Northamptonshire Teaching PCT Annual Report 2007/08

Transcription

1 Northamptonshire Teaching PCT Annual Report 2007/08 If you require the document in any other format, for example large print, audio or in another language call the Patient Advice and Liaison Service (PALS) on

2 2 Northamptonshire Teaching PCT Annual Report 2007/08

3 Contents Annual Report Contents Introduction...4 Non executive team...10 Executive team...12 Operating and fi nancial review...14 Annual accounts...62 Statement of internal control (summary version)...80 Statement of accounting offi cer s responsibilities

4 Introduction from Professor William Pope, Chairman, and John Parkes, Chief Executive. We are delighted to present the second Annual Report of Northamptonshire Teaching Primary Care Trust. Over the past two years we have been working to shape a new organisation aimed at developing world class health care services for the people of Northamptonshire. Professor William Pope Chairman John Parkes Chief Executive 4 Northamptonshire Teaching PCT Annual Report 2007/08

5 Introduction Our organisation is now fi rmly in place and already making massive strides in commissioning heath services. The past 12 months have seen us tackle the fi nancial problems faced by our predecessor organisations and eliminate our defi cit down from 45 million to an end of year surplus of 4 million to ensure that the local NHS is on a much more stable fi nancial footing. This is an outstanding achievement in a short period of time. Having established stability for the county s health services, we are now working towards developing a world class commissioning service with our NHS partners to provide better services, closer to people s homes. At the same time we have been building a reputation for innovation and for taking the initiative. This is refl ected in the fact that we are now one of the top performing primary care trusts (PCTs)in developing the Choose and Book referral system for GPs and only one of three PCTs in the country to achieve a 90 per cent Choose and Book referral target. Choose and Book is an electronic booking system whereby patients can choose an appointment at a time and place that suits them. Hospital and community services have continued to develop and some of these are highlighted in this document. We are also working with partners across the Northamptonshire health economy to develop wellbeing services and promote healthier lifestyles. We are well on the way to achieving our goal of being the best PCT in the East Midlands. Indeed we are seeking to forge a reputation for excellence on a national stage through our innovative approach to developing new ways of working. This includes making full use of private sector expertise to strengthen our commissioning base and ensuring we provide value for money as well as effective services for the local people of Northamptonshire. We must now look towards the future and ensure that we can face any challenges and grasp all the opportunities that come our way. We will be engaging with the public in the coming months, looking to gain your views on the future of health services in Northamptonshire, as part of the NHS Next Stage Review led by Lord Ara Darzi. Please look out for these opportunities. We commend this report to you. If you wish to comment on any aspect of this report and the services highlighted, please contact us on Professor William Pope, Chairman John Parkes, Chief Executive 5

6 Main services of Northamptonshire Teaching PCT Northamptonshire Teaching PCT serves a population of 652,000, which is expected to grow to 739,000 over the next decade. The PCT was formed on 1 October 2006 as part of the national reorganisation of PCTs and Strategic Health Authorities (SHAs). The PCT was created from the merger of the three former Northamptonshire PCTs: Daventry and South Northamptonshire, Northampton Teaching and Northamptonshire Heartlands. As part of the reconfi guration, the NHS boundary for Northamptonshire was extended to match that of Northamptonshire County Council. The PCT is now also responsible for health and health services for patients in the areas around Oundle and Wansford in East Northamptonshire and Brackley and Byfi eld in South Northamptonshire. The PCT brings together general practitioners (GPs), community nurses, practice nurses and other community services and agencies dealing with primary care services. The three main functions of the PCT are: engaging with the local population to improve health and wellbeing commissioning a comprehensive range of high quality, responsive and effi cient services across all service sectors, and directly providing high quality, responsive and effi cient services where this gives best value. The PCT s strategic direction is set by the Board, which is responsible for ensuring accountability and fi nancial probity. Led by the Chairman, it comprises the Non-Executive Directors, the Chair of the Professional Executive Committee and the Executive Directors. The Chairman of the Northamptonshire Primary Healthcare Forum, the independent patient and public involvement forum for the PCT, also sits with the Board and participates in the discussions and decisions. The PCT brings together general practitioners (GPs), community nurses, practice nurses, other community services and other agencies dealing with primary care services. 6 Northamptonshire Teaching PCT Annual Report 2007/08

7 Introduction The PCT s Executive Directors are responsible for the day-to-day operation of the organisation. From 01 April 2008, the PCT became a predominantly Commissioning organisation, in line with national expectations. This means that the front line clinical services which in the past would have been directly provided by the PCT, will, in future, be commissioned instead. Currently, the PCT commissions services from the following providers: 83 GP surgeries 84 dental practices 115 pharmacies 59 optical premises Kettering General Hospital NHS Trust Northampton General Hospital NHS Trust Northamptonshire Healthcare NHS Other hospitals outside the area Voluntary organisations Out of hours service providers Private providers 7

8 The frontline Provider Services, which have historically been directly provided by the PCT but will be commissioned in future, include: Community nursing Physiotherapy Occupational therapy Podiatry Speech and language therapy Intermediate care Nutrition and dietetics Wheelchair services Community equipment Chlamydia screening Stop smoking service Community dental services Community rehabilitation Health promotion Location and facilities of Northamptonshire Teaching PCT The PCT s current headquarters is at Bevan House in Kettering, but we also maintain a strong presence at Highfi eld in Northampton and Danetre Hospital in Daventry. Other major PCT facilities include: Willowbrook Health Complex, Corby includes Dental Access Centre, Minor Injuries Unit, Corby Community Hospital, Lakeside and Willowbrook surgeries. Danetre Hospital Daventry includes Dental Access Centre, Snowdoc Out of Hours service and a range of other services. Isebrook Hospital, Wellingborough includes community rehabilitation wards Beechwood and Hazelwood, the base for the PCT s Stop Smoking Service, the Local Improvement Finance Trust (LIFT) Project Team, and the PCT s Estates department. Cynthia Spencer Hospice, Northampton Cransley Hospice, Kettering Favell House Physical Disability Unit, Northampton Rushden Hospital 8 Northamptonshire Teaching PCT Annual Report 2007/08

9 Introduction In addition, clinics are operated from various other sites across the county. The PCT has a number of exciting building projects including the redevelopment of the Willowbrook Health Complex in Corby and a Primary Care Centre in Northampton. In addition, the PCT plans to commission GP practices to open from 8am to 8pm in Kettering, Corby, Wellingborough and Northampton. There are also plans for a new health centre at Isebrook Hospital in Wellingborough to replace the Gold Street Medical Centre, and plans to develop Brackley Cottage Hospital. In March 2008, a brand new one-stop primary care centre opened in Lower Street, Kettering. The new Prospect House Medical Centre offers a range of superb facilities including 35 consulting rooms, training facilities, and two minor injuries suites. 9

10 Non executive team Chair: Professor William Pope William is currently non executive chairman of several health, safety and environmental businesses and was recently appointed to the board of the East of England Development Agency. He was formerly Chief Executive Offi cer of Bedford based The Casella Group Ltd. Non executive directors Richard Aveling Richard was Director of Finance at the University of Northampton from 1989 but is now retired. Philip Dearing Philip is Chair of the PCT s Audit Committee and Deputy Chair of the Board. He was previously a Non Executive Director of Leicestershire, Northamptonshire and Rutland Strategic Health Authority. Tansi Harper Tansi was a non-executive director with the former Leicestershire, Northamptonshire and Rutland Strategic Health Authority, and before that with Northamptonshire Health Authority. 10 Northamptonshire Teaching PCT Annual Report 2007/08

11 Non executive team Susan Hills Susan was Chair of the former Northamptonshire Heartlands PCT and was also a non-executive director of Northamptonshire Health Authority. Maggie McCutcheon Maggie has worked for both Northamptonshire and Bedfordshire Health Authorities as a clinician and manager. She currently works for the University of Bedfordshire. Kate Page Kate is interim Chief Executive of Milton Keynes Council, and prior to this she was Corporate Director of Neighbourhood Services. Diana Wright Diana is the founder of No Limits Consultancy, which advises organisations on diversity management and related issues. 11

12 Executive team John Parkes Chief Executive John has been Chief Executive of Northamptonshire Teaching PCT since its inception in October Prior to leading a commissioning body, John spent his career running hospitals and improving organisations in challenging situations. John s hospital experience includes 15 years working in university hospitals across England, including Mid Yorkshire Hospitals NHS Trust. John is also a member of the national Independent Reconfi guration Panel who provide advice to the Secretary of State on disputed or controversial service reconfi gurations. Gill Scoular Director Finance Gill was previously Director of Finance and Corporate Services for Leicestershire, Northamptonshire and Rutland Strategic Health Authority. Acting as deputy to John Parkes, Gill s responsibilities include fi nance, performance, and capacity planning and strategic estates. Louise Proctor Managing Director of Provider Services Louise joined Northamptonshire Teaching PCT from the former Melton, Rutland and Harborough PCT where she was Director of Primary Care and Community Services. Her directorate s responsibilities include community hospitals, adult community services (including physiotherapy, occupational therapy, community nursing, wheelchair service, long term conditions etc), child and family services, estates and facilities. Richard Alsop Director of Strategic Development and Commissioning Prior to becoming the PCT s Commissioning Director, Richard was Director of Service Improvement and Performance at Northamptonshire Heartlands PCT. The Strategic Development and Commissioning directorate s responsibilities include: Community commissioning and individual packages of care, mental health commissioning, pharmacy and prescribing, primary care commissioning and contracting, strategic development and planning. 12 Northamptonshire Teaching PCT Annual Report 2007/08

13 Executive team Dr Stephen Horsley Director of Public Health Prior to his appointment, Stephen was Director of Public Health with Northamptonshire Heartlands PCT. Responsiblities of the Public Health Directorate include: Choosing Health, Dental Public Health, Emergency Planning, Health Development, Health Intelligence, Health Protection, Medical Director, NICE Guidance, Partnerships, Public Health, Public Health Analysis, Research and Development. Jan Norman Director of Quality, Standards and Learning A trained nurse, Jan has been involved with the NHS all her life and previously worked as East Midlands Area Manager for the Healthcare Commission. Directorate responsibilities include: Clinical Quality and Standards, Clinical/Health Outcomes, Equality and Diversity, Clinical Workforce Reform. Sue Basham Director of Corporate Services and Human Resources Sue has worked in Northamptonshire since May 2005, when she joined the former Northamptonshire Heartlands PCT as Director of Healthcare Governance. Directorate responsibilities include: governance, communications, headquarters services, human resources and organisational development, policy development and best practice, public engagement. Phil Hurd Director of Information Management and Technology Phil has worked within the NHS in Northamptonshire for a number of years. He was Director of Northamptonshire Health Informatics, which was hosted by Northampton PCT, and prior to that, with Northamptonshire Health Authority. Directorate responsibilities include: Caldicott Guardian, Choose and Book, Clinical Systems, Connecting for Health, IT Support, Information Governance, Information Management, Information Technology, Knowledge Management, Library Services, Systems Developments and Web Services. 13

14 Operating and fi nancial review As the PCT moved into its second year of existence, a number of national and local trends and factors infl uenced the development and performance of the PCT. 14 Northamptonshire Teaching PCT Annual Report 2007/08

15 Operating and fi nancial review Development and performance of the PCT during 2007/08 As the PCT moved into its second year of existence, a number of national and local trends and factors infl uenced the development and performance of the PCT. These included the move towards establishing an arm s length Provider Services organisation, laying the foundations for working towards becoming a World Class Commissioning PCT, and improving access to primary care services. The development of Practice Based Commissioning also moved on apace during 2007/08. All of these factors also need to be put into context with the national NHS Next Stage Review led by Lord Ara Darzi, and the PCT has been engaging with clinicians and the public to gather views on the future direction of health services in Northamptonshire. In addition, the PCT achieved a remarkable fi nancial turnaround during 2007/08, moving from a 7.9m defi cit at the start of 2007/08 to a 4m surplus at year-end. Main trends and factors underlying the development, performance and position of the PCT in 2007/08 Arm s length provider services During 2007/08, the PCT, in line with national policy, started the move towards becoming a primarily commissioning organisation. This means the PCT will, in future, increase the extent to which it buys in or commissions services from a range of providers, ensuring it continues to get best value services which refl ect local need. To help facilitate this, a considerable amount of work was completed to ensure that, by 01 April 2008, the Provider Services element of the PCT became an arm s length organisation. This means it now has a separate Board and operates as a discreet organisation but is still accountable to the PCT and Chief Executive. Provider Services is the name for all the frontline clinical services historically directly provided by the PCT (for example district nursing, physiotherapy, intermediate care) as well as other services such as Estates. From 1 April, instead of these services being directly provided by the corporate PCT, they will instead be commissioned (bought in). The change is part of an ongoing review of NHS services which started with the reconfi guration of PCTs as part of Commissioning a Patient Led NHS, and is all about creating more patient focused services provided closer to home. 15

16 The National Operating Framework published by the Department of Health states that: During 2008/09, all PCTs should review their requirements for community services and use this process to consider all the options for models of service provision. Whilst this is being undertaken, and from 1 April 2008, all PCTs should create an internal separation of their operational provider services, and develop Service Level Agreements for these, based on the same business and fi nancial rules as applied to other providers. This means in future Provider Services will have a similar relationship with the Corporate Commissioning part of the PCT as, for example, the acute trusts such as Kettering or Northampton General Hospitals. The services will be bought in or commissioned by the PCT and managed through a Service Level Agreement (contract). In 2008/09, Healthy Schools, the Local Improvement Finance Trust (LIFT) team and Infection Control nurses have also moved accross to Provider Services. This is a structural change, and the PCT would like to reassure patients that they can still access the frontline clinical services in exactly the same way as before. Community nurses in Corby 16 Northamptonshire Teaching PCT Annual Report 2007/08

17 Operating and fi nancial review If you have any questions relating to the restructuring of Provider Services, please call or 17

18 World Class Commissioning A fundamental part of the PCT s move to a predominantly commissioning organisation is the drive for Northamptonshire Teaching PCT to become a world class commissioner. Work began during 2007/08 to lay the foundations for this goal and will continue in 2008/09. The PCT is currently developing its assurance system for the move towards world class commissioning. The assurance system forms a crucial element in the world class commissioning programme as it will not only hold commissioners to account and reward performance and development, but also ensure health outcomes are improving. It provides one nationally consistent system which will be overseen by the Strategic Health Authorities (SHAs). The assurance system has three elements: health outcomes, competencies and governance. Outcomes will be a locally determined subset of the Vital Signs indicators. PCTs will set local stretch targets to move them towards the best in the NHS, and then towards world class. The world class commissioning competencies will be measured through a combination of self assessment, evidence gathering and external panel review. Performance against these competencies are marked below baseline, intermediate, or world class. The world class commissioning competencies will be measured through a combination of self assessment, metrics and evidence gathering, 360 degree feedback and external panel review. 18 Northamptonshire Teaching PCT Annual Report 2007/08

19 Operating and fi nancial review The 11 competencies require that commissioners: 1. Are recognised as the local leader of the NHS. 2. Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalities. 3. Proactively seek and build continuous and meaningful engagement with the public and patients, to shape services and improve health. 4. Lead continuous and meaningful engagement with clinicians to inform strategy and drive quality, service design and resource utilisation. 5. Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements. 6. Prioritise investment according to local needs, service requirements and the values of the NHS. 7. Effectively stimulate the market to meet demand and secure required clinical and health and wellbeing outcomes. 8. Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and confi guration. 9. Secure procurement skills that ensure robust and viable contracts. 10. Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvements in quality and outcomes. 11. Make sound fi nancial investments to ensure sustainable delivery of priority outcomes. Governance will assess board capability, fi nance and the strategic planning process and content. Between the end of January (when development of World Class Commissioning began) and the summer, the Department of Health, in partnership with the SHAs and the McKinsey led consultancy support team built the infrastructure and processes that will underpin the delivery of the system. The system was fi nalised in June 2008, with capacity building in the SHAs taking place by September 2008, and assessment with PCTs taking place until December A panel made up of independent experts, a Chief Executive from an organisation outside of the area, clinical representatives, local government representatives, and an SHA director, will visit the PCT in Autumn The PCT is currently undertaking an internal selfassessment process to determine work priorities for the assessment process towards the end of the calendar year. 19

20 Improving access to primary care Improving access to primary care was one of the key priorities for the PCT during 2007/08. We have made signifi cant progress in achieving this goal including extended hours at GP practices and minor injury services. During 2007/08 the PCT has worked on a number of initiatives to improve access for patients providing a challenge to those practices with lower survey results in the 2006/07 Patient Access Survey, but also recognising good performance. In response to survey results, 83 practice access action plans were completed and approved by the PCT. Each surgery was asked to review telephone access, appointment access, booking ahead, access to particular GPs, opening times for the practice, ratio of differing appointment e.g (urgent v routine), bloods and chronic illness clinics such as diabetes sessions and nurse triage etc and action any fi ndings with a view to achieving better access for their patients. All surgeries rose to the challenge. The PCT engaged the services of the Improvement Foundation (an organisation with links to the Department of Health which provides training to primary care organisations) to deliver an Access Improvement event in September 2007 for all practices in the county and work individually with 13 practices who achieved lower than average results in four key access areas: 1. Telephone access 2. Appointments in 24/48 hrs 3. Booking ahead 4. Booking with a particular GP The Patient and Public Involvement Forum kindly assisted with this project, individually visiting 13 practices with a view to looking at their access action plans from a patient perspective. David Colin Thome, Head of Primary Care at the Department of Health visited the Great Oakley surgery to gain an insight into services locally. In addition there were campaigns including press interviews and articles encouraging patients to use appointments sensibly and cancel those they cannot make. In the move to improve GP access, a number of early successes included: Most practices now open reception from 8.00am to 6.30pm Monday to Friday Practices have installed extra phone lines Phil Hope MP for Corby at the official launch of the Corby Minor Injury Unit weekends service 20 Northamptonshire Teaching PCT Annual Report 2007/08

21 Operating and fi nancial review Use of patient participation groups whereby patients can get more involved with practice decision-making. Electronic web based services in some practices enable patients to book GP/ nurse appointments, order repeat prescriptions, change address details and message the practice in a secure manner. All practices have reviewed their ratio of appointments to their demand and introduce changes as necessary. Extended opening hours beyond the core hours of 8am to 6.30pm and introducing commuter clinics or early bird surgeries. A range of projects are being implemented to extend opening hours, including plans for four health centres which will open from 8am to 8pm, seven days a week. Practices across Northamptonshire have also started opening in evenings, mornings and Saturdays depending on local need. Nursing home care many practices across the county now work closely with nursing homes to improve care for the elderly. Each patient receives a care home plan which is benefi cial for a range of professionals treating the elderly such as care home staff, paramedics and out of hours staff. Patients can also think about and work with their GP should they want an end of life plan. Phlebotomy the PCT has invested an extra 200,000 into practice based phlebotomy services. During 2007/08 the PCT worked with Kettering General Hospital to put in place plans to extend the opening hours of Corby Minor Injuries Unit. It is now open at weekends as well as during the week. Choose and Book patients have a choice of hospitals available to them via a directory of services. All practices use this system to refer patients for operations. 21

22 Main trends and factors which are likely to affect the PCT s future development, performance and position World Class Commissioning will play a key role in the PCT s future development and performance. We will continue to build upon the excellent progress on primary care access achieved during 2007/08. The relationship between the PCT and the Provider Services organisation will be key to the success of both Commissioning and Provider organisations in the future. In addition to these factors, the NHS Next Stage Review, which has already had a significant impact during 2007/08, will move on apace during 2008/09 with a full public engagement exercise, and the PCT will work to fulfil the aims set out in its vision. In addition, the 4m underspend at the start of 2008/08 will assist the PCT in achieving these goals. The NHS next stage review Northamptonshire NHS Partnership Board, which is made up of senior representatives from all health and social care organisations in Northamptonshire, invited over 300 people to three events in December The stakeholder events form part of the NHS Next Stage Review led by Lord Ara Darzi and known locally as Facing the Future in Northamptonshire. Those attending included patient representatives, NHS staff, representatives from voluntary organisations, local authorities and other partner organisations. As part of the review, nine workstreams have focused on individual areas of health and produced reports which have contributed to the PCT s strategic vision for the county and a full public consultation was launched in the summer of The workstreams are: Maternity and newborn Children Long term conditions Acute care Planned care Mental health Learning disabilities End of life care Staying healthy Northamptonshire NHS Partnership Board will provide a process through which health professionals, partner organisations and the public can infl uence how services will develop and improve in the coming years. Above: The workstream leads for Facing the Future 22 Northamptonshire Teaching PCT Annual Report 2007/08

23 Operating and fi nancial review Initial reports were considered by the workstreams at a Confi rm and Challenge event in February 2008, attended by 90 representatives from health and social care, and fed into the consultation. Above: Kathy McLean, NHS East Midlands Clinical lead for Our NHS Our Future, and John Parkes, Chief Executive, PCT, at the Confirm and Challenge stakeholder event in February As part of the review, nine workstreams have focused on individual areas of health and produced reports which have contributed to the PCT s strategic vision for the county. For more information on the consultation go to

24 The PCT vision Northamptonshire Teaching PCT s vision for the future of health services in Northamptonshire is: To improve population health and reduce inequalities through effective commissioning To develop the next generation of NHS leaders To be an exemplary world class commissioning PCT If we deliver on this vision, we will have: One of the healthiest populations with the best treatment facilities and care arrangements for those who need them A working environment that values and empowers individuals who challenge the status quo, rewards and encourages innovation, and attracts, retains and develops staff Infl uence that extends beyond the East Midlands To be able to achieve this vision, the PCT has four priorities: 1. To build a commissioning system that understands needs, designs services to meet those needs, maps out capital and workforce consequences 2. To build a war chest so we can invest rather than spend all our money and so we are not blown off course from delivering our vision by external pressures 3. To become amazing at communicating with our population and stakeholders, so that we can understand how to serve them and so they can understand how we can help 4. To become an organisation with a strong organisational development culture at its core 24 Northamptonshire Teaching PCT Annual Report 2007/08

25 Operating and fi nancial review 25

26 Key performance indicators in 2007/08 Northamptonshire Teaching PCT monitors delivery against key performance indicators based on nationally set targets. Information on how we have achieved key performance indicators is included in this section. Stop Smoking Service There were 2,808 successful four-week quitters in Northamptonshire during 2007/08. During 2007/08, the Stop Smoking Service has been working in partnership with general practice and local pharmacy to ensure that stop smoking support is widely available across the county through primary care. This has meant training health care professionals, supplying resources, developing a Local Enhanced Services contract and raising awareness with the general public. Although this has ensured broad support it has not always targeted that support to where it is really needed such as in areas of high deprivation where there is also high smoking prevalence. To ensure that the health inequality gap does not get wider the Stop Smoking Service has recruited to stop smoking reducing health inequality co-ordinators whose remit is to work with and support hard to reach groups across Northamptonshire to engage with Stop Smoking Services and quit smoking. Their work programme over the next year will include supporting Northamptonshire Healthcare NHS Trust to implement Smoke Free legislation from 1st July 2008 through two pilots and identification of alternative activities to smoking in mental health in-patient settings and training up service users to support inpatients. The PCT s Stop Smoking Service will now lead the development of a working group whose main aim is to make it easier for people who want to stop smoking to quit. The group will comprise partners from primary and secondary care, the voluntary sector, local business, Practice Based Commissioners and service users. The working group will feed directly into the Smoke Free Strategic Alliance along with three other working groups: Communications, Normalising Smoke Free Lifestyles and Tackling Illegal and Counterfeit Tobacco. This will ensure that all the work streams are coordinated and that consistent messages such as where to access local stop smoking support are delivered to the general public and key stakeholders. 26 Northamptonshire Teaching PCT Annual Report 2007/08

27 Operating and fi nancial review In addition, the post-holders will work to improve access to community based stop smoking support for black and minority ethnic groups who may find access to primary care challenging, and work in neighbourhood management areas in partnership with the Building Capacity Programme. They will also undertake a pilot in Corby, which has the highest rates of smoking in the county, which will include a door drop and promotional activities that raise awareness of the importance of accessing NHS support for quitting. Youth stop smoking pilots will also be implemented to help inform the growing body of evidence about which interventions work best at helping young people quit. Above: The PCT s Stop Smoking team with members of the public in the Grovesnor Centre, Northampton on No Smoking Day, 12 March 2008 Smokers who want help to quit can call the Stop Smoking Service on

28 Sexual health There has been an improvement in the access to sexual health services during 2007/8, with over 98% of clients offered an appointment within 48 hours of contact and over 70% seen within that period. The ultimate aim is the provision of services with a reduced or no waiting time so that a low level of infection incidence is maintained. Teenage conception rates in Northamptonshire are falling, 40.9 girls per 1, , which is a reduction of 10.4% since the 1998 baseline. 18 Weeks from referral to treatment From December 2008, no patient will wait more than 18 weeks from GP referral to consultant led treatment (unless there is a clinical reason otherwise). During March 2008 all organisations who provide acute services for the people of Northamptonshire were monitored against the fi rst national 18 week targets: 85% of admitted patients from GP referral to start of treatment (RTT) within 18 weeks 90% of non-admitted patients RTT within 18 weeks. Northamptonshire Teaching PCT was one of the few PCTs in the East Midlands to achieve the 18-week target by March This would not have been possible without all the hard work by our partners in GP practices, Kettering General Hospital and Northampton General Hospital. Figures show that 3808 people who were admitted to hospital for treatment during March had waited less than 18 weeks from their referral, which is 90.1% of the total of 4,226. The national target was 85%. For those patients who received their treatment in a setting other than during an inpatient stay, 7688 were treated within 18 weeks of referral, which is 92.9% of the total of Northamptonshire Teaching PCT Annual Report 2007/08

29 Operating and fi nancial review This dedication and hard work by all staff in primary and secondary care is improving services for the people of Northamptonshire by reducing non-clinical delays and delivering earlier diagnosis and treatment. The 18-week National Intensive Support Team visited Northampton General Hospital (NGH) during January and February The subsequent report described NGH as an exemplary site for the management of 18 Weeks. NGH has agreed to be available to give practical advice and support to other local health communities as requested. A countywide seminar on 18-week waits was held on 7 December at King s Park Conference Centre, Moulton. Staff attended from primary and acute care, clinical and non-clinical roles, patient and public groups in the county. Speakers were from the national and regional 18-week teams. David Colin-Thome (National Clinical Director for Primary Care) talked about the importance of collaboration and integrated working between the PCT, Practice Based Commissioners and providers to achieve more effi cient services. A communication campaign commenced in July 2007 and continues into 2008/09. Communications have been directed at all staff in all organisations in the county, across all professions and departments/teams. Communication of the 18 week programme has been delivered to the public of Northamptonshire via: Circulation of nationally published 18-week booklets to all GP practices, local libraries and pharmacies. Presentations to voluntary groups and public forums. Media releases, local and regional. Northamptonshire Teaching PCT was one of the few PCTs in the East Midlands to achieve the 18-week target by March Dr David Colin-Thome 29

30 Cancer waits Two week target for referral to an oncologist In total, 99.7% of patients with suspected cancer within Northamptonshire were seen within two weeks by an Oncologist. This is only 0.3% below the national target of 100.0%. 7,921 patients were urgently referred by their GP to see an Oncologist and 7,900 were seen within two weeks. There were 21 breaches of the two-week target for urgent GP referral to date fi rst seen by an Oncologist during 2007/8. Two of these breaches were at Kettering General Hospital and 4 were at Northampton General Hospital. The remaining 15 were at Peterborough and Stamford Foundation Trust. 31-day target for decision to treat to fi rst defi nitive target In total, 2,544 patients received a definitive treatment following a decision to treat and 2,526 waited less than 31 days. This means 99.3% of Northamptonshire Teaching PCT patients were treated within 31 days following a decision to treat. This is 1.3% above the national target of 98%. There were 18 breaches of the 31-day target for decision to treat to fi rst defi nitive treatment. 10 of these breaches were at Kettering General Hospital and six were at Northampton General Hospital. Of the remaining two breaches, one was at the University Hospitals of Leicester NHS Trust and the other was at another out-of-county Acute Trust. 62-day urgent GP referral to fi rst defi nitive treatment target In total, 1,110 patients received a definitive treatment following an urgent GP referral and 1,066 waited less than 62 days. This means 96% of Northamptonshire Teaching PCT patients were treated within 62 days after being urgently referred by their GP. This is 1% above the national target of 95%. There were 44 breaches of the 62-day urgent GP referral to fi rst defi nitive treatment target. 14 of these were at Kettering General Hospital and 25 were at Northampton General Hospital. Of the remaining six breaches, three were at the University Hospital of Leicester NHS Trust, one was at the Oxford Radcliffe Hospitals NHS Trust and the other two were at other out-of-county acute trusts. 30 Northamptonshire Teaching PCT Annual Report 2007/08

31 Operating and fi nancial review 100.0% 99.5% 99.0% Cancer Waits 2 Week Wait PCT KGH NGH Target Left: Graph showing the PCT s performance on two-week target for patients referred by a GP to the date they are first seen by an Oncologist. 98.5% 98.0% Q1 Q2 Q3 Q % 99.0% 98.0% 97.0% Cancer Waits 31 Day Decision to Treat to Treatment PCT KGH NGH Left and below: Graphs illustrating the PCT s performance on 31-day target for decision to treat to first definitive treatment and 62-day urgent GP referral to first definitive treatment target. Target 96.0% 95.0% 94.0% Q1 Q2 Q3 Q4 Cancer Waits 62 Days from Referral to Treatment 100.0% 99.0% 98.0% PCT 97.0% KGH 96.0% NGH Target 95.0% 94.0% 93.0% Q1 Q2 Q3 Q4 31

32 Referrals to Accident and Emergency There was an overall reduction in the number of attendances at Accident and Emergency departments in 2007/8. The combined attendances at Kettering General Hospital and Northampton General Hospital reduced by 1.4% in comparison to 2006/7. At Kettering General Hospital, there was a slight increase of 0.3%, while Northampton General Hospital s Accident and Emergency Department saw a reduction of 3.1%. The Health Act 2006 (Hygiene Code) The purpose of the Hygiene Code is to help NHS bodies plan and implement how they can prevent and control Health Care Acquired Infections (HCAIs). It sets out criteria by which managers of NHS organisations are to ensure that patients are cared for in a clean environment, where the risk of HCAIs is kept as low as possible. Failure to observe the Code may result in either an Improvement Notice being issued on the NHS body by the Healthcare Commission (HCC) or in it being reported for signifi cant failings and placed on special measures. There are a total of 11 duties within the code and the PCT runs a rolling self-assessment against these duties across the year. The PCT is currently compliant with 8 of the 11 duties and an action plan is underway to address the three areas where further work is required. These areas include the pilot and implementation of a new HCAI risk assessment tool which will help to identify patients at risk of any healthcare acquired infection, and the development and implementation of new infection control policies. 32 Northamptonshire Teaching PCT Annual Report 2007/08

33 Operating and fi nancial review Infection Control Northamptonshire Teaching PCT made Infection Control a top priority in 2007/08 by working with local acute trusts, with the help of a 385,000 grant from NHS East Midlands, to tackle hospital acquired infections in Northamptonshire. Measures introduced in 2007/08 included: Deep-cleans of all acute wards and community wards Distribution of hand-washing kits to all community based staff Rolling programme of training in the community on hand hygiene for primary care and nursing homes Replacement of commodes and piloting of new cleaning agent at Kettering General Hospital Hotspot audits both in the acute hospitals and in the community Countywide infection control group meeting regularly Launch of Infection Predictor Tool pilot at Kettering General Hospital The PCT also took part in NHS East Midlands (Strategic Health Authority s) Hand in Hand: Fighting Infection Together Week in December 2007, when every NHS organisation in the East Midlands carried out a publicity campaign to highlight what they were doing to tackle infections. During the week, the PCT held handwashing demonstrations using UV lightboxes at sites including Willowbrook Health Centre, Corby, and Isebrook Hospital, Wellingborough, launched a staff newsletter and competition and members of the Infection Control team gave a presentation at the Environmental Health Conference. The PCT won an award from NHS East Midlands for providing the best media support in the East Midlands during Hand in Hand: Fighting Infection Together week. This included a series of newspaper features, radio interviews and newsletters. The PCT continues to take infection control very seriously and will continue to find new ways of reducing healthcare acquired infections and promoting the hand hygiene message. We are contributing to the East Midlands wide Infection Control Strategy and will be participating in the national campaign during summer

34 Standards for Better Health Every NHS Trust in England is responsible for ensuring that it is complying with the Department of Health s Standards for Better Health. As part of the annual health check, all trusts assess their performance against the core standards and publicly declare this information. The PCT actively monitors its compliance levels to the core standards throughout the year via a self-assessment process which culminates in a PCT Board approved declaration to the Healthcare Commission on the levels it has achieved for the assessment period 1 April 2007 to 31 March This declaration is submitted not later than 30 April 2008 and is used to inform the Quality of Services part of the Annual Health Check, which is a performance rating given to all NHS Trusts by the Healthcare Commission in the autumn of each year. For the 2007/08 period the PCT is declaring compliance with 39 of the 43 standards that make up the core standards framework; this is an improvement on the 2006/07 position in which compliance was declared in 36 of 44 standards. An action plan is already in place to address those areas that need further improvement which include improving the response time on safety alerts, reviewing child protection procedures, ensuring that equality and diversity schemes are fully embedded across the organisations and improving the management of corporate records. Auditors Local Evaluation (ALE) The ALE is the Audit Commission s assessment framework involving auditors making scored judgements on fi ve key areas of fi nancial performance in the NHS: Financial reporting Financial management Financial standing Internal control Value for money These judgements are combined to give an overall use of resources score for all NHS trusts. ALE forms the use of resources assessment for non-foundation trusts and (PCTs) within the Healthcare Commission s annual health check. The PCT carried out a self assessment against the key lines of enquiry during December 2007 and January 2008; this was then submitted, along with the evidence to the PCT s external auditors at the end of January The PCT has been working very closely with the external auditors to ensure that they have sight of all appropriate evidence. The scores for this assessment will be released in the autumn as a use of resources score in the Annual Health Check 34 Northamptonshire Teaching PCT Annual Report 2007/08

35 Operating and fi nancial review As part of the annual health check, all trusts assess their performance against the core standards and publicly declare this information. 35

36 Further service developments and performance in 2007/08 In addition to the overall strategic development and performance of the PCT, and key performance indicators as outlined, there have been a number of other service developments in 2007/08 which are worth highlighting. SWAN partnership Sex Workers Around Northamptonshire This service won the East Midlands regional award for Drugs team of the year recognising the valuable work they undertake in improving health and aiding the exiting from the trade for this client group. The partnership also won an award for Improving Health and Reducing Inequalities at the East Midlands Health and Social Care Awards. Above: Samantha Benfield, SWAN (Sex Workers Around Northamptonshire) Project Coordinator, Paul Howard, Health Improvement and Inequalities Manager, and Angela Hillery, Associate Director, Health Improvement (Child and Family). 36 Northamptonshire Teaching PCT Annual Report 2007/08

37 Operating and fi nancial review Health Improvement Child and Family The PCT was successful in its bid to become a second wave research site for the Family Nurse Partnership Programme. The programme involves working with the young and most vulnerable families offering intensive support for the fi rst two years. This programme is based on 20 years of research conducted in the USA and has demonstrated many positive health and social benefi ts both for children and parents. The PCT was also successful in tendering for the health care provision to Her Majesty s Prison and Young Offenders Institute Onley. A project team has worked over hard with the prison and health care staff to ensure a smooth transition over to the PCT which took place on the 1st April 2008 following a well attended launch at Onley Prison. This is a new area for the PCT and has been a steep learning curve developing existing services and working with new partners to ensure that prisoners, who are known to have high levels of health care needs, receive a fi rst class health care service. The Family Nurse Partnership programme is based on 20 years of research conducted in the USA and has demonstrated many positive health and social benefi ts both for children and parents. 37

38 Daventry Sure Start Children s Centre The centre s building programme has now been completed and provides a reception area and increased capacity for family work. The team worked very hard to minimise the inconvenience to users of the centre and it is to their credit that this building programme went so smoothly. Daventry Sure Start Children s Centre continues to grow and develop offering innovative programmes to support 0-5 s and their families in Daventry. Chlamydia screening programme A Chlamydia screening service is now available for young people aged between 15 and 25 in Northamptonshire. Chlamydia is the most common sexually transmitted infection in the UK and the highest rates are among under-25s. This service was in the third wave nationally and went online in November The services are growing rapidly and have been praised by the regional co-ordinator for reaching the target of 500 screens. The target for 2008/09 will be 14,000 screens. Chlamydia screening is available at a variety of venues across the county, including colleges, community centres and some GP practices, as part of the national drive to improve sexual health. There is also a local dedicated, confi dential helpline and a national website at chlamydiascreening.nhs.uk. The service can be contacted on Time 2 Talk Time 2 Talk continues to lead the way when involving and engaging with young people. They offer a high quality service addressing a variety of needs including counselling, housing and sexual health. It is a very well used service by this traditionally hard to reach group demonstrating that it is highly valued. The PCT held its fi rst ever countywide Healthy Schools awards ceremony in December 2007, with over 50 schools participating and representation from Northampton Saints Rugby Club and Northampton Town Football Club. 38 Northamptonshire Teaching PCT Annual Report 2007/08

39 Operating and fi nancial review Developments within Choosing Health priority areas in 2007/08 Staying healthy has been a key priority for the PCT. A comprehensive strategy has been developed with the aim for Northamptonshire to be the fi ttest county in the country. Joint working with our partner organisations via the Local Area Agreements will maximise resources to tackle underlying causes of ill health, support healthy lifestyles and improve wellbeing. The PCT and Northamptonshire County Council are working together to develop wellbeing centres in every library in the county so that individuals and families can access information from selected books and resources. This will be enhanced by twenty NHS Health Trainers who are currently undergoing a nationally accredited training programme provided by Northampton College which will enable the provision of individual support in the development of a personal health plan. 39

40 Healthy eating and physical activity The prevalence of obesity is continuing to increase and achieving change will require a partnership approach to improve physical activity, the availability of healthy food, meal planning and cooking skills. A multi professional group, supported by a specialist dietician and weight management service project manager, is developing appropriate care programmes for patients to underpin a wide range of programmes for delivery across the county. This will include programmes available within GP practices as well as community settings. Partnership working with Northamptonshire Sport will increase opportunities for physical activity and work with Cycling England will aim to increase the uptake of cycling. Oral health Good oral health is achievable and maintainable. The oral health of the population in the United Kingdom has improved over the past 30 years. Indeed more people are keeping more teeth for longer. The oral health of children in England is the best since records began. However, the dramatic improvement in the dental health of 5 year-olds has not continued and the overall trend in the oral health of fi ve-year-olds seems to be worsening. Although the level of dental decay between children aged 5 and 11 in Northamptonshire is below the national average, both as the percentage of children who have experience of dental decay and the average number of teeth affected by decay, there are areas of higher levels of disease and untreated decay. Over the past year the oral health promotion team have worked with key health workers such as health visitors, school nurses, general practice staff and pharmacists to increase understanding and disseminate the key messages on how to prevent oral disease and the Healthy Schools award now has an oral health element. 40 Northamptonshire Teaching PCT Annual Report 2007/08

41 Operating and fi nancial review Improving mental health Mental wellbeing protects physical health and increases recovery rates from illness. Conversely poor mental health reduces recovery rates and contributes to poor health behaviours and this compounds poor physical health (National Institute for Mental Health in England 2005) and the promotion of good mental health is integral to the Public Health agenda. The Everybody s Business, Promoting Mental Health For Northamptonshire Strategy is an essential element in our efforts to improve the general health and well-being of our population, increase life expectancy and improve the life chances of people living and working in the county. The Strategy aims to: Promote mental health in specifi c settings, based on local needs; Reduce discrimination experienced by people with a mental illness and their carers; Promote employment or other occupational activity, adequate housing and appropriate entitlement to welfare benefi ts for people with mental illness and their carers; Promote awareness of the impact of mental health and well being on society. Alcohol and drugs The national alcohol harm reduction strategy for England has been guiding local service developments since 2004, and local stakeholders have contributed actively to the various Drink Debates that have taken place across Northamptonshire. The Drink Debates have been organised as part of a partnership made up of Northamptonshire County Council, Northamptonshire Teaching PCT, Northamptonshire Police, local borough and district councils, and other organisations. An alcohol project manager has been recruited to coordinate the PCT s work on harm reduction and support ongoing research on profi ling use of health services by alcohol abusers. 41

42 Environmental matters Environmental targets the PCT is working to meet include: Reduce the overall level of primary energy consumption by 15% or 0.15 MtC (million tonnes carbon) from March 2000 to March 2010 Achieve a target of GJ/100m 3 (gigajoules per 100m 3 ) energy effi ciency performance for all new capital developments and major redevelopments/refurbishments; and GJ/100m 3 for existing facilities. To achieve this: We use nationally negotiated contracts for the provision of our primary energy fuels. The recent contracts specify that the supplier has to obtain some of their capacity from renewable energy sources mostly wind power in the UK. Our new buildings have been designed to meet the energy targets notably the new Danetre Hospital and The Manfi eld development. The new LIFT schemes will also be designed to meet this target. In these cases, new buildings will have replaced old, ineffi cient buildings. The PCT has made a pledge towards reducing our carbon footprint. In June 2007, the PCT signed the Nottingham Declaration, one of 23 NHS organisations in the region to make a commitment to reduce their impact on climate change and the environment. The PCT made three pledges, which were as follows: Pledge 1 The PCT pledges to help mitigate the impact of existing environmental conditions on public health. The PCT will commission and ensure delivery of an appropriately comprehensive range of high quality health services. In doing so, the PCT will: Take into account, where we can, the impact of local environmental conditions on public health; Help to move towards sustainability in our activities by ensuring that these services are provided as close to patients homes as possible, while being consistent with patient safety considerations, and Endeavour, to the extent that we reasonably can, to implement the fi ndings of the Crisp Report Global Health Partnerships and thereby assist in the delivery of the health Millennium Development Goals. Pledge 2 The PCT pledges to take steps to mitigate the impact of our activities on the environment. The PCT will develop and implement environmental and sustainability policies where we can, reducing the carbon footprint of our activities where this is consistent with patient safety considerations, and endeavouring to ensure that these policies are appropriately refl ected in our future local health plans and health service development plans. Pledge 3 The PCT pledges to help mitigate further environmental damage and support moves towards a more sustainable future. The PCT will support and work with local partners on tackling environmental issues particularly where these 42 Northamptonshire Teaching PCT Annual Report 2007/08

43 Operating and fi nancial review The PCT has made a pledge towards reducing our carbon footprint. 43

44 Northamptonshire Teaching PCT values its staff and is committed to promoting and protecting equality and diversity within the organisation. 44 Northamptonshire Teaching PCT Annual Report 2007/08

45 Operating and fi nancial review The PCT s employees The PCT s Human Resources and Training department is responsible for managing the safe management and support of staff, training and development of staff, working with payroll, and implementing electronic staff records. The department has faced a number of challenges in 2007/08, including dealing with issues from the contracted out Payroll service, the staggered introduction of Electronic Staff Records (ESR), and managing higher levels of recruitment activity within the PCT following the Commissioning a Patient Led NHS reorganisation of PCTs. During 2007/08, the PCT has experienced an increased level of partnership working with the Staff of the Joint Consultative and Negotiating Committee (JCNC) on policy development and the range of organisational change issues that have taken place during the year. Work is continuing on the development of the ESR, which will produce the workforce information for the Human Resources and Training department to be able to provide Provider Services and the Commissioning organisation with monthly Key Performance Indicators. Provider Services was supported by Human Resources in completing the senior management restructuring required in 2007/08. Training Mandatory Training covers 17 different types of training delivered in various levels depending on whether the member of staff is clinical or nonclinical. Training is delivered in a range of formats, including e-learning and taught learning. In addition to the Mandatory Training, which covers areas such as Fire Safety and Child Protection, the Human Resources and Training department also facilitates other training including National Vocational Qualifi cations. In December 2007, an audit of IT skills was carried out by the PCT and as a result, a programme of IT training has been commissioned from Northampton College in consultation with the Information Management and Technology Directorate. 45

46 Human Resources policies The PCT s Human Resources Policies are available in full on the PCT website at the following link: nhs.uk/pct/foi/policies_and_procedures/ Governance/index.htm Knowledge and Skills Framework The Knowledge and Skills Framework was relaunched nationally in the autumn of The Appraisal and Personal Development Policy, incorporating the NHS Knowledge and Skills Framework, has been amended to refl ect the increase in e-ksf use and was ratifi ed in January Communication with staff The PCT communicates with staff in a range of ways including team meetings, through the staff intranet, alerts and electronic bulletins and briefi ngs. John Parkes, Chief Executive has presented the PCT Vision at a range of venues and there have been opportunities for staff to ask questions following Executive Management Team meetings. The PCT communicates with staff in a range of ways including team meetings, through the staff intranet, alerts and electronic bulletins and briefi ngs. 46 Northamptonshire Teaching PCT Annual Report 2007/08

47 Operating and fi nancial review Workforce planning Northamptonshire Teaching PCT has signed up to the Learning and Skills Council s Skills Pledge. The Sector Skills Agreement (SSA) is a nationwide strategy for transforming the skills of the health workforce in line with health service priorities and patient need. An East Midlands wide SSA is currently being worked on with input from health staff with responsibilities for workforce planning, service improvements and clinical placements. The pledge makes a commitment for the PCT to: 1. Actively encourage and support employees to gain the skills and qualifi cations that will support their future employability and meet the needs of our business and organisation. 2. Actively encourage and support our employees to acquire basic literacy and numeracy skills, and with Government support, work towards their fi rst Level 2 qualifi cations in an area that is relevant to our business and organisation. 3. Demonstrably raise our employees skills and competencies to improve company/ organisation performance through investing in economically valuable training and development. Looking to the future A major priority for 2008/09 is the development of a Staff Experience Strategy. There will be two strategies, one for the Commissioning and one for the Provider arm of the PCT. Priorities will include staff communication, delivery of appraisals, staff wellbeing programme, staff recognition, and management development programmes. 47

48 Social and community issues The PCT works hard to involve patients and the public in all of its work to ensure the services we provide are what people want. Social cohesion is an important determinant of the health and wellbeing of our population. Socially isolated people die at two or three times the rate of people with a network of social relationships and sources of emotional and instrumental support. Actions to enhance positive social cohesion remain primary tasks for the local government, NHS, voluntary sector and other partners in the community. As an organisation concerned with improving the health and wellbeing of its local population, the PCT takes corporate social responsibility seriously. During 2008/09 the PCT will develop and implement a social responsibility policy to drive our commitment further. The PCT works hard to involve patients and the public in all of its work to ensure the services we provide are what people want and need. In addition to the previous information on environmental matters, the PCT is working with partners in local authorities, police and the voluntary sector, through the Local Area Agreement, to address the social, economic and related issues which can have an impact on patients health. These include a range of factors such as community safety, deprivation, housing and social cohesion. More than 125,000 new homes will be built in Northamptonshire in the next 23 years and we want to ensure that all parts of the county benefi t from this major growth. A Sustainable Communities Strategy is currently being developed with input from all the relevant partners and using feedback from the public. This strategy will form the basis of the second Local Area Agreement the agreement with central government on how public services will be developed from Further information about the Sustainable Communities Strategy can be found on the PCT website at Consultations/Sustainable_Communities_ Strategy_for_Northamptonshire/index.htm Other PCT projects which address health-related social issues included: Wellbeing initiatives Health Trainers Sex workers around Northamptonshire (SWAN) Expert patient programme (for patients with long term conditions) Activity on referral schemes 48 Northamptonshire Teaching PCT Annual Report 2007/08

49 Operating and fi nancial review Policies on equal opportunities The PCT respects and works to promote equality and diversity, and as such, has a number of schemes and policies in place to address inequalities based on disability, gender and race, both for PCT staff and the public we support. Equality and Diversity is part of the mandatory training at the PCT, which all staff must complete. Following a public consultation, the PCT has published its fi rst Gender Equality Scheme, along with a revised Race Equality Scheme that builds on the work of the predecessor PCT organisations. The PCT welcomed Diana Wright as Equality and Diversity Non Executive Director to demonstrate the PCT s commitment to this agenda The PCT has also established an Equality and Diversity Forum and representatives of the PCT joined with colleagues from Northamptonshire Healthcare NHS Trust at the Disabled Staff Focus Group to explore ways of supporting disabled applicants and staff members in employment. Policy on disabled employees The Disability Equality Scheme was published in December 2006 and sets out how the PCT fulfi ls its duty to promote disability equality and contains an Action Plan which identifi es agreed prioritised objectives and sets out steps to achieve them. The Scheme was published in line with the Disability Discrimination Act (2005) legislation which was introduced to remove barriers disabled people face when accessing employment or services. The full document can be found on the PCT website at northamptonshire.nhs.uk/pct/foi/policies_and_ procedures/governance/index.htm 49

50 Race In addition to the Disability Equality Scheme, the PCT has also developed a Race Equality Scheme and a Gender Equality Scheme. The Race Relations (Amendment) Act (2000) requires the PCT to: Eliminate unlawful racial discrimination Promote equality of opportunity between persons of different racial groups Promote good relations between persons of different racial groups. The associated Race Equality Duty requires the PCT to have due regard to the need to: Eliminate unlawful racial discrimination Promote equality of opportunity between persons of different racial groups, Promote good relations between persons of different racial groups. The Race Equality Duty can be found on the PCT website at PCT/foi/Corporate_information/index.htm Gender The Equality Act (2006) states that all public bodies have a duty to promote gender equality. The legislation expects the public sector to positively remove the barriers men, women and transgender people face when accessing employment or services. The associated Gender Equality Duty requires the PCT to have due regard to the need to: Eliminate discrimination that is unlawful under the Sex Discrimination Act 1975 Eliminate discrimination that is unlawful under the Equal Pay Act 1970 Eliminate discrimination and harassment against transsexual individuals in employment and vocational training including further and higher education (and from December 2007 in the provision of goods, facilities and services). The Gender Equality Scheme can be found on the PCT website at northamptonshire.nhs.uk/pct/foi/corporate_ information/index.htm 50 Northamptonshire Teaching PCT Annual Report 2007/08

51 Operating and fi nancial review Public engagement As part of our commitment to social responsibility, the PCT engages with the public to ensure that the services we plan reflect the needs of our local population. During 2007/08 the PCT undertook a number of public consultations. These included a consultation on residential services for people with learning disabilities, Child and Adolescent Mental Health Services (CAMHS), Vital Signs, and the PCT s Gender Equality Scheme. In addition to the public consultations, the PCT continued to hold regular Older Persons Health Forums, and involved the Patient and Public Involvement Forum in a number of projects, including an independent audit of the 13 GP practices which performed least well in the 2006/07 Patient Survey. In addition, the PCT held three well attended stakeholder events as part of the Our NHS Our Future review of NHS services led by Lord Ara Darzi. These events were used to help inform the local workstream reports of the Northamptonshire NHS Partnership Board, which will in turn feed into the local vision document on which the Board will be engaging with the public. This will help determine the future strategic direction of NHS services in Northamptonshire. More information is available on this in the section on the NHS Partnership Board on page 22. The PCT is always working to improve and develop relationships with patients, the public, and other stakeholders. Anyone wishing to have their say on PCT plans or become more involved in developing services can contact Public Engagement on The PCT is always working to improve and develop relationships with patients, the public, and other stakeholders. 51

52 Learning disabilities Northamptonshire County Council, Northamptonshire Healthcare NHS Trust and Northamptonshire Teaching PCT consulted with adults with learning disabilities who live in NHS residential care, and their families and carers to help us plan new housing and support services that promote ordinary living. By 2010, NHS housing for people with learning disabilities will be phased out. NHT, the county council and the PCT want to ensure that as wide a range of housing options as possible is available to replace the NHS accommodation. Child and Adolescent Mental Health Services (CAMHS) Local services have been working together to of the areas identifi ed was the need for implement the Joint Strategy for Mental Health improved, consistent and more integrated Child and Emotional Wellbeing, which was developed and Adolescent Mental Health Services. A three in consultation with local partners and launched month consultation, run jointly by the PCT and in December This strategy, which took Northamptonshire County Council, closed in account of local service confi guration as well as October 2007 on the future of CAMHS in local needs, had identifi ed a number of gaps Northamptonshire. The tendering process for and inequities in the provision of services. One this service has been completed. 52 Northamptonshire Teaching PCT Annual Report 2007/08

53 Operating and fi nancial review Vital signs The PCT consulted with patients and staff on what they felt were the most important Vital Signs or priorities, which should be included in the 2007/08 Operating Plan, which outlines the PCT s key priorities for the fi nancial year. There are a number of vital signs which have been identifi ed nationally and that the PCT is working on in 2008/09 to ensure that it delivers the best possible health outcomes locally. In tandem with these national priorities, there are also a number of local vital signs which the PCT needed to look at. The majority of respondents said that the main priorities were improving access to primary care dental services and ensuring more patients with depression or anxiety disorders had access to psychological therapies. Complaints and PALS (Patient Advice and Liaison Service) In addition to individual Public Engagement projects as outlined above, the PCT runs a PALS service and a Complaints service, and ensures changes are made to refl ect the comments received through these mechanisms. Gender Equality Scheme The PCT consulted with men, women and transgender people to create a Gender Equality Scheme for the PCT. The Gender Equality Duty is similar to the existing duties on race and disability equality. All three have the same spirit and intention: public authorities are to act to tackle discrimination, to prevent harassment, and to ensure that their work promotes equality of opportunity. 53

54 During 2007/08 there were a total of 1635 PALS queries in Northamptonshire Teaching PCT. Of these, 1248 were signposting, and 201 were verbal concerns. 54 Northamptonshire Teaching PCT Annual Report 2007/08

55 Operating and fi nancial review Patient Advice and Liaison Service (PALS) Report 2007/08 The number of PALS enquiries has risen considerably since January Improvements to services as a result of calls received by PALS include: The PALS service is always seeking to improve the quality and content of its services to patients and the public. It also assists the PCT in ensuring that it is fi t for purpose. The following improvements have been made: Ethnic origin is now being recorded and is available for reporting for service improvement purposes. PALS has been advertised widely using Your Guide to Local Services (sent to households in Northamptonshire through the use of Yellow Pages). A cross county PALS group has been set up to share experiences and promote and improve the service and liaison between Trusts locally. This includes Northamptonshire Healthcare Trust, Kettering General Hospital and Northampton General Hospital. PALS service contact details are being used as the fi rst contact on PCT information leafl ets. PALS has advised local GPs to identify the local contact number when discussing the Choose and Book appointment booking system with patients. This follows complaints from patients regarding a national standard letter they had received which gave a contact number for the national booking line but this line does not make appointments, which has caused some confusion and frustration amongst patients. The PALS service has been working with dental advisors and contracts managers to improve the spread of Units of Dental Activity (funding for NHS dental appointments) across the county. This aims to ensure patients get better access to dentists across the county. For information and advice on any issues relating to the PCT you can contact the PALS service on Complaints report During 2007/08, proactive promotion of the complaints process has taken place to support staff in responding to complaints in a timely and safe manner. In total, 295 written complaints were received over the 12-month period. Out of these, 143 complaints were concerning Family Health Service Practitioners (GPs, dentists, pharmacists and opticians). Of the other complaints, 147 were about the services provided by the PCT and the remaining 5 were about other organisations. 96% of all complaints were acknowledged within 2 working days and 91% of complaints were responded to within 25 working days. During 2007/08 there were 20 cases referred to the PCT s Conciliation Service for resolution, of which 11 cases were resolved, 8 were unresolved and 1 is ongoing. Service improvements following complaints include the following: As a result of several complaints being made against the wheelchair service regarding provision and the time it took for young people in particular, to obtain wheelchairs, the PCT Board approved an additional 360,000 to cut the waiting list down to 13 weeks or less. A new service for patients with acquired brain injuries was developed as the result of a complaint regarding the provision of Continuing Healthcare in Northamptonshire. 55

56 Principles for remedy The Parliamentary and Health Service Ombudsman has published the Principles for Remedy document, setting out six principles that represent best practice and are directly applicable to NHS procedures. Good practice with regard to remedies, according to the document, means: 1. Getting it right 2. Being customer focused 3. Being open and accountable 4. Acting fairly and proportionately 5. Putting things right 6. Seeking continuous improvement The PCT will be reviewing its Complaints Policy in September 2008 and will ensure that these six principles for remedy are incorporated into our new policy and procedures. A downloadable version of the Principles for Remedy document is available on the Health Service Ombudsman website at improving_services/remedy/principles_remedy. html Organisations which are essential to the business of the PCT Organisations and partners which are essential to the business of the PCT include: Patients Local GPs Dentists Opticians Kettering General Hospital NHS Trust Northampton General Hospital NHS Trust Northamptonshire Healthcare NHS Trust NHS Direct East Midlands Ambulance Trust Local authorities Local voluntary organisations Market and competitive environment The PCT operates in a competitive environment as an NHS commissioner and provider in the context of Practice Based Commissioning, the voluntary sector and private health care providers. 56 Northamptonshire Teaching PCT Annual Report 2007/08

57 Operating and fi nancial review 57

58 Regulatory environment Regulations that the PCT must abide by include considerations such as health and safety, management of risk and other governance arrangements and one of the primary organisations the PCT must work with is the NHS Litigation Authority. In addition, the PCT must continue to develop and adhere to new legislative Acts of Parliament as they are passed. Examples of the regulatory environment in which the PCT operates are outlined below. NHS Litigation Authority Risk Management Standards Assessment for PCTs The NHS Litigation Authority (NHSLA) is a Special Health Authority, which was established in 1995 to administer the Clinical Negligence Scheme for Trusts (CNST) and thereby provide a means for NHS organisations to fund the cost of clinical negligence claims. In 1999 the Liabilities to Third Parties Scheme (LTPS) and Property Expenses Scheme (PES), together known as the Risk Pooling Scheme for Trusts (RPST), were established to fund the cost of legal liabilities to third parties and property loss. Membership of the schemes is voluntary and open to all NHS trusts, NHS foundation trusts and PCTs in England. Funding is on a pay-asyou-go non profi t basis, and organisations receive a discount on their scheme contributions where they can demonstrate compliance with the relevant NHSLA risk management standards. The PCT volunteered to participate in the pilot of the new risk management standard for PCTs and was assessed at Level 1 in November The assessment concluded that the PCT had successfully achieved 41 of the possible 50 criterion which resulted in a pass at this level. In real terms, this means that the PCT will receive a 10% discount on its contributions to the scheme for the 2008/09 period. 58 Northamptonshire Teaching PCT Annual Report 2007/08

59 Operating and fi nancial review Risk management The PCT has continued its commitment to risk management with the appointment of key personnel to take forward the Risk Management Strategy. The PCT has continued to build on its Board Assurance Framework and the process of identifying, managing and addressing key risks through a successful educational programme for managers and staff. The PCT has embraced the National Patient Safety initiative in the reporting and investigation of incidents that have occurred within the Trust and integrated the process within a proactive, learning culture dedicated to delivering a quality environment and health care service to patients, staff and visitors. Health and safety The focus for Health and Safety has been the completion of the Annual Health & Safety Action Plan together with the revision of many associated policies and processes which have enabled the Trust to fulfi l its commitment to a proactive Health and Safety culture and maintain its commitment to the welfare of staff, patients and visitors. 59

60 Fire With the introduction of the Regulatory Reform Act the Trust has continued its Fire Risk Assessment Programme for all Primary Care premises and has strengthened its working relationship with the Fire and Rescue Service, GP s and local County Council. The Assessment Programme has allowed the Trust to establish a Risk and Investment profi le for the forthcoming year. This has been welcomed by all parties and held as best practice throughout the county. Mental Capacity Act The PCT is working in partnership with health and social care partners in Northamptonshire to embed this important piece of legislation. Approximately 900 PCT and primary care staff will receive training on the Act in 2008/9. In February 2008, the PCT and Northamptonshire County Council held a conference attended by 150 delegates from the local health economy, social services, nursing and care homes, mental health providers and Independent Mental Capacity Advocates to promote best practice under the Act and to begin the preparation for the new legislative requirements of Deprivation of Liberty Safeguards. The MCA Local Implementation Network has been extended to include a steering group to implement the new legislative requirements. This will be chaired by the recently appointed PCT lead for the Mental Capacity Act and Safeguarding Adults. Technological change There have been a number of technological developments the PCT has responded to in 2007/08, not least the continued work towards implementation of programmes such as Choose and Book, Electronic Staff Records, and Electronic Patient Records. Choose and book The PCT is one of the top performing PCTs nationally in developing the Choose and Book referral system for GPs, and is only one of the three PCTs in the country to achieve a 90 per cent target. 60 Northamptonshire Teaching PCT Annual Report 2007/08

61 Operating and fi nancial review SystmOne The PCT has a very active programme for developing secure electronic clinical records in all its wards and departments. This includes the deployment of SystmOne, one of the systems available through the national Connecting for Health programme. Working with nurses, therapists and administrative staff, the clinicians based within the IM&T Directorate have worked to make sure that patients and clinicians get the most from this new system. This has included using SystmOne s Community module within our community hospitals. This allows trained and authorised staff to share records electronically with the patient s agreement between medical, nursing and therapy staff who are caring for the patient in hospital and at home. This includes, where relevant, the patient s GP. We understand that this is the fi rst use of SystmOne across the in patient and community care pathway in this way. Information governance Information governance is a framework for handling personal information in a confi dential and secure manner to appropriate ethical and quality standards in a modern health service. Information governance covers a number of areas and legislation including Confi dentiality and Disclosure; Data Protection; Information Quality Assurance; Information Security (including ); Records Management and Access to Information Regimes including Freedom of Information, Environmental Information Regulations and Access to Health Records. The Information Governance Team are developing policies, protocols and advice and guidance on all of the above. Service desk As well as traditional computer and software issues, the Information Management and Technology directorate manages Information Governance legislation, ensuring the organisation s compliance, and reductions to the organisations exposure to risk. There is a National Programme for IT (NPfIT) team responsible for rolling out new applications as part of the Government s 10 year 6bn agenda to provide better health care through provision of IT systems. The directorate manages the information needs of the organisation; for example, ensuring statutory returns are completed. 61

62 Annual accounts 2007/08 Northamptonshire Teaching PCT is responsible for ensuring that the funding received for local health services is spent appropriately and with a focus on achieving good value for money. The summary fi nancial statements and commentary that follow provide a picture of the PCT s results for the year ended 31 March Northamptonshire Teaching PCT Annual Report 2007/08

63 Annual accounts 2007/08 Position of the PCT at the end of 2007/08 Northamptonshire Teaching PCT began with a fi nancial defi cit brought forward of 7.9M, and was required to come back into fi nancial balance in Following repayment of the defi cit to the Strategic Health Authority (SHA), NHS East Midlands, the PCT was then provided with a control total of 4.2M underspent by the SHA. This formed Northamptonshire s part of the overall control total for NHS East Midlands of 140M. The accounts set out in this report are a summary only and not a complete set of fi nancial statements. A full set of the PCT s Annual Accounts are available free of charge on request to the Director of Finance and Performance (telephone ), or they can be downloaded from the PCT s website at These statements incorporate a full set of notes which provide a more detailed analysis of expenditure and can help the reader gain a wider understanding of the PCT s fi nancial policies. Financial targets Northamptonshire Teaching PCT has the following fi nancial targets: STATUTORY TARGET To achieve the PCT s operational fi nancial plan ADMINISTRATIVE TARGETS To recover our full costs in relation to provider functions To remain within our capital resource limit To ensure all invoices are paid in line with the Better Payments Practice Code (BPPC) OUR PERFORMANCE Revenue resource limit underspent by 4.2M as planned OUR PERFORMANCE The PCT fully recovered its full costs in relation to the provider function Capital resource limit underspent by 4.4M The PCT paid 96.4% of non-nhs invoices within 30 days against a target of 95% 63

64 Summary financial statements Operating cost statement for the year ended 31 March / / Commissioning Gross Operating Costs 787, ,787 Less: Miscellaneous Income (23,578) (27,981) Commissioning Net Operating Costs 764, ,806 Provider Gross Operating Costs 65,263 62,275 Less: Miscellaneous Income (7,187) (7,097) Provider Net Operating Costs 58,076 55,178 Net Operating Costs before Interest 822, ,984 Interest Received or Receivable 0 0 Interest Paid or Payable Net Operating Cost for the Financial Year 822, , Northamptonshire Teaching PCT Annual Report 2007/08

65 Annual accounts 2007/08 Statement of recognised gains and losses for the year ended 31 March / / Fixed asset impairment losses (446) 0 Unrealised surplus on fi xed asset revaluations/indexation 4,399 4,904 Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets 0 0 Additions/(Reductions) in the General Fund due to the transfer of assets from/(to) NHS bodies and the Department of Health 0 0 Additions / (Reductions) in other reserves 0 0 Recognised gains and losses for the financial year 3,953 4,904 Prior period adjustment other 0 0 Gains and losses recognised in the financial year 3,953 4,

66 Balance sheet as at 31 March March March FIXED ASSETS Intangible assets Tangible assets 65,580 64,567 Investments ,687 64,722 CURRENT ASSETS Stocks and work in progress Debtors 26,145 17,812 Investments (other e.g. EU Emissions Trading Scheme) 0 n/a Cash at bank and in hand TOTAL CURRENT ASSETS 26,924 18,371 CREDITORS : Amounts falling due within one year (61,209) (49,508) NET CURRENT LIABILITIES (34,285) (31,137) TOTAL ASSETS LESS CURRENT LIABILITIES 31,402 33,585 Creditors: Amounts falling due after more than one year (258) (285) Provisions for liabilities and charges (2,643) (3,037) TOTAL ASSETS EMPLOYED 28,501 30,263 FINANCED BY: TAXPAYERS EQUITY General Fund 1,479 5,112 Revaluation reserve 24,802 23,039 Donated asset reserve 1,585 1,489 Government grant reserve Other reserves 0 0 TOTAL TAXPAYERS EQUITY 28,501 30, Northamptonshire Teaching PCT Annual Report 2007/08

67 Annual accounts 2007/08 Cash flow statement for the year ended 31 March / / OPERATING ACTIVITIES Net cash outflow from operating activities (815,408) (751,274) SERVICING OF FINANCE AND RETURNS ON INVESTMENT: Interest paid 0 0 Interest received 0 0 Interest element of fi nance leases (65) (80) Net cash outflow from servicing of finance and returns on investment (65) (80) CAPITAL EXPENDITURE Payments to acquire intangible assets 0 (39) Receipts from sale of intangible assets 0 0 Payments to acquire tangible fi xed assets (1,896) (3,124) Receipts from sale of tangible fi xed assets 1, Payments to acquire fi xed asset investments 0 0 Receipts from sale of fi xed asset investments 0 0 Net cash outflow from capital expenditure (405) (3,128) Net cash outflow before financing and management of liquid resources (815,878) (754,482) MANAGEMENT OF LIQUID RESOURCES (Purchase) of other current asset investments 0 0 Sale of other current asset investments 0 0 Net cash outflow from management of liquid resources 0 0 Net cash outflow before financing (815,878) (754,482) FINANCING Net Parliamentary Funding 815, ,507 Other capital receipts surrendered 0 0 Capital grants received 0 0 Capital element of fi nance lease rental payments 0 (24) Cash transfers (to)/from other NHS bodies 0 0 Net cash inflow from financing 815, ,483 Increase in cash

68 Operational financial balance The PCT has a statutory obligation to achieve its operational fi nancial plan. For 2007/08, the PCT planned to underspend by 4.2M, in line with the control total provided to it by NHS East Midlands. This was delivered in full during the fi nancial year, signifi cantly improving the PCT s fi nancial position from that reported in 2006/07, which showed an overspend position of 7.9M. The table below shows the PCT s performance against the operational fi nancial balance duty for 2007/08 and 2006/ / /07 Total Revenue Budget 822, ,950 Total Revenue Expenditure 817, ,861 Over/ (underspend) ( 4,159) 7,911 Main trends and factors affecting the PCT s development and performance now Within the fi nancial year, there have been a number of items which have impacted upon this fi nancial position or which have resulted in signifi cant items of expenditure/ saving. Firstly, since the PCT started the fi nancial year with an overspend carried forward of 7.9M, in order to come back into fi nancial balance in and achieve its control total, the PCT was required to produce and deliver a 34.9M fi nancial recovery plan. This plan contained a number of schemes to reduce costs throughout the organisation, and the achievement of the increased effi ciencies required to produce these savings will stand the PCT in good fi nancial stead for the future. Also in , the PCT received above average growth from the Department of Health, enabling it to invest additional funding in key service areas. Most notably, 16.4M additional funding has been invested in local health services in in reducing the total patient journey time to 18 weeks. In addition to this, there has also been signifi cant new investment in mental health services and continuing care. 68 Northamptonshire Teaching PCT Annual Report 2007/08

69 Annual accounts 2007/08 Looking to the future Looking ahead to future fi nancial years, there are a number of fi nancial risks which have been anticipated, and mitigated where possible. One of the key risks relates to the anticipated increase in population for the county over the next 15 years. Since revenue allocations are based on forecast registered GP populations, there may be a risk that funding allocated to the PCT is not suffi cient to keep up with population growth, leaving the PCT with a fi nancial problem. Work is ongoing in the PCT to quantify this risk, and secure funding from alternative sources, such as Section 106 monies, which are paid by developers to statutory agencies (including health bodies and local government) to support additional infrastructure costs which arise as part of large residential building projects, and which would help us support the new population until they become included in the population count used to determine PCT allocations. The PCT is also developing long term fi nancial plans to identify early on future fi nancial pressures so these can be addressed where possible. It is likely that future government investment in healthcare will reduce from that seen in recent years, and long term fi nancial planning is a key tool in identifying early warning signs that fi nances may be stretched, allowing the PCT time to identify more cost effective treatment alternatives and plan for more effi cient future developments, leading to improved fi nancial resilience in times of challenge. Capital resources The PCT has a fi nancial target to remain within its Capital Resource Limit. In , the PCT s capital resource limit was 5,717,000. In addition to this, the PCT received 1,640,000 of additional capital funding due to the disposal of assets in year, giving a total capital budget of 7,357,000. Following capital expenditure in year of 2,933,000, this gave an underspend against the Capital Resource Limit of 4,424,000. In comparison, for the PCT had a limit of 4,873,000 and spent 2,387,000 of this, giving an underspend of 2,486,000. As at 31 March 2008, the PCT had no capital commitments ( 250,000 in ). 69

70 Management of financial resources In order to most effectively manage the fi nancial resources of the PCT, approved budgets are delegated to budget holders on an annual basis, in line with the PCT s Standing Financial Instructions (SFIs). Budget holders are responsible for the performance of budgets under their control, and these are monitored and reported upon on a monthly basis to both the budget holders and the PCT Board. This enables early identifi cation of fi nancial pressures and risks within the system, and allows corrective action to be taken as necessary. In addition to this, quarterly reviews of Directorate budgets are undertaken by the Director of Finance to ensure areas of concern are identifi ed and resolved as required. Financial risk is also monitored using the above processes, with identifi ed risks quantifi ed and addressed clearly within the body of the PCT Board papers. In addition, a Financial Recovery Executive Group operated throughout to ensure that risks around the delivery of the PCT Financial Recovery Plan were managed appropriately, and that slippage on schemes was minimised. Risk is also monitored via the PCT s Audit Committee, which reviews and monitors performance against fi nancial, operational and organisational risks identifi ed during audit processes. Further information on the Audit Committee is provided below. Asset management As at 31 March 2008, the PCT holds fi xed assets of 65,687,000 ( 64,722,000 as at 31 March 2007). These assets support the PCT in achieving its objectives through providing premises and equipment (including IT hardware and software) to enable the PCT to carry out its core duties. In addition to these assets, the PCT leases a range of buildings and equipment. More detail on both the fi xed assets and the operating and fi nance leases held by the PCT is available in the Annual Accounts. Cash management & liquidity Every year the PCT receives a cash allocation, known as the cash limit, which represents the total cash available to the PCT in year. Department of Health/Treasury cash management guidance states that this should not be drawn down before it is needed, that PCTs should not hold excessive bank balances at the end of any accounting period, and that PCTs must fully spend their cash limit in year. For , the PCT had a cash limit of 820,777,000 ( = 767,753,000), and as at 31 March 2008, the PCT held cash and cash equivalents of 24,000, an increase of 6,000 on the previous year. For , the PCT robust cash management ensured the PCT had suffi cient cash to pay its creditors, no payments were delayed due to liquidity issues and no interest payments were made in relation to late payments for commercial debts. Information on the PCT performance against the Better Payments Practice Code (BPPC) is presented later in this report. 70 Northamptonshire Teaching PCT Annual Report 2007/08

71 Annual accounts 2007/08 Other resources The main non-fi nancial resource employed by the PCT is the staff body, which comprised 1,808 whole time equivalents (WTEs) in (1,828 WTEs in ). In total, these staff cost the PCT a total of 63,443,000 in The PCT takes the development and welfare of its human resource seriously, and an organisational development programme for staff is currently being developed, to ensure that all staff have the skills necessary to conduct their duties. More detail on staff costs is provided below. Value for money Northamptonshire Teaching PCT actively seeks value for money in all its business activities. As part of our continuing review of organisational effi ciency, the PCT has reviewed all key areas of commissioned and provided services and has identifi ed and implemented a range of schemes and policies to promote best value for money. These include the introduction of benchmarking to measure best practice against peer organisations, the use of performance information in identifying and improving areas of ineffi ciency, and a number of demand management schemes, to ensure that patients are treated in the most appropriate setting. Charitable funds The PCT has charitable funds, which are held in separate charitable funds accounts, and are submitted and audited to the guidelines and timetable set down by the Charities Commission. The balance of the charitable fund at 31 March 2008 is 1,331,753 ( 1,350,388 as at 31 March 2007). Pooled budgets Northamptonshire Teaching PCT hosts a pooled budget for the commissioning of adult mental health services across Northamptonshire in partnership with Northamptonshire County Council. The PCT also contributes to pooled budgets hosted by Northamptonshire County Council for community equipment services in both the north and the south of the county, and the Northamptonshire Drug Action Team (DAT). Details of the joint income and expenditure for these budgets can be found in the full set of accounts. 71

72 Audit Committee The Audit Committee s role is to provide an independent and objective view of the PCT s internal control by: Overseeing the Internal and External Audit services. Reviewing financial and information systems and monitoring the integrity of financial statements. Monitoring the compliance with the PCT s Standing Orders and Standing Financial Instructions Reviewing the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the PCT External Audit Northamptonshire Teaching PCT s external auditors are KPMG LLP. The total cost of their statutory work in 2007/08 was 362,000. This related to the auditing of the final accounts to ensure it has been prepared in accordance with relevant policies and gives a true and fair view of our financial state. In addition, they reviewed the annual report for consistency with the audited financial statements. In addition to the external audit, they provided VAT advice to the PCT at a cost of 59,000. A Payment by Results audit was included in KPMG s audit plan at a cost of 35,000 but was undertaken by the Audit Commission. Better Payment Practice Code (BPPC) The PCT s policy is to comply with the CBI Prompt Payment Code and the Government accounts rules. These state that the timing of payment should be stated in the contract. Where this is not the case, departments should pay within 30 days of receipt of goods and services, or upon presentation of a valid invoice, whichever is later. Number 000s Non-NHS Creditors Total Bills Paid in the Year 210, ,469 Total Bills Paid Within Target 202, ,941 Percentage of Bills Paid within Target 96.36% 91.00% NHS Creditors Total Bills Paid in the Year 3, ,878 Total Bills Paid Within Target 2, ,539 Percentage of Bills Paid within Target 82.08% 96.82% 72 Northamptonshire Teaching PCT Annual Report 2007/08

73 Annual accounts 2007/08 Staff costs The average number of whole-time equivalent staff employed by Northamptonshire teaching PCT in was 1,808. Costs associated with employing those staff were as follows: 2007/ / Salaries and wages 53,333 50,826 Social security costs 3,781 3,573 Employer contributions to NHSPA 6,329 6,070 Other pension costs Total 63,443 60,931 Management costs The PCT measures its management costs according to the defi nitions provided by the Department of Health. The management cost per head of weighted population is shown below: Management Cost ( 000s) 13,785 10,649 Weighted Population (number) 588, ,265 Management Cost per Head of Weighted Population ( ) The information in these pages is a summary only. A full set of the PCT s Annual Accounts can be downloaded from the PCT s website at

74 Remuneration report Remuneration and terms of services committee membership Professor William Pope (Chairman of the PCT) Richard Aveling (Non Executive Director) Philip Dearing (Non Executive Director) Tansi Harper (Non Executive Director) Susan Hills (Non Executive Director) Maggie McCutcheon (Non Executive Director) Kate Page (Non Executive Director) Diana Wright (Non Executive Director) Policy on remuneration of senior managers The Remuneration and Terms of Services Committee sets the salary for all Directors. All other staff remuneration rates are set nationally. Summary of policy on duration of contracts, notice periods and termination payments The PCT adheres to Agenda for Change terms and conditions for duration of contracts, notice periods and termination of payments. The PCT s Chief Executive is recruited through national advertisement and is appointed by the PCT Chairman. The Executive Directors have been recruited through local and national advertisement and were appointed by the Chief Executive and Chairman. Details of service contract for each senior manager who has served during the year Executive Directors (including the Chief Executive) have permanent contracts, which include a notice period of three months. The PCT s Remuneration and Terms of Services Committee, a committee of the PCT Board, determines payment and terms of service for senior managers in accordance with national Very Senior Managers guidance. Executive Directors are subject to the standards set out in the PCT s Standing Orders, Code of Conduct and human resources policies. Explanation of any significant awards There have been no signifi cant awards made between 01 April 2007 and 31 March Northamptonshire Teaching PCT Annual Report 2007/08

75 Annual accounts 2007/08 Director s salaries and allowances. Period: April 07 March / /07 (6 Months) (See Note 3) Salary Other Remuneration Benefits in Kind Salary Other Remuneration Benefits in Kind (bands of 5,000) (bands of 5,000) (rounded to nearest 00) (bands of 5,000) (bands of 5,000) (rounded to nearest 00) Name and Title John Parkes Chief Executive (started Nov 2006/07) Gill Scoular Director of Finance (started Nov 2006/07) Richard Alsop Director of Commissioning Dr Stephen Horsley Director of Public Health) (see note 1) Louise Proctor Managing Director of Provider Services (started Nov 2006/07) Jan Norman Director Quality Standards & Learning (started July 2007/08) n/a Sue Basham Director of Corporate Services & HR Phil Hurd Director of IM&T Professor William Pope PCT Chair (see note 2) Susan Hills Non Executive Director Richard Aveling Non Executive Director Philip Dearing Non Executive Director Margaret McCutcheon Non Executive Director Kathleen Page Non Executive Director Tansi Harper Non Executive Director Diana Wright Non Executive Director (started May 2007/08) 5-10 n/a Pay is not performance related. Note: 1. Dr Stephen Horsley during 2006/07 was part time working 3 days a week. During 2007/08 he became full time undertaking additional responsibilities, resulting in the increase in remuneration shown above. 2. In 2007/08 Professor William Pope received an additional months pay, as during 06/07 he was only paid for 11 months. 3. The prior year comparators relate to the period 1 October 2006 to 31 March 2007 as Northamptonshire Teaching PCT came into existence on the 1st October 2006 following the reconfi guration of PCTs. Therefore, the amounts shown under 2006/07 only relate to remuneration paid during this period. 4. For 2007/08 remuneration paid to the Professional Executive Committee has been excluded from this report as members of the committee are not considered to be senior managers who infl uence the decisions of the PCT as a whole. 75

76 Pension benefits Real increase in pension at age 60 Real increase in pension lump sum at age 60 Total accrued pension at age 60 at 31 March 2008 Lump sum at age 60 related to accrued pension at 31 March 2008 Cash Equivalent Transfer Value at 31 March 2008 Cash Equivalent Transfer Value at 31 March 2007 Real increase in Cash Equivalent Transfer Value Employer s contribution to stakeholder pension (bands of 2,500) (bands of 2,500) (bands of 5,000) (bands of 5,000) Name & Title John Parkes Chief Executive Gill Scoular Director of Finance & Performance Richard Alsop Director of Commissioning Dr Stephen Horsley Director of Public Health Louise Proctor Managing Director of Provider Services Jan Norman (started July 2007/08) Director Quality Standards & Learning Sue Basham Director of Corporate Services & HR Phil Hurd Director of IM&T * * * * * * * * * * * Non-pensionable * * * * * * * * Note: That the information contained within this table is based on pension information provided by the NHS Pension Agency. The entries marked with an * have been queried with the NHS Pension Agency who were unable to resolve them in time for inclusion within this report. The NHS Pensions Scheme is an unfunded, defined benefit scheme that covers NHS employers and other bodies. Board and Professional Executive Committee members not listed here are not direct employees of the Northamptonshire Teaching PCT. The scheme is accounted for as a defined contribution scheme and the cost is equal to the contributions payable to the scheme for the accounting period. The cash equivalent transfer value represents the capitalised pension scheme benefi ts accumulated by a member at a particular point in time. These are member s accumulated benefi ts and any contingent spouse s pension payable from the scheme. Further information can be found in the PCT s full set of accounts. The annual NHS Pension Scheme can be viewed at John Parkes, Chief Executive, June Northamptonshire Teaching PCT Annual Report 2007/08

77 Annual accounts 2007/08 Significant interests A number of our Board members and PEC members belong to organisations or agencies with which the PCT does business. These organisations and agencies have received payments from the PCT and include: Richard Aveling (Non Executive Director) Director of The Castle, Wellingborough. Susan Hills (Non Executive Director) Member of the Patient and Carer Network for the Royal College of Physicians. Husband is a Consultant at Northampton General Hospital. Margaret McCutcheon (Non Executive Director) Husband is a Councillor at Northampton Bourough Council. Kate Page (Non Executive Director) Corporate Director of Neighbourhood Services at Milton Keynes Council. Diana Wright (Non Executive Director) Independant co-opted Member on Standards Committee at Daventry. 77

78 Independent auditor s statement to the Directors of the Board of Northamptonshire Teaching Primary Care Trust We have examined the summary fi nancial statement the Operating Cost Statement, Statement of Total Recognised Gains and Losses, Cash Flow Statement and Balance Sheet. This report is made solely to the Board of Northamptonshire Teaching Primary Care Trust as a body, in accordance with Section 2 of the Audit Commission Act Our audit work has been undertaken so that we might state to the Board of Northamptonshire Teaching Primary Care Trust, as a body, those matters which we are required to state to them in an auditor s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than Northamptonshire Teaching Primary Care Trust and the Board of Northamptonshire Teaching Primary Care Trust, as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of directors and auditors The Directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the summary fi nancial statement within the Annual Report with the statutory fi nancial statements. We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary fi nancial statement. Basis of opinion We conducted our work in accordance with Bulletin 1999/6 The auditors statement on the summary fi nancial statement issued by the Auditing Practices Board. Our report on the statutory fi nancial statements describes the basis of our audit opinion on those fi nancial statements. Opinion In our opinion the summary fi nancial statement is consistent with the statutory fi nancial statements of Northamptonshire Teaching Primary Care Trust for the year ended 31 March We have not considered the effects of any events between the date on which we signed our report on the statutory fi nancial statements (20 June 2008) and the date of this statement. KPMG LLP Chartered Accountants Birmingham 1 September Northamptonshire Teaching PCT Annual Report 2007/08

79 Annual accounts 2007/

80 Statement of internal control (summary version) Scope of responsibility The Board is accountable for internal control. As Accountable Offi cer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation s aims, objectives and policies. I also have responsibility for safeguarding public funds and the organisation s assets for which I am personally responsible as set out in the Accountable Offi cer Memorandum. Although I, as Chief Executive, have overall responsibility for risk management, clinical, corporate and fi nancial; the following organisational delegations have been made at Director level: The Director of Finance is responsible for the management of fi nancial risk and organisational probity and to monitor estates and performance of services provided or commissioned by the Trust. The Director of Corporate Services and Human Resources is responsible for the strategic development and implementation of risk management including health and safety and security but with the exception of fi nancial risk. The Interim Director of Public Health is a dual role linked with Northamptonshire County Council and is responsible for identifying the health needs of the population in Northamptonshire and ensuring these are fully taken into account when commissioning services. He is also the Medical Director responsible for all medical staff on the PCTs Performers` list and those providing support to Provider Services The Director of Information Management and Technology (IM&T) is responsible for ensuring effective IM&T governance across the organisation and local health community. The Director of Strategic Development and Commissioning is responsible for ensuring compliance of commissioning processes and commissioned services to national standards. The Director of Quality, Standards and Learning is responsible for validating and regulating the delivery of quality components of all contracts with providers including those with independent contractors, providing the lead for Safeguarding Children and Adults, Equality and Diversity, Mental Capacity Act, Deprivation of Liberty and is the Director for Infection Prevention and Control (DIPaC). The Managing Director of Provider Services is responsible for implementing the processes to minimise clinical risk. Committees operate to provide assurance and challenge to the operating processes of the PCT (Primary Care Trust), such as the Audit Committee, Remuneration and Terms of Service Committee, Finance and Performance Committee, Governance Committee, Commissioning Governance Committee and Strategic Commissioning Executive and others 80 Northamptonshire Teaching PCT Annual Report 2007/08

81 Statement of internal control (summary version) such as the Charitable Funds Committee, the Reference Committee and the Pharmacy and Dispensing Committee. The Board also receives reports from each of the Directorates and minutes from the Audit Committee, Finance and Performance Committee and Governance Committee. Northamptonshire Teaching PCT has strong links with the Strategic Health Authority (NHS East Midlands) through such meetings as Quarterly Review, Leadership Strategy Group, the Local Safeguarding Children s Board, East Midlands Strategic Commissioning Board, Director of Finance meetings, Chief Executive Offi cer Meetings, Specialised Commissioning and a variety of other strategic meetings as appropriate. The PCT also meets regularly with other partner organisations including Northamptonshire County Police, Healthier Communities Scrutiny Committee, commissioning meetings with main providers including the Acute and Mental Health Trusts, the Local Area Agreement and the Drug Action Team. There are also formal Section 75 Partnership Agreements in place between the PCT and Local Government in order to improve services through closer working between the NHS and Local Government, pursuant to the obligations for the Partners to co-operate with each other in the provision of services. The PCT s full statement of internal control can be found in the full set of accounts and on the PCT website ( nhs.uk) This full version sets out: The purpose of the system of internal control Our capacity to handle risk Our risks and controls framework Review of effectiveness The Head of Internal Audit has reviewed work carried out by Internal Audit during the year on the effectiveness of the management of those principal risks identifi ed within the organisation s assurance framework. Signifi cant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design and/or inconsistent application of controls put the achievement of particular objectives at risk. I am confi dent that the organisation has plans in place to address weaknesses and ensure continuous improvement of the current systems. Signed: John Parkes - Chief Executive, Northamptonshire Teaching PCT Dated: 81

82 Statement of accounting offi cer s responsibilities Statement of the Chief Executive s responsibilities as the accountable officer of the Primary Care Trust. The Secretary of State has directed that the Chief Executive should be the Accountable Offi cer of the Primary Care Trust. The relevant responsibilities of Accountable Offi cers are set out in the Accountable Offi cers Memorandum issued by the Department of Health. These include ensuring that: there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance value for money is achieved from the resources available to the authority the expenditure and income of the authority has been applied to the purposes intended by Parliament and conform to the authorities which govern them effective and sound fi nancial management systems are in place annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the fi nancial year and the net operating cost, recognized gains and losses and cash fl ows for the year To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Offi cer. Signed: John Parkes Chief Executive, Northamptonshire Teaching PCT Date: 82 Northamptonshire Teaching PCT Annual Report 2007/08