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Ambitions for a healthy Kirklees

Performance Strategy Versio n 4.1


Document status Version control Document title: File name: Author:

Ambitions for a healthy Kirklees: Performance Strategy Performance Strategy V4.1 Natalie Tarbatt, Deputy Director/Head of Performance Support and Business Planning Contributors: Peter Flynn Helen Bridges Version: 4.1 Date of production: 26th August 2009 Review date: March 2010 Post holder responsible for revision: Natalie Tarbatt, Deputy Director/Head of Performance Support and Business Planning Restrictions: None Revision History Version 1.1 1.2 2.0 2.1 2.2

Date 16th January 2009 12th February 2009 22nd March 2009 16th June 2009 29th June 2009

3.0

13th July 2009

4.0 4.1

30th July 2009 26th August

Comment Significant structural change Significant content change Significant structural change Increased content Amended in line with comments received and implementation plan populated Amended following presentation at Senior Management Team Proof reading amendments Additional clarification points and comments from Trust Board

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Contents Ambitions for a healthy Kirklees...........................................................................................................1 Document status.....................................................................................................................................2 1.Purpose................................................................................................................................................8 2.Summary.............................................................................................................................................8 3.Scope...................................................................................................................................................8 4.Context................................................................................................................................................8 5.Vision and strategic objectives...........................................................................................................9 5.1 Vision...............................................................................................................................................9 5.2 Strategic priorities for performance.................................................................................................9 6.Performance culture..........................................................................................................................10 Performance monitoring is very much about systems and processes that staff within an organisation use. To shift this to performance management and improvement leadership and culture are essential components. Figure 1 below represents the key links between the different dimensions of an organisation..........................................................................................................................................10 6.1 Performance culture.......................................................................................................................10 6.2 Leadership......................................................................................................................................10 6.3 Learning.........................................................................................................................................11 7.Performance monitoring...................................................................................................................11 7.1 Why monitor performance.............................................................................................................11 7.2 Added value information to support decision making...................................................................12 7.3 Reporting........................................................................................................................................12 8.The views of performance................................................................................................................14 8.1 World class commissioning and measuring local success.............................................................15 8.2 Care Quality Commission..............................................................................................................15 8.3 Comprehensive area assessment ...................................................................................................16 8.4 Local area agreement.....................................................................................................................16 8.5 Healthy ambitions..........................................................................................................................16 8.6 Vital signs......................................................................................................................................17 8.7 Practice based commissioning.......................................................................................................17 9.Performance framework....................................................................................................................19 9.1 The need for a performance framework.........................................................................................19 9.2 The framework for NHS Kirklees..................................................................................................19 Where we want to go...........................................................................................................................20 What needs to be done.........................................................................................................................20 How we are going to do it....................................................................................................................20 What you must do ...............................................................................................................................21 This is where the buck stops................................................................................................................21 Getting it done......................................................................................................................................21 Have we done it...................................................................................................................................21 How did we do.....................................................................................................................................22 10.Performance tools...........................................................................................................................22 10.1 Software solution.........................................................................................................................22 10.2 Benchmarking..............................................................................................................................23 11.Implementing the Strategy..............................................................................................................24 The strategy is written to set out the direction of travel for the next five years. It sets out the place we want to be, not necessarily how we are going to get there. The attached implementation plan gives further detail on the high level actions required to take us on the journey to our desired state. The highlights are that:........................................................................................................................24 NHS Kirklees Performance Strategy Page: 3 of 38


End of Year 1 Achievements...............................................................................................................24 End of Year 3 Achievements...............................................................................................................24 End of Year 5 Achievements...............................................................................................................24 NHS Kirklees will have an established culture of continuous improvement, which will be embedded into the everyday working lives of staff. Staff will have shaped and adopted the values and behaviours of the organisation.............................................................................................................24 Year 1 Action Plan...............................................................................................................................25 Strategic Priorities................................................................................................................................25 Success Criteria/...................................................................................................................................25 Outcome Measure................................................................................................................................25 Actions.................................................................................................................................................25 Timescales............................................................................................................................................25 Leads/...................................................................................................................................................25 Stakeholders.........................................................................................................................................25 NHS Kirklees will be seen as one of the highest performing PCTs in the country.............................25 Inclusion of targets in lead managers objectives with lead managers held to account for delivery, reporting plus identification and mitigation of risks............................................................................25 September 2009...................................................................................................................................25 Natalie Tarbatt.....................................................................................................................................25 Systematic in-depth reviews of under performing/high risk areas – using an appreciative inquiry approach to focus on the positives and actions for improvement........................................................25 August 2009 and continued throughout the year.................................................................................25 Peter Flynn...........................................................................................................................................25 Natalie Tarbatt.....................................................................................................................................25 Closing the loop on actions – narrative from lead managers to highlight the impact of actions taken to support the sharing of good practice................................................................................................25 August 2009 onwards..........................................................................................................................25 Performance management of the Strategic Plan and Operating Plan..................................................26 March 2010..........................................................................................................................................26 Samantha Williamson..........................................................................................................................26 Support the commissioning of high quality, effective, safe services...................................................26 Commissioning of services is underpinned by the use of performance information, as part of the prioritisation processes to improve health and reduce health inequalities...........................................26 Delivery of programmes in line with the local Programme Planning Framework..............................26 March 2010 and beyond.......................................................................................................................26 Programme/Lead Managers.................................................................................................................26 Develop skills on the use of and value added through benchmarking.................................................26 March 2010..........................................................................................................................................26 Karen Gallagher...................................................................................................................................26 Implementation of a benchmarking tool..............................................................................................26 Implementation commences August 2009...........................................................................................26 Commissioning Intelligence Manager.................................................................................................26 Practice Based Commissioners use performance information to commission new or different services through business case development.......................................................................................26 August 2009 onwards..........................................................................................................................26 PBC teams and consortia.....................................................................................................................26 Alignment of performance reporting and management across health and social care.........................27 August 2009 onwards..........................................................................................................................27

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Support the development of a commissioning system that builds the culture and capability in which NHS Kirklees can excel.......................................................................................................................27 The culture of the organisation harnesses continuous improvement with the necessary capacity and capability in staffing structures............................................................................................................27 Inclusion of a performance module in the Commissioning Development Programme.......................27 March 2010..........................................................................................................................................27 Natalie Tarbatt.....................................................................................................................................27 Performance manager role descriptor agreed and used when working with lead managers...............27 August 2009.........................................................................................................................................27 Performance Team...............................................................................................................................27 Use of the performance framework ....................................................................................................27 August 2009 onwards..........................................................................................................................27 Lead by the performance team.............................................................................................................27 Procurement process for performance management software solution based on user and organisational requirements.................................................................................................................27 November 2009....................................................................................................................................27 Natalie Tarbatt.....................................................................................................................................27 Assure the people of Kirklees that they are receiving high quality care and services.........................28 Production of high quality, timely performance reports, that contain added value information from lead managers.......................................................................................................................................28 August 2009 onwards..........................................................................................................................28 Performance Team...............................................................................................................................28 Robust assurance processes that enable the Trust Board, when meeting in public, focus the debate on the areas of priority..............................................................................................................................28 August 2009 onwards..........................................................................................................................28 Peter Flynn...........................................................................................................................................28 September 2009 onwards.....................................................................................................................28 Lead Managers.....................................................................................................................................28 Evidence that as a result of patient feedback services have improved................................................28 November 2009 onwards.....................................................................................................................28 Lead managers.....................................................................................................................................28 ..............................................................................................................................................................30 PCT Organisational Development WCC Competency Plan Trajectory..............................................34 Competency.........................................................................................................................................34 Current Score.......................................................................................................................................34 Expected Score Yr 2............................................................................................................................34 Competency.........................................................................................................................................34 Current Score.......................................................................................................................................34 Expected Score Yr 2............................................................................................................................34 1............................................................................................................................................................34 Reputation as local leader of the NHS.................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 6............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 Reputation as change leader of local organisations.............................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 NHS Kirklees Performance Strategy Page: 5 of 38


Prioritisation of investment to improve population’s health................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 Creation of Local Area Agreement based on joint needs....................................................................34 3............................................................................................................................................................34 3............................................................................................................................................................34 7............................................................................................................................................................34 1............................................................................................................................................................34 2............................................................................................................................................................34 Ability to conduct effective partnerships.............................................................................................34 3............................................................................................................................................................34 3............................................................................................................................................................34 Alignment of provider capacity with health needs projections...........................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 Reputation as an active and effective partner......................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 1............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 8............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 Public and patient engagement............................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 4............................................................................................................................................................34 3............................................................................................................................................................34 3............................................................................................................................................................34 9............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 1............................................................................................................................................................34 2............................................................................................................................................................34 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3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 1............................................................................................................................................................34 2............................................................................................................................................................34 5............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 10..........................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 2............................................................................................................................................................34 3............................................................................................................................................................34 Appendix VI – Annual health check measures....................................................................................36 Existing Commitment..........................................................................................................................36 Access to GUM clinics........................................................................................................................36 Category A calls meeting 19 minutes standard....................................................................................36 Category A calls meeting 8 minute standard.......................................................................................36 Category B calls meeting 19 minutes standard....................................................................................36 Commissioning of crisis resolution/home treatment services.............................................................36 Commissioning of early intervention in psychosis services................................................................36 Data quality on ethnic group................................................................................................................36 Delayed transfers of care.....................................................................................................................36 Diabetic retinopathy screening ...........................................................................................................36 Inpatients waiting longer than the 26 week standard...........................................................................36 Outpatients waiting longer than the 13 week standard........................................................................36 Patients waiting longer than 3 months (13 weeks) for revascularisation.............................................36 Time to reperfusion for patients who have had a heart attack.............................................................36 Total time in A&E...............................................................................................................................36 Glossary...............................................................................................................................................37 References and further reading............................................................................................................38

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1.

Purpose

The purpose of this strategy is to set out the strategic direction of travel for the performance agenda in NHS Kirklees. Our goal is to move from a “fair” performing organisation to an “excellent” performing organisation by setting a clear direction of travel and empowering staff to understand the significance of their role. In order to become a world class commissioner, NHS Kirklees needs to embrace the cultural and organisational process changes required, the implementation of this strategy will be key to driving improvements in performance. The strategy will clarify the differing views of performance that are taken by regulatory bodies and key stakeholders. This will enable key managers within the organisation to understand what they are required to do to improve the view of performance and how all these views interlink. It also sets out a performance framework within which NHS Kirklees will deliver the performance agenda.

2.

Summary

This strategy sets out the strategic direction of travel for the performance agenda within NHS Kirklees.

3.

Scope

The strategy is clearly aligned to the vision and strategic objectives set out in the 5 year organisation strategy, Ambitions for a healthy Kirklees Five Year Strategic Plan 2008-2013. The scope of this strategy is to set out the framework within which NHS Kirklees will work to drive and deliver improvements in performance. Integral to this will be improvements in reporting and learning from and sharing of good practice. Through the performance framework the role of lead managers across the organisation will be defined and will bring clarity around the organisations expectations of them. The framework will support the organisation in delivering the strategic priorities for performance. Through delivery of the three year implementation plan, the strategic priorities of this strategy will be realised.

4.

Context

Performance management within the NHS has evolved over time and is increasingly moving away from activity and waiting time targets to evidencing improvements in patient care and outcomes. NHS Kirklees is currently perceived as being one of the best performing PCTs in the country and aspires to remain so. This view has been taken from the various monitoring of performance both in terms of targets but also in terms of how the organisation operates. As part of the world class commissioning (WCC) assessment process NHS Kirklees was praised for its self awareness of its own strengths and weaknesses relating to the ten WCC competencies. This clear understanding of our current position offers a position of strength from which to improve performance. NHS Kirklees has also been rated fair for both quality of services and value for money as part of the annual health NHS Kirklees Performance Strategy Page: 8 of 38


check performance ratings published by the Healthcare Commission, which has been superseded by the Care Quality Commission (CQC) as of 1st April 2009. In order to maintain the view that we are one of the best performing PCTs in the country, these two key facets must be improved. Performance management of the organisation will require investment of time and capability to maximise the benefits of the programmes in place to deliver the priorities. This is not purely around how the performance monitoring and reporting is undertaken but a cultural shift to performance management of programmes, clearly linked to monitoring and evaluation. Key managers are already building their skills around programme management The improved use of information and tighter performance management across the breadth of NHS Kirklees programmes and priorities is a critical component of our journey towards excellence.

5.

Vision and strategic objectives

5.1 Vision NHS Kirklees has recognised the performance needs of the organisation and the need to develop a performance strategy to support delivery of the national and local agendas. This strategy is driven by a clear vision: To deliver the best possible health outcomes to the population of Kirklees by supporting decision making through the availability of accurate, timely and meaningful performance information to ensure effective planning, delivery and evaluation of health services. 5.2 Strategic priorities for performance In order to meet the needs of the organisation there are key strategic priorities for the performance agenda. They directly contribute to the organisational purpose, goals and priorities and are: • • • •

Shifting NHS Kirklees from a fair performing organisation to an excellent performer; Support the commissioning of high quality, effective and safe services; Support the development of a commissioning system that builds a culture and capacity in which NHS Kirklees can excel; and Assure the people of Kirklees that they are receiving high quality care and services.

We will achieve these by:•

Developing a performance culture to support all staff to maximise their ability to understand and effectively use performance information and techniques to continually improve performance;

Improving our systems and processes to ensure that performance information is captured effectively and used appropriately to drive improvement;

Supporting effective working relationships between partner organisations by sharing resources and knowledge to give a consistent view of performance;

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6.

•

Working to continually improve the quality and timeliness of performance information; and

•

Continuing personal and professional development to ensure that staff within the performance team maintain and develop specialist expertise on available performance tools and techniques to support lead managers effectively.

Performance culture

Performance monitoring is very much about systems and processes that staff within an organisation use. To shift this to performance management and improvement leadership and culture are essential components. Figure 1 below represents the key links between the different dimensions of an organisation. 6.1 Performance culture To maximise the benefit of the systems and processes being established across NHS Kirklees around, but not exclusively to, performance monitoring, use of information and business planning a change in culture is required. This will be supported through the implementation of the organisational development strategy. We need to operate within a culture in which people are empowered and supported to improve performance across all aspects of PCT business. This is not purely about their individual skills and confidence but also around the systems and processes and the communication of these. As we move further towards a performance culture there are more tangible aspects of business that can be implemented to embed the desired way of thinking. This will include improving people’s understanding of the accountability for delivery of targets and what this means for them e.g. lead managers have targets specifically written into their individual objectives. It also includes putting all this into the context of how it impacts on the local population and the wider organisation. 6.2 Leadership Clear leadership and accountability is essential to the success of any organisation as figure 1 below demonstrates. The potential for excellent achievement and performance will be maximised with this. Figure 1

Organis ation

People

Process es

Systems and informat ion

Leadership and direction

Culture and behaviours Source: [ HM Treasury, 2008]

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As part of the ongoing organisational change and the development programmes being established further work is also planned to translate the theory of leadership into the behaviours and needs of NHS Kirklees and its commissioning partners. We will empower staff to continually improve the work of NHS Kirklees, including personal development. We need to lead people to lift their heads and look at what could be instead of looking for pitfalls. 6.3 Learning Continuous learning and sharing brings with it many benefits and within the right environment can influence the achievement of excellence. By striving for excellence in everything we do and sharing areas of outstanding achievement with others, there will be many positive impacts on the organisation and its staff, including morale, being an employer of choice, being recognised as a leader of the local NHS. Learning is also clearly linked to benchmarking in its broadest sense where we can not only share our learning but also learn from others within NHS Kirklees, with the NHS and outside the NHS nationally and internationally. By embedding this in organisation systems and processes such as in performance reporting measuring the success of actions taken to improve performance and reporting against them, the organisation will further enhance its culture of continuous improvement in performance.

7.

Performance monitoring

7.1 Why monitor performance Monitoring of performance is essential to any performance framework. Not only does it highlight where performance is off track, it also highlights areas of excellence. These can then be used as examples of good practice to share. Regular reporting into the public environment is essential if we are to demonstrate to the population of Kirklees that we are improving their health and access to health care. Performance monitoring is also undertaken by external bodies, including the Department of Health, Strategic Health Authority and Care Quality Commission (see appendices I, VI and VII). These Bodies collate their information from the national reporting structures, which include statutory returns. NHS Kirklees is performance managed on this and it is what the public and other organisations see. This information is not only used for what it contains but also to give a view as to how well NHS Kirklees is managed. Timely submission of the statutory returns mentioned above is also taken into account when the CQC form their opinion of us. Effective performance management also supports the principle of “no surprises�. By reporting timely information, that includes both qualitative and quantitative information e.g. patient feedback, this enables the organisation to identify risk at early stage and take mitigating actions as appropriate. Staff will also feel the benefits of improved monitoring. Through robust reporting lead managers are able to secure organisational support for actions and have a greater understanding of blockages which could hinder improved performance. By increasing this understanding, managers are then empowered to make evidencebased decisions to do something about it. Through embedding a supportive culture and empowering staff to NHS Kirklees Performance Strategy Page: 11 of 38


take ownership of targets, and identifying innovative ways of achieving them, this will actively contribute to NHS Kirklees being an employer of choice that achieves excellent results in terms of staff motivation and turnover. 7.2 Added value information to support decision making By linking the implementation of the information and health intelligence strategy and the performance strategy, NHS Kirklees will be in a better position than ever before to make evidence-based decisions to improve health outcomes for its population. Significant progress has been made in ensuring that decisions around business cases are informed by robust information. These structures, although still evolving, will also ensure that evaluation of business cases can be measured against a specified set of key performance indicators and outcomes. The evolving structures also ensure that conscious decision making is transparent. The diagram, information to support decision making, in Appendix II demonstrates how information and performance can effectively inform decision making at all levels of the organisation. It is imperative that we can demonstrate that we are using public money wisely and one of the best ways of doing this is by ensuring that the reporting across the organisation tells the story and answers the right questions. This requires different types and formats of performance information that are appropriate for the audience. NHS Kirklees has improved its performance reporting over the last 12 months but there are still improvements to be made. We need to shift from reporting retrospective performance to incorporating forecasting information on where performance will be at a specified point in the future. There also needs to be a more systematic and rigorous approach to identifying actions for the management of risk and reporting how these will and have improved performance. As NHS Kirklees fully embraces its world class commissioning role performance needs to be a key platform on which to assess the performance and quality of commissioned services. This is already being addressed through the agreements with our main providers where contracting schedules provide the assurance that we are commissioning high quality services. Through monitoring of these schedules by the contracting groups and quality boards, NHS Kirklees can provide assurance that services are in line with need. 7.3 Reporting The art of performance reporting is to understand what needs to be reported and do so in a way that simply and clearly outlines what the issues are. Quality reports should be easy to interpret with the appropriate level of detail. The potential complexity of reporting is driven by the different views of performance that need to be taken, some which are purely internal but the majority of which reflect external performance monitoring of the organisation. 

The reporting needs to be focused on the priorities of the organisation. It should add value to the corporate agenda. All reports must have a clear focus and be continually reviewed to ensure that they are still fit for purpose. In the ever changing environment it is essential that performance reporting supports evidence-based decision making and demonstrates progress being made against changing targets and definitions.



The focus of reporting must be for the benefit of the organisation with the national requirements naturally falling out of it. It would be naive to lose sight of national requirements given the political environment we work within. However the level of energy required must be proportionate to meeting the needs of our local population. NHS Kirklees Performance Strategy Page: 12 of 38


All reporting must have a clear purpose and the use of it be reviewed to ensure still fit for purpose.

Current performance reporting Current reporting is through the performance report submitted to the Finance & Performance Committee (F&P) on a monthly basis. There is a clear timetable setting out the deadlines for submission of performance information by lead managers and how this fits with the governance requirements of NHS Kirklees. The running of the performance environment, with clear reference points in each month, is a necessary component on the framework. The timetabling is scheduled back from the key reporting forums of Trust Board and Local Strategic Partnership (LSP) to ensure the systems for assurance are enabled to undertake their assurance role with confidence. Over the last year a significant amount of effort has been invested in ensuring that the report meets the needs of the audiences, F&P and Trust Board to support decision making and improvement. This work has also supported the emerging change in culture that ensures the framework within which the report is presented provides assurance. For example, Trust Board now receives a shorter summary report, highlighting key successes/areas for improvement, with assurance that the full performance report has been fully scrutinised by the formal F&P sub-committee. The recently formed Strategic Development Committee (SDC) also has a significant role to play in the performance management of the organisation. The SDC will be providing assurance to the Trust Board that the individual programmes are delivering the anticipated outcomes set out in the Five Year Strategic Plan. This committee does not duplicate the role of F&P, but supports the achievement of the targets and outcomes through supporting programme management. One of the fundamental principles of the performance reporting system now in place is that the information is captured once and used many times. Examples of how this information is used are:  

Monthly reports to senior management team for more operational discussions around actions required to improve performance; Produce comprehensive mid and year end reports that cover the full spectrum of work of NHS Kirklees e.g. cross cutting agendas such as governance, patient and public involvements, prescribing, etc. This reflects the full business of NHS Kirklees and not just those areas directly linked to national targets; and Demonstrating to the Strategic Health Authority (SHA) what the key achievements and areas for improvement are within NHS Kirklees.

One source of data for multiple purposes is definitely the way forward but it needs to function in a way that supports rather than adds layers of confusion. By getting this right both in terms of systems, process and support we can achieve a professional and innovative approach to performance reporting. Underpinning the performance information is also a significant number of statutory returns which inform the external view of NHS Kirklees. In all there are approximately 30 commissioner based statutory returns which require submission either monthly or weekly. NHS Kirklees Performance Strategy Page: 13 of 38


The other key performance management requirement is the Local Area Agreement (LAA). Kirklees has been held up as a shining example of good practice for their LAA and work on reporting from a health perspective needs to be consolidated and improved. This has definite and strong links into the Comprehensive Area Assessment (CAA) performance regime that is currently being implemented. Work has already started looking at improving the system for providing reports to support NHS Kirklees’ non-executive directors, directors and lead managers to support the partnership structures, which include the Local Strategic Partnership (LSP) and Local Public Service Boards (LPSBs), in making informed decisions. The future of performance reporting As an organisation we need to ensure that statutory reporting reflects the most accurate view of the organisation. It is essential for lead managers to understand and have ownership of the submitted data. The submission of these returns has had a change of emphasis at a national level in that the returns are being increasingly used to assess our ability as an organisation which uses information to drive performance improvement through timeliness and accuracy of information. In order to maintain an excellent reputation and credibility it is essential that lead managers are sighted on these and have full ownership of the targets relating to their programme areas. As we move forward in our journey to excellence we also need to consider more innovative and flexible ways of presenting performance information. Initial thinking is the use of some of the following techniques:      

Heat maps High level indicator reports Dashboards Drill down capability Scorecards Added value benchmarking/comparative data

CAA is now in place and we need to be able to evidence that as an organisation our reporting systems are robust but also as a partnership. This is not restricted to “traditional” performance information but how we make the links between all the softer knowledge around how well we are performing as a Kirklees community. We also need to be able to demonstrate our contribution to the delivery of Healthy Ambitions across the Yorkshire and Humber region. Initial work has been undertaken by the SHA on the metrics they feel would measure the outcomes required and this work will be built upon over the coming months. As a health community we will be measured by the SHA on this and as a consequence we need to ensure we have clearly mapped the requirements against local priorities and have systems in pace to performance report and manage as appropriate. Performance reporting against the operating plan will also be undertaken. To deliver the Five Year Strategic Plan year on year monitoring of progress is essential.

8.

The views of performance

There are a number of different ways in which the performance of NHS Kirklees is viewed.

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8.1 World class commissioning and measuring local success World class commissioning is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice based commissioners and others, NHS Kirklees supported by the SHA, will lead the local NHS in turning the world class commissioning vision into a reality, adding life to years and years to life. The assurance process assesses PCTs against competencies, outcomes and governance (see appendices II, IV and V). The 2008/09 assurance process (the first of its kind) assessed NHS Kirklees against the ten competencies, each competency having three sub-competencies. NHS Kirklees compared well both locally and nationally. We chose our outcomes in line with the assurance process. Outcomes are a series of measures where the PCT strives for improvement and are closely linked to specific population needs highlighted in the Joint Strategic Needs Assessment (JSNA). In addition to the outcomes NHS Kirklees selects there are two statutory outcomes; improved life expectancy and improved quality of life. During the 2009/10 assurance process, the improvement in our chosen and statutory outcomes will be assessed. Governance includes the Board’s responsibilities, the five year strategic plan and finance. All of these aspects were assessed in 2008/09 and will be in 2009/10. For 2009/10 we have aspirations for competency improvement (Appendix IV). NHS Kirklees aspires to improve on almost all of its competencies and has plans in place to do so. In addition there are improvement plans for each outcome and governance. NHS Kirklees will be successful if when assessed in April 2010 there is a demonstrable improvement in;   

Each sub-competency and competency overall as per the aspiration. In addition, success will see NHS Kirklees achieve level three for each competency area. Each outcome measure has improved on last year and compares favourably with peer and neighbouring PCTs. Governance is measured as green in all areas, specifically the Board’s responsibilities, strategy and delivery of the strategic plan.

Given our strong performance in the 2008/09 assurance we would want to as a minimum maintain this but aspire and improve in 2009/10 remaining in the top 15 performing PCTs nationally. 8.2 Care Quality Commission At present for 2007/08 performance under the annual health check regime, NHS Kirklees was rated “fair” for quality of services. One of the strategic priorities for both this strategy and the organisation is to shift this so we are seen as an “excellent” performing organisation. Appendix VI lists the current targets the PCT is measured against for the annual ratings. From April 2009, the CQC took up its role as regulator. It has already signalled that the annual health check will be replaced by a new regime for performance after 2009/10. There will be a shift to ‘periodic reviews’ which should provide more meaningful information to people so they can make informed choices and exercise greater control over their care.

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NHS Kirklees will be assessed using information from the WCC assurance system, alongside the vital signs indicators talked about later in this section. This will be used in conjunction with a value for money assessment. The CQC will also be designing an overarching framework for health and adult social care commissioning to feed into the CAA. It is expected that this move away from the traditional annual health check assessment of targets to a thematic review approach. 8.3 Comprehensive area assessment Comprehensive Area Assessment (CAA) is the recently introduced performance regime against which local communities will be measured. The two main threads of CAA are the partnership view of performance and the individual organisations performance. In the case of NHS Kirklees, the individual organisation view of performance will be undertaken by the CQC. The joint review looks at how the local partners, which include Kirklees Council, West Yorkshire Police, West Yorkshire Fire Brigade and the voluntary sector amongst others, are working together to improve the health and wellbeing of the people of Kirklees. One aspect of the assessment is how the local community is performing against a set of 198 indicators. These are national indicators of which 35 are related directly to health and were health partners take on lead role for delivery. A number of these indicators have been selected as local priorities for inclusion in the Local Area Agreement. 8.4 Local area agreement The priorities for Kirklees are clearly articulated in the Local Area Agreement (LAA), with a performance structure underpinning it that will ensure delivery. It was clear from the corporate assessment report produced by the Audit Commission in October 2007 that there is an impressive understanding of local communities and their needs and aspirations. We need to build on this, in partnership, to reach the aspirations set out by Kirklees Partnership through the LAA through the use of the performance framework and in conjunction with the work of the LPSBs. 8.5 Healthy ambitions Healthy ambitions is the strategic framework for improving the health and healthcare in this region. It is built up on national and international evidence of best practice as well as being informed by local circumstances and need. This regional framework sets the backdrop and context for NHS Kirklees to set its own strategy, which it did. As part of delivering healthy ambitions, key performance measures are being developed by pathway delivery boards. Many of these link through to other performance regimes and information flows such as vital signs indicators and secondary user service data flows. However there may be some that do not. At present NHS Kirklees has submitted trajectories where the suggested measures are directly linked to the local priorities. Once final metrics have been agreed, trajectories will be set in line with the strategic direction and priorities of NHS Kirklees to evidence our local contribution to improving the health and wellbeing of the region. NHS Kirklees Performance Strategy Page: 16 of 38


8.6 Vital signs The operating framework clearly sets out the priorities for 2009/10. It has progressively set out the intention to devolve greater power and autonomy to the local level. This is evidenced through the three tiers of the vital signs indicators. Tiers one and two are national targets that must be monitored and delivered against. Tier three allows organisations to select measures which are in line with their local health needs and priorities. 8.7 Practice based commissioning Throughout 2008/09 significant progress has been made on the provision of performance information into Practice Based Commissioning (PBC) consortia, stand-alone and individual practices. To date this has very much focussed on performance against activities directly linked to PBC budgets with links made to demographic and Quality Outcomes Framework data. The information has also been incorporated into a number of successful business cases. Moving forward however we need to shift the thinking within PBC so there is a much stronger emphasis on achievement of commissioning performance measures. This is much broader than secondary care activity and prescribing data and budgets. As a commissioning structure we need to ensure that we are commissioning high quality services for our local population. Practice based commissioners need to fully own the commissioning targets, including those not directly linked to the services they provide in their role as providers of care. 8.8

Primary care

Performance management of primary care contractors does not fall within the scope of this strategy, but how they are performing impacts on other performance views of NHS Kirklees. A primary care quality benchmarking tool is currently in development which will enable GP practices to look at how they perform across a set of agreed metrics compared to their peers. This tool will enable practice level comparisons of interlinked metrics and facilitate identifying the questions that need further information. The aim of this tool is not to performance manage but to bring relevant quality information together in one place to enable NHS Kirklees to support improving quality within primary care. The initial focus of this will be on general practice but with a clear expectation that this be broadened out to cover other contractors in time. Summary of the views of performance Figure 2 demonstrates the overlap and links between the different views of performance. The key regulatory bodies from a performance perspective are also identified and linked to their specific areas of interest and scrutiny. The Healthy Ambitions and WCC outcomes are highlighted with dotted line borders as they cut across all views of performance.

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Figure 2

What is being measured? Kirklees Council/ Partnership

CQC Existing Commitments 1

13

14 National Priorities

NIS 198

Health 30

LAA 11

Vital Signs 64 9

20

3

5

2

3

Other

WCC Outcomes

8 SHA

23

Healthy Ambitions

DoH

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9.

Performance framework

9.1 The need for a performance framework If we cannot see success we cannot learn from it and equally if we cannot recognise failure we cannot correct it. A good framework can show a clear line of sight from the vision and corporate objectives of NHS Kirklees through to individual and team objectives. This helps staff understand how they personally support the organisation in the achievement of its aims and objectives. By having this golden thread all the way through the organisation, accountability at all levels can be clearly identified. The adoption of a framework is potentially academic if it is not integrated across the entire PCT and this would include local partners in the context of improving health and wellbeing as part of the new CAA framework. 9.2 The framework for NHS Kirklees The framework for NHS Kirklees is built around the Audit Commissions work and sets out where NHS Kirklees is going. Figure 3 visually represents the principles of the framework that need to be tailored to our own local needs and requirements. Figure 3

Elements of a performance management framework This is where we want to go

Here's what needs to be done

This is how we're going to do it

Set out what you want to achieve

Translate it into something meaningful for different levels of your organisation

Identify and provide resources

How did we do? What did we do well and what should we do

This is what you must do

Analyse and review

Clarify responsibility

Have we done it?

Getting it done

This is where the buck stops

Monitor

Take action

Clarify accountability

Source: Audit Commission, 2002

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The framework can be applied at all levels of the organisation from strategic decision making to local delivery of business cases. To demonstrate its application the sections below set out what this framework means in terms of delivering this strategy and implementation plan. Where we want to go The strategic plan clearly sets out where the organisation plans to be in five years for the 11 priority programmes. These will be delivered within the context of the goals to ensure we achieve the overall vision of the PCT. This performance strategy is fully aligned with this and implementation of the framework will demonstrate delivery and achievement alongside the change in culture. What will good look like:     

Excellent, timely, added value performance reporting making the best possible use of technology. Cultural change where performance improvement and management is the heartbeat of the organisation Excellent performing organisation Reputation as a credible and delivering organisation Skilled, motivated and proud workforce

What needs to be done What needs to be done is clearly set out in the Annual Operating Plan. This is further underpinned by programme plans and then linked directly to individual objectives. Clear plans with measurable inputs, outputs and outcomes are an essential part of the framework. In order to ensure delivery of the longer term outcomes often associated with health, the use of interim metrics should be advocated to evidence that progress is being made and support identification of risk. By grouping a number of metrics, a view can be formed as to whether there is an anticipated achievement of the desired outcomes. Delivery of year 1 of the performance strategy implementation plan and the skills development workstream being developed to support World Class Commissioning will support this. How we are going to do it Through embracing the evolving processes around programme management, business planning, project management and business case development, delivery of what needs to be done will be achieved. All of the above will be built on solid foundations of information, benchmarking and good practice. One of the most important aspects of this is ensuring that robust evaluation and risk management can be, and is, undertaken. Throughout the delivery of actions monitoring is key to assess progress and manage risk. To maximise the potential, the principles of appreciative inquiry will be used. Appreciative Inquiry works because it:    

Builds relationships; Creates the opportunity for people to be heard; Generates opportunities for people to dream and share their dreams; Creates an environment which supports people to choose how they contribute; NHS Kirklees Performance Strategy Page: 20 of 38


 

It gives people discretion and support to act; and It encourages and enables people to be positive.

Such an approach will build a culture of continuous improvement and develop leadership at all levels in the organisation. What you must do To make this real to individuals, objectives should be clearly linked to the priorities and strategic objectives of the organisation. You as individuals must deliver against these objectives and routinely review them through performance development reviews and regular contact with line managers. Communication is also a key component of what you must do. This is not only in terms of actual delivery but also in terms of reporting progress and the impact on performance of the organisation. The provision of accurate, timely and appropriate information is a common theme throughout everything we do. Lead managers should also use the organisational structures to support them in delivery. The structures are in place to ensure the smooth running of NHS Kirklees and where there are blockages in the system, appropriate reporting through the governance structures can facilitate actions to move things on. This is where the buck stops Staff at all levels are responsible for achievement of performance goals. By aligning the strategic objectives to the operational aspect of the organisation transparency on accountability can be achieved. This may include the explicit inclusion of performance targets in individual lead director and manager objectives. As part of the assurance and performance management process lead managers will be asked for further detailed information around the work streams and potential risks/blockages. This will ensure that the accountability structure is used to its full potential to support lead managers in the achievement of targets. Getting it done The recently reviewed programme planning framework and project management approach will result in targets being achieved and risks being mitigated as far as possible. The emphasis will be on delivery of plans. It essential that NHS Kirklees ensures sufficient capacity and capability to deliver agreed plans. This should be through prioritisation and investment, with this investment specifically including organisational and staff development. A significant amount of investment has already been made into training lead managers in the use of Managing Successful Programmes (MSP). This has been further built upon to tailor it to local needs and develop standard documentation for use when managing programmes. Have we done it Measurement and assessment against key performance indicators and outcomes identified in “how we are going to do it” and “what you must do” will demonstrate whether the actions had the planned and desired effect. Through this assessment and review, learning can be shared across and outside the organisation.

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As part of the programme planning framework, routine reviews of progress against plans are integral. Delivery of programme plans and key milestones against set timescales will inform when we have done what we set out to achieve in terms of actions. Measurement of outputs and outcomes will determine whether we have delivered what we wanted to. From an organisational perspective, if we deliver the Operating Plan successfully, including management of risk to maximise achievement, NHS Kirklees will have achieved a rating of “excellent” in line with its strategic priorities. If the overall business of NHS Kirklees is viewed as a programme in itself, there will be cross-cutting themes where the systematic capturing of performance information once, for multiple uses will bring great value. The management of the long term conditions programme is already beginning to work in this way both in delivery of individual condition programme areas but also How did we do The ultimate question is whether what we planned and actually did delivered what we expected. Understanding how we did is broader than delivery of action plans and achievement of targets. It is also about what we learned and what we want and need to share. As part of understanding how we did we need to take a more outward focus to celebrating our successes. By learning from our successes we will spread good practice. Systems are already in place to help us do this but pro-active sharing of successes and learning needs to become the norm. By the same token we should also learn from where plans have not delivered the desired outcomes and understand what, if anything, we could have done differently. Learning from what has not gone as well is just as valuable as learning from what has. Looking at “how did we do” must take place at all levels from organisational goals to individual objectives. This includes annual health check performance ratings, WCC assessments, operating plan, strategic plan, programme plans, personal development reviews and so on. Embedding within the culture the celebration of the work that we do will bring pride and enjoyment in the work that we do and the recognition we receive.

10.

Performance tools

10.1 Software solution Performance Accelerator is currently the software solution of choice with NHS Kirklees. The use of the system integrates the performance and governance agendas. We must link the two together to ensure that the performance management of programmes and action plans to deliver targets identify risks at an early stage. Identification of risks at an early stage allows mitigating actions to bring about improvements in performance. Software solutions on their own will not deliver improvements. Supporting processes and culture are equally important aspects. Indeed, software solutions can often be a drive for changing culture. NHS Kirklees has started the development of a culture where lead managers fully own the targets that form part of their NHS Kirklees Performance Strategy Page: 22 of 38


programme and work plans. The software solution must and will support managers in management of their responsibilities. The benefits of such solutions will be explicit supporting the cultural shift of NHS Kirklees and add value to all. Full potential will be realised when the solution of choice is seen as a positive management tool not merely for performance monitoring. From a performance perspective national and local targets are included in the system for example, Vital Signs, WCC outcomes, the health aspects of the LAA. It is essential as we move through implementation of both the Performance and Information & Health Intelligence strategies that we have the performance software solution to interact/link with the data warehouse and other information sources. This would further support the principle of capture it once, use it for many purposes. Technical solutions bring many advantages, including enabling effort to be focused on delivery of strategic goals. 10.2 Benchmarking As with any tool the concept must be embedded within the organisation for it to truly realise the benefits. There are a number of definitions for benchmarking that are used around the globe. In essence however it is involves learning, sharing information and adopting best practice to bring about step changes in performance. The definition which NHS Kirklees has adopted is: Benchmarking is finding and implementing best practice to enable evidence-based comparisons of practice, drawing conclusions and implementing improvements. At present the use of benchmarking information is not rigorous and consistent in its application. There are a number of existing tools and reports which benchmark within NHS Kirklees and nationally. Examples of where benchmarking information is currently provided are:     

Practice based commissioning performance packs – these benchmark secondary care services, prescribing, population demographics Public health observatory practice profiles which compare individual practices to national and peer practices Better care better value indicators Strategic Health Authority reports Dr Foster

Future plans already in training include:   

The Primary Care Quality Benchmarking Tool which looks at a range of indicators across the full spectrum of primary care at practice level. The commissioning of a benchmarking tool Improving information to enable PBCs drive decision making based on a full picture of health needs (see appendix II, Information flows for Decision Making)

To reach our full potential and learn from good practice we must fully embrace the use of benchmarking techniques. We must focus on the areas where the biggest impact and outcomes can be achieved. Purely by having the benchmarking information will not result in improvement. Using information in a systematic way to identify and implement actions will result in learning and improvement. NHS Kirklees Performance Strategy Page: 23 of 38


Benchmarking is not purely about comparing numbers from elsewhere. There is great validity in tracking performance over time internally. Learning from good practice in other teams or organisations, both within and external to the NHS, is also an excellent way of benchmarking for improvement. Learning about what has and has not worked plus unpicking any of the factors that were key to success are very productive experiences which we are beginning to harness as an organisation. Excellence will be achieved through applying learning from ourselves and comparisons to others.

11.

Implementing the Strategy

The strategy is written to set out the direction of travel for the next five years. It sets out the place we want to be, not necessarily how we are going to get there. The attached implementation plan gives further detail on the high level actions required to take us on the journey to our desired state. The highlights are that: End of Year 1 Achievements A robust action plan, spanning the organisation, will be agreed setting out the actions and timescales for delivery of this strategy. This will be based on the good practice and progress to date and continue the development of a culture of continuous improvement. End of Year 3 Achievements The PCT will be seen as one of the highest performers in the country by each of the regulatory bodies. This will extend beyond the pure measures of performance included in the Annual Health Check to the reputation of NHS Kirklees as innovative and world class commissioners of care. End of Year 5 Achievements NHS Kirklees will have an established culture of continuous improvement, which will be embedded into the everyday working lives of staff. Staff will have shaped and adopted the values and behaviours of the organisation.

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Year 1 Action Plan Strategic Priorities

Success Criteria/ Outcome Measure

Actions

Timescales

Leads/ Stakeholders

Shifting NHS Kirklees from a fair to excellent performer.

NHS Kirklees will be seen as one of the highest performing PCTs in the country.

Inclusion of targets in lead managers objectives with lead managers held to account for delivery, reporting plus identification and mitigation of risks.

September 2009

Natalie Tarbatt Directors Lead managers

Systematic in-depth reviews of under performing/high risk areas – using an appreciative inquiry approach to focus on the positives and actions for improvement.

August 2009 and continued throughout the year

Peter Flynn

Closing the loop on actions – narrative from lead managers to highlight the impact of actions taken to support the sharing of good practice.

August 2009 onwards

Natalie Tarbatt

Performance team Lead Managers

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Strategic Priorities

Support the commissioning of high quality, effective, safe services.

Success Criteria/ Outcome Measure

Commissioning of services is underpinned by the use of performance information, as part of the prioritisation processes to improve health and reduce health inequalities.

Actions

Timescales

Leads/ Stakeholders

Performance management of the Strategic Plan and Operating Plan.

March 2010

Samantha Williamson Natalie Tarbatt

Delivery of programmes in line with the local Programme Planning Framework.

March 2010 and beyond

Programme/Lead Managers

Develop skills on the use of and value added through benchmarking.

March 2010

Karen Gallagher Samantha Williamson Natalie Tarbatt

Implementation of a benchmarking tool.

Implementation commences August 2009

Commissioning Intelligence Manager

Practice Based Commissioners use performance information to commission new or different services through business case development.

August 2009 onwards

PBC teams and consortia

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Strategic Priorities

Support the development of a commissioning system that builds the culture and capability in which NHS Kirklees can excel.

Success Criteria/ Outcome Measure

The culture of the organisation harnesses continuous improvement with the necessary capacity and capability in staffing structures.

Actions

Timescales

Alignment of performance reporting and management across health and social care.

August 2009 onwards

Inclusion of a performance module in the Commissioning Development Programme

March 2010

Natalie Tarbatt Karen Gallagher Samantha Williamson

Performance manager role descriptor agreed and used when working with lead managers

August 2009

Performance Team

Use of the performance framework

August 2009 onwards

Lead by the performance team

Procurement process for performance management software solution based on user and organisational requirements

November 2009

Natalie Tarbatt

Leads/ Stakeholders Natalie Tarbatt

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Strategic Priorities Assure the people of Kirklees that they are receiving high quality care and services.

Success Criteria/ Outcome Measure

Actions

Timescales

Leads/ Stakeholders

Production of high quality, timely performance reports, that contain added value information from lead managers.

August 2009 onwards

Performance Team Lead Managers

Robust assurance processes that enable the Trust Board, when meeting in public, focus the debate on the areas of priority. More effective use of media resources.

August 2009 onwards

Peter Flynn

September 2009 onwards

Lead Managers

Evidence that as a result of patient feedback services have improved.

November 2009 onwards

Lead managers

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Appendices

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Appendix I – Vital signs

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Appendix II – Information Flows for Decision Making

Decision Making

Information Flows for Decision Making Trust Board Board Sub Committees

SMT

LSP/LPSB

Strategic Priorities

Benchmarking Reports

Evaluation

Outcomes

Capacity Planning

Service Reviews

Uses

Business Case Developments

Planning

Implem entation

Service Improvements

Customer Satisfaction

JSNA Financial PBC

Analysis and Interpretation

HITS

Local Information/Analysis Reports

Secondary User Service

Public Health Information

Finance

Local Systems

Performance Accelerator

Inc: Providers SHA Prescribing KCHS Data

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Appendix III – World Class Commissioning outcomes Health Area

Metric No

Metric

Metric Definition

Comment

Health Inequalities Life Expectancy

Average IMD (deprivation index) score

Mandatory for all PCTs

Life expectancy at time of birth, in Years

Mandatory for all PCTs Large impact on infant deaths, low birth weight, Kirklees bottom 10% Very high levels in certain localities In LAA Largest impact on health, lot to do especially in women In the LAA (NIS 123) Probably lot yet to do Bottom 25% of 32performance BUT small numbers, limited impact

Birth

6

Smoking during Pregnancy

Actual %age of women known to be smokers at the time of delivery

Staying Healthy

16

Smoking quitters

Rate per 100,000 population aged 16 and over

Acute

33

Stroke admissions given a brain scan within 24 hours

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

Mental health

42

Alcohol harm

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

Long term conditions

50

CHD controlled BP

Other

55

Childhood Obesity

% of people with Coronary Heart Disease in whom the last BP reading was 150/90 or less in the past 15 months % obesity among primary school age children in Year 6

Other

56

Other

57

Emotional health of children People with LTC supported

Baseline to be established through national Tellus Survey in Summer 2008. Targets will be set for 09/10 People with LTC supported to be independent and in control of their condition, definition to be confirmed by central government.

Rapidly rising levels of excess drinking locally, worse than regionally High impact, including cerebrovascular disease In LAA (NIS 56) Large impact Lot to do In LAA (NIS 50) Large impact Lot to do In LAA (NIS 124) VSC11 (but not nominated to DH/HCC) Large impact Lot to do BUT reliability of data?

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Appendix IV – World Class Commissioning competencies

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PCT Organisational Development WCC Competency Plan Trajectory Competency

Current Scor e

Expected Score Yr 2

Competency

Current Scor e

Expected Score Yr 2

2

3

Prioritisation of investment to improve population’s health Incorporation of priorities into strategic investment plan Knowledge of current and future provider capacity and capability

2

3

2

3

1

2

Alignment of provider capacity with health needs projections Creation of effective choices for patients

2

3

1

2

2

3

2

3

2

3

2

3

2

3

1

2

Predictive modelling skills and insights 1

2

3

Reputation as local leader of the NHS

2

3

Reputation as change leader of local organisations Position as the local healthcare employer of choice

2

3

2

3

Creation of Local Area Agreement based on joint needs

3

3

Ability to conduct effective partnerships

3

3

Reputation as an active and effective partner Influence on local health opinions and aspirations

2

3

2

3

6

7

Identification of improvement opportunities 8 Implementation of improvement initiatives

Public and patient engagement Improvement of patient experience

2

3 Collection of quality and outcome information

2

3

Clinical engagement 4

Understanding of providers economics 3

Dissemination of information to support clinical decision making Reputation as leader of clinical engagement Analytical skills & insights 5

3

9 Negotiation of contracts around defined variables

1

2 Creation of robust contracts based on outcomes

2

3 Use of real time performance information

2

3

2

3

2

3

Understanding of health needs trends Use of health needs benchmarks

10

2 3 Implementation of regular provider performance NHS Kirklees Performance Strategy discussions 2 3 Page: 34 of 38 Resolution of ongoing contractual issues 2 3


Appendix V – World Class Commissioning governance

Strategy  Vision and objectives  Initiatives to ensure delivery of strategic objectives  Board challenge and ownership of the strategic plan  Consistency of financial plan with the strategy  Achievement of milestones to date Finance  Sustainable financial position  Historical financial management  Robustness of planning assumptions Board  Organisation  Risk  Information  Performance  Delegation  Board Interaction

Red, amber, green status (RAG) 2008/09 measure 2009/10 aspiration Amber Green Amber Green Amber Green Amber

Green

Green

Green

Green Green Green Green

Green Finance assurance will appear as an 11th competency and not within governance for 2009/10.

Green Green Green Green Amber Green Green

Green Green Green Green Green Green Green

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Appendix VI â&#x20AC;&#x201C; Annual health check measures Existing Commitment Access to GUM clinics Category A calls meeting 19 minutes standard Category A calls meeting 8 minute standard Category B calls meeting 19 minutes standard Commissioning of crisis resolution/home treatment services Commissioning of early intervention in psychosis services Data quality on ethnic group Delayed transfers of care Diabetic retinopathy screening Inpatients waiting longer than the 26 week standard Outpatients waiting longer than the 13 week standard Patients waiting longer than 3 months (13 weeks) for revascularisation Time to reperfusion for patients who have had a heart attack Total time in A&E National Priority 18 week referral to treatment times Access to primary care Access to primary dental services All age all cause mortality All cancers: one month diagnosis (decision to treat) to treatment (including new cancer strategy commitment) All cancers: two month urgent referral t treatment (including new cancer strategy commitment) All cancers: two week wait Breast cancer screening Cervical screening for women aged 25 to 64 years Childhood obesity rate Chlamydia screening Commissioning a comprehensive CAMHS Experience of patients Four week smoking quitters Incidence of Clostridium difficile NHS staff satisfaction Number of drug users recorded as being in effective treatment Pregnant women: 12 week maternity appointment Proportion of individuals who complete immunisation by recommended ages Prevalence of breastfeeding at 6-8 weeks from birth Reduction of <75 cancer mortality rate Reduction of <75 CVD mortality rate Stroke care Teenage conception rates

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Glossary Benefit - Improvement resulting from an outcome perceived as an advantage by a stakeholder. CQC – Care Quality Commission. JSNA – Joint Strategic Needs Assessment. Since 1 April 2008, local authorities and PCTs have been under a statutory duty to produce a Joint Strategic Needs Assessment (JSNA). The JSNA describes a process that identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness. Knowledge, Skills Framework (KSF) – A framework introduced into the NHS to ensure that all staff have a structured skills development framework for their personal development. LAA – Local Area Agreement between local public sector organisations. LSP – Local Strategic Partnership. LPSB – Local Public Service Board. Operating Framework – National guidance on the priorities for the coming year issued by the Department of Health Outcome - Change/impact affecting people. Output – Quantifiable, tangible product of an activity. PBC - Practice Based Commissioning – is about involving GP practices and other health and primary care professionals in the commissioning of services. It allows for budgets to be devolved from PCTs to individual GP practices. PCT - Primary Care Trust responsible for commissioning all health care in their community. Programme Plan - A framework to support the coordinated organisation, direction and implementation of a dossier of projects and transformational activities (i.e. The Programme) to achieve outcomes and realise benefits of strategic importance. Builds on the programme mandate Vital Signs – Key national guidance listed within the Operating Framework World Class Commissioning - World Class Commissioning aims to deliver a more strategic and long-term approach to commissioning services, with a clear focus on delivering improved health outcomes. There are four key elements to the programme; a vision for world class commissioning, a set of World Class Commissioning competencies, an assurance system and a support and development framework.

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References and further reading Audit Commission and Improvement & Development Agency (2002). Acting on Facts – using performance measurement to improve local authority services. Northampton: Audit Commission and Improvement & Development Agency. Department of Health (2006a). Our Health, Our Say, Our Care: a new direction for community services. London: The Stationery Office. Department of Health (2007a). World Class Commissioning Competencies. London: Department of Health and National Health Service. Department of Health (2007b). Commissioning Framework for Health and Well-being. London: Department of Health. Department of Health (2008a). High Quality Care For All: NHS Next Stage Review Final Report. Norwich: The Stationery Office. Department of Health (2008b). Commissioning Assurance Handbook. London: Directorate of Commissioning and System Management. Department of Health/NHS Finance Performance and Operations (2008). The Operating Framework for 2009/10. London: Department of Health and National Health Service. HM Treasury (2008). Doing the Business – managing performance in the public sector – an external view. London: HM Treasury. Improvement & Development Agency (2001). All in a Days Work. Improvement & Development Agency. Institute for Innovation and Improvement (2008). Commissioning to Make a Bigger Difference. Coventry: NHS Institute for Innovation and Improvement. Kirklees Partnership (2009). Health and well-being key issues for the people of Kirklees. Joint Strategic Needs Assessment for Kirklees. Huddersfield: Kirklees Partnership. Kirklees Partnership (2008). Kirklees Local Area Agreement 2008- 2011. Huddersfield: Kirklees Partnership. NHS Kirklees (2008). Ambitions for a Healthy Kirklees Five Year Strategic Plan 2008-2013. Huddersfield: Kirklees PCT. NHS Yorkshire and the Humber (2008). Delivering Healthy Ambitions. Leeds: NHS Yorkshire and the Humber.

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