KPCT-07-230_Provider_Services_Report

KIRKLEES PRIMARY CARE TRUST

Report to the Board

December 2007

CONTENTS

Page

1. Director of Provider Services

4. Localities

6. HVMH

10. Therapies

13. Specific Services

15. Adult Transformation change Team

48. Children, Young People and Families Transformation Change Team

53. Therapies Transformation Change Team

Agenda Item: 51Enclosure: PSB/07/27

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December 2007

DIRECTOR OF PROVIDER SERVICES

1.0 Purpose of Report

This report is designed to give an overview of the current developments within provider services.

The main body of the report covers the key operational services, as well as giving detail on the current service improvement activity.

2.0 People issues

2.1 Jo Whincup, locality manager for Huddersfield North, is taking up a secondment to Marie Curie in Leeds. Elaine Sergeant is replacing Jo. Elaine is currently a District Nurse Team Leader with excellent experience in service improvement

The Provider board now has 2 front line clinical representatives. These are Jane Wragg, Health visiting team leader, and Julia Calcraft, Matron at Holme Valley Hospital.

3.0 Workstream updates

3.1 Provider services are currently developing work streams in 4 key areas. These are:

1. 18 week implementation plan. This is a group of operational managers responsible for delivering the 18 week target across the whole of provider services. This group has already made a significant difference in certain services. It is chaired by Pam Lumb, Head of Therapies

2. Adult services integration board. This board is jointly formed with social services. It leads work on bringing together services which can and should work more closely together. Its first output is to lead a pilot in Lindley of District Nurses and Home care workers operating more closely together. It is chaired by Tina Quinn, Assistant Director with responsibility for Therapies and specific services.

3. HR and workforce planning. This group is responsible for


Report to the Board

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developing a workforce plan and monitoring key HR information, including absence rates. This is chaired by Barry lane, Assistant Director of HR.

4. SystmOne implementation group. This group leads the development of SystmOne into all clinical disciplines within provider services. It is well supported by the Directorate of performance and information. It is chaired by Linda Meeson, Head of podiatry services. At present SystmOne implementation is on track (please see provider services minutes for road map)

4.0 Training and development

4.1 In January Provider services begins a long term programme of organizational development – in particular around leadership. The initial work is being done at team leader level. This means approximately 40 team leaders are going to be taken out of their job for 1 week to look at some personal development and training to help them manage their teams more effectively. The first of these weeks is in mid January, with last one taking place in the first week of February.

The development programme looks at all areas of front line leadership from personal behaviours to clinical practice to financial management.

Over the course of the New Year this development programme will be extended to include some coaching for operational managers in service improvement and performance management techniques.

5.0 Recruitment

5.1 Over the past few months Provider services have been recruiting into key front line disciplines, including district nursing, health visiting and therapies. More detail is included in some of the reports, but the general trend has been positive with good responses to nearly all adverts.

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6.0 Route to Solution

6.1 On November 28 Provider services held their first Route to Solution event. This event is the first in a series of 3 events which will see GP practices, frontline staff and operational managers redesign district nursing services. The first event was well attended by GP practices and feedback has been positive. The service improvement team are now working to develop early thoughts and ideas so that the next event can be as successful

Robert FlackDirector of Provider Services

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Report to the Board

December 2007

LOCALITIES


The purpose of this report is to update board on the latest developments in localities, and report on specific areas of achievement or concern.

Both Provider board and main board should note that all locality managers are now working with their public health counterparts to help shape the direction of service around the JSNA.

2.0 Access

2.1 All community services are reporting some pressure on teams. This has been caused by 2 main factors:

o High levels of short term sickness due to viruso The interregnum that teams are suffering whilst new people are

recruited. The absence leads were a particular issue is the Huddersfield South Locality with 43 days sickness in a two month period. This has now stabilised.

2.2 Health Visitors in Grange Moor (Denby Dale and Kirkburton Locality) have opened a one stop shop with surestart. This service has been positively received and enables clients to access child health services more locally.

3.0 Utilisation

3.1 The main area of concern here has been Health Visiting in Dewsbury and Batley. These services were approaching crisis point due to insufficient people in post. A paper was taken to SMT which set this issue out in detail. SMT agreed to the short term (6 month) appointment of 9 Health visitors; Provider Services now needs to put a business case in through approved process to make these positions permanent.

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3.2 All District Nursing teams are now using SystmOne. This means that we are now receiving high quality information about both activity levels and clinical caseloads which can help us work with GP practices to deliver the best possible care.

3.3 All housebound patients are receiving ‘flu injections from DN at present. We expect 100% coverage by 31st December 2007.

4.0 Quality

4.1 Over the past 3 months the community nursing service has received 6 letters of compliment and no complaints. In particular the Huddersfield North team received a significant charitable donation to district nursing equipment.

4.2 All Health Visitors are undertaking the common Assessment Framework (CAF) Training which will allow them to work more closely with social care and child protection teams.

4.3 A Kite Mark award for services promoting sexual health to teenagers in Kirkburton has been received. This service is provided by a combination of the GP surgery and the school nursing team. This is an excellent award and congratulations go to all staff.

5.0 Additional Information

5.1 Over the past 6 months the locality managers have made an enormous effort to work more closely with GP’s. Every practice has been visited on at least one occasion and in most cases action plans have been put in place to improve services at the local level. This work will continue and the locality teams hope to further improve these relationships.

5.2 These were an excellent attendance by District Nurses at the first route to solution event. Feedback from district Nurses was very positive, and pleased that their views were being listened to and changes could be made.

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Report to the Board

December 2007

HVMH Report

1.0 Access

1.1 Moorfield PCC

Open Monday – Friday 0800-1700Current Waiting times (circulated to all GPs in Huddersfield by Team Leader)

MSK ESP Kay Bradley-Higgins ESP Helen Smith ESP Hilary Turnbull GPwSI Jamie Buckle Podiatrist Patrick Roberts

6 weeks6 weeks6 weeks5 weeks8 weeks

Podiatry – Surgery Podiatry – Moorfield

5 weeks14 weeks

Neurology – Moorfield Neurology –HVMH

3 weeks1 week

ColposcopyDermatologyPlastic Surgery

4 weekstbatba

1.2 Walk in Centre open Mon – Fri 09.00 – 18.30

New patients attending : (further details available on request)

September 1500 October 1539November 1565

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1.3 Day Surgery Unit, HVMH

Opening times from 3.12.07 MondayTuesdayWednesday ThursdayFriday

1200 - 21000730 - 19000800 - 17000800 - 13000800 - 1630

2.0 Utilisation

2.1 Moorfield PCC

Monday Tuesday

Wednesday

Thursday

Friday

ampmampmampmampmampm

1 room available2 rooms available1 room availableNone available1 room available4 rooms availableNone2 rooms available2 rooms available3 rooms available

2.2 Maple Ward – step up and step down beds

Bed Occupancy Length of stay

September 87% October 84% November 86%

17.5 days17 days17.26 days

As part of winter planning, Maple Ward reports daily into organisational SITREPS.

2.3 Day Surgery Unit, HVMH – available room capacity

Monday a.m. Theatre free, 3 clinical rooms free p.m. 1 clinical room freeTuesday all day No capacity availableWednesday a.m. Theatre free p.m. Theatre free and 2 clinical rooms freeThursday a.m. 1 clinical room free p.m. All rooms freeFriday a.m. 1 clinical room free p.m. 1 clinical room free

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2.4 Walk in Centre

Either 2 or 3 consulting rooms utilised depending on staffing levels. Treatment room used daily for phlebotomy.

3.0 Quality

All areas complete patient satisfaction questionnaires. Complaints and Incidents monitored by Clinical Manager and action taken where appropriate.

Some policies and procedures used on Maple Ward were highlighted in the NHSLA review as requiring upgrading. These are currently being reviewed by the PCTs Clinical Governance team in conjunction with the Ward Manager for Maple Ward.

In line with the DoH recommendations around infection control, Maple Ward is required to undertake a “deep clean” before the end of the financial year. Money from the SHA is available to help fund this. The staff are working with the Estates Department and Infection Control to enable the deep clean to take place with the minimum disruption to patients.

4.0 Growth

4.1 Day Surgery Unit, HVMH

From December 2007-March 2008 there will be an increase in activity in Plastic Surgery and Podiatric Surgery to bring these waiting lists down in preparation for 13/52.

Business Development working with commissioners around bringing Podiatric Activity out of Mid Yorks and into HVMH.

6.0 Anything Else, Relevant or Important

6.1 Moorfield PCC

Estates are currently working with an architect to redesign the interior of Moorfield to ensure it becomes a “fit for purpose” area.

6.2 Day Surgery Unit

Building work will take place over the Christmas period when the Unit is closed to convert the first consulting room into a “colposcopy suite”. This will allow the operating theatre to become free on Thursday mornings and will comply with a recommendation from the National Cervical Screening Agency around privacy and dignity.The Minor Injuries Unit will be refurbished as a consulting room.

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The Theatre floor is to be re-layed.

6.3 SystmOne

Is to be introduced to Moorfield and DSU in February 2008. Clinical staff are currently working with H.I.S. to ensure all appropriate programmes are installed to capture required data for reporting.

6.4 Maple Ward, HVMH

The Ward was successfully nominated by Sheila Dilks to be part of the “Productive Ward” programme. Key staff have attended an initial workshop with more planned, and the concept of the productive ward presented to the Ward staff. Amanda Johnson, Senior Staff Nurse from Maple Ward, will take the operational lead, which will involve 50% of her working week. The programme runs for 9 months and all staff have to be fully committed in its implementation.

6.5 Walk in Centre

Problems with the C.A.S. (Clinical Assessment System) since the upgrade, as it is not capturing the required information for reporting. This is a National problem, which the company supplying the software are working on, with the WiC to resolve.

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Report to the Board

THERAPIES

1.0 Access

Detail attached – table 1. All services operating within 18 week target with the exception of Community Occupational therapy which is operating with a 25 week wait. There is an action plan in place to employ 2.5 occupational therapists into this team, on a short term basis which will reduce the wait to 10 weeks by February 2008.

In addition, there are plans to recruit short term staff into other therapy teams with the intention of driving waiting times down by March 2008:

MSK South – 2 sessions of physiotherapy per week. Domiciliary physiotherapy – 5 sessions per week. SLT – 10 sessions into Paediatric therapy.

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Service Number of weeks August September October

Community Occupational Therapy Service 20 weeks 26 weeks 25 weeks Community Rehabilitation Team -Physiotherapy 9 weeks 11 weeks 7 weeks Community Rehabilitation Team - Speech & Language 8 weeks 7 weeks 5 weeks Community Rehabilitation Team - Dietetics 21 days 3 weeks 4 weeks Community Rehabilitation Team - OT 8 weeks 8 weeks 8 weeks OT – Learning Disability Service 8 weeks 6 weeks 8 weeks Paediatric Occupational Therapy 10 days 10 days 2 weeks Jubilee Rehabilitation 9 -10 weeks 9 -10 weeks 8 weeks Domiciliary Physio Service 18 weeks 18 weeks 16 weeks

SLT - Paediatrics 14 weeks 6 weeks SLT - School Age Special Needs Communication 8 weeks 7 weeks 8 weeks SLT - School Age Special Needs Dysphagia 8 days 7 days 5 days SLT – Child Development Centre 15 weeks 15 weeks 15 weeks SLT - Adults with a Learning Disability Dysphagia 12 days 8 days 6 days SLT - Adult with a Learning Disability Communication 8 weeks 6 weeks 4 weeks SLT - Adults Voice 1 week 3 weeks 3 weeks SLT - Adults Neuro 2 weeks 6 weeks 6 weeks

Podiatry - Community 6 - 8 weeks 2 - 6 weeks 2-6 weeks

Podiatry - Diabetic 7 - 10 weeks 10-12 weeks 11-12 weeks

Podiatry - Biomech 5 weeks 10 - 12 weeks 7 weeks

Podiatry - Nail Surgery 3 weeks 2 weeks 1-2 weeks

2.0 Quality

There are no complaints being dealt with at the moment. Positive feedback received from a patient’s family member regarding rapid response service:

“I am e-mailing to express my delight at the response of the [rapid response] service. When I spoke to [my father] this evening he told me that he had been visited (for almost 2 hours) this afternoon by a lady from the service, that measures to give him support has been agreed, that two people came to help him with his evening meal (also leaving something prepared for his supper) and that, from tomorrow, he will get help with all his meals, starting with breakfast at 8.15am.

I am really grateful and very impressed by the rapid response from your staff.”

3.0 Utilisation

Detail attached – table 2. Current average intermediate bed occupancy 91% -an improvement of 8% on previous month.The Chart below should intermediate care bed occupancy for beds used in Batley, Spen and Dewsbury. The chart shows average bed occupancy at 91%, 8% improved on October 07.

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Bed Occupancy

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Se

pt

Oct

Westmoor

Fieldhead Park

Batley Hall

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Report to the Board

December 2007

SPECIFIC SERVICES


This report concentrates exclusively on contraception and sexual health service (CaSH) and the community matron service. Specific services also include specialist nursing, interprets services and primary care (PMS) provision. These will be included in future reports.

2.0 Access

2.1 CaSH

Within CaSH, there is currently a waiting time of 48 hours in Huddersfield and 3 weeks in Batley.

It should be noted that the staff have been working to an action plan to reduce waiting times in Batley and, to date, have reduced the waiting period from 6 weeks to the present figure.

It is intended to continue with the action plan to reduce this waiting time further so that both sites reach our intended 48 hour access target.

2.2 Community Matrons

There are nine community matrons plus 2 case managers delivering the service at the moment. In addition there are:

0.8 on secondment0.8 on study leave requiring backfill1.0 on maternity leave1.0 case manager vacancy

Currently, all patients referred into the community matrons are allocated within a week.

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3.0 Quality

3.1 CaSH

No complaints have been received by any part of the service during the past month.

During October concerns were expressed about the suitability of the environment and the welcome given to young people at the drop-in clinics in Huddersfield. The staff have considered the issues fully and, as a result, an action plan has been developed to ensure that young people will feel welcome and that issues of confidentiality improved. ‘Mystery shoppers’ will be visiting the clinic in the New Year and we look forward to their feedback on the young people’s service.

3.2 Community Matron

There has been a failure to recruit appropriately skilled staff to the discharge co-ordinator posts and the community lead post. There is an action plan in place to recruit to these posts.

4.0 Utilisation

4.1 CaSH

A review has been undertaken of clinic appointments to ensure that there is full Utilisation of clinic capacity. With the implementation of SystmOne it is intended to move to varied appointment lengths to ensure that capacity is used to its maximum. The new appointment of business Administration Manager will be used to support this work.

5.0 Growth

5.1 Community Matron

Appointed to 2 heart failure specialist nurse posts, 1 respiratory specialist nurse post and 1 community matron post.

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Report to the Board

December 2007

Report from Adult Transformational Change Team

Introduction

The aim of the Adult Transformational Change Team (TCT) was to work with service providers to enable a programme of development and improvement to be established, implemented and sustained.

Adult services were identified and key individuals invited to a meeting. Two time limited subgroups were formed to provide an opportunity to discuss key issues and to provide feedback as to progress on the key tasks.

Objectives

The main objectives of the TCT are:

To identify areas for improvement and development within a defined service

To devise and implement a process of continuous development To educate and support staff in developing and using Service

Improvement and Business Development skills To ensure Systm One is fully integrated across all services and it’s

utilization is exploited to maximum effect To ensure services continue to develop in line with the Provider Arms

metrics of Access, Quality, Utilisation, Finance and Growth To enable a culture of transformational thinking and working to develop

and be sustained across services

Key Outputs required by 14th September 2007

To produce a base line assessment of current state of service to include staff mix and roles, services provided and financial situation

To produce a service delivery plan identifying areas of high priority for service re-design, opportunities for expansion and growth and areas of low value returns

To produce a workforce development plan, outlining forecast staffing needs and mix, training needs and opportunities and outline financial projections

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The above 3 outputs to form the basis for tailored Business Development and Service Improvement support

Strategic Links

It is imperative that the work of the TCT links directly to the 9 Key Strategic Tasks identified for Kirklees Provider Services. For ease of reference these are:

Getting people to support the new organization Growing and supporting leaders Securing, sustaining and growing the organization Using resources to greatest effect Improving access Constantly improving quality Managing finances Establishing the service portfolio Implementing an enabling governance framework

All outputs and recommendations from the TCT should be tied to at least one of the above and supported by direct evidence of added value to that Strategic Task.

The above is also intrinsically linked to the Provider Services Fitness for Purpose high level action plan and will form the basis of regular updates to inform the Provider Board about timely compliance with the action plan.

Services reviewed

32 services were considered under the remit of the Adult TCT Although some services cover both adults and children these have been included and agreed with the other TCT’s (Children and young people and Therapies). Service specifications have been developed by some services, are in progress in others and not required by others (Table 1).

Table 1.

Service Group

Service NameService

specification completed

Service Specification in

Draft

Service Specification not

required

Adult services

Case Managers Yes

Adult services

Community Matrons Yes

Adult services

District Nursing Days Yes

Adult services

District nursing Out of hours

Yes

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Service Group

Service NameService



Draft


required

Adult services

End of Life Facilitator Yes

Adult services

Evenings and Night service

Yes

Adult services

Flexi nights Social services

Adult services

Funded Nursing Care Yes

Adult services

Leg Ulcers Yes

Adult services

Macmillan Nurses Yes

Adult services

Sitting service Yes

GP Practices

Broughton House PMS contract

GPPractices

Dr Dutts GMS contract

GP Practices

Slaithwaite GMS contract

GP Practices

University Practice Yes Via Childrens TCT

GP Practices

Whitehouse PMS contract

GPSWI Colposcopy/ menhorragia

Yes

GPSWI Dermatology Yes

GPSWI MSK Yes

Other CaSH Yes

Other Community Dental Services

Yes

Other Interpreter Services Yes

Other Maple Ward Yes

Other Newsome Next Generation

Yes Via Childrens TCT

Other Reception Services Yes

Other Smoking cessation Still in public health

Other University Practice Via Childrens TCT

Other Walk in centre To be separate TCT

Specialist Nurses

Asylum seekers Via Children’s TCT

Specialist Nurses

Cardiac rehab and CHD

Yes

Specialist Nurses

Continence Specialist nurses

Yes

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Service Group

Service NameService



Draft


required

Specialist Nurses

Diabetes Specialist Nurse- North

No No

Specialist Nurses

Diabetes Specialist nurses- Huddersfield

Yes

Specialist Nurses

Homeless Via Children’s TCT

Specialist Nurses

Nurse Practitioners Part of various GP practices

Specialist Nurses

Primary Prevention Nurse

Yes

Specialist Nurses

Respiratory Nurse Yes To Transfer from mid yorks

The only service specification expected that a draft has not been seen on is the Diabetic Specialist nurse –North

The current services have the following Whole Time Equivalent (WTE) (Table 2) and numbers of staff. The accuracy of this information is limited as it is drawn from the Nominal role and some services are not easily identifiable. GPWSI services have had their figures collated as one service as it is not possible to split these for individual services from the nominal role.

Service NameStaff Establishment

(WTE)Staff Establishment

(Numbers)

District Nursing Days 174.52 321.00

Community Dental Services 53.60 62.00

Maple Ward 22.12 28.00

Evenings and Night service 14.95 41.00

CaSH 14.72 32.00

District nursing Out of hours 13.85 34.00

Community Matrons 13.50 12.00

Broughton House 11.37 14.00

Dermatology 9.19 15.00

Slaithwaite 8.61 10.00

Walk in centre 8.48 9.00

Whitehouse 7.83 12.00

Interpreter Services 7.07 6.00

Smoking cessation 7.00 6.00

Continence Specialist nurses 6.94 10.00

Primary Prevention Nurse 6.09 7.00

Diabetes Specialist nurses-Huddersfield

5.86 6.00

Flexi nights 5.50 15.00

Case Managers 2.00 2.00

Homeless 1.10 2.00

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Service NameStaff Establishment

(WTE)Staff Establishment

(Numbers)

End of Life Facilitator 1.00 1.00

Macmillan Nurses 1.00 1.00

University Practice 1.00 0.00

Cardiac rehab and CHD 1.00 1.00

Diabetes Specialist Nurse- North 0.80 1.00

Funded Nursing Care 0.00 0.00

Dr Dutts 0.00 0.00

Newsome Next Generation 0.00 0.00

Respiratory Nurse 0.00 0.00

Reception Services 0.00 22.00

Sitting service 0.00 0.00

MSK 0.00 0.00

Asylum seekers 0.00 0.00

Nurse Practitioners 0.00 0.00

Colposcopy/ menhorragia 0.00 0.00

Leg Ulcers 0.00 0.00

The largest service in terms of staffing is the District Nursing Day Service.

The Financial situation for each service cannot be collated centrally as budgets are still being negotiated and financial challenges established.

Areas of high priority for service redesign are highlighted in Table below.

Service Name Service redesign in past 3 years

High Priority for service redesign

Medium Priority For

service redesign

Redesign to be team led


Yes No Yes NoLeg Ulcers Yes Yes No NoInterpreter Services No Yes No NoCase Managers No Yes No NoDistrict Nursing Days No Yes No NoDistrict nursing Out of hours No Yes No NoWalk in centre No Yes No NoCaSH No Yes No NoDermatology No Yes No NoColposcopy/ menhorragia No Yes No NoMaple Ward No Yes No NoEvenings and Night service No Yes No YesPrimary Prevention Nurse No No Yes YesCommunity Matrons Yes No Yes NoWhitehouse Yes No Yes NoRespiratory Nurse No No No YesReception Services No No No YesSitting service No No No YesContinence Specialist nurses

Yes No No Yes

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Community Dental Services No No No YesNurse Practitioners No No No NoSmoking cessation No No No NoFlexi nights No No No NoUniversity Practice No No No NoBroughton House No No No NoNewsome Next Generation No No No NoFunded Nursing Care No No No NoDr Dutts Yes No No NoCardiac rehab and CHD No No No NoAsylum seekers No No No NoSlaithwaite No No No NoHomeless Yes No No NoMacmillan Nurses No No No NoEnd of Life Facilitator No No No NoMSK No No No No

The following areas for priority design has been assessed on a matrix (attached)

Areas of high priority

Throughout the work of the TCT it is clear that staff are prepared to work hard to share the work their services deliver. This has been demonstrated by the commitment that staff have shown in either writing the service specifications or by contributing to them.

There are several areas that have been identified as priority areas for service development but this is not exhaustive as new areas will emerge and develop as priorities change. The list below demonstrates the initial areas that have been identified as immediate priorities, each area will be taken in turn to provide a brief overview on the scope of the project. It must be noted that this list is not exclusive and there are clearly new priorities emerging on a regular basis.

DN workforce and service. DNA rates across a variety of services. Waiting times in Moorfields. Interpreter service Maple ward Walk in centre. Developing performance indicators for all services Community Dentistry. Fusion of separate services from previous PCT’s.

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DN workforce and service.

The DN service is one of the largest services within Provider Services with a large budget. The Standard role although now defined in a service specification needs defining and developing in greater detail. The enhanced services show a wide variety of activities and in all areas there are roles undertaken by the DN service which would be better undertaken by other services. Therefore the role of the DN service needs clearly defining and the workforce developed to meet this need. There is a clear need to create fusion in the service from historic differences in areas of the PCT. Part of this will be to ensure equity of role and remuneration.

There is a potential that homecare may take on the role of administering chronic eye drops. This will create some capacity in the teams which will need to be managed with an effective transfer of care. This spare capacity will release Health Care assistant time which could be used to expand their role potentially in delivery of care above their current role e.g administering of insulin injections for long term stable diabetics. This would create capacity for trained nurses to develop new areas, eg IV chemotherapy. There is potential to take on new work from work traditionally delivered in an Acute setting.

Performance management needs to be integral into this and the use of Systm One, the development of mobile IT solutions to work with Systm One need to be linked.

Leg ulcer clinics although a separate service specification are in Huddersfield run by DN teams and the new clinics set up in 2006 are either not running or there is difficulty in running them with inconsistent staffing and data collection, costs of transport and lack of podiatry personnel following a retirement.

Lack of professional guidance generally for the DN service and a lack of clear strategic direction will leave the service vulnerable. Given this is an area of scrutiny by GP’s with a potential threat of GP’s wishing to employ their own DN, this is clearly and area of high risk.

In order to agree the imminent priority within DN and to focus on the future this needs to link clearly with the “Focus on” sessions to be described under the GP relationship section and also a workshop with DN to agree the best way to meet the needs.

There is a bid to Yorkshire and Humber and if successful would lead to work on developing a productive team in Kirkburton.

In order to manage the changes successfully, there needs to be a clear strategy on the direction of travel for this service which needs informing from the commissioners. This can then lead to an appropriate action plan that will inform a project plan.

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Links to strategic aims

Growing and supporting leaders, using resources to the greatest effect, improving quality, managing finances, establishing a service portfolio and implementing an enabling governance framework.

DNA rates across a variety of services.

A common theme across many of the clinic based services is the DNA rate which impact on waiting times, and efficiency of the service. Each service has developed some techniques to tackle this, however lessons can be learnt from within provider services and from national examples including technological advances. This has been highlighted in Continence, Interpreter, CaSH, and Dentistry, but is likely to be a theme relevant to other provider services. Investigating the use of alternative technologies eg text messaging services

Waiting times in Moorfields. (see Appendix 1 for service report)

There is a waiting time in Moorfields plastic surgery GPWSI over the 18 week limit. Urgent redesign and evaluation is required to address this. There is already some work from service development to address this and this needs to continue.

Interpreter service (see Appendix 2 for service report)The current service has a large expenditure (insert budget) with increasing demand and need providing a service to CHT which is unpaid for. There are different levels of service in different parts of the PCT. Again in this service there are issues of DNA or wasted visits or late cancellations which are costly when using a subcontracted service.

Maple ward.Plans to move this into a new ward will generate opportunities for development and is part of the Governments plans for community hospitals and funding. There is also a bid to Yorkshire and Humber for a Productive Team(Separate TCT)

Walk in centre.This service has not been reviewed by the adult TCT, however has been identified as needing a separate TCT due to the level and type of activity in the service.

Developing performance indicators for all services.

It has become clear in developing the service specifications that very little investment has been made in the past years on qualitative performance measures in all services. Similarly there has not been a system of systematic data collection. This is an area of high risk to ensure value for money and quality of service, and developing evidence under Fitness for Purpose and to provide evidence of effective service delivery and outcome for patients.

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Community Dentistry.

As a service covering not only Kirklees PCT but also Calderdale PCT this service has developed some regular performance measures which are regularly reported upon. There is a potential opportunity to explore expansion into neighbouring PCT’s.

Fusion of separate services from previous PCT’s.

There are few services that this does not affect in terms of culture, pay, activity and differences in services offered and delivered. A key role of service development will be to work with service managers in developing all services in this way. There are some services which do not have an equivalent service delivered in another part of the PCT, for example the primary prevention team is not replicated in the Huddersfield area, and the diabetes team providing services in the Batley, Birstall and Birkenshaw, Dewsbury and Mirfield and Spen localities are largely employed by Mid Yorkshire Hospitals rather than the PCT.(See Appendix 3)

Community Matrons

Is an area of high expenditure in terms of staffing and also of high service expectation to reduce the demand on secondary care services. With further recruitment expected there needs to be consistency of service delivery targeting consistently with clear expectations on outcome. This has been inconsistent in parts of the service to date and as the service grows this needs to be supported. The scope of this needs further defining.

Cash

Waiting Times in part of the service is greater than the 48 hour recommended . There may be potential opportunities to deliver more tier 2 services. There are also financial challenges in this service for IUCD and implants.

Relationship management.

GP’s are the key customers as well as patients and this relationship needs to be managed to ensure appropriate and responsive service delivery. Action is required to develop this. The running of 7 “focus on” sessions in the localities will be a high priority.

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General

From the areas highlighted above there are long medium and short term projects. As teams become more developed in service improvement techniques the requirement of service development will change. In the first instance part of the role of service development will be more “hands on” and over time anticipate more consultative.

As the commissioners decommission services there will be opportunities to tender for contracts, there needs to be sufficient capacity within service development to do this.Throughout the projects there needs to be meaningful engagement of patients in service redesign.

Proposed design of TCT

The membership of the TCT will need to change to reflect the above service development needs.

Conclusion

There are many services that would benefit from service development input. Clearly the service development team is unable to meet the needs of all the services. Consequently it is imperative that our staff are given the opportunity to develop the skills to identify opportunities for redesign and to implement the changes. It has not been possible to complete all the information required for this report due to the lack of centrally held accurate information

Recommendations

The TCT recommends these actions are approved and implemented

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Appendix 1.Moorfields Community Treatment Centre: Report on Services

Kirklees PCT Provider Services

Aim

The purpose of this report is to outline current service provision at Moorfields Community treatment centre and to identify potential improvement opportunities surrounding thecurrent model of patient care.

Moorfields currently provides a range of Primary Care services; the centre was established by the former Huddersfield PCTs in line with national policy drivers to deliver care closer to home.

This report intends to outline the current issues facing the services, to inform potential service development opportunities.

Current service model

The services going through Moorfields are split into two constituent parts. Firstly, those directly delivered on the premises: - Musculo Skeletal, Dermatology and Plastics. Secondly, the co-ordination of waiting lists for Colposcopy and Surgical Podiatry

In addition to this, Moorfields generates & triages patients for minor plastic surgery at Holme Valley Memorial Hospital.

Clinical Assessment Service (CAS)

The clinical assessment service was historically located at Moorfields, more recently this has been relocated to St Luke’s House to ease operational pressure. CAS currently supports all the extended primary care services provided via Moorfields treatment centre.

Referrals are processed by the CAS staff ready for triage by the relevant clinician by specialty, at present, triage either takes place on the premises or electronically.

Since its implementation in 2006, CAS has received and processed approximately 7360 referrals, 4360 of which were seen in a primary care setting.

Directly provided services

Musculo Skeletal (MSK)

Dr Jaime Buckle, GP with a special interest in MSK, provides the service directly on site with the following exceptions

Urgent Referrals Patients under the age of 18 Rheumatological Referrals Suspected Cancers

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Working along side Dr Buckle are four Extended Scope Physiotherapists, to support the management of MSK conditions. In addition, a Podiatrist works every Monday morning to compliment the work of the MSK team.

Clinics are currently held on Monday am, Tuesday (full day), Wednesday am and Thursday am.

Current Activity for MSK

Waiting lists are currently managed by clinician within each specialty, the detail for MSK is outlined below:-

Clinician/ Role

Clinic sessions and times

New Appointment Time

Review Appointment Time

Current Waiting Time

Waiting List (08-07)

Dr Buckle (GPWSi)

Monday 9.30-12.30Tuesday 9.30- 12.00Wednesday9.30- 12.30Thursday

30 minutes 15 minutes 8 weeks

Patrick Roberts (Podiatrist)

Monday 9.00- 12.00


Helen Smith (ESP)

Tuesday 13.00- 16.00Thursday09.00-12.00


Alison Sharp (ESP)

Monday8.30-11.30


Hilary Turnbull(ESP)

Tuesday 13.00- 16.00Wednesday08.30- 11.30Thursday 08.30- 11.30


Kay Bradley-Higgins(ESP)

Monday 8.30- 11.30Wednesday8.30-11.30Thursday8.30-11.30


Comments Re MSK Activity

1st Tuesday am and 4th Thursday in the month are lost due to ongoing professional development commitments

Dr Buckle has 30 minutes to triage on Tuesday/ Thursday All the ESPs see mainly new patients, but if a review is needed, two patients are

put into a 30 minute slot.

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Plastics

Dr Colin Wright GP with a specialist interest in Plastic surgery provides a plastics clinic on alternate Monday afternoons and evenings (2pm to 8pm) with the following exceptions

Procedures in the minor surgery guidelines: additional services and enhanced services (unless opted out)

Urgent cases Cancers Children under 16 years of age- (sent directly to secondary care)

Once referrals are received they are triaged into the local anesthetics plastics service (delivered at Holme Valley by Dr Wright) or referred into secondary care. The Dermatology service at Moorfields also generates patients requiring plastic surgery which impacts on the waiting time.

Current Activity for Plastics

Clinician/ Role

Clinic sessions and times





Dr Wright (GPWSi)

14.00-20.00Alternate Mondays14.00-20.00Alternate Mondays(mat leave cover for Dermatology)

30 minutes 29 weeks

Dermatology

Drs Tim Swift, Gemma Simcox and Anil Aggarwal provide a Dermatology GPWSi service, supported by Dr Hempel, a consultant dermatologist.

Currently Dr Simcox is on maternity leave until November 07, extra sessions are being made available with Dr Wright, the GPWSi for Plastics at Holme Valley.

Current Activity for Dermatology

Clinician/ Role Clinic sessions and times





Dr Hempel(Consultant Dermatologist)

Tuesday 9.15-12.30


Dr Swift(GPWSi)

Tuesday13.30-15.30


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Thursday13.00-15.00Friday10.30-12.00

Dr Aggarwal(GPWSi)

Friday 11.00-13.30


Recommendations for Moorfields

Organise a process mapping event for each service area, with an initial focus on plastics.

Demand has increased significantly since the centre opened. Once the pathway has been mapped we have looked at the process to identify any bottlenecks/ potential areas for streamlining.

The option of additional resource needs to be considered- or setting a referral limit for each calendar year (based on the capacity available) when this limit is reached, patients are then diverted along other pathways.

RH to sit in on plastics clinical session to scope out the current issues/ follow the patient journey

Look at the patient pathway for plastics using lean methodology, explore the offer to showcase Moorfields as part of the lean training event on the 18th, 19th and 20th September.

Agreements are already in place for the following surgeries to provide minor surgery services:-

Dr Anderson and Partners (Fartown)Dr Clayden and Partners (Holmfirth)Dr Gowa (Huddersfield Town Centre)Dr Hamid (Newsome)Dr Mitchell and Partners (Meltham)Dr Parker and Partners (Honley)Dr Priestman and Partners (Kirkburton)Dr Seeley and Partners (Scissett)Dr Swift and Partners (Paddock)Dr Welch and Partners (Skelmanthorpe)Dr Jabczynki and Partners (Skelmanthorpe)

A recommendation would be to recruit one of these interested GPs to provide some additional plastics sessions to manage the waiting list.

Maternity leave for Dr Simcox (GPWSi Dermatology) is coming to an end in November 07- this should free up Dr Wright to provide additional plastics sessions.

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Premises and Facilities Improvement

After consultation with staff, the following improvement opportunities have been identified regarding facilities and premises.

The Moorfields premises are currently used as follows:-

1. Four consulting/ treatment rooms.

2. Waiting room/ reception area containing seating for patients, with access window into the administration office.

3. Administration office with four computer workstations and filing area.

4. Kitchen adjoining the admin office for staff use.

5. File store room for patient records with two computer workstations.

6. Separate staff and patient toilet facilities (two rooms)

7. Parking facilities for patients and staff (approximately 20 spaces for communal use with the local community centre and co-op)

Moorfields Community Treatment Centre: Facilities & Premises Improvement Opportunities:-

1. Signage from the road.

2. Two additional treatment rooms.

3. Additional room for post treatment information.

4. Staff area.

5. Main admin office, to have a ‘front of house’ split- reception area to be separate from other activities

6. Combination locks on treatment room doors

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Appendix 2.

Linkworkers/Interpreting ServiceKirklees PCT

Service Report

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Introduction

It is evident that patients whose first language is not English face numerous difficulties when trying to access healthcare provision. In order to provide effective access to services to such patients the health service needs to provide an effective language service.To counteract barriers and to fulfil its duties Kirklees PCT needs to develop an accurate easily available speedy and cost effective translation and interpreting service.

Services must include;

Face to face interpreters Translation services,Sign languageTelephone translation

Legislation and Guidance

The NHS plan, core principle 4, states that the NHS must be responsive to the different needs of different populations

The NHS plan states;

The NHS will need to address local inequalities including issues such as access to services for black and ethnic minority communities; By 2003 a free nationally available translation and interpreting service will be available from every NHS premises through NHS Direct. (NHS plan 2001)

The McPherson (1999) and Acheson (1998) reports raise ethical issues around a whole range of problems regarding access to services.

Given these drivers and the fact that Huddersfield serves an ethnically diverse population the trust needs to ensure that an interpreter should be available for anyone for whom English is not their first language.

The languages in demand fluctuate over time and change considerably as this is influenced by world events and issues outside of the UK therefore it is difficult to predict the scale and nature of the future need.

Definition and background

Communication is defined as the transmission of information from one party to another.

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What is important in any interview situation is to minimise, as far as possible, factors which may block the communication process, i.e.: the language barrier.

The role of the interpreter is to eliminate the language barrier and thus facilitate communication between two or more parties that do not speak the same language.

Face to face interpreting involves a minimum of three people, the professional, the patient and the interpreter meeting at a pre arranged time and location.It is best used for;

Complicated procedures, such as assessments consultations with professionals in healthcare settings

Face to face interpreting also includes British Sign Language.

Telephone interpreting involves three or more people, the professional, the client/patient and the Interpreter having a telephone conversation.

This should be restricted to;

Unplanned and emergency situations Instances where a face to face interpreter is not provided or the interpreter

fails to attend Resolving simple issues (not good for complex or lengthy consultations) Confirming or rescheduling appointments

Without a trained interpreter professionals may rely on family members or friends

Problems can occur with confidentiality and accuracy of information transferred between the health professional and patient when an Interpreter is not used.

Key strategic objectives

To deliver a high quality interpreting service

Raise profile of the current service

To increase efficiency and accessibility for patients, families and staff

Further develop and improve the centralised electronic booking system Produce and develop an Internal register of interpreters >BSL.> and

improved translation services

Current provision

The present structure of the of the interpreting service as it stands

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The PCT employs a team of 3 permanent Linkworkers covering core languages such as Urdu/Punjabi, one full time equivalent administration support to the electronic booking system for the Interpreting service, and 2 bank staff to pick up ad hoc assignments on an as and when required basis covering Urdu/Punjabi.However there are some vacant posts, (French, Arabic, Kurdish and Farsi) these posts have been vacant for over 12 months due to the PCTs financial position.

The following organisational chart shows service provided in house and the current vacant posts

Internal team are highly skilled and experienced and deliver a professional service to patient and professionals

There is a need to expand the internal team in order to deliver a professional service to its users

Benefits of internal staff

Highly skilled, enhanced performance

Urdu/PunjabiTeam Leader

Part time 30 hours

Urdu/Punjabi3 staff

Part time Total of 82 hours

Kurdish/Farsi/ArabicTotal 52 hours

Vacant post

Administration2 staff

1 full time equivalent

French/ArabicTotal of 35 hours

Vacant post

Bank staffUrdu/Punjabi

Currently one person on bank list

KirkleesCommunity Language

Service

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All team trained to certificate and Diploma level Improved accessibility to patients Continuity to professionals and patients Good knowledge of healthcare, its systems and processes. Increased accountability Flexible, accessible, reliable, and highly professionals

Freelance approach

It is evident that a high quality service offering a wider range of languages needs to be provided internally to ensure easy access to healthcare for patients and families for who English is not there first language

The service needs to provide effective delivery of service maintaining a register of freelance interpreters offering a wider range of languages available through the Linkworkers/Interpreting team

Adopting best Practice

Leeds language Link, and SCAIS of Sheffield (local Interpreting services)

Objectives

Raise the profile of the Interpreter service Provide an out of hour’s service to emergency services Single point of access To bring all PCT linkworker/Interpreters to together into one team Reducing the use of external resource for core languages To determine the role and function of the internal team Increase efficiency and improve quality thus reducing risk Develop an interpreting service that is cost effective A service that is open to others thus generating income Improve the management structure for the service Link with PALS promoting service and access Interpreters should be recruited, trained and employed by the NHS

Good Practice

The availability of good quality interpreting is the most important factor governing access to health service for those who have difficulty communicating in English.

As good practice, professionally trained interpreters should be made available

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The use of family members, carers and particularly children should be discouraged in order to ensure effective communication, patient confidentiality and impartiality.

Cultural sensitivity needs to be considered when booking interpreters, as gender matching is important within sensitive areas of health e.g. (family planning, maternity services and the mental health team.

All health care professionals should receive cultural awareness training, covering the cultural dietary and sensitive needs of the patient.

Lack of awareness about cultures and making assumptions is one of the biggest factors to inappropriate use of the interpreting service resulting in wasted resources

Emergencies and out of hours services;

Telephone interpreting needs to be improved and promoted and should be made available as a back up through the National Interpreting Services

The use of this service will need to be made available to all PCT Acute and Mental Health staff, this service is extremely expensive but offers a wide range of languages, is easy to access and normally responds within minutes of a request being made

Training should be made available to all staff on the use of the National Interpreting service

Guidance on the use of the Interpreting service is currently outdated and needs to be reviewed and updated

In emergency situations access to a freelance Interpreter should be made available through the main Switchboard at the HRI

A register of on call interpreters should be kept with the main switch board at the HRI

Activity

Since its establishment in 2000 the Linkworkers and interpreting service has delivered over 15,000 pre planned health service sessions in over 40 languages across the Huddersfield area

Total numbers of face-to-face assignments carried out by interpreters provided through the department are as follows;

200 to 250 within a one week period (9th July to 13th July 2007)

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40 to 50 on a daily Total number of Interpreters sessions provided to Kirklees PCT is 15055

over the period from January 2006 to July 2007 (Huddersfield wide)

The Linkworkers and Interpreting service records and monitors all requests, including those they cannot fulfil, but are confident that they are meeting 90% of the demand internally and externally

Demand is growing from the Eastern European languages since the accession to the EU of 10 countries; however it is difficult to predict the collective language needs in advance as this is strongly influenced by global events and policies.

Data found:

The following table below shows most common languages requested for which interpretation is provided by the Linkworkers and interpreting services in Huddersfield.

Requests collated are from period September 2005 to June 2006

languages met and unmet sep2005/june2006

562

1160

1293

713

182139

626

392

272233

82

178 166

0

200

400

600

800

1000

1200

1400

Urdu Punjabi Kurdish Farsi tygrinian amharic French polish Turkish Russian cantones mandarin Arabic

most common languge requests

req

ue

sts

re

cie

ve

d

95% of the above appointments are met and only 5% not met which includes cancellations either from departments or patients.

Total expenditure

BudgetsPeriod March to June 06Period March 0/6 to July 07

£79,655.18Total £292,546,16

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The above does not include any face-to-face assignments carried out by the internal team of LinkworkersWho we are serving?

Service Who is served Who is not/why LinkworkersInterpreters, face to face.

Health visitors, midwives, clinics, acute services GPs, Mental Health, The Whitehouse CentreDental

OpticiansSocial workers

Sign language All health service staff Sometimes a free service, occasionally require freelance

National Interpreting Service (telephone interpreting)

All health professionals GP surgeries, some dental practices. Whitehouse Centre

A highly expensive service used as a backup or in emergencies.

Translation of documents, medical reports, leaflets and signs

All PCT StaffAcute, GPs ,etc.

No charge to PCT.There is a fee for larger documents, or reports.

Service is available;

Monday to Friday (9.00 am – 5.00pm)

Currently the Trust does not provide an out of hour’s service;

The Whitehouse Centre

The Whitehouse Centre is one of the largest key service usersYorkshire and Humberside has the highest dispersed asylum seekers within the UK. Statistics show that Kirklees is one of the top ten councils within the UK who has the highest dispersed asylum seekers within NASS accommodation.

Statistics

Asylum applications for quarter 4; 0ctober-December 2005 Countries NumberIran 820Eritrea 595Afghanistan 510China 470Somalia 405Zimbabwe 385

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Nigeria 265Pakistan 255De Rep of Congo 235Iraq 185Other nationalities 2,035Total 6,165

Regions with highest numbers of asylum seekers in NASS accommodation;Quarter 4; December 2005

Yorkshire and Humberside 22%North West 17%Scotland 15%West midlands 14%Wales 7%East midlands 6%

Statistics taken fromAsylum Seeker national statistics for Quarter 4 October-December 2005

Whitehouse continued

Previously the internal team of Linkworkers usually Kurdish, Farsi and French provided regular cover to the Whitehouse.

It was a highly cost effective form of service provision

Whitehouse Centre could benefit with direct booking of interpreters to meet their specific need in house, and an individual set budget for the centre.

Salaried part time Linkworkers could be allocated to the Whitehouse Centre in specific languages with temporary contracts so as to ensure changing need of the service

Vacant Linkworkers posts need to be filled in order to reduce waste of resource and money to freelance interpreters

Administration provision

All requests received are entered on to the electronic booking system.Issues that may need to be considered included during the booking process

Gender Country of origin/dialect Specialist knowledge (team leader to address)

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Continuous training to the admin team to meet changing need of the service

Currently the Interpreting service is developing a single point of access to all Kirklees health professionals in order to deliver effectively further administration hours and IT resources will be required in order to cope with increased volume of Interpreter requests, manage Linkworkers diaries and keep up with invoices from KCLS

Monitoring the electronic booking system

Due to the massive increase in interpreter requests the volume of calls within a day can range from 50 to around 75 calls.

The department has set up centrally coordinated interpreting booking system incorporating standardised proceduresIn addition a new system of faxing interpreter requests has been made available to staff, this helps free up the busy telephone booking system

The service is desperate need of IT resources, without these resource the service fails to function effectively

To improve the booking system further communication resources will needed to be provided such as; desk top computer, up to date telephones and further administration hours on an as and when required basis to deal with requests, queries and invoices

Kirklees Community Language Service

A highly expensive service provided through the council Kirklees is a council run agency that provides freelance interpreters for the Trust through the Linkworkers and Interpreting services. This has huge cost implications and the Trust has little control over the quality of the service provided by KCLS. It often fails to meet the expectations of healthcare professionals and continuity cannot be provided to patients and staff

Implications when booking is made through the Kirklees language service

Costly Unreliable Poor quality of service Double bookings Lack of continuity Communication problems High volume of complaints from service users

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Current KCLS charges

As of March 2006 new revised rates from KCLS are as follows;

Up to 1-hour minimum charge £22.00 plus travelling expensesCar mileage at 0.27 pence per milePlus travel time £5.00) within locality, £7.50 immediate borders and £15 anything beyond, subsequent charge after the 1st hour £7.00+15% on total amount

Missed appointments still require interpreters to be paid; there is a cancellation fee if agency is not informed within 24 hours of a cancelled appointment. Late cancellations by health professionals/service users are a re occurring problem.This is a waste of valuable Interpreter time and resource therefore professionals need to be made aware of this cancellation charges incurred by KCLS

Appropriate and robust training programmes need to be in place on the use of interpreters, this should be done on a rolling programme to cover new and existing staff.

Linkworker Role

The work of interpreters is undervalued, at least in part, because of the failure to understand the skills involved, this leads to low rates of pay even for highly qualified and experienced interpreters and to the mistaken belief that anyone who speaks the other language concerned can do the job adequately.

The various roles and responsibilities of Linkworkers and the expectations

Bi lingual workerInterpreterAdvocateHealth advisorHealth promoterOutreach workerPatient representativeChaperoneCounsellorMessengerCultural advisorChauffer Clerical support

Linkworkers Salaries

Most bilingual workers are employed on A&C grades, but there is great disparity in the grading. Some staff are paid on A&C grade 5-6, while others are one A&C grade 2-3. (Baxter et al 1996)

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It is matters of personal disadvantage to the post holder themselves, which is compounded by the lack of career structures with opportunities for progression up a salary scale (Warrier and Goodman 1996).

Secondly, in a status conscious and hierarchal body like the NHS, Linkworkers on A&C grades are likely to find that their low salaries are reflected in the low esteem that their posts may have in the eyes of colleagues (Cornwell and Gordon 1984)Linkworkers employed by Huddersfield PCTs are graded at;

Before Agenda for change A&C 3After Agenda for change team have been awarded a mere Band 3.(This does not reflect the professionalism of the Linkworkers)

The low salary levels have several consequences.

Salaries should be reviewed in line with development of the skills and roles of Linkworkers.

Low salaries leads to low team morale and losing highly skilled staff as they will seek better paid employment elsewhere. Recruitment is costly and it will take new recruits a along time to gain the level of expertise held by the current team

There is also a need to raise awareness among users regarding the interpreter provision, including promoting the interpreter or Linkworkers as a fellow professional

“Staff deserve to be treated fairly and with respect, a key challenge is to ensure that equality of opportunity is integrated into everything the NHS does – not only in service delivery but in how staff are treated and valued”(The Vital Connection, equalities framework for the NHS)

Training

All Linkworkers employed by the PCT have undergone specific training and are highly skilled, they possess the bilingual skills certificate, or a Diploma in Public service Interpreting enabling the team to utilise the specialist terminology when conducting assignmentsThe training provided has helped enhance the performance and the role of the Linkworkers in Huddersfield.

Specialist training should be a standard minimum requirement for new and existing bi lingual staff employed by the Trust

The Diploma in Public Service Interpreting is the recognised national standard for interpreters and translators in the UK.

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Robust training packages will need to be in place for freelance interpreters ensuring confidentiality and reducing risk to patients

Title for Linkworkers

The term linkworker seems to be out dated, the term “worker” is confused with the term Interpreter, the title of the internal team of Linkworkers need to be reviewed.

Suggestions from the team were made such as, “link officers”, or “Liaison officers”

Bank staff

The rates of pay for the bank staff are poor and currently as a result has become extremely difficult to retain staff, over the last 12 months the service has lost 8 highly skilled salaried, and bank Linkworkers to the Kirklees community language service.

Rates of pay for freelance interpreters or bank Linkworkers need to be reviewed in order to establish and retain a register or pool of bank staff

Rates of pay externally are more attractable to staff which is one of the factors in staff retention as is flexibility in working hours –

Management and support

Currently the team leader for the service operationally manages the service.The team leaders role consists of providing the facilitation of communication between patients/families and healthcare professionals, this usually takes up large amount of the team leaders time. This includes face-to-face assignments and liaising between healthcare staff and patients over the phone.

Additionally team leader’s role is to manage the day to day running of an efficient interpreting service and ensuring that a high quality of interpreting provision is provided and delivered to professionals who access the service, ensuring that the demand of the professionals is met in an efficient and cost effective manner.Continuity and consistency has to be provided to specific staff enabling them to then provide continuity to their clients e.g. heath visitors, midwives.

The booking system also has to be maintained by the team leader in the absence of administration staff and supported by the Linkworkers team if and when they are available.

Team leader Is expected to carry out the role of a Linkworker, a service manager, and administration officer all at the same time, this means that there is inadequate time to devote to any of these three roles, thus jeopardising the quality and standard of the service.

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In order to address complex issues and queries immediately the team leader should be available and contactable, this would ensure that specialist advice is available to service/staff. This is paramount taking in to account the nature and complexity of the service and roles, thus also ensuring that aftercare is provided to the Linkworkers after stressful assignments.

The demands of current jobs make it all the more important that the management task is clearly defined and that the right support is in placeManaging for excellence in the NHS (October 2002)

Management and support

Due to ever-increasing demands on the service and increasing need of the Urdu/Punjabi languages and the demand put on the team leader there is lack of effective time contributed to service development

In order to rectify this situation it is necessary to clarify:

What are senior management’s expectations of the team leader?

Is the team leaders role that of a Linkworker, or a service manger.

What exactly is the role and capacity of the team leader?

What support structure do the Linkworkers need in order to undertake their roles to the best of their ability

Outreach assignments need to be carried out by dedicated and designated team members and not by team leader

Time spent by the team leader undertaking assignments seriously jeopardises the service standards and quality and also undermines the role of the team leader in the eyes of the other team members.

The service needs a dedicated service manager not a team leader

There needs to be clear distinction between the role of the team leader and the rest of the team

The team leader’s job description needs to be revised in order to ensure it covers the functions of a service manager.

Total commitment, adequate support and dedication to the development of the interpreting service is required from a service manager supported by senior officers in the PCT

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Adequate after-care to the Linkworkers after difficult and complex assignments should be available by the service manager

Team leader needs to be available to provide frontline advice to service providers, (including information about languages and dialects spoken in different regions in the world, and information about cultures and customs)

Team leader should always be available to handle enquiries regarding materials for translation, advising on the feasibility of requests.

Team leader should be available respond to service development in a timely manner to complaints about service, staff and service providers, seeking guidance from Human Resource or complaints manager where necessary

Effectively manage and monitor the performance of the interpreters/ Linkworkers with regard to punctuality and reliability and issues where appropriate

Ensure that the service is promoted internally and externally

Ensure that the needs of people with disabilities is promoted and developed so that the disabled have access to information

Due to the problematic nature of an interpreting service, total commitment of the team leader is required to deal with staff issues, adequate co ordination of assignments and complete supervision of the service on a day to day running of a presently highly problematic service

Team leader needs to be available to deal with the diverse needs of a diverse team

Recommendations

Additional resources will need to be provided to employ another Urdu/Punjabi speaking Linkworkers in order that the team leaders role could be properly freed and redefined to ensure it is dedicated to addressing the operational running of the service,

Developing the service to meet the current and future needs of NHS in Kirklees, addressing quality and staffing issues and establishing a programme of training around Working With Interpreters for health care professionals.

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Team leader to work closely with senior mangers to design and deliver specialist training for staff working with interpreters in the course of their work

Publicise and promote the language service

Develop publicity materials, including information leaflets on the operational policies of the service and best practice guidelines for using it and ensuring effective dissemination of such materials

Link with PALS

Development and future potential

Interpreting services need to be developed in response to the increasing need from non-English speaker within the Kirklees PCT

Currently a large amount of money is spent funding interpreters provided by the Kirklees council. This money needs to be invested back in to the NHS, recruit and employ Interpreters at better rates of pay, and put robust training and recruitment packages in pace.

Provide more interpreters who are employed by Kirklees PCT Increase the efficiency and quality of the service, in particular reliability of

interpreters Provide an out of hours/emergency cover Implement effective monitoring through staff/patient satisfaction survey The service can be advertised to external agencies thus generating

income Reduce risk

The interpreting service needs to develop its electronic booking system, a more advanced IT software package tailor built for the language service needs to be developed in order to meet the increased demand

Bank contracts and the freelance approach is more suited rather than salaried staff to pick up ad hoc assignments

The link workers time should be freed up for professional development and health promotion work,

Having a bank of Linkworkers can increase the availability of the Linkworkers and help provide a more reliable service to its potential users.

Huddersfield could benefit from the provision of having generic Linkworkers facilitating access to other essential services; they could be on a shared register of Linkworkers.

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To develop and enhance the Linkworkers roles to more specialist areas; this could be developed if returning to a community based model of delivery

In view of the infrequent workloads of many interpreters it would be beneficial for the health service to co operate with other services and other agencies to ensure regular work and hence retention of interpreters. (Police, solicitors, social workers, etc.)

(Any further salaried Linkworkers employed with the PCT would be more suited on temporary contracts) Clearly the demand for interpreting is increasing and now that this entitlement is enshrined in the Human Rights Act and the NHS plan the Trust needs to ensure that the service is funded adequately.

In conclusion whilst there is clearly a need for interpreter provision in a broad range of languages across Huddersfield and the Kirklees area, current structures and provision do not meet that need

PCT must give careful consideration to how services should be delivered taking in to account the duty to promote race and disability and to eliminate discrimination.

Performance management and monitoring The interpreting service will maintain the following information on record, which can be made available to the PCT on request,

Invoices Interpreter claim forms Number of requests received Faxes Electronic database

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Appendix 3

Service NameHuddersfields

LocalitiesDewsbury, Batley and

Spen LocalitiesMid Yorks CHFT

District Nursing Days Y Y

District nursing Out of hours

Y Y

Leg Ulcers Y Y- Different criteria

Sitting service Y Marie Curie

Funded Nursing Care Y Not Known

Community Matrons Y Y

Macmillan Nurses Y Not known

End of Life Facilitator Y Y

Reception Services Y Y

CaSH Y Y GUM GUM

Interpreter Services Y Y PROVIDED TO

Community Dental Services

Y Y

Dermatology Y Y Y

Colposcopy/ menhorragia Y

MSK Y Y

Maple Ward Y

Primary Prevention Nurse N Y


Y

Diabetes Specialist Nurse-North

N Y Y

Continence Specialist nurses

Y Y

Nurse Practitioners Y Y

Asylum seekers Y N

Homeless Y N

Respiratory Nurse Y Y

Cardiac rehab and CHD Y Y

Walk in centre N Y N

Smoking cessation

Evenings and Night service Y Y

Case Managers Y Y

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Report to the Board

December 2007

The Children, Young People And Families Transformational Change Team

Background

The aim of the Children, Young People and Families Transformational Change Team (TCT) was to work with service providers to enable a programme of development and improvement to be established implemented and sustained.Key stakeholders in Provider Services who deliver services to Children and Families in Kirklees Primary Care Trust were identified and invited to a meeting. Three meetings during a time-limited period gave an opportunity to discuss key issues for these services, provide an overview of services delivered as well as identifying areas for improvement.

Objectives

The main objectives of the TCT were agreed:

To identify areas for improvement and development within a defined service To devise and implement a process of continuous development To educate and support staff in developing and using Service Improvement and

Business Development skills To ensure SystmOne is fully integrated across all services and it’s utilisation is

exploited to maximum effect To ensure services continue to develop in line with the Provider Arms metrics of

Access, Quality, Utilisation, Finance and Growth To enable a culture of transformational thinking and working to develop and be

sustained across services

Key Outputs





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Strategic Links

The work of the TCT directly links to the following 9 Key Strategic Tasks identified for Kirklees Provider Services:

Getting people to support the new organisation Growing and supporting leaders Securing, sustaining and growing the organisation Using resources to greatest effect Improving access Constantly improving quality Managing finances Establishing the service portfolio Implementing an enabling governance framework

All outputs and recommendations from the TCT to be tied to at least one of the above and supported by direct evidence of added value to that strategic task.

The above is also intrinsically linked to the Provider Services Fitness for Purpose high level action plan and will form the basis of regular updates to inform the Provider Board about timely compliance with the action plan.

Services reviewed

Services were considered under the remit of the Children’s TCT. Some services that cover both adults and children have been included and agreed with the other TCT’s (Adults and Therapies). Service specifications that demonstrated what the services are currently providing have now been completed for the following services.

SERVICE NAME COMMENTS LEAD TCTContraception & Sexual Health

Adult

Children’s Community Nursing Team

Children

Community Dental Services

Adult

Continence Specialist Nurse Team

Adult

Diabetes Nursing Service Paediatric Service for PCT with DDH

Adult

Health Advisor for Homeless, Asylum Seekers & Refugees

Adult

Health Visiting Service Service Spec completed in localities

Children

Immunisation Team ChildrenInterpreter Services AdultNewsome Next Generation

Children

Occupational Therapy Therapy

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Community Paediatrician ChildrenSchool Nursing Service Service spec completed in

localitiesChildren

Speech & Language Therapy Service

Children

University Practice Children

During the process of completing the Service Specification on what the services are currently delivering, information was gained on where services viewed opportunities for growth and expansion.This information will be used in helping to prioritise areas for service improvement and ensure that this forms part of the work programme.

During the time frame of the Transformational Team there has been ongoing service development with some of the services that were already going through a process of modernisation and service review.

SERVICE AREA WORK IN PROGRESSHealth Visiting Service Reviewing capacity and

developmental areas across service (AH)

Exploring options re weighting of population needs across Kirklees (AH)

Reviewing Child Health Promotion Programme (LHB)

Roll out of Universal Needs Assessment (LHB)

Identifying differences and similarities across service area (AH)

Change management support and facilitation with some teams (AH)

Working towards integrated teams in localities

Briefing paper completed of key issues for service (AH)

School Nursing Service Briefing paper completed of key

issues for service (AH) Identifying similarities and differences

in services across Kirklees (AH) School Nurse Team Leaders sharing

best practice across Kirklees. Exploring weighting tool options for

the service area (AH). Reviewing Child Health Promotion

Programme (LHB)

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Speech and Language service Service review being commissioned across Kirklees (LHB)

Health Advisor Homeless and WhitehouseWhitehouse

Strategy for Asylum Seekers ,Refugees and Homeless process of development (TQ)

Walk in Centre Service review being considered (JR)CASH service Development work in progress

(GR/KE) Involving .Young .Citizens .Equally

commissioned to undertake young person’s service user group for this service (LHB)

NB Following lead persons for some of the areas have been identified in the table. AH – AHornerGR – Gwen RuddlesdinKE – Kath EvansTQ – Tina Quinn

This list is not exhaustive as it may be that services have progressed development areas and this has not been captured during the short time frame but will be progressed in due course.

A service directory with detailed service specifications are in the process of being collated and will be available for commissioners of services and key partners.

The Children’s TCT identified the following service areas as key priority areas for progressing modernisation and review.

Health Visiting and School Nursing Service

The health visiting and school nursing services are already responding to the key challenges of the modernisation of Children and Family services nationally and locally.There are differences in the service delivery across Kirklees due to previous Primary Care Trust implementation of national guidelines and there is a need to have a corporate approach as well as recognising individual locality needs. The services need to be fit for practice and for the future. Some of this work is ongoing and already being progressed. A key current issue is the capacity of the health visitor workforce in some localities to deliver a standard quality service and a briefing paper for Provider Board is being prepared.

The interpreter services

This service works closely with the workforce across Kirklees PCT and partner services in supporting families who do not have English as a first language. There are increasing demands on the team to deliver a service to the diverse population of Kirklees. The recent Joint Area Review inspection across all children’ services identified language and interpreter services as one of the key priority areas and it is likely that this will be one of the key recommendations in the forthcoming report due in October 07.

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Health Advisor for Homeless, Asylum Seekers and Refugees

There is currently a strategy for the Homeless, Asylum Seekers and Refugees service being developed through Provider Services and the health advisor role will be integral within this strategy. There have been needs and gaps identified within this service for some time and recommendations from the service providers that a review is needed in particular of role/responsibilities and administration support for the service

Key Outputs

In terms of key outputs for the Children, Young People and Families’ Transformational team a baseline assessment of current state of service has been completed and priority areas for service review, re-design or growth have been identified by most of the services as part of completion of the service specification.

The workforce development plan that will outline forecast staffing needs, training needs, opportunities and financial projections will be progressed in partnership with colleagues in the Patient Care and Health Professional Directorate and some of this work has been initiated with Primary Care Trust representation.

RECOMMENDATIONS

The Children, Young People and Families Transformational Change Team recommend that the health visiting and school nursing service are the two key priority areas that are identified for service improvement. A strategic steering group through this TCT will lead these project areas.

The strategic future direction for children’s services such as health visiting and school nursing is towards increased integrated working around the needs of the child and family. This provides an opportunity for the ongoing modernisation of the services to be in partnership with our key partners in statutory and voluntary sector ensuring meaningful engagement with our service users.

Further workstreams for consideration through the TCTs are the interpreter and health advisor services. There needs to be agreement as to which of the TCTs will lead these areas of work.

Angela Horner – Service Development Manager – Children & Families Lead, Provider Services 17th October 2007.

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Report to the Board

December 2007

Report from Therapies Transformational Change Team

Introduction

The aim of the Therapies Transformational Change Team (TCT) was to establish a working group of representatives from Therapy, Intermediate Care services and the Patient Care and Professions directorate to establish a baseline of services and identify areas for development and improvement.

Objectives

The main objectives of the TCT are:

To identify areas for improvement and development within a defined service To devise and implement a process of continuous development To educate and support staff in developing and using Service Improvement

and Business Development skills To ensure System One is fully integrated across all services and it’s

utilization is exploited to maximum effect To ensure services continue to develop in line with the Provider Arms

metrics of Access, Quality, Utilisation, Finance and Growth To enable a culture of transformational thinking and working to develop and

be sustained across services

Key Outputs required by September 2007





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Key Strategic Tasks

It is imperative that the work of the TCT links directly to the 9 Key Strategic Tasks identified for Kirklees Provider Services. For ease of reference these are:

Getting people to support the new organization Growing and supporting leaders Securing, sustaining and growing the organization Using resources to greatest effect Improving access Constantly improving quality Managing finances Establishing the service portfolio Implementing an enabling governance framework

Baseline of services

All service areas have completed service specifications that identify current level of service provision and staffing levels to deliver the service.

See Appendix 1 for service specifications that have been completed.

Performance information

A performance data set has been developed for all services to monitor referrals rates, waiting times and number of patients on waiting lists. This information has been reviewed at each meeting and has been used to inform the priorities for service redesign and process redesign.

See Appendix 2 for performance data.

Financial information

Clarity re the finance available for each service following the efficiency savings has been sought and the impact the savings target has had on each service has been identified.

It is clear that further work is required jointly with Finance and Senior Management in order for the budgets to be delegated to budget holders.Financial information is available but has not been included in the service specifications at this stage.

Appendix 3 outlines staffing and budget levels.

Priorities For Service Redesign

1. Services at risk of not meeting local and national targets

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All services within Therapies and Intermediate Care are delivered within locally agreed and national targets which are identified in the service specifications and the majority of services are delivered well within the 18 week target.

Services which are breaching or are about to breach the 18 week target from referral to treatment include:

Community OT Paediatric Speech Therapy

Work needs to focus on process mapping and redesign to deliver services in a more timely way so that they do not breach the 18 week target and then a process of continuous improvement needs to be followed to reduce the waiting times to as low as possible.

2. Improving access to services

Single point of access needs developing for Intermediate Care referrals for South Kirklees and for Rehabilitation referrals for Community Rehabilitation Team, Jubilee Rehabilitation Service and Domiciliary Physiotherapy.

The single point of access for Intermediate Care will act as the gatekeeper to all community based and bed based services to improve utilisation of resources and facilitate early discharge from hospital and reduce admissions to hospital.

The single point of access for rehabilitation services will stop multiple referrals to services and allow patients to be directed to the most appropriate service in a timely way.

3. Equitable service delivery across provider services

Services that are currently delivered as separate services in North and South Kirklees need to be integrated in to one service to deliver equitable services. These include:

Intermediate Care MSK

4. Integration of Rehabilitation Services

Integration of Rehabilitation services in the north, ie Community Rehabilitation Team, Jubilee Rehabilitation service etc.

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Areas of low value returns

Review health/social nail care within podiatry services. Ensure there is an appropriate skill mix to deliver the service and interface with Social Services.

Opportunities For Growth And Expansion

1. Intermediate Care residential beds in partnership with KMC.

2. Review of Intermediate Care beds to identify gaps in provision and new business opportunities eg new continuing care guidance.

3. Provision of services to out of area patients.

4. Podiatry surgery for all Kirklees residents.

5. New guidance re blue badge assessments could provide opportunity for additional therapists to carry out assessments.

6. Delivery of specialist training packages to other professions and agencies/organisations.

Workforce Plan

1. Skill mix review of administration staff especially looking at the number and role of staff in each service area and ensuring we are maximising resources.

2. All staff without qualifications to be educated to at least NVQ level 2/3.

3. All staff to have the opportunity to be skilled to deliver services in the new world and equipped to benefit from the new opportunities for service growth.

4. Therapists delivering services in the PCT but employed by another Trust should be consulted on to move into the PCT.

5. Realign staffing in services hardest hit by the efficiency review and removal of posts to ensure equity of provision.

6. To identify opportunities for integration with other services within the directorate ie secondments, transfer of staff to improve service delivery to patients.

Recommendations

The Therapy TCT recommends these actions are approved and implemented.

Appendix 1

Service Spec Lead ContactService Development Contact Progress Comments

MSK (North Kirklees) [email protected] Maureen Taylor Final

Intermediate Care Team (North [email protected] Maureen Taylor Final

Intermediate Care Team (South) [email protected] Maureen Taylor Final

Paediatric OT [email protected] Maureen Taylor Final

Community OT [email protected] Maureen Taylor Final

Wheelchair Services [email protected] Maureen Taylor Final

Learning Disabilities OT [email protected] Maureen Taylor Final

Acute OT [email protected] Maureen Taylor Final

Podiatry Services [email protected] Maureen Taylor Final

Community Rehab [email protected] Maureen Taylor Final

Westmoor Rehab [email protected] Maureen Taylor Final

Jubilee Rehab [email protected] Maureen Taylor Final

Speech and Language Adults [email protected] Maureen Taylor Final

Paediatric SLT [email protected] Maureen Taylor Final Draft

Learning Disabilities Adults SLT [email protected] Maureen Taylor Final Draft

Learning Disabilities Paediatric SLT [email protected] Maureen Taylor Final Draft

Falls Assessment [email protected] Maureen Taylor Final

Moving and Handling [email protected] Maureen Taylor Draftbeing worked on

Domiciliary Physiotherapy [email protected] Maureen Taylor DraftBeing worked on

Appendix 2

Bed Occupancy Rates

Service April May June July August

Westmoor 82% 89% 79% 67% 86%

Fieldhead Park 68% 79% 65% 75% 61%

Batley Hall 76% 74% 85% 82% 70%

Waiting Times

Service July

Community Occupational Therapy Service 18 weeksCommunity Rehabilitation Team - Physiotherapy 10 weeksCommunity Rehabilitation Team - Speech & Language Therapy 8 weeksCommunity Rehabilitation Team - Dietetics 5 daysCommunity Rehabilitation Team - Occupational Therapy 9 weeksRheumatology – High Priority 1 weekRheumatology - Normal 6 weeksIntermediate Care 0 weeksMSK Service 1 - 5 daysCommunity Matrons 1-2 weeksOT – Learning Disability Service 3 weeksPaediatric Occupational Therapy 10 daysJubilee Rehabilitation 9 -10 weeksDomiciliary Physio Service 17 weeks

SLT - Paediatrics 10-14 weeksSLT - School Age Special Needs Communication 8 weeksSLT - School Age Special Needs Dysphagia 5 daysSLT – Child Development Centre 14 weeksSLT - Adults with a Learning Disability Dysphagia 5 daysSLT - Adult with a Learning Disability Communication 7 weeksSLT - Adults Voice 5 weeksSLT - Adults Neuro 7 weeks

Podiatry - Community 6 - 8 weeksPodiatry - Diabetic 12 weeksPodiatry - Biomech 5 weeksPodiatry - Nail Surgery 4 - 6 weeks

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Waiting Lists

Service July

Community Occupational Therapy Service 159Community Rehabilitation Team - Physiotherapy 23Community Rehabilitation Team - Speech & Language Therapy 9Community Rehabilitation Team - Dietetics 3Community Rehabilitation Team - Occupational Therapy 22Rheumatology 6Intermediate Care N/AMSK Service 0Community Matrons 5OT – Learning Disability Service 6Paediatric Occupational Therapy 0Jubliee Rehabilitation 44Domiciliary Physio Service 45

SLT - Paediatrics 39SLT - School Age Special Needs Communication 12SLT - School Age Special Needs Dysphagia 2SLT – Child Development Centre 20SLT - Adults with a Learning Disability Dysphagia 1SLT - Adult with a Learning Disability Communication 6SLT - Adults Voice 4SLT - Adults Neuro 1

Podiatry - Community 196Podiatry - Diabetic 148Podiatry - Biomech 82Podiatry - Nail Surgery 16

Referrals

Service JulyCommunity Occupational Therapy Service 43Community Rehabilitation Team - Physiotherapy 9Community Rehabilitation Team - Speech & Language Therapy 4Community Rehabilitation Team - Dietetics 5Community Rehabilitation Team - Occupational Therapy 9Jubilee Rehabilitation 38Rheumatology 9

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MSK Service 101Community Matrons 35Intermediate Care Team North 115Rapid Response South 68OT – Learning Disability Service 19Paediatric Occupational Therapy 6Domiciliary Physio Service 10Acute OT 257

SLT - Paediatrics 73SLT - School Age Special Needs Communication 14SLT - School Age Special Needs Dysphagia 4SLT – Child Development Centre 9SLT - Adults with a Learning Disability Dysphagia 4SLT - Adult with a Learning Disability Communication 5SLT - Adults 69

Podiatry - Community 102Podiatry - Diabetic 33Podiatry - Biomech 36Podiatry - Nail Surgery 11

Appendix 3

Finance Information For Therapies And Intermediate Care

WTE Budget

Podiatry 17.79 605,311

Speech Therapy 20.35 678,115

Jubilee 4.82 182,713

Community Rehab Team 12.11 403,410

Westmoor 5.58 160,277

Intermediate Care Teams 19.85 731,024

OT Learning Disabilities 3.26 117,561

OT Community 5.74 205,048

OT Acute 18.11 569,789

OT Paediatrics 4.95 182,099

Wheelchair Services 1.00 36,400

Movement & Handling Advisor 1.00 43,100

This information is taken from August Financial Reports. Further work is ongoing to improve the accuracy of these figures.

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