Transcript NHS WCC slide master

Panel Report
Kirklees PCT
19 December 2008
Overview
The panel thanks Kirklees PCT for participating in this round of assessments for World
Class Commissioning, and for making us so welcome on the panel day and engaging with
the panel in an open and constructive way.
The panel asks the PCT to accept this report in the spirit in which it is intended: a support
tool on the journey to world class commissioning and as a considered perception of the
organisation’s strengths and weaknesses based on the insight the PCT itself gave the
panel into its commissioning approach. With regard to the competencies, the panel feels
that the results from the self-assessments almost totally matched the panel’s perceptions
during the assurance test.
During our review of Kirklees, the panel developed an overall impression of the
organisation, which is that the PCT has good foundations in place (systems, processes,
resources, partnerships). The PCT has identified its significant challenges and now is the
time to deliver the vision.
The panel identified 5 over-arching recommendations that the PCT will need to consider
as the PCT positions itself to drive transformation of health and healthcare in Kirklees.
These are set out at the beginning of this report. The report also contains the world class
commissioning scorecard, a commentary on the PCT’s potential for improvement,
observations and recommendations on the outcomes chosen by the PCT, and the panel
scores/ratings and recommendations for the 10 world class commissioning competencies
and PCT governance.
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Commentary
The panel identifies 5 major areas for consideration by the PCT at this stage on its journey:
1. The panel acknowledge the journey the PCT is on to improve clinical engagement
Observation: The panel observed that the PCT is on a journey to improve its clinical engagement. The PCT has made an
impressive start and is making good headway but with more to do in some areas. The PCT has a good multidisciplinary PEC
and has made good efforts to engage PBC and is starting to improve relationships. The PCT has also involved social care
through their HITS. The panel noted the PCT’s novel concept of a ‘commissioning college’ to bring together PBC, PEC and
HITS. The panel observed that the PCT still has work to do on information quality especially to support the management of the
primary care contract and variances in practices.
Recommendation: The PCT’s ‘commissioning college’ is an innovative solution to bring together PBC, PEC and HITS.
However the panel recommend that the PCT be aware of the challenges and risks that this presents. The PCT will need to be
clear about the continuing statutory role of the PEC. The PCT should work to improve the quality of information it provides to
support the management of the primary care contract and variances in practices.
2. The panel observed the PCT’s strong partnership working
Observation: The panel was impressed by the sensitive reciprocal partnership working it has seen with the LA. Its breath and
depth is impressive, from the front line to the most senior levels. The PCT clearly appreciate that this relationship is critical to
success in achieving its vision. This enables a sensitive local approach to meeting community needs, and the panel heard some
excellent examples of how this is working for Kirklees.
Recommendation: The panel recommend that the PCT should use this strong partnership to drive delivery forward and as a
means to keep a focus on the vision during some challenging times ahead. The PCT is well placed to tackle future challenges
constructively and provide mutual support to the LA.
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Commentary
3. The panel observed there were some key risks facing the PCT
Observation: The panel want to reflect back some of the key risks that the PCT is already aware of in delivering its strategy:
• MYHT - The PCT is likely to face ongoing challenges with managing the performance, finances and future developments
at MYHT. As system managers, the PCT will need to keep alert and aligned to the risks it may present
• Locality working – The PCT is clear why it is doing this, but this will require sensitive and sophisticated handling to
ensure all stakeholders are and remain on board with this strategy
• Focus – The PCT has lots of initiatives underway and planned and it will be important for the Board to determine how to
prioritise these initiatives and the related investment, and provide the appropriate oversight to ensure their successful
delivery.
Recommendation: The panel recommend that the Board reflects on how it prioritises the efforts of the organisation and the
focus of the Board. This includes how the PCT prioritises its investments. The PCT should not underestimate the challenges
for staff of programme management of a broad range of initiatives.
4. The panel noted that the culture of the PCT is beginning to change from turnaround to investment
Observation: The panel noted that the culture of the PCT is beginning to change from turnaround to investment. Culture
change is always difficult and the planned move to a new headquarters building and the additional resources the PCT has to
spend will mean further change.
Recommendation: The PCT should consider how it readies its staff and teams to think more about investing in work that will
clearly provide value for money and benefit more quickly, without losing the strength of the turnaround disciplines.
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Commentary
5. The panel noted that PCT could benefit from more clearly articulating its strategy
Observation: It became clear to the panel what the PCT’s strategy was through the Chief Executive’s ‘pitch on the patch’
and through the interview sessions. Through these the panel were able to pick up the passion of the team, the importance of
partnerships as well as the other good work being done by the PCT. However it was the panel’s view that the current
strategy document, as written, did not put this across as effectively as it could and could sell the PCT and its vision short.
Recommendation: The panel recommend that the PCT considers how it communicates its strategy. The PCT should reflect
on the flow, structure, order and clarity of the document with a view to amending the presentation of the strategic plan as part
of the work to refresh the document over the coming weeks.
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Current
Previous
Upper Quartile
COMPETENCIES
KIRKLEES PCT HEALTH OUTCOMES AND QUALITY
GOVERNANCE
Outcomes Selection Date: Sep-Oct 2008
0
Strategic Priority
National
1. Life expectancy
National Median
Worst
Value
73
100
th percentile
Best
PCT Rate of
Value
Change
M
F
87
2. Health Inequalities
48
8
3. Smoking during pregnancy
38
4
4. Smoking quitters
85
2051
M
0.4%
F
0.5%
Level 4
Time
period
CY 2004/06
Level 1
Local leader of NHS
NA
CY 2007
Collaborates with
partners
NA
FY 2006/07
Patient and public
engagement
49.0%
FY 2007/08
Clinical leadership
Strategy
A
Finance
16
81
6. Rate of hospital admissions per
100,000 for alcohol related harm
2683
545
7. CHD controlled blood pressure
86
92
Assess needs
-17.1%
CY 2006
6.4%
FY 2006/07
Prioritisation
0.2%
FY 2007/08
Stimulates provision
G
Local
5. Percentage of stroke admissions
given a brain scan within 24 hours
8. Childhood obesity
9. Emotional health of children
10. People with LTC supported
NA
NA
NA
Innovation
Procurement and
contracting
Board
G
Performance
management
M = Male
F = Female
CY = Calendar Year
FY = Financial Year
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Potential for Improvement Commentary
PCT trajectory
• The PCT has strong foundations across the breadth of its work. It has some robust
business processes and innovative ideas. There is clear aligned leadership.
• However, it also has a challenging context, both in terms of service challenges and in the
huge diversity of needs of its communities. This means that the PCT will need to be alert to
how its environment changes, and look to deploy its management effort and capabilities to
tackle these significant challenges.
Areas for organisational development
• The panel recommend that the PCT revisit the written strategy to ensure it conveys the full
strength of its ambitions, and the initiatives it has in place to deliver it. The PCT should
consider whether it has the skills in place to manage such a wide number of programmes;
the panel believe the PCT has set itself an ambitious task in this regard.
• The PCT will need to strengthen some parts of its clinical engagement. The PCT should
also look to build up its market management capability.
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Outcomes
Outcomes chosen
1. Smoking during pregnancy
2. Smoking quitters
3. Percentage of stroke
admissions given a brain
scan within 24 hours
4. Rate of hospital admission
per 100,000 for alcohol
related harm
5. CHD controlled blood
pressure
6. Childhood obesity (locally
defined)
7. Emotional health of
children (locally defined)
8. People with LTC
supported (locally
defined)
Panel observations on outcomes:
• The outcomes were selected to have a strong read through to the JSNA, LAA,
Healthy Ambitions and the PCT’s vision and values.
• The PCT wanted a breadth of outcome metrics and ones that they could act on
locally that would have a big impact on health and also can be robustly
measured.
• The Board discussed and challenged the selection of the outcome metrics. The
metrics were also discussed by the PEC, and taken through PBC and their fora.
• The metrics chosen were partly to reflect partnership priorities. The PCT already
has rigorous performance monitoring of outcomes so those areas where the
PCT is currently underperforming will already be managed through this process.
• The PCT also wanted to ensure that delivery against the outcomes is focused
on the localities within Kirklees to make a difference on health inequalities.
• In terms of the specific metrics selected:
– Infant mortality was important but not selected because of the small
numbers involved. The PCT instead looked to the risk factors e.g. smoking
during pregnancy, which would have wider health benefits.
– The council run an annual ‘Tell Us’ survey through schools using school
nurses to understand the needs of children. This directly influenced the
choice of emotional health of children as a metric.
– The LTC metric involves a range of measures such as reduction in length of
stay, percentage of people dying at home, etc.
• The PCT acknowledges that it still has some work to do to determine the interim
milestones for some of the outcomes.
Recommendations:
• The PCT should be clear about interim milestones for delivery against the
outcomes.
• The PCT should consider how it will benchmark its locally defined metrics
nationally.
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PCT's Self Assessment
Overview - Competencies
panel assessment
PCT Self-Assessment
Competency
Level Level Level
1
2
3
Level
4
1. Locally lead the NHS
2. Work with community
partners
3. Engage with public
and patients
4. Collaborate with
clinicians
5. Manage knowledge
and assess needs
Topline introduction
•
The panel agreed with 28 of the PCT’s 30 self-assessment
ratings. However, the panel found it necessary to adjust the
remaining ratings.
•
The panel acknowledges that in the few areas where it has
adjusted self-assessment ratings, the PCT has made inroads
into achieving sub-elements of the competencies.
6. Prioritise investment
7. Stimulate market
8. Promote improvement
and innovation
9. Secure procurement
skills
10. Manage the local
health system
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PCT's Self Assessment
Competency 1: Panel assessment
Competency
Are recognised as the
local leader of the NHS
Measure
•
Reputation as the ‘local leader of the NHS’
•
Reputation as a change leader for local organisations
•
Position as the local healthcare employer of choice
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT has a communication engagement strategy. Health issues are regularly included in the council’s news-letters to the
public. The PCT has just delivered its first newsletter (‘Health Talk’) to the public. The PCT commissioned Leeds Metropolitan
University to understand the effectiveness of this communication (60% of recipients read it and it did change their perception
positively) .
• The panel heard how the PCT has become more sophisticated in its communication, for example in its ongoing communication
around the Mid Yorkshire Trust’s Service Strategy.
• Press coverage for June – Sept ‘08 was more positive than negative.
• In the public perception survey 61% of people agree that the PCT improves services for people like them, compared to the
regional average of 67%.
• The PCT works well with its Local Authority, and used the JSNA to lead the health agenda with all its partners. The PCT works
closely with neighbouring PCTs, as evidenced by its participation in a number of Boards.
• The workforce survey suggests the PCT has a fairly high turn-over rate (above SHA average but inline with the national
average). Staff satisfaction was near average. The PCT is based across split sites which does not help staff satisfaction but the
PCT is moving into a new headquarters in 2010. The PCT links staff development very explicitly to the 8 goals of the
organisation.
Recommendations going forward:
The panel recommends the PCT should:
• Act on the findings of the Leeds Metropolitan University research to improve its public-facing communications.
• Build on its work with partners to establish a stronger brand with the public.
• Be clear about the benefits of working at NHS Kirklees for commissioning staff.
Adding life to years and years to life10
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PCT's Self Assessment
Competency 2: Panel assessment
Competency
Work collaboratively with
community partners to
commission services that
optimise health gains and
reduce health inequalities
Measure
•
Creation of Local Area Agreement based on joint needs
•
Ability to conduct constructive partnerships
•
Reputation as an active and effective partner
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The LAA was identified by Government Office as a good example nationally. The LA is a 4 star rated organisation.
• The Kirklees Partnership Executive (which includes the PCT) worked closely to develop the 35 priorities for the LAA. The PCT
takes leadership of several of the cross cutting themes (e.g. the alcohol agenda including resources from the DAT, adult
services and the police). Delivery responsibilities for each of the targets was clear e.g. the PCT produced an alcohol strategy
that has 5 areas with milestones.
• The PCT has several joint posts beyond the DPH. The joint posts report back into the LSP Boards. The PCT and LA also have
pooled spending on MH and LD.
• The PCT and LA have commissioning teams aligned with the 4 LSP Partnership Boards.
• The PBC consortia have signed off commissioning plans with the PCT.
• The PCT has a track record of delivery in partnerships in line with planned milestones.
Recommendations going forward:
The panel recommends the PCT should:
• Develop clear clinical and PBC leadership and engagement in the LAA as it is refreshed.
• Consolidate work with a wide range of partners to increase its effectiveness as a partner.
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PCT's Self Assessment
Competency 3: Panel assessment
Competency
Measure
Proactively build continuous and
meaningful engagement with the
public and patients to shape
services and improve health
•
Influence on local health opinions and aspirations
•
Public and patient engagement
•
Improvement of patient experience
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT has a communication strategy which segments its key stakeholders. The PCT uses a range of media including specialist radio
stations to reach target groups. The PCT is also currently revamping its website to make it more user friendly.
• The PCT uses its regular survey of adults and children to shape its priorities. For example on physical activity, the survey led them to set
targets to increase activity amongst young people.
• The PCT has conducted multiple consultations with the public, e.g. ‘Looking to the Future’, urgent care consultation, the future of
Liversedge and Slaithwaite Health Centres. The PCT also has a Readers Panel to ensure information and leaflets are easy to read and
understand.
• The PCT could give some comprehensive examples of where patient engagement was driving improvement for e.g. ‘Diabetes Year of
Care’ Programmes and urgent care. The PCT is now working with partners to do this more systematically.
• The PCT noted that they receive a relatively low level of complaints, and so it is difficult to spot trends, but the PCT is using queries to its
PALS service (e.g. podiatry and dentistry) and other sources to help do this. The PCT has made changes as a result, for e.g. with access
to dentistry where, in response to feedback through PALS, the PCT set up an information helpline to direct the public to the right place.
Recommendations going forward:
The panel recommends the PCT should:
• Build on the research evidence of effective communication techniques to reach seldom heard and different segments of the local
communities.
• Review the PCT website in terms of making it more patient-public friendly.
• Build on the opportunities of joint work with the LA to feedback how patient and public views have influenced commissioning of care for
local communities.
Adding life to years and years to life12
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PCT's Self Assessment
Competency 4: Panel assessment
Competency
Measure
Lead continuous and meaningful
engagement of all clinicians to
inform strategy and drive quality,
service design and resource
utilisation
•
Clinical engagement
•
Dissemination of information to support clinical
decision making
Reputation as a leader of clinical engagement
•
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT is planning to set up a ‘commissioning college’ to pull together the PEC, PBC and HIT teams. This was kicked off at
an event with 60 clinicians. The PEC will remain as a statutory body.
• The PCT involves a range of clinicians in all its improvement work, for example, the PCT involved clinicians from across the
patch in driving the changes in urgent care. The PCT used ‘Route to Solution’ to pull together clinicians from primary and
secondary care for which the PCT won an award.
• Clinical leadership appears embedded within the business of the PCT (e.g. HITS) and influences strategic planning and
service design. There is also local social care representation on a number of the HITS.
• The PBC survey shows that satisfaction with the quality, format and frequency of PCT information supplied for PBC is broadly
considered to be inline with the SHA average.
• Quality performance data for primary care is still at a development stage. The PCT has a good information system with a web
based system that clinicians can access, although the PCT was concerned over the variability in access to quality data. The
PCT recognised that there are inconsistencies across the patch from the history of 3 PCTs but has plans in place to resolve
these issues.
Recommendations going forward:
The panel recommends the PCT should:
• Move towards the model of a ‘commissioning college’ which will move clinical leadership and engagement even further in
influencing commissioning and clinical “buy-in” to delivery of the strategic plan.
• Further develop the quality data set to support PBC commissioning and also the performance management of primary care
contractors.
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PCT's Self Assessment
Competency 5: Panel assessment
Competency
Measure
Manage knowledge and undertake
robust and regular needs
assessments that establish a full
under-standing of current and future
local health needs and requirements
panel assessment
Level 1
•
Analytical skills and insights
•
Understanding of health needs trends
•
Use of health needs benchmarks
Level 2
Level 3
Level 4
Rationale for scoring:
• In the JSNA, the PCT has outlined a detailed assessment examining the most current local health needs. Prior to this year’s
assessment, a range of smaller scale assessments and survey had been carried out.
• The PCT is working through a refresh of its JSNA and is trying to carry out more modelling work to understand future needs
(e.g. dementia)
• The JSNA provides a fact-based understanding of local outcomes for most major diseases and establishes links with other
relevant diseases and conditions in each case. Data for the 7 localities within Kirklees is also compared against the Kirklees
average and the national average on indicators for all major health needs (e.g. infant mortality, suicide, premature deaths from
CHD, etc.).
• The PCT has presented tailored findings of the JNSA to providers, PCT provider arm and PBC.
• The infant mortality issue was identified to the public through the use of benchmark data and it was communicated sensitively
through community groups and the media.
• The LA has a bimonthly news-letter to all households which includes a health section. The LA also has good results on its
LSPA targets including those related to health and these are also benchmarked.
Recommendations going forward:
The panel recommends the PCT should:
• Continue work to identify unmet future needs in Kirklees in order to reduce gaps.
• Develop plans to systematically improve performance to health needs through use of stretch targets and benchmarking.
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PCT's Self Assessment
Competency 6: Panel assessment
Competency
Prioritise investment
according to local needs,
service requirements and
the values of the NHS
Measure
panel assessment
Level 1
•
Predictive modelling skills and insights
•
Prioritisation of investment to improve population’s health
•
Incorporation of priorities into strategic investment plan
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT has demonstrated risk modelling through its work with MYHT structures for the new hospital in Wakefield. Services
were redesigned based on modelling done in pathway work.
• Acute care contracts are not just for activity, but include age, locality and time modelling as well.
• The PCT demonstrated its use of best and worse case scenarios (e.g. in their long term conditions work).
• The PCT has a relatively rigorous business case process and the Board challenges and approves business cases as they are
presented. All business cases are required to have clear criteria which requires mapping to vision, locality, strategic objectives
and input from all appropriate stakeholders. Outcomes are a standard part of their internal process and are a required element
as well as detail regarding investments and disinvestments.
Recommendations going forward:
The panel recommends the PCT should:
• Continue to refine its prioritisation process, as data from local providers and public become more timely and actionable.
• More clearly demonstrate in their planning the links between individual investments and overall programmes.
• Develop a more robust criteria weighting system to assist in prioritising business cases.
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PCT's Self Assessment
Competency 7: Panel assessment
Competency
Effectively stimulate the
market to meet demand
and secure required
clinical and health and
wellbeing outcomes
Measure
•
Knowledge of current and future provider capacity
•
Alignment of provider capacity with health needs
projections
•
Creation of effective choices for patients
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT acknowledged that it had yet to systematically analyse the market to identify the full range of providers, or
to assess their relative costs and quality although some analysis had been carried out in relation to priority areas
e.g. MH with the LA.
• The PCT acknowledged that they had more work to do on soliciting patient feedback.
• The PCT was testing market capacity through its tendering exercises.
• Work on projections had identified capacity gaps in the areas of plastics and neurology and further work was under
way with the SCG in relation to neurology.
• The PCT has focussed on ensuring effective “Choose and Book” services. Local campaigns have been conducted
on raising the awareness of choice. More work is required on ensuring patient choice around the content and style of
services.
Recommendations going forward:
The panel recommends the PCT should:
• Carry out further analysis of the market to identify the full range of providers and their relative costs and quality.
• Continue to expand the depth and breadth of the work to obtain patient feedback on services.
• Further develop the PCT’s strategy relating to patient choice.
Adding life to years and years to life16
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PCT's Self Assessment
Competency 8: Panel assessment
Competency
Promote and specify
continuous improvements in
quality and outcomes through
clinical and provider
innovation and configuration
Measure
panel assessment
Level 1
•
Identification of improvement opportunities
•
Implementation of improvement initiatives
•
Collection of real time quality and outcome information
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT clearly demonstrated the use of a common pathway design model used by new improvements (LTC was given as an
example).
• The PCT has identified a process map listing the specific interventions that are required at each point in the LTC pathway
including prevention work as the first step in the process.
• PBC is clearly engaged in pathway work and local and national benchmarks have been used (e.g. in community nursing)
• The PCT found that the MSK triage service did not have the projected impact in the orthopaedic pathway, so more work was
carried out through root cause analysis to provide solutions in the processes.
• The PCT has monitoring in place for most providers; some have very frequent meetings and reporting if issues have been
identified, less regular for others (e.g. twice yearly for GP practices).
• PBC does not see the full impact of pathway redesign and commissioning as yet at locality level.
• The PCT is currently developing provider based systems to more fully understand activity and outcomes.
Recommendations going forward:
The panel recommends the PCT should:
• Continue to work on improved data from GP practices which will inform the pathway redesign process.
• Strengthen systematic input into redesign as changes are made to clinical pathways.
• Conduct more regular and more frequent meetings with primary practices as they develop more robust provider specific
information.
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PCT's Self Assessment
Competency 9: Panel assessment
Competency
Secure procurement skills
that ensure robust and
viable contracts
Measure
•
Understanding of providers economics
•
Negotiation of contracts around defined variables
•
Creation of robust contracts based on outcomes
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• A considerable amount of work has gone into understanding the economics and market dynamics of MYHT and the PCT is
working through similar issues with SWYMHT. The procurement work on urgent care and equitable access to primary care
had also helped the PCT to understand provider economics and market analysis.
• Patient data relating to providers was obtained via SLAs and as part of the equitable access scheme.
• The PCT has a procurement strategy.
• The PCT has an agreed negotiation process both for its lead role as a commissioner and as an associate commissioner.
Roles have been agreed internally and the key negotiation variables have been agreed, e.g. standard negotiations approach
with set, clear expectations across the negotiation team, including cost, quality and information variables.
• The PCT has set out the outcome measures in the new SLAs for urgent care, equitable access and the third sector although
the existing SLAs have not all got clearly specified outcomes.
• The PCT’s contracts have defined break clauses linked to performance variables.
Recommendations going forward:
The panel recommends the PCT should:
• Ensure that existing contracts are reviewed with a view to including clearly specified outcomes and quality metrics.
• Embed the recently adopted procurement strategy across the PCT.
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PCT's Self Assessment
Competency 10: Panel assessment
Competency
Effectively manage systems and
work in partnership with providers
to ensure contract compliance and
continuous improvement in quality
and outcomes and value for money
Measure
•
Use of real time performance information
•
Implementation of regular provider performance
discussions
•
Resolution of ongoing contractual issues
panel assessment
Level 1
Level 2
Level 3
Level 4
Rationale for scoring:
• The PCT’s performance monitoring of its main providers is monthly, with specific areas reviewed by exception (e.g.
A&E performance).
• The PCT appears to have a good understanding of contract terms and conditions and its contracts are managed
efficiently (e.g. coding compliance).
• The performance information is worked through with PBC consortia on a speciality basis.
• The PCT holds regular performance meetings with its main providers (e.g. meets with CHFT fortnightly).
• The PCT has a track record of using the contractual process to engineer service improvement (e.g. SWYMHT crisis
resolution). Chair and Chief Executive, executive to executive director meetings, patch meetings, Board to Board
meetings and performance notices have all been used to resolve contractual issues.
Recommendations going forward:
The panel recommends the PCT should:
• Ensure contract performance notices are used to strengthen performance improvement processes.
• Integrate primary and secondary care information flows, i.e. understand and measure care pathway improvements.
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panel assessment
Governance: Panel assessment on Strategy
Overall recommendation on governance:
The PCT Board will need to focus on clarifying the link between the vision and the initiatives and conveying this to partners. The Board should also continue
to focus on managing its key risks, e.g. MYHT
Assessment
A
Measure
•
Vision and objectives
•
Initiatives to ensure delivery of strategic objectives
•
Consistency of financial plan with the strategy
•
Board challenge and ownership of the strategic plan
•
Achievement of milestones to date
Red
Amber
Green
Rationale for rating:
• The panel believe that the strategy, as written, does not sufficiently convey how the initiatives and HITS will deliver the
overarching vision and objectives. The panel found this much easier to understand from its visit to the PCT, so believes that
this is predominantly a matter of style rather than substance. However, it is for this reason that the panel have scored the
strategy section amber.
• Further work is also needed to clarify the timelines for investment and strengthen the link between finance and health
outcomes.
• There is evidence that the Board provided regular and robust challenge of the strategic plan, and their input was sufficiently
incorporated into the end product. The panel heard of the establishment of a new committee to oversee the delivery of the new
initiatives and it will be important that this committee is clear about the information it needs to fulfil its role.
• The PCT went through a successful turnaround from 2006/07.
Recommendations going forward:
The panel recommend the PCT should:
• Articulate the strategic plan so that there is a clear relationship between the PCT’s vision, goals and initiatives.
• Ensure that the Board is clear how it will track the progress of strategic initiatives and the impact of those on health outcomes.
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panel assessment
Governance: Panel assessment on Finance
Assessment
G
Measure
•
Sustainable financial position
•
Historical financial management
•
Robustness of planning assumptions
Red
Amber
Green
Rationale for rating:
•
•
•
•
The PCT is projecting a surplus in every year over the next 5 year period which is in line with SHA expectations.
In 2006/07 the PCT forecast a deficit, but a small surplus was achieved.
The PCT have robust financial monitoring processes in place.
The PCT’s assumptions for inflation, incidence, activity and population rates are credible with a convincing rationale
articulated. The plan is granular, building incidence assumptions up by disease group. The PCT may need to review its
assumptions around MYHT in the medium to long term. The PCT’s capacity management appears to be in line with activity
projections.
Recommendations going forward:
• The PCT needs to develop a community wide financial strategy which includes Wakefield District PCT regarding the MYHT
service and financial strategy.
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panel assessment
Governance: Panel assessment on Board
Assessment
G
Measure
•
•
•
•
•
•
Red
Amber
Green
Organisation
Risk
Information
Performance
Delegation
Board interaction
Rationale for rating:
• The PCT has a clear and well defined organisational structure which is well understood by the Board. The roles and
accountabilities are clearly articulated and delineated. The PCT has outlined capability gaps which are aligned with those
identified in the self assessment and has clear robust actions with timelines to address these gaps. The PCT has clearly
articulated values that have been communicated consistently to stakeholders. The PCT’s OD plan outlines actions to be taken
in response to the staff survey.
• The ALE score for internal control = 2.
• The PCT’s provider Board reports and provider performance reports provide consistent and actionable data of a timely and
accurate nature.
• The PCT tracks clinical and operational performance of its providers on a monthly basis. The PCT reports to its Board on
clinical, service and financial performance indicators. The Board plays and active role in acting to address disparities in
performance (e.g. A&E).
• The PCT has described the process for delegation and management of the PBC consortia.
• The entire PCT Board including executives and non-executive directors played an active role in shaping the PCT’s strategy.
Recommendations going forward:
• The Board should reflect on how it focuses its effort and oversight in terms of prioritising and the timing of investments.
Adding life to years and years to life22
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Glossary
A&E
Accident & Emergency
PCT
Primary Care Trust
ALE
Auditors' Local Evaluation
PEC
Professional Executive Committee
CHD
Coronary Heart Disease
PPI
Patient and Public Involvement
CHFT
Calderdale Hospital Foundation Trust
SCG
Specialist Commissioning Group
DAT
Drugs Action Team
SCP
Strategic Care Partnership
DPH
Director of Public Health
SLA
Service Level Agreement
HITS / HIT
Health Improvement Team
SWYMHT
South West Yorkshire Mental Health Trust
JSNA
Joint Strategic Needs Assessment
WCC
World Class Commissioning
LA
Local Authority
LAA
Local Area Agreement
LD
Learning Disabilities
LSP
Local Strategic Partnership
LTC
Long Term Condition
MH
Mental Health
MRSA
Methicillin Resistant Staphyloccns Anrens
MSK
Musculoskeletal Service
MYHT
Mid Yorkshire Hospital Trust
OD
Organisational Development
PALS
Patient Advise and Liaison Service
PBC
Practice Based Commissioning
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