yorks Health Trust NIHCE – National Institute of Health and Clinical Excellence NSF – National Service Framework OOH – Out of Hours Services PBC – Practice Based Commissioning PBR – Payment By Results PEC – Professional Executive Committee SCG – Specialist Commissioning Group SHA - Strategic Health Authority SWYMHT – South West Yorkshire Mental Health Trust WCC – World Class Commissioning YAS – Yorkshire Ambulance Service

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Further information about the PCT can be found on the PCT’s website (www.kirklees-pct.nhs.uk) or by contacting the PCT at: Kirklees Primary Care Trust St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH Tel: 01484 466000


http://www.kirklees.nhs.uk/fileadmin/documents/meetings/march09/new/KPCT-09-51%20NHSK_5%20Year%20Str