Document

Ambitions for aHealthy Kirklees

Organisational Development Plan

2009/10

Contents

Chief Executive’s Introduction

Background Information

1.1 Introduction to NHS Kirklees and our approach to organisationaldevelopment

1.2 Strategic challenges1.3 Organisational vision and values1.4 Goals 1.5 Delivering our vision1.6 Equality and diversity

How the PCT is Organised

2.1 Organisation structure2.2 PCT Board2.3 Governance structures 2.4 PCT Directorate structure

Organisational Development

3.1 PCT current position 3.2 Current Organisational Development Needs3.3 Organisational Development Self Assessment Initiatives3.4 Partnership working3.5 Employer of choice3.6 Leadership development3.7 National programme for IT (NPfIT)

Organisational Development Overview

4.1 Objectives for the current year4.2 Achieving our objectives4.3 Risk4.4 Finance

Conclusion

Appendices

1 McKinsey’s 7-S Model 2 Vision and values chart3 Kirklees PCT directorate structures 5 PCT Organisational Development – WCC Competency

Plan Trajectory4 WCC outcome of first assessment6 Kirklees organisational development action plan

Section 1

Section 2

Section 3

Section 4

Section 5

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Ambitions for a Healthy Kirklees Organisational Development Plan 2009/10

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Chief Executive’s Introduction

NHS Kirklees has made much progress overthe past eighteen months and is in a strongposition to meet future challenges. Duringthis time we have focused on strengtheningour commissioning capability to ensure thatwe spend public money in the mostefficient way to achieve the best possiblehealth for all the people of Kirklees.

We have continued to strengthen workingrelationships with our key partners acrossthe health economy. This has beenparticularly so with Kirklees Council wherewe have work jointly across a number ofagenda’s and have a number of joint posts,including the Director of Public Health. Aspart of our working with the council wehave completed a Joint Strategic NeedsAssessment (JSNA). This has provided uswith a wealth of information on the needsof the people in the seven localities thatmake up the borough of Kirklees. The NHSKirklees Strategic Plan reflects these needsin the outcomes we have identified as apriority, and also how we will measureprogress over the years.

We recognise the need to continue toengage and build stronger partnershipswith both our local clinicians and the peopleof Kirklees as they play a central role ininfluencing the way we commissionservices.

We engaged very positively with the WorldClass Commissioning (WCC) assessmentprocess in the period October to December2008, seizing this as a supportiveopportunity to identify requireddevelopment of our commissioning role.Careful consideration was given to our selfassessment of the current position against WCC competencies, and we were pleased

that the panel only felt it appropriate toalter two of our scores which resulted in theYear 1 WCC scoring process achieving 3scores at 3, 23 scores at 2, and 4 at 1, with2 greens and 1 amber for our StrategicPlans, placing us in a good place incomparison with the best PCT’s in thecountry.

Feedback from the panel was felt to be fairand good ’the panel developed an overallimpression of the organisation which is thatthe PCT has good foundations in place(systems, processes, resources, partnerships)the PCT has identified its significantchallenges and now is the time to deliverthe vision’.

Looking forward to 2009/10, we will drivetowards the outcomes we have identifiedand in this continue to tackle the issuesaffecting our local community, includingobesity, tobacco control, mental health andsexual health. We will continue to improveaccess and choice for service users thatreflect our diverse communities and deliverservices closer to people’s homes where it issafe to do so.

These key priorities are outlined in the PCT’sStrategic Plan. This clearly sets out how weintend to achieve our goals by workingproactively with partner organisations andengaging with clinicians, the public andservice users within Kirklees.

Mike PottsChief Executive

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Section 1

Background Information

1.1 Introduction to NHS Kirklees andour Approach to OrganisationalDevelopment (OD)

The NHS Kirklees OrganisationalDevelopment Plan builds on our existingwork and is designed to ensure the deliveryof both world class commissioningstandards and the PCT’s Strategic Plan. Theplan has been developed as a result ofseveral multi-disciplinary workshopsattended by the PCT Board, PEC, PCT seniormanagers, local authority representatives,local clinicians and Public and PatientInvolvement (PPI) representatives.

Diagnosis of our development to date andour future needs has been identified usingMcKinsey’s 7-S Model (Appendix 1). Thismodel has been shared amongst the seniormanagement team and will be adopted asour approach for future development. It hasallowed the PCT as a whole to look at themulti-dimensional areas that need to beconsidered to ensure the organisationaldevelopment plan is realised.

In November 2008 the PCT commissionedKPMG to work with the Board to identifyfuture needs and deliver an ongoingdevelopment programme to meet the needsidentified. This work, including BoardDevelopment, review of Governance,development of Provider Services hascontributed to the priorities identified in thisplan. A key part of developing providerservices is ensuring that Kirklees CommunityHealthcare Services (KCHS), the PCTprovider arm, is fit for purpose as outlinedin Transforming Community Services.

A Strategic Organisational DevelopmentGroup has been established to oversee thedelivery of the Organisational DevelopmentPlan for the forthcoming year. It is chairedby the Director of Human Resources andOrganisational Development with membersfrom the Director Group, and output fromthe group will report to the Chief Executiveand Senior Management Team andultimately the Board. The OD plan is a livedocument and will be further refined andupdated as the PCT continues itsdevelopment towards achieving world classcommissioning status.

1.2 Strategic ChallengesTo date, a number of key external strategicchallenges have been identified that willimpact on the PCT’s ability to meet its goals.These have been identified as part of ourwork with Kirklees Council and our partnersthrough the Kirklees Partnership.

The Kirklees Partnership has identifiednational and international trends that willhave a local impact and to which Kirkleesneeds to respond:

• Climate change – tackling ourcontribution to and planning to adaptto the impact of climate change.

• Ageing population – a growing ageingpopulation with long term conditions,many with co-morbidities

• Changing economic context

In addition, factors specific to Kirklees mustalso be addressed. To create a moresustainable Kirklees and achieve our 2020vision we must narrow the gaps inherent in:

• Infant mortality and other healthinequalities, including a lifeexpectancy below the nationalaverage

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• Educational attainment• A low skill, low wage economy• Lack of confidence in some of our

towns (particularly in North Kirklees –Dewsbury, Batley)

• Community relations

These challenges are identified within theJoint Strategic Needs Assessment developedin partnership with Kirklees Council. ThePCT Strategic Plan identifies the actionsrequired to address them, the expectedoutput from these actions and how this willbe measured. The Strategic Plan wasdeveloped with our key partners enabling acomprehensive, joint approach to tacklingthese issues. The organisationaldevelopment plan is designed to ensurethat the PCT has the culture, capabilitiesand capacity to deliver this.

1.3 Organisational Vision and ValuesVisionThe PCT vision and values were originallydeveloped in collaboration with staff andour partners through a series of workshopsand communication events and were signedoff by the Board in 2007. In 2008, wereviewed our vision, values and goals inlight of world class commissioning, HealthyAmbitions and our strategic priorities.

Our vision is:

Working together to achievethe best health and well-being for all the people ofKirklees

This means that NHS Kirklees workstogether - with ourselves and with ourpartners - to achieve the best health andwell-being for all the people of Kirklees.

Some services are provided by our own staffand we commission services from others,including GPs, dentists, pharmacists,optometrists, voluntary organisations andhospitals. Our ambition is to further developour partnership working with these groupsfor the benefit of people in Kirklees.

ValuesOur vision is underpinned by our values.These are to:

• recognise that people are at the heartof everything we do;

• support people in taking responsibilityfor their own health and well-being;

• encourage innovation and continuousimprovement and celebrate thecontribution made by our staff;

• encourage open, clear and honestcommunication;

• value diversity and challengediscrimination;

• show understanding, dignity andrespect for all our clients, partners andstaff; and

• be accountable for the decisions wemake, the work we do, the resourceswe use and our impact on theenvironment.

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1.4 GoalsTo achieve our vision, we are driven byclearly defined goals. These goals havebeen reviewed in the light of HealthyAmbitions and reflect both the key nationaldrivers and our local priorities. For thesereasons, our goals will form a ‘goldenthread’ running through our plans, and willunderpin our approach to our priorityhealth programmes.

Our goals are to:

• To place the person at the centre ofeverything we do.

• To improve health and reduce healthinequalities.

• To improve quality and promote safety.• To promote choice and accessibility.• To work well in partnership with

communities, individuals and theirfamilies, staff and organisations.

• To promote local sensitivity througheffective commissioning.

• To promote strong clinical leadership• To drive service redesign and

innovation.• To be a visibly credible organisation,

operating to the highest standards.

1.5 Delivering our visionWe have been working with local partners,stakeholders and our own staff to put inplace a range of programmes designed toalign the local NHS and related system todeliver the goals described above. Theseprogrammes form the key strategicpriorities within the PCT and have beenrigorously assessed to ensure deliveryagainst both the PCT’s goals and ourunderpinning vision and values.

An example of a successful programmeincludes the Population Centric WorkforcePlanning Programme undertaken

(Organisational Development Services) inthe field of obesity. This programme has ledto the development of a obesity servicespecification, which has in turn influencedthe work of Yorkshire and Humber on theDARZI obesity workforce development.Results of this work include, informing thecommissioning of the Public Health (PH)Continuing Professional Development (CPD)programme for teaching public healthnetwork. We have developed and increasedcapacity and capability within Kirklees. Todate we have run 26 specific PH Courseswith 211 people trained in motivationinterviewing and brief interventions up toDecember 2008

A number of enablers have been identifiedwhich will underpin delivery against theseprogrammes and these are identified withinthe Strategic Plan and will further beclarified by the Programme DeliveryStrategy. This organisational developmentplan includes key enablers, but also focusesmore broadly on world class commissioningand delivery of the PCT’s Strategic Plan.

Our organisational development goals havebeen developed to ensure that the PCT’svalues are integral to the way we conductour business, from our practice basedcommissioning process and associatedbusiness planning through to the way weengage with our community and cliniciansand lead our staff.

The organisational development plan is oneof the strategies identified as being integralto the delivery of the PCT’s goals. Forexample, we have invested in acomprehensive personal developmentreview (appraisal) process to ensure that allstaff are well trained, understand ourpriorities and are motivated to deliver them. We will measure this through our newperformance management framework; the

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NHS Staff Survey; and achievement of theInvestors in People standard, towards whichwe are currently working.

Appendix 2 shows our vision and valuechart, which has been communicated tostaff and stakeholders alike.

1.6 Equality and diversity We are committed, to equality and diversityunderpinning everything we do, and this isreflected in both our vision and values andin our goals and Strategic Plan. It is anintegral part of the programme approach.Our JSNA clearly identifies the needs of ourdiverse communities and our commissioningstrategies are designed to ensure that notonly the programmes but resources aredirected where most needed.

Internally a multi directorate steering groupis leading the implementation of theequality duties across the commissioningside of the organisation. A substantiveappointment to a diversity manager posthas been agreed which replaces the fixedterm contract previously in place. An initialstock take of our organisational position onequality and diversity has been led by thesteering group and an action plan prepared.

The PCT also strives to ensure that itsworkforce reflects our diverse communityand its employment policies and proceduresfollow best practice. All policies, includingthose of human resources, are required toundertake an equality impact assessment aspart of their review, development andfollowed through in their implementation.In addition, basic awareness of equality anddiversity is featured in everyone’sKnowledge and Skills Framework (KSF) andis provided as part of our statutory trainingsupport.

Section 2

How the PCT is Organised

2.1 Organisation StructureKirklees PCT was established in October2006 from the three former PCTs inHuddersfield and North Kirklees. We havethe same boundaries as Kirklees Council(KC) and organise our work across the sameseven localities. We serve a population ofsome 400,000 people which is expected togrow by a further 33,000 by 20181.

In common with other PCTs, we have threemain functions:

• engaging with our local population toimprove health and well-being;

• commissioning a comprehensive andequitable range of high quality,responsive and efficient services withinallocated resources, across all servicesectors; and

• directly providing high quality,responsive and efficient services wherethis gives best value.

As a PCT, we are responsible for makingsure that NHS services are in place to meetthe needs of local people. The PCT isaccountable for ensuring that these servicesare accessible, high quality and safe. As thecustodian of NHS services in the local areawe are known as ‘NHS Kirklees’.

Kirklees’ seven localities are shown on themap below. Each locality has a locality plan,which specifically identifies needs anddevelopment within that area. The localityplans are overseen by a locality board.

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1ONS 2006-based population forecasts (whereas the Kirklees Joint Strategic Needs Assessment,published in February 2008, uses ONS 2004-based forecasts).

NHS Kirklees Boundary

2.2 PCT BoardThe PCT Board is responsible for agreeingthe strategic direction, policy andperformance of the PCT. It is alsoresponsible for making sure the keyrequirements of governance are in place.The Board consists of:

• Chair, Rob Napier• Chief Executive Mike Potts• Six Non Executive Directors• Four Executive Directors

Board meetings are also attended by theProfessional Executive Committee (PEC)Chair and others, including PCT Directors, aPEC member, and a member of our LocalInvolvement Network (LINks) Forum.

2.3 Governance StructuresThere are nine Board committees whoprogress and oversee delivery of the PCTstrategy. These are:

• Remuneration and Terms of ServiceCommittee

• Audit Committee• Communications and Public Relations• Provider Board• Strategic Service Development• Specialist Commissioning Group• Governance Committee• Professional Executive Committee

(PEC)• Finance and Performance Committee

2.4 PCT Directorate StructureWhen the PCT was established in 2006,eight directorates were created: six in thecommissioning arm and two in the providerarm.

The PCT has been working closely with itsProvider Arm to oversee and support it inpreparation for delivery of TransformingCommunity Services. Several individual andjoint workshops have been held to discussthe implications of the split and the actionsnecessary to accomplish it.

The PCT Workforce Risk Assessment Planfor 2008 identified that a potential risk forboth the Commissioning and Provider armsof the PCT over the forthcoming year is thecapability and capacity issues arising from aformal split of the commissioning andprovider functions. A review of workforcecapability and capacity is currentlyunderway and output from this will informthe restructuring process required which isbeing planned.

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Batley, Birstalland Birkenshaw

Spen

Dewsbury and Mirfield

HuddersfieldSouth

HuddersfieldNorth

The Valleys

Denby Daleand Kirkburton

Commissioning functions are carried outwithin six directorates and in April 2009 weare reviewing the effectiveness of thesearrangements and split across directorateportfolios in the light of the providerseparation and WCC feedback anddevelopment required.

• Commissioning and StrategicDevelopment (CSD)Reviews, plans and develops a widerange of high quality, responsive andefficient health care services. It alsosupports practice basedcommissioners and manages the localdelivery plan and Local AreaAgreement

• Public Health (PH)Delivers key public health goals,working in partnership with the localauthority. It influences thecommissioning of services to makesure they improve health locally andreduce health inequalities.

• Patient Care and Professions (PCP)Provides professional advice, leads onthe redesign of primary care servicesand oversees clinical governance ofthe PCT. It is also responsible forprofessional development andeducation.

• Performance and Information (PI)Manages performance systems andprocesses for the PCT so that it canmeasure its performance againstnational and local targets. It alsoevaluates the performance of ourprimary care services against nationaland local targets. This directorate alsoleads on the National Programme forInformation Technology

• FinanceEnsures robust financial controls are inplace so that the PCT can meet itsstatutory duties and achieve financialbalance. It also supports managers

and staff in ensuring that the servicescommissioned are value for money.

• Corporate Services (CS)Responsible for enabling andsupporting the PCT’s corporateagenda. It works across alldirectorates, contributes to thestrategic priorities and makes surestatutory duties and legislation arecomplied with. It leads oncommunications and engagement forthe PCT and risk management.

The provider arm of the PCT includes twodirectorates:

• Human Resources andOrganisational Development(HR/OD)Leads on human resources andorganisational development forKirklees and Calderdale PCTs, both onthe commissioning and provider arms.This directorate also provides supportfor workforce planning anddevelopment.

• Kirklees Community HealthcareServices (KCHS) Provides a range of primary care andcommunity services, including healthvisiting, school nursing, therapyservices and community dentalservices.

The Board and senior management teamare responsible for the delivery of the PCT’sgoals and priorities and these are sharedand delivered through the directoratestructure. Key commissioning activity isundertaken by the Commissioning andStrategic Development Directorate. Its workis informed and supported by the work ofthe other directorates across thecommissioning arm of the PCT, who all haveresponsibility for ensuring thecommissioning function of the PCT isdelivered.

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Cross-directorate working is carried outinformally, through organised developmentevents and Director, Deputy and AssistantDirector Meetings which are held monthly.There is potential for strengthening anddevelopment in cross-directorate workingand matrix working is currently beingexplored as an option for delivering this.

To maximise the opportunities forintegrated ways of working between healthand social care and other partnerorganisations, we have established anumber of Health Improvement Teams(HITs). These teams are made up ofmembers of our commissioning staff,clinical leads and representatives from ourpartners and stakeholders. Each HIT isresponsible for tackling a health priorityprogramme, identified within the StrategicPlan. Each HIT creates a clearcommissioning plan and performancemanages its implementation and ongoingactivity.

We have also appointed several people tothe new role of ‘clinical leads’. The purposeof the clinical lead is to act as a clinicalchampion for their area and facilitate jointworking between the Professional ExecutiveCommittee (PEC) (either as a direct memberor through their GP representative) andpractice based commissioners (PBC). ThePEC is responsible for clinical governance ofall business planning activities undertakenby HITs.

An innovation within the PCT is theestablishment of a Commissioning Collegewhich has been established to facilitatediscussion among all the key stakeholdersmentioned above. Meeting monthly beforethe PEC, this assembly allows stakeholdersto be informed and inform decisionsregarding the PCTs commissioning agenda.Feedback from the Commissioning Collegeinforms the clinical decisions taken by thePEC who retain their statutoryresponsibilities. The Director of CorporateServices has undertaken a review of theroles and statutory responsibilities of thePEC and the Commissioning College.Responsibilities have been clarified andcommunicated appropriately across relevantmembers. This model of working hasallowed us to develop more integratedworking with our strategic partners acrossboth health and social care.

A review of our governance structures iscurrently underway. The PCT hascommissioned KPMG to support the PCTwith this work. Our aim is to ensure theyare fit for the future and provide assuranceon the quality, safety and delivery of theservices we commission and provide.

Appendix 3 shows the Kirklees PCTdirectorate structures.

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Chief Executive

Chief ExecutiveOffice

Public Health(PH)

HumanResources andOrganisationalDevelopment

(HR/OD)

KirkleesCommunityHealthcare

Services (KCHS)

Commissioningand StrategicDevelopment

(CSD)

CorporateServices (CS)

Care andProfessions (PCP)

Performance and Information

(PI)

Finance

Section 3

Organisational Development

3.1 Our Journey to DateAs a result of the Fitness for PurposeReview, NHS Kirklees developed acomprehensive development plan that was,in effect, an organisational developmentplan. The action plan was overseen by thePCT Board and delivery against keyoutcomes has been achieved. Wheredevelopment objectives are ongoing, somehave been streamlined into the PCT’sperformance framework and some areincorporated into our world classcommissioning development plans.

The key development areas addressedduring this period include:

• Public and service user engagement –an expansion of the PPI andcommunications team capacity.

• Business planning process andprioritisation – establishment of aprocess with HIT teams puttingforward business cases against thatprocess.

• Development of roles and capacity inthe PCT in commissioning, financeand information directorates with anemphasis on informingcommissioning, contracting andprocurement (for example engagingwith the advanced commissioningprogramme).

3.2 Current OrganisationalDevelopment Needs

During the past ten months the PCT hasbeen building on the development needsidentified from the Fitness for Purposeprocess. Throughout 2007 and 2008, wehave been working to develop and align ourstructures and systems to ensure delivery ofour goals, the development of our staff,organisational culture and ethos asidentified in our vision and values. This hasresulted in a clear performancedevelopment framework throughPerformance Accelerator that monitorsdevelopment and delivery of outcomes.Needs and gaps are swiftly identified andreported to the Board for further action asappropriate.

As part of our commitment to our ongoingorganisational development needs, the PCThas engaged in diagnostic work includingfitness for purpose, links with LocalAuthority Assessments, our Investors inPeople preparation and latterly WCCassessments, aimed at continuouslyimproving our performance in order toimprove our reputation as the ’local leaderof the NHS’.

A number of events have been held toexplain the WCC Strategy and its impact. Inaddition, the PCT utilised a number ofdiagnostic tools, including SWOT and PESTanalysis to identify needs in NHS Kirklees.This was followed through with a crossdirectorate analysis of the WCCCompetencies, using the strategic goals andpriorities as a baseline of activity required infuture.

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WCC Assessment 2008 Feedback

Feedback from the WCC AssessmentProcess identified 5 major areas forconsideration by the PCT at this stage on itsjourney:

The panel acknowledges the journeythe PCT is on to improve clinicalengagementRecommendation: The PCT’s‘commissioning college’ is an innovativesolution to bring together PBC, PEC andHITS. However the panel recommends thatthe PCT be aware of the challenges andrisks that this presents. The PCT will needto be clear about the continuing statutoryrole of the PEC. The PCT should work toimprove the quality of information itprovides to support the management of theprimary care contract and variances inpractices

The panel observed the PCT’s strongpartnership workingRecommendation: The panel recommendthat the PCT should use this strongpartnership to drive delivery forward and asa means to keep a focus on the visionduring some challenging times ahead. ThePCT is well placed to tackle futurechallenges constructively and providemutual support to the LA

The panel observed there were somekey risks facing the PCTRecommendation: The panel recommendsthat the Board reflects on how it prioritisesthe efforts of the organisation and thefocus of the Board. This includes how thePCT prioritises its investments. The PCTshould not underestimate the challenges forstaff of programme management of abroad range of initiatives

The panel noted that the culture of thePCT is beginning to change fromturnaround to investmentRecommendation: The PCT shouldconsider how it readies its staff and teamsto think more about investing in work thatwill clearly provide value for money andbenefit more quickly, without losing thestrength of the turnaround disciplines.

The panel noted that PCT could benefitfrom more clearly articulating itsstrategyRecommendation: The panel recommendsthat the PCT considers how itcommunicates its strategy. The PCT shouldreflect on the flow, structure, order andclarity of the document with a view toamending the presentation of the StrategicPlan as part of the work to refresh thedocument over the coming weeks.

In order to deliver the necessary progresswe have grouped actions into the followingareas, in addition to those identified in theearlier Organisational Development Plan,which will continue to allow the PCT togrow and achieve the developmentobjectives identified to meet the trajectories(Appendix 4).

• improve the quality of information itprovides to support the managementof the primary care contract andvariances in practices – A review ofthe PCT internet and intranet isunderway. From March 2009 a linkwill be established for Primary Care, itwill communicate key information toprimary care contractors includingdiscussion and output from thecommissioning college.

• Culture Change – Supported by amove to a centralised Headquartersfor all Commissioning Staff where

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consistent practices are achieved.Underpinning the culture change is acomprehensive leadership programmefor all those with leadershipresponsibility and shared objectivesthrough team development and PDRfor all staff

• System and Process Development –Systems and processes are beingreviewed to ensure a clear strategiccommissioning process from businesscase to implementation andmonitoring. In addition, clarity onwhat our goals will specifically achieveand how these will be measured,including, links to uality outcomesframework (QOF), programmebudgeting

• A refresh of the Strategic Plan is beingconducted for the end of March 09.

3.3 Organisational Development SelfAssessment Initiatives

In addition to the competency selfassessment, the PCT has conducted atraining needs analysis with representativesfrom our commissioning community toassess further details of the keydevelopment needs to deliver the WCCcompetencies. A Leadership Programmewill be procured in the next two months forthose involved in the commissioningprocess. This will not only address capabilityissues but will support the PCT to developthe culture and commitment necessary todelivery our Strategic Plan, including tofurther support relationship buildingbetween clinicians and managers.

In addition to the training needs analysis thePCT is working with the Peter Spurgeonfrom the NHS Institute as part of a pilotinto improving medical engagement. One

of three PCTs throughout the UK to becomeinvolved in the project, the feedback willenable us to put in place steps to continueto improve how we actively work with ourcolleagues in primary care.

3.4 Partnership WorkingA key priority for the PCT is theestablishment and further development ofpartnership relationships, for example, withKirklees Council and practice basedcommissioners. Over the past twelvemonths, we have implemented structuresand systems to improve our relationshipwith our partners and have held a numberof development events to support this.

Our key organisational developmentchallenges for partnership include:

• Enhancing clinical engagement andcollaboration through thedevelopment and establishment of theCommissioning College (see 2.4)

• Building a leadership community withKirklees Council though joint learningevents both at Directorate and seniormanager levels.

• Developing joint approaches tobusiness planning through clinicalleads, HITs, and the CommissioningCollege

3.5 Employer of ChoiceTo meet our commitment to our staff,achieve our values and goals, and continueto work towards achieving employer ofchoice status, we have formally committedto working towards Investors in Peopleaccreditation. This work is being led by arange of employees from each directorateand is chaired by a Non Executive Director.

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A review against the standard wasundertaken in 2007. The results have beenincluded in an organisational action planbeing implemented by the IIP Group. Thisgroup has also worked with directors toaddress the needs identified in the 2007staff survey. Some of the staff supportinitiatives developed include:

• Chief Executive Talk Time• Celebration events to recognise and

reward staff• Information events to support the

transfer to the PCTs new Headquarters• Refocus and support to the PCT’s

Personal Development Review process• Improved communication networks, to

include improvements to the PCTwebsite.

• Implementation of stress at workguidance and developmentprogramme for managers

• Review of information anddevelopment for new starters,including the Induction process andEmployee Handbook

• Employee development initiative toencourage all staff to achieve a NVQLevel 2 as a minimum

As well as using the information receivedfrom our staff survey, we have held anumber of focus groups to establishprogress against the development actionsarising out of the previous year’s survey andto identify future development. The focusgroups highlighted that much progress hasbeen made. However, further developmentis needed in the following areas:

• Communication and establishing aclearer feedback loop

• Job satisfaction and how this isaffected by change in the PCT

• To ensure the quality of personaldevelopment reviews (PDR) are

improved.• Improved access to mentoring and job

shadowing for all staff• Improved cross-directorate and inter-

team communication

Initial feedback from the 2008 surveyindicates a positive improvement across allthe areas identified above and action plansare currently being developed to improvethis further and address development areasidentified in the current survey. The PCT isconsidering assessment against theInvestors in People Standard in 2009.

NHS Kirklees’ workforce planning activity isclosely linked with its intention to be anemployer of choice, and is underpinned bythe organisation’s new workforce scorecard.This allows the organisation to moreeffectively monitor and improve keyelements related to the workforce, includingsickness, agency spend and staff well-being.

The PCT has increased its capacity foranalysing workforce data and recruitmentactivity through the appointment of aworkforce analyst who will enable the PCTto review how well we are achieving ourdesire to be an employer of choice.

Our key organisational developmentchallenges for our role as an employerinclude:

• Ensuring appraisal/personaldevelopment review (PDR) isconducted consistently and to a highquality

• Creating a learning environmentthroughout the PCT effectively – theLearning and Development Strategyhas formally been presented to theGovernance Committee

• Managing change and risk arisingfrom formal split of commissioning

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and provider functions• To support recruitment of new staff

from those communities who are lessrepresented within NHS Kirklees, anexample would be the slivers of timeproject being rolled out across thePCT.

3.6 Leadership DevelopmentThe Board has committed to an ongoingdevelopment programme commissionedfrom KPMG that builds on the previouswork with both Finnamore ManagementConsultants and the Audit Commission.The diagnosis reports from thesedevelopment activities identify that theBoard is a well performing team, that has aclear understanding of priorities and howthese will be achieved. Relationships arewell formed and appropriate levels ofchallenge are achieved. This was furtherconfirmed in feedback from our recentWCC Board observation event.

Our most recent Board diagnosticundertaken by KPMG includes Boardobservation, one to one interviews, reviewof personal development reviews and areview of governance information. A BoardDevelopment Programme is currently beingplanned for delivery over the forthcoming18 months.

The PCT signed off its Leadership Strategyin November 2007 and funding for deliverywas secured in early 2008.

During June and July, the Board undertookan assessment using the PCT world classcommissioning self assessment tool(Appendix 5).

We will continue to assess our progressagainst this and continue to adapt our ODplan as our needs develop.

Our key organisational developmentchallenges for leadership include:

• To embed a consistent approach tousing our vision and values in how wework

• To consider issues of talentmanagement and succession planningin future leadership investment

• To further develop business planningand project management skills

Plans are currently underway to deliver arange of development programmes insupport of our clinical and commissioningleaders; including

• Leadership programme for PCTmanagers and stakeholders withresponsibility for commissioning

• Development programme forCommissioning College

• Development of the DDAD (Director,Deputy Director and AssistantDirector) Network

• Talent management and selection ofstaff to regional leadershipprogrammes, including AspiringDirectors, National MiddleManagement DevelopmentProgramme and AdvancedCommissioner Programme

3.7 National Programme for IT(NpfIT)

NHS Kirklees will support its programmeunder the National Programme for IT (NpfIT)through:

• its existing capacity/capability • the procurement of additional capacity

from its main IT services provider, TheHealth Informatics Service (THIS) andfrom external agencies, such as ThePhoenix Partnership (TPP)

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Our key organisational developmentchallenges for IT include:

• achieving good project managementskills;

• employing sufficient high qualityinformation specialists; and

• planning for the ongoing support ofan increasingly IT-dependentworkforce.

Sufficient specific funds have beenidentified in the forward resource plan toenable these issues to be addressed. As partof this work, we will ensure:

• that basic IT training is included in allmandatory training for staff; and

• we have enough specialist IT staff tosupport the sustainable use of IT andInformation systems.

In designing the existing PCT structure wehave already expanded capacity to lead thisthrough the Performance & Informationdirectorate, which was created as the PCTcame into being in late 2006.

Section 4

Organisational DevelopmentOverview

4.1 Objectives for the Current YearIn developing our Strategic Plan, we haveidentified a range of enablers, which willsupport the PCT to deliver its goals andpriorities. These enablers are integral withinthe PCT and reviews show that there arestrengths in both capacity and capabilitywithin these enablers.

We have also undergone a rigorous selfassessment process against the WCCcompetencies, engaging with stakeholdersincluding PBC and Kirklees Council to givebalance in this self assessment

Arising from this process we have identifiedthe following specific weaknesses (wherewe scored ourselves at 1) in our currentcapability:

• dissemination of information tosupport clinical decision making

• knowledge of current and futureprovider capacity

• creation of effective choices for serviceusers

• creation of robust contracts based onoutcomes

In addition, to the above, the PCT hasconsidered through its strategicdevelopment a number of key strategicdocuments, including NHS Quality Care forAll, Health Ambitions, NHS Next StageReview, as well as local strategies anddocuments such as the Joint StrategicNeeds Assessment.

Some of the PCT’s organisationaldevelopment objectives will have a direct

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impact on the working of the PCT’s corerole on an ongoing basis, while others aremore externally focused and will have alonger time frame for delivery.

Our strategic organisational developmentobjectives have been updated to:

• Ensure that NHS Kirklees as a brand isrecognised as a leader of the NHSwithin Kirklees. As set out in thecommunications strategy, this meansenhancing our profile withstakeholders and the public. We willalso continue to work with ourpartners for the specific benefit of thepeople of Kirklees.

• Provide the local lead for the NHS inKirklees, ensuring that all leaderswithin the PCT understand their roleand can deliver our strategic goals.We have developed our shared valuesand improved internal communicationto ensure clarity for all staff and this isdelivered though regular PDR and useby all of the Knowledge and SkillsFramework (KSF).

• Develop our clinical leadership andImprove our clinical engagement incollaboration with our clinicians tocommission and prioritise with greaterfocus on outcomes.

• Develop greater knowledge ofprovider capacity and consequencesfor service user choice.

• Continually improve the quality ofservices that we commission, ensuringthat these are evidence based, costeffective, and where possible deliveredcloser to people’s homes. A number ofstrategies are currently beingformalised and signed off or are indevelopment. For example,the Value

for Money Strategy was agreed at theFebruary 2009 PCT Board and iscurrently being implemented This isinfluenced by our need to build ourinformation skills.

• Increase and improve our service userand public involvement so that theymay be actively engaged in anongoing basis in the development anddelivery of our services. The PCT candemonstrate engagement andinvolvement activity in thedevelopment and commissioning/procurement of care pathways andservices.

• Create a learning environmentthroughout the PCT, where innovationis valued and recognised and staffcapacity and capability are key to thedelivery of our services. We have settargets through the workforcescorecard and will demonstrateongoing commitment throughshowcasing work in celebratingsuccess and annual staff awards

• Ensure that our governancearrangements are fit for purpose andwill support the delivery of ourstrategic goals. We need to embedstronger governance, performancemanagement and following use of theexternal Audit Commission boarddiagnostic tool have initiated a furtherreview

These overarching PCT organisationaldevelopment objectives will becommunicated to staff and partners as partof our communication strategy for worldclass commissioning and our Strategic Plan.

19


20

4.2 Achieving Our Objectives NHS Kirklees has a strong foundation onwhich to continue to develop the PCT.The PCT has a strong Board andrelationships between the Board and PECare good with clear lines of accountabilityand understanding of roles. In our recentanalysis against the WCC competencies weidentified additional strengths as follows:

• Our people • Leadership/Chief Executive• Our partnerships and the way we

develop relationships• Joint working to influence

commissioning decisions acrossorganisations to maximise benefits forthe people of Kirklees.

• Our culture (open and reflective)• Understanding the health needs of the

population (JSNA)• Our systems and how the PCT works• Ever improving use of information to

support commissioning decisions.

We wish to consolidate our position on thecompetencies and steadily progress tobecoming world class. Our detailed PCTdraft trajectories are incorporated into thisOD plan as Appendix 4, which is subject toBoard discussion in March 2009.

4.3 RisksIn order to achieve our ambitions we willneed to address the following capacity andcapability gaps. These include the followingrisks, which have an action plan to addressthem:

• The organisation must be able torecruit and retain high quality staff inthe face of competition fromsignificantly larger local andneighbouring organisations

• Small teams are vulnerable to capacity

problems if individuals leave or areincapacitated for any reason

• There is a limited labour pool foremployees with high quality specialistskills

• There are skill/capacity gaps withinvarious teams that need to beaddressed

• In driving forward our investment inproject management this may increasethe marketability and retention issueswith our own staff

• The potential of our newly formedcommissioning college may not berealised.

There is further work to be done beforeworkforce planning is fully integrated withthe organisation’s standard businessprocesses, though there are plans toaddress this; and the workforce planningrelationship between commissioner andprovider is still evolving. However, NHSKirklees is pleased with its progress to dateand continues to make positive steps in theright direction.

A further area for development is how thePCT addresses the issues of healthinequalities and the capability of staff withinthe PCT to address this agenda. There aretwo levels of action required to achieveimprovements in health inequalities andwell-being for all the people of Kirklees:

• a systematic cultural change across thewhole public sector system whichincludes real partnership working; and

• specific targeted programmes, whichwould include recruitment selectionand development of future andcurrent staff

The PCT is in a fortunate position in that ithas already invested resources in developinginternal organisational developmentcapacity. Therefore, our programme ofdevelopment is comprehensive and co-ordinated in its approach, accessing externalcapacity only as appropriate. The organisational development action planshown in appendix 6 identifies the range ofhigh level actions that have been identifiedto ensure that the PCT achieves world classcommissioning status.

4.4 FinanceIn the year 2007/2008 significantinvestment has been made in increasing ourPCT capacity within a number ofdirectorates; the further diagnostic workwill assist us in assessing whether additionalresources are being appropriately utilised orneed to be redirected internally. We havealso made non recurrent investment intraining needs analysis and leadership whichin forthcoming years will be mainlysustained using internal OD capacity.

The strategic and financial plans recognisethe need for limited further investment incapacity and capability. Workforce changesas a result of changes in service delivery willbe accommodated within workforce plansin the HITs. Workforce planning is identifiedas a critical component in our developmentand initial workforce risk assessments havebeen completed.

It is acknowledged that we have yet toidentify costs and return from the specificinitiatives identified in the OD action plan,such as key finance and performancemetrics (for example uptake of mandatorytraining, employee days per head ondevelopment etc). This detail will enhancethe content of our workforce scorecard indue course.

Section 5

Conclusion

We are confident that our plans will help usachieve the growth and developmentrequired to ensure we become a WorldClass Commissioning organisation and alsodeliver better healthcare for the people ofKirklees as outlined in our Vision, Valuesand Goals.

21


22

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31


Pharmacy Strategy

Committee

Exceptions Committee

PCT - LOC Interface

PCT - LPC Interface

PBC Forum

PEC

PCT - PDC Interface

PCT - LMCInterface

ProfessionalAdvisory Group

Information Governance

Group

Operational Clinical

Governance Group

Pharmacy PanelPrimary Care panel Medicines

Management Committee(Area Prescribing

Committee)

Records Management

Group

Governance Committee

Commissioning /Provider Split

OperationalRisk Management

Group

Strategic Emergency

Planning Group(Operational Emergency

Planning Group)

32

Audit CommitteeFinance &

PerformanceCommittee

Provider Board

Strategic Development

Group

Communications & Public Relations

Committee

PEC

TRUSTBOARD

Finance andPerformanceCommittee

Productivity and Efficiency

Group

GovernanceCommittee

Remuneration &Terms of Service

Committee

Specialist Commissioning

Group

33


Any section 11 consultation

group

Equality and Diversity Group

Communications and Public Relations

Committee

Internal Communications

Group

34

Appendix 4

PCT Organisational Development - WCC Competency PlanTrajectory

CurrentScore

Expected Score Yr 2

1

2

3

4

5

6

7

8

9

10

Reputation as local leader of the NHS

Reputation as change leader of local organisations

Position as the local healthcare employer of choice

Creation of Local Area Agreement based on joint needs

Ability to conduct effective partnerships

Reputation as an active and effective partner

Influence on local health opinions and aspirations

Public and patient engagement

Improvement of patient experience

Clinical engagement

Dissemination of information to support clinical decision making

Reputation as leader of clinical engagement

Analytical skills & insights

Understanding of health needs trends

Use of health needs benchmarks

Predictive modelling skills and insights

Prioritisation of investment to improve population’s health

Incorporation of priorities into strategic investment plan

Knowledge of current and future provider capacity and capability

Alignment of provider capacity with health needs projections

Creation of effective choices for patients

Identification of improvement opportunities

Implementation of improvement initiatives

Collection of quality and outcome information

Understanding of providers economics

Negotiation of contracts around defined variables

Creation of robust contracts based on outcomes

Use of real time performance information

Implementation of regular provider performance discussions

Resolution of ongoing contractual issues

2

2

2

3

3

2

2

2

2

3

1

2

2

2

2

2

2

2

1

2

1

2

2

2

2

2

1

2

2

2

3

3

3

3

3

3

3

3

3

3

2

3

3

3

3

3

3

3

2

3

2

3

3

3

3

3

2

3

3

3

Competency

35


Appendix 5

WCC outcome of first assessment

Competency 1: Self assessment

Are recognised as thelocal leader of the NHS

NHS Kirklees leads the health agenda inKirklees. We are core members of the LocalStrategic Partnership. We have strongworking relationships with Kirklees Council(KC), working on the health elements of theLocal Area Agreement (LAA).

We have strong & effective relationships &partnerships with other providers in primarycare, secondary care, mental health & aredeveloping this with the voluntary sector.This has enabled the PCT to drive forwardhealth issues & strategy acrossorganisational boundaries for the benefit ofour public & patients.

We developed our relationships with thepublic through such forums as the LiNKs &partnership forums & listening events. ThePCT uses Social Marketing techniques, forexample in commissioning urgent careservices, to allow us to get to the core ofwhat people need. In conjunction with theJSNA this gives the PCT a clear awareness &direction for developing & improving itsrelationship with the public we serve.

The PCT has led on a number of events withpartners that cut across a variety oforganisations & allows strategy to be setthat influences health care. An example ofthis is joint events with KMC ‘A Picture ofKirklees’. In addition the PCT has led onhealth economy events focusing on 18week delivery with secondary & primarycare clinicians to enable cross organisationpathway development.

The PCT has a strong focus on developingits staff with a variety of opportunities tomaximise individual potential, for exampleparticipation in the AdvancedCommissioning Programme.

The PCT is proud of its staff & as suchinvests in celebrating its success. Severalindividuals & groups have been recognisedregionally & nationally. In addition the PCTholds its own award events to congratulatestaff for the work they do.

Competency MeasureLevel

1Level

2Level

3Level

4

• Reputation as the ‘local leader ofthe NHS’

• Reputation as a change leaderfor local organisations

• Position as the local healthcareemployer of choice

36


Work collaborativelywith communitypartners tocommission servicesthat optimise healthgains & reduce healthinequalities

The JSNA was developed with the PCTpartners, principally KC. The PCT worksclosely with Local Strategic Partnership (LSP)to develop & agree the LAA. The LAAreflects the JSNA & clearly demonstrateswhat is to be delivered either in partnershipor by specific organisations with keymilestones, for which the PCT has a historyof delivering. The PCT plays a key role inensuring that the LAA priorities reflect theJSNA & the needs of localities. For examplethe Children’s & Young people’s plan hasbeen informed by the JSNA & monitoredthrough the LAA. The PCT has an active rolein shaping & influencing locality workingwith KC. The PCT has a clear approach tothe delivery of its element of the LAA,working closely with partners in health &social care & also statutory services, such asthe Police & the voluntary sector.

NHS Kirklees & KC share posts include thejoint DPH & commissioning managers forChildren, Older People & Physical & SensoryImpairment. This has allowed greaterintegration with the functions & cultures ofthe PCT & KC. The partnership posts have

allowed for the development of pathwaysof care, for example in older people, tosupport health & social care delivery. Inaddition there are clear & effectivegovernance arrangements for these posts.There are clear structures in both the PCT &KC where the partnership posts influence &deliver on commissioning intensions jointlyto enable delivery of the LAA, optimisehealth gains & reduce health inequalities.

The JSNA & LAA, together with PBC localknowledge, allow PBC consortiacommissioning plans to be set. The PCTworks closely with PBC & encourages theproduction of practice plans that outlinespecific actions to address local need to beimplemented.


1Level

2Level

3Level

4

• Creation of Local AreaAgreement based on joint needs

• Ability to conduct constructivepartnerships

• Reputation as an active &effective partner

37



Proactively buildcontinuous &meaningfulengagement with thepublic & patients toshape services &improve health

NHS Kirklees communication & patient &public involvement (PPI) strategies focus onensuring a meaningful & rich relationshipwith the public & the PCT. We haveconsistently sought to offer different waysof addressing improved communicationeither through literature or public events,such as ‘A Picture of Kirklees’ & formalconsultation sessions on service strategyhave enabled the public to work inpartnership with us & to influencecommissioning decisions. We activelyinvolve patients in developing services thatpromote independence, health, wellbeing &personalisation. The ‘Year of Care’ work indiabetes, the Co-creating healthprogramme for Musculoskeletal as well asself care for Long Term Conditions followthe principles of care of Long TermCondition management & actively involvepatients in the design & development ofthese services. The expert patientprogramme has been recognised nationally& encourages people to maximise theirpotential. Our approach to patient & publicinvolvement has ensured that there is atangible influence on how services are

commissioned. Social Marketing techniqueshave been used to influence how UrgentCare Services are designed & commissioned,& is being used in a wide range of issues,for example in safeguarding children &asking about their attitudes to alcohol,obesity, infection control. The PCT, with KC,has partnership forums; the Working InPartnership team that hold consultationsessions with the public. These areopportunities to share information & havetwo way dialogue with people who useservices & allow commissioning intension tobe influenced. Involving Young Citizensequally with children & parent involvementfurther demonstrates our approach as doesthe redesign of speech & languagetherapies involving parents. PALs are anintegral link between us & the public,receiving issues & complaints that areanalysed & reported to the Board, as well asinfluencing commissioning decisions.


1Level

2Level

3Level

4

• Influence on local healthopinions & aspirations

• Public & patient engagement

• Delivery of patient satisfaction

38


Lead continuous &meaningfulengagement of allclinicians to informstrategy & drivequality, service design& resource utilisation

The PCT’s structure & PBC arrangementsstrengths are that it generates strong clinicalengagement. The PEC & PBC participate ina joint commissioning forum with the PCTwhich strengthens integration & clinicalengagement in our commissioningfunctions. All clinicians, GPs & others, areactively involved in the PCT planningforums, such as Health Improvement Teams(HITs), the Long Term Conditions Board &redesign groups with regular PECattendance. We are actively engaged withPBC consortia to ensure joint developmentof commissioning plans based on the needsof patients, using the JSNA & broaderplanning documents such as HealthyAmbitions, whilst maintaining a local focus.PBC consortia have the delegatedresponsibility to drive improvement in health& wellbeing through their commissioningplans. To support PBC, resource utilisationpacks have been developed & regularlydiscussed with practices. The intention isthat these give an accurate picture of howservices & resources are being used.Clinicians are encouraged to submitcommissioning plans & business cases to

improve health gains. Clinical engagementin redesign is seen as paramount in thesuccessful development & implementationof pathways. Primary and 2º care clinicianswork with the PCT on pathway redesign ofwhich the PCT actively facilitates & leadsjoint working. Our success in our approachto clinical engagement for 18 weeks wasrecognised nationally as excellent. Clinicalengagement is embedded in other areas ofdevelopment, Urgent care, Health visiting,Intermediate Care, all using pathways ofcare as the basis of improving services forpatients. The PCT is currently establishing acommissioning development programmewith clinicians supported by a trainingneeds analysis, that will further enhanceclinical & management partnerships inKirklees.


1Level

2Level

3Level

4

• Clinical engagement

• Dissemination of information tosupport clinical decision making

• Reputation as an active &effective partner

39



Manage knowledge &undertake robust &regular needsassessments thatestablish a fullunderstanding ofcurrent & future localhealth needs &requirements

The JSNA is comprehensive & refreshed onan annual basis & takes into accountinformation from public involvement &clinical opinion. PBC annual plans are basedon the JSNA & allow commissioning ofservices at a local level through consortia &practice plans. Other data is used &analysed to support commissioningdecisions; secondary care activity referralrates for example. This information is usedas part of predictive modelling. Inconjunction with the JSNA gaps in serviceprovision are recognised & addressed. TheStrategic Development Plan provides aframework for commissioning that gives apriority to the major health needs ofKirklees.

The JSNA identifies clear priorities for localpopulation by locality, children, youngpeople & adults. The JSNA identifies riskfactors for disease, current & future, &focuses on these allowing subsequentcommissioning decisions to be made. Thereis also trend data for mortality of majorhealth issues. The CLIK & YPHS majorsurveys have contributed significantly to theJSNA.

Part of the JSNA focuses on benchmarkingKirklees nationally & further work onbenchmarking against local PCTs is beingdeveloped. The PCT benchmarks itselfagainst other PCTs in a number of otherareas, e.g. delivery of the 18 week standard& the PCT’s position against this regionally ismeasured & used as a tool to driveperformance & influence commissioningdecisions. Health Care Commission reportsbenchmark the PCT performance against allPCTs & from these come action planssupported by commissioning plans toimprove performance.

PBC use resource utilisations packs thatdemonstrate patterns of activity at practicelevel across the PCT where it is usedthrough peer development, to drive forwardimprovements through focused redesignwork & changed commissioning plans.Further needs assessments are undertakenas appropriate; for example children withdisabilities, cardiovascular disease, obesity,health behaviours of women of childbearing age.


1Level

2Level

3Level

4

• Analytical skills & insights

• Understanding of health needstrends

• Use of health needs benchmarks

40


Prioritise investmentaccording to localneeds, servicerequirements & thevalues of the NHS

NHS Kirklees uses predictive modellingacross a range of its functions. Notably theService Strategy with Mid Yorkshire HospitalTrust as part of forecasting commissioningintention for service provision in the newhospitals. This long term model, at specialtylevel, has been developed across primary &secondary care incorporating demographic& health needs based data. Redesign ofservices at Calderdale & HuddersfieldFoundation Trust has used predictivemodelling to inform commissioningintensions at specialty level.

Specialty level modelling is used annually forcapacity & demand planning with acutetrusts. As part of this process wherechanges in service delivery are made, fromsecondary to primary care for example, thisis incorporated. An example of this is inLong term Conditions where disinvestmentin secondary care & investment in primarycare is planned.

These changes are progressed through thebusiness planning & commissioning cycle.The business planning process is an

outcome from HITs. There are HITs for all ofthe PCTs key strategic areas & fit withdelivery of policy, for example ‘healthyambitions’. Business plans have definedcriteria & fit with the vision & values as wellas the goals of the PCT & highlight whereimprovements will be made. In addition, thecomposition of the HITs incorporatesclinicians as well as managers & otherstakeholders ensuring the commissioningcycle & business planning process isreceptive to local need, clinicians &stakeholders.

Through locality working & the use of theJSNA the PCT has been able to focusinvestment & develop services where theneed is greatest. The equitable access centrewill be in Dewsbury, this is an area with alower patient to GP ratio. The sameapproach has been used to invest indentistry. These being agreed inconsultation with key stakeholders includingGPs & other clinicians.


1Level

2Level

3Level

4

• Predictive modelling skills &insights

• Prioritisation of investment toimprove population’s health

• Incorporation of priorities intostrategic investment plan

41



Effectively stimulatethe market to meetdem& & securerequired clinical &health & wellbeingoutcomes

NHS Kirklees understands the local marketfor health services & jointly commissionedservices with social care. We have usedcompetitive processes to procure services.The equitable access procurement sourced anumber of providers to enable delivery ofthis initiative. Urgent care procurement forOut of Hours care & the development ofurgent care services has stimulated themarket & attracted a variety of potentialproviders for this service. As part of theurgent care procurement publicconsultation & social marketing techniqueshave been used to ensure that patients’views & opinions are included in thespecification. In addition the inclusion ofpatients & clinicians in the procurementprocess has been vital. There has beenanalysis of the providers ability to deliver theservice at a defined minimum level ofquality & within a specific budgetaryenvelope. This is representative of the PCTapproach to procurement & sourcingproviders.

To further develop our approach toincreasing the supply market we havedeveloped a procurement policy ensuringfuture procurement is robust in itsassessment of a wide range of providersusing competitive approaches.

The PCT uses demand & capacity analysistools in conjunction with secondary careproviders to plan specialty based activityforecasts incorporating local needdetermined by the JSNA. Review is on amonthly basis, any gaps in service provisionare commissioned accordingly. An exampleof this is Audiology where capacity in localservices was not available in order to reducewaiting times. An independent sectorprovider, sourced through a procurementprocess, was secured to deliver the activity& reduce waits to acceptable levels.

Patients will be offered Choice by their GP.Where it becomes apparent that there is alack of services & Choice then the PCTensures GPs are aware alternative providers.


1Level

2Level

3Level

4

• Knowledge of current & futureprovider capacity

• Alignment of provider capacitywith health needs projections

• Creation of effective choices forpatients

42


Promote & specifycontinuousimprovements inquality & outcomesthrough clinical &provider innovation &configuration

The PCT incorporates benchmarking intoservice improvement. This is demonstratedboth in our performance managementprocesses where current performance insome areas is benchmarked against national& local levels. In addition GP performance isbenchmarked locally, for example in referralrates, so that there can be an analysis ofextreme high & low referrers & any changesmade accordingly.

Developing commissioned services throughjoint working and innovation is essential &the PCT has a track record of this. Clinicalpathway improvement has been seen in anumber of areas, Musculoskeletal Care,Gynaecology, Cardiology, Diabetes amongstothers. Within pathway development thewhole patient journey is consideredhighlighting key areas where improvement& changes can be made. For example LongTerm Conditions pathway focuses on selfcare & all 3 levels of prevention includinghow patients can be cared for in a primarycare setting as the norm, not admission tosecondary care, a specific example being,the ‘Year of Care’ programme, involving

patients & clinicians, considers how patientscan improve self care & with cliniciansimprove outcomes.

PBC are core to pathway development. ThePCT has a ‘planned care’ HIT with PBCinvolvement. PBC are also involved withsecondary care to develop integrated carepathways. As part of 18 weeks, clinicians &patients reviewed pathways underdevelopment. This formed a strong basis ofensuring pathway implementation fits withpatients need & is clinically driven. Pathways are developed against a seriesexpected outcomes which are thenmeasured. Quality boards have beenestablished with MYHT, CHFT & SWYMT.The PCT is improving its process ofincorporating quality metric & benefitrealisation techniques into it improvementwork.

The PCT holds regular monitoring sessionswith providers, in areas where there isongoing improvement, for example urgentcare, this is weekly, for other areas this ismonthly.


1Level

2Level

3Level

4

• Identification of improvementopportunities

• Implementation of improvementinitiatives

• Collection of real time quality &outcome information

43



Secure procurementskills that ensurerobust & viablecontracts

Through the PCT relationship with itsproviders & broader intelligence the PCT hasgood understanding of provider economics& market dynamics. NHS Kirklees has anrobust and mutually respectful relationshipwith its major acute providers & mentalhealth providers. The contract unit meetwith providers to discuss capacityconstraints, activity & financial positionsagainst plan on a monthly basis & includesfeedback on patient experience. All of thisinformation is documented & reported onat weekly internal contracts meetings. Thesemeetings also ensure that the strategicdirection of providers is in line withcommissioning intentions. Finance &Commissioning Directors lead contractnegotiation in line with the PCTsprocurement strategy supported by thecontract team where variables such as cost& quality are identified.

A more systematic approach to quality isbeing developed with quality metricsintegrated into contracts & new QualityBoards being integrated into contractmanagement structures. However there is a

requirement for further improvement inincorporating patients experience into thecontracting & reporting process. Wherethere are variables for example, referralrates or variance of activity against plan,these are discussed & solutions agreed atregular, at least monthly, contract teammeetings.

Contracts are based on outcomes. Recentlydeveloped contracts for Equitable Access &Urgent care for example, are outcomebased & include quality metrics that aremonitored through key performanceindicators. Contracts with major acuteprovides are standard & legally bindingincluding details of arbitration & breakclauses.

The PCT has risk sharing arrangements forspecialist commissioning & chairs theSpecialist Commissioning Group (SCG).Through the SCG a number of specialties &provided services have been improvedthrough clear common performanceindicators & robust specifications.


1Level

2Level

3Level

4

• Understanding of providerseconomics

• Negotiation of contracts arounddefined variables

• Creation of robust contractsbased on outcomes

44


Effectively managesystems & work inpartnership withproviders to ensurecontract compliance &continuousimprovement inquality & outcomes &value for money

The PCT has a dedicated information teamthat analyses & validates data & presents inusable formats to ensure that information isprovided in a such a way that is easilyunderstood by commissioning staff &stakeholders as appropriate. Where there isa need for validation or to challengeinformation provided this is done. Theinformation is then used to supportcontracting meetings, provide evidence forpathway development & supportperformance management. This isparticularly important where there arevariances against plan & actions required tobe taken. The performance data & minutesfrom contract & performance discussionwith main providers is used internally by thecontract team to assimilate all providerperformance & take coordinated actionsaccordingly.

In addition where there are specific areas ofmonitoring required on a weekly basis theinformation is provided in a format to allowdecisions to be made to influences keyprogramme areas, for example 18 weeks &A&E performance.

Performance is shared with PBC consortiawho have opportunities throughcommissioning forums to reflect onperformance & play an active role incommissioning decisions.

The PCT also produces & disseminates dailyreal time information relating to access tocommunity based services & any providedservice issues through SITREP reports.

A corporate performance report is producedmonthly & reported to the board & is publicinformation. The board takes a keen interestin performance & have influence over keydecisions relating interventions requiredwith providers particularly if performancevaries significantly or consistently from theplan. Further interrogation is through theFinance & Performance committee,reporting to the board. There are monthlybespoke performance reports for key areasto support specific development workincluding 18 weeks, cancer waits & A&Efour hour target. Reports are shared withproviders on a regular basis.


1Level

2Level

3Level

4

• Use of real time performanceinformation

• Implementation of regularprovider performance discussions

• Resolution of ongoingcontractual issues

45


Ap

pen

dix

6

Org

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Act

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Plan

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47


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del

iver

y o

f o

ur

serv

ices

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nsu

re t

hat

PMO

bec

om

es a

core

way

of

wo

rkin

gth

rou

gh

ou

t N

HSK

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nhan

ce o

ur w

ork

with

our

ser

vice

use

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d th

e pu

blic

inK

irkle

es

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elop

a r

obus

tst

rate

gy f

or p

ublic

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gem

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elop

a s

trat

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and

reso

urce

ban

k fo

rso

cial

mar

ketin

gin

itiat

ives

and

eng

age

with

soc

ial m

arke

ters

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erst

andi

ng k

eyth

emes

sur

roun

ding

succ

essf

ul p

rogr

amm

em

anag

emen

t w

hat

aPM

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unct

ion

can

dofo

r N

HSK

Dev

elop

men

t of

am

etho

dolo

gy t

hat

can

be u

sed

and

adop

ted

thro

ugho

ut N

HSK

on

a co

nsis

tent

bas

is

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crea

se o

ur le

vels

of

part

ners

hip

with

our

serv

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user

s an

d pu

blic

inK

irkle

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erst

andi

ng b

y st

aff

ofke

y th

emes

sur

roun

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succ

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enga

gem

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oolk

it fo

r su

stai

ned

publ

ic e

ngag

emen

t is

deve

lope

d

Del

iver

mea

sura

ble

impr

ovem

ents

for

our

inve

stm

ents

and

how

thes

e ca

n be

mon

itore

dan

d tr

acke

d

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erst

and

whe

n to

use

Expl

ore

the

conc

ept

of a

mem

bers

hip

coun

cil

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umbe

r of

key

sta

ff h

asal

read

y un

dert

aken

PM

trai

ning

and

pla

ns a

reun

derw

ay t

o ex

tend

thi

str

aini

ng.

Usi

ng t

he k

now

ledg

ew

ithin

NH

SK t

o sh

are

know

ledg

e an

d de

velo

ppr

otoc

ol a

nd n

ew s

yste

ms

and

proc

esse

s us

ing

PMO

Com

mun

icat

ions

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tegy

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ted

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sat

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ctio

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serv

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user

and

pub

licop

inio

n su

rvey

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prov

ed q

ualit

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dica

tor

perf

orm

ance

as a

sses

sed

thro

ugh

our

cont

ract

s w

ith o

ur k

eypr

ovid

ers

PMO

bec

omes

an

embe

dded

way

of

wor

king

thr

ough

out

NH

SK

Dec

embe

r20

09

June

200

9

Dire

ctor

of

Cor

pora

teSe

rvic

es

Dire

ctor

of

Publ

ic H

ealth

52

Staf

f an

d S

kills

Wo

rld

Cla

ssC

om

mis

sio

nin

gC

om

pet

ency

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anis

atio

nal

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elo

pm

ent

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ject

ive

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ion

s R

equ

ired

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tco

mes

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sure

sTi

mes

cale

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uti

veLe

ad

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ctiv

ely

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ula

te t

he

Mar

ket

Secu

rePr

ocu

rem

ent

Skill

s

To e

nsu

re t

hat

PC

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as t

he

rig

ht

cap

acit

y an

dca

pab

ility

to

mee

td

eman

d a

nd

secu

re r

equ

ired

clin

ical

an

d h

ealt

han

d w

ell b

ein

go

utc

om

es

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evel

op

key

asp

ects

of

pro

cure

men

t,co

ntr

act

man

agem

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bu

sin

ess

risk

s an

dfi

nan

ce

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nhan

ce a

naly

tical

skill

s an

d ab

ility

to

unde

rtak

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st/b

enef

itan

alys

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evie

w c

apac

ity a

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sour

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apab

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ss t

he P

CT

and

brin

g in

exp

ertis

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requ

ired

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erst

and

wha

tsu

cces

sful

str

ateg

icso

urci

ng lo

oks

like

Dev

elop

unde

rsta

ndin

g ar

ound

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man

agem

ent,

nego

tiatio

n an

d le

gal

issu

esD

evel

opm

ent

of k

eybu

sine

ss r

isks

unde

rsta

ndin

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how

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e ca

n be

man

aged

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d un

ders

tand

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of f

inan

cial

ris

km

anag

emen

t,tr

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es

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prin

cipl

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cros

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of

dem

and

and

supp

ly t

hat

prod

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r ga

p an

alys

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ndpr

opos

ed a

ctio

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ocus

on

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man

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roce

ss f

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bedd

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as a

goo

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ders

tand

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and

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icat

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ocur

emen

t co

ntra

ctm

anag

emen

t an

dbu

sine

ss r

isks

at

appr

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te le

vels

fro

mth

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thro

ugho

ut.

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isk

regi

ster

/pla

n is

impl

emen

ted

at N

HSK

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d to

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rd le

arni

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ith h

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orm

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pora

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in p

lace

to

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and

cou

ntno

n-m

anda

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activ

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t Pr

oces

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tatio

n of

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rogr

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data

regu

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hmar

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rmat

ion

in S

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rfor

man

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epor

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e pr

oduc

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nqu

arte

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asis

)

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200

9

May

200

9

Dire

ctor

of

Com

mis

sion

-in

g an

dSt

rate

gic

Dev

elop

men

t

Dire

ctor

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mis

sion

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g an

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Dev

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men

t

53


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mo

teIn

no

vati

on

an

dC

han

ge

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reat

e a

lear

nin

gen

viro

nm

ent

thro

ug

ho

ut

the

PCT,

wh

ere

inn

ova

tio

n is

valu

ed a

nd

reco

gn

ised

an

dst

aff

cap

acit

y an

dca

pab

ility

are

key

to t

he

del

iver

y o

fo

ur

serv

ices

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on

sid

er is

sues

of

tale

nt

man

agem

ent

and

succ

essi

on

pla

nn

ing

inta

rget

ing

fu

ture

lead

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ipin

vest

men

t

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ontin

ue t

o em

bed

the

PCT

Pers

onal

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elop

men

t Re

view

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ess

(PD

R)To

ens

ure

that

PPI

‘insi

ghts

’ to

be b

uilt

into

prio

ritis

atio

n

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uild

inte

grat

ion

ofJS

NA

into

com

mis

s’in

g de

cisi

ons

& p

riorit

isat

ion

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eliv

ery

the

PCT

Lear

ning

and

Dev

elop

men

t St

rate

gy

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tify

area

s w

here

turn

over

or

addi

tiona

lca

paci

ty is

an

issu

e

The

KSF

pro

ject

lead

to c

ontin

ue t

o w

ork

with

KSF

cha

mpi

ons

to e

nsur

e ad

optio

n of

the

KSF

pro

cess

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ater

und

erst

andi

ng o

fth

e PC

T st

rate

gic

obje

ctiv

es a

nd p

riorit

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byal

l sta

ff a

nd h

ow t

hey

supp

ort

thei

r de

liver

y.To

em

bed

a va

lue

for

mon

ey m

inds

et a

ndcu

lture

thr

ough

out

NH

SK

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ing

pers

onal

deve

lopm

ent

to t

hebu

sine

ss o

f th

e PC

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wel

l as

care

erde

velo

pmen

tEn

surin

g th

at a

ll st

aff

have

the

appr

opria

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owle

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lls a

ndbe

havi

ours

to

deliv

er t

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role

s

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alen

t an

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cces

sion

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ures

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PC

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equi

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deliv

er it

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ieve

men

t of

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acr

oss

the

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orce

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reca

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prov

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taff

sur

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resu

lts o

n th

e qu

ality

of

appr

aisa

lsA

ll st

aff

with

in t

he P

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havi

ng a

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out

line

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nsur

e th

at t

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SF is

ado

pted

PC

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ide

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men

t of

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ple

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velo

pmen

tpl

ans

on e

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Ann

ual t

rain

ing

plan

deriv

ed f

rom

e-K

SF

July

200

9

2009

/10

Mar

ch20

09

Dire

ctor

of

HR&

OD

Dire

ctor

of

HR/

OD

Dire

ctor

of

HR&

OD

54

To e

nsur

e fu

ture

capa

bilit

y ne

eds

are

iden

tifie

d ac

ross

the

PCT

in a

tim

ely

man

ner

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nsur

e th

at t

hePC

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aini

ng a

ndD

evel

opm

ent

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tegy

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ligne

d to

the

PC

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rate

gic

Fram

ewor

k

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nsur

e th

at t

hebu

sine

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lann

ing

proc

ess

iden

tifie

spo

tent

ial d

evel

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ent

need

s ne

cess

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liver

the

pla

n

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nsur

e th

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from

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ng n

eeds

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iden

tifie

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t of

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annu

altr

aini

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lan

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ew o

f PC

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aini

ngan

d de

velo

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t st

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ens

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fitne

ss f

orpu

rpos

e

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pdat

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sine

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anni

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ss s

o th

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t ne

eds

are

requ

ired

to b

e id

entif

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as p

art

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roce

ss

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nsur

e th

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clo

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anni

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rain

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lopm

ent

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irem

ents

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ompl

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aini

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port

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rogr

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act

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deve

lope

d fo

r al

lth

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ld c

lass

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mis

sion

ing

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the

out

com

es o

f th

etr

aini

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eeds

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aff

surv

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chie

vem

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of t

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anda

rdPD

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oces

sU

pdat

ed t

rain

ing

and

deve

lopm

ent

stra

tegy

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sed

busi

ness

proc

ess

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ld c

lass

com

mis

sion

ing

trai

ning

prog

ram

me

deliv

ered

Mar

ch20

09

Dec

embe

r20

09

Dire

ctor

of

Patie

nt C

are

and

Prof

essi

on

Dire

ctor

of

Perf

orm

ance

& Info

rmat

ion

Dire

ctor

of

Perf

orm

ance

& In

form

atio

n

Prio

riti

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vest

men

t

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ocu

rem

ent

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s/M

anag

eLo

cal H

ealt

hSy

stem

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pro

ve t

he

pri

ori

tiza

tio

n o

fre

sou

rces

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urt

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d t

op

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rman

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y ar

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mes

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how

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nsur

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nder

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key

stra

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rate

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ir ro

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May

200

9

June

200

9

May

200

9

Dire

ctor

of

Fina

nce

PCT

Boar

d

Dire

ctor

of

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nt C

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and

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essi

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55


56

Stru

ctu

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Wo

rld

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ssC

om

mis

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om

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nsur

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at t

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long

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erm

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prov

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rent

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ntly

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s cu

rren

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re s

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opor

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sepa

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skill

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quire

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57


Further information about the PCT can be found on the PCT’s website

(www.kirklees-pct.nhs.uk) or by contacting the PCT at:

Kirklees Primary Care TrustSt Luke’s House

Blackmoorfoot RoadCrosland Moor

HuddersfieldHD4 5RH

Tel: 01484 466000

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