Competency 1: Self assessment

1. Competency 1: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Are recognised as the local leader of the NHS • Reputation as the ‘local leader of the NHS’ • Reputation as a change leader for local organisations • Position as the local healthcare employer of choice NHS Kirklees leads the health agenda in Kirklees. We are core members of the Local Strategic Partnership. We have strong working relationships with Kirklees Council (KC), working on the health elements of the Local Area Agreement (LAA). We have strong & effective relationships & partnerships with other providers in primary care, secondary care, mental health & are developing this with the voluntary sector. This has enabled the PCT to drive forward health issues & strategy across organisational boundaries for the benefit of our public & patients. We developed our relationships with the public through such forums as the LiNKs & partnership forums & listening events. The PCT uses Social Marketing techniques, for example in commissioning urgent care services, to allow us to get to the core of what people need. In conjunction with the JSNA this gives the PCT a clear awareness & direction for developing & improving its relationship with the public we serve. The PCT has led on a number of events with partners that cut across a variety of organisations & allows strategy to be set that influences health care. An example of this is joint events with KMC ‘A Picture of Kirklees’. In addition the PCT has led on health economy events focusing on 18 week delivery with secondary & primary care clinicians to enable cross organisation pathway development. The PCT has a strong focus on developing its staff with a variety of opportunities to maximise individual potential, for example participation in the Advanced Commissioning Programme. The PCT is proud of its staff & as such invests in celebrating its success. Several individuals & groups have been recognised regionally & nationally. In addition the PCT holds its own award events to congratulate staff for the work they do. NHS Kirklees, 7th October 2008,

2. Competency 2: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Work collaboratively with community partners to commission services that optimise health gains & reduce health inequalities • Creation of Local Area Agreement based on joint needs • Ability to conduct constructive partnerships • Reputation as an active & effective partner The JSNA was developed with the PCT partners, principally KC. The PCT works closely with Local Strategic Partnership (LSP) to develop & agree the LAA. The LAA reflects the JSNA & clearly demonstrates what is to be delivered either in partnership or by specific organisations with key milestones, for which the PCT has a history of delivering. The PCT plays a key role in ensuring that the LAA priorities reflect the JSNA & the needs of localities. For example the Children’s & Young people’s plan has been informed by the JSNA & monitored through the LAA. The PCT has an active role in shaping & influencing locality working with KC. The PCT has a clear approach to the delivery of its element of the LAA, working closely with partners in health & social care & also statutory services, such as the Police & the voluntary sector. NHS Kirklees & KC share posts include the joint DPH & commissioning managers for Children, Older People & Physical & Sensory Impairment. This has allowed greater integration with the functions & cultures of the PCT & KC. The partnership posts have allowed for the development of pathways of care, for example in older people, to support health & social care delivery. In addition there are clear & effective governance arrangements for these posts. There are clear structures in both the PCT & KC where the partnership posts influence & deliver on commissioning intensions jointly to enable delivery of the LAA, optimise health gains & reduce health inequalities. The JSNA & LAA, together with PBC local knowledge, allow PBC consortia commissioning plans to be set. The PCT works closely with PBC & encourages the production of practice plans that outline specific actions to address local need to be implemented. NHS Kirklees, 7th October 2008,

3. Competency 3: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Proactively build continuous & meaningful engagement with the public & patients to shape services & improve health • Influence on local health opinions & aspirations • Public & patient engagement • Delivery of patient satisfaction NHS Kirklees communication & patient & public involvement (PPI) strategies focus on ensuring a meaningful & rich relationship with the public & the PCT. We have consistently sought to offer different ways of addressing improved communication either through literature or public events, such as ‘A Picture of Kirklees’ & formal consultation sessions on service strategy have enabled the public to work in partnership with us & to influence commissioning decisions. We actively involve patients in developing services that promote independence, health, wellbeing & personalisation. The ‘Year of Care’ work in diabetes, the Co-creating health programme for Musculoskeletal as well as self care for Long Term Conditions follow the principles of care of Long Term Condition management & actively involve patients in the design & development of these services. The expert patient programme has been recognised nationally & encourages people to maximise their potential. Our approach to patient & public involvement has ensured that there is a tangible influence on how services are commissioned. Social Marketing techniques have been used to influence how Urgent Care 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 In Partnership team that hold consultation sessions with the public. These are opportunities to share information & have two way dialogue with people who use services & allow commissioning intension to be influenced. Involving Young Citizens equally with children & parent involvement further demonstrates our approach as does the redesign of speech & language therapies involving parents. PALs are an integral link between us & the public, receiving issues & complaints that are analysed & reported to the Board, as well as influencing commissioning decisions. NHS Kirklees, 7th October 2008,

4. Competency 4: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Lead continuous & meaningful engagement of all clinicians to inform strategy & drive quality, service design & resource utilisation • Clinical engagement • Dissemination of information to support clinical decision making • Reputation as an active & effective partner The PCT’s structure & PBC arrangements strengths are that it generates strong clinical engagement. The PEC & PBC participate in a joint commissioning forum with the PCT which strengthens integration & clinical engagement in our commissioning functions. All clinicians, GPs & others, are actively involved in the PCT planning forums, such as Health Improvement Teams (HITs), the Long Term Conditions Board & redesign groups with regular PEC attendance. We are actively engaged with PBC consortia to ensure joint development of commissioning plans based on the needs of patients, using the JSNA & broader planning documents such as Healthy Ambitions, whilst maintaining a local focus. PBC consortia have the delegated responsibility to drive improvement in health & wellbeing through their commissioning plans. To support PBC, resource utilisation packs have been developed & regularly discussed with practices. The intention is that these give an accurate picture of how services & resources are being used. Clinicians are encouraged to submit commissioning plans & business cases to improve health gains. Clinical engagement in redesign is seen as paramount in the successful development & implementation of pathways. Primary and 2º care clinicians work with the PCT on pathway redesign of which the PCT actively facilitates & leads joint working. Our success in our approach to clinical engagement for 18 weeks was recognised nationally as excellent. Clinical engagement is embedded in other areas of development, Urgent care, Health visiting, Intermediate Care, all using pathways of care as the basis of improving services for patients. The PCT is currently establishing a commissioning development programme with clinicians supported by a training needs analysis, that will further enhance clinical & management partnerships in Kirklees. NHS Kirklees, 7th October 2008,

5. Competency 5: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Manage knowledge & undertake robust & regular needs assessments that establish a full understanding of current & future local health needs & requirements • Analytical skills & insights • Understanding of health needs trends • Use of health needs benchmarks The JSNA is comprehensive & refreshed on an annual basis & takes into account information from public involvement & clinical opinion. PBC annual plans are based on the JSNA & allow commissioning of services at a local level through consortia & practice plans. Other data is used & analysed to support commissioning decisions; secondary care activity referral rates for example. This information is used as part of predictive modelling. In conjunction with the JSNA gaps in service provision are recognised & addressed. The Strategic Development Plan provides a framework for commissioning that gives a priority to the major health needs of Kirklees. The JSNA identifies clear priorities for local population by locality, children, young people & adults. The JSNA identifies risk factors for disease, current & future, & focuses on these allowing subsequent commissioning decisions to be made. There is also trend data for mortality of major health issues. The CLIK & YPHS major surveys have contributed significantly to the JSNA. Part of the JSNA focuses on benchmarking Kirklees nationally & further work on benchmarking against local PCTs is being developed. The PCT benchmarks itself against other PCTs in a number of other areas, e.g. delivery of the 18 week standard & the PCT’s position against this regionally is measured & used as a tool to drive performance & influence commissioning decisions. Health Care Commission reports benchmark the PCT performance against all PCTs & from these come action plans supported by commissioning plans to improve performance. PBC use resource utilisations packs that demonstrate patterns of activity at practice level across the PCT where it is used through peer development, to drive forward improvements through focused redesign work & changed commissioning plans. Further needs assessments are undertaken as appropriate; for example children with disabilities, cardiovascular disease, obesity, health behaviours of women of child bearing age. NHS Kirklees, 7th October 2008,

6. Competency 6: Self assessment Competency Measure Level 1 Level 2 Level 3 Level 4 Prioritise investment according to local needs, service requirements & the values of the NHS • Predictive modelling skills & insights • Prioritisation of investment to improve population’s health • Incorporation of priorities into strategic investment plan NHS Kirklees uses predictive modelling across a range of its functions. Notably the Service Strategy with Mid Yorkshire Hospital Trust as part of forecasting commissioning intention for service provision in the new hospitals. This long term model, at specialty level, has been developed across primary & secondary care incorporating demographic & health needs based data. Redesign of services at Calderdale & Huddersfield Foundation Trust has used predictive modelling to inform commissioning intensions at specialty level. Specialty level modelling is used annually for capacity & demand planning with acute trusts. As part of this process where changes in service delivery are made, from secondary to primary care for example, this is incorporated. An example of this is in Long term Conditions where disinvestment in secondary care & investment in primary care is planned. These changes are progressed through the business planning & commissioning cycle. The business planning process is an outcome from HITs. There are HITs for all of the PCTs key strategic areas & fit with delivery of policy, for example ‘healthy ambitions’. Business plans have defined criteria & fit with the vision & values as well as the goals of the PCT & highlight where improvements will be made. In addition, the composition of the HITs incorporates clinicians as well as managers & other stakeholders ensuring the commissioning cycle & business planning process is receptive to local need, clinicians & stakeholders. Through locality working & the use of the JSNA the PCT has been able to focus investment & develop services where the need is greatest. The equitable access centre will be in Dewsbury, this is an area with a lower patient to GP ratio. The same approach has been used to invest in dentistry. These being agreed in consultation with key stakeholders including GPs & other clinicians. NHS Kirklees, 7th October 2008, 6

7. Competency 7: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Effectively stimulate the market to meet dem& & secure required clinical & health & wellbeing outcomes • Knowledge of current & future provider capacity • Alignment of provider capacity with health needs projections • Creation of effective choices for patients NHS Kirklees understands the local market for health services & jointly commissioned services with social care. We have used competitive processes to procure services. The equitable access procurement sourced a number of providers to enable delivery of this initiative. Urgent care procurement for Out of Hours care & the development of urgent care services has stimulated the market & attracted a variety of potential providers for this service. As part of the urgent care procurement public consultation & social marketing techniques have been used to ensure that patients’ views & opinions are included in the specification. In addition the inclusion of patients & clinicians in the procurement process has been vital. There has been analysis of the providers ability to deliver the service at a defined minimum level of quality & within a specific budgetary envelope. This is representative of the PCT approach to procurement & sourcing providers. To further develop our approach to increasing the supply market we have developed a procurement policy ensuring future procurement is robust in its assessment of a wide range of providers using competitive approaches. The PCT uses demand & capacity analysis tools in conjunction with secondary care providers to plan specialty based activity forecasts incorporating local need determined by the JSNA. Review is on a monthly basis, any gaps in service provision are commissioned accordingly. An example of this is Audiology where capacity in local services was not available in order to reduce waiting times. An independent sector provider, sourced through a procurement process, 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 a lack of services & Choice then the PCT ensures GPs are aware alternative providers. NHS Kirklees, 7th October 2008,

8. Competency 8: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Promote & specify continuous improvements in quality & outcomes through clinical & provider innovation & configuration • Identification of improvement opportunities • Implementation of improvement initiatives • Collection of real time quality & outcome information The PCT incorporates benchmarking into service improvement. This is demonstrated both in our performance management processes where current performance in some areas is benchmarked against national & local levels. In addition GP performance is benchmarked locally, for example in referral rates, so that there can be an analysis of extreme high & low referrers & any changes made accordingly. Developing commissioned services through joint working and innovation is essential & the PCT has a track record of this. Clinical pathway improvement has been seen in a number of areas, Musculoskeletal Care, Gynaecology, Cardiology, Diabetes amongst others. Within pathway development the whole patient journey is considered highlighting key areas where improvement & changes can be made. For example Long Term Conditions pathway focuses on self care & all 3 levels of prevention including how patients can be cared for in a primary care setting as the norm, not admission to secondary care, a specific example being, the ‘Year of Care’ programme, involving patients & clinicians, considers how patients can improve self care & with clinicians improve outcomes. PBC are core to pathway development. The PCT has a ‘planned care’ HIT with PBC involvement. PBC are also involved with secondary care to develop integrated care pathways. As part of 18 weeks, clinicians & patients reviewed pathways under development. This formed a strong basis of ensuring pathway implementation fits with patients need & is clinically driven. Pathways are developed against a series expected outcomes which are then measured. Quality boards have been established with MYHT, CHFT & SWYMT. The PCT is improving its process of incorporating quality metric & benefit realisation techniques into it improvement work. The PCT holds regular monitoring sessions with providers, in areas where there is ongoing improvement, for example urgent care, this is weekly, for other areas this is monthly. NHS Kirklees, 7th October 2008,

9. Competency 9: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Secure procurement skills that ensure robust & viable contracts • Understanding of providers economics • Negotiation of contracts around defined variables • Creation of robust contracts based on outcomes Through the PCT relationship with its providers & broader intelligence the PCT has good understanding of provider economics & market dynamics. NHS Kirklees has an robust and mutually respectful relationship with its major acute providers & mental health providers. The contract unit meet with providers to discuss capacity constraints, activity & financial positions against plan on a monthly basis & includes feedback on patient experience. All of this information is documented & reported on at weekly internal contracts meetings. These meetings also ensure that the strategic direction of providers is in line with commissioning intentions. Finance & Commissioning Directors lead contract negotiation in line with the PCTs procurement strategy supported by the contract team where variables such as cost & quality are identified. A more systematic approach to quality is being developed with quality metrics integrated into contracts & new Quality Boards being integrated into contract management structures. However there is a requirement for further improvement in incorporating patients experience into the contracting & reporting process. Where there are variables for example, referral rates or variance of activity against plan, these are discussed & solutions agreed at regular, at least monthly, contract team meetings. Contracts are based on outcomes. Recently developed contracts for Equitable Access & Urgent care for example, are outcome based & include quality metrics that are monitored through key performance indicators. Contracts with major acute provides are standard & legally binding including details of arbitration & break clauses. The PCT has risk sharing arrangements for specialist commissioning & chairs the Specialist Commissioning Group (SCG). Through the SCG a number of specialties & provided services have been improved through clear common performance indicators & robust specifications. NHS Kirklees, 7th October 2008,

10. Competency 10: Self assessment • Competency • Measure • Level 1 • Level 2 • Level 3 • Level 4 • Effectively manage systems & work in partnership with providers to ensure contract compliance & continuous improvement in quality & outcomes & value for money • Use of real time performance information • Implementation of regular provider performance discussions • Resolution of ongoing contractual issues The PCT has a dedicated information team that analyses & validates data & presents in usable formats to ensure that information is provided in a such a way that is easily understood by commissioning staff & stakeholders as appropriate. Where there is a need for validation or to challenge information provided this is done. The information is then used to support contracting meetings, provide evidence for pathway development & support performance management. This is particularly important where there are variances against plan & actions required to be taken. The performance data & minutes from contract & performance discussion with main providers is used internally by the contract team to assimilate all provider performance & take coordinated actions accordingly. In addition where there are specific areas of monitoring required on a weekly basis the information is provided in a format to allow decisions to be made to influences key programme areas, for example 18 weeks & A&E performance. Performance is shared with PBC consortia who have opportunities through commissioning forums to reflect on performance & play an active role in commissioning decisions. The PCT also produces & disseminates daily real time information relating to access to community based services & any provided service issues through SITREP reports. A corporate performance report is produced monthly & reported to the board & is public information. The board takes a keen interest in performance & have influence over key decisions relating interventions required with providers particularly if performance varies significantly or consistently from the plan. Further interrogation is through the Finance & Performance committee, reporting to the board. There are monthly bespoke performance reports for key areas to support specific development work including 18 weeks, cancer waits & A&E four hour target. Reports are shared with providers on a regular basis. NHS Kirklees, 7th October 2008,