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Delivering health services closer to home

Kirklees PCT Provider ServicesAnnual Review 2007/08

KirkleesPrimary Care Trust

2 • Delivering health services closer to home

Population 400,000 people Budget for 2007/08 £28m Employed staff 1,000

Facts about Kirklees

d

Outlane

Holme

Holmbridge

MelthamHonley

Lindley

Marsh

Fartown

Netherton

CroslandMoor Newsome

Huddersfield Dalton

Almondbury

Fixby

Sheepridge

Scholes

Brockholes

Farnley Tyas

Bradley

Rawthorpe

Deighton

Scholes

Highburton

Kirkburton

Skelmanthorpe

Roberttown

Lepton

Gomersal

Birkenshaw

Birstall

Grange Moor

Heckmondwike

Denby Dale

Shepley

Holmfirth

Marsden

Slaithwaite

Golcar

Emley

Dewsbury

Batley

Clayton West

Flockton

KirkheatonThornhill

MirfieldRavensthorpe

Liversedge

Cleckheaton

Batley, Birstall and Birkenshaw

Huddersfield North

Huddersfield South

Spen

Denby Dale and Kirkburton

The Valleys

Dewsbury and Mirfield

Kirklees PCT Provider Services – our area

Kirklees is the third largest local authority in England by area, covering 254 square miles including some of the most beautiful countryside in the UK. Of this, 11% is in the Peak District National Park and 71% is classified as Green Belt. Kirklees PCT Provider Services is working with partners across this area to improve the health of people in all communities. The challenges we are addressing are:

• Of the 23 council wards in Kirklees, eight fall within the 25% most deprived in England and Wales.

• Our main challenge is to tackle the underlying causes of deprivation, which result in health inequalities.

• Infant mortality in Kirklees is higher than the national average in all but two localities. Dewsbury had over twice the national rate and there was a three fold variation across the whole area.

• Tooth decay among five year olds in Kirklees is significantly higher than the national and regional average.

• One in five people have had depression, anxiety or other

nervous illnesses in the past year: 22 percent of those were under 65. The major issues locally are depression and anxiety, post-natal depression and bereavement.

• More people locally have heart disease – 6.8%. The national rate is 5.7%.

• South Asian people are up to six times more likely to get diabetes than white people.

• Smoking rates are still too high. One in four adults still smoke.

• Life expectancy in Kirklees is significantly lower than the national average, particularly in some wards in the town centre area of Huddersfield and some wards within North Kirklees.

• Nineteen percent of children in reception classes were overweight and 30 percent of 11 year olds were classified as obese; 4O% of women aged 18-44 were obese or overweight.

• In 2005, 41 percent of women aged between 18-44 reported binge drinking in the previous week.

Foreword…

In the last year we have taken considerable

steps in our plans towards making Kirklees

Provider Services an independent organisation

from Kirklees PCT.

Strong governance will be key to its future

success. Our first step has been to establish an

arm’s length organisation with its own separate

board whose members bring strength and

expertise in running provider services. We are

grateful for their support and input.

The board’s role is to ensure that we have the

right structure in place and that employees

have the right skills to deliver first class service

to our patients.

I believe progress to date has been excellent

and Provider Services is already in a strong

position to meet the challenges of the future

and be a provider with a strong reputation for

delivering high quality services to patients.

…from Vanessa Stirum, Chairman of the

Provider board of Kirklees Primary Care Trust

…from Mike Potts, Chief Executive,

Kirklees Primary Care Trust

This Annual Review is the first produced by Provider

Services. It not only highlights the excellent services

that have been delivered to the people of Kirklees,

but is part of our move to becoming a self sufficient,

independent business – albeit under the umbrella of

Kirklees PCT.

The focus for our organisation is to tackle the health

priorities for our area – identified in the Joint Strategic

Health Needs Assessment – and this will drive our

future investment decisions.

A priority for the next year will be to work closely with

the organisations who commission healthcare. Together

we need to agree what services are needed and how

to deliver these. We need to give them confidence that

we can deliver services in new and innovative ways to

meet the needs of our local community – and that we

can tailor them to the specific needs of very local areas.

Our watchwords are to provide excellent clinical quality

and excellent patient experiences.

We are in good financial shape, with money to invest

on developing new services and we need to ensure the

PCT wants to spend their money with us.

I want staff to feel good about working for Provider

Services and be proud of the contribution they make

to the health and well being of the people of Kirklees.

…from Robert Flack, Director, Kirklees Provider ServicesThis has been a year of challenge and opportunity

and it is a credit to everyone in Provider Services

that they have responded so enthusiastically.

Nurses and therapists have spent a lot of time

listening to their patients, GPs, hospital colleagues,

social services and other partners. They are

redesigning how they work to reduce waiting

times, deliver better support to patients and

generally provide an improved service.

Our clinicians are keen to ensure they are friendly

and approachable – and that patients have better

lives as a result of their help. That could be by

improving recovery times, making it easier for

people to live independently, having more choice

about their treatments or preventing people from

becoming ill in the first place.In the last year we have significantly improved

waiting times. While this work continues, we

now want to make sure that patients can see the

clinicians when and where it is convenient for

them.My thanks to everyone for a year of real

achievement.

Delivering health services closer to home • 3


Delivering health services closer to homeKirklees PCT Provider Services exists to provide nursing and therapy to the 400,000 residents of Kirklees, as near to where they live as possible . At the moment Provider Services remains a part of the PCT . However, as the PCT develops its commissioning role, our community services arm will become independent.

The key aims of Provider Services are to:

1. Put patients and their carers first and involve them in their care package.

2. Change our services so that we deliver the patient’s need.

3. Deliver care as close to home as possible.

Our remit is to work in community based teams to help people manage their health outside hospital. This means we work with GPs and hospital doctors to ensure the best possible quality of care can be delivered.

To do this we employ around 1,000 people from a range of professions – including nurses, therapists, doctors , dentists and social workers.

Much of our work is based in localities – again making sure we can serve the needs of our community and tailor care around where people live.

In line with government policy we are now working towards Provider Services becoming an independent organisation. To do this the board has agreed the following six strategic areas:

• Creating a patient-centred organisation

• Creating the right working environment

• Securing our current position

• Meeting our targets: national and local

• Devising an accountability and governance structure

• Defining the services we deliver.

Palliative Care Therapy TeamOne of the most difficult problems for patients with cancer is coping with fatigue. Sleep alone does not help.

The palliative care therapy team is there to help people live independently and, for the many patients who want to, eventually to die peacefully at home.

Margaret Houghton is a senior occupational therapist at Dewsbury District Hospital and produced a leaflet on managing fatigue with tips to help patients improve quality of life: “Simple advice can make a real difference. The leaflet shows how to prioritise what matters and then how to pace yourself. Build in restorative activities to your day such as a short walk, listening to music, painting or aromatherapy – things that make you feel good.”

It is rare to have dedicated occupational therapists in a palliative team. It means patients have a single point of contact and therapists can learn about best practice and go on courses that would not be available to generalists. In the last year assessment times have been speeded up and most patients are seen within a working week, and many within 24 hours of referral.

Margaret Houghton added: “We have a real range of resources to help people and this is such a rewarding job. We get a lot of positive feedback from patients and their families.”

Service level agreementsProvider Services currently receives the majority of its income from the PCT, which is managed through a service level agreement.

This is an annual agreement between Provider Services and the PCT, acting in its role as Commissioner, and sets out the services that we have to provide and the responsibilities for ourselves and the PCT. It also underpins how much money we receive.

For each of the services currently provided we are drawing up a baseline specification, which will be agreed with the PCT.

The finance team are in the process of working out the cost of delivering each individual service. This information will be used to refine the service level agreement and will be the basis for discussing next year’s contract.

My husband was always so impressed with the way you found solutions to assist with his increasing frailty. Your sensitivity was very much appreciated by his family. The equipment you provided made a real difference to his quality of life and meant that we could respect his wish to be cared for at home.

Extract from a patient letter


Teamwork was at the heart of a dramatic cut in waiting lists earlier this year. Just before Christmas, a mobile theatre became available and all the stops were pulled out to get the logistics sorted in time to use it.

Pam Linton, team leader at Holme Valley Memorial Hospital, explains how they operated on 190 people needing minor plastic surgery and a further 50 for foot surgery: “I can’t praise everyone enough. People at different hospitals and in different roles were just amazing in what they achieved.”

Pam’s own team increased their hours ‘without any moans’ to maximise the opportunity; the finance and HR teams at St Luke’s House cleared funds to buy extra equipment and recruited more staff nurses within a few days; procurement and supplies at Huddersfield Royal Infirmary helped with the ordering of new equipment and extra consumables; and Barnsley NHS Foundation took on sterilising all equipment.

Pam Linton adds: “Barnsley took on a 12 hour turnaround for the equipment every day for five weeks. They worked till midnight and never let us down once.”

Last year, Pam’s team had won an award of £300 for improving patient care. They used this to put on a celebration for the teams involved: “The best bit was that patients were so happy to get their treatments.”

Mobile Theatre UnitWatz Cooking

A one stop Continence Service across Kirklees is helping to improve the quality of care for patients by treating them in one place by clinicians they know and trust

Following the merger of Eddercliffe and Fartown continence teams, staff have had extra training in areas such as continence physiotherapy so that patients no longer have to be referred to secondary care for some treatments.

Joanne Whiteley, continence service manager, explained: “Bladder dysfunction is not something that people want to talk about anyway, so it can be distressing if they have to explain their problem twice – once to us and then again at hospital.”

One Stop Continence Service

Veronica is one patient who has benefited from the supportive and friendly service. She referred herself to the service following complications after surgery for bladder problems.

“She was distraught as she had pain, was struggling to pass urine, felt generally unwell and did not know where to turn,” said Joanne Whiteley. “From a psychological slant Veronica needed a lot of emotional support and I’m proud to say as a service we did this very well. Alongside, drastically improving her physical bladder symptoms.

“I saw Veronica become a different, more confident lady as we established a

relationship, giving her confidence, appreciation and trust in her care.”

Last summer, Laura Mosley inspired young people to cook. She and her public health colleagues put on free healthy eating workshops for 16 young people, aged 8 to 16, in the holidays.

The menus really interested the young people and they have carried on cooking at home – and encouraged their parents to do more cooking.

The recipes ranged from home made soups, chicken curry and healthy pizzas to wholemeal bread, flapjacks, fruit salads and pineapple cake.

Laura Mosley says the children really took to the twice weekly sessions which ran for four weeks: “Lots of families see cooking as quite messy and time consuming. These workshops showed how quick and cheap it is to make delicious but healthy meals.

The workshops were funded by Newsome Next Generation Healthy Living Programme with the help of Big Lottery money.

At the final session, the young people created a ‘Kidz Café’. They made placemats and menus to decorate it and invitations to invite their parents and guardians. The three course meal they cooked really impressed their families, who gave such positive feedback that the workshops will be run again in the coming holidays.

“I would be willing to pay for my son to attend this in the future! It’s well worth it”

“It would be good if you ran more workshops like this again!”

“Think I could get into this healthy stuff!”

Three happy parents


In September 2006, the government introduced a catch-up campaign for children who had missed out on Hib immunisation. Across the UK there has been a fall in the number of children getting septicaemia or meningitis and there was a push to ensure every child has had the Haemophilus Influenza B (Hib) injection.

Child Health identified there were 6,600 children who would need this vaccine.

Ann Brady, children’s community matron, was part of the team ensuring every child had the opportunity to receive this vaccine: “This is a really important vaccine and we were all keen to get rid of the waiting list. The Child Health department organised additional clinics and our part-time immunisation nurses did

a great job coming in full-time for several months so that we could catch up without affecting the ongoing clinics.”

This worked so well that there is no longer a waiting list.

Another campaign just starting is to encourage more parents of pre-school children to have the MMR vaccine against measles.

Ann explained: “We’ve worked with the communications team to put together really good information for the public, answering the questions that worry them. We can’t wait for the government to do this.

“It’s very early days but we are already seeing a significant increase in the number of calls from parents, wanting to know more. It looks a very good sign.”

“Good leadership skills not only improve the quality of clinical care and provide a more friendly service, but are actually proven to decrease intervention, increase independent living, aid recovery time and offer patients more choice,” explains Karen Johnson, locality manager for Spenborough.

Karen, her team and their patients are benefiting from the leadership training for front line staff across Kirklees aimed at improving and re-designing services that are more sensitive to the needs of their patients.

“We have encouraged people to look at their

own particular styles of leadership and to go out and learn from innovative practice across the country.”

More than 50 team leaders, including health visitors, therapists, nurses, interpreters and support staff, have been encouraged to seek out the best practice in their particular specialisms from around the country. At a one day conference in April 2008 front line staff shared their findings with colleagues.

The team leadership development programme is based on research from Aston University that shows that good management has a direct impact on patient care.

Jackie Hatfield’s training in leadership has given her the confidence to push forward with an innovative plan to help drug users.

The district nurse team leader for Dewsbury has secured an award from The Queen’s Nursing Institute to fund the setting up of a drop-in wound care clinic for injecting drug users.

She explained: “For several years I’ve wanted to set up a clinic because there is a real gap in services for a group who are so often stereotyped if they go to A&E. The leadership skills training was the boost I needed to help me put the business plan together.”

Jackie and her colleague Tracey Conroy, a tissue viability specialist nurse, will be running the clinic

in the Dewsbury premises of substance misuse agency Lifeline, which is a partner in the project.

“We will be offering a non-judgemental clinic and hope to pull those people off the streets who are not accessing the service at the moment,“ said Jackie. “Often this group doesn’t get community nursing visits because of their

chaotic lifestyles. We hope that our new service will help to reduce A&E costs and give this client group a better service.”

Children’s Community Matrons

Leadership Training Queen’s Nursing Award

Jackie Hatfield has secured an award from The Queen’s Nursing Institute to fund the setting up of a drop-in wound care clinic for injecting drug users.


The majority of people employed by Kirklees PCT Provider Services are nurses and therapists, backed up by support and administrative teams.

In the last year we have been looking at new ways of working to support our frontline teams and ensure we meet patients’ needs. One of these areas has been flexible working.

We carried out a consultation with staff, which highlighted inconsistencies in the various flexible working schemes across the organisation – particularly where some staff are allowed to work flexibly and others not.

A new ‘Options’ scheme is being piloted up to end March 2009 which should give all employees a chance to work flexibly, not just some departments, and to change their hours if personal circumstances change – such as increased carer responsibilities.

Key features of Options include:• Annualisedhours

• Compressedworkinghours

• Purchaseadditionalholidays

We employ more than 1000 people:

477 Registered nurses

135 Nursing support

101 Health professionals including physiotherapists, occupational therapists, speech and language therapists and podiatrists

110 GPs, medical and dental staff

35 Healthcare assistants

120 Support and administrative

25 Managers

Our People

People with diabetes and patients requiring wound dressings are among those who are benefiting from an extra hour a day of community nursing care provided by a new flexible employee working scheme. Jill Stancliffe, Dalton district nursing team leader, said: ”When we introduced flexible working we had to ensure that we continued to deliver high quality care. What has been remarkable is that as well as accommodating all employees’ wishes for flexible hours, we are actually offering patients a better service.”Flexible working means that community nursing care now starts at 8.00am - half an hour earlier - and finishes half an hour later, at 5.30pm. Jill explains: “Patients with diabetes need their insulin injection before they eat, so they can now have an early visit from their nurse if they need to have breakfast before 8.30am. “Our flexible hours also help people who need new dressings before morning hospital appointments so they don’t have the embarrassment of going out with untidy bandages.”

District Nursing Service

Our valuesLooking after our patients is core to what we do. We need top quality people to give the best possible patient care and a culture where individuals feel they can and are allowed to give their best. These are the values that we have agreed to create our patient-centred organisation.

• Enjoy the challenge

• Give credit where it’s due

• Treat others as you would wish to be treated

• Learn, not blame

• Be friendly

• Make this a place where we want to be

• Practise what we preach.


Summary financial statementsIn 2007/08 Provider Services spent £28.1m. This expenditure was managed within Provider Services’ budgets of £28.5m, resulting in a small under spend in the year.

For 2008/09 a net uplift of 1.7% has been applied to budgets and a number of new developments agreed with the commissioner. Included in the new budgets are these developments:

• Additional health visitors – business case approved by the PCT in 2007/08.

• Additional posts at Holme Valley Memorial Hospital

The total opening budget for 2008/09 is £29.2m.

In addition to these developments work is ongoing on “Route to Solution”

(looking at a new way of delivering improved district nursing services across Kirklees) and additional business cases which should result in additional services being provided by Provider Services.

Over the last 12 months the finance team has focused on the following areas:

• Ensuring Provider Services’ budgets are robust and consistent with the services delivered

• Ensuring there is a stable recurrent financial position

• Assisting budget holders with understanding their budgets and the current financial environment with a view to devolving budgets down to team leaders to manage.

During 2008/09 the priorities for the finance team will be to:

• Continue working with budget holders across the Provider Services team

• Devolve budgets to team leader level

• Ensure all appropriate overheads are correctly reflected within Provider budgets

• Develop unit costs for Provider Services

• Extend roll-out of portal reporting (on-line access to budget holder reports)

• Agree and maintain a schedule of budget holder meetings for the full year.

Provider Services has a team of six finance staff who support frontline service teams in managing their budgets. In the team are:

Julie Lawreniuk, Assistant Director of Finance

Helen Davies, Finance Manager

Nicola Tinker, Assistant Finance Manager

Khadim Hussain, Finance Officers

Asif Kazi, Finance Officers

Vicky Wainwright, Finance Assistant.

Budget management support

The finance team have been supporting Gill Kaye and her colleagues to manage her own budgets and understand unfamiliar systems such as spreadsheets.

Gill Kaye, nurse team leader at Moorfield Primary Care Centre, can respond quickly to the needs and requests from patients now that she is managing her own budgets.

She explained: “We ask patients for their views in an annual satisfaction survey. Now we are in control of our own budgets we can act on some of the feedback. We have the flexibility of being able to identify and buy a piece


Provider Services does not currently have a statutory duty to prepare separate Provider financial accounts. A full set of financial accounts is produced by the PCT which incorporates both Commissioning and Provider costs.

A copy of these full accounts can be obtained free of charge by writing to:The Director of Finance Kirklees PCTSt Luke’s HouseBlackmoorfoot RoadCrosland MoorHuddersfield HD4 5RH

One of the PCT’s financial duties that relates directly to Provider Services is that “The PCT is required to recover full costs in relation to its Provider functions”. Our key goal is therefore to manage Provider Services within the budget agreed with the PCT.

Financial summaryPerformance for 2007/2008

Provider full cost recovery duty 2007/08 £000

Provider gross operating cost 32,422

less: Miscellaneous income relating to provider functions (4,328)

Net Operating Cost 28,094

less: Costs met from PCT’s own allocation (28,471)

Under / (over) recovery of costs (377)

Provider Services managed within the budget agreed by the PCT in 2007/08.

Health VisitingService18%

School Nurses6%

Therapies14%

District NursingDay Service

29%

District Nursingout of hours

6%

Community Matrons4%

Specialist Nursing4%

OtherSpecialist Services

19%

Split of Kirklees PCT Provider Budgets 2007/08

How we spend our money

Provider Services spent their money in 2007/08 on the following services.

of equipment that will help patients, whereas before we had to submit a business case for it. For example, the waiting room often crops up in the survey, so if there is budget left at the end of the year we can pay for improvements.

This is a great opportunity for me to decide how best to spend our money. Previously the process to raise invoices was lengthy and we could wait months for pieces of clinical equipment – in some cases that could mean that patients would have to be referred to hospital.”

Staff member, Sam Macleod, entertains a young visitor in the reception area of Moorfield Primary Care Centre

Modernising our district nursing (‘Route to Solution’)Over the last few years there has been growing frustration among GPs and district nurses about the way their service was structured. They both felt that patients would be seen more quickly and conveniently if they reorganised how they allocated district nurses to GP practices.

Last year, a team at Provider Services decided to go back to basics and asked everyone who had any kind of interest in district nursing if they wanted to help design a new way of working. The response was enormous: GPs, PCT commissioners, public health officials, nurses, patient care standards and others all offered help.

A working group was established and a major event held to identify

the issues and come up with

ideas to improve how we work. More than 100 people attended this.

Groups of colleagues are now looking at best practice around the country to see how other district nurses organise their workloads. A number of GPs have also come up with their own suggestion for working through a ‘cluster’ group of GPs.

As we go to print, a full project plan is being designed. This will ensure that any snags are anticipated and

resolved before a new way of working is rolled out.

If this process brings tangible benefits to patients and GPs, then we hope to apply it to other areas.

A working group was established and a major event held to identify the issues and come up with ideas to improve how we work.


Dr David Anderson, GP at the Grange at Fartown, has played an active part in discussions about how district nursing should be organised.

He believes the approach taken by Provider Services is right: “It’s a very good principle to involve all parties in planning a service. I’m pleased we are taking time to get it right. It’s very refreshing.

“In the past, we’ve often had to implement new ideas very quickly. This time we are listening to front line clinicians and I’m certain patients will be the ones to reap the benefits.”

Community nurses used to be based on geographical areas, so some nurses could be working with up to as many as 15 GP practices.

“We are now looking at how nurses could work with practices differently. That may

be with a single practice, or it could be several smaller practices. The service is being built around the GP practices, which is really important.”

He added: “The different providers of services need to work together constructively to deliver quality services, recognising each others expertise and what we can learn from each other.”

Dr Anderson hopes that many of the principles from the district nursing redesign can eventually be applied to other services: “These structures won’t work for every service, but when we can apply them, we should.”

This time we are listening to front line clinicians and I’m certain patients will be the ones to reap the benefits.


Members of the board

Vanessa Stirum Chair (NED)

Rob Millington Vice Chair (NED)

Robert Flack Director of Provider Services

Denise Boyd Deputy Director of Provider Services

Julie Lawreniuk Assistant Director of Finance

Tina Quinn Assistant Director of Provider Services

Helena Corder Director of Corporate Services

Barry Lane Assistant Director of HR

Julia Calcraft Clinical Manager, HVMH - Clinical Representative

Peter Flynn Director of Performance and Information

Jane Wragg Health Visitor Team Leader - Clinical Representative

Rosemary Norbury District Nurse Team Leader - Clinical Representative

Sue Smith Assistant Director of Clinical Governance

Priorities for Provider Services board in 2008/9

1. Improve our performance to give patients better care

2. Maximise our new IT system to improve all areas of operation, such as secure and efficient patient notes and better systems with partners

3. Help patients manage long term conditions outside hospital

4. Work with our staff to help them give better patient care

Date of publication: May 2008Ref: RF2372© Kirklees Primary Care Trust

Over the last decade, there has been far better diagnosis of children with motor co-ordination problems – such as dyspraxia – but the support and treatment has not kept pace. Waiting lists across the UK were anything up to four years and in Dewsbury, more than three years.

Carol Banks, who leads the paediatric occupational therapy at Dewsbury Hospital, said: “This was unacceptable, children were missing out on their education.”

Carol’s team looked at the assessment process. At that time every child was receiving a full assessment but only some needed this level. The team redesigned an

effective screening process and, using the same resources, focused help when and where it was needed – and there is no longer a waiting list.

Carol explains that working with parents and teachers, often simple things can change a child’s life: “Teaching a child how to dress differently or organising a computer for schoolwork can really help. For more serious problems, we can focus a lot more on therapy support to help a child develop.

“Getting help at the right time ensures children have better self-esteem, cope with school work and ultimately get a job.”

Kirklees Provider Services

Batley Health Centre130 Upper Commercial StreetBatleyWF17 5ED

Director: Robert Flack

Email: [email protected]

Tel: 01924 351555 Fax: 01924 473136

www.kirklees-pct.nhs.uk

This report can be made available in other formats or languages by contacting the communications team on the telephone number above.

Paediatric Occupational Therapy

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