Northfleet Swanscombe Dartford Gravesend Swanley Greenhithe

Bexley South Bean Darenth

Longfield Farningham Meopham Snodland West Otford Kingsdown

Aylesford

Sevenoaks

Allington Bearsted

West Westerham Hadlow Malling Maidstone Coxheath Lenham Hildenborough

Barming Shepway Wateringbury

Sutton Yalding Tonbridge Langley Valence Edenbridge Paddock Wood

Brenchley Headcorn Pembury Speldhurst

Tunbridge Wells Goudhurst

Cranbrook

Lamberhurst

Hawkhurst What’s in this report? Contents

p3 Introduction p19 Advice and information for p5 Who we serve patients p5 Who we are p19 Complaints handling p5 What we commission p19 Adherence to Principles for 674,000 p5 Primary Care Remedy people p6 Prevention services p19 Staff satisfaction and p6 Community services engagement p6 Mental health and learning p19 Staff survey 2009 disability services p20 Sickness absence and p7 Acute services stress at work p7 Specialist services p20 Equal Opportunity and p7 Continuing care Diversity Policy p8 What have we achieved? p20 Education, development p8 Improving health and training p8 Acute care p20 Health and safety p8 Creating a seamless service p20 Measuring Performance p9 Creating a fairer service National scrutiny p10 Foundations for the future p22 Local scrutiny and audit p10 Considerable Challenges p22 Performance management p10 Population p22 Clinical governance p10 Lifestyle factors p22 Risk assessment and p10 The ageing population Foreword p10 Long term conditions management p11 Financial situation p22 Incident reporting p11 Political and reputation p23 Information Governance NHS West Kent is responsible for the challenges p23 Data protection healthcare of over 670,000 people living in the area we serve. Our ambition is to ensure p11 Focussing our efforts to p23 Data loss and that they enjoy the best possible health. realise our ambition confidentiality breaches p11 Increasing support p23 Freedom of information Here you will see how we have worked to p13 Helping people take control p23 Environmental Issues and achieve this over the last year, and how we p14 Self-management are striving to realise that ambition in the Sustainability p14 CareCall future. p23 Equality and Human Rights p15 Health Trainers p23 Equality and Human Rights p15 Prevention It’s not just the NHS that deserves credit for Strategy the success we’ve achieved, or that takes p16 Increasing efficiency and p23 Equality Impact responsibility for the improvements we need performance Assessments (EIA) to bring. More than ever before we are p16 Stroke involving you, the public, patients and p24 Corporate Governance p16 Diabetes clinicians in the work we do. You have a p24 PCT Board p16 Opthamology valuable opportunity to help us shape the p25 Directors’ declarations of p17 The next five years future of the health service. interests 2009/10 p18 Pride, pace and purpose p26 Financial Review Welcome to our Annual Report for 2009/10. p19 Statutory and business p33 Independant Auditors information Report NHS West Kent annual report 09/10 03

Steve Daryl Phoenix Robertson Rod Smith

Julia Declan Ross O’Neill David Griffiths James Thallon Welcome Harshad Topiwala Julie Hunt Brian Jill Sweetland Barry Ruddock Wilding

Rosanne Corben Peter Conway

The NHS in West Kent is a wide-ranging network of services all designed to fit together for one aim - to offer the people of West Kent the best possible health. Rather than being a single organisation, it is a family consisting of NHS, local authority, private sector and voluntary sector providers as well as contractors such as dentists, GPs and optical practitioners. The local NHS has unique skills and experience, and is continually learning and developing to do the job better. It also has unique challenges, which doesn’t change our ambition but makes it harder to achieve.

NHS West Kent is an organisation known regional networks where services are as a Primary Care Trust (PCT). Our role is better designed covering a larger area. to commission that network of services to achieve outcomes which will bring about We also work with our population, our ambition. In 2009/10 we had a clinicians and local elected officials to budget of £994 million to manage across shape the future of our health services. the health system in West Kent to ensure Our Health Network is a vibrant and ever- the best outcome for the population. We growing collection of members of the do not simply purchase or contract for public who give us the benefit of their services - our role is to provide knowledge and experience in building leadership and support to organisations new services. Many members of the and individuals who provide healthcare, public sit on the PCT’s working groups as well as challenging them to do better and committees to give their unique for the people of West Kent. perspective. We are building services for the community, with the community’s As commissioners, we select the best help. providers for each part of the service, then oversee and work in partnership The population in West Kent is ever with them to get the best from the skills changing, as is the environment the and experience they share. At the same health service operates in. The health time, we work together to mitigate the needs of that population do not stay the ever-changing challenges the NHS faces. same, neither do people’s expectations. We drive the providers we commission to Knowledge and best-practice is improve, and learn from their own developing all the time. NHS West Kent is experiences and those of other committed to negotiate these constantly- providers. We work with other PCTs to shifting factors to deliver the excellent create a more seamless service, benefit standards the people of West Kent from economies of scale and develop deserve. 04 NHS West Kent annual report 09/10

It is important for NHS West Kent to take on board public and patient feedback so the services that are funded are the ones we would choose for ourselves. “ As service users we can give a perspective on quality and what works well that may not be reflected in other “ measures used. My main interest is in mental health and I hope all future engagement with those most affected by mental health issues will have a good result, and that the outcomes do reflect all of our efforts. Alex Williams

Alex Williams is one of over 730 Health Network members who play an important role in helping to shape local services and influence commissioning strategies.

Since becoming a member more than two years ago, Alex has participated in various consultations and training sessions, provided feedback on documents and strategies, and written for the Health Network newsletter. The 32-year-old has also joined the NHS West Kent Patient Experience Group, which meets every three months with local healthcare providers to share user focused research ideas. NHS West Kent annual report 09/10 05

Who we serve • Population 674,600 • Mix of urban and rural • Significant pockets of deprivation • Proportion of over-65s set to rise

West Kent has a population of 674,600 * living in a mix of provided services. West Kent Community Health acts, as rural and urban settings. The population is generally far as possible, like any other NHS body we commission well-off and healthy - 60 per cent of the population is services from. It has its own Board and manages its own made up of groups such as career professionals, budget. younger families in newer homes, and older suburban families, which tend to be relatively affluent and enjoy During 2010-11, we anticipate that NHS West Kent will good health. cease to provide any services directly. We are currently exploring a range of options for the best way to provide However, there are significant areas of deprivation where these community services, and the best shape for an there are greater health problems. These can be found organisation or organisations to deliver them. throughout West Kent - although the greatest concentration of deprived wards can be found in There are a total of 2,358 people working for NHS West Dartford and Gravesham, there are also some highly Kent, in 1,709 full-time equivalent posts. Of these, 508 deprived areas in and around Swanley, Sevenoaks, work in the commissioning part of the organisation in Tonbridge, Tunbridge Wells and Maidstone. 437 full-time posts, and 1,850 work for West Kent Community Health in 1,272 posts. Furthermore, the population is getting older. The over-65 population is set to increase significantly in this decade, and will make up a larger proportion of the population as What we commission well. • GPs, dentists, opticians and pharmacists • Hospitals and specialist care Who we are • Mental health and learning disabilities • Preventative and community services • Commissioning and ‘arm’s-length’ community services • 2,358 people overall Primary Care • 1,709 full-time equivalent posts GPs, dentists, pharmacists and optical practitioners are NHS West Kent is made up of a range of staff and contracted to provide a service to the NHS. These professionals with experience of frontline healthcare, primary care professionals are the first port of call for management, finance and all the skills necessary to most people with health needs. There are 107 GP manage a budget of around £1 billion. The PCT is practices, 104 dental practices, 111 community committed to developing as a commissioning pharmacies, and 76 optometric practices in West Kent. organisation - this means we focus on designing, Currently, 93 per cent of West Kent GP surgeries offer overseeing and managing the health system in West appointments outside the normal 8.30am-5.30pm time Kent but do not provide any services directly. slots.

Historically, NHS West Kent has performed both NHS West Kent commissioned a new out-of-hours functions as we commissioned healthcare across the primary care service in 2009/10 from South East Health. region and provided community services such as health The service is better integrated with hospitals and other visiting and district nursing. From 2009, however, NHS services than ever before. It is made up of call-handlers, West Kent formed an ‘arm’s-length’ division called West nurses and doctors and aims to provide responsive, Kent Community Health to manage these directly- timely care to people outside normal office hours. Increasing authority has been given to GPs through

*Source: Office for National Statistics mid-year population estimates © Crown Copyright 06 NHS West Kent annual report 09/10

Practice-Based Commissioning (PBC). This is a scheme West Kent Community Health has its own management that enables groups of GPs to team up and commission board which is made up of: services across their local area. It means the PCT gives frontline clinicians the support and resources to become Mark Shepperd Managing Director more involved in commissioning decisions based on their greater knowledge and experience of the Barrie Collins Chief Nurse community they serve. There are seven PBC ‘clusters’ of GP practices covering West Kent. Most practices in West Margaret Daly Director of Human Resources Kent are now part of Practice-Based Commissioning. Mary Leadbeater Interim Director of Finance Access to NHS dentistry in West Kent has traditionally been lower than average in England, but there has also Jackie Kavanagh Programme Office Director been a high number of people who opt to use private dentistry. This has begun to change, particularly since West Kent Community Health’s management board is the recession in 2008 and 2009. chaired by a PCT non-executive director, Rosanne Corben. Three Independent lay members were also Primary care and community services made up 30 per appointed during the year to bring non executive cent of NHS West Kent’s spending in 2009/10. balance.

Prevention services Community midwifery is provided across West Kent by Maidstone and Tunbridge Wells NHS Trust and Dartford NHS West Kent does not just commission services to and Gravesham NHS Trust. respond to existing health problems - we have started to establish services aimed at improving people’s overall health and wellbeing and preventing health problems Mental health and learning from arising. One example of this is West Kent CareCall, disability services an innovative service commissioned from BUPA Health Dialog. This is aimed mainly at people with long-term Mental health services are commissioned across Kent conditions and helps them manage their health more and Medway by NHS Medway. NHS West Kent works proactively, leading to fewer hospital admissions, less closely with the service to ensure that West Kent’s reliance on traditional health services and generally population’s needs are met. We commission a range of better health and wellbeing. services from the NHS, voluntary sector and private sector. IN 2009/2010 Mental Health and learning We also commission providers such as local authorities disability commissioning represented nine per cent of and healthy living centres to engage with local NHS West Kent’s budget. communities with programmes for improving health. Examples include programmes to give access to The main mental health provider in West Kent is Kent and physical activity, brief interventions for alcohol misuse Medway NHS Social Care Partnership Trust (KMPT). The and schemes to tackle obesity. trust provides a wide range of services for people experiencing mental health problems across Kent and Community services Medway. It also provides other services including some learning disability services, a substance misuse service Most services in the community in West Kent are and a range of specialist services. provided by West Kent Community Health, currently an ‘arm’s-length’ part of NHS West Kent which we aim to In 2009, KMPT introduced a new service for common commission like any other part of the health service. mental health problems commissioned by NHS West Their services include community nursing, specialist Kent called ‘Improving Access to Psychological nursing in areas such as continence, cancer, respiratory Therapies’ which is based on national best-practice and diseases and heart failure, and intermediate care. aims to help people regain control of their lives. West Kent Community Health also runs a number of community hospitals, which provide services such as rehabilitation, minor injuries units and diagnostics. NHS West Kent annual report 09/10 07

Acute services The trust operates from 63 ambulance stations and three Emergency Dispatch Centres, as well as numerous Acute, or hospital, services are provided mainly by two administrative, fleet, equipment and training bases. It NHS hospital trusts, one serving the north of the patch responded to more than 500,000 emergency calls in and the other serving the south. In 2009/10, 43 per cent 2009/10, and employs over 3,000 staff, more than half of of NHS West Kent’s budget was spent on acute whom are paramedics and ambulance technicians. services. We also commission some acute services from Medway Dartford and Gravesham NHS Trust provides an NHS Foundation Trust, South London Healthcare NHS extensive range of acute, mainly hospital-based health Trust, Queen Victoria Hospital NHS Trust and East Kent services to the people of Dartford, Gravesham, Swanley, Hospitals Trust. Bexley and also neighbouring districts across South East London and Kent. Specialist services

The trust has around 1,900 staff operating mainly from For complex needs, NHS West Kent commissions Darent Valley Hospital in Dartford. The hospital has a specialist services from a number of organisations. heart centre meaning local people can now benefit from These include specialist cancer services from the Royal a more comprehensive range of cardiac services at their Marsden NHS Trust and specialist burns services from local hospital, including angiography, angioplasty and the Queen Victoria Hospital NHS Trust. Other providers pacemaker implantation. are Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, and University The trust also has a new midwifery-led birthing unit and College Hospital. a new paediatric assessment unit to treat children attending A&E. Darent Valley Hospital is run as part of a NHS West Kent hosts the South East Coast Specialist Private Finance Initiative (PFI). Commissioning Group, which commissions specialist services such as IVF for the whole of the South East Maidstone and Tunbridge Wells NHS Trust (MTW) area. Specialist commissioning made up 11 per cent of provides general hospital services to the south of West NHS West Kent’s budget in 2009/10. Kent and parts of North East Sussex. In addition, the trust provides specialist cancer services for the whole of Continuing care Kent, Hastings and Rother. NHS West Kent commissions ‘continuing care’ - that is, MTW is leading developments in laparoscopic surgery in residential care where people have predominantly the NHS and is increasing the range of other highly health-related needs. We commission over 50 care specialised services available locally to patients. It has homes and 60 domiciliary providers, as well as voluntary approximately 4,750 staff operating from Maidstone sector providers including hospices. Continuing care Hospital, Kent & Sussex Hospital, Pembury Hospital and represented three per cent of NHS West Kent’s Preston Hall as well as working in the community. A new spending in 2009/10. £225 million hospital with all single-room en suite bedrooms is being built at Pembury.

NHS West Kent commissions ambulance services from South East Coast Ambulance Service NHS Trust. The trust was formed from ambulance trusts in Kent, Surrey and Sussex in 2006. The trust responds to 999 calls from the public, urgent calls from health professionals and in Kent and Sussex, and provides non-emergency patient transport services (pre-booked patient journeys to and from healthcare facilities).

South East Coast Ambulance Service covers a geographical area of 3,600 square miles (Brighton & Hove, East Sussex, West Sussex, Kent, Surrey, and North East Hampshire) and serves a resident population of 4.5 million. 08 NHS West Kent annual report 09/10

and NHS West Kent to bring levels of infection down. What have we achieved? The PCT has invested additional funds and worked with the trust to change culture and management structures • Improving the health of the population that mean outbreaks are prevented, or if they cannot be • Improvements in acute services prevented, managed. Levels of infections have reduced • Creating better links between services steadily in both our main acute trusts over the last five • Developing fairer and more accessible services years. • Building foundations for the future Waiting times and A&E performance has also improved, NHS West Kent has been working hard for the local despite significant pressure on some hospital services. population since it was established in 2006. In that time The heavy snowfalls in December 2009 and January we have overcome a £25 million deficit inherited from 2010 created problems with access and additional previous organisations, and built solid foundations for pressure on A&E, both from slips and falls and because future healthcare. many rural GP surgeries were inaccessible. The normal winter issues such as Norovirus infection also posed a Improving health challenge for acute services in the area, in addition to which, the Swine Flu pandemic added further difficulties NHS West Kent has worked hard to improve the health with a small number of patients needing significant help and wellbeing of people in West Kent over 2009/10. This for serious respiratory complications. In spite of these work has included preventative programmes to help difficulties, hospitals improved performance over the people address lifestyle issues, improving access to year in these areas. screening and vaccination to identify or stop future problems, and improving support and information. Equally importantly, patients reported that the experience they had of these services was better than in In 2009/10 NHS West Kent offered eye screening to 100 the past. per cent of people known to have diabetes. This is important, as diabetes can lead to eye damage. Regular Creating a seamless service screening of the tiny blood vessels at the back of the eye can potentially prevent the blindness which can We have also helped to create better links between occur if diabetes is not managed well. hospitals and other parts of the health system to create a more seamless and responsive service to people who We also increased the number of children who had the need health services. An example of this is the triple Measles, Mumps and Rubella (MMR) vaccination commissioning of a new out-of-hours primary care and girls who had the Human Papillomavirus (HPV) service, which was preparing to go live as the financial vaccination. This has helped to prevent potentially life- year ended. threatening conditions in a large number of people. We also rolled out screening for bowel cancer for over-65s In addition, an innovative service based in A&E during the year. departments is fully integrated with the GP out-of-hours service. This has helped to ensure that patients are Acute care directed towards the most appropriate service, meaning they are seen and treated faster and acute services are Performance across acute hospitals in West Kent freed up for more appropriate patients. improved significantly in a number of areas in 2009/10. Since May 2009, a seamless service for people who The out-of-hours and GP ‘front end’ services have have a stroke has been in place, meaning wherever they considerable potential to improve people’s access to the are in West Kent and at whatever time of day the stroke right services, while costing less than the previous takes place, they will have direct access to ‘clot-busting’ service did. drugs at one of four hospitals operating on a 24-hour rota. A major test of the way health services worked together was seen in the Swine Flu pandemic, which was first Hospital acquired infections have been a very important declared by the World Health Organisation in April 2009. issue to many people in West Kent following the NHS West Kent appointed a director and team to Healthcare Commission’s critical report into Maidstone oversee the local health system’s response to this and and Tunbridge Wells NHS Trust in 2004. Since then, other winter pressures. The team marshalled services however, a great deal of work has been done by the trust across the area to make sure the spread of infection was NHS West Kent annual report 09/10 09

minimised, anti-viral medication was available to anyone Individual requests for treatment are made in rare or who needed it, GPs were supported and kept informed, exceptional cases, or where the PCT does not have a and the vaccination programme was available to people commissioning policy that covers a particular health in vulnerable groups. need. Examples are where a consultant recommends a cancer drug that they believe will benefit the patient, This work was highly successful, with over 70 anti-viral despite the drug not being licensed or approved by the collection points set up in community pharmacies and National Institute for Health and Clinical Excellence around 40 per cent of the at-risk population vaccinated (NICE) for that particular use. before the virus began to diminish in early 2010. In the past, NHS West Kent was publicly criticised for the The West Kent CareCall telephone based support decisions it made in these cases. Some of these were service promises to complement existing services by overturned on appeal and there were suggestions that giving GPs more data about the particular health issues the PCT was being inconsistent. The PCT engaged the in their local areas, at the same time as helping patients carer and husband of a patient, who had initially been use services more effectively. The service was refused requested treatment for bowel cancer, to help us introduced in late 2008/09, and became firmly develop the new policy. The new process is clearly established in 2009/10 with more than a third of West based around principles of fairness, with all decisions Kent GP practices signed up for the service to be being made on the basis of the best clinical evidence offered to their patients. available.

Creating a fairer service Engaging someone with experience of the system also helped to make it one of the most inclusive of any PCT. In 2009/10 we made major strides in enabling the voice An important part of the process is that the patient, or a of the public and clinicians to shape the services we representative of their choice, is invited to address the build and the decisions we take. Members of the public panel directly so the process is not just held behind have helped us commission a new out-of-hours GP closed doors. Panels can also have a lay member who service and are helping us improve choice in maternity has the same decision-making powers as PCT and services. clinical representatives to ensure an independent view.

A major development for NHS West Kent in 2009/10 was the introduction of a new policy for individual funding requests in January 2010.

A 12-year-old girl who was born with one leg shorter Four months after she than the other underwent pioneering surgery in France, thanks to a decision by the Individual Funding Request completed lengthening, she panel. Although leg lengthening surgery is available in “was off crutches, could dance the UK, the girl’s family wished to have it performed in and run short distances and France, where a radical new procedure is used. was considering hockey. But The family’s consultant applied to NHS West Kent and she said the single biggest the family presented their case to the panel for having thing for her is that for the

the surgery abroad. The panel considered the safety first time in her life she can

and efficacy of the treatment before making a decision walk with both feet flat on to fund. the ground. She is doing In summer 2009, the school girl travelled to France for phenomenally well an“ d the procedure, which involved inserting a metal thriving, and none of it ratcheted rod inside the bone marrow. She had a two- would have been possible month stay in France for surgery and intensive post-op, including daily ratcheting of the device implanted within without the PCT. the leg to continually achieve small amounts of growth. Her parents 10 NHS West Kent annual report 09/10

Foundations for the future In addition, not engaging these populations in a discussion about lifestyle factors will lead to a significant cost to the NHS West Kent’s significant achievement during NHS with an increase in long-term conditions and 2009/10, has been to put in place the means to change preventable illness. the way healthcare is provided so we can meet the challenges of the years to come and fulfil our ambitions. Lifestyle factors The principles and plans for our future development are set out in chapter 3, ‘Focusing our efforts to realise our The cost of healthcare related to obesity, alcohol and ambition’. smoking across the whole of West Kent is over 20 per cent of the PCT’s total budget. Over 2,000 people die in The challenges, however, are considerable. With the West Kent every year due to smoking, while over changing nature of the population’s health needs and 130,000 residents are estimated to be obese. the likelihood of increased financial pressure, continuing with the NHS in the same form as it is currently will The ageing population simply not be an option. The ageing nature of West Kent’s population will also lead to greater pressure on the health service in the Considerable future. The Office of National Statistics estimates that by 2017, over-65s will make up one fifth of West Kent’s Challenges population.

• Changing population Over-65s are 18 times more likely than the average to • Lifestyle factors suffer long-term heart or circulation problems. They are • Long-term conditions also 20 times more likely to suffer eye conditions. In • Economic and political 2009/10, a third of West Kent’s population of over-65s suffer from long-term conditions. This age-group tends, A number of significant challenges faced the NHS as a unsurprisingly, to use more health services than the whole in 2009/10 and will continue to do so for years to average. come. NHS West Kent also faced specific challenges locally. Long-term conditions Population Long-term conditions such as diabetes, heart disease, hypertension and even common mental health disorders The population of the more deprived areas of West Kent are are increasing, nationally and locally. In West Kent, 15 more likely to suffer health problems arising from lifestyle per cent of people suffer from a long-term condition. factors such as smoking and poor diet. However, Data we have gathered shows that the five per cent of experience tells us that although people in these patients in the group most at risk from long-term circumstances would tend to need services more, they conditions spend over fifty times as long in hospital than actually use NHS services less than the average. the average.

At the present time, men in the 10 per cent most deprived In some areas, things are heading in the right direction. areas will live on average seven years less than men in the Mortality rates have reduced in recent years. However, 10 per cent most affluent. For women, the difference is four the inequalities in life expectancy according to level of years. deprivation are still marked. The biggest causes of death in West Kent are stroke, heart disease and cancer. West Engaging these groups is a challenge the health service Kent currently has worse survival rates for cancer than faces - failing to ensure they are knowledgeable about the average for England, and yet we spend more than health and seek help early will mean failing to catch the national average. problems sooner. This could lead to more health problems in this population and a potential increase in preventable The number of people with diabetes in West Kent is deaths. expected to increase by 2.3 per cent each year between now and 2015 - Type 2 diabetes is strongly associated with ageing and obesity, both of which are set to increase. NHS West Kent annual report 09/10 11

There are estimated to be 8,000 undiagnosed diabetics The degree of political and public interest in health in West Kent, leading to greater risks of complications. services has led to developments in maternity services being scrutinised at the highest level. In February 2010, The ageing population and the increase in long-term the HOSC referred the proposed centralisation of conditions means that a growing proportion of the maternity services in the new Pembury Hospital to the population will take on caring roles in future. Secretary of State for his consideration. The Secretary of State passed this to the Independent Reconfiguration Financial situation Panel, to look at the evidence around the need for change. The global economic downturn has added to the pressure on the NHS both locally and nationally. In recent years including 2009/10, NHS West Kent has Focusing our efforts to benefited from a five per cent increase in budget above inflation. It is likely that after 2010/11, NHS West Kent will realise our ambition only receive budget increases in line with inflation. If our commissioning spend was to continue to increase at the • Increasing community support for patients and current rate, this would mean a £150 million gap in the carers budget over five years. • Putting people in control of their healthcare • Increasing efficiency and improving performance NHS West Kent has been working for a number of years • Plans for the next five years to get more for less for the people of West Kent. This has involved looking at our own management costs, which The challenges NHS West Kent faced in 2009/10, and are among the lowest for any PCT in the South East, but will continue to face in the future, make it harder to which we intend to reduce further by nearly 30 per cent achieve our ambition. They do not however, change at all over the next three years. what we want to achieve - that the people of West Kent will enjoy the best possible health. In fact, the financial We have been working with provider organisations to and population challenges make it even more imperative improve efficiency, taking full advantage of the market to that we work towards that aim with pace and purpose. get best value, and developing services that will reduce the cost to the NHS over time through improving health. The challenges we have explored and set out have informed the work we have done in 2009/10 and our The current financial situation means we will have no plans for the future. The principles of this work are: room for compromise when it comes to driving efficiency improvements and reordering the health service to focus • we will increase the level of support to patients and on prevention. their carers in the community, • we will develop services to help people take control Political and reputation challenges of their own health, • we will continue to improve, innovate and increase The population of West Kent is well informed and efficiency in health services. engaged in debate about public services. This has led to a significant amount of public interest in The achievements we have made historically and in developments such as the new hospital at Pembury. 2009/10 were set out earlier - however, these Local people are proud and protective of their local achievements are in many cases an important step services, which in part is a testament to the high regard towards achieving our overall aim of ensuring that the in which they are held. It does however mean that people of West Kent enjoy the best possible health. people are reluctant to accept the need for change and the NHS has to argue its case very strongly. Increasing support

Kent County Council takes a close interest in health, and NHS West Kent recognises that being responsible for the has set up the Kent Health Watch telephone service to healthcare of a population of over 670,000 people does signpost patients and the public to the appropriate part not simply mean providing services to fix problems once of the health service. The Council’s Health Overview and they happen. We have endeavoured to take a holistic Scrutiny Committee (HOSC) has taken a close interest in view of healthcare. a number of developments. 12 NHS West Kent annual report 09/10

An important plank of this strategy is recognising that In 2009/10, NHS West Kent successfully bid to run a new people should be able to get support closer to where pilot programme to improve NHS support for carers they live and even in their own homes. Another important across West Kent. The scheme is one of only seven in point to recognise is that many people with long-term the country and will be operated in partnership with needs rely on one or more carers - we need to support voluntary organisations. As part of the pilot, new these carers to continue their caring role and to ensure dedicated staff will now work directly with carers in the their own health needs are met. area to boost the help they get from the health service.

Carers can often feel isolated or even depressed due to the responsibility, stress and practicalities of caring for someone. Our role is to help relieve some of that stress, such “as helping to organise respite care, working with Social Services, GP practices, hospitals and directing

them to other support organisations. We also keep in touch with carers to make sure

they are seeing results.

“We’ve had great success at Darent Valley Hospital, particularly on the dementia “ ward, where we have a visible presence. We help carers prepare for when the person they care for is discharged and we’ve put together information packs for both carers and staff.

Tanya Stephens is a Carer Support Worker as part of NHS West Kent’s pilot programme, Better NHS Support for Carers, which launched in April 2010. She supports carers across Gravesend, Dartford and Swanley, alongside her co-worker Jo Hankey. NHS West Kent annual report 09/10 13

NHS West Kent has also worked hard to increase service aimed to prevent people with dementia being support for people with dementia and their carers. admitted to hospital or to a care home because of Services for people with dementia were not fully meeting problems with their carer. The service is designed to best-practice and relied heavily on inpatient beds, which enable individuals to remain in their own homes with were expensive compared to the level of care people appropriate support, including night sitting where received. A listening exercise in 2008 told us that people necessary. It is short-term service which supports the found the care inconvenient and with insufficient support person with dementia and their carer through a crisis at home. period up to, but usually less than, six weeks.

Closing some of the rarely-used beds freed up The service was commissioned from the private and resources to enable us to start putting in place the voluntary sector and it was operational from April 2010. It services people told us they wanted. An example of this is a person-centred quick-response crisis service using is liaison between acute services and patients with their trained and experienced care workers, who can be carers. This is essential to ensure that people are mobilised quickly and are able to stay with the person assessed correctly and supported wherever possible to with dementia and their carer until a full assessment of return to their own homes. Acute liaison is now in place their needs can be made. This will enable better in all three acute hospitals in West Kent. A review is planning, avoid unnecessary admissions and enable planned to ensure the service can meet demand. crises to be better managed.

Another important area people told us they wanted was crisis support. NHS West Kent commissioned a new

Helping people take control

When his bowel cancer and lung metastasises spread to his brain, 66-year-old Michael Shackleton was adamant he would spend his last days in the comfort of his own home. With the support of his GP and local hospice, this was made possible. Michael’s widow, Kathy, has spoken out about the exceptional care her husband received and the valuable support she and their two children experienced. She said:

Dr Nicola Pulham from The Orchard Medical Centre provided care above and beyond what anyone could expect. Her manner and approach on each visit was such that my children and I felt utterly comforted that Michael was being looked after. We knew the situation was extremely critical, but we never felt alone “– instead we felt totally supported and cared for.

As well as Dr Pulham’s support, we had visits from two excellent district nurses based at Coxheath. Fiona visited us at home when my husband was first released from hospital. She has a lovely manner – soothing, caring and comforting. As well

as taking care of my husband’s personal needs, Jude lifted our spirits with her attitude and positive frame of mind.

My grief, and that of my children’s, is tempered by the knowledge that Michael’s medical care was second to none, that everything th“ at needed to be done for him was done, and that his suffering was minimal. This is entirely due to the excellent doctors and nurses who helped him and supported us. Losing a loved one is never going to be easy, but the way in which Dr Pulham, Fiona and Jude helped us made the experience seem somehow manageable. 14 NHS West Kent annual report 09/10

Self-management Katherine Markey , who was diagnosed with In 2009/10 NHS West Kent developed its self- diabetes two years ago, is much more confident management strategy. This aims to set out how we can about managing her condition thanks to CareCall. support people to manage their own health needs. There are numerous benefits to this - patients experience more The 73-year-old came across CareCall when her control and choice, as well as better health. The strategy doctor’s surgery, The Cedars Surgery in Swanley, was developed after seeking views from members of the signed up to the service. She said: public, including 33 people with long-term conditions and 11 carers.

By managing their own health better, especially where The service is fantastic long-term conditions are concerned, people tend to – I have talked to friends and have fewer episodes of serious poor health. This in turn reduces pressure on the health service and reduces neighbours who, while they don’t cost so resources can be invested elsewhere. “need to use the service at the moment, are reassured to know that For example, data shows people in West Kent with it is there for them if they do. I was diabetes control their blood sugar well. The PCT is in the surprised to hear that not all top 25 per cent of PCTs for people whose blood sugar level is in acceptable limits. However, control of blood surgeries use the service – I think pressure is below the national average and work needs anyone with a long-term condition to be done to reduce the number of people with like mine would benefit from diabetes who are admitted to hospital in an emergency. speaking to a Health Coach.

Diabetes is a long-term condition that, if poorly managed, can lead to hospital admission for My Health Coach, Gwen, has really complications such as hypoglycaemia and ketoacidosis. helped me manage my diabetes by It can increase risk of heart attack, stroke and blindness. offering suggestions and encouragement on diet and exercise. The self-management strategy looks at co-ordinating She’s really terrific, and my family care better by developing personal plans for patients, as well as improving access to information and education. are reassured because they feel the The strategy looks at linking services better with existing service has given me much more health improvement initiatives such as weight confidence and they feel happier that management. I’ve got extra support.

CareCall My doctor is great but when I go to

West Kent CareCall is an innovative service that puts see him there is a lot to take in and I patients at the centre of their own healthcare decisions. don’t always think of the questions I The service is telephone-based and consists of trained needed to ask u“ ntil afterwards. Now nurses called ‘health coaches’ developing ongoing I can speak to Gwen who helps me relationships with patients to give advice and encouragement, and support their use of the health when I need an answer, and makes service. This has already proved invaluable for a number me feel better about myself and my of people who have not previously had the confidence health. or the knowledge to get the best out of the health services they use. The health coaches can link between services, signpost patients to the most appropriate services, and over a period of time learn their needs and wants and how best to meet them. NHS West Kent annual report 09/10 15

Health Trainers NHS Health Trainers are recruited from local communities and have a strong working knowledge of NHS West Kent is developing further new services to local services and programmes and an understanding support local residents who want to have more control of local challenges to health. They aim to help people over their health, and who want to make health improving make successful behaviour changes through the lifestyle changes. Another example is the Health Trainer development of personalised plans and a programme service. of motivational support.

Health Trainers worked with 23-year-old Chloe Wilde Health Trainer Sarah Surry said: to help her lose almost two stone in weight.

Chloe attends Peppercorns in Dartford, part of DGSM yourChoice, a charity which supports people Chloe’s weight loss was with learning disabilities.

achieved by her sheer determination In January 2010, Chloe and her group embarked on and enthusiasm. She has gone from

a healthy living course under the guidance of a being someone with little knowledge project worker. This aimed to tackle all areas of “ of healthy eating to someone who health, but in particular to concentrate on weight definitely understands the management issues. “ implication of a poor diet. She The Health Trainer service became involved in achieved this with the support of two weekly meetings with the group, who had poor partners working together – DGSM eating habits and little knowledge of healthy living. yourChoice and the NHS Health The weekly sessions included health education, diet Trainer service. advice, food diaries and regular health walks.

Chloe weighed 20st 1lb on 28 January 2010, but four months later she had lost 2st 8lbs.

Prevention South East. This was a live discussion event designed to gauge the public’s view on alcohol and developing ideas It is a well-used truism in healthcare that prevention is to reduce alcohol-related problems in society. better than cure - however, the NHS has traditionally not been as good as it could have been at living by this In March 2010, NHS West Kent hosted the South East principle. NHS West Kent launched its Prevention launch of the new Start4Life programme, designed to Strategy in early 2010, and this sets out how we intend to help inform and educate new mothers about improve the health of the population by preventing future breastfeeding and other health issues for babies. In this health problems. This encompasses a range of areas way NHS West Kent is helping to realise the idea of the where health problems are preventable, such as obesity, NHS as a ‘cradle to grave’ service. smoking, sexual health. There are already a range of programmes for these areas, linking in with national initiatives such as Change4Life.

The implementation of the national Health Checks programme by 2012 will lead to the identification of more people with undetected disease and should improve the management of cardiovascular risks. In 2009/10, NHS West Kent was at the forefront of the national debate about improving the nation’s health. In November 2009 the PCT supported The Big Drink Debate in Maidstone, one of only two such events in the 16 NHS West Kent annual report 09/10

Increasing efficiency Diabetes Research conducted by NHS West Kent showed a need and performance to streamline services for people with diabetes. A typical pathway for a newly diagnosed Type 1 diabetic may Alongside the introduction of revolutionary new services involve contact with up to four different providers in the such as CareCall, designed to fundamentally change first year, including GP practice, acute hospital, the way people use the NHS, we are committed to community services and retinal screening provider. developing existing services. Driving improvement in existing services means they will benefit more patients to A number of local Practice-Based Commissioning a greater degree. It also means they will become more groups have begun to focus on diabetes care through a cost effective, so funds can be re-invested in the health range of local schemes. There is interest in improving service to improve other services and develop new the consistency of diabetes care and in ensuring that ones. This ‘more for less’ principle will be a critical strand good quality care is provided close to people’s homes of NHS West Kent’s strategy as we move into leaner with the assurance of appropriate expertise and financial times. support. A technique we use to help measure this is called Ophthalmology programme budgeting - we look at the outcomes achieved in various services across the country A good example of the kind of development that NHS compared with the amount spent on them. This gives us West Kent is championing can be seen in ophthalmology a strong indication of whether we are achieving good services. The Community Ophthalmology Team is made results and getting good value for the taxpayer. up of optometrists and a GP, and they operate out of local opticians’ practices. This has enabled patients to Stroke avoid visits to hospital, with all the attendant inconvenience arising from travel, parking and waiting. Before 2009/10, stroke services in West Kent were After a successful pilot, the service has been expanded uneven across the patch and the outcomes for people to cover all of West Kent who had a stroke were not always as good as we would hope for, compared with elsewhere in the country. During It provides a more convenient service for patients and the last year, therefore, a major programme of improving links in better with GP practices. This is an example of these services took place. Maidstone Hospital opened the planning we have developed in our Strategic its stroke unit, meaning all three major hospitals in West Commissioning Plan for the next five years. Kent have a fully operational stroke unit.

Importantly, alongside the new unit is a specialist neuro- psychology team in place across the area - one of only a Snodland few such teams in the country. Aylesford Continuing the theme of building links between services and developing more support in the community and at home, a pilot for supporting discharged stroke patients in the north has extended to South West Kent. We intend Allington Bearsted

to build on this approach to achieve strong community West rehabilitation and rapid access to therapy. Hadlow Malling Maidstone Coxheath Lenham The performance of the service is being managed Barming Shepway closely by NHS West Kent and improvements have Wateringbury

already been demonstrated. For example, we now meet Sutton Yalding Valence Langley

the national standard that stroke sufferers spend 90 per Paddock cent of their time in hospital in a dedicated stroke unit. Wood

Brenchley

Pembury

NHS West Kent annual report 09/10 17

The Community Ophthalmology Team consists of they can be seen sooner and in more convenient 17 optometrists and one GP, who treat people with and familiar locations. serious eye problems in the community, rather than in hospital. The team has recently expanded to cover Deacon Harle, Optometrist and Community the whole of West Kent, as a result of its success in Ophthalmology Team member, said: South West Kent.

Before the Community Ophthalmology Team, if you had a problem with your eyes, your optician would Until recently, if you had

refer you to your GP, who would refer you to hospital. glaucoma it meant treks to hospital But now, the team gets involved right at the and a lengthy waiting list. Now you

beginning so patients get quicker and more could be seen in a local optician’s convenient treatment. Once your optician decides “ surgery at a time that is more you need to see a specialist, the team determines convenient for you. The principle whether it is best for you to be treated in hospital or “ by a member of the team in your local community. of treating people closer to home, with greater accessibility and One condition the Community Ophthalmology Team convenience, is one that will be frequently sees is glaucoma, which if left untreated seen in an increasing number can cause blindness. People with stable glaucoma can have their six-monthly check-ups with a member of services. of the team at their local optician’s practice, meaning

The next five years The areas earmarked for development are:

NHS West Kent is building on these foundations to • revamp cancer care by developing a ‘pathway’ for create real, significant improvements in healthcare over cancer patients, the next five years as we work towards West Kent people • create better outcomes for stroke patients, and enjoying the best possible health. These developments reduce inequalities, are enshrined in our Strategic Commissioning Plan Best • increase access to NHS dentistry, Possible Health developed in 2009/10 and looking to the • reduce the incidence of diabetes, and improve the future. quality of services, • improve sexual health and increase access to GUM We took the principles we knew would lead to the services, transformation of the health service into the form it would • build levels of immunity to infectious diseases need to take for future years. We looked at the areas that through vaccination, would lead to the greatest improvement and focused our • improve women’s experience of childbirth, efforts here. • improve the efficiency and performance of mental health services, This work led us to identify priority areas that fitted within • obtain better outcomes in neurology from a the principles shown at the beginning of this chapter as streamlined service, well as the need to transform community services • develop a network of services for trauma and injury described in the introduction. service, • utilise the market better to get better services and value, • develop a strategy for preventing ill health, • develop personalised care that supports people to control their own health, • develop a future model for community services, • develop a model of care for older people, and • develop community based services for respiratory diseases. 18 NHS West Kent annual report 09/10

Pride, pace and purpose

NHS West Kent must carry out this transformation of the health service in the same way that we have worked throughout 2009/10 - with purpose, as we have identified our path and must not be diverted from it; with pace, because today’s circumstances do not allow for delay; and with pride, because everyone in NHS West Kent has worked tirelessly and achieved great things for the people we serve.

Our work so far and our future plans, as you have read, involve being more efficient, doing more with less, and putting people in control of their own healthcare. This is not about limiting access to care or passing the health service’s responsibility to the people who rely on it. It is about finding out where people can be less reliant on the health service to benefit both them and the population as a whole.

The overall trends in the population and its health needs mean we need to make care more seamless and convenient, to provide care closer to home and better support to enable that.

The challenges we face are considerable, but we can overcome them and make West Kent people the healthiest in Britain. NHS West Kent annual report 09/10 19

NHS West Kent recognises that when a complaint is Statutory and business made it is important that everything is done to correct any injustice and hardship endured. Complaints are information Advice investigated taking all factors into account without bias, unlawful discrimination or prejudice. Failures are and information acknowledged and responsibility accepted with a clear explanation and regret for any hardship that may have for patients occurred. The PCT uses lessons learned to ensure that poor service is not repeated. Our freephone helpline (0800 0 850 850) provides a first point of contact for people who need information and Remedies offered will be fair and proportionate to the support to access local health services. complainant’s injustice or hardship where possible, returning the complainant and others who have suffered In 2009/10 the Customer Services Team dealt with 4,567 similarly, to the position they would have been in if the calls – more than double the number of calls the situation had not occurred. previous year, which totalled 1,877. On-the-spot help and advice was offered to 700 callers, while 3,800 were Staff satisfaction and engagement signposted to a range of services across West Kent. The greatest number of calls received was from people Following the 2007/08 staff survey we introduced the looking for an NHS dentist. Turning Point programme to improve staff experience and satisfaction. Focus groups and other dialogue with In 2009/10 we published the second of our annual staff highlighted key themes for improvement. ‘Good Health Guide’, providing health advice and explaining the treatment options and services available Staff survey 2009 locally. The 2010/11 updated version is currently being distributed to every household in West Kent. In 2009 NHS West Kent encouraged all staff to take part in the national staff survey, whereas in previous years a During 2009/10 we continued to develop the PCT random sample was asked to complete the survey. Sixty website, which was launched the previous year, with per cent of commissioning staff responded. more information and advice for patients - www.westkentpct.nhs.uk. In the following areas, NHS West Kent’s results were better than national average Complaints handling • Impact of health and well-being on ability to perform work or daily activities The Local Authority Social Services and National Health • Staff appraisals Service Complaints (England) Regulations 2009 came • Work related injury into force on 1 April 2009. In the following areas, NHS West Kent’s results This followed a pilot in West Kent of a complaints represented an improvement over 2008 handling process designed to be more flexible and offer • The number of staff who have had appraisals rose more responsive early resolution. to 82 per cent • The number of staff indicating they had support A number of important changes have been made within from their managers rose the NHS West Kent complaints process as a result of • The number of staff who had completed equality participating in the pilot, including more face-to-face and diversity training increased meetings with complainants at an early stage, service managers taking more responsibility for investigating and dealing with complaints, working more closely with GPs to support their complaints management, and establishing a complaints review group to ensure the organisation learns lessons, which is chaired by a non- executive director and includes lay representation. Adherence to principles for remedy Following previous surveys the PCT had instigated the 20 NHS West Kent annual report 09/10

Turning Point programme to improve staff satisfaction. programmes and supporting staff to undertake 3,099 Focus groups and other dialogue with staff highlighted clinical development training courses. In addition to this key themes for improvement. We have made significant 5,585 applications were approved for staff to undertake progress in each of the areas: statutory and mandatory training.

• Improving leadership by establishing the West Kent Health and safety Leaders’ Forum and good employment workshops for managers The PCT meets its responsibilities under the relevant • Ensuring management value staff by providing legislation and constantly seeks to improve compliance training in appraisal and health and safety, and around organisational risk management standards and holding monthly staff forums legal obligations. • Improving communication by introducing the Good Health Guide, distributed to every household in West All staff receive health and safety training as required Kent and the PCT produces regular reports and undertakes • Providing better tools to help staff to do their job, risk assessments on health and safety issues, such as such as easy-to-understand flow charts for fire risks and security. The PCT emphasises learning processes like recruitment and ordering from incidents to avoid repeat issues, and staff are • Improving IT by investing £1.6m in new PCs, making encouraged to report their concerns so the organisation our e-mail system better and improving the network can respond.

Sickness absence and stress at work Emergency planning

The number of full-time equivalent staff lost each month NHS West Kent has a major incident plan that is fully due to sickness in 2009/10 was 2.82 per cent in the compliant with the NHS Emergency Planning Guidance commissioning part of the organisation and 4.8 per cent 2005 and all associated guidance. Preparedness was in the ‘arm’s length’ division, West Kent Community tested in a number of national and regional exercises Health. during 2009/10 including Exercise Saxon Shore in August 2009 which tested organisations’ response to a Sickness absence rates due to stress rose by 2.12 per ‘dirty bomb’ explosion in Dover, and Exercise Black cent in NHS West Kent commissioning and fell by 0.11 Velvet in March 2010, which tested organisations’ per cent in West Kent Community Health during the past responses to a ‘toxic plume’ incident. year. We are training staff about how to recognise signs of stress and highlighting the support available to them. Sickness absence rates and the reason for absence are Measuring Performance regularly monitored. National scrutiny Equal opportunity and diversity policy NHS West Kent is assessed for how well it commissions We are committed to a policy of equality in employment services through the World Class Commissioning practices and strive to eliminate unfair discrimination, Programme. This measures PCTs against 11 harassment, bullying and victimisation. Equality of competencies from level 1 to level 4, 4 being the highest. opportunity is a high priority within the PCT. We will not During 2009/10, the first year of the programme, NHS unlawfully, unfairly or unreasonably discriminate or treat West Kent was assessed with five competencies at level individuals less favourably on the grounds of gender, 1 and five competencies at level 2. Significant marital status, sexual orientation, religion or belief, improvement is expected for the following year. disability, age, race, nationality or ethnic origin. The Care Quality Commission (formerly the Healthcare Education, development and training Commission) conducts an annual evaluation of NHS organisations based on a range of national targets and We invested £526,302 last year to develop staff skills standards. For 2009/10 the PCT’s quality of and competencies. In total over 11,000 training commissioning services was assessed as ‘good’, which applications were processed including sponsoring 30 means that NHS West Kent received at least the second people to undertake professional registration highest score for all the assessments that contribute to qualifications, supporting 50 staff to study for NVQ the overall score. These include meeting core standards, NHS West Kent annual report 09/10 21

meeting existing commitments and performing well against national priorities. The equivalent score in 2008/9 NHS West Kent Stop Smoking Service helps was ‘fair’. around 3,000 people give up each year. Anne Cable, a 31-year-old teacher from Gravesend, is The targets and priorities include: just one of the service’s success stories.

• Eye screening for diabetics Anne smoked for 12 years before quitting in March • Waiting time for hospital treatments 2009. She decided it was time to kick the habit as • Supporting patients so they can be discharged from she stood next to the coffin of a close friend who hospital as soon as they are medically fit to leave died of smoking-related cancer. • Administering thrombolysis treatment to heart attack patients within one hour She said: • Providing effective treatment for drug users • Reducing the number of overweight and obese children This was the first time that the health implications really hit me. Many of the areas are also national challenges, such as chlamydia screening, smoking cessation and teenage She was far too young to leave us, and pregnancy rates. To improve uptake of chlamydia left behind a shattered family. I stood screening among 15 to 24 year olds, NHS West Kent has “next to her coffin and I knew I didn’t developed a number of projects including screening want that to be me.” promotion at events such as university freshers’ weeks and local music nights, in addition to ongoing work in place with GPs and pharmacies. The smoking cessation Anne went to her nearest NHS West team has worked across a range of settings to enable Kent Stop Smoking Service drop-in easy referral to smoking services, including working with and started group sessions, local businesses, local hospitals, GPs, midwives and completing a 12-week course. dentists. Despite this progress, there is much more work to be done in these and other challenging areas. Sarah my counsellor was great. I was The Audit Commission measures how effectively NHS worried that it would be ‘My name is organisations use the resources that are allocated to Anne and I am a smoker’, but it them wasn’t like that at all. I’d let her know if I was struggling and we simply The PCT’s score for ‘use of resources’ for 2009/10 was ‘good’, which means that NHS West Kent is adjudged to chatted like friends. I still have her exceed minimum requirements and perform well. The details in case I am ever tempted to equivalent score in 2008/9 was ‘fair’. relapse.

The outcome of NHS West Kent’s Annual Health Check The Stop Smoking Service helped in 2007/08 was ‘fair’ for use of resources and ‘fair’ for quality of services. because it gave me a weekly focus and provided a place where I knew I wouldn’t be judged. Since I gave up, I don’t sm“ ell like an ashtray anymore, my skin is much clearer and I’m not constantly bunged up. My morning ‘throat clear’ is also a thing of the past. 22 NHS West Kent annual report 09/10

Local scrutiny and audit Risk assessment and management

Kent County Council’s Health Overview and Scrutiny The Board receives regular reports on risks and reviews Committee provides local scrutiny on health and social action plans to address them, in accordance with the care issues. PCT’s risk management strategy and policy.

South Coast Audit provides internal and counter fraud Clinical risks are addressed by the clinical effectiveness services for NHS West Kent, and provides audit on the and quality committees. Subgroups working on organisation’s arrangements for corporate governance, information governance, risk management and a range risk management and assurance, and assessing value of compliance areas report to the Governance for money. Management Group.

The Kent LINk is an independent network that enables The audit committee oversees the maintenance of the local people and community groups to influence and system of integrated governance, risk management and improve health and social care in Kent. internal control that supports the achievement of the PCT’s objectives. Performance management Incident reporting The PCT Board provides internal scrutiny, monitoring operational and financial performance. Regular reports NHS West Kent encourages staff to report serious and data are received from the senior management untoward incidents (SUIs) so that lessons are learned team. and guidelines developed to reduce the risk of future harm to patients or staff. A serious untoward incident is Regular directorate business and performance review defined by NHS South East Coast as an “accident or meetings are used to monitor progress against business incident when a patient, member of staff, or member of objectives. Change programme boards provide an the public suffers serious injury, major permanent harm opportunity for the strategic overview of commissioning or unexpected death, (or the risk of death or injury), on decisions in key areas under development. hospital, other health service premises or other premises where health care is provided and where actions of Performance of local acute hospitals, mental health and health service staff are likely to cause significant public community service organisations is monitored and concern”. managed through contract terms and Service Level Agreements (SLAs), which set out required standards of In July 2008 NHS West Kent took over from NHS South service to be met. The Kent and Medway Acute East Coast the management of SUIs occuring at trusts Contracting Team and South East Coast Specialised the PCT commissions services from - NHS West Kent’s Commissioning Group measure performance against SUIs are managed by the strategic health authority. The these SLAs on behalf of the PCT. All other SLAs, PCT’s patient safety group plays an important role in including the contract with West Kent Community Health, managing SUIs and ensuring that processes and are monitored by designated PCT leads. procedures are correctly followed.

Clinical governance During 2009/10, the PCT managed 97 SUIs from trusts it commissioned services from, and 17 from the PCT itself The clinical governance team safeguards standards, and services it manages. ensuring safety and quality of care. It works across the PCT and includes specialists in infection control, clinical audit and patient safety.

Clinical governance includes the analysis of complaints and of incidents reported by staff, sharing best-practice and measuring performance against agreed benchmarks. NHS West Kent annual report 09/10 23

A Carbon Committee has been established to help NHS Information Governance West Kent implement low carbon and sustainable initiatives wherever these are practicable. In December Data protection 2009, the PCT announced its commitment to 10:10 – an initiative to reduce carbon emissions by 10 per cent in Staff receive training in the Caldicott guidelines to 2010. protect the confidentiality of patient data. Staff are required to password-protect documents containing This commitment has received support from all directors. patient data sent electronically, to use ‘safe haven’ fax The PCT has also applied to join the NHS Carbon numbers and to use locked print when printing to shared Management Programme, which will enable it to printers. Patient data taken outside the PCT on laptops or accurately measure its carbon baseline and the effect of other electronic media must be encrypted. the actions it is taking to reduce carbon emissions.

The potential for a breach of confidentiality is identified NHS West Kent urges its employees to take simple steps as a high risk given the data which the organisation which can make an immediate difference, including regularly uses in the course of its business. Risk controls recycling, shutting down computers, lights and are in place to minimise any loss of information. The risk electronic devices as much as possible to save energy management group, information governance steering and adopting a carbon-aware approach to travelling to group, Caldicott guardian and the board all participate in work and meetings. maintaining and checking these controls. Data loss and confidentiality breaches Equality During 2009/10 there were 11 SUIs reported which and Human Rights related to the loss of information. In these cases confidential information was lost. Comprehensive The preservation of equality, diversity and human rights investigations and thorough root-cause analyses were is central to the values of NHS West Kent. The PCT carried out in all cases to identify the reasons for the strives to improve access to services and considers the incidents and lessons were learned. These were shared diverse needs of people who experience disadvantage across the organisation in order to prevent such or health inequalities due to social class, deprivation, occurrences in the future. In all cases the individuals ethnicity, disability, age, gender, sexual orientation and whose information was lost were informed of the breach religion or belief. and apologised to. Equality and Human Rights Strategy Freedom of Information The Equality and Human Rights Strategy 2007-2010 sets The Freedom of Information Act gives the public the right out the PCT’s commitment to ensuring that all services of access to information held by public bodies. A are accessible, equitable and free of discrimination. The Publication Scheme is available on the website PCT’s three equality schemes also set out our legal (www.westkentpct.nhs.uk) which contains a range of obligations and clear aspirations and action plans for information, making it easy for people to get hold of promoting race, gender and disability equality. information they may require. In line with NHS guidelines, NHS West Kent moved towards a single equality scheme (SES) in 2009. The Environmental Issues SES encompasses the six equality strands of race, gender, disability, age, sexual orientation and religion or and Sustainability belief. The NHS is the largest organisation in the UK, and with Equality Impact Assessments (EIA) 25 per cent of total public sector emissions in England it is the largest contributor to the public sector’s carbon The Race Relations (Amendment) Act 2000, Disability footprint. Climate change is also predicted to have major Discrimination Act 2005 and the Equality Act 2006 harmful impacts on human health, making it even more require all public authorities to asses their functions, vital that the NHS commits to tackling the problem. policies and services for impact in relation to race, disability and gender equality and to publish the results. 24 NHS West Kent annual report 09/10

An EIA provides an opportunity to assure and promote strategies and services. A rolling programme of policy inclusive and fair service delivery and employment review is being undertaken, which includes existing and practices. EIAs consider the implications of policies and new policies. services for race, gender, disability, age, sexual orientation and religion/belief. EIAs are reviewed by the Head of Equalities and Human Rights, then discussed at the champions’ group and are NHS West Kent has developed an EIA framework and approved by the equality and human rights committee agreed an implementation plan with each directorate as before being uploaded to the PCT website. well as the organisation as a whole to review all

Corporate Governance

PCT Board

A Board of non-executive and executive directors, led by Chairman David Griffiths, governs the PCT.

The non-executive directors are members of the public with professional expertise, appointed by the NHS Appointments Commission to bring an independent perspective and rigorous scrutiny to decision making. Name Title David Griffiths Chairman Steve Phoenix Chief Executive Dr James Thallon Medical Director Dr Harshad Topiwala Non-Executive Director and Vice Chairman (acting Chairman November 2009 - January 2010)

Peter Conway Non-Executive Director and Chair of the Audit Committee Rosanne Corben Non-Executive Director Ray Morris Non-Executive Director (until 30th September 2009) Jill Ruddock Non-Executive Director Bryan Sweetland Non-Executive Director Barry Wilding Non-Executive Director Meradin Peachey Director of Public Health (until 1st December 2009)

Daryl Robertson Deputy Chief Executive Rod Smith Director of Finance Julia Ross Director of Strategy and Communications Julie Hunt Director of Nursing Dr Declan O’Neill Director of Health Improvement (from 1st December 2009)

NHS West Kent’s Board meets in public six times a year in venues around the area. A number of formal sub- committees, chaired by non-executive directors, report directly to the Board. NHS West Kent annual report 09/10 25

Directors’ declarations of interests 2009/10

Peter Conway , Non-Executive Director Independent Member of the Audit Committees of: Home Office DEFRA Health & Safety Executive Child Maintenance and Enforcement Commission Trustee of Tonbridge Citizens Advice Bureau (until 10th January 2010)

Rosanne Corben , Non-Executive Director Chairman of West Kent Community Health Trustee of Tenterden Day Centre Vice President of Leonard Cheshire Disability Vice President of Heart of Kent Hospice (until 2nd June 2009)

David Griffiths , Chairman Chairman of the Royal London Society for the Blind Shareholder in Accenture Ltd. Family member employee of PriceWaterhouseCoopers (until 1st June 2009)

Ray Morris , Non-Executive Director (until 30th September 2009) Professional adviser to ‘The Place to Be’ (a national charity involved in providing therapeutic support to children in school) (until 1st June 2009)

Bryan Sweetland , Non-Executive Director Member of Gravesham Borough Council Member of Kent County Councillor (until 10th June 2009)

James Thallon , Medical Director Partner, Kingswood surgery – provider of primary care services Member, On Call Care – provider of out-of-hours medical services (until 4th June 2009)

Barry Wilding , Non-Executive Director Director and shareholder in Live Leads Limited (Private Company) Director and shareholder in Get Local Limited (Private Company) Director and shareholder in Bulldoza Limited (Private Company) Director and shareholder in UmYup Limited (Private Company). Spouse is a counsellor providing services for GP practices Non-Executive Director of Cova Security Gates Limited Elected member to the Council of People Living with Diabetes. Member of the UK Advisory Council of Diabetes UK Independent Board Member of Russet Homes 26 NHS West Kent annual report 09/10

Financial Review STATUTORY FINANCIAL DUTY their lives. Pay and prices increase too, for example we all know how much fuel prices have increased, which NHS West Kent has a statutory duty to spend within its have a direct impact on our ambulances and any patient allocated revenue and capital resource limits. facilities where we need heat and light. The extra money Performance against these targets was: we receive each year is not sufficient to pay for the extra costs, so we continually challenge ourselves and others On revenue, the PCT achieved its planned underspend to make the money go further. What that really means is of £2m (0.2 per cent). supporting our staff to work as effectively as possible, which in turn means making sure we are all doing the Revenue right things, and then making sure we are doing the right £m things in the best way. Sometimes it can be difficult to Revenue resource limit 988.969 believe that some things we do are not the right things, Revenue expenditure 986.956 because inevitably they are done with good intention Under/Over(-) spend 2.013 and are often good. Balancing the sometimes different needs of individuals and whole communities as On capital, the PCT under spent by £5,000 (0.02 per taxpayers and as users of services is the challenge that cent). This under spend is not added to the revenue has always faced the NHS. When money is more scarce, under spend and is not expected to be carried forward and service gaps are highly publicised, the challenge to the next year. remains essentially the same, albeit greater. Capital £m It is with an eye to the future that we set ourselves the Capital resource limit 23.571 challenge to achieve a surplus, and it is to the future that Capital expenditure 23.566 we must direct our attention. What can we draw on or Under/Over(-) spend 0.005 learn from the year just past that will help us make further progress? The PCT met the requirement to stay within its cash limit. It is clear that major improvements can be achieved in the quality of our services by drawing different elements FINANCIAL COMMENTARY of existing services together and making sure they work in concert. When we find the right solution, great results NHS West Kent received 10.36 per cent more funding in follow and follow quickly and everybody shares in the 2009/10 than in 2008/09. achievement. The improvements in stroke services are a clear example, where NHS West Kent has promoted and 2009/10 may be remembered for Swine Flu, and one of led joint working involving hospital and primary care the harder winter periods in recent years. The NHS in clinicians resulting in West Kent being the most improved West Kent responded well to both, and the sound area in the country. preparation and resilience of our services was demonstrated; thankfully the nature of Swine Flu was not As we move forward, our whole approach to as severe as we all feared it might be. It is in this context commissioning is adapting in a way that will ensure we that our achievement of a planned £2m surplus is set. find far more of the right solutions, by working ever Our collective ability to ensure that our community closer with our colleagues in a way that really makes services division, West Kent Community Health and our sense. Our approach is based on ‘programmes of care’ local hospitals also achieved financial balance is another that really places people at the heart of our decision- achievement, but the real successes are the making about the services we provide. We need to make improvements in health and healthcare services that some really difficult decisions to make sure the money have been achieved by our collective efforts. It is in this we have is spent in a way that really achieves as much of context that we step forward together to meet the even our vision as we possible can; that vision is to ensure greater financial challenges that lie ahead. that all the people in West Kent enjoy the best possible health. That vision is underpinned by our values that we Each year the population of West Kent increases slightly rely on when we have to balance what is right, with what and as the average age of the population increases, the is achievable and what is fair. Without the vision and the average use of health services increases. As new drugs values, the money means nothing. Without the money and technologies become available, the costs often and sustainable spending, we cannot be true to our increase as we help people re-gain their health or extend values or our vision. NHS West Kent annual report 09/10 27

As we progress though 2010/11 and the years ahead, make this work, we all need to work together and use our we expect to be tested hard and we expect to succeed values to give us the strength to do what is right. in increasing the real value for the money we spend on behalf of all the people who live in West Kent. Financially our aim is to achieve balance; financial balance, balance Full details of the investments planned for 2010/11 can for taxpayers and a well-balanced range of services for be found on the PCT’s website at all those who need our care. http://www.westkentpct.nhs.uk/The_PCT/Our_plans/index .html Looking forward to 2010/11 the PCT has agreed a balanced budget. The recurrent allocation for 2010/11 includes an increase of 5.5 per cent. Most of this is WHERE THE MONEY WAS SPENT required to pay for service levels we achieved last year, which included spending our contingency. We are also NHS West Kent receives funding from the Department of responsible for £5m of services previously funded Health in the form of a Revenue Resource Allocation. outside the PCT. £10m is needed to put in place some The allocation for 2009/10 was £988.97m and in addition of the transformational changes that will reward us in the PCT received £5.4m non-discretionary funding for future years, and we need to increase our surplus by ophthalmic services. Out of this allocation, which £8m to prepare for the lower increase in funding represents just £4.04 per person per day for the expected the following year. So what we achieve in residents of West Kent, the PCT ensures that the 2010/11 will largely depend on what we improve using healthcare needs of the population are met. This doesn’t what we already have, rather than additional cash just mean the treatments provided at GP surgeries and investment. Where there is investment, it will be local hospitals but also specialist services, ambulance supported by savings; often from the same areas. Where services and health promotion and preventative there are real increases in spending for a whole area, treatments. there will be real savings to match from other areas. To

The table and chart (See over leaf) below shows how your £4.04 was shared across the services in 2009/10 by NHS West Kent. Service Area Total £m £ per % of total person Primary Care Includes GP, dental and ophthalmic services and primary 140.3 208 14.1 care services provided to prisons. Prescribing This is the cost of prescriptions issued by primary care 101.0 150 10.2 teams including GPs, prescribing nurses and dentists. Community Services As well as the costs of the community services, district 84.7 126 8.5 nurses, school nurses, health visitors and therapists this category contains the costs of running the community hospitals . Mental Health Mental health services, high secure placements, 85.1 126 8.5 counselling services and drug and alcohol action teams. People with Learning Costs relating to the services provided for people with 29.6 44 3.0 Difficulties learning difficulties. General & Acute Main hospital services but also includes high cost drugs, 517.7 767 52.1 maternity services, A&E and ambulance costs.

Corporate Costs In addition to management costs this category contains 33.9 50 3.4 impairments (decrease in the value of assets due to the current economic climate) and grants, training costs, premises costs and other general expenses. Surplus for the year 2.0 3 0.2 Total 994.3 1,474 100

£1,474 per year = £4.04 per day 28 NHS West Kent annual report 09/10

Analysis of healthcare spend 2009/10 - £ per person

Primary Care, £208

Prescribing, £150

General & Acute £767 Community Services, £126

Mental Health, £126

People with Learning Source: note 5.2 in annual accounts Disabilities, £44

ADOPTION OF INTERNATIONAL FINANCIAL REPORTING SUMMARY FINANCIAL STANDARDS (IFRS) STATEMENTS In the 2008 budget the Chancellor announced the requirement for government bodies to adopt IFRS from 1 April 2009, including the restatement of 2008/09 The summary financial statements that follow are taken comparatives. In order to meet the requirements NHS from the full annual accounts of the PCT which are West Kent has been running a transition project since reproduced within the Annual Report. A separate copy August 2008 culminating in the production of the first full of the full annual accounts may be obtained on request set of accounts under IFRS in April 2010. The PCT from the PCT at Wharf House, Medway Wharf Road, transition project successfully met all required deadlines. Tonbridge, Kent, TN9 1RE. Summary financial statements may not contain sufficient information for a PENSION SCHEME full understanding of the PCT’s financial position and performance. Details of the PCT’s pension liabilities can be found in the accounting policies note to the accounts and in the remuneration report. NHS West Kent annual report 09/10 29

Operating Cost Statement for the Year Ended 31 March 2010 2009/10 2008/09 £000 £000

Commissioning Gross Operating Costs 1,234,020 1,107,676 Less: Miscellaneous Income (304,805) (267,638) Commissioning Net Operating Costs 929,215 840,038 Provider Gross Operating Costs 68,450 61,370 Less: miscellaneous income (7,427) (5,702) Provider Net Operating Costs 61,023 55,668 Net Operating Costs before interest 990,238 895,706 Other (Gains)/Losses (348) (338) Finance Costs 2,438 2,493 Net Operating cost for the Financial Year 992,328 897,861

Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2010 2009/10 2008/09 £000 £000

Net operating cost for the year (992,328) (897,861) Non-cash charges – cost of capital (691) (696) Net Parliamentary funding 990,085 909,117 Release of reserves to Operating Cost Statement (90) 0 Fixed asset impairment losses 00 Unrealised surplus / (deficit) on fixed asset revaluations/indexation (3,470) (5,941) Increase in the donated asset reserve and government grant reserve 0 due to receipt of donated and government granted assets Additions / (Reductions) in the General Fund due to the transfer of 19 0 assets from/(to) NHS bodies and the Department of Health Changes in Taxpayers’ Equity recognised in the year (6,475) 4,619 30 NHS West Kent annual report 09/10

Statement of Financial Position as at 31 March 2010 31 March 2010 31 March 2009 £000 £000 NON-CURRENT ASSETS Property, Plant and Equipment 58,385 69,426 Intangible assets 26 39 Trade and Other Receivables 10,794 10,933 TOTAL NON-CURRENT ASSETS 69,205 80,398 CURRENT ASSETS Inventories 146 147 Trade and Other Receivables 10,573 19,428 Cash and Cash Equivalents 12 11 Non-current Assets Held for Sale 1,865 1,825 TOTAL CURRENT ASSETS 12,596 21,411 TOTAL ASSETS 81,801 101,809 CURRENT LIABILITIES Trade and Other Payables (60,821) (72,467) Provisions (794) (1,487) Borrowings (966) (938) TOTAL CURRENT LIABILITIES (62,581) (74,892) NON-CURRENT ASSETS PLUS/LESS NET CURRENT ASSETS/LIABILITIES 19,220 26,917 NON-CURRENT LIABILITIES Provisions (4,203) (4,430) Borrowings (36,568) (37,563) TOTAL NON-CURRENT LIABILITIES (40,771) (41,993) TOTAL ASSETS EMPLOYED (21,551) (15,076)

FINANCED BY: TAXPAYERS’ EQUITY General Fund (29,249) (26,900) Revaluation reserve 6,531 10,163 Donated asset reserve 1,167 1,661 TOTAL TAXPAYERS’ EQUITY (21,551) (15,076) NHS West Kent annual report 09/10 31

Statement of Cash Flows for the Year Ended 31 March 2010

2009/10 2008/09

£000 £000

OPERATING ACTIVITIES

Net cash outflow from operating activities (989,516) (896,588)

CASH FLOWS FROM INVESTING ACTIVITIES:

Payments to purchase property, plant and equipment (7,094) (15,616)

Payments to purchase intangible assets 0 (32)

Proceeds of disposal PPE and intangible assets 8,456 3,910

Payments for other financial assets 0 (226)

Proceeds of disposal of other financial assets 2,334 0

Net cash inflow/(outflow) from investing activities 3,696 (11,964)

Net cash inflow/(outflow) before financing (985,820) (908,552)

CASH FLOWS FROM FINANCING ACTIVITIES

Net Parliamentary Funding 990,085 909,117

Other capital receipts surrendered (100) 0

Capital grants received 100 0

Capital element of finance lease rental payments (4,264) (562)

Net cash inflow/(outflow) from financing 985,821 908,555

Increase/(decrease) in cash 13

The financial statements were approved on behalf of the Board which delegated authority to do this to the Audit Committee. The financial statements were signed on the Board’s behalf by:

Steve Phoenix, Chief Executive 9 June 2010 32 NHS West Kent annual report 09/10

Better Payment Practice Code – measure of compliance

The Better Payment Practice Code requires the PCT to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The figures are derived from the Shared Business Services General Ledger.

2009/10 2009/10 2008/09 2008/09

Non-NHS Payables Number £000 Number £000 Total bills paid in the year 41,595 111,883 41,869 96,684 Total bills paid within target 39,132 104,513 37,171 85,376

Percentage of Non-NHS trade invoices paid within target 94.08% 93.41% 88.78% 88.30%

NHS Payables Total bills paid in the year 9,130 950,109 7,446 826,127 Total bills paid within target 8,447 916,371 5,468 778,397 Percentage of NHS trade invoices paid within target 92.52% 96.45% 73.44% 94.22%

Management Costs

2009/10 2008/09 Management costs (£000s) 14,839 11,817

Weighted population (number) 602,263 601,649 Management cost per head of weighted population (£) 24.64 19.64

The PCT measures its management costs according to the definitions provided by the Department of Health. Statement on Internal Control The Statement on Internal Control can be found in the PCT’s Annual Accounts which are reproduced within the Annual Report or available on request from the PCT. External Audit The approved external auditors of the PCT are Audit Commission. They undertake the statutory audit of the PCT as well as undertaking further work at the request of the PCT. The cost of the statutory audit service provided in the last financial year was £323,000. No work in addition to the statutory audit was commissioned by the PCT in 2009/10. NHS West Kent annual report 09/10 33

INDEPENDENT AUDITOR’S REPORT TO THE BOARD OF DIRECTORS OF WEST KENT PRIMARY CARE TRUST

I have examined the summary financial statement for the Remuneration Report year ended 31 March 2010 which comprises the Salaries of Executive Directors are determined by the Operating Cost Statement, the Statement of Financial Remuneration Committee, which is a formal committee Position, the Statement of Cash Flows, the Statement of of the Board made up normally of non-executive Changes in Taxpayers’ Equity and notes on directors. The membership of the Committee was as Management Costs and compliance with the Better follows: Payment Practice Code. I have also examined the information in the Remuneration Report that is subject to David Griffiths audit. Peter Conway This report is made solely to the Board of Directors of Rosanne Corben West Kent Primary Care Trust in accordance with Part II Ray Morris of the Audit Commission Act 1998 and for no other Jill Ruddock purpose, as set out in paragraph 49 of the Statement of Dr Harshad Topiwala Responsibilities of Auditors and of Audited Bodies Bryan Sweetland prepared by the Audit Commission. Barry Wilding Respective responsibilities of directors and auditor The main role of the Remuneration Committee is to make recommendations to the Board on the remuneration and The directors are responsible for preparing the Annual terms of service of the Executive Directors. Since Report. October 2006, the Committee has operated within the My responsibility is to report to you my opinion on the new national pay framework for “Very Senior Managers”. consistency of the summary financial statement within This framework provides for a recurrent salary uplift, the Annual Report with the statutory financial statements. where performance meets a minimum standard and up I also read the other information contained in the Annual to seven per cent non-recurrent bonus for meeting Report and consider the implications for my report if I additional standards of achievement. All directors are become aware of any misstatements or material subject to individual Personal Review. This involves the inconsistencies with the summary financial statement. setting of objectives on an annual basis and subsequent This other information comprises the remaining elements appraisal reviews to assess the level of achievement of the Financial Review, the Foreword, and the remaining against these objectives. In the case of the executive sections of the Annual Report. directors the performance appraisal is conducted by the I conducted my work in accordance with Bulletin Chief Executive with input from the Chair and non- 2008/03 “The auditor's statement on the summary executives, sitting as the Remuneration Committee. The financial statement in the United Kingdom” issued by the consensus view was that all executive directors had Auditing Practices Board. My report on the statutory performed strongly during 2008/09 and accordingly financial statements describes the basis of my opinion were awarded a range of performance bonus of on those financial statements. between 1.5 per cent and five per cent with an average between three and 3.5 per cent. The performance Opinion appraisal for the Chief Executive Officer is conducted by In my opinion the summary financial statement is the Chairman following a meeting of the Remuneration consistent with the statutory financial statements of the Committee. All executive directors are employed on West Kent Primary Care Trust for the year ended 31 substantive contracts, and the liability to the PCT in the March 2010. I have not considered the effects of any event of early termination of these contracts is events between the date on which I signed my report on determined by national terms and conditions for the statutory financial statements (10 June 2010) and the redundancy and the regulations of the NHS Pensions date of this statement. Scheme, and will vary dependant on the age and length of service of each individual. Executive director Darren Wells contracts all have a notice period of six months. Officer of the Audit Commission 16 South Park, Sevenoaks, TN14 1AN Salaries for other groups of staff (excluding medical 30 July 2010 staff) are determined by assessment of their jobs under Agenda for Change criteria. 34 NHS West Kent annual report 09/10

Details of salaries paid to Directors and their pension entitlements are set out in the following tables. Directors’ Related Party Transactions During the year the following Board Members or members of the key management staff or parties related to them has undertaken material transactions with the West Kent PCT.

2009-10 2008-09 Title Name Notes Salary Other Benefits Salary Other Benefits (bands of remuneration in kind (bands remuneration in kind £5,000) (bands of (rounded of (bands of (rounded £5,000) to nearest £5,000) £5,000) to nearest £100) £100) £000 £000 £00 £000 £000 £00

Chairman David 35 to 40 0035 to 40 00 Griffiths Chief Executive Steve 165 to 170 0 71 150 to 155 0 57 Phoenix Director of Rod Smith 115 to 120 00110 to 115 00 Finance Director of Julia Ross 90 to 95 0085 to 90 00 Strategy & Communicatio n Director of Jenny 2 55 to 60 0095 to 100 00 Strategy and Thomas Corporate Affairs

Director of Public Meradin 1 35 to 40 0030 to 35 00 Health Peachey

Medical Director James 105 to 110 0070 to 75 00 Thallon

Director of Daryl 115 to 120 00100 to 105 00 Performance and Robertson Delivery Director of Health Declan 3 40 to 45 04- -- Improvement O’ Neill Director of Julie Hunt 4 95 to 100 00- -- Nursing & Quality NHS West Kent annual report 09/10 35

2009-10 2008-09 Title Name Notes Salary Other Benefits Salary Other Benefits (bands of remuneration in kind (bands remuneration in kind £5,000) (bands of (rounded of (bands of (rounded £5,000) to nearest £5,000) £5,000) to nearest £100) £100) £000 £000 £00 £000 £000 £00

Non Executive Peter 10 to 15 0010 to 15 00 Director Conway Non Executive Rosanne 5 to 10 005 to 10 00 Director Corben Non Executive Ray Morris 5 0 to 5 000 to 5 00 Director Non Executive Jill 5 to 10 005 to 10 00 Director Ruddock

Non Executive Dr. Harshad 15 to 20 005 to 10 00 Director Topiwala

Non Executive Bryan 5 to 10 0-0 to 5 -- Director Sweetland

Non Executive Barry 5 to 10 0-0 to 5 -- Director Wilding 36 NHS West Kent annual report 09/10

Pension Benefits

Title Name Note Real increase in Real increase in Lump pension at the age Sum at the age of 60 60 (bands of £2500) (bands of £2500)

£000 £000

Chief Executive Steve Phoenix 0 - 2.5 5 - 7.5

Director of Finance Rod Smith 0 - 2.5 0 - 2.5

Director of Strategy & Communications Julia Ross 0 - 2.5 0 - 2.5

Director of Jenny Thomas 2 0 - 2.5 0 - 2.5 Strategy and Corporate Affairs Director of Public Health Meradin 1 - - Peachey

Medical Director James Thallon 0 - 2.5 0 - 2.5

Deputy Chief Executive, Director of Daryl 2.5 - 5 7.5 - 10 Commissioning and Performance Robertson Director of Health Improvement Declan O’Neill 3 0 - 2.5 0 - 2.5

Director of Nursing & Quality Julie Hunt 4 0 - 2.5 5 - 7.5

Notes: 1. Meradin Peachey is employed by Eastern and Coastal Kent PCT and is a joint appointment with that organisation and with Kent County Council. The salary shown represents the share of the costs borne by West Kent PCT. Pension benefits are reported by Eastern & Coastal Kent PCT.

2. Jenny Thomas ceased to be a Board member on 31.10.2009.

3. Declan O’Neill joined the Board of the PCT on 1.12.2009.

4. Julie Hunt joined the Board of the PCT on 01.04.2009.

5. Ray Morris left the PCT on 30.09.2009. NHS West Kent annual report 09/10 37

Total accrued Lump sum at age Cash Equivalent Cash Equivalent Real Increase Employer's pension at age 60 60 related to Transfer Value at Transfer Value in Cash contribution to at 31 March 2010 accrued pension 31 March 2010 at 31 March Equivalent stakeholder (bands of £5000) at 31 March 2010 2009 Transfer Value pension (bands of £5000) £000 £000 £000 £000 £000 £00

25-30 80-85 560 473 63 0

30-35 100-105 617 552 37 0

20-25 65-70 403 361 24 0

30-35 95-100 587 525 36 0

------

20-25 65-70 390 333 40

35-40 105-110 737 614 92 0

25 - 30 85 - 90 717 659 25 0

25 - 30 80 - 85 490 406 64 0 38 NHS West Kent annual report 09/10

NOTES

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