panel report hastings and rother pct 25 november 2008

Panel Report

Hastings and Rother PCT25 November 2008

2Adding life to years and years to life 2

Overview

First, the panel thanks Hastings and Rother PCT for participating in this round of assessments for World Class Commissioning.

The panel asks the PCT to accept this report in the spirit in which it is intended: a support tool

on the journey to world class commissioning as a considered perception of the organisation’s strengths and weaknesses based on the insight the PCT itself gave the panel into its commissioning approach.

During our investigation of Hastings and Rother PCT, the panel developed an overall impression of the organisation, which is that the PCT has considerable strength and is self-aware regarding areas for improvement.

The panel feels that the results from the competencies self-assessments largely match the panel’s perceptions during the assurance test.

The panel identified 4 main recommendations that the PCT will need to consider as the PCT positions itself to drive transformation of health and healthcare in Hastings and Rother.


Commentary

The panel identifies 4 major areas for consideration by the PCT at this stage on its journey:

1. The PCT will need to ensure there is sufficient focus to deliver on the overall vision and ambition for the health of the local population.Observation: The panel observed that the PCT is engaged in a wide variety of initiatives and programmes, from the older people’s strategy through to healthy living initiatives targeting young families. However, it is less clear how these initiatives are prioritised or focused to make significant impacts on the local population, or that the alignment between selected outcomes with strategic goals and initiatives is fully developed and articulated.Recommendation: The panel recommends that the PCT simplify its strategy, prioritising its initiatives to focus on the most important issues (e.g. quality). The forthcoming management and governance review will be a good starting point for these discussions.

2. There is a need to ensure the strategic investment plan is ambitious enough considering the local health needs.Observation: The PCT will require an ambitious strategic investment plan in order to address the significant and varying health needs of the local population. The panel observed that there is a need to translate plans which are rooted in the JSNA into action, and to ensure that levels of investment are high enough to impact health needs in the most deprived areas. Recommendation: The panel recommends that the PCT review its strategic plan to ensure it is aligned with the recognised health needs of the population. In addition the Board will need to ensure there is sufficient challenge to the planning process (e.g. to ensure there is sufficient investment in priority areas to address local health challenges).


CommentaryThe panel identifies 4 major areas for consideration by the PCT at this stage on its journey:

3. The PCT will need to develop its capacity and capabilities to ensure it delivers its ambitious strategic plan, particularly in light of its shared executive with East Sussex Downs and Weald.Observation: The PCT acknowledges that there are additional challenges arising from the joint management arrangements between Hastings and Rother and East Sussex Downs and Weald. The panel observed that Board Governance will need to be exceptional to manage this arrangement, including ensuring that there is appropriate executive challenge (e.g. planning assumptions) across both PCTs. The PCT acknowledges that there is a need to implement stronger performance management of programmes and initiatives to avoid slippageRecommendation: The panel recommends that the PCT ensure there is adequate space for discussion and debate around strategic decisions (e.g. by creating additional seminar time). The panel also recommends that the PCT strengthen its capacity and capabilities (e.g. by strengthening performance management processes)

4. There is a need for the PCT to build on the strength of relationships with a full range of providers to transform the local health system.Observation: The PCT can provide examples of close collaborative working with local acute providers and GPs. However, the panel observed that there is an opportunity to build on these relationships to demonstrate leadership and further modernise the local health system (e.g. transforming procurement to focus on outcomes for patients rather than service provision).Recommendation: The panel recommends that the PCT further develop its procurement strategies and more proactively exploit the opportunities (e.g. surplus and relatively healthy population) to drive innovation and quality.


Potential for improvement

The panel recognises that the PCT has developed strengths in terms of building relationships with PBCs, rooting strategic objectives in the health needs of the local population (e.g. via the JSNA) and developing strong partnerships with stakeholders The panel is confident in the PCT’s ability to exploit the opportunities open to it (e.g. relatively healthy population, financial surplus), and observes that the PCT has strong potential for improvement.

Strategy

Finance

Board

A

A

A

GOVERNANCECOMPETENCIES

Local leader of NHS

Collaborates with partners

Patient and public engagement

Clinical leadership

Assess needs

Prioritisation

Stimulates provision

Innovation

Procurement and contracting

Performance management

Level 4

Level 1

Current Previous Upper Quartile

HASTINGS AND ROTHER PCT HEALTH OUTCOMES AND QUALITY

Outcomes Selection Date: Sep-Oct 2008

National Median th percentile

Strategic Priority Indicator

73 87 0.1%CY 2004/06

0.4%

48 8NA NACY 2007

89 227.6% CY 2003/05

39 892.2% FY 2007/08

85 2051-6.2% FY 2007/08

59 81-0.6% FY 2006/07

68 85-5.9% FY 2007/08

2683 5457.7% FY 2006/07

55 16NA NACY 2004/06

77 871.5% FY 2007/08

Worst Value

4. Proportion of children who complete MMR immunisation (1st and 2nd dose) by their 5th Birthday

5. Smoking quitters

Nat

iona

lLo

cal

9. Mortality from bronchitis, emphysema and other chronic obstructive pulmonary disease

10. CHD controlled cholesterol

6. Cervical screening: coverage of women aged 25-64

7. Patient and user reported measure of respect and dignity in their treatment

8. Rate of hospital admissions per 100,000 for alcohol related harm

1. Life expectancy

2. Health Inequalities

3. Under 18 conception rate

Time period

Best Value

PCT Rate of Change

M

F

MF

1000


Outcomes

Panel observations on outcomes:• Board developed outcomes based JSNA and prioritised

through a set of criteria (e.g. local need, ability to achieve, patient and public input).

• Board and PEC provided challenge to proposed outcomes to ensure that they were aligned with JSNA.

• PCT acknowledges that the population profile across the patch shows significant variation with regards to some outcomes (e.g. cervical screening).

• PCT notes that there are no national indicators which would measure investment in older people’s services.

Recommendations:• The panel acknowledges that the PCT has selected an

appropriate mix of public health and access measures and that these are linked to the health needs of the population and the strategic aims of the PCT.

• The panel recommends that the PCT consider including a local indicator to measure the impact of their older people’s strategy.

Outcomes chosen

1. Life expectancy

2. Health inequalities

3. Under 18 conception rate

4. Proportion of children who complete MMR immunisation (1st and 2nd dose) by 5th birthday

5. Smoking quitters

6. Cervical screening (women 25-64)

7. Patient and user reported measure of respect and dignity

8. Rate of hospital admissions per 100,000 for alcohol related harm

9. Mortality from bronchitis, emphysema, and other chronic pulmonary diseases

10. CHD controlled cholesterol


Overview - CompetenciesUncalibrated Panel Assessment

PCT's Self Assessment

PCT Self-Assessment

Competency

1. Locally lead the NHS

2. Work with community partners

3. Engage with public and patients

4. Collaborate with clinicians

5. Manage knowledge and assess needs

6. Prioritise investment

7. Stimulate market

8. Promote improvement and innovation

9. Secure procurement skills

Level 1

Level 2

Level 3

Level 4

10. Manage the local health system

Topline introduction• The panel agreed with 20 of the PCT’s 30

self-assessment ratings.

• However, the panel found it necessary to adjust the remaining ratings.

• The panel acknowledges that in some areas where it has adjusted self-assessment ratings, the PCT has made inroads into achieving the sub-indicators.


Competency 1: Self assessment

Are recognised as the local leader of the NHS

• Reputation as the ‘local leader of the NHS’

• Reputation as a change leader for local organisations

• Position as the local healthcare employer of choice

Competency Measure Level 3 Level 4Level 2Level 1

Source: Hastings and Rother PCT self assessment submitted on 29/10/2008

HASTINGS AND ROTHER PCT

Rationale for scoring:

• The PCT recognises tension between itself as a commissioner and the acute trust. However, the PCT notes that the trust is now using the JSNA to plan its services

• MORI polls show a positive public perception of the local NHS (highest scores in SEC SHA).

• The PCT is clear that the strategic aims and needs of the health population (as shown in the JSNA) are similar between Hastings and Rother and East Sussex Downs and Weald. However the PCT notes that there is significant variation in the mechanisms for delivery.

Recommendations going forward:

• The panel recommends that the PCT build on the opportunity of higher levels of recognition to build its reputation as a change leader and the leader of the local NHS (e.g. by capturing the opportunities presented by the change in branding).

Uncalibrated Panel Assessment




Work collaboratively with community partners to commission services that optimise health gains and reduce health inequalities

• Creation of Local Area Agreement based on joint needs

• Ability to conduct constructive partnerships

• Reputation as an active and effective partner





• PCT can give examples of engagement at all levels with local authority partners (e.g. through LSP) and can give examples of engagement with voluntary sector (Hospice at Home services delivered in partnership with MacMillan Cancer Care).

• PCT ensures it is accountable for the plans it outlines to the population through joint boards and committees and can demonstrate links between these and the LAA (e.g. Children’s Trust).

• However, the PCT is still developing its mechanisms to jointly prioritise initiatives alongside local partners.

• PCT can give some examples of joint working to deliver against LAA plans (e.g. memory services).


• The panel recognises the strong relationships between the PCT and other local agencies. Going forward, the PCT should continue to build on these to ensure performance management processes are aligned to deliver coherently against LAA targets and plans.





Proactively build continuous and meaningful engagement with the public and patients to shape services and improve health

• Influence on local health opinions and aspirations

• Public and patient engagement

• Delivery of patient satisfaction




Rationale for scoring:• The PCT can provide examples involving patients and the public in the development of services (e.g. learning disabilities,

workshops to involve the public in developing criteria for future investment and disinvestment decisions).

• The PCT has begun developing small scale programmes (e.g. for young mums) around health prevention. Social marketing work has begun (e.g. around smoking). The PCT is developing new ways of working with the hardest to reach communities (e.g. community outreach midwives).

• The PCT acknowledges the challenges resulting from the need to develop maternity services across 2 sites going forward (e.g. the need for the acute trust to recruit the staff required to deliver the services).

• The PCT can provide limited examples where patient feedback or complaints has led to improved services for patients (e.g. access to memory services in Rother). However it is less clear that the PCT systematically and actively reviews feedback in order to develop services.

Recommendations going forward:• The panel recommends that the PCT continue to build on its existing programmes and plans to ensure that engagement with

the public and patients both encourages the public to take control of their own health opinions and lifestyles and to get involved with the development of healthcare services.

• In addition, the panel recommends that the PCT look for further opportunities to review and incorporate feedback from patients (e.g. address low response rate to complaints).





Lead continuous and meaningful engagement of all clinicians to inform strategy and drive quality, service design and resource utilisation

• Clinical engagement

• Dissemination of information to support clinical decision making

• Reputation as a leader of clinical engagement





• The PCT has a clinical leaders group where acute and primary care clinicians from across the patch engage in strategic discussions with the PCT. (e.g. anti-coagulation).

• Each pathway redesign project directly involves clinicians. PEC or PBC nominate a clinician (may be a GP, community matron, AHP) to lead input into each pathway redesign. Nominated clinicians report back through PEC or PCT Board.

• The panel recognises that the PCT has a powerful GP voice. In addition, the PCT can provide some examples of involving a wider range of clinical views (e.g. through networks or around specific projects).

• The PCT can give examples of implementing initiatives to redesign care (e.g. COPD, anti-coagulation).


• The panel recommends that the PCT build on the achievements it has made in this area to date, and continue to build on its relationships with clinicians other than GPs.

• The panel recognises that the PCT’s self-assessment on 4B was rooted in a time-limited issue and expects the PCT to improve in the coming months.





Manage knowledge and undertake robust and regular needs assessments that establish a full under-standing of current and future local health needs and requirements

• Analytical skills and insights

• Understanding of health needs trends

• Use of health needs benchmarks





• The PCT has developed a complete JSNA broken down by ward which informs strategies and services, and can clearly demonstrate that it understands the links between the health needs of the population and the development of service strategies and pathways (e.g. older people’s health needs).

• In addition, the PCT undertakes specific health needs analysis (e.g. sexual health needs in most deprived wards) as required.

• PCT acknowledges that health needs benchmarking is still in development, particularly for measures which are not part of standard national data sets (e.g. older people’s measures).


• The panel recommends that the PCT works with its peers to develop a wider range of benchmarked health needs, including developing plans to improve performance against them.





Prioritise investment according to local needs, service requirements and the values of the NHS

• Predictive modelling skills and insights

• Prioritisation of investment to improve population’s health

• Incorporation of priorities into strategic investment plan





• PCT recognise that predictive modelling skills and insights need to be developed and these are addressed in the OD plan

• The PCT can demonstrate some level of prioritisation of investment, but the rigour and processes used will need further development (e.g. PCT will need to be able to consistently and clearly articulate the criteria by which it prioritises investment).

• The PCT acknowledges that it is still developing its capacity to evaluate projects and initiatives against prioritisation.


• The PCT will need to develop its process and methodology for prioritisation, including the alignment of initiatives and outcomes.

• In addition, the panel recommends that the PCT ensure there is sufficient challenge to planning assumptions, and that the strategic investment plans are robust enough to deliver against the high level of ambition.





Effectively stimulate the market to meet demand and secure required clinical and health and wellbeing outcomes

• Knowledge of current and future provider capacity

• Alignment of provider capacity with health needs projections

• Creation of effective choices for patients





• The panel acknowledges that the PCT has made a realistic self-assessment on this competency.

• The PCT plans include limited disinvestment (e.g. in mental health), however the panel acknowledges that the PCT are required to support two viable DGHs across the patch.


• PCT will need to further develop its market analysis potential (building on KPMG work) to fully understand its ability to offer patient choice.

• Panel recommends that as part of this the PCT focus on non-acute services (e.g. primary and community care, mental health services).





Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration

• Identification of improvement opportunities’

• Implementation of improvement initiatives

• Collection of real time quality and outcome information


Source: East Sussex Downs and Weald PCT self assessment submitted on 29/10/2008




• PCT can provide some examples of clinical pathway redesign, and while these show some evidence of benchmarking, the panel could not find evidence that benchmarking is consistently undertaken to proactively identify new opportunities for improvement.

• PCT uses a patient experience tracker to redesign services to improve patient experience through action from feedback (e.g. on a community hospital ward).


• The panel recommends that the PCT build on the patient tracker and expand its toolkit of improvement techniques to ensure it includes pathway redesign tools (e.g. lean).

• The panel recommends that the PCT build on the Board enthusiasm and commitment to the quality agenda to ensure it is developing real time quality and outcome information.




Secure procurement skills that ensure robust and viable contracts

• Understanding of providers economics

• Negotiation of contracts around defined variables

• Creation of robust contracts based on outcomes





• The panel acknowledges that the PCT is participating in the Purchased Healthcare pilot, which will provide a good starting point to build non-acute procurement skills.

• However, there is still room to develop a robust negotiation strategy to ensure the PCT is best placed to engage with acute and non-acute providers in contractual negotiations.


• The panel recommends that the PCT build on the output of the market analysis currently being procured through KPMG to design a robust procurement strategy. The PCT will need to review its procurement capabilities in partnership with local

authority partners in the context of this work.

• The panel recommends that the PCT further develop its approach to negotiations





Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvement in quality and outcomes and value for money

• Use of real time performance information

• Implementation of regular provider performance discussions

• Resolution of ongoing contractual issues





• The PCT acknowledges that it is still developing its ability to collect real time performance data (less than one month old for monthly data) from non-acute providers.

• The PCT acknowledges that there is a need to develop more regular performance discussions with primary care and community services.


• The panel recommends that the PCT revisit its performance management processes with primary and community providers, ensuring regular performance discussions are in place and contracts are monitored robustly.




Governance: Panel assessment on Strategy

A

Overall recommendation:

The PCT recognises the importance of the JSNA, and the need to root future strategic decisions and initiatives in the health needs of the local population. However, the PCT is still translating these links into actions, for example by ensuring that it is able to develop robust investment and disinvestment plans based on these needs. Going forward, the PCT will need to ensure it is able to clearly prioritise its initiatives and that these are reflected in the strategic investment plans. In addition, the PCT will need to ensure the Board and staff have the capacity and capabilities to develop transformational relationships with acute and non-acute providers.

Strategy:

• The PCT can clearly describe the links between the health needs of the population, the chosen outcomes measures and the strategic goals and initiatives outlined in the strategic plan. However, there are some areas of strategy (e.g. older people) which are not currently reflected explicitly in the chosen outcome set.

• The panel observed that the strategic plan does not fully link the initiatives with impact on the health of the local population, and that there is a need to further prioritise these.

• The PCT acknowledges the challenges in focusing on the right indicators and initiatives to deliver on its overall strategic ambitions.

• The JSNA forms the basis for the PCT’s strategy going forward, and notes that the acute trust now references the JSNA in developing their own plans.

• The panel observed that whilst the PCT is beginning to understand the links between strategic investment and outcomes, there is further work to do in this area.


Governance: Panel assessment on Finance and Strategy

A

A

Finance:

• The panel recognises that the PCT has a strong history of financial management. However it will need to further develop its understanding of the differences between financial planning and strategic investment.

• The PCT will need to ensure the Board has full ownership and understanding of the planning assumptions which underpin the strategic plan. The Board should regularly test and validate the robustness of these assumptions, and provide sufficient challenge to the executive.

Board:

• The panel observed that the Board approached the panel with a reflective, open and self-aware attitude and were highly professional throughout the process.

• The Board will need to ensure it has sufficient time designated for quality discourse and challenge.

• The panel acknowledges the unique challenges faced by the joint management board. The relationship with East Sussex Downs and Weald also provides opportunities and potential benefits which should be further developed (e.g. through the pending management and governance review) to improve the effectiveness of the PCT.

• The PCT recognises there is a need to further systematise the performance management regimes across the PCT.


Potential for Improvement Commentary

PCT trajectory• The panel recognises that the PCT has developed strengths in terms of building

relationships with PBCs, rooting strategic objectives in the health needs of the local population (e.g. via the JSNA) and developing strong partnerships with stakeholders (including local authorities and the voluntary sector) to deliver a wide variety of services (including children’s services).

• The panel also acknowledges the reflective, self-aware style of the leadership, and the opportunity this presents for the PCT to develop in the future.

• The panel is confident in the PCT’s ability to exploit the opportunities open to it (e.g. relatively healthy population, financial surplus), and observes that the PCT has strong potential for improvement.

Areas for organisational development• The PCT will need to ensure there is adequate space for discussion and debate around

strategic decisions (e.g. by creating additional seminar time) in order to inform a robust debate around plans and proposals.

• The panel also recommends that the PCT strengthen its internal capacity and capabilities (e.g. by strengthening performance management processes).

• The panel acknowledges the unique challenges faced by the joint management board. The relationship with East Sussex Weald and Downs also provides opportunities and potential benefits which should be further developed (e.g. through the pending management and governance review) to improve the effectiveness of the PCT.

panel report hastings and rother pct 25 november 2008

Documents

pct positions

commentarythe panel

panel reporthastings

panel thanks hastings

local health needs

local population

local health challenges

transformation of health