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Annual report 2009/10

Kirklees Community Healthcare Services | Annual Report 2009/102

Our MissionTo deliver high quality healthcare, closer to home

Our VisionWe will strive to understand the needs and wants of our patients and will deliver excellent quality and best value care to exceed the expectations of the people in Kirklees. We will raise the bar of community healthcare and become the first choice provider by embracing new technologies with a well-trained, well-managed, focussed and motivated team.

Our ValuesThis is a vibrant organisation with a driving ambition to provide the best possible community healthcare for the people of Kirklees. We’re passionate about people and patients and we know the wisdom of developing effective relationships with our stakeholders. All this, together with our local experience and expertise, built over the years, means we are very much a part of this community and deliver the services local people want and need - closer to home.

With a budget of £47.2m and 1202 employees, we provide community healthcare in a wide range of locations around the area including health centres, local authority children’s centres and Holme Valley Memorial Hospital. Our aim is to deliver a first class patient focussed service to the Kirklees community in the following areas:

• district nursing

• health visiting

• school nursing

• community matrons

• palliative care

• community dentistry

• stop smoking support and sexual health

• podiatry

• speech and language therapy

• physiotherapy

• occupational therapy

Huddersfield South

Spen Valley Batley Birstall and Birkenshaw

The Valleys

Huddersfield North

Denby Daleand Kirkburton

Dewsbury and Mirfield

Who are we and what do we do?

Kirklees Community Healthcare Services (KCHS) serves a population of over 400,000 across seven localities in Kirklees, the third largest local authority in England. Our localities mirror those of Kirklees Council, the Police and Fire Service. Our region is one of diversity, with densely populated urban areas, Green Belt land and sparsely populated rural towns and villages.

// Throughout this Annual Report we have included positive comments sent by patients or their families //

Annual Report 2009/10 | Kirklees Community Healthcare Services 3

The evolution of the organisation has continued at a tremendous rate over the last 12 months. With our new name and our new dynamic approach we have driven through change to increase transparency and efficiency and all but separate from the commissioning arm of NHS Kirklees. This is in common with other community services provider arms of primary care trusts across the country. As a result we are now in a contractual relationship with NHS Kirklees.

As part of the high speed pace of change for KCHS during 2009-2010 we began to examine the future organisational form options available to us as we break away completely from the PCT. One thing has remained constant and will do so whatever our form; we will make sure our staff are trained and empowered to provide excellent patient care.

Change can be difficult but we are pleased to say that the KCHS workforce is interested in and embracing the choices facing us. We thank them for their hard work and their commitment.

Suzy Brain England - ChairRobert Flack - Managing Director

This Annual Report is an invitation to take a look at the achievements of Kirklees Community Healthcare Services (KCHS) for the year 2009-2010.What a year it has been!

As we entered the financial year we were poised to develop our technological capabilities to help our front line colleagues deliver first class patient care, closer to home – our overriding focus. You will see in the following pages just how far we have progressed. Using Tough Books - small, lightweight, but highly durable, laptop computers - has transformed ways of working. Mobile working is now an essential component of our drive to improve productivity, whilst keeping the patient at the centre of all that we do. KCHS is one of the largest NHS users of mobile technology in the country.

An invitation…

Board members 2009-2010

Key areas for delivery over the year for KCHS have been:

Ensuring that we constantly improve our services, making sure that safety and quality are paramount

Rolling out our ambitious mobile technology programme, enabling front line services to have access to patient records in the patients’ homes

Working very closely with partners, particularly Kirklees Council’s Social Care, helping to bring about a seamless service, reducing duplication and increasing efficiency

Empowering our service and clinical leads to make more decisions based on their patients’ health needs and in their patients’ best interests.

All directors confirm that, as far as they are aware, there is no relevant audit information of which the auditors are unaware and they have taken all steps they ought to have taken as a director in order to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.

No director holds a company directorship or has a significant interest which may conflict with their KCHS responsibilities.

Suzy Brain EnglandChair (Non-Executive Director)

Robert FlackManaging Director

Munir AhmedNon-Executive Director

Janice BoucherFinance Lead

Patricia DrakeNon-Executive Director

Tina QuinnClinical and Operational Lead


Working together for KirkleesWe rely on our people - their enthusiasm, commitment and talent helps us continue to provide first class community healthcare in Kirklees. We are delighted with what has been achieved by everyone within KCHS during 2009/10, a time of change and uncertainty. Colleagues have been working together and with our key partners to continue to improve patient care and services throughout the Kirklees area.

Investors in People successInvestors in People is a national quality standard awarded to well-run organisations demonstrating good management practice with a high emphasis on people management and development. KCHS, together with NHS Kirklees, has been awarded the Investors in People (IiP) standard. Around 150 colleagues took part in one-to-one and group interviews for the assessment. It was reported that we have built ‘a people-oriented culture where staff learning and development is strong’.

The KCHS workforceKCHS employs 1202 people and our workforce is spread as follows:

Nursing and Midwifery 49.4%

Additional Clinical Services 17.3%

Administrative and Clerical 17.3%

Allied Health Care Professionals 9.2%

Medical and Dental 2.4%

Senior Managers 2.3%

Estates and Ancillary 1.4%

Students 0.7%

The profile of the workforce by ethnic origin:

White 90.1%

All other ethnic groups 9.4%

Undefined/not stated 0.5%

Everyone has their sayOver the past year the Staff Partnership Forum has met on a monthly basis to discuss areas of mutual concern. Workforce representatives and managers have considered a wide range of issues and members of the Forum are committed to creating a working environment where everyone opinions are valued.

Maintaining a high quality effective workforcePatients benefit from the team at KCHS being well trained, motivated and focussed. All colleagues participate in an annual mandatory training programme that covers fire; health, safety and risk; basic life support and infection control. During 2009/10 100% of relevant staff attended clinical safeguarding training and 94% of relevant staff attended non-clinical safeguarding training.

We ensure that our team, both clinical and non-clinical retain the necessary competence to provide highly skilled care through in-house and external activities and courses. Further development and learning is encouraged and discussed in one-to-one development review sessions. We have 85 colleagues studying for vocational qualifications.

It is important that new employees get the best possible start to their career at KCHS and everyone takes part in the two phase induction programme that introduces them to the organisation and our vision and values.

Leading to meet our challengesDuring 2009/2010 the new KCHS Leadership Framework was conceived and developed. This framework sets out clear expectations for the leadership behaviours and attributes that we value and expect in KCHS; and it is fundamental to our Vision and Values. We are committed to supporting people within the organisation in their ongoing development of Leadership Framework behaviours and attributes, through our annual Personal Development Review process. A project to roll out the Leadership Framework across KCHS is one of our main priorities for 2010/2011.

Sue Ellis, NHS Kirklees, Kathryn Riddle, NHS Yorkshire & Humber, Robert Flack, KCHS, Carol Reed, IiP

// I can’t express how grateful I am that these professional women, who must see hundreds of patients a week, took the time and energy to make me feel completely safe and comfortable with a procedure I had been dreading.//


Supporting our teamIn 2009/10 the Human Resources team has provided a wide range of support for colleagues within KCHS. These include maternity, childcare and carers support, occupational health, counselling and stress management. The result is a sickness rate of 4.2%, a reduction on last year’s figure of 4.5%.

Celebrating SuccessThe KCHS Awards were held at the Galpharm Stadium in October 2009, a night of fun and celebration. With a new name, new ethos and new vibrancy this was an opportunity to thank all colleagues for their continued hard work and commitment. Special congratulations to everyone who won an award in the face of fierce competition. The roll of honour is:

• The Top Hat Award - Huddersfield North School Nurses

• The Extra Mile Award - Elizabeth Stringer

• Engagement and Involvement Award - Christine Farmery

• Innovation in Patient Care - Gillian Brearley

• Leadership Award - Angela Harris

• Best Team Award - Day Surgery Unit HVMH

• Working in Partnership Award - Integrated Night Service

• Ringmaster - Rachel Grogan

• Juggler - Child Health Team

• Acrobat - Heather Banham

• Chair’s Special Commendation Award - Health Visitor Team Leaders

Wound Care Clinic does it again!Congratulations to Dewsbury District Nurse Team Leader Jackie Hatfield who, with Mid Yorkshire Hospitals’ Tissue Viability Nurse, Tracey Conroy,, scooped two awards for the highly praised Drop-In Wound Care Clinic for injecting drug users. They won the “collaborative working” category in Mid Yorkshire Hospitals Trust’s Celebrating Success awards as well as being runners-up in the national Nursing in Practice Award for Wound Care. The team work in partnership with the charity Lifeline in Dewsbury.

Productivity produces successKCHS was one of just 36 shortlisted organisations from a list of over 100 in the Lean Healthcare Academy Awards. We worked with Ilkley-based Lean on the roll out of the “Productive Series” and our Lean facilitator, Abdul Ghani nominated us for the Facilitator’s Choice Award for our commitment to “Productive” and the progress we’ve made.

Service Development Manager, Kath Evans represented KCHS at the Awards event and reported a huge amount of interest in our work.

Innovation in Kirklees

Ground breaking work carried out by Dewsbury Speech and Language Therapist Mariani Tanton, means that patients in Kirklees can be treated earlier for feeding and swallowing problems and help avoid further health complications. The Dewsbury Feeding and Swallowing Screen made it to the final of the NHS Innovations Yorkshire and Humber 2010 Awards and has received excellent comments from nursing staff. Already in use~ in a number of locations around the region, the screening tool and accompanying training package could be rolled out nationally to detect these potentially life threatening problems.

Student nurse training praiseKCHS has had a fantastic evaluation from student nurses for 2009/2010. The majority either agreed or strongly agreed that their expectations were met and they gained confidence in professional practice. They were given the opportunity to interact with other members of the healthcare team and felt well supported by them. Two thirds said they would recommend KCHS as a placement to other students. So well done to everyone involved.

Integrated Night Service Team, Working in Partnership Award

Jackie Hatfield

Mariani Tanton

//Thank you for the loving care you gave Mum over the last few months. You all do a fantastic job, sometimes in very difficult circumstances.//


Cutting the cost of frequent callers‘Frequent callers’ to the emergency services cost the health care system £800,000 a year in Kirklees. KCHS Community Matron Angela Harris, her close colleagues, members of Yorkshire Ambulance Service and the A&E department at Dewsbury District Hospital have come up with a simple and potentially award-winning answer to this costly problem.

They have devised a bright yellow, highly visible emergency care plan for the patient’s home. It details the patient’s condition plus their medication and blood pressure, heart rate etc. which are normal for them but might be considered abnormal generally.

The plan helps ambulance staff and other health care professionals decide the most appropriate course of action for that patient and means the 999 call doesn’t always have to result in a hospital visit.

Improving services for patientsWe have continued to invest in our services and our people in order to improve patient care.This includes state-of-the-art technology such as Tough Books and Telehealth and also organising our teams so they can work more effectively to deliver a better service.

Inventors of the emergency care plan

A&E and other hospital admissions have reduced by 60% among this target group in Kirklees since the plans were introduced. It also means the underlying causes of the patients’ repeated 999 calls are being addressed, leading to better quality of care for them and reduced pressure on the urgent care system.

“The Emergency Care Plan” has been shortlisted for two Nursing Times awards and is being taken up in other areas in Yorkshire and Humber and nationally.

Tough at the topDuring the year we invested in 600 Panasonic Tough Book broadband-enabled laptops to help front line staff carry out their every day care duties. This has significantly changed the way they work.

District Nurse Kirsty Shepherd spends less time at base as she has the information she needs on her Tough Book. She is able to discuss her patients’ care and update their notes in their homes as part of her visit.

In addition using Tough Books bring savings of around £600,000 a year intravel costs.

Kirsty Shepherd working with her Tough Book


A healthy change“It looks after me!” That’s patient Alan Pogson’s verdict on Telehealth, a simple-to-use touch-screen system that patients use in their own homes to monitor their own condition.

It is part of KCHS’s drive to improve services for people with long-term health conditions. Alan, who is 70-years-old, has an acute respiratory illness which needs close monitoring. “I put it on every day.” says Alan, “It’s meant I haven’t been to the doctor in months If there’s anything going wrong, that machine will tell me. It’s given me a lot of confidence.”

Daily readings are automatically relayed to health professionals who can take action when necessary. Telehealth will also alert patients when something is wrong so they can summon help if they need it.

Alan’s local community matron, Jill Adams, says she has seen significant benefits too. “We’ve fundamentally changed the way care is delivered for people with long-term conditions. Their care has been improved and they now have more ownership of their condition.”

Teen confidenceTeenagers find discussing their healthcare problems one of the most embarrassing things to do.

At Batley Girls High School, School Nurse Ruth Day tackled this problem by working with school staff to co-ordinate a stand-alone Wellbeing Centre away from the main school building where students are able to discreetly come and go for general health advice.

“Confidentiality is an absolute MUST at the centre so students feel reassured their privacy is protected. We have a ‘Confidentiality Statement’ which informs them of their confidentiality rights and our responsibilities to them,” she says.

Ruth adds: “The Wellbeing Centre is a safe environment where girls can come to discuss general health concerns. They can also access supplies of condoms, be screened for Chlamydia, have a pregnancy test, or have a rapid referral to other agencies that can help them if they need it.”

Smokefree Kirklees KCHS offers support to those wanting to give up smoking by offering professional, free, confidential and practical help. Sessions are held in various locations around the region by a dedicated team of professionals. A choice of group or individual appointments is offered during the day and in the evening. The Kirklees Stop Smoking Service has also been using Age Progression technology to highlight the dramatic effects of smoking on an individual’s appearance.

Releasing time to careBuilding on the success of Productive Team training in 2008/9, major advances have been made by teams throughout KCHS looking into inefficiencies in their daily working routines. Here are two examples:

Marsden District Nurses

Marsden District Nurses analysed the number of inappropriate referrals they were responding to and as a result increased productivity, improved care and reduced costs.

Louise Macaskill, District Nurse Team Leader said: “It’s hard for a nurse to say no but when we looked at the evidence and the impact all these jobs had on our time, it made sense. We discussed and agreed this with GPs and hospital staff and we are now more productive, can spend time with the patients who need us most and feel that we are working in line with KCHS’s mission and vision to deliver high quality healthcare.”

Cardiology

Caroline Ellis, Cardiology Team Leader, wanted to challenge current practice to improve her team’s service to their patients. Together they needed a more efficient way to prepare for their patient Health Education Sessions.

Now an admin team member does the preparation and they have a standard operating procedure to prepare the “Health Education Box”. As a result Caroline and her colleagues have more time to spend on face to face patient care and are looking at other ways they can improve their performance in the future.

Smoker Robbie Simpson uses Age Progression technology

// Keep up the fantastic job you’re doing – we need more nurses like you!. //


In 2009/10 KCHS spent £47.2m. This was against income of £42.3m from NHS Kirklees & NHS Calderdale plus £5m of income from other sources.

KCHS income from NHS Kirklees increased by £1m in 2009/10 as services moved over to our organisation and the separation of overheads progressed.

Over the last 12 months we have experienced considerable budget pressures. We have put in place a number of cost saving initiatives including investing in new technologies that will result in cost savings in the short and long term.

• KCHS has invested in Tough Book technology to facilitate mobile working throughout our workforce. This programme which will continue into 2010/11 will result in cost savings and an improvement in quality of care. Tough Book users will save time by being able to update records whilst with a patient and spend less time travelling.

• KCHS has introduced a new telephone based interpreter service that has meant a 20% saving. It has also allowed us to increase the number of languages offered to callers.

• Increased recycling of community loan equipment has resulted in considerable savings.

• Attrition levels have provided opportunities to reduce cost by reviewing our skill mix and resource levels whilst maintaining quality of service.

• KCHS are committed to eliminating waste and has launched a series of ‘productivity projects’ throughout the organisation.

Financial SummaryKirklees Community Healthcare Services has not had a statutory duty to prepare independent financial accounts for the year 2009/10. A full set of financial accounts has been produced by NHS Kirklees and these incorporate both commissioning and provider costs.

A copy of these full accounts can be obtained free of charge by writing to:

Director of Finance NHS Kirklees, Broad Lea House Bradley Business Park Dyson Wood Way Huddersfield HD2 1GZ

One of the PCT’s financial duties that relates to the provider arm is ‘The PCT is required to recover full costs in relation to its provider functions’. So the key financial goal for Kirklees KCHS has been to manage its services within the budget agreed with NHS Kirklees. The performance for 2009/10 is as follows:

Summary financial statements

2009/10 (£000)

2008/09 (£000)

Provider gross operating costs 47,288 43,783

Provider Operating Revenue (4,906) (4,770)

Net Provider Operating Costs 42,382 39,013

Costs Met Within PCTs Own Allocation (42,451) (39,233)

Under/(Over) Recovery of Costs (69) (220)

How KCHS spent its money during 2009/10 financial year

District Nursing 27%

Long Term Conditions 12%

Health Visiting 10%

Therapies 19%

Community Dental 4%

Sexual Health (inc CASH & Chlamydia) 5%

School Nursing 4%

Kirklees Community Equipment Stores 3%

Other Clinical Services 6%

Overheads 10%


Measuring our successOur performance figures show our front line staff have cared for a high number of patients and demonstrated considerable successes. For example, the national target for the wait for outpatient treatment is 18 weeks; our figures impress with an average wait of between two and seven weeks, depending on the service.

The KCHS approach to caring for patients with long term conditions at home as much as possible (Community Matrons working with Local Authority Case Managers) is reducing the need to be admitted to hospital for an increasing number of people.

And where we have not quite met targets, such as for some of the childhood immunisations, steps are being taken to bring about improvements for the year ahead. A staggering 38% of parents failed to keep appointments for their child’s immunisations and our staff have already taken a new approach to encourage them to keep appointments. This should result in higher figures for this financial year.

We have not been able to compare activity with the previous year on all services but we are increasingly measuring performance so will be able to present a far richer picture in our next Annual Report.

Waiting Times to Treatments

ServiceAverage

Wait (Weeks)Total Patients

Treated

Dermatology 5 1378

Musculoskeletal North 4 1677

Musculoskeletal South 2 1017

Neurology 5 180

Plastic Surgery 7 443

Podiatric Surgery 5 847

Total 4 5542

Childhood Immunisations

IndicatorAnnual Target

Actual

% 1yr olds completedrecommended immunisation

95%DTaP/IPV/Hib = 93.9%MenC = 93.3%PCV = 93.5%


95%

DTaP/IPV/Hib = 97.4%MMR = 93.9%PCV Booster = 92.6% MenC Infant = 97.7% Hib/MenC Booster = 95.4%


95%

Primaries = 97.3%MMR 1st dose = 95.9%MMR 2nd dose = 90.9% DTaP/IPV Booster 91.5%

KEY

DTaP/IPV/HibDiptheria, Tetanus, Putussis (Whooping Cough), Polio

MenC Meningitis C

PCVPneumococcal Meningitis,Pneumonia, Septicaemia

PrimariesThe course of three injections for babies given one month apart, as in 1yr old indicator

Activity April 09 - March 10Adult ServicesDistrict Nurse patient contacts:

2008-09 275,580 2009-10 293,533

Children’s ServicesHealth Visitor contacts:

2008-09 51,815 2009-10 81,440

School Nurse contacts:2008-09 8,754 2009-10 16,915

Children’s Specialist Nurses contacts:2008-09 No data 2009-10 2,800

Location Admissions DischargesLength of stay

(days)

Maple Ward(HVMH)

185 173 33

Batley Hall 98 97 15

Fieldhead Park 197 191 15

Westmoor 181 176 35

Intermediate Care

A total of 26,996 appointments were made; 16,847 patients were seen; 10,149 appointments were not kept = 38%.

For the period Oct 2008-March 2009 the total caseload was 1007 patients. Oct-Dec 2008, 58% fewer patients were admitted to hospital after being referred to this service.Jan-March 2009, that figure increased to 71%. (This is the latest available data.)

Long Term Conditions – Community Matrons

Stop Smoking Specialist advisors

In 2008-2009 the % of smokers referred to the service who had quit after four weeks was 65%. In 2009-2010, that had increased to 73%.


Tackling infectionKCHS is committed to delivering safe and effective care. In 2009/10 all staff received infection control training.

Over one third of our staff were immunised against pandemic flu and we provided sessions to immunise GP practice, dental, pharmacy and social care staff. In addition, we supported the distribution of anti-viral drugs for the people of Kirklees

Emergency PlanningAll our services have developed business continuity plans to ensure we are able to respond to emergency situations. A major Incident Plan, which is fully compliant with NHS Emergency Planning Guidence 2005, is in place.

Risk ManagementWe have implemented systems to ensure that all actual – and potential – incidents are reported and fully investigated. Further consideration is given to all incidents by a KCHS team to ensure that any trends or organisation-wide issues are identified and resolved at an early stage.

Compliance with national standardsKCHS declared full compliance with the national Standards for Better Health criteria during 2009-10 and, in April 2010, the Care Quality Commission provided KCHS with full registration for all clinical services.

The annual PEAT (patient environment assessment) at Holme Valley Memorial Hospital was undertaken in January 2010 and demonstrated that the quality of the environment, and privacy and dignity, was good; and that the quality of the food was excellent.

Listening to youWe are always happy to receive compliments about our services but understand that sometimes things go wrong. We welcome comments, suggestions and complaints so that we can investigate and ensure that our services make improvements when necessary. All our services have undertaken questionnaires during the year to help us further improve patient care and we have developed links with Patient Opinion, an organisation that allows people to make comments through email, telephone contact or letter, and which then publishes them on a website that is available to all members of the public.

In 2008-2009 (KCHS) dealt with 20 official, written complaints. The number for 2009-2010 was 36. We have increasingly encouraged people to let us have their views so it is not surprising there has been an increase in the number of complaints received, particularly since we treat any concern raised with us as an official complaint which we then investigate fully.

Our patients are our focus and we want them and their families to be completely satisfied with the care they receive. If someone is unhappy about any aspect of our services whether clinical or not we want to know.

How we measure up on quality and governance

Joan Booth, Head of Localities and Nurse Lead receiving her flu vaccine from Helen Frain, Head of Long Term Conditions as our staff flu vaccination programme began.

//My District Nurse was extremely punctual and caring. Her motivation and encouragement led to a quick and positive recovery.//


Time for teaPaul Hudson officially opens Maple Ward

A sunny outlook at Holme Valley Memorial HospitalBBC Weatherman Paul Hudson opened the £2 million state-of-the-art intermediate care ward at Holme Valley Memorial Hospital last October. It didn’t take long for both patients and staff to settle in to the excellent new surroundings which include 20 single and three-bed en suite patient rooms, treatment rooms, a nursing observation post and conservatory. For those that have been following the story, the pipistrelle bats are doing fine in the special bat boxes and roosts provided for them in the grounds.

The patient gardens at HVMH, were opened in November 2009 and have proved to be hugely popular with patients and their visitors. The landscaped area, patio and therapy garden were built thanks to a donation of £30,000 from the Holme Valley League of Friends. The generous donation also allowed some extra equipment to be bought for the new Maple Ward.

Preparing for change

The care we in KCHS provide will continue during the year ahead - that’s our reason for being. The way we provide that care and the way we do business is bound to evolve, and we hope, improve, even further given our commitment to offering the best possible standards of care and our determination to work smarter, harness new technology and be more productive. We have exciting new developments in the pipeline.

What will make 2010-2011 different are the preparations we will have to undertake for change, because we cannot stay as we are. The publication of the Department of Health document, Transforming Community Services, began the process of separating the provider and commissioning arms of primary care trusts. We have a new NHS Operating Framework and the new Government’s White Paper, Equity and excellence; liberating the NHS, and we now know we have to be completely separate by 1 April 2011.

What type of organisation we will be on that significant date is yet to be decided. We have three options open to us: merge with an NHS foundation trust providing secondary, i.e. hospital, care; become a franchise of an NHS foundation trust or become a social enterprise. All have advantages and disadvantages which need exploring but one decision we have already made with Kirklees Council is that we will work together even more closely. Although KCHS can decide which option we think will enable us to provide excellent person-centred services for the area, the actual decision rests with NHS Kirklees.

Whatever form our organisation takes from 2011 we will continue to focus on our patients and invite them to work with us in shaping future care through a variety of methods including via our expanding website www.kirkleeschs.nhs.uk

We will never forget that the reason behind our new technology drive our plans to expand services at Holme Valley Memorial Hospital is the ambition to provide the best possible care for each individual.

Kirklees Community Healthcare Services First Floor Beckside Court Bradford Road Batley WF17 5PW

T: 01924 351555

www.kirkleeschs.nhs.uk

If you would like further copies of this Annual Report or require translation into a language, other than English, or large print, Braille or on audiotape please contact [email protected] telephone 01924 351504

Date of publication: September 2010 * Ref: AT3071 * ©Kirklees Community Healthcare Services.

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