HEALTH AND ADULT SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE 18 AUGUST 2011 LEGACY DOCUMENT FOR MEDWAY Report from: Rose Collinson, Director of Children and Adults Author: Rosie Gunstone, Democratic Services Officer
Summary
A report on a ‘handover document’ being produced by NHS West Kent, which will contain knowledge and information, accumulated through the years for use during the NHS transition.
1. Budget and Policy Framework
1.1 Under Chapter 4 – Rules, paragraph 22.2 (c) terms of reference for Health and Adult Social Care Overview and Scrutiny Committee has powers to review and scrutinise matters relating to the health service in the area including NHS Scrutiny.
2. Background
2.1. The attached report sets out the requirement, set out by the National Quality Board, for a legacy document to be produced for use during the NHS transition.
2.2. The legacy document needs to be produced by 5 September 2011 for first submission to the Strategic Health Authority. This Committee, along with Medway LINk, is being asked for comments on the format of the document and its contents and suggestions on any further information, which it would be beneficial to include. As the document relates to Kent and Medway it is also being submitted to Kent’s Health Overview and Scrutiny Committee.
3. Risk management
3.1. There are no risk implications at this stage.
4. Legal and Financial Implications
4.1. There are no legal and financial implications at this stage.
5. Recommendations
5.1. Members are asked to comment on the legacy document and suggest any further areas of information to be included in future revisions.
Lead officer contact
Rosie Gunstone, Democratic Services Officer Ext 2715 [email protected]
Background papers - none
NHS Primary Care Trusts - Legacy Documents
This paper is for information and aims to:
provide the background and context for legacy documents describe the legacy document preparation process and key stakeholders role in this
Background
The Government’s White Paper, Equity and excellence: Liberating the NHS set out the programme for change in the NHS aimed at:
putting patients at the heart of all NHS care; delivering improved healthcare outcomes; and empowering local organisations and professionals to improve quality
The transition to the new system architecture for the service will result in structural changes in how the NHS is organised and run. Subject to legislation, the following organisational changes will have been achieved by 2014:-
a national commissioning board responsible for overseeing the commissioning of NHS services and allocation of the NHS budget will have been established strategic health authorities and primary care trusts will have been abolished clinical commissioning groups (previously referred to as GP commissioning consortia) responsible for commissioning the majority of local health services for their populations will have been established all NHS provider trusts will be foundation trusts HealthWatch, a new champion for the patient voice will have been created a number of arms length bodies will have been abolished
Managing a smooth transition to the new system whilst ensuring the quality of NHS services is both maintained and improved is essential. Research in the NHS and elsewhere has demonstrated an increased potential risk to service during times of major change.
In it’s document, Maintaining and improving quality during the transition: safety, effectiveness, experience the National Quality Board of the Department of Health proposed that outgoing organisations, i.e. strategic health authorities and primary care trusts developed ‘legacy documents’ as part of a robust system of handover that effectively captures and transfers organisational memory.
Purpose of the Legacy Document
The primary care trusts (PCTs) in the Kent and Medway cluster rely heavily upon the professional and organisation knowledge and corporate memory of its 1,000 employees. The reform of the NHS will remove several tiers of management. The legacy document, therefore, seeks to preserve the collective knowledge of the local service at a point in time during the transition to the new system architecture and to refresh the information contained in it in the light of experiences throughout the transition to organisational closure. As part of this process, the involvement of local key stakeholders is essential.
The document will form part of the eventual handover process with both outgoing and incoming organisations having a responsibility for ensuring that the new organisations have a good understanding of the whole quality picture of the providers for whom they are taking on responsibility. This will be augmented by face-to-face processes involving the departing chief executive and all managers and clinicians, as part of their public sector duties.
Content of the document
As a minimum, for the PCTs in the Kent and Medway cluster, the legacy document will provide:-
information on the services provided to the local population, a ‘pen portrait’ overview of the key information on the local population including key population facts and figures, geographical boundaries, assessment of strategic needs, population trends, etc. the current state of play with regard to quality, finance, performance, capacity, and people relevant organisational memory, i.e. financial trends, staff turnover, quality trends future challenges and risks, through the formal risk register detailing mitigating actions and ongoing monitoring, etc a library of knowledge/skills, i.e. strategic documentation, consultancy reports, public consultation reports, etc. a directory of services and skills such as information sources, skills available regionally, key contact information
Development of the document
Development of the legacy document is part of the cluster’s transition plan. Judy Clabby, Assistant Chief Executive, will lead this workstream with a small project team covering each of the three constituent PCTs.
A common template is in use across the South East Coast region which will be augmented by further key information headings as these documents develop over the next two years
The Cluster will ensure that the document is maintained until organisational closure
PCTs’ legacy documents will be amalgamated at SHA level to ensure robust handovers between SHAs, the NHS Commissioning Board and the Provider Development Authority and are modelled on the practice of due diligence to ensure a transfer of both hard and soft intelligence from the outgoing to the incoming organisations.
Public and stakeholder engagement
The legacy document has been subject to a (public) board level discussion for assurance purposes and it is recommended by the National Quality Board that the documents are available publicly to enhance and ensure their vigour. The Kent and Medway draft legacy document is available on PCT websites. Click here to view the Legacy Document .We will be developing signposting to the sources of reference used in them, as part of our publication schemes.
Due to the nature of some of the information to be provided ultimately there will also be a confidential section to the document including, for example contact details for key outgoing staff and details of patient-specific issues at the time of handover.
The Care Quality Commission and Monitor are expected to have sight of the legacy documents at the SHA stage and will have the opportunity to flag any issues they may have and address any areas they feel should be in included in the documents.
Proposal and/or Recommendation
The Overview and Scrutiny Committee is asked to support the production and maintenance of the documents as appropriate and suggest any further areas of information to be included in revisions.
Judy Clabby Assistant Chief Executive August 2011
LEGACY DOCUMENT – KENT AND MEDWAY PCT CLUSTER
NHS EASTERN AND COASTAL KENT NHS MEDWAY NHS WEST KENT
09 appendix 2 legacy document.doc1 10/08/2011 1 of 91
Title Legacy Document
Summary
Associated Documents See Appendix 1 for document log
Target Audience Successor authorities
Document Version Version 1
Date of this Version June 2011
Date of Issue June 2011
Date of Next Review September 2011 Author Judith Clabby, Cluster Assistant Chief Executive
Organisation Kent and Medway Cluster: NHS Eastern and Coastal Kent NHS Medway NHS West Kent Approved by
Signature of Chief Executive
09 appendix 2 legacy document.doc1 10/08/2011 2 of 91
Contents
PART 1 PUBLIC DOCUMENT
1 Introduction ...... 6 1.1 Overview ...... 6 1.2 Purpose of the Legacy Document ...... 7 1.3 Content of the document...... 7 1.4 Development of the document...... 7 2 Description of the Patch...... 9 2.1 Geographic boundaries and local authorities ...... 9 2.2 Consortia profile within the geographical boundaries and potential gaps ...... 10 2.3 Population demographics, socio-demographics considerations ...... 12 2.4 Key health issues...... 15 2.5 Projections around population changes...... 16 2.6 Profile of current demand for various services and projected changes in this...... 17 2.7 Reference to Annual Operating Plans...... 18 3 Information on all services provided to the local population ...... 19 3.1 Primary Care Services – General Overview...... 19 3.2 Primary Care Services Providers List ...... 22 3.3 Acute Providers – General Overview ...... 23 3.4 Acute Providers List ...... 24 3.5 Tertiary Services – General Overview...... 32 3.6 Tertiary Services List...... 32 3.7 Mental Health Providers – General Overview ...... 34 3.8 Mental Health providers List ...... 34 3.9 Community Services – General Overview ...... 35 3.10 Community Services List ...... 36 3.11 Voluntary Services – General Overview...... 38 3.12 Voluntary Services List ...... 38 3.13 Other ...... 41 09 appendix 2 legacy document.doc1 10/08/2011 3 of 91
4 Quality...... 43 4.1 Effectiveness...... 43 4.1.1 Summary of commissioning prioritisation decisions (eg low priority treatments)...... 43 4.1.2 Summary of key prioritisation processes adopted by the organisation ...... 44 4.2 Patient experience including- ...... 44 4.2.1 Methods of communications with patients and public...... 44 4.2.2 Summary of patient/public views ...... 46 4.2.3 Analysis of complaints data – April 10-March 11...... 47 4.3 Safety and Safeguarding ...... 49 4.3.2 Update on any current safety breaches, including identified management strategy...... 51 4.3.3 Trend analysis/reference to learning from SIRIs...... 51 4.3.4 Summary of performance in relation to Healthcare Acquired Infection (with reference to significant historic issues and achievements)...... 52 4.3.5 Review of estate safety, including compliance issues against national legislative requirements ...... 53 4.4 Innovation (summary of key innovative approaches underpinning the delivery of future healthcare) ...... 54 5 Performance ...... 56 5.1 Summary of current and historic performance against national core standards ...... 56 5.2 Track record in delivering choice...... 59 6 Financial history ...... 60 6.1 Pen picture of the financial history of the PCT area ...... 60 6.2 Summary of current organisational budgets...... 64 6.3 Update on current high risk financial issues and identified management strategies to manage these...... 65 7.0 Provider capacity ...... 66 7.1 Summary of historic service capacity issues, including outstanding issues ...... 66 09 appendix 2 legacy document.doc1 10/08/2011 4 of 91
7.2 Market management initiatives (e.g. AWP) ...... 67 7.3 Procurements undertaken over the last 3 years for patient services ...... 67 8. Workforce...... 69 8.1 Snapshot of current workforce...... 69 8.2 Summary of identified workforce challenges, including summary of achieved and required workforce reductions ...... 70 9. Summary of key planned changes ...... 71 9.1 Intended consultations (Summary taken from 2011/2012 Integrated Plan)...... 71 9.2 Intended significant procurements ...... 71 9.3 Risk assessment relating to implementation ...... 72 10. Organisational assets and liabilities ...... 73 10.1 Physical assets of the organisation, including estate, equipment (including computers), information systems, software, etc 73 10.2 Contracts for support (non-healthcare) services...... 73 11. Stakeholder map ...... 75 12. Governance ...... 77 12.1 Boards, committees and clinical networks, terms of reference, roles, responsibilities...... 77 12.2 Summary of key policy documents...... 78 12.3 Corporate risk register ...... 78 13 Appendix 1...... 80 Document Library – in the process of being built ...... 80 14 Appendix 2...... 83 Glossary of Terms ...... 83 15 Appendix 3...... 90 Directory of Services – to be developed...... 90
09 appendix 2 legacy document.doc1 10/08/2011 5 of 91
Part 1
1 Introduction
1.1 Overview
The Government’s White Paper, Equity and excellence: Liberating the NHS1 set out the programme for change in the NHS aimed at:
Putting patients at the heart of all NHS care; Delivering improved healthcare outcomes; and Empowering local organisations and professionals to improve quality
The transition to the new system architecture for the service will result in major structural changes in how the NHS is organised and run. Subject to legislation, the following organisational changes will have been achieved by 2014:-
A national commissioning board responsible for overseeing the commissioning of NHS services and allocation of the NHS budget will have been established Strategic Health Authorities and Primary Care Trusts will have been abolished Commissioning consortia responsible for commissioning the majority of local health services for their populations will have been established All NHS Trusts will be Foundation Trusts HealthWatch, a new champion for the patient voice will have been created A number of arms length bodies will have been abolished
Managing a smooth transition to the new system whilst ensuring the quality of NHS services is maintained and improved is essential. Research in the NHS and elsewhere has demonstrated an increased potential risk to service during times of major change. In it’s document, Maintaining and improving quality during the transition: safety, effectiveness, experience the National Quality Board proposed that outgoing organisations, i.e. Strategic Health Authorities and Primary Care Trusts developed ‘Legacy documents’ as part of a robust system of handover that effectively captures and transfers organisational memory.
1 Equity and excellence: Liberating the NHS can be downloaded here: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset /dh_117794.pdf 09 appendix 2 legacy document.doc1 10/08/2011 6 of 91
1.2 Purpose of the Legacy Document
The Primary Care Trusts (PCTs) in the Kent and Medway cluster rely heavily upon the professional and organisation knowledge and corporate member of its 1,000 employees. The reform of the NHS will remove several tiers of management. This legacy document, therefore, seeks to preserve the collective knowledge of the local service at a point in time during the transition to the new system architecture and to refresh the information contained in it in the light of experiences throughout the transition to organisational closure. As part of this process, the involvement of local key stakeholders is also being sought.
The document will form part of the eventual handover process with both outgoing and incoming organisations having a responsibility for ensuring that the new organisations have a good understanding of the whole quality picture of the providers for whom they are taking on responsibility. This will be augmented by face-to-face processes involving the departing chief executive and all managers and clinicians, as part of their public sector duties.
1.3 Content of the document
As a minimum, for the PCTs in the Kent and Medway cluster, the document will provide:-
information on the services provided to the local population, a ‘Pen Portrait’ overview of the key information on the local population including key population facts and figures, geographical boundaries, assessment of strategic needs, population trends, etc. the current state of play with regard to quality, finance, performance, capacity, and people relevant organisational memory, i.e. financial trends, staff turnover, quality trends future challenges and risks, through the formal risk register detailing mitigating actions and ongoing monitoring, etc a library of knowledge/skills, i.e. strategic documentation, consultancy reports, public consultation reports, etc. a directory of services and skills such as information sources, skills available regionally, key contact information
1.4 Development of the document
Development of the legacy document is part of the cluster’s transition plan. An executive lead has been appointed to oversee this transition plan workstream with a small project team covering each of the three constituent PCTs.
09 appendix 2 legacy document.doc1 10/08/2011 7 of 91
Linked to the production and maintenance of the document is the records management programme for the cluster to ensure document access, archiving and retrieval in line with national guidance and legislation. Signposting to live websites to provide further information will be used to enrich the quality of the document.
A regular process of stakeholder engagement will underpin the quarterly updates to the document.
09 appendix 2 legacy document.doc1 10/08/2011 8 of 91
2 Description of the Patch
Kent and Medway Cluster covers the whole population of the county of Kent and Medway unitary authority. Covering 1,500 square miles the population is distributed in rural and urban communities.
Detailed information on the demographics of these areas can be found on the Kent and Medway Public Health Observatory, see: http://www.kmpho.nhs.uk
Summary of key achievements and ongoing PH issues and clinical networks for next iteration.
2.1 Geographic boundaries and local authorities
The population of Kent and Medway is clustered in the major towns:-
Town PCT Pop. 000s Local Authority District/Borough Councils Ashford Ashford Borough Canterbury Eastern Canterbury City Dover and Kent County Dover District 732 Shepway Coastal Council Shepway District Swale Kent Swale Borough Thanet Thanet District
09 appendix 2 legacy document.doc1 10/08/2011 9 of 91
Chatham Gillingham Rainham Medway 280 Medway Council Rochester Strood Dartford Dartford Borough Gravesend Gravesham Borough Maidstone Maidstone Borough West Kent County Sevenoaks 679 Sevenoaks District Kent Council Tonbridge Tonbridge & Malling Borough Tunbridge Tunbridge Wells Borough Wells
2.2 Consortia profile within the geographical boundaries and potential gaps
Consortium Boundary No of GP Pop. Comment practices 000s Ashford Ashford, 16 122 Discussions on merger Charing, Wye, into 3 CCGs are in Hamstreet, progress, as is Sellindge, federation for all nine Tenterden, CCGs Woodchurch Canterbury Canterbury, 21 177 Coastal C4 Faversham, Consortium Bridge, Herne Bay, Chartham, Sturry, Ash, Sandwich, Boughton, Whitstable Deal Deal 5 35 Dover and Dover, River, 10 57 Aylesham Aylesham Shepway New Romney, 18 108 Hythe, Cheriton, Lydd, Folkestone, Hawkinge, Lyminge, Elham, Dymchurch Swale Isle of Sheppey, 20 (one not yet 104 Sittingbourne, signed up Teynham, Iwade, Milton Regis and Kemsley
09 appendix 2 legacy document.doc1 10/08/2011 10 of 91
Thanet Ramsgate, 19 (one not yet 124 Consortium Margate, signed up) Cliftonville, Westgate-on- sea, Minster, Broadstairs, St Peters, Birchington, Garlinge Whitstable Whitstable 1 33 Medical Practice East Cliff East Cliff 1 15 Medical Practice, Ramsgate
DMC Sheppey(Part of Swale)
1 Orphan Swale Canterbury 1 2 Road, Sittingbourne 1 Orphan Thanet Cliftonville 1 2 Avenue, Margate Medway Medway PCT 61 280 Pipeline consortium Dartford, West Kent 38 248 Gravesham and PCT – north Swanley patch Maidstone and Maidstone and 10 91 Malling surrounding area Salveo West Kent 54 367 PCT – south west patch
Lists of those practices covered in each of the proposed CCGs can be found using the following links:-
For Eastern and Coastal Kent
NHS Eastern & Coastal Kent GP Practices by Consortia
For Medway
NHS Medway GP Practices by Consortia
For West Kent
NHS West Kent GP Practices by GP Consortia
09 appendix 2 legacy document.doc1 10/08/2011 11 of 91
2.3 Population demographics, socio-demographics considerations
Eastern and Coastal Kent
The population is expected to rise by 5% over the next 5 years, with the largest area of growth in the 65y-84y age group. Historically, migration has been the largest contributor to population group (4,200 in 2007/8).
Ninety six per cent of the population is white, with an increasing percentage from Eastern Europe and in the transient and mobile populations. There is a large (3,280) prison population, focused in the prison cluster on the Isle of Sheppey. There are significant concentrations of relative deprivation (28% of wards within the 20% most deprived in Kent,) mainly in the urban centres and the coastal towns (10% within the most deprived in England).
Life expectancy has steadily improved with a decline in premature all age all cause mortality. Life expectancy at birth is now similar to that for the rest of Kent and England. Those in the more affluent areas of Eastern and Coastal Kent would be expected to live on average 10y longer than those in the more deprived areas.
See the Operating Plan 2011/12 for more detail
09 appendix 2 legacy document.doc1 10/08/2011 12 of 91
Medway
Medway has a smaller proportion of over-65ys than England as a whole; this is expected to continue. However, the rate of growth in the 65y and over group is greater than the national rate and population numbers in the group are projected to increase by 28.1% between 2010 and 2020. Therefore service demand is likely to grown more quickly in Medway that the national average. Between 2005 and 2020 the number of people with diabetes is expected to increase by 46% to over 14,700.
Life expectancy is lower than in the south east and England as a whole, with significantly higher rates of early death from cancer and cardiovascular disease. Lifestyle and social determinants of health are contributory factors, with significantly higher rates of obesity in both children and adults compared to the national averages (11.2% compared to 9.2% and 31.4% compared to 24.2% respectively).
Three wards fall within the 20% most deprived in England and two within the 20% least deprived. Areas with high levels of deprivation typically involve all domains, i.e. income, employment, health, education, crime and living environment.
See the Operating Plan 2011/12 for more detail
09 appendix 2 legacy document.doc1 10/08/2011 13 of 91
West Kent
West Kent has a largely healthy and affluent population although this profile masks significant pockets of deprivation. A number of wards in the Dartford and Gravesend areas are within the 20% most deprived nationally, with smaller areas of deprivation also in Swanley, Maidstone, Tonbridge and Tunbridge Wells. Some of the most deprived wards are rural and adjacent to the most affluent 20% in England.
By 2017 over 65ys will constitute almost 20% of the population increasing to 30% by 2020. Fifteen percent of residents have long-term conditions; 33% in the 65y+ age group
Mortality rates are reducing, but there are inequalities and unacceptable variation. Cancer, heart disease and stroke are the biggest killers for both men and women, accounting for over 60% of all deaths, with respiratory disease a smaller but important contributor (13% of deaths).
There is a gap in life expectancy - 7.1y for men and 4.2y for women between the 10% most and least deprived communities, most acute in the most deprived communities of Dartford and Gravesham.
There is significant variation in some health outcomes, for example: Below England average 5 year survival rates for all major cancers, with significant mortality variation in breast, lung, prostate and colorectal cancers
09 appendix 2 legacy document.doc1 10/08/2011 14 of 91
Stark difference in premature mortality from Circulatory Disease and prevalence between some neighbouring communities Marked variation in COPD admission rates across practices High levels of admissions due to diabetes Women from more vulnerable groups are more likely to experience complications in childbirth and are at higher risk of death
Healthcare costs directly attributable to obesity, alcohol and smoking are estimated to be more than £200m p.a., ie over 20% of the PCT’s annual budget. These costs include a major proportion of spend on cancer, circulatory disease (heart disease & stroke) and COPD. Obesity has been linked to a wide range of diseases. In West Kent there are estimated to be 130,000 obese adults and 23,000 obese children, costing £83m in 2010.
Over 2,000 people die prematurely each year due to smoking; the average smoker loses more than 7 years of healthy life. More than 10,000 hospital admissions each year are due to smoking at an estimated cost of £17m. In 2007/08 there were 342 admissions directly related to alcohol misuse.
A further £3m of activity was partially due to alcohol. Men (average age 40) account for 73% of these admissions. There is a clear link between lifestyle factors and deprivation, with higher levels of smoking, binge drinking and obesity in Dartford, Gravesham and Maidstone.
People with mental health problems are less likely to lead healthy lifestyles, which in turn have been shown to exacerbate mental health issues.
See the Operating Plan 2011/12 for more detail
2.4 Key health issues
Key health issues for each of the PCTs are described in the 5-year Strategic Commissioning Plans. See links below:-
For Eastern and Coastal Kent
See Chapter 9 of the Strategic Commissioning Plan 2010-2015 Demand side analysis
For Medway
See Section 3 of the Strategic Commissioning Plan 2010-2015 (Growing Healthier).
09 appendix 2 legacy document.doc1 10/08/2011 15 of 91
For West Kent
See Section 3 the 5y Strategic Commissioning Plan 2010/15 – Priority Health Outcomes for detail
2.5 Projections around population changes
The Association of Public Health Observatories compiles information on population health and well being. For Kent and Medway it covers the following areas:
Medway Sevenoaks Gravesham Swale Canterbury Thanet Dover Shepway Ashford Maidstone Tonbridge and Malling Tunbridge Wells
For detailed information on each area please access the following links:-
See Health and Social Care Maps
For Eastern and Coastal Kent
ONS from Matt
For Medway
The Office of National Statistics (ONS) projections suggest the overall population of Medway is expected to grow by 5.1% (12,000) between 2010 and 2020.link
For West Kent
The over-65y population will comprise 20% of the total by 2017. those over 65ys are 18 times more likely to suffer long term heart/circulatory problems 20 times more likely to suffer with eye conditions
The rise in prevalence of long term conditions and the ageing profile mean that, in future, many more people will take on a caring role and for longer.
09 appendix 2 legacy document.doc1 10/08/2011 16 of 91
See Population Change (Section 3.2.2) of the strategic Commissioning Plan 2010-2015
ONS from Matt
2.6 Profile of current demand for various services and projected changes in this
For Eastern and Coastal Kent
See Chapter 9 Strategic Commissioning Plan 2010-2015- Demand side analysis
For Medway
The Joint Strategic Needs Assessment (JSNA) and current service performance tell us that areas in which we particularly need to focus our service redesign to deliver are:
Primary and Secondary prevention of Chronic Heart Disease (CHD), Chronic Obstructive Pulmonary Disease (COPD) and cancer, Support for people with long-term conditions, Support for people with dementia, End of Life Care, Urgent Care Services and Mental Health Services.
As a result of this approach, we would expect to see the following outcomes:
Over the longer term, an improvement in health and reduction in health inequalities in Medway; In the short to medium term, an increase in the number of people who feel able to manage their own condition, in some cases with the support of NHS and social care staff, and a reduction in the number of emergency attendances at/admission to hospital; And therefore, a reduction in the acute capacity required in the system – and as we increase flexible working in the community potentially a reduction in community estate – which leads to a more efficient NHS.
NHS Medway Strategic Commissioning Plan
For West Kent
Information from the Joint Strategic Needs Assessments (JSNAs) were combined with a range of other data sources to create a ‘Helicopter View (A4). The Helicopter View describes sources of current and future demand, including the JSNA, Local Area Agreement (LAA), performance, quality and patient experience data and poses a number of questions to identify issues 09 appendix 2 legacy document.doc1 10/08/2011 17 of 91
and opportunities which form the basis of the Strategic Commissioning Plan. See also Section 3.2.1 of the Plan
2.7 Reference to Annual Operating Plans
Each PCT has a board-approved Annual Operating Plan for 2011/12 which cover the 2nd year of each Strategic Commissioning Plan.
For Eastern and Coastal Kent
Annual Operating Plan
For Medway
Annual Operating Plan
For West Kent
Annual Operating Plan
09 appendix 2 legacy document.doc1 10/08/2011 18 of 91
3 Information on all services provided to the local population
3.1 Primary Care Services – General Overview
For Eastern and Coastal Kent
General Practice
There are 604 GPs (not including Registrars) on the Performers List. There are 114 GP surgeries: of these 76 are General Medical Services (GMS), 30 are Personal Medical Services (PMS), 2 are Alternative Provider of Medical Services (APMS) and 6 are currently provided by Kent Community Services (KCS) but are out to tender and will be APMS contracts from the 1st December 2011.
The budget for general practice contracts is approximately £85.3m.
Dental
There are 376 dentists on the Performers List. There are 102 dental contracts; of these 94 are General Dental Services (GDS) and 8 are Personal Dental Services (PDS). All PDS contracts include Orthodontics. The budget for dental is £33.6m + £4.5m for community dental services. The PCT expects to recover approximately £8m in Patient Charge Revenue.
Optometry
There are 125 optometrists on the Performers List and 98 optometry contracts. The budget for optometry is £6.9m.
Pharmacy
There are 258 pharmacists working within 145 pharmacy contracts.
The pharmacy budget is approx. £25.8m.
Contracts
The primary care contracts are currently held by the contracts team based at Kent House, Ashford.
09 appendix 2 legacy document.doc1 10/08/2011 19 of 91
For Medway
General practice Patients registered with the 67 Medway practices total almost 282,000. Of these 59 are GMS contracts, 2 are PMS contracts, 1 is a PCT PMS contract, and 5 are APMS contracts (held by 3 contractors).
The practices are divided across 581 main sites and 21 branch sites. Twenty eight are single-handed practitioners; 39 are partnership contracts, of which 21 have 3 or more GPs. There are a total of 165 GPs in Medway, of which 47 are female. The average list size is 4,208. Total budget including all contractual and premises expenses is £ 40m.
Dental Thirty five practices offer general dental care (GDS contracts), of which: 3 treat children only 9 treat children and exempt adults only 23 treat children, exempt adults and charge paying adults
Two of the above practices also provide advanced mandatory services for minor oral surgery and treatment under sedation (PDS contracts) – these practices also provide treatment to NHS West Kent and NHS Eastern & Coastal Kent patients. The funding for these specialist services is included in NHS Medway’s funding allocation. The historic level of service provision has been maintained for non-Medway patients so there are no cost implications to the PCT of non-Medway patients being treated at these practices.
There is one full time dentist providing domiciliary care (PDS contract) in patients’ own homes (mainly limited to examinations, scale & polish and the provision of dentures).and one Specialist Orthodontic Practice (PDS contract); this practice also provides treatment to NHS West Kent and NHS Eastern & Coastal Kent patients. The funding for this specialist service is included in NHS Medway’s funding allocation. The historic level of service provision for non-Medway patients has been maintained so there are no cost implications to the PCT of non-Medway patients being treated at this practice.
Total Primary Care Dental budget for 2009/10 has £17.391m which includes indicative patient charges of £3.3m and £661k income for 6 vocational training practices.
Optometry The new General Ophthalmic Services (GOS) contract was introduced in August 2008. Unlike the other Independent Contractor contracts, the GOS contract does not restrict the Contractor to the level of service it can provide or the location of practices. The GOS contract is solely for the provision of NHS sight tests to eligible patients (under 16ys, under 19ys and in full time education, over 60ys, patients suffering from diabetes or glaucoma; and patients in receipt of certain benefits). Sight tests to all other patients is on a private basis. Patients that are eligible for NHS sight tests and require glasses 09 appendix 2 legacy document.doc1 10/08/2011 20 of 91
or contact lenses may also be entitled to a voucher to assist with the cost of these. Any other Ophthalmic or Optical provision is outside of the GOS contract and will be a Locally Enhanced Service funded separately by the PCT. Historically the funding for the GOS contract was from a centrally held non-cash limited budget and payment for NHS sight tests and vouchers is made by Kent Primary Care Agency (KPCA). KPCA also undertake probity checks on behalf of the PCT to ensure claims are made in accordance with the GOS regulations and that patients who claim NHS provision are entitled to this. The GOS budget has been devolved to PCTs. As there will be no changes to the GOS contract this could result in a significant cost pressure to the PCT if new practices open or more sight tests are carried out and vouchers issued than in the test period used to devolve the budget to the PCT.
The service includes:-
• 21 practices offering NHS sight tests and the issue of NHS vouchers for glasses and contact lenses (GOS contracts). • 15 contractors providing domiciliary care for NHS sight tests and the issue of NHS vouchers for glasses and contact lenses (GOS Additional Services Contracts). • 15 practices provide a cataract referral service providing pre and post operative assessments and advice for patients requiring cataract surgery (as a local enhanced service (LES). • 2 practices in the Rochester and Strood locality are piloting a primary eye care acute referral service (PEARS)
For West Kent
General Practice NHS West Kent has 103 GMS and PMS (12 of which are PMS) contracts and including 2 APMS contracts. One practice is a PCT-managed practice. The two APMS practices have been commissioned via a tendering process since 2008 and one PCT managed practice was transferred to a GMS contract in April 2011. The PCT spends around £13m on QOF of which most practices achieved 95% last year. Participation in QOF is entirely voluntary; 99% of NHS West Kent practices participate. Payments are made based on each practice’s achievement, adjusted for the actual prevalence in each clinical area within the practice and their list size. The maximum number of points achievable is 1000, allocated as follows: Clinical 697; Organisational 167.5; Additional Services 44; Patient Experience 91.5.
The PCT spends in the region of £12-13m on enhanced services; work is in progress to explore the future commissioning arrangements for enhanced services and rationalise what services are delivered to address the overspend in this budget.
09 appendix 2 legacy document.doc1 10/08/2011 21 of 91
Dentistry NHS West Kent has 109 GDS and PDS contracts. Most of these contracts were inherited by the PCT in 2006. Since then the PCT has made a significant investment of an additional £3million into improving access to NHS dentistry, via a procurement exercise, providing access for an estimated 40,000 more people to regularly see an NHS dentist. Total budget as at April 2011 is £24.4m.
However, provision of NHS dentistry remains challenging. This is because NHS West Kent has the 12th lowest financial allocation per patient out of 151 PCTs in England. The average allocation per resident for England is £43. In comparison, the allocation for NHS West Kent is £34, (21% less than the national average). If NHS West Kent received funding closer to the national average, it would have approximately £5 million extra to spend on NHS dentistry. This situation has been contained as far as possible by the implementation of robust and effective contract monitoring procedures to ensure that wherever possible, contracts deliver as close to 100% of their contracted activity, with appropriate treatment intervals for patients. These measures have helped to increase the number of patients regularly accessing NHS dentistry from 276k at December 2009 to 289k at December 2010. There is auditor’s significant assurance that the PCT had taken appropriate and effective performance management action, to identify and address significant activity and delivery issues with its dental contracts. The SHA regional and national tables confirm this with the PCT noted as having the second lowest 0-3 months re-attendance of patients in the SHA, ranked at 32nd nationally, with an SHA range of ranking between 28 and 123. Further, NHS West Kent was noted as having the second lowest number of units of dental activity per patient in the SHA at 3.14 compared with an SHA average of 3.38 and England average of 3.43. NHS West Kent has the lowest cost per patient in the SHA at £80.58 compared with £86.88 average in the SHA and £89.11 average in England. These results mean that through careful and continued contract monitoring, NHS West Kent dentists are following NICE Guidelines on patient re-call intervals more so than in other areas, resulting in better value.
Optometry Optometry contracts were initiated in 2008. NHS West Kent has 69 mandatory contracts of which there are 35 additional (Domiciliary) contracts, 18 contractors providing both these mandatory and additional services. Optometrists provide two enhanced services: for Post-Operative Cataract Care, provided by 8 performers; and for Glaucoma Pre referrals to reduce the number of inappropriate hospital referrals, provided by 21 performers.
3.2 Primary Care Services Providers List
A list of primary care service providers can be found at here.
09 appendix 2 legacy document.doc1 10/08/2011 22 of 91
3.3 Acute Providers – General Overview
For Kent and Medway
There are four main NHS acute providers located in Kent which provide the majority of acute services to the Kent & Medway PCT Cluster as follows:-
Dartford and Gravesham NHS Trust
Dartford and Gravesham NHS Trust, based at Darent Valley Hospital in Dartford, close to the Bluewater Shopping Centre. This is a PFI hospital opened in 2000 (total beds 470). The trust offers a range of services to a population of approximately 270,000 residents mainly in Dartford, Gravesham, Swanley and Bexley. Services offered include day care surgery, general surgery, trauma, orthopaedics, cardiology, general medicine and maternity.
East Kent University Foundation NHS Trust
East Kent University Hospitals Foundation NHS Trust – Operates from 5 sites – William Harvey Hospital Ashford, Queen Elizabeth Queen Mother Hospital Margate, Kent & Canterbury Hospital Canterbury, Royal Victoria Hospital Folkestone and Buckland Hospital Dover (total beds 1634). The trust serves a population of around 600,000.
Maidstone and Tunbridge Wells NHS Trust
Maidstone and Tunbridge Wells NHS Trust, a medium-size non-teaching acute hospital trust providing a full range of general hospital services to around half a million people resident in south west Kent and parts of north East Sussex. (total beds 742 (rising to approx. 960). Many of the people using this trust live in the Maidstone and Tunbridge Wells areas.
The Trust provides specialist cancer services via its flagship cancer centre at Maidstone, and satellite unit at the Kent & Canterbury Hospital, to approximately 1.8million people resident in Kent and Medway and the Hastings and Rother area of East Sussex.
The trust has historically operated from four clinical sites; Maidstone Hospital, Kent & Sussex Hospital, Pembury Hospital and Preston Hall (Aylesford). A new £230m PFI hospital will all single room/en suite accommodation will be fully open from November 2011, at which point the Kent & Sussex Hospital will close and a programme of centralisation of some services between Pembury and Maidstone completed.
There is a third-wave national independent sector treatment centre on the Maidstone Hospital site, due to reach contract termination in November 2011.
09 appendix 2 legacy document.doc1 10/08/2011 23 of 91
Medway Foundation NHS Trust
Medway Maritime Hospital treats 400,000 patients predominantly from the Medway (Chatham, Gillingham, Rainham, Rochester and Strood) and Swale areas with some from other parts of north and west Kent (total beds 881). On average there are 1,400 outpatients seen and 200 patients using the emergency department weekly.
The range of services offered has grown over recent years. This includes a cardiac catheter suite, the West Kent Vascular Centre, West Kent Centre for Urology, a dedicated stroke unit and the Macmillan Cancer Care Unit.
3.4 Acute Providers List
09 appendix 2 legacy document.doc1 10/08/2011 24 of 91
For Eastern and Coastal Kent
All contracts are for one year
NHS Eastern and Plan 000s 000s 000s 000s 000s Coastal Kent 000s SLA 000s SLA 000s boundary boundary Indicative PCT Position Geographical Geographical Outturn 09.10 Outturn 09.10 Outturn 08.09 Outturn 10.11 Outturn 10.11 Contract Value from Plan 000s Plan 000s from all SLAs are not all SLAs are Services Provided Services Provided Modelled Variance Modelled Variance Envelope - note as Envelope - note Modelled SLA FOT Modelled SLA signed this may be may be signed this different to the final to the different East Kent Hospitals General University NHS Acute / Maidstone Foundation Trust NiCU and and 385,765 395,636 9,871 415,994 Renal Salveo 415,994 398,100 373,179 330,556 Maidstone and General Maidstone Tunbridge Wells Acute / and NHS Trust 16,480 17,519 1,038 17,295 Cancer Salveo 17,295 17,259 16,640 13,272 Medway NHS General Foundation Trust Acute / 44,076 45,897 1,820 45,642 NiCU Total PCT 45,642 46,126 43,123 34,639 East Sussex General Hospitals NHS Trust 834 863 23 840 Acute Total PCT 919 794 824 634 Guy's and St General Thomas' NHS Acute and Foundation Trust 24,414 25,009 595 25,639 Specialist Total PCT 24,488 25,169 24,483 20,079 King's College General Hospitals NHS Acute and Foundation Trust 15,986 15,917 -68 15,799 Specialist Total PCT 16,497 15,655 15,535 14,170 Mid Essex Hospital General Services NHS Trust 65 91 26 65 Acute Total PCT 89 101 45 81 Queen Victoria General Hospital NHS 4,421 4,531 109 4,551 Acute and Total PCT 4,413 4,422 4,533 3,405
09 appendix 2 legacy document.doc1 10/08/2011 25 of 91
Foundation Trust Specialist
Royal Free General Hampstead NHS Acute and Trust 1,087 1,013-74 1,102 Specialist Total PCT 1,093 1,055 991 653 Royal National General Orthopaedic Hospital Acute and NHS Trust 1,494 1,687 193 1,516 Specialist Total PCT 1,839 1,755 1,366 1,084 The Lewisham General Hospital NHS Trust Acute and 1,502 1,384 -118 1,524 Specialist Total PCT 484 1,118 1,663 990 University College London Hospitals General NHS Foundation Acute and Trust 3,756 4,436680 3,882 Specialist Total PCT 4,610 4,277 3,482 2,365 The Royal Marsden General NHS Foundation Acute and Trust 2,255 2,017 -239 2,289 Specialist Total PCT 1,736 2,153 2,114 1,257 Total 502,142 515,998 13,857 536,138
09 appendix 2 legacy document.doc1 10/08/2011 26 of 91
For Medway
NHS Medway 000s 000s 000s 000s 000s 000s 000s 000s 000s 000s boundary boundary Indicative Indicative Plan 000s Plan 000s PCT Position Geographical Geographical Outturn 10.11 Outturn 09.10 Outturn 08.09 Contract Value Contract Value from Plan 000s from Plan 000s Services Provided Modelled Variance Variance Modelled Modelled SLA FOT SLA Modelled this may be different SLAs are not signed signed SLAs are not to the final SLA 000s Envelope - note as all - note Envelope Dartford and Gravesham General 3,848 3,360 -488 3,485 Dartford 3,460 3,848 3,028 2,655 NHS Trust Acute General East Kent Hospitals Acute / Maidstone University NHS 6,125 6,156 31 5,987 NiCU and 5,987 6,123 5,466 5,757 Foundation Trust and Salveo Renal General Maidstone Maidstone and Tunbridge 11,737 12,307 570 12,635 Acute / and 12,635 12,423 11,690 10,381 Wells NHS Trust Cancer Salveo General Medway NHS Foundation 124,371 124,679 307 124,703 Acute / Total PCT 124,703 126,296 121,604 97,515 Trust NiCU General Guy's and St Thomas' Acute 12,394 11,167 -1,227 11,079 Total PCT 10,610 11,042 11,389 9,405 NHS Foundation Trust and Specialist General King's College Hospitals Acute 5,660 5,652 -8 5,739 Total PCT 6,014 5,601 5,153 4,590 NHS Foundation Trust and Specialist
09 appendix 2 legacy document.doc1 10/08/2011 27 of 91
Mid Essex Hospital General 32 53 20 49 Total PCT 42 40 40 14 Services NHS Trust Acute General Queen Victoria Hospital Acute 4,131 4,454 323 3,954 Total PCT 4,333 4,431 3,935 3,284 NHS Foundation Trust and Specialist General Royal Free Hampstead Acute 525,399. 387 -139 332 Total PCT 377 454 488 459 NHS Trust and Specialist General Royal National Acute Orthopaedic Hospital 719 1,062 343 796 Total PCT 1,242 1,036 644 615 and NHS Trust Specialist General The Lewisham Hospital Acute 142 219 76 246 Total PCT 188 193 136 161 NHS Trust and Specialist General University College Acute London Hospitals NHS 864 1,471 606 1,512 Total PCT 1,505 1,498 923 949 and Foundation Trust Specialist General The Royal Marsden NHS Acute 609 920 312 943 Total PCT 1,021 862 601 522 Foundation Trust and Specialist Total 171,160 171,886 727 171,460
09 appendix 2 legacy document.doc1 10/08/2011 28 of 91
For West Kent
SLA FOT Plan may be may be Services Variance Provided boundary boundary Indicative PCT contract Geographical Geographical Outturn 10.11 Outturn 10.11 Outturn 09.10 Outturn 08.09 Modelled SLA Modelled SLA Contract Value not signed this not signed as all SLAs are envelope - note - note envelope different to final to different final Dartford and General Gravesham NHS 102,102 110,894 8,792 110,600 Dartford 110,600 114,800 102,875 86,061 Acute Trust East Kent General Maidston Hospitals Acute / 10,297 10,148 -149 10,124 e and 10,124 10,007 8,752 7,908 University NHS NiCU and Salveo Foundation Trust Renal Maidstone and General Maidston Tunbridge Wells 173,622 186,190 12,568 183,281 Acute / e and 183,281 186,500 179,406 149,412 NHS Trust Cancer Salveo General Total Medway NHS 12,779 12,509 -271 11,627 Acute / 11,627 12,320 11,710 10,590 PCT Foundation Trust NiCU East Sussex General Total Hospitals NHS 3,020 3,257 237 3,261 3,261 3,129 3,009 2,877 Acute PCT Trust Guy's and St General Total Thomas' NHS 36,248 37,758 1,510 36,042 Acute and 36,042 37,412 36,090 30,476 PCT Foundation Trust Specialist King's College General Total Hospitals NHS 26,236 26,925 688 26,111 Acute and 26,111 27,230 25,744 20,894 PCT Foundation Trust Specialist Mayday General Total Healthcare NHS 198 187 -11 92 92 173 193 171 Acute PCT Trust
09 appendix 2 legacy document.doc1 10/08/2011 29 of 91
Mid Essex General Total Hospital Services 78 67 -10 54 54 67 79 70 Acute PCT NHS Trust Queen Victoria General Total Hospital NHS 10,592 11,754 1,163 10,907 Acute and 11 11,234 10,829 8,296 PCT Foundation Trust Specialist Royal Free General Total Hampstead NHS 998 834 -164 829 Acute and 829 839 959 907 PCT Trust Specialist Royal National General Orthopaedic Total 1,764 1,750 -14 1,749 Acute and 1,749 1,691 1,674 1,149 Hospital NHS PCT Specialist Trust Royal Surrey County Hospitals General Total 160 94 -66 54 54 96 176 107 NHS Foundation Acute PCT Trust South London General Total Healthcare NHS 21,363 20,813 -550 18,258 Acute / 18,258 20,322 21,459 15,941 PCT Trust NiCU The Lewisham General Total Hospital NHS 1,395 1,817 423 1,864 Acute and 1,864 1,621 1,274 1,302 PCT Trust Specialist University College General London Hospitals Total 3,810 3,911 101 3,839 Acute and 3,839 3,803 3,469 2,467 NHS Foundation PCT Specialist Trust The Royal General Total Marsden NHS 2,218 2,957 740 2,898 Acute and 2,898 2,902 2,349 1,948 PCT Foundation Trust Specialist Barts and The General Total London NHS -0 0 0 2,167 Acute and 2,167 1,677 1,798 1,892 PCT Trust Specialist Moorfields Eye General Total -0 0 0 777 777 828 525 322 Hospital NHS Acute and PCT
09 appendix 2 legacy document.doc1 10/08/2011 30 of 91
Foundation Trust Specialist The North West General Total London Hospitals -0 0 0 494 Acute and 494 521 525 303 PCT NHS Trust Specialist Imperial College General Total Healthcare NHS -0 0 0 1,327 Acute and 1,327 1,310 1,456 795 PCT Trust Specialist St George's General Total Healthcare NHS -0 0 0 1,270 Acute and 1,270 1,186 962 800 PCT Trust Specialist Chelsea and General Total Westminster NHS -0 0 0 745 Acute and 745 791 612 282 PCT Foundation Trust Specialist Total 406,878 431,863 24,985 428,369
09 appendix 2 legacy document.doc1 10/08/2011 31 of 91
3.5 Tertiary Services – General Overview
The Specialised Commissioning Group, hosted by NHS West Kent, commissions specialised services for the cluster (and the whole of South East Coast region). Its remit is to maximise the use of resources in terms of expertise, high tech equipment and specialised treatments. These services are financially risk-shared between the PCTs in South East Coast, minimising financial exposure for individual PCTs.
The Specialised Commissioning Group also manages a number of contracts and agreements with tertiary providers on behalf of the PCTs it serves. The purpose of these arrangements is to cover those specialised services where local providers do not have expertise. The normal referral route is from consultant in a local trust to the tertiary provider, however for some, where a local service does not exist, referrals are made direct by the GP.
3.6 Tertiary Services List
For Kent and Medway
All contracts are for one year
000s 000s 000s outturn Approx Approx Provider Services provided Financial Financial Financial Eastern & Eastern Coastal PCT PCT Coastal 2010/11 000s 000s 2010/11 Medway PCT Medway contract value value contract West Kent PCT PCT Kent West outturn 2008/09 outturn 2008/09 outturn 2009/10 outturn 2009/10 Great Ormond Specialist Street Paediatrics £4,278 £4,681 £4,985 £3,501
Royal Brompton & Specialist Harefield Cardiac & £5,558 £5,786 £5,032 £3,821 Respiratory
Royal Free Hearing Hampstead NHS problems Trust GI problems
Musculo skeletal system
Renal problems Royal National Orthopaedics Orthopaedic Hospital NHS Trust
Guy’s and St Coronary Heart Thomas’ Hospital Disease NHS FT Renal problems
09 appendix 2 legacy document.doc1 10/08/2011 32 of 91
St George’s Cancer- Healthcare NHS Urological & Trust Haematological
Trauma & Orthopaedics
Kings College Cancer- Hospital NHS FT Urological & Haematological
Barts and the Coronary Heart London NHS Trust Disease
Trauma& Orthopaedics
Maternity & Reproduction
Moorfields Eye Eye problems Hospital NHS FT
Queen Victoria Burns Hospital NHS FT
Royal Marsden NHS Cancer FT
University College Cancer London Hospitals Neurological NHS FT Musculo skeletal system
Care UK – Will Ophthalmology Adams NHS Treatment Centre Trauma & Orthopaedics
BMI Fawkham Trauma & Manor Hospital Orthopaedics
BMI Somerfield Trauma & Hospital Orthopaedics
Spire Alexandra Trauma & Hospital Orthopaedics
General Surgery
Horder Centre Trauma & Orthopaedics
The Chaucer Hospital
St Saviour Hospital Hythe
Beneden Trauma & 09 appendix 2 legacy document.doc1 10/08/2011 33 of 91
Orthopaedics
GI problems
The Spencer Wing (Ashford/Margate)
3.7 Mental Health Providers – General Overview
NHS Medway hosts lead commissioning for mental health (adult 18+ and old age functional) for all three PCTs in Kent and Medway, and works closely with both local authorities (Kent County Council and Medway Council). Commissioning means that it continuously reviews the mental health and wellbeing needs of the population of Kent and Medway, works with strategic partners to develop supports for those at risk and services for those with mental health problems and their carers, contracts for delivery of services across NHS, independent and voluntary services, performance manages and monitors the effectiveness of service delivery, and makes improvements in a continuous cycle of improvement.
Needs are reviewed continuously, but an extensive Joint Strategic Needs Assessment was completed in April 2009. The scope of services arranged is extensive. Kent & Medway Partnership Trust is the largest service provider, providing access, recovery, and acute services, and specialist services for those with eating disorders, mothers with MH problems, those with learning disabilities and mental health problems, some other more specialist services, and some secure services. Kent and Medway PCTs will spend >£144m with KMPT this year on these services. MH commissioning also funds Primary Care Psychological Therapy Services, funds a number of voluntary organisations to provide many community support services, purchases prison mental health services, and purchases secure placements from many independent sector providers
3.8 Mental Health providers List
All providers listed below can be accessed by all appropriate refers across Kent and Medway. Placements and funding are co-ordinated by Medway PCT as lead commissioner and are agreed by two Kent and Medway wide panels.
09 appendix 2 legacy document.doc1 10/08/2011 34 of 91
For Kent and Medway
All contracts are for three years.
(£m) (£m) Approx Approx outturn 2010/11 2010/11 Provider Services provided Financial contract value value contract
Kent and Full adult mental health £160,109 £160,109 Medway services. (East £72,943) (East Partnership Specialist tier 3 mental health (Med £26,667) £72,943) and Social services for children and (West £60,499) (Med Care NHS adolescents. £26,667) Trust (West £60,499)
South £1,755,594 (confirm) Mental health specialist London and inpatient and outreach the services for children and Maudsley adolescents NHS Trust SLAM £2.4 (£0.4m ADHD) Cygnet Priory Group Care Aspirations Care Principles Partnership in Care Mental health placement St Andrew’s providers Cornerstone Curocare Woodleigh St Magnus Whitepost Eastbourne Vista Ludlow Cassel St Georges
3.9 Community Services – General Overview
There are two main Community service providers across Kent and Medway; these are the Kent Community Health NHS Trust who provides services for Eastern and Coastal Kent and West Kent PCT’s and Medway Community Healthcare C.I.C who provide services to Medway PCT.
Additionally the Paula Carr Trust (Charity provider) provides retinopathy screening services to all three Kent and Medway PCTs.
09 appendix 2 legacy document.doc1 10/08/2011 35 of 91
3.10 Community Services List
For Eastern and Coastal Kent
Kent Community Health NHS Trust provides community services for Eastern and Coastal Kent, these services include: Adult Speech and Language Therapy, physiotherapy, pharmacy, dental, dietetics and nutrition, GPsWI, ICATs, management of specialist clinical services, PMS practices, podiatry, podiatric surgery and orthotics, sexual health services, wheelchair and integrated equipment services, smoking cessation, 24-hr nursing community care, cardiac rehab nursing specialist team, community hospital inpatient services and community matrons. (www.kentcht.nhs.uk)
value length served served Approx Approx Current Current contract contract contract Provider Services provided Indicative Boundary Boundary Geographic Geographic Kent Community Community Eastern and Coastal 3 Years Health NHS Trust services for Kent PCT and West adults and Kent PCT boundaries children (not including Medway)
For Medway
Medway Community Healthcare C.I.C provides community services for Medway PCT, these services include: Adult Speech and Language Therapy, Adults with Learning Disability SALT, podiatry services, occupational therapy, nutrition and dietetics, musculoskeletal and neuro physiotherapy, clinical assessment, total community nursing and twilight nursing, continence care service, intermediate care service (Walter Brice), rapid response, phlebotomy, community equipment loans service, health visiting, SALT for the under-5s, supporting young parents integrated team, children’s therapy service, family nurse partnership, respiratory, diabetes, tissue viability and wound therapy, cardiology – rehab, heart failure and diagnostic, arrhythmia, stroke, falls, palliative care, dermatology MedOCC same day treatment and on call service, night nursing, advanced clinical assessment team, anticoagulation therapy. (http://www.medwaycommunityhealthcare.nhs.uk)
Provider Services provided Indicative Geographic Boundary served Current length contract Approx value contract Medway Community services Medway 5 Years £40m Community for adults and Health CIC children
09 appendix 2 legacy document.doc1 10/08/2011 36 of 91
South East Coast Patient transport Kent and 1 year £600k Ambulance NHS Medway remaining Trust Marie Stopes Termination of Medway 2 Years £550k Pregnancy Kent Community Cont and sexual Medway 1 year £1.1m Health NHS Trust health, HIV/Aids, outreach clinic, ISIS project, minor injuries, Lymphoedema, Medway Patient transport Medway 1 Year £58k Foundation NHS booking service Trust
For West Kent
Kent Community Health NHS Trust provides community services for West Kent, these services include: Adult Speech and Language Therapy, physiotherapy, pharmacy, dental, dietetics and nutrition, GPsWI, ICATs, management of specialist clinical services, PMS practices, podiatry, podiatric surgery and orthotics, sexual health services, wheelchair and integrated equipment services, smoking cessation, 24-hr nursing community care, cardiac rehab nursing specialist team, community hospital inpatient services and community matrons. (www.kentcht.nhs.uk)
Provider Services provided Indicative Geographic Boundary served Current length contract Approx value contract Kent Community Community Eastern and 1y £59m Health NHS Trust services for adults Coastal Kent PCT and children and West Kent PCT boundaries (not including Medway) Physiotherapy – The Physiotherapy South West Kent 3 years £97900 Wells (currently in year 2) Physiotherapy Osteopathy Sevenoaks 1 year 6120 practices Physiotherapy – Physiotherapy South West Kent 1 year £39,600 Laverstock GpwSI Dermatology TBC TBC 85,923 GpwSI Dermatology TBC 14,774 – PCBS GpwSI ENT ENT GpwSI South of Kent but 3 years £106,000 services and catchment areas to microsuction be more specific when new service at Snodland from August 2011.
09 appendix 2 legacy document.doc1 10/08/2011 37 of 91
Please note new service from August contract value not yet set so not included in this document as yet. GpwSI Minor Skilled Primary West Kent Variable – £511,071 Surgery Care Surgery between 1-3 p.a. years (end date Mar 2012 or Mar 2013) GpwSI Primary care South West Kent 3 years (in £50180 Rheumatology rheumatology year 2) service GpwSI Primary care South West Kent 3 years (in £3491 Rheumatology – rheumatology year 2) PCBS service GpwSI Community Renew date £36,410 respiratory service = 31/3/12
3.11 Voluntary Services – General Overview
Kent & Medway Cluster PCTs work in partnership with a number of local voluntary services as follows:-
3.12 Voluntary Services List
For Kent and Medway
09 appendix 2 legacy document.doc1 10/08/2011 38 of 91
Provider Services provided Current length contract Approx value contract & Eastern PCT Coastal PCT Medway PCT Kent West Paula Carr Retinopathy 3 Years Screening service Age Concern Foot care and day 1 Year £40k care Medway Asthma care 1 Year £11k Asthma Self Help Stoke Stroke rehab and 1 Year £66k Association support Hi Kent Hearing aid support 1 Year Royal Sign Language 1 Year Cost per Association for interpreting case the Deaf Maidstone Support, friendship 1 Year £20k Homestart and practical help for families under stress in own homes Young Lives Children’s advocacy 1 Year £39k Foundation service Kent County Joint contracts for 1 Year Council carer support Medway Joint contracts for 1 Year Council carer support National Breastfeeding 1 year £4k Childbirth Support Trust Salvation Room Hire 1 year £3k Army (breastfeeding) Blackthorn Pain Management Ends 2013 £45,000 trust British Terminations Ends 2013 £39K Pregnancy Advisory Service Hi Kent Hearing aid support Yearly (Hearing Aids) services at a payment of number of clinics £7149 across West Kent, supply of batteries from MTW Marie Stopes Terminations Ends 2013 £820k International Marie Stopes Vasectomies Ends 2013 £164K International End of Life Carer support Annual £100k Care – Crossroads Ellenor Palliative care Two year 1.2m per Foundation (currently in year (grant in aid – year 1) not contract) Cruse Bereavement Annual 8k Bereavement services Heart of Kent Palliative care Two year 900k per Hospice (currently in year (grant in aid – year 1) not contract) Hospice in the Palliative care Two year 755k per Weald09 appendix 2 legacy document.doc1(currently in year (grant10/08/2011 in aid – year 1) 39not ofcontract) 91 Marie Curie Night sitting Annual 16k (grant in aid – not contract)
09 appendix 2 legacy document.doc1 10/08/2011 40 of 91
3.13 Other
Provider Services provided Current length contract Approx value contract & Eastern PCT Coastal PCT Medway PCT Kent West SECamb Ambulance service and patient transport Medway Interpreting Service None £97k Council Hospices
Out of Hours
Provider Services provided Indicative Geographic Boundary served Current length contract Approx value contract Eastern & Out of Eastern Ends Coastal Hours and March 2012 Kent Coastal Contract Kent South East Out of West Kent 3 years 5.3m Health Hours GP from 1st Limited services April 2010 Out of Hours MEDOCC
Independents
Provider Services Provided Indicative Catchment Current Contract Length Approx. Contract Value Functional Odstock Medical West Kent None – cost Budget = Electrical Company per case £11,341 Stimulation Benenden Direct Access Renew date £24,728.00 Imaging 31/3/12 BMI Fawkham Renew date £196,064.00 Radiology 31/3/13 BMI Fawkham and Renew date £48,425.00 Chelsfield DVT 31/3/13 BMI Fawkham Pulmonary Renew date £22,000
09 appendix 2 legacy document.doc1 10/08/2011 41 of 91
Rehabilitation 31/3/13 Service
09 appendix 2 legacy document.doc1 10/08/2011 42 of 91
4 Quality
4.1 Effectiveness
The Kent and Medway Cluster is currently seeking to coordinate the quite differing approaches to implementing clinical effectiveness across each PCT. PCTs in the area played a leading role in the reform of the IFR process in 2009 and a Kent-wide policy based upon South East Coast norms is in the process of being drafted. There are well-developed integrated systems in all 3 PCTs for determining access to new drugs and systems of therapeutics and whilst authority to determine policy on these issues will be within the gift of clinical commissioning groups it is likely that they will wish to share expertise across the cluster.
Assurance of the delivery of clinically effective initiatives by commissioned services, with particular reference to NICE guidance, sits within the Quality Directorate and discussions about how these two functions might mutually support one another are nearing conclusion. The West Kent Clinical Effectiveness Committee is likely to be preserved under our new arrangements and will transmit its policy-making function, supportive of IFR and high cost treatment policy development, and complementary to local commissioning intentions, into the new clustered arrangements.
4.1.1 Summary of commissioning prioritisation decisions (eg low priority treatments)
There is a Kent and Medway Referral and Treatment Criteria policy in place based on existing Low Priority Procedure (LPP) documents within the South East Coast region and nationally. The PCTs acknowledge the work undertaken by NHS Surrey in 2010. There is no blanket ban on these procedures; there is an established mechanism for dealing with individual funding requests (IFRs)/expectations. The application form for clinicians wishing to request funding for individuals that are eligible against the definitions of a “rarity request” or an “exceptionality request” as set out in each of the PCTs’ Policy and Operating Procedures for dealing with IFRs.
Patients who fulfil the criteria (unless otherwise stated) do not need to be considered by the review panel. However, these procedures will be subject to periodic audits to ensure adherence to the criteria. The policies and thresholds detailed relate to elective pathways of care in the main.
This document covers referral and treatment criteria across primary, community, secondary and specialised care.
Patients who are discharged due to not meeting the criteria will have their 18 week clock stopped (recorded as ‘no treatment required’).
09 appendix 2 legacy document.doc1 10/08/2011 43 of 91
The list of referral and treatment criteria will be reviewed by the relevant group in each PCT on an annual basis (a lead PCT will be agreed for each area), or when new guidance or policy is issued.
Insert link to Policy
4.1.2 Summary of key prioritisation processes adopted by the organisation
To be added
4.2 Patient experience including-
4.2.1 Methods of communications with patients and public
The Kent and Medway PCT Cluster believes strong communication and engagement is essential to ensure our staff, partners in care, and citizens are informed about and involved in delivering and designing healthcare services. We embrace the principles and pledges within the NHS Constitution and in the spirit of the health reforms, as well as providing strong leadership to ensure statutory responsibilities around patient engagement and Equalities and Diversity are met.
In April 2011 we took a cluster-wide approach and began matrix working across the three Communications and Engagement Teams, from Eastern and Coastal Kent, West Kent and Medway. In this way we are ensuring best practice from all three is raising the standard of our services for the PCTs and supporting developing clinical commissioning groups. We are also continuing to forge strong links with partner organisations such as Kent County Council and Medway Council, and preparing to play into a nationwide shared communications and engagement service.
During the transition healthcare services are under increased public and media scrutiny, making timely and robust communications even more important to maintain patient and public confidence in the local NHS and continue to protect the reputation of the NHS at a time of change. This is against a backdrop of financial pressures and management cost reductions, It is therefore more important than ever that we develop more cost effective and better quality methods of delivering communications and engagement, avoid duplication, and scale up where possible to achieve efficiencies.
However, our top priority remains ensuring we are at all times putting the best interests of patients and public first, and delivering high quality communications and engagement that is timely, appropriate to the needs of the audience, and addressing the key priorities of the Cluster.
Detailed below are the main methods of communication and engagement deployed by the team across the three PCTs. At this stage the descriptions are based on the way in which they have operated separately, and we are still
09 appendix 2 legacy document.doc1 10/08/2011 44 of 91 in the process of developing one strategy for the cluster, with single and consistent methods of delivery.
Add link to Joint Comms Strategy when complete.
All PCTs utilise a wide range of communication and engagement methods the detail of which can be found in their individual Communications and Engagement Plans. See below for overviews and links:-
Eastern and Coastal Kent
NHS Eastern and Coastal Kent utilises the following methods (list is not exhaustive)
• Press releases • Your Health • Brochures • Website • Marketing materials eg posters • Social media • GP bulletin • Stakeholder bulletin • Face to face focus groups/practice patient groups etc
Insert Links: ‘In the interests of our patients’ – Connecting with the Community 2010 V12 Communications and Citizen Engagement – activity plan V2 May 2011
Medway
Press releases are issued to the local media (Medway Messenger, kmfm, Medway News, Your Medway, Kent on Sunday, Heart FM, BBC Radio Kent, BBC South East, ITV Meridian). Information is also sent to parish councillors for their ward magazines, local councillors and MPs and partner and stakeholder organisations, to Link and residents’ publications for the rural areas such as the Hoo Peninsula.
Medway has contacts in regional and national publications and media outlets, as well as specialist press, depending on the subject matter.
All proactive press releases are published on the internet and, where applicable, intranet in staff news. Medway also publishes news via Twitter, in some cases, with Medway Council and other partners to publish on their websites/Twitter etc.
We are also now working as a communications cluster across Kent so a lot of our joint messages will also be sent to regional publications.
Insert link to Medway Comms and Engagement Strategy
West Kent
09 appendix 2 legacy document.doc1 10/08/2011 45 of 91
The PCT uses its Health Network, a panel of patient and public representatives living in West Kent, to maintain an ongoing dialogue with residents of West Kent to input into commissioning decisions. The Health Network has over 800 members (as of 26 May 2011) who are contacted on a monthly basis via a Health Network newsletter. This is distributed by post and email and is available on the PCT website; www.westkentpct.nhs.uk/Have_Your_Say .
The PCT website is another mechanism used to communicate with patients and public in West Kent. A dedicated section of the website has been developed to update people on live consultations, how to contact customer services, join the Health Network, results of previous consultations and the annual stakeholder engagement report.
Insert link (DH renamed Real Accountability Report 2010). Insert link – Comms & Marketing Strategy
Specific pieces of work are undertaken by the PCT to determine patients experience of services when commissioning decisions are being made. These are undertaken using a range of methods such as focus groups, surveys, telephone interviews and meetings depending on the target population.
The stakeholder engagement team distribute information of relevance/importance to a range of key stakeholders to ensure that information is communicated as far and wide as possible. This includes voluntary sector organisations who in turn include this information in their own bulletins, MPs, Borough Councils, Kent County Council, Maidstone & Tunbridge Wells NHS Trust, Dartford & Gravesham NHS Trust, and Kent Community Health NHS Trust.
The PCT also input into the Kent LINk (Local Involvement Network) bulletin and website on a monthly basis. The stakeholder engagement team coordinate this with the Kent LINk development workers. The Kent LINk is a panel of people living in Kent who have an interest in health and social care and act in a scrutinising capacity towards providers/commissioners of these services.
4.2.2 Summary of patient/public views
Eastern and Coastal Kent
The level and extend of the engagement, participation and involvement is dependent upon the size and scale of the project/change in order that the PCT meets the requirements of Section 242 of the NHS and Social Care Act. Each project lead will maintain the summary of patient/public views from the activity undertaken, e.g. Dover, Faversham, Maternity Services Review, etc.
The PCT also uses the Virtual Panel. The Virtual Panel is made up of individuals who have either agreed to being contacted to share their views in 09 appendix 2 legacy document.doc1 10/08/2011 46 of 91 the future about various health related issues or are existing partners who we already regularly contact and work with. The panel members don’t need to meet up as information is shared via email or the post
See Communication and Citizens Engagement Directorate Board Reports – insert link
Medway
NHS Medway’s programme of public engagement is branded the Medway Health Debate and aims to ensure that all of our engagement activity is co- ordinated and meaningful, is acted upon and informs commissioning decisions. The Debate includes public meetings, meetings with local community groups and organisations, drop-in sessions at public venues such as the Sunlight Centre and the Medway Health Debate survey online.
The Medway Health Debate culminates in an annual public event, which last year was held in partnership with Medway Local Involvement Network (Medway LINk) at the Corn Exchange on 26 October 2010. Over 150 people attended. There were more than 30 third sector organisations and delegates reflected Medway’s diverse population. The event recognised the importance of public involvement with speakers from Medway LINk and clinicians and patients talking about how they influenced commissioning decisions.
The theme of the event was how to get the best use out of limited public resources, while improving health outcomes and the experience of patients. We asked people what they thought about healthcare locally, what should be prioritised and where money could be better spent. We wanted to know what we should stop doing and how we could support people to better manage their own health. Feedback from the event has been used by commissioning managers in their projects, and has helped to shape the Strategic Commissioning Plans and the Communications and Engagement Strategies.
Insert link
West Kent
The stakeholder engagement team summarises all engagement activities carried out throughout the year in the Stakeholder Engagement Annual Report which is presented at the PCT Board, uploaded on the PCT website on the Have Your Say section for the public to access. http://www.westkentpct.nhs.uk/Have_Your_Say The report is advertised to the Health Network and Kent LINk through their newsletters.
4.2.3 Analysis of complaints data – April 10-March 11
For Kent and Medway
Each PCT reports on the complaints it receives as a commissioner of services and, until 2011, additionally as a provider of community services and provides trend analyses in the individual complaints annual reports and summaries. 09 appendix 2 legacy document.doc1 10/08/2011 47 of 91
There are statutory requirements to report on monitoring and learning from complaints and publish details of this learning. The annual report and accounts is the usual vehicle for publication in ensuring adherence to this statutory requirement.
As well as receiving complaints about a variety of providers, it is usual to receive complaints following certain policy changes. During 2010/11 the following issues gave rise to complaints across the three PCTs:
IVF – Complaints typically focussed on patients not fitting the criteria (this could be age limits, or BMI, one of the partners having a child from a previous relationship or number of attempts available on the NHS).
Individual Funding Requests – complaints focussed on change in process of IFR in West Kent, complaints about the triage process and panel decisions. In East Coast Kent complaints focussed on panel decisions and the lack of information given to patients around the decision making process and outcome. There are a number of patients wanting abdominoplasties having had successful gastric band operations and complaining that they cannot have these procedures paid for the NHS.
Low Priority Procedures – Complaints ranged from delays being imposed on procedures (budget constraints in West Kent) to the return of referrals to GPs by the Acute Hospitals Trust in East Coast Kent as a consequence of tighter protocols. People with orthopaedic problems who are in pain are distressed that the Hospitals Trust has rejected the referral. Linked with this is the need to have an acceptable BMI which patients are sometimes affronted by. There are also returned ophthalmology, dental (all minor oral surgery) referrals.
O84 telephone numbers for General Practice Surgeries – This is a continual stream of complaint across all three PCTs and the subject of multiple MP enquiries.
Gluten-free prescribing – East Coast Kent was the first to implement changes to gluten free prescribing and these changes resulted in an unprecedented amount of patient complaints, MP enquiries and gluten free manufacturers’ correspondence. In Medway complaints arose on the same issue in advance of the changes because GPs have been forewarning patients on the changes due to come into place on 1 July 2011.
Homeopathy – In West Kent the change of access to homeopathy through triage by consultant rather than by choice resulted in complaints.
Audiology – In West Kent the closure of Clinicentres causes access problems for hearing aid batteries and repair of aids. Patients now having to be referred by GP to audiology department in Acute Trusts for repairs, batteries obtained via third sector at selected outreach clinics. Similar issues and complaints in East Coast Kent.
09 appendix 2 legacy document.doc1 10/08/2011 48 of 91
Orthotics – In West Kent waiting lists developed due to service changes at Maidstone and Tunbridge Wells Trust. Delays in access to supports and insoles.
Changes in providers – Common themes in complaints can be lack of communication, inadequate handover arrangements (with patients falling into a black hole), problems in transferring lists from one provider to another, patients thinking that there was nothing wrong with the previous provider and questioning the PCT’s rationale for change.
Each of the PCTs has systems in place for reviewing patient experience themes from complaints and ensuring that learning from complaints is embedded.
Generally if a complaint is about a provider it is accepted practice to get the patient’s consent to pass the complaint to a provider and ask them to respond, with a final copy to the PCT. The final PCT copy is then reviewed by the PCT to see if further action is required. The PCT will always co-ordinate complaints that straddle multiple organisations and will draw in responses from the various providers. Such complaints are usually complex and time consuming with different providers having conflicting priorities.
Complaints and PALS data is now recorded on the Datix software system in all 3 PCTs. This enables reports to be prepared and submitted to committees and commissioning teams so that they have sight of complaint issues.
See PCT Annual Reports for annual analysis of complaints data.
4.3 Safety and Safeguarding
The Kent and Medway PCT Cluster is setting in place a system to safeguard quality through transition based on the substantial strategies and plans in place in the 3 PCTs. These include:
● the patient Safety and Care Quality Strategy ● [insert title of WK document] ● [insert title of MW document] ● insert title of 3 PCT HCAI plans
These strategies and plans will underpin a Cluster quality strategy and plan that will ensure safe performance and governance systems are in place across Kent and Medway through the period of change.
The way in which the delivery of quality and safety will be embedded into the Kent and Medway health system through transition is threefold. The commissioning and contracting process will utilise the Enhancing Quality Programme, the CQUIN process, and the Safe care and Compassion Integrated Plan programme.
Insert link - to EQP, CQUIN information and the Safe Care and Compassion County Plan 09 appendix 2 legacy document.doc1 10/08/2011 49 of 91
Local Clinical Commissioning Groups (CCGs) are at various stages of development in relation to their approaches to quality commissioning. The Cluster strategies and plans will be further developed to focus on the core task of supporting CCGs to develop their approach to commissioning for safety and quality.
Assurance about the quality and safety of commissioned services is provided to the 3 PCT Commissioning Boards, that incorporate reports from the local commissioning groups and to the Cluster Board through formal quality reports to each meeting.
Insert link – Cluster Board Quality Reports
Safeguarding is addressed through a similar system of planning and governance. The Cluster is developing a Kent and Medway All Age Safeguarding Plan – building on exiting plans for child and adult safeguarding extant within the 3 PCTs. This integrate plan will incorporate the Improvement Plan for safeguarding children that has followed from the Ofsted and CQC visit in 2010.
Insert link - safeguarding strategies and plans from all 3 PCTs
Assurance about the impact of existing safeguarding plans is incorporated within the quality reports to the Cluster Board
4.3.1 Summary of any significant safety breaches, including service failures (any confidential information should be included in the Part B report)
Eastern and Coastal Kent
Include here CEGs, Performance meetings, Safety Sub Committee, PSCQC, Safeguarding Group etc
Medway
Significant safety breaches are discussed at the Clinical Quality Committees. Please see below for agenda from February, April and June 2011. They are also discussed at provider quality review groups – minutes can be supplied if required but would also be confidential
Link to February, April and June Clinical Quality Committee agendas.
Please also see the three most recent SI reports that went to the Board. The lessons learned are included another section of this template below.
Insert links to January, March and May SI reports
09 appendix 2 legacy document.doc1 10/08/2011 50 of 91
Please see the three most recent reports on providers that went to the board highlighting issues.
Inset links to February, April and June reports.
West Kent
The clinical quality team provides the Board, via its Quality Committee with updates on the number, nature and range of serious incidents requiring investigation (SIRIs) and actions being taken to effectively report, investigate, learn from and close cases, to mitigate the risk of recurrence. At any given time there are a range of incidents within process. As at May 2011 there were 160 SIRIs being reported by West Kent provider organisations and the PCT itself which reports on behalf of GPs, care homes, prisons, out of hours services and the Kent Primary Care Agency which it hosts for the Cluster. 4.3.2 Update on any current safety breaches, including identified management strategy
Eastern and Coastal Kent
Link to Joint HCAI Report
Medway
These are included in the Board reports on providers above and Board lessons learned reports below. Minutes for the most recent Clinical Quality Committee could be provided but would be confidential.
Also see HCAI and safeguarding response to SHA:
Link to HCAI Report
West Kent
The incidence of pressure ulcers continues to breach limits in both main acute providers; the PCT is, therefore, working with both to ensure that root causes are identified and lessons shared. A series of improvement actions has been agreed with each provider.
4.3.3 Trend analysis/reference to learning from SIRIs
Eastern and Coastal Kent
See annual reports on serious incidents, 2008/09, 2009/10 and 2010/11. Insert link
Medway
NHS Medway has not historically produced SI annual reports. The three most recent SI lessons learned confidential reports to the Board are included in Part 2 of this document. 09 appendix 2 legacy document.doc1 10/08/2011 51 of 91
West Kent
The clinical quality team focuses on the positive impacts of process improvement by concentrating on performance indicators such as reduction in trends. The team’s increased visibility with providers, particularly in clarifying information necessary to close incidents, has been well received.
The PCT supports providers in their understanding of root causes and how these feed in to process improvements that positively affect overall outcomes. The team stresses the need for root cause analysis to pinpoint the fundamental breakdown or failure of a process which, when resolved, will prevent a recurrence of the problem.
The team holds “learning” workshops to ensure continuous improvement to processes and to disseminate learning from experiences. The patient safety group meets bi-monthly to discuss relevant issues with the clinical quality team to performance manage and monitor SIRIs. This intensifies the focus on trends and clusters of incidents as they arise in order to provide greater oversight, ensure learning and suggest organisational changes that prevent similar trends from recurring. A working group meets weekly to review individual incidents and close those that have provided appropriate assurances of investigations, action plans, and lessons learnt.
See quality reports to the Board. Insert link
4.3.4 Summary of performance in relation to Healthcare Acquired Infection (with reference to significant historic issues and achievements)
Eastern and Coastal Kent
See infection prevention and control annual reports for 2008/9, 2009/10, 2010/11 and board reports. Insert links
Medway
Below is the most recent HCAI report provided to the Clinical Quality Committee. It also includes the annual report.
Insert link to HCAI report
See recent response to SHA below:
Insert link to SHA response HCAI
West Kent
The public health department works with providers to ensure they undertake an in-depth investigation into Healthcare Acquired Infections (HAIs) to 09 appendix 2 legacy document.doc1 10/08/2011 52 of 91 determine the root cause and identify any necessary changes to clinical practice.
Previous cases investigated have resulted in the following actions being taken:
Patients placed on the CDiff cohort ward in line with policy to control spread Enhanced programme of cleaning, including fogging with hydrogen peroxide to vacated rooms. Outbreak meetings held, usual measures put in place as per the Outbreak policy Infection control team support to ward based staff with further training and auditing. Haemato-oncology undertaking a full governance review and audit of antibiotic prescribing Ward based training to improve record keeping Purchase of dry fogging machines by a provider to improve the timeliness of cleaning after a period of increased incidence of CDiff Change in procedure in laboratory reporting of CDiff testing. Additional support for medical ffficers managing patients with CDiff in community hospitals through specific training and to proactively seek advice from microbiologist. Additional training for cleaning staff. Formalisation of reporting arrangements on identification and during an outbreak of infection. Review of data collection sheet for follow-up of reportable infections. Development and availability of CDiff information leaflet for patients, visitors and staff. Implementation of initiatives to promote appropriate antibiotic prescribing in the community.
Insert links to recent Quality reports
4.3.5 Review of estate safety, including compliance issues against national legislative requirements
The Cluster PCTs have a large estate portfolio, including, HQ offices, community hospitals, health centres, directly-managed GP practices and clinics. The majority of this estate is due to transfer to the newly formed community providers during 2011/12.
Health and Safety advice is provided through a combination of outsourced service and inhouse expertise. This will be amalgamated during 2011/12 utilising TUPE transfer of staff from Kent and Medway Facilities, a sector of the Kent and Medway Partnership and Social Care Trust.
09 appendix 2 legacy document.doc1 10/08/2011 53 of 91
Eastern and Coastal Kent
Information is held on the Kent & Medway Facilities function. Monthly updates are received. See: Compliance Checklist. Insert link
Medway
Health and Safety Report. Insert link
West Kent
See Action Plan WK v3.doc and 110419WKPCTv4Compliance Checklist Jan 2010. Insert link
4.4 Innovation (summary of key innovative approaches underpinning the delivery of future healthcare)
For Kent and Medway
There are a number of products which have been developed by the Cluster PCTs to support commissioning as follows:-
Health and social care maps; dashboards; Toolkit; CQUINs, thematic (eg LTC) Information and dashboards, bespoke reports on activity, referral and finance information. Informatics Contract monitoring tools, GP practice monitoring and benchmarking tools. iMethod developed to interrogate acute performance information. Health Needs Health needs assessments for specific conditions. Mental Health JSNA. K&M PH and Opportunity Observatory. South East PHO. Signposting, needs assessment, population Assessment profiles, equity audits, ToRs. Communications PPE - Patient participation model HealthNetwork, eNewsletter for GP practices and PPE Healthy Passport Club. Clinical Business case templates; Clinical commissioning and pathways programme; Commissioning Integrated performance reporting with quality focus. Pulse indicators, KPIs, QPIs. and Planning Workforce Assurance Guide toolkit. Scenario generator, competition v cooperation tool, market analysis framework, Quality forward competitive procurement plan, procurement strategy Commercial Quality Development Framework for medical practices, GP scorecard, bespoke Commissioning - Medway contract variation system and monitoring and documentation process Provider Management Safety and Quality Toolkits; Safeguarding Partnerships. Bespoke assurance Corporate framework, governance and performance dashboard.
An external review of innovation products and further opportunities was conducted across the Cluster during May 2011 in the context of demographic changes, rising public and patient expectations, resource constraints, new technology and fundamental system changes.
Lessons learned from innovating in Kent and Medway to date show:-
09 appendix 2 legacy document.doc1 10/08/2011 54 of 91
Early and thorough communication and engagement is essential to secure buy-in and diffusion A charismatic and trusted clinical leadership increases the likelihood of success Clinical networks can help with spread Evidence of benefits already gained helps persuade others to adopt Innovations which improve the working lives of clinicians as well as improved outcomes for patients are more likely to be adopted Innovations which use simple technologies and which integrate with existing information systems do better Good project planning and management is essential Clear and visible support from the top increase the likelihood of success Detailed performance management of implementation can increase resistance
Innovations studied in Kent and Medway include:-
Primary angioplasty service Audit Plus – a tool to help clinicians do the right thing for patients Telehealth and telecare
The findings and recommendations from the review are currently being considered. This section will be updated in future refreshes.
In Eastern and Coastal Kent PCT there has been a pilot of Assistive Technology (Telehealth).
See: Telehealth Pilot Executive Summary and Audit Commission report on Assistive Technology. Insert link
09 appendix 2 legacy document.doc1 10/08/2011 55 of 91
5 Performance
5.1 Summary of current and historic performance against national core standards
Performance and delivery reports have sought to reflect the progress of each PCT in delivering their strategic commissioning plans as well as summarising operational performance and progress in relation to national and local priorities and standards.
The style and format of each constituent PCT in the Kent and Medway Cluster has varied to suit the requirements of individual PCT boards. The cluster intends to deliver a single integrated performance report that provides detail at both cluster and Clinical Commissioning GP level with a style that focuses on the most recent available data and an emphasis on what has changed/delivered for patients.
Summary of performance against national key performance indicators for 2010/11:
Eastern and Coastal Kent
Data for 2010/11 demonstrates that NHS Eastern and Coastal Kent met the majority of the existing commitment indicators, however, category A (8 minutes) and category B ambulance response rates were not achieved. Performance against the national priority indicators was more variable with a number of indicators rated as underachieved or failed:
Underachieved Failed 18 week referral to treatment waiting times 12 week maternity appointments (also a vital (also a vital sign tier 1 KPI) sign tier 2 KPI) Access to primary dental services (also a Breast cancer screening vital sign tier 2 KPI) Cancer referral to outpatient appointment Chlamydia screening (also a vital sign tier 2 (two week wait) (also a vital sign tier 1 KPI) KPI) Childhood immunisation rates (also a vital Teenage conception rates (also a vital sign sign tier 2 KPI) tier 2 KPI)
Performance against the vital signs tier 1 and 2 indicators is summarised below:
Vital signs tier 1 All except two indicators achieved: Referral to treatment waiting times Extended cancer two week waits Vital signs tier 2 7 of the 16 KPIs not achieved: 12 week maternity appointments Teenage conception rates Childhood obesity Immunisation by recommended ages 09 appendix 2 legacy document.doc1 10/08/2011 56 of 91
Chlamydia screening Dental services Breastfeeding at 6-8 weeks. NB – there remains an overlap between vital signs indicator set and the national priorities; for clarity the indicator sets have been separated and overlaps noted.
Care Quality Commission Annual Health Check Report 2008/09
NHS Eastern & Coastal Kent Annual Audit Letter 2009/10
NHS Eastern & Coastal Kent Performance Summary
NHS Eastern & Coastal Kent Use of Resources 2009/10
NHS Eastern & Coastal Kent Vital Signs Performance Report 2009/10
NHS Eastern & Coastal Kent World Class Commissioning Panel Report 2010
NHS Eastern & Coastal Kent World Class Commissioning Panel Report 2008
Medway
Data for 2010/11 demonstrates that NHS Medway met the majority of the existing commitment indicators, however, category B ambulance response rates and the number of delayed transfers of care were not achieved. Performance against the national priority indicators was more variable with a number of indicators rated not achieved:
Breastfeeding at 6-8 weeks (also a vital sign Chlamydia screening (also a vital sign tier 2 tier 2 KPI) KPI) Childhood immunisation rates (also a vital Teenage conception rates (also a vital sign sign tier 2 KPI) tier 2 KPI)
Performance against the vital signs tier 1 and 2 indicators is summarised below:
Vital signs tier 1 All KPIs achieved Vital signs tier 2 The following KPIs were not achieved: Teenage conception rates Childhood obesity Immunisation by recommended ages Chlamydia screening Breastfeeding at 6-8 weeks. Mortality rates – all age, all cause, and cancer NB – there remains an overlap between vital signs indicator set and the national priorities; for clarity the indicator sets have been separated and overlaps noted.
Most recent activity projections report and performance dashboard Summary of QIPP tracker
09 appendix 2 legacy document.doc1 10/08/2011 57 of 91
West Kent
Data for 2010/11 demonstrates that NHS West Kent met the majority of the existing commitment indicators, however, category B ambulance response rates and time to reperfusion for patients who have had a heart attack (NB – Q4 data not available at the time of publication of this report) were not achieved. Performance against the national priority indicators was more variable with a number of indicators rated as underachieved or failed:
Underachieved Failed 12 week maternity appointments (also a vital Breast feeding at 6-8 weeks (also a vital sign sign tier 2 KPI) tier 2 KPI) Childhood obesity rate (also a vital sign tier 2 Access to primary dental services (also a KPI) vital sign tier 2 KPI) Childhood immunisation rates (also a vital Chlamydia screening (also a vital sign tier 2 sign tier 2 KPI) KPI) Cancer referral to treatment two month wait Teenage conception rates (also a vital sign target tier 2 KPI) Breast cancer screening NHS staff satisfaction Stroke care – proportion of patients with TIA scanned and treated within 24 hours
Performance against the vital signs tier 1 and 2 indicators is summarised below:
Vital signs tier 1 All except three indicators achieved: MRSA Cancer referral to treatment two month wait target Stroke care – proportion of patients with TIA scanned and treated within 24 hours Vital signs tier 2 The following KPIs were not achieved: Teenage conception rates Childhood obesity Immunisation by recommended ages Chlamydia screening Dental services Breastfeeding at 6-8 weeks. NHS staff satisfaction
(mortality rates data to be confirmed) NB – there remains an overlap between vital signs indicator set and the national priorities; for clarity the indicator sets have been separated and overlaps noted.
NHS West Kent Performance Report
09 appendix 2 legacy document.doc1 10/08/2011 58 of 91
5.2 Track record in delivering choice
Eastern and Coastal Kent
The PCT has historically achieved an average Choose and Book compliance of 60%. This is above the national average of 50%. The current compliance (June 2011) is at 50% however this remains comparable to the national average.
Performance was routinely reported to the Elective Care Commissioning Steering Group.
NHS Eastern & Coastal Kent Performance Report
Medway
In the Strategic Commissioning Plan, NHS Medway identified six key health goals to deliver over the next five years these included developing the capacity and capability of local services whilst offering more choice and responsiveness. The PCT has also developed End of Life care pathways so that heart failure patients have better choices, are not subjected to unnecessary emergency care or admissions to acute wards.
Locally the PCT has completed an expansion of capacity for Phlebotomy in Primary Care to give patients a great choice and better access to this service.
West Kent
The NHS Constitution gives patients a legal right to choose their provider when they are first referred to a consultant-led outpatient service; thus, Free Choice remains both a statutory and local priority.
Based on the latest available data (reporting structure has changed) a total of 26 separate providers were booked into in December 2010 by West Kent patients; with a total of 118 separate providers being used since the full implementation of Free Choice in April 2008. During April 2011 bookings to Independent Providers were 6.1% of the total bookings.
Choose and Book performance in April 11 was 41% (proportion of GP referrals made via choose and book) compared with SEC performance of 29% and national performance of 52%). Action plans are in place to further build on this performance.
09 appendix 2 legacy document.doc1 10/08/2011 59 of 91
6 Financial history
6.1 Pen picture of the financial history of the PCT area
Eastern and Coastal Kent
NHS ECK was formed in October 2006. Despite some localised financial difficulties, the new PCT delivered a surplus of £6m on a turnover of over £900m in 2006/07. Since then, turnover has increased steadily through to 2010/11 – though this was the final year of substantial real growth being allocated to the NHS. In 2010/11, the PCT delivered a surplus of £12m on a turnover of nearly £1.3bn.
During this time, substantial investment was made in all NHS services to fund:
• generic increases in attendances at hospitals • a population with an increasing age profile • new high cost drugs (eg Lucentis) • improving services, in line with the Joint strategic Needs Assessment for Kent
RRL CRL Year RRL Outturn CRL Outturn £m £m £m £m 2006/07 908,561 901,946 4,361 2,402 2007/08 1,010,465 1,006,505 4,584 4,536 2008/09 1,100,227 1,095,181 1,140 1,101
2009/10 1,212,382 1,206,252 5,130 5,031
2010/11 1,294,895 1,282,923 4,537 4,534
Medway
NHS Medway began in October 2006. After many years when Medway’s funding had been significantly below the Department of Health’s funding formula2007/08 saw its budget increased by 12 per cent or £37million.
To make best use of this funding increase, a detailed investment strategy for all major aspects of our business was drawn up. NHS Medway also invested heavily in the services it provided directly.
Due to the scale of the increase, it was not possible to plan and spend the additional resources in the best way within one financial year. NHS Medway therefore lodged £20million for safekeeping with the South East Coast Strategic Health Authority.
There are three statutory financial targets (revenue resource limits, capital resource limits and cash limit) and NHS Medway has successfully met these for each financial year of its existence. 09 appendix 2 legacy document.doc1 10/08/2011 60 of 91
Between 1 April 2009 and 31 March 2010 NHS Medway had £426.7million to spend on healthcare. This equated to more than £1,520 for each man, woman and child in Medway. In total, NHS Medway spent £423million of its revenue budget, giving a surplus of £3.7million.
For the same period it also spent £5.2million on capital costs, including: £3.1million on improvements to NHS buildings £1.2million on buying a site near Chatham High Street for development into a healthy living centre £800,000 on IT equipment and software
In 2010/11 NHS Medway’s budget was £448million this means that for each man, woman and child in Medway, NHS Medway spent £1,673. As in previous years all financial targets were met despite national resource pressures.
West Kent
2006/07 The PCT came into being on 1 October 2006 following the merger of South West Kent, Dartford Gravesham and Swanley, and Maidstone Weald PCTs. West Kent PCT inherited a mixed financial position from its predecessor organisations. In 2005/06, Maidstone Weald made a small surplus, while South West Kent and Dartford, Gravesham and Swanley recorded overspends. In their financial plans for 2006/07, the PCTs were required to make a contribution to the Strategic Health Authority’s revenue reserve totalling £22.4m. In addition they had to plan for repayment of prior year debts and brokerage of £15.5m. The SHA agreed to release £4.5m of the contingency fund to South West Kent and £2m to Dartford, Gravesham and Swanley in order to support their financial plans. Both Maidstone Weald and South West Kent were able to set balanced budgets, and in their final reports indicated that they were on target to deliver on plan, although this would be tight given that there were a number of risks which could impact on the final position. The breach of the revenue resource limit relates mainly to the former Dartford, Gravesham and Swanley PCT, where a balanced budget was not formally agreed for the year until 27 July 2006, and included unidentified savings of £9.8m. An external review of the financial position assessed the likely year-end overspend to be between£17m and £18m. On the creation of West Kent PCT, a revised outturn target in 2006-07 of a £13m overspend was agreed with the Strategic Health Authority. The actual outturn has exceeded this, principally relating to expenditure on GP prescribing, non-contracted care and individual placements, causing the PCT to review a number of its budgetary and control processes.
2007/08 West Kent PCT started 2007/08 with significant financial challenges, including a savings target of £24.9m, following the overspend in 2006/07 and the continuing upward trend in spending requirements for high-cost drugs, specialist services and continuing care. Having been in the position of reporting an overspend the PCT was determined to move the financial position of the PCT onto a firmer footing. As a result of the issues identified in 09 appendix 2 legacy document.doc1 10/08/2011 61 of 91
2006/07, a critical external report and to ensure that effort was focussed where it was most needed, the PCT instigated a thorough review known as Strengthening the Finance Function. This project had the aims of: Securing appropriate capacity and capability within the finance function; Embedding key financial controls, systems and processes throughout the PCT; Ensuring budgetary responsibility is fully aligned to PCT objectives. During 2007/08 the PCT addressed the financial position and implemented recommendations which improved the performance and capacity of the finance function to an appropriate level. The work on Strengthening the Finance Function reached a satisfactory stage and the objectives of the project were delivered, the main one being that the project would not be a project so much as a change in ethos enabling the PCT to continue to develop and improve under its own momentum. The PCT at this point was in a position to report sound and effective financial systems and controls and a small surplus of £193,000 for the year. The work undertaken in 2007/08 enabled the PCT to advance from an external assessment, Healthcare Commission, Use of Resources rating, of poor for 2006/07 to fair for 2007/08, and with realistic and realisable ambitions to move to good and ultimately excellent.
2008/09 The PCT was particularly successful in 2008/09 with regards to capital expenditure, especially in working in close partnership within the NHS and with outside agencies to achieve excellent benefits for Learning Disabilities services through the “Valuing People” reprovision project. In order to improve the quality of care for patients, the PCT bought 31 properties at a cost of £13m. A further £535,000 was spent on 11 of these properties to ensure they met current standards and on buying another property. These 12 properties were then sold on to Registered Social Landlords which specialise in the provision of housing for people with learning difficulties. In 2009/10 the PCT spent a further £6m buying and improving properties after which all the remaining properties were sold to Registered Social Landlords. This all adds up to better care for a section of our community. The PCT receives an external assessment from the Healthcare Commission for its Use of Resources. In 2007/08 this was rated as ’fair‘. Considerable work was undertaken in 2008/09 to improve performance and build a platform for the future.
2009/10 NHS West Kent received 10.36 per cent more funding in 2009/10 than in 2008/09. 2009/10 may be remembered for Swine Flu, and one of the harder winter periods in recent years. It is in this context that the achievement of a planned £2m surplus was set.
2010/11 NHS West Kent received 5.5% more funding in 2010/11 than in 2009/10. Initially the PCT planned to achieve a surplus of almost £10m, which would have been available in 2011/12. The plan was ambitious and the volume and cost of services exceeded plans in some areas, requiring early remedial action, which escalated throughout the year to ensure a satisfactory year end financial position for the PCT and our major local acute hospitals. Finally a 09 appendix 2 legacy document.doc1 10/08/2011 62 of 91 small surplus of £771k was achieved, and some service restrictions were necessary to avoid breaching the statutory financial duties.
During 2010/11 the PCT invested £7.8m in capital expenditure which helped to ensure that facilities and expensive items of equipment are modernised and maintained to safe standards.
The PCT has continuously improved its performance in paying bills promptly, both within the NHS and external contractors. This is a reflection of the importance the PCT places on supporting businesses and the economy as well as ensuring smooth and effective management processes. For the first time the PCT has achieved the 95% standard in all four key Better Payment Practice Code performance indicators.
A particular feature of the finances in West Kent over the history of the PCT has been the position of Maidstone and Tunbridge Wells NHS Trust (MTW) which will have received over £67m financial support over a five year period from 2007/08 up to and including 2011/12. Of the total £67m received by MTW £22m has been funded by West Kent PCT, £18.8m funded centrally, £2.5m funded by other PCTs and the final £23.6m funding not identified.
The support can be divided between £18.8m relating to Pembury project management and the remaining £49m relating to double running/ financial remediation, which is now known as the Foundation Trust Improvement Plan.
The Revenue Resource Limit (RRL) and Capital Resource Limit (CRL) and the associated outturns for each of the years of the PCT are set out below.
RRL CRL Year RRL Outturn CRL Outturn £m £m £m £m
2006/07 730.550 15.943 8.427 0.642
2007/08 817.190 0.193 2.287 0.356
2008/09 896.130 3.791 12.443 0.466
2009/10 988.969 2.013 23.571 0.005
2010/11 1,036.298 0.776 7.791 0.016
09 appendix 2 legacy document.doc1 10/08/2011 63 of 91
6.2 Summary of current organisational budgets – to be checked*
Area of Expenditure Eastern & Medway West Kent Coastal PCT PCT PCT £m £m £m Secondary Care EKHUFT 422 6 10 KMPT 67 23 57 Medway FT 45* 128* 12 MTW 16 13 183 DGS * 111 SECAmb 26 8 19 Other Acute 80 5 75 Other Mental Health 40 13 23 Learning Difficulty 17 11 4 Children’s Services 9 1 4 Other Urgent 16 8 18 Continuing Care 32 6 31 Specialised 24 37 137* Other Secondary 26 13 0 Community Care ECK-CS 121 1 57 MCH C.I.C 0 47 0 Prisons 10 3 2 Other community 4 0 2 Primary Care GP Prescribing 132 40 105 GP Practices 101 36 93 Pharmacy 24 12 23 Dental 27 13 22 Ophthalmic 7 2 6
09 appendix 2 legacy document.doc1 10/08/2011 64 of 91
6.3 Update on current high risk financial issues and identified management strategies to manage these
Eastern and Coastal Kent
Delivery of the Integrated Plan in 2011/12 including QIPP of £48m. This is monitored on a fortnightly basis, but remains a risk to achieving financial balance in 2011/12 The acute contract with EKHUFT valued at £416m in 2011/12. A risk share has been agreed in that both the PCT and EKHUFT share costs, or savings, if expenditure is over, or under, contract. Impact of the new PCT Cluster assuming accountability for the 3 K&M PCTs. Risk of loss of focus, key staff attrition, lack of motivation to deliver. New structures are being developed to counter these risks Impact of Clinical Commissioning Groups. Currently 9 CCGs in East Kent - risk of lack of collaboration, loss of focus on the large pan East Kent issues, lack of risk sharing practices, management resource required to manage 9 CCGs. Potential reduction to running costs. The PCT has already made substantial savings to achieve previous management cost savings targets. Further down-sizing will place increased pressure on an already stretched management resource.
Medway
To follow
West Kent
The issues with high financial risks are achievment of: 1. QIPP savings plans £37m 2. Pembury Hospital non-recurrent support £13m 3. In year activity greater than plan across whole portfolio 1% = £10m
09 appendix 2 legacy document.doc1 10/08/2011 65 of 91
7.0 Provider capacity
7.1 Summary of historic service capacity issues, including outstanding issues
Each PCT has developed organisational development plans and strategic commissioning plans. These plans focus on the delivery and future delivery of services and serve as mechanisms to test, and highlight potential capacity issues.
For Eastern and Coastal Kent
Chapter 10 of the Strategic Commissioning Plan 2010-2015 Supply Side Analysis contains details of both the historic and future service capacity issues for the Commissioning organisation. These include:
Organisation capacity to deliver 5 strategic goals Capacity to deliver strategic change programmes A drive to Increase commissioning capacity and capability Treatment capacity for cancer Community service capacity to deliver health and social care Research and innovation capacity Endoscopic capacity to meet future demand Future bed mix capacity
For Medway
The ‘Growing Healthier’ Strategic Commissioning Plan (2010-2015) analyses both current and future service need in order to meet the demands placed upon it. An example of these is:
Increase capacity within older people’s services Mental health commissioning capacity in order to offer greater choice for patients Access to GP services Increasing local service capacity and market Increase community service capacity to offer care closer to home Managing acute capacity both historically and in the future Increasing capacity of the ‘Stop Smoking’ services Increase capacity of the MEND programme
For West Kent
West Kent has included as part of its five-year Strategic Commissioning Plan a market analysis to describe the current and future capacity issues. These include: 09 appendix 2 legacy document.doc1 10/08/2011 66 of 91
Access to dental services Acute maternity capacity Improve integrated capacity within older people’s services Managing emergency admission capacity Improve capacity of provider services to assist with reducing avoidable emergency admissions
7.2 Market management initiatives (e.g. AWP)
The term Market Management encapsulates the processes undertaken to ensure high quality effective services are commissioned. As commissioners of services, PCTs have to manage knowledge, stimulate markets and create demand whilst working with partners, collaborate with clinicians, engaging with the public and our patients and supporting our existing providers.
The Government White Paper introduced an additional concept into this process which enabled any qualified provider (AQP) to be considered for providing an appropriate service. At this stage AQP is not defined.
Examples of market management initiatives across Kent and Medway are:
CAMHS Tier 4 (across Kent and Medway) Prison health service (across Kent and Medway) Adult prison mental health service (across Kent and Medway) Acquired Brain Injury Team (across Kent and Medway) Tysabri Infusion service Community cataract services Physical therapy services, Community dermatology services.
Currently a market management exercise is underway for CAMHS Tier 2 and Tier 3 (cluster wide, jointly with KCC).
7.3 Procurements undertaken over the last 3 years for patient services
Over the last three years there has been a wide range of procurement activity across Kent and Medway, shown below:-
Eastern and Coastal Medway West Kent Kent GP referred physical Health and Welfare therapy service Clinic Community based Digital Retinopathy transitional inpatient Screening Service neuro rehabilitation Mercury Clinic (Sexual Social marketing for 09 appendix 2 legacy document.doc1 10/08/2011 67 of 91 health services) Smoking Cessation service Audiology Service IAPT IAPT Community Endoscopy Community Level 4 Anti0Coagulation Therapy Service Ophthalmology Adult Male Low security Outpatients Clinics Inpatient Service Kent Eye Screening Kent Eye Screening Service Service X-ray Service ENT Outpatients Clinic Cataract Surgery Intermediate minor oral surgery CAMHS Tier 4 CAMHS Tier 4 CAMHS Tier 4
09 appendix 2 legacy document.doc1 10/08/2011 68 of 91
8. Workforce
As at 30th June 2011, the workforce of the three Kent and Medway PCTs which make up the PCT Cluster is affordable within the management cost allowance of the legacy PCTs.
Staffing structures have been reviewed and new Cluster wide senior structures are in place which broadly align, for the period of transition, functions to future commissioning forms and support cluster integrated plan delivery.
This alignment of staff as described above will provide a good platform from which to develop a workforce plan, including clinical commissioners (by September 2011) to meet the needs of commissioning organisation from 2013. This plan will enable managed change and development with staff and thus support retention for the cluster and emerging clinical commissioning groups.
8.1 Snapshot of current workforce
For Kent and Medway
PCT FTE Hosted Head count Management savings number Eastern & 378 419 32 Coastal Kent PCT Medway PCT 286 340 8 West Kent 355 142 398 PCT TOTALS 1019 1157
For Eastern and Coastal Kent it is anticipated that the fte will reduce further with the transfer of information governance , and community estates staff between the PCT and the Kent Community Health NHS Trust and the transfer of the finance consortium to an as yet to be agreed provider organisation.
For West Kent . It is anticipated that these figures will reduce in the first quarter of 2011 with the completion of workforce reductions in KPCA and 10 staff exiting under the Mutually Agreed resignation Scheme (MARS). The SCG is due to be transferd to the NHS CB in October 2011.
09 appendix 2 legacy document.doc1 10/08/2011 69 of 91
8.2 Summary of identified workforce challenges, including summary of achieved and required workforce reductions
There are common challenges that face all the PCTs in Kent and Medway which are being addressed through collaboration. Consultations are underway to move from PCT staff structures into a cluster-wide structure to better support the transition to clinical commissioning and other NHS reforms. This will provide a transition framework which gives clear and accountable structures, gives clarity for staff and assists the delivery of future commissioning needs.
The next phase of this will be to align staff for transition to emerging clinical commissioning grops and associated commissioning bodies; and to assign staff for transition to other bodies such as Kent County Council and Medway Council for public health services.
There are no further planned workforce reductions for the financial year 2011 /12 across Kent and Medway. Assessment of running costs for 2012/13 is in hand to enable plans for 2012/13 to be managed approapriately.
Workforce reductions were achieved in KPCA as part of a significant cost reduction exercise carried out in accordance with the organisational change policy. This ends on 30 June 2011 with a final reduction in posts and some compulsory redundancies; 10 staff remain at risk of redundancy.
09 appendix 2 legacy document.doc1 10/08/2011 70 of 91
9. Summary of key planned changes
9.1 Intended consultations (Summary taken from 2011/2012 Integrated Plan)
The table below includes the current details of planned as well as potential consultations regarding services provided by the Kent and Medway PCTs.
Eastern and Coastal Medway West Kent Kent Eating disorder service Short term intensive To follow improvement management beds for complex dementia Maternity Review likely Minor Oral Surgery To follow to go to consultation AWP Childrens services Gynaecology To follow potential to go to Community OP consultation CAMHS Tier 3 Dementia - Acute To follow procurement of new Mental Health Beds service potential for (Organic) significant service discussion Medway Potential Medway Potential To follow consultation round consultation round continuing healthcare continuing healthcare hospital/nursing home hospital/nursing home being closed being closed MIU review potential for Provision of beds for To follow consultation paper to go intermediate care (and to IUCB June stroke) Managed practices Mental Health acute To follow procurement of 6 beds practices.
9.2 Intended significant procurements
The following table contains a current list of the intended procurements that will be undertaken across Kent and Medway over the financial year 2011/12, several of which will be conducted as a Cluster-wide exercise.
Eastern and Coastal Medway West Kent Kent CAMHS (Tier 2 and Tier CAMHS (Tier 2 and Tier CAMHS (Tier 2 and Tier 3) 3) 3) Wheelchairs Wheelchairs Wheelchairs Non-emergency Patient Non-emergency Patient Non-emergency Patient 09 appendix 2 legacy document.doc1 10/08/2011 71 of 91
Transport Transport Transport Pathology Services Short term intensive Kent Primary Care management beds for Agency SLA complex dementia Early diagnosis and Prison Pharmacy and intervention in primary Health Care care and dementia support team Pathology Services Pathology Services
9.3 Risk assessment relating to implementation
Risks associated with planned changes are documented in both locality plans and risk registers as well as in the Kent and Medway Cluster QIPP Tracker.
Although these risks relate to local implementation across three PCTs and are very much focused on delivering QIPP they can be broadly described by the following themes:
Lack of clinical engagement Lack of capacity in the project teams Secondary care capacity not reduced leading to unplanned activity and costs Delays to projects and benefit realisation due to long consultations Lengthy procurement processes lead to project delays and delays in benefit realisation. Lack of engagement and support for planned changes
09 appendix 2 legacy document.doc1 10/08/2011 72 of 91
10. Organisational assets and liabilities
Organisational assets and liabilities are unique to each individual organisation as their purpose is to enable the organisation to meet the demand placed upon it. However, they do share common themes and categories and are all audited and managed in line with national guidance and regulation.
10.1 Physical assets of the organisation, including estate, equipment (including computers), information systems, software, etc
For Eastern and Coastal Kent
NHS Eastern & Coastal Kent Fix Asset Register
For Medway
Information asset register (link) Fixed asset register (link) Register of leases and licences (link) IT asset register including software (link)
For West Kent
NHS West Kent Deeds held by Brachers
NHS West Kent Deeds held by Capsticks
NHS West Kent IT Asset Register
10.2 Contracts for support (non-healthcare) services
09 appendix 2 legacy document.doc1 10/08/2011 73 of 91
Eastern and Coastal Medway West Kent Kent CLUSTER-WIDE Acute Contracting Team South Coast Audit (internal) Kent & Medway Health Informatics Service Kent Primary Care Agency Specialised Commissioning SEC Procurement Hub NHS Protect (counter fraud) Kent & Medway Kent & Medway Kent & Medway Facilities + Payroll Facilities + Payroll Facilities + Payroll Medway PCT Mental Medway PCT Mental Medway PCT Mental Health Commissioning Health Commissioning Health Commissioning
Audit Commission PKF (external audit) Audit Commission (external audit) (external audit)
Kent Community Health Medway Community Kent Community Health NHS Trust Healthcare (Staff NHS Trust training) Finance Consortium SBS Finance and Accounting
Dover Counselling MTW – Emergency Planning and Business Continuity – for termination in December 2011 East Kent University Hospitals Trust
09 appendix 2 legacy document.doc1 10/08/2011 74 of 91
11. Stakeholder map
For Eastern and Coastal Kent
Stakeholder/Partner Nature of Areas of Communication relationship Particular interest Methods Kent County Councillors Political All health Email Non Executive Directors PCT business All health Email, meetings, telephone Executive Team PCT business All Health and Email, meetings, Social Care telephone Voluntary Organisations Engagement and All health Email, meetings views Local Authority Chief Information and All health Email, letters, Executives integration telephone Media Any Email, telephone GPs Contracted Primary care, Email, telephone, consortia meetings/visits Dentists Contracted Medical area Email, telephone, specific meetings/visits Opticians Contracted Medical area Email, telephone, specific meetings/visits Pharmacists Contracted Medical area Email, telephone, specific meetings/visits Parish councillors Engagement and All health Email, telephone, views letter Kent Police Assist with DAT Email, meetings development work Kent Fire and Rescue Engagement and views The Public Patients All health All
For Medway
Stakeholder/Partner Nature of Areas of Communication relationship Particular interest Methods MPs Political All health Email HOSC Political Health and Social Email, HOSC Care meetings, letters LINKs Assist with Health and Social Email, monthly development work Care bulletin, quarterly events Voluntary Organisations Engagement and All health Email, meetings views Local Authority Leaders Information and All health Email, letters, and CEs of other integration telephone providers Media Any Email, telephone GPs Contracted Primary care, Email, telephone, consortia meetings/visits Dentists Contracted Medical area Email, telephone, specific meetings/visits Opticians Contracted Medical area Email, telephone, specific meetings/visits Pharmacists Contracted Medical area Email, telephone, specific meetings/visits
09 appendix 2 legacy document.doc1 10/08/2011 75 of 91
Hospices Contracted, Medical area Email, telephone, engagement and specific meetings/visits views Kent Police Assist with DAT Email, meetings development work Kent Fire and Rescue Engagement and views General Public Patients All health All
For West Kent
Stakeholder/Partner Nature of Areas of Communication relationship Particular Methods interest MPs Political All health Email HOSC Political Health and Social Email, HOSC Care meetings, letters Kent Local Involvement Assist with Health and Social Email, monthly Network development work Care bulletin, quarterly events Voluntary Organisations Engagement and All health Email, meetings views Local Authority Leaders Information and All health Email, letters and CEs integration Health Network Panel of All health Email, post, monthly representatives newsletter, meetings managed by PCT Media Any Email, telephone GPs Contracted Primary care, Email, telephone, consortia meetings/visits Dentists Contracted Medical area Email, telephone, specific meetings/visits Opticians Contracted Medical area Email, telephone, specific meetings/visits Pharmacists Contracted Medical area Email, telephone, specific meetings/visits Hospices Contracted, Medical area Email, telephone, engagement and specific meetings/visits views Health Network Members Panel of All Health representatives managed by PCT Locums and OOHs Contracted General
In addition each PCT communications team holds a communications and engagement database.
Eastern and Coastal PCT (link) Medway PCT (link) West Kent PCT (link)
09 appendix 2 legacy document.doc1 10/08/2011 76 of 91
12. Governance The operating framework for 2011/12 included a new requirement for all PCTs in England to form into ‘clusters’. NHS Kent and Medway was created in June 2011 and received delegated authority by way of an Establishment Agreement from Eastern and Coastal Kent PCT, Medway PCT and West Kent PCT in May 2011.
The role of the cluster is to:
Sustain management capacity, and a clear line of accountability, for the delivery of current PCT functions in terms of statutory duties, quality, finance, performance, QIPP and NHS Constitution requirements; Provide space for developing Clinical Commissioning Groups (CCGs) to operate effectively; Provide a basis for the development of commissioning support arrangements, allowing current commissioners and new entrants to develop a range of commissioning support solutions from which CCGs and the NHS Commissioning Board can secure expert support; Similarly, provide space for new arrangements with Local Authorities, and particularly Health and Wellbeing Boards to develop; Provide a mechanism to enable high quality NHS staff to move to new roles in CCGs, commissioning support arrangements and the NHS Commissioning Board, including minimising unnecessary redundancy costs; Support the provider reform element of the transition particularly in terms of ensuring progress with the FT pipeline through commissioning plans.
The cluster has seen the joining of each PCT’s Remuneration Committee into a Cluster Remuneration Committee and each PCT’s Audit Committee into a Cluster Audit Committee.
The day-to-day running of each organisation still has to remain grounded at a local level and this is reflected in the local governance structures. The local committees feed into the Cluster structure through committee reports and the Executive leads for each organisation.
A common set of strategic goals are in the process of being agreed by the Cluster and these will be fed into locality plans. An Assurance Framework and Corporate Risk Register is being put in place to monitor that this is effective.
12.1 Boards, committees and clinical networks, terms of reference, roles, responsibilities
Following the clustering of PCTs in June 2011 a common committee structure has been agreed and each PCT has a Quality Committee, Finance and Performance Committee and a Commissioning Committee to enable consistent reporting of information. In addition there are some residual committees; these are: 09 appendix 2 legacy document.doc1 10/08/2011 77 of 91
Staff Consultation Committee (Eastern and Coastal Kent) Turnaround Group (Eastern and Coastal Kent) Delivering Health Together in Medway Group (Medway) Medway Transition Board (Medway)
Clinical Networks
There are four clinical networks across Kent and Medway and the cover the following clinical areas:
(Cancer) (Stroke) (Cardiac) (Pathology)
Click on the links above to connect to the network’s website
12.2 Summary of key policy documents
Each organisation carries a portfolio of local policies which have been developed to support both local a national need. The Information Commissioners’ Office recommends that a model publication scheme is used to communicate a selection of these to our population and these are available through each organisations web page.
Eastern and Coastal PCT Medway PCT West Kent PCT
Click on the links above to connect to the PCTs’ websites.
Additionally, each organisation maintains a full suite of policies and procedures which are held on individual intranets. A register of these is contained in section 13 (Appendix).
Going forward some policies and procedures will be merged inline with the sharing of resources across the Kent and Medway Cluster. This will enable a consistent approach across the Cluster as well as the sharing of good practice and learning. As they are developed these policies will replace the respective individual organisations policies and procedures.
12.3 Corporate risk register
The Kent & Medway Cluster intends to amalgmate the three separate Corporate Risk Registers into one for the Cluster. This will also contain risks specifically focussing on the Cluster and its role (insert link when completed)
Each organisation will still collate its operational risks into a local Corporate Risk Register to enable effective local surveilance and monitoring before 09 appendix 2 legacy document.doc1 10/08/2011 78 of 91 escalation to the Cluster Corporate Risk Register. Locally the process for this is:
To follow in next iteration
09 appendix 2 legacy document.doc1 10/08/2011 79 of 91
13 Appendix 1
Document Library – in the process of being built
LEGACY DOCUMENT LOG
Section 2 2.2 WK GP Practice per Consortia 2.2 Medway GP Practices per Consortia 2.3 ECK AOP 2011 2.3 Medway AOP 2011 2.3 WK AOP 2011 2.4 ECK SCP 2.4 Medway SCP 2.4 WK SCP
Section 3 3.2 ECK Dental Providers List 3.2 ECK GP Providers List 3.2 ECK Opticians List 3.2 ECK Pharmacy Provider List 3.2 Medway GP Providers List 3.2 WK Dental Providers List 3.2 WK GP Providers List 3.2 WK Opticians List 3.2 WK Pharmacy Providers List
Section 4 4.1.1 KM Referral and Treatment Criteria (RaTC) (Final 7 March 2011) 4.2.1 ECK Communications and Citizen Engagement detailed activity plan v2 4.2.1 ECK Connecting with the Community 2010 v12 4.2.1 Medway Communications and Engagement Strategy 4.2.1 WK Comms & Marketing Strategy 4.2.1 WK Stakeholder Engagement Annual Report 4.2.2 ECK Communications Directorate Report Jan 11 4.2.3 ECK Customer Services Annual report 2010-11 4.2.3 Medway Complaints Annual Report 0910 4.3 ECK HCAI Improvement Plan Final Version 2011-2013 4.3 ECK Infection Prevention Control Annual Report 2010-11 4.3 ECK Approved PSQ Strategy March 09 4.3 ECK CQC and Ofsted Inspection of Services for Safeguarding and Looked After Children Action Plan 4.3 ECK CQC Looked After Children Report 4.3 ECK Infection Prevention Control Annual Report 2009-10 4.3 ECK Planning Self Assessment Tracker 2010-11 4.3 ECK Safeguarding Benchmarking Policy - Approved October 2010 4.3 ECK Safeguarding Response to the SHA May 2011 4.3 ECK Patient Safety & Care Quality Toolkit 4.3 EQ Incentive Deliverables V1 16 Final 09 appendix 2 legacy document.doc1 10/08/2011 80 of 91
4.3 Kent Final Improvement Plan Kent Safeguarding and Looked After Children June 2011 4.3 Kent Inspection of Safeguarding and Looked after Children 4.3 Medway Final DIPC annual report-09-10 4.3 Medway Quality Report April 4.3 WK CQC and Ofsted Inspection of Service for Safeguarding and Looked after Children 4.3 WK CQC Report Looked After Children 4.3 WK IPC Action Plan 4.3 WK North Action Plan HCAI 4.3.1 ECK Board Report March 4.3.1 ECK Board Report May 4.3.1 ECK PSSC-SCSC Safety Risks 4.3.1 ECK Safe Care Report to April PSCQ 4.3.1 ECK Safe Care Report to June PSCQ 4.3.1 ECKPSSC-SCSC Safety Risks 4.3.1 Medway Quality Report June 4.3.1 Medway Clinical Quality Committee April 4.3.1 Medway Clinical Quality Committee Feb 4.3.1 Medway Clinical Quality Committee June 4.3.1 Medway January SI Report 4.3.1 Medway March SI Report 4.3.1 Medway May SI Report 4.3.1 Medway Provider April Report 4.3.1 Medway Provider February Report 4.3.1 Medway Provider June Report 4.3.1 WK Quality Report May 4.3.1 WK Report to Quality Committee from Clinical Quality Team July 4.3.1 WK Report to Quality Committee from Clinical Quality Team May 4.3.2 Medway HCAI Report 4.3.3 ECK Annual Report on Serious Incidents 2010-11 4.3.3 Medway HCAI 4.3.3 Medway Lessons Learnt Report January Part 2 4.3.3 Medway Lessons Learnt Report March Part 2 4.3.3 Medway Lessons Learnt Report May Part 2 4.3.3 WK Quality Report May 2011 4.3.4 ECK HCAI Response to the SHA May 2011 4.3.4 ECK Infection Prevention and Control Annual Report 2010-11 FINAL 4.3.5 ECK Compliance Checklist 4.3.5. WK Compliance Checklist 4.4 ECK Audit Commission Report on Assistive Technology 4.4 ECK Teleheath Pilot Executive Summary
Section 5 5.1 CQC Annual Health Check Report 2008-09 5.1 ECK 2009-2010 - Annual Audit Letter incl UoR result 5.1 ECK Performance Summary 5.1 ECK UoR 2008-09 5.1 ECK WCC Panel Report 5.1 ECK WCC Panel Report - December 2008
09 appendix 2 legacy document.doc1 10/08/2011 81 of 91
5.1 ECK Vital Signs Performance Report 2009-10 5.2 ECK Performance Report May 2011 5.2 WK Performance Report May 2011
Section 10 10.1 ECK Fixed Asset register 01 04 11 10.1 WK Deeds held by Brachers 10.1 WK Deeds held by Capsticks 10.1 WK IT Assets Register
09 appendix 2 legacy document.doc1 10/08/2011 82 of 91
14 Appendix 2
Glossary of Terms Glossary
A A&E Accident and Emergency Department Accountability Everything done by those who work in the NHS must be able to stand the test of parliamentary scrutiny, public judgements on propriety and professional codes of conduct. Acute Care Care provided by the larger general hospitals. Acute Hospital A hospital which provides a range of care that normally takes a short time to complete – e.g. accident and emergency, maternity, surgery, medical, x-ray, radiotherapy, and so on. APMS Alternative Provider Medical Services ASH Action on Smoking and Health Assessment Assessment of a person’s health and social care needs. AWP Any Willing Provider B BAF Board Assurance Framework BMA British Medical Association Bed blocking (Also known as delayed discharge) where patients that are fit for discharge remain in acute hospital beds when other more suitable forms of care are not provided. BHD BUPA Health Dialogue BME Black and Minority Ethnic groups Business Plan A plan setting out the goals of an organisation and identifying the resources and actions needed to achieve them. C C&B Choose and Book Caldicott All NHS organisations are required to appoint a Caldicott Guardian Guardian – a person who has a responsibility for policies that safeguard the confidentiality of patient information. CAMHS Child and Adolescent Mental Health Service Care A system of organising care to vulnerable adults by local authority Management social services departments. It involves assessing needs, care planning, the organisation of care packages within available resources, monitoring and review and close involvement with service users and carers. Care Pathways The route that a patient will take from their first contact with an NHS member of staff (usually their GP), through referral, to the completion of their treatment. You can think of it as a timeline, on which every event relating to treatment can be entered. Carer One of six million informal carers that look after elderly, ill or disabled relatives or friends. CAS Central Alert System (incidents) CCP Co-operation and Competition Panel CDiff Clostridium Difficile Toxin CHD Chronic heart disease CLB Clinical Leadership Board – formal committee of the PCT Board Clinical Audit A cyclical evaluation and measurement by health professionals of the clinical standards they are achieving. Clinical A framework through which NHS organisation are accountable for 09 appendix 2 legacy document.doc1 10/08/2011 83 of 91
Governance improving continuously the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. Clinical A breach of duty by healthcare practitioners in the performance of Negligence their duties. Collaborative Working in partnership across organisations and with various groups. Commission/ Process in which the health service identifies local needs for Commissioning services and assesses them against the available public and private sector provision. Priorities are decided and services are purchased from the most appropriate providers through contracts and service agreements. As part of the commissioning process services are subject to regular evaluation. Communities Is a collective term referring to people who share identities, experiences or interests. E.g. this might include people living in the same locality, people sharing identities as members of a minority ethnic group or as disabled people, or people who share the experience of being a single mother or living in poverty. Community Care A network of services provided by social service departments of local authorities in conjunction with the NHS and volunteers. It supports old people, people who have mental health problems, or people who have learning disabilities, who might previously have been in a long stay hospital. Not to be confused with community health services. Community Care provided locally designed to keep people out of hospital and Health Services providing treatment in or near their homes. It is normally given by district nurses, health visitors, community midwives, and community psychiatric nurses, attached to general practice surgeries. COPD Chronic obstructive pulmonary disease Corporate The rules and regulations within which an organisation works to Governance ensure probity and accountability. CQC Care Quality Commission – health and social care inspectorate which replaced the Healthcare Commission in April 2009 CQUIN Commissioning for Quality and Innovation CSU Commercial Support Unit CT Computerised Tomography D D&G Dartford and Gravesham NHS Trust – acute provider Deprivation A measure of material poverty based on a number of criteria such as income, economic circumstances, environment etc… DH Department of Health DIPC Director of Infection Prevention and Control – every provider organisation has one Direct Access An arrangement for general practitioners to make use of facilities in a hospital. These can include laboratory investigations, x-rays, physiotherapy, and so on, without reference to a third party such as a consultant. DMG Decision Making Group DPH Director of Public Health DST Decision Support Tool DVH Darent Valley Hospital, Dartford E Elective Care Care that is planned in advance as a day case or inpatient. Eligibility Criteria To receive NHS funded Continuing Healthcare, a person must be 09 appendix 2 legacy document.doc1 10/08/2011 84 of 91
assessed as meeting eligibility criteria produced by the Strategic Health Authority. People who meet these criteria will always have complex, unpredictable or deteriorating conditions with extensive health care needs. ENT Ear, nose and throat EPP Expert Patient Programme – an NHS course for people living with long-term health conditions, to help them understand and manage their conditions. Executive Board level senior management employees of the Health Directors Authority, NHS Trust or Primary Care Trust who are accountable for carrying out the work of the organisation. F FDP Financial Delivery Plan FESC Framework for Procuring External Support for Commissioners Foundation Trust NHS Foundation Trust will be established as new public interest organisations accountable to local people and free from Whitehall control. Drawing on models from co-operative societies, mutual organisations and charities in Britain and abroad, NHS Foundation Trusts will work for NHS patients and wide public benefit. Each NHS Foundation Trust will have a Board of Governors, including governors elected by members of the local community and NHS staff, to provide accountability to stakeholders. FRP Financial Recovery Plan G GDS General dental services GP General Practitioner - doctor who usually with colleagues in partnership, works at a local surgery and provide medical advice and treatment to patients, and takes a leading role in the management and provision of local health care through their influence on the Primary Care Trusts. Their surgeries, general practices, often have a Practice Manager, and are now staffed by specialist nurses and therapists, and many accommodate dentists, opticians, and pharmacists. GPwSI GPs with Special Interests GUM Genito-urinary medicine H HAIs Hospital-acquired infections HCAIs Hospital and community acquired infections Health A term used to embrace all the organisations, NHS and others, Community, or whose activities have an effect on people’s health in a local area. Health Economy It can include local authority function such as services, environmental health and transport, and housing associations, water suppliers, and voluntary organisations. Health Inequality The term used to describe the fact that people living in deprived areas usually have poorer health than people living in more affluent areas. This can also apply to differences in the health of the people of various ethnic groups. HOSC Health Overview and Scrutiny Committee – this committee scrutinises services which have an impact on the health of the local community and must be consulted about any proposals for a substantial change or development in health services. Healthcare Independent watchdog for healthcare in England. Promotes Commission improvement in quality of NHS and independent healthcare, highlights variations in performance, urging poorer performing 09 appendix 2 legacy document.doc1 10/08/2011 85 of 91
trusts to learn from the best. HMA Healthcare market Analysis HRGs Health Resource Groups – means of categorising procedures HSJ Health Service Journal – NHS Managers weekly trade magazine Hosted Responsible to a single statutory organisation but providing a service to a number of organisations. I IAPTs Improving Access to Psychological Therapies ICO Information Commissioners Office IG Information Governance IFR Individual Funding Request Inequalities In the context of this document, ‘inequalities’ refers to services which are not equally accessible by all geographical areas of client groups in West Kent. Intermediate Health care for patients who are not ill enough to be in an acute Care hospital and not well enough to be at home unsupported. ISTC Independent Sector Treatment Centre J JCPCT Joint Committee for Primary Care Trusts JSNA Joint strategic needs assessment – covers health and social care K K&S Kent and Sussex Hospital, Tunbridge Wells KCC Kent County Council KP’s Key Performance Indicators L LAA Local Area Agreement LACS0 Looked After Children’s Services LINks Local Involvement Networks aim to give people a stronger voice in how their health and social services are delivered. The role of LINks is to find out what people want, monitor local services and to use their powers to hold them to account. LMC Local Medical Committee – the statutory committee elected by all general medical practitioners (GPs) in contract with the Health Authority to represent them and contributes to the debate on local health issues. LSP Local Strategic Partnership – non-statutory, multi agency partnerships, which matches local authority boundaries. LSPs bring together at a local level the different parts of the public, private, community and voluntary sectors; allowing different initiatives and services to support one another so that they can work together more effectively. LTC Long Term Conditions - conditions that cannot, at present, be cured, but can be controlled by medication and other therapies. They include diabetes, asthma, and chronic obstructive pulmonary disease. M MIU Minor injuries unit MoU Memorandum of Understanding MRI Magnetic Resonance Imaging MRSA Methicillin Resistant Staphyloccous Aureus MTW Maidstone and Tunbridge Wells NHS Trust – acute provider N NED Non Executive Director – independent member of the PCT Board. Independent appointees of the Secretary of State, who work with 09 appendix 2 legacy document.doc1 10/08/2011 86 of 91
the Executive Directors overseeing the business of the Health Authority, NHS Trust or Primary Care Trust. The Chair of a health authority or trust board is also a non-executive director and appointed by the Secretary of State for Health. NHS National Health Service NHS Continuing Care provided over an extended period of time to a person aged Care 18 or over to meet physical or mental health needs which have arisen as the result of disability, accident or illness. NHS Direct 24 hour advice about personal health care. Nurses give callers advice and reassurance or direct them to the service they need, calling an ambulance if necessary. NHS Direct The internet source of health advice and information. Online NHS Plan A plan for ten years, published in 2000 with the stated aim of putting patients and people at the heart of the health service. NHS Trusts These provide health care locally, mainly Primary Care Trusts, acute hospital trusts, or ambulance service trusts. They are each managed by a board headed by a lay Chairman, with part-time non-executive directors who represent the local community and special interests, and the senior full time staff, including the Chief Executive. NICE National Institute for Clinical Excellence - guides NHS staff about new health technologies including medicines, medical devices, techniques and procedures. NSFs National Service Frameworks these are nationally defined standards which set out the range of health care that should be in place for a specific service or group of patients. O OD Organisational Development OOH Out of Hours – primary care services normally provided by GPs in hours. P PAG Professional Advisory Group – panel which assesses doctors’ performance issues PALS Patient Advice and Liaison Services. Provided with NHS Trusts and PCT’s to provide on the spot help and advice to patients and carers. Patients People who are currently using or waiting for health services. PB Programme Budgets PbC Practice-based Commissioning - a government policy which takes the responsibility for commissioning (purchasing) some services for NHS West Kent and gives it to the local GP practices, who work with neighbouring GP practices to purchase the services which are most needed for their patients. PCT Primary Care Trust - enables GPs and other front line clinicians to redesign services that better meet the needs of their patients. Freestanding statutory bodies, which are able to manage and provide a range of community services directly; and commission hospital and other care from NHS trusts and other providers. PFI Private Finance Initiative, a government–led arrangement that involves private concerns in providing facilities which will be run by the NHS. PPI Patient and Public Involvement Primary Care Health services delivered in or near to a person’s home to which patients have direct access. These services include those 09 appendix 2 legacy document.doc1 10/08/2011 87 of 91
provided in GPs’ surgeries, health centres and community hospitals, or in patients’ homes, by a team of professional staff including GPs, practice nurses, community nurses, therapists and others. PROMS Patient Related Outcome Measures PSI Programme for Service Improvement Public A term used to describe everyone who is not part of the organisation or the professional team. We are all members of someone else’s ‘public’.
Q QALYs Quality Adjusted Life Years QIPP Quality, Innovation, Productivity and Prevention QOF Quality and Outcomes Framework - of new GP contract that rewards quality.
R RAG Red – Amber – Green rating RCGP Royal College of General Practitioners ROI Return on Investment S SBS Shared Business Service SCP Strategic Commissioning Plan Secondary Care Patients whose needs are too complex to be managed in primary care are referred to more specialist services. Secondary care includes local hospitals and treatment given away from the hospital setting, such as mental health services, learning disability services and help for older people. SECSHA NHS South East Coast – Strategic Health Authority Service user Anyone who uses or who has used a product or a service. This may mean current users or also include potential users. SHA Strategic Health Authority - There are ten of these across England, acting as the regional headquarters of the NHS. NHS South East Coast is the strategic health authority for Kent, Surrey and Sussex. Its role is to lead and support the local NHS and to hold it to account for delivering high quality, effective services for patients and service users. SIC Statement on Internal Control SIRI Serious Incidents Requiring Investigation SIRO Senior Information Risk Owner SLA Service Level Agreement Social Care Social care services are normally run by local councils, sometimes in conjunction with local NHS providers and organisations. Most of us are likely to become clients of social care services at one time or another but some of the main groups using the services include children or families who are under stress, people with disabilities, people with emotional or psychological difficulties, people with financial or housing problems and older people who need help with daily living activities. SS Social Services Stakeholders Anyone who has an interest in the way services are delivered, including service users, carers, patients, service providers, staff, health professionals and partner organisations, such as social
09 appendix 2 legacy document.doc1 10/08/2011 88 of 91
services, district and borough councils and other community or voluntary groups. STEIS Strategic Executive Information System T T&O Trauma and orthopaedics Tertiary Care Service provided by specialist hospitals which have diagnostic and treatment facilities not available at general hospitals, or given by doctors who are uniquely qualified to treat unusual disorders that do not respond to therapy available at acute hospitals. It can also include hospice care for people who are terminally ill. TIA Transient Ischaemic Attack - stroke U UDA Unit of dental activity UNPS Unique new patients seen (relates to dental contracts) UOA Unit of orthodontic activity V VTE Venous thromboembolism W WCC World Class Commissioning WKCH West Kent Community Health – the provider arm of NHS West Kent X Y Z
09 appendix 2 legacy document.doc1 10/08/2011 89 of 91
15 Appendix 3
Directory of Services – to be developed
09 appendix 2 legacy document.doc1 10/08/2011 90 of 91
Part 2: Confidential report
1. Quality 2. Liabilities 3. Key Staff Contacts 4. Current Issues – Briefing 5. Resilience & EP/BC
09 appendix 2 legacy document.doc1 10/08/2011 91 of 91