Paper copies of this report are available to the public free of charge. Please call 01384 366874 to request a copy.

This document can also be made available on request in other formats including other languages, large print and on audio tape.

We are also distributing the key contents of this document to 117,859 households across the Borough via the Dudley, Halesowen and Stourbridge Chronicles on the 25th June 2009, along with sending extra copies of this publication to your GP reception area.

We are always keen to hear your views on any document we produce. This year we received the following feedback which we took into account when writing this document:

"May I suggest that in the coming publication there is a ‘button’ on the web site accessing the report when it is published."

"The people that do read it are only interested in how financial cuts are going to affect the services provided, this should be the priority, to explain what is happening and the worst case scenario!"

"As every individual has a different slant on the services that are needed, it would not come amiss to highlight the problems being encountered meeting everyone needs due to the constraints in cash flow but to assure the public that front line services are not going to be reduced in any way."

"I would be happy to receive the documents via email. Although expensive, I realise that using the public wrap around is probably the only way that you can ensure that this very important information reaches most of the people in the Borough."

Foreword

We are serious about our ambition to deliver world-class healthcare as we continue to work towards being a World Class Commissioner. Our most recent assessment was in the winter of 2008, the report from the visiting panel, which is published in full on our website, gave us a high score for our continued focus on improving the quality of care, improving health and wellbeing and reducing health inequalities. It also noted our strengths in clinical engagement, partnership working, the use of high quality information and all round commissioning capability.

While we are encouraged by these findings, we recognise that there is always room for improvement. We know that we still have challenges ahead, in particular the need to ensure all Dudley borough residents experience equally good health and well-being. To help us reduce health inequalities in our borough we have been working with our partners including Dudley Metropolitan Borough Council (DMBC), to understand the current and future health and well-being needs of our population. This will allow us to identify those groups whose needs are not being met and we need to focus our efforts to reduce existing inequalities.

While we continue to plan for the future we are pleased to report on the excellent improvements that have been made in the borough during 2009/10. The level of choice available to Dudley residents regarding their healthcare has increased following the opening of the borough’s first Walk in Centre and a new practice at Pensnett, in addition 74% of GP practices locally now offer extended opening hours. Local people are being treated quicker than ever and the level of care received from all providers in the Borough continues to improve. However where care does not meet the required standard we are committed to ensuring that improvements are made through our robust contract management procedures. We are 100% focused on ensuring that everyone in the Dudley Borough receives the highest quality of care when they require it.

Looking to the year ahead, NHS Dudley, along with the NHS nationally is facing some financial challenges due to a reduction in funding available. However, we are in a good position to tackle this as we have a great track record for managing the money we have available. We are now focussed on how we can make sure healthcare services are of a higher quality, are more accessible and more patient focussed within the budget we have available.

At the heart of this approach is our commitment to achieving the best value we can when we commission services. To achieve this we work in partnership with other commissioning organisations to reduce duplication of services, and to optimise our combined use of resources. NHS Dudley will be working with Dudley Metropolitan Borough Council in the coming months to engage local communities in our investment strategies and to build consensus on the changes we can each make towards achieving best value as well as best quality.

We are committed to doing this with our local clinicians, patients and partners to ensure that you get improved quality of service no matter what treatment you receive.

We would like to end this message by acknowledging our dedicated workforce and partners from within the voluntary and statutory sectors, without whom the wide range of health and related services across Dudley would not be possible. We would like to thank all our staff at NHS Dudley, in Dudley Community Services and those in the wider NHS in Dudley for their endeavours throughout the year. Our thanks also go to Mark Cooke who was NHS Dudley’s Chief Executive until January 2010. Mark’s contribution to the development of the organisation during the four years he was in post was invaluable and we wish him well for the future.

1. About NHS Dudley

Dudley Primary Care Trust was formed in 2006 and covers the same area as Dudley Metropolitan Borough Council (DMBC). On 1st October 2009, the commissioning arm and providing functions of the PCT began operating as distinct functions. The commissioning arm began trading as NHS Dudley, while the provider function was renamed as Dudley Community Services. This report focuses on the work and achievements of NHS Dudley throughout 2009/10. The work of Dudley Community Services is detailed in this report, along with other providers of healthcare in the Dudley Borough.

NHS Dudley holds the NHS budget for the local diverse population of approximately 306,000 people.

We support the work of GP practices, pharmacists, dentists and opticians and work closely with five GP practice ‘clusters’ to enable commissioning of services to take place as close to the local population as possible. We are responsible for monitoring the contracts that are in place with healthcare providers locally including the Dudley Group of Hospitals Foundation Trust, Dudley Community Services and Dudley and Walsall Mental Health Partnership Trust.

1.2 Mission

1.3 Values

At NHS Dudley we have developed, through wide consultation, a set of values within which we wish to work.

• We will be open and honest in our approach.
• We will value equality and diversity and ensure that everyone is treated with respect. We will work to continuously improve services.
• We will support and empower people to contribute to improving their health and that of their community.
• We will actively seek, listen to, value and respond to the views of all.
• We will strive to secure seamless services that best meet the needs and preferences of the community.
• We will spend funds wisely.
• We will value, support and develop all our staff.
• We will embrace partnership working.
• We will set a clear direction and deliver on our promises.
• We will ensure all staff who are not directly involved in patient care will continue to give priority to supporting clinicians.

Our commitment to the people of Dudley is that these values are considered whenever we make a decision. They are embedded in the ethos of the organisation and adopted by all staff. We really want to ‘live’ these statements, to make a difference and improve the health and wellbeing of the people of the Dudley borough.

1.4 Vision

We want all Dudley borough residents to be as healthy as possible no matter where abouts in the borough they live. At present, some people in one part of the borough could die up to 8 years earlier than those in other parts. By 2014, we want to reduce this difference. Therefore our vision is:

1.5 Our Borough

Around 310,000 people live in the borough and the population is very diverse.

Within our 38 square miles, we have 132,000 residential houses, a range of businesses and industries; one 700 bedded district general hospital, 55 GP practices and a Mental Health NHS Trust. We directly employ over 1,100 staff of which 800 support our provider arm.

We have some of the most deprived areas in the country - with some of the deepest pockets of inequalities. We have areas which have a concentration of poor diet, poor physical exercise, poor housing, poor levels of employment, poor educational attainment and poor mental wellbeing. We have 8 out of our 72 wards classified as the most deprived in the Country. Some of these areas have a very high proportion of Black Ethnic Minority communities and who may experience difficulties in accessing services.

We also have some wards which are among the most affluent in the country. People living in these wards tend to have better education, jobs, housing, self-confidence and higher life expectancy than those from more deprived areas.

1.6 Our Population’s Health

Our Director of Public Health, with Dudley Metropolitan Borough Council’s Directors of Adult Care, Housing and Childrens’ Services, completed an updated Joint Strategic Needs Assessment. This shows that:

• The number of over 65s will increase by 24% from 2007 to 2010.
• The number of over 85s will increase by 52% by 2020
• Increase in life expectancy is slower in Dudley than the rest the country.
• The two biggest causes of premature death are circulatory diseases and cancer.
• After cardiovascular disease and cancer, respiratory diseases have the third next significant impact on premature mortality.
• About a fifth of the Dudley boroughs population smoke and reducing this will have the biggest impact on premature death.
• Accident mortality has increased, almost entirely within the over 65’s age group and falls is an important element of this.
• Obesity levels have more than doubled between 1992 and 2002.
• Alcohol-related diseases have risen rapidly and deaths from these are increasing.
• The incidence of alcohol related hospital admissions has increased rapidly for Dudley and is above that for England.
• The life expectancy for the people of Dudley has continued to rise, but the gap between the most and least deprived wards has widened from 6.6 years in 2005 to 8.6 years in 2008.

2. A Year in the Life of NHS Dudley

2009/10 has been a busy year for all of us here at NHS Dudley. Here are some highlights and key dates from our year.
Sarah

3. Helping people to be as healthy as possible

‘Our aim is to improve the health and wellbeing of all people in the Dudley borough and widen access to services that promote good health and independence. Tackling inequalities in health is a key driver for all of our work.

2009/10 has seen some fantastic developments in projects and services to help people get healthy and stay healthy. This has been supported by increased partnership working with Dudley Council and colleagues in Primary Care. Below you will see some of the work of the Public Health Directorate this year.

The Public Health team will continue to help people improve the quality of their life by engaging with communities, improving patient experience and supporting people to improve their own health and support all of the borough townships to make Dudley a healthy town.’

Valerie A Little
Dudley Director of Public Health

3.1 Reducing Risks from Tobacco

Smoking remains the single greatest cause of preventable premature death and health inequalities, killing more than 80,000 people every year. Smoking can cause 50 different conditions and costs the NHS £2.7 billion to treat every year.

We are proud that our ‘Stop Smoking Service’ is one of the best in the country and in 2010 we celebrate our 10 year anniversary and have supported over 30,000 smokers to quit during that period. We strive to provide local people with a choice of stop smoking support in convenient and accessible locations across the borough. Some of our achievements last year were:

• In 2009/10 we had a record number of quitters with 2,611 people having a successful quit attempt.
• We carried out a sustained year long marketing campaign, using innovative ideas such as a local radio text campaign and street face to face marketing teams to encourage people to use the Dudley Stop Smoking Service.
• Routinely offered ‘health checks’ as part of our group stop smoking events including lung age, Blood Pressure and BMI checks.
• 2009/10 was a springboard for our Young Person’s Service, with youth advocacy projects key to increasing awareness and successful youth led campaigns.
• This year also saw the start of proactive work with local businesses in partnership with Environmental Health Services, who carried out approximately 200 visits to promote workplace stop smoking services.
• We continued to increase service provision in numerous different settings including a very successful community led stop smoking group in Wollescote, Stourbridge.

3.2 Tackling Obesity

In the Dudley borough over half of all adults are overweight or obese. Our obesity strategy, developed in partnership with Dudley Council, aims to combat rising obesity levels in the borough.

The strategy recognises that there are plenty of simple steps people can take to improve their fitness and lose weight and many initiatives have been developed to help both adults and children achieve a healthier lifestyle. These include:

For adults:

• Slimmer’s Kitchen: An initiative for obese or overweight people who wish to improve their knowledge, skills and confidence to cook healthy meals for themselves and their families and lose weight.
• Weight Loss Referral Programme: A referral system available to all GPs enabling them to signpost obese patients, with a Body Mass Index (BMI) greater than 30, to Weight Watchers or Slimming World sessions in the borough at no cost to the patient.
• Shapes: A free, twice weekly weight loss programme that includes both exercise and nutrition and introduces participants to a new activity each week.
• Fit Blokes Club: A 12 week programme for men only run by a male instructor.

For children:

• Jumping Beans for 2-5 year olds and Phyzkids for 4-7 year olds: programmes involving the whole family that look at ways to prevent obesity and assist parents/carers to make healthy choices for their children.
• Kicking Fit Kids for 8 -11 year olds: a martial arts programme that aims to increase physical activity levels, confidence and self esteem of overweight and very overweight children.
• MEND or PULSE for 7-13 year olds: Mind, Exercise, Nutrition, DO it! Fun, free after-school courses that encourages young children and their families to make healthy changes to their diet and lifestyle.
• Phases for 11-18 year olds: interactive workshops, fun games and activity sessions for children and young people who need to lose weight.

3.3 Healthy Eating

NHS Dudley aims to widen access to healthy, affordable foods and raise awareness of and encourage healthy food choices. We offer a variety of schemes to ensure the healthy eating message is targeted and achieves maximum impact.

• 129 Get Cooking! sessions were delivered.
• 141 Dudley Food for Health Awards were presented to catering establishments in the borough for providing healthy eating choices in hygienic surroundings. More than double the amount awarded last year.
• Breast Feeding Buddies: 50 Buddies have been trained to help support mothers in the borough who want to breastfeed their babies.
• Bostin Value: A pilot project, funded by the Big Lottery, to encourage parents and children to eat more fruit and veg, has provided a market stall at Hawbush Primary School twice a week.

3.4 Physical Activity

NHS Dudley has many initiatives across the borough to encourage people to become more active including:

• Exercise Referral Service: Patients can be referred from their GP practice to a programme of exercise at the Action Heart Centre or one of Dudley Council’s leisure centres. Patients can also be signposted to outdoor exercise through the ‘Green Exercise’ referral scheme.
• ‘Walkzone’: An innovative website to encourage people to make walking part of their daily routine.
• ‘Walk Fit’: A nationally accredited programme of walking based activities for all fitness levels, delivered in partnership with Dudley Council. Activities include led walks, ‘Greenfit’ outdoor exercise sessions, buggy fitness for mums and babies and Nordic walking sessions.
• ‘Take Part in the Park’: In conjunction with Dudley Council, an extensive programme of fun activities for young people is delivered in parks during the summer holidays.
• ‘Tandrusti’: A community based programme that addresses the health needs and experiences of minority ethnic communities in Dudley.
• ‘Leap over 60’: An activity programme in partnership with Age Concern and Dudley Council to create more exercise and activity opportunities for all older people, whatever their ability.
• ‘Take a book for a walk’: This pedometer loan scheme allows the public to borrow a pedometer from any public library in Dudley.

3.5 Pharmaceutical Public Health

The pharmacy team have continued to promote good prescribing for Dudley patients. The emphasis has been on promoting practice which improves the health of our population, protects patients against harmful side effects and provides value for money to the NHS. Key achievements include:

• Sustained reduction in antibiotic prescribing rates, building on the previous year’s campaign to support appropriate GP prescribing.
• Lead on the production of clinical guidelines for prescribers, including the management of hypertension, constipation, cholesterol lowering and antibiotics.
• Continued support for GPs by providing pharmacist services to every practice.
• The creation of two new specialist posts to support older people and people with neurological conditions such as Parkinson’s disease and epilepsy.
• Implementation of key requirements of the NHS Constitution with respect to decisions made relating to funding of new drugs and other treatments.
• Continued development of the prescribing role of our pharmaceutical team; all practice based pharmacists are qualified independent prescribers.
• Successful co-ordination of a pharmacist and nurse ran Antiviral Collection Point set up to respond to the swine ‘flu pandemic.
• Continued development of the Priory Community Pharmacy, including intervention to help smokers quit, raising awareness of alcohol issues and provision of Chlamydia screening kits.

3.6 Emotional Health and Wellbeing

Mental health problems are extremely common, with one in four people experiencing a mental health problem at any one time. The burden on individuals, families, communities and society as a whole include psychological distress, impact on physical health, social consequences and financial and economic costs. However, improving mental health brings huge benefits to individuals and society.

We are committed to improving people’s emotional health and well being and building emotionally resilient communities.

Initiatives included:

• ‘It’s good to be you’ to raise public awareness of how to look after mental health
• ‘It’s good to be you’ mental health promotion resources developed in community languages with user involvement and engagement with community groups
• Mental health promotion resources developed for people with learning disabilities with user involvement
• Launch of 20 Voices - a mental health promotion needs assessment of people seeking asylum/refuge, and the workers who supported them, which resulted in a series of monologues representing real experiences of people as powerful individual spoken stories. These findings were launched during Refugee week
• Road to relaxation survey completed findings showed that 94% of respondents were satisfied or very satisfied with the Road to Relaxation pack and 85% of respondents rated the effectiveness of the booklet as helpful or very helpful in reducing stress
• Road to relaxation packs sent to 450 individuals and 27 organisations

3.7 Community Health Improvement

The Community Health Improvement Team looks at promoting health initiatives throughout the borough and in particular increase awareness of Sexual Health and Alcohol issues.

Cervical Screening

In the West Midlands region, cervical screening saves one life every day. During February 2010, Women and Theatre, an award winning Theatre Company from Birmingham, talked to over 70 women in the Dudley borough to gather their stories and experiences of going for cervical screening. Staff from GP surgeries were also asked to identify good examples from their practice which have helped to increase the uptake of screening, along with examples of some of the challenges they face. During March Women & Theatre put on four performance of ‘The Cervical Monologues’ for 85 health professionals and local women. The performances raised awareness of the barriers to cervical screening, and gave local women and health professionals the opportunity to discuss how even more women can be encouraged to go for their smear test.

Alcohol Misuse

While the number of young people drinking alcohol has declined, those who are drinking are consuming more alcohol, more often. The UK has one of the highest rates in the EU of admission to hospital or A&E due to alcohol use by 15-16 year olds. The Community Health Improvement Team (Public Health) and Geese Theatre Company have been working with teenage girls in Dudley to produce a DVD which explores the issues around teenage binge drinking and raise people’s awareness of the damaging effects. The DVD will be used in local schools, colleges, training providers, youth centres and children’s centres with both young people and parents.

3.8 Healthy Communities

Our Healthy Communities Volunteer Programme is now in its fifth year. Set up to tackle health inequalities in Dudley, it recruits, trains and supports local people to deliver the work of Public Health in the community helping to deliver programmes such as:

• Physical Activity
• Get Cooking and Healthy Eating
• Weight Management
• Stop Smoking
• Breast Feeding
• Diabetes
• Expert Patient Programme

3.9 Infectious Diseases

Protecting the population against infectious diseases remains a high priority in Public Health. Our Communicable Disease Team works with all our partners in Infection Control, Tuberculosis Prevention and Treatment and Immunisation

• Over 95% of Dudley borough girls aged between 12-13 years were immunised against cervical cancer during the year.
• 69.6% of over 65s and 49.5% of the ‘at risk’ group in the Borough were vaccinated against flu.
• The Immunisation Team trained over 280 NHS employed and contracted staff.
• Swine Flu vaccine offered to all eligible groups of patients and staff between Sep 09 and end of year.
• Developed a full programme of Infection Prevention and Control training for Community staff and Mental Health provider staff. Over 800 Dudley Community Services and Primary Care staff have been trained.
• Obtaining a ‘live’ laboratory linked infection surveillance system which has enabled a more timely input from the Infection Prevention & Control Team into the management of cases in Dudley.
• Health economy work to reduce cases of health care associated infection have been successful and national reduction targets for MRSA bacteraemia and Clostridium difficile cases have been met. Work continues across the health economy to further reduce cases with a ‘Zero tolerance’ premise adopted.
• Dudley has seen the lowest number of Tuberculosis notifications since 2001, with 30 confirmed cases.
• All TB patients continue to be offered Specialist Nurse support and cases are reviewed by a multi disciplinary health team. In accordance with NICE guidance all Dudley TB Patients are now offered HIV testing.
• The TB team have worked to increased awareness of TB and have delivered sessions to over 300 health care workers and ‘at risk’ public/user groups.
• The Communicable Disease Team were instrumental in the containment and vaccination phases of the Swine Flu Pandemic response for NHS Dudley. The team swabbed and gave treatment to over 300 suspected cases of swine flu, communicated national and local messages to all our health partners across Dudley and planned and co-ordinated the Swine Flu vaccination programme.

3.10 Healthy Towns

In Britain almost two thirds of adults and a third of children are either overweight or obese.

By 2050 it is predicted these figures will rise to almost nine in ten adults and two thirds of children, unless there is intervention.

Dudley Healthy Towns project will see £4.5 million of investment in our borough under the government’s Healthy Towns project, which aims to pilot ways of reducing obesity levels.

To encourage families to make the most of outdoor areas we are using the money to transform five of the borough’s parks and play areas into healthy hubs.

The hubs will be located at:

• Silver Jubilee (Coseley)
• Netherton Park
• The Dell and Fens Pool (Pensnett)
• Mary Stevens Park (Stourbridge)
• Huntingtree (Halesowen)

Each of the hubs sites will have a Healthy Towns building, activities, events, walking routes, signage, outdoor gym equipment and toilets as well as traffic-calming measures, cycle storage, footpath and canal tow path improvements, crossing upgrades and police support.

3.11 Health Promoting Schools

In Dudley there are 79 primary schools, 21 secondary schools, 7 special schools, 4 Pupil Referral Units (PRU) and 1 independent school.

• 100% of Dudley schools and PRUs have achieved National Healthy School Status.
• A phased approach for schools to start work on the enhancement model has been introduced linking in with Extended Schools.
• The Whole School Improvement Obesity Prevention Plan has been developed and will be targeted for implementation in the Healthy Town hub schools first (catchment area of 1.25 km from hub).
• 13 out of 18 children’s centres are trained and offering the Jumping Beans programme. Jumping Beans is both an obesity prevention and treatment programme open to all families with children aged 2 - 4 years.
• ‘Its good to be you’, emotional health and well being campaign was launched, with a range of activities including the massage in schools programme, anti-bullying programmes and improving children and young people’s access to a variety of support agencies, through in-school noticeboards.
• A closer emphasis on multi agency working has been developed through the emotional health and wellbeing theme group, which will continue through the TaMHS programme providing both universal and targeted training and interventions.
• A six week baseline programme for Sex and Relationship work in secondary schools was launched.
• A roadshow and theatre for targeted year groups were developed to raise awareness of the risks of alcohol and sex and relationships for all secondary phase schools.
• Tier 1 training on Drugs and alcohol awareness was delivered widely, in order to improve staff knowledge and a consistant approach to drug related issues.
• The Health Related Behaviour Questionnaire was carried out in 77 primary schools and all 21 secondary schools.
• Safety Town was held for 4 weeks for year 2 pupils in the borough, offering key safety messages from a variety of emergency service professionals, including police and fire service.
• A primary schools council conference was held for 20 school representatives to attend to look at improving and developing the pupil voice.
• A sun safety pilot was carried out with 17 primary and special schools, looking at changing attitudes and behaviour to sun safety and cancer prevention.

3.12 Expert Patient Programme

One in five people in Dudley are reported to have a long-term condition which limits their daily activity and 35,000 people care for someone with a long-term condition. There is considerable national and international evidence to show that supporting self care results in health benefits for people with chronic health conditions and therefore overall gain for the care system. Dudley EPP is committed to providing free EPP courses to empower people with the skills, knowledge and understanding they need to self manage the practical and emotional effects of living with a long term health condition or caring role.

Last year in the Dudley Borough

• 531 people attended a free EPP course
• 4% of the courses were delivered in community languages including Arabic, Punjabi, Hindi & Urdu.
• EPP worked in partnership with local GP practices, DMBC, Children’s Centres, Voluntary, Community & Faith organisations to promote & deliver EPP courses so that they were more accessible and convenient to the whole community.
• Online registration at www.dudley.nhs.uk/epp was developed to make it easier for people to register for a place on a course.
• EPP Volunteer Tutors won the Dudley CVS Heath & Wellbeing Award for their hard work and commitment to delivering self management courses.

4. Buying Health Services which Meet Local Needs

“Here at NHS Dudley we are committed to ensuring that every Dudley borough resident has access to the most appropriate healthcare services when required. We are focused on understanding what our local population needs and making sure the services we commission meet these requirements.

The Service Development and Partnerships Directorate is responsible for negotiating and awarding the healthcare contracts that are awarded to the various providers in the borough and monitoring these contracts to ensure the highest level of quality and safety for local people. I am passionate about making sure that we get the best possible services, for the best possible value for the population of Dudley.”

Sue Roberts
Director of Service Development and Partnerships

“NHS Dudley is focused on ensuring we have clear direction for the future, so that we are 100% prepared to meet the changing needs of the local population. We are always looking ahead and considered new and innovative ways of working that will make healthcare here in Dudley world class.”

Hilary Walker
Director of Strategy and Innovation and Executive Nurse

4.1 Our Plans

One of our values is to set a clear direction and deliver what we promise. It is therefore important to us that our plans are transparent. Each year we write a business plan, which can be found on our website, www.nhsdudley.nhs.uk.

We have three strategic objectives:

• To help people to be as healthy as possible
  
  Our first, and most crucial, strategic objective is to reduce the reliance on health and social care services. We can only do this through impacting on the things that lead to poor health.
  
  It would be great to have a population that only used healthcare services when it was truly unavoidable.
  
  
• To make sure health services meet the needs of the local people
  
  Our second strategic objective is about creating a picture. A picture of what our professionals, service users, carers and our public wish to see and experience from a health and social care system. We then commit to commissioning services to meet those needs.
  
  
• To raise the quality of services
  
  Our third strategic objective is about continuing to raise the quality of NHS services. We are proud in Dudley of the achievements we have made, and the quality of services our residents receive.

To achieve these objectives we have developed 10 goals. These are:

• Tackle obesity.
• Reduce alcohol misuse.
• Improve mental health and wellbeing.
• Provide systematic and targeted prevention.
• Provide care at the appropriate setting.
• Improve urgent care services.
• Manage long term conditions.
• Improve patient safety and outcomes.
• Improve patient experience.
• Champion innovation and excellence.

4.2 Becoming a World Class Commissioner

In the winter of 2008 we participated in a round of intensive assessments of its commissioning functions as part of the World Class Commissioning (WCC) programme of work.

Following the assessment, the panel reported :

“During our review, the panel developed an overall impression, which is that the PCT is a good organisation and is well placed to make the transition to becoming a high performing organisation.”

They also highlighted five areas for improvement:

• Board Development
• Organisational Development
• Strategy & Financial Plan
• Clinical leadership
• Relationship with Dudley Group of Hospitals FT

Since the assessment we have taken action to address the highlighted points including:

• Engaged external partner for board development
• Joint board development and negotiation
• Joint workshops with PEC on prioritisation & PBC development
• Developed a new structure for clinical engagement
• Launched a range of organisational development/ programmes targeting all levels of staff within the organisation

We are now awaiting feedback from our second round of assessments which were held in May 2010. As with the previous round we were required to a set outcomes to measure our effectiveness as commissioner of services in the Dudley borough.

We have been set two national outcomes on life expectancy and health inequalities.

However, working alongside partners the Trust also identified eight local outcomes that align with its strategic plans. They are:

• Prevalence of obesity in yr 6 children
• Number of 4 week smoking quitters per 100,000 population > 16 years.
• Infants breastfed at 6-8 weeks
• Rate of hospital admissions per 100,000 for alcohol related harm
• Proportion of children who complete MMR immunisation by 2nd birthday
• Proportion of all deaths that occur at home
• Proportion of stroke admissions to DGoH given a brain scan within 24hrs of stroke
• Number of patients on hypertension registers as proportion of expected

4.3 Practice-Based Commissioning

“2009/10 has been a busy year for Practice Based Commissioning in the Dudley borough. The five clusters have continued to develop services for their patients with several 'invest to save' proposals supported by NHS Dudley. These schemes aim to treat patients closer to home, and the money saved is reinvested in other services for patient benefit.

All of the clusters across the borough are committed to innovative ways of working to ensure local residents have access to the most appropriate services in the most appropriate places. Some examples of Practice Based Commissioning developments this include:

• A Primary care based no scalpel vasectomy service is now operating, providing a one stop shop for patients with flexible appointments.
• A community dermatology service to improve patient access was launched

All initiatives developed within clusters focus on improving the quality of service received by patients. This year has seen a Glaucoma referral refinement scheme with local optometrists developed which aims to improve the quality of referrals into hospital. We have also seen a competency framework developed for ECG and event monitoring within primary care aimed at reducing 60% of inappropriate activity within secondary care by improving quality at GP practice level.

Recognising that patients prefer to stay at home as opposed to hospital stays has been key to the development of community based services this year. Examples of services developed to support patients to remain at home during their illness include:

• A COPD focused initiative which has seen staff trained for a COPD diploma. The initiative has reduced emergency hospital admissions, improved access, widened choice and empowered patients through the development of self managed plans.
• The introduction of Generic Healthcare workers to support patients to stay in their own home
• The introduction of Family stroke support worker to facilitate earlier discharge from hospital.
• A Paediatric Triage service was launched to establish whether a referral to secondary care is necessary and providing advice on how the patient can be managed in primary care.

Partnership working is integral to the success of Practice Based Commissioning projects and close working relationships have been developed with colleagues at Acute Trust’s across the region, at NHS Dudley, Dudley Community Services and the voluntary sector including Diabetes UK and Breatheasy. We look forward to the continued success of PBC initiatives throughout the coming year and ensuring that Dudley residents have the highest standard of healthcare available to them.”

Dr David Hegarty, Chair of the Dudley Commissioning Forum

4.4 Commissioning Business Support Agency

In 2007, 17 primary care trusts in the West Midlands region came together to form the Commissioning Business Support Agency (CBSA), which is hosted by NHS Dudley. The CBSA:

• Provides accurate and timely contract management information for both practice-based commissioners and PCTs, to manage secondary care contracts more effectively.
• Provides ‘knowledge-based’ information such as comparative or benchmarking analysis throughout the West Midlands.
• Provides direct management support in negotiation and dealing with secondary care providers.
• Supports the work of co-ordinating PCTs and world class commissioning in the West Midlands

The Commissioning Business Support Agency (CBSA) and the Healthcare Contracting directorate of Healthcare Purchasing Consortium (HPC) merge on 1st April 2010. The organisation will continue to be hosted by NHS Dudley but will be known as the Healthcare Commissioning Services.

5. Raising the Quality of Services

“I believe that everyone who lives in the Dudley borough is entitled to the highest quality of healthcare services.

Following the high profile reports from Mid Staffordshire and the coverage of failings in Out of Hours care in Cambridge, I am more committed than ever to ensuring that all services provided in the Dudley borough are of a high standard.

Throughout 2009/10 there have been some real developments in services across the borough and I am looking forward to continued improvements throughout the coming year that will benefit Dudley borough residents.”

Hilary Walker
Interim Director of Strategy and Innovation and Executive Nurse

“The safety of patients when they are being cared for in the Dudley borough is of upmost importance in everything that we do. As the Director responsible for governance arrangements here in Dudley I am continually striving to ensure the services available to local people are the safest they can be.“

Kimara Sharpe
Director of Community Engagement and Primary Care

Part of our organisation, Dudley Community Services, provides community nursing care to the population of Dudley. We have been operating at ‘arms length’ with Dudley Community services since April 2009 to ensure that we can purchase the best quality care, as close to home as possible for people within the borough.

We also contract services from our primary care colleagues, GPs, Opticians, Dentists and Pharmacists to ensure that people have access to good quality healthcare right on their doorstep and at a time that suits them.

1 in 4 people will experience a mental health problem at some point in their life and we know that having appropriate mental health services there for people when they need them is very important. We buy these services on behalf of Dudley people from Dudley and Walsall Mental Health Partnership Trust.

And if people really do need to go into hospital either for an emergency, to have a baby or for a planned operation we know that they expect and deserve a good experience. We work hard with our main provider for hospital care, Dudley Group of hospitals, to monitor performance and drive up the quality of care that people get when they need to be in hospital.

Some services and treatments are for very rare or specialist conditions and when buying these we join forces with our neighboring Primary Care Trusts to purchase the best care available. This is known as specialised commissioning. In this section of the report our main providers key achievements are detailed.

5.1 Dudley Community Services

NHS Dudley’s primary business is to commission - plan and purchase - healthcare, including preventative care for the population of Dudley. However we do still provide many services through our Community Services Arm of the organisation. Dudley Community Services (DCS) provides the people of Dudley with services in the community where they are needed most, 24 hour district nursing, health visiting, adults’ and children’s learning disabilities, podiatry, audiology, school nurses, physiotherapy, continence, speech and language therapy and occupational therapy.

“We have achieved remarkable progress in improving and delivering high quality, safe care this year. None of this would have been possible without the dedication of all the staff within Dudley Community Services. The care they provide is inspirational and really does make a difference to people’s lives.”

Tessa Norris
Managing Director of Dudley Community Services

This year DCS has made the following achievements:

• In November 2009, Dudley Community Services introduced a new Children, Young People and Family Directorate. This new directorate means that Health Visiting teams no longer deliver services to older people developing their services around the 0-school entry age group. As part of this development, each Children’s Centre throughout Dudley now has a named, and a deputy, Health Visitor.
• The Diabetes Specialist Team continues to extend their portfolio of structured clinical and patient education initiatives. The Dudley Model for Comprehensive Insulin Management (accredited with the University of Wolverhampton at degree level) has seen three quarters of all GP practices completing Part One with several now having completed Part Two. This will ensure that less people in Dudley with diabetes will need to receive diabetes hospital based outpatient care.
• In 2009/10 Dudley Community Services continued with its participation in the Strategic Health Authority’s ‘Productivity Improvement Programme’. This was named locally as ‘Releasing Time to Care’. The programme included a number of initiatives, which involved measurement of the costs of the clinical functions that we provide and, crucially, what we get in return for the investment such as the volume of services delivered and the staff used to deliver those services.
• Dudley Community Services launched their Virtual Ward pilot scheme at Keelinge House Surgery in September 2009. The scheme is designed to address the needs of patients who are most at risk of repeated unplanned hospital admissions The pilot Virtual Ward at Keelinge House Surgery is to run for an initial 12 month period. If effective, the Virtual Ward programme will be rolled out in the north of the Borough to address a significant level of health needs for some Dudley’s most deprived populations.
• Dudley Community Services (DCS) has introduced an innovative new paediatric asthma and allergy clinic to provide a holistic nurse-led service for children and parents at a time and venue, which is convenient to them. Funding for this new service has been made possible by a joint initiative between the Queen’s Nursing Institute and NHS West Midlands’ Innovation Funds.
• The Learning Disabilities Health Access service continues to support clients to access cancer screening programmes; e.g. Breast, Cervical and Bowel screening. The service ensures that all information is as accessible as possible to help mainstream services make reasonable adjustment for patients with Learning Disabilities.
• The Learning Disability Specialist Health Service continues to address health inequalities of patients with a learning disability through the provision of over 1,700 specialist training places throughout 2009/2010 for staff working within learning disability services, generic health and social care providers. In addition, the service provides training to GPs and their surgery staff in support of the DES health screening.
• In September 2009, Dudley Community Services developed and implemented Nursing Metrics Audit for use in community nursing. Audits are conducted with five observational visits per team, per month and action plans are then implemented to drive up standards throughout nursing teams. Key improvements have been seen in record keeping, preventing the spread of infection and holistic patient assessment to include pain, nutrition and falls risk as standard.

5.2 Dudley and Walsall Mental Health Partnership NHS Trust

Dudley and Walsall Mental Health Partnership NHS Trust provides a wide range of integrated mental health services to children, adults and older people across the communities of Dudley and Walsall.

Dudley and Walsall Mental Health Partnership NHS Trust aims to deliver flexible, high quality, evidence based services to enable people to achieve recovery.

In this first full year of operation, the Trust faced a challenging period and worked exceptionally hard to embed policies and organisational principles. The focus was to ensure that the Trust established solid foundations and ensure that quality services were maintained.

“We have made significant progress throughout the year, creating organisational form and function as well as reviewing all clinical services. Throughout the last twelve months, we have continued to focus on maintaining the delivery of high quality services and we have celebrated some key achievements including:

• The Trust’s Older People’s inpatient services have continued to achieve the new AIMS (Accreditation for Acute Inpatient Mental Health Services) accreditation. This quality programme, developed by the Royal College of Psychiatrists' Centre for Quality Improvement, which covers a wide range of inpatient service quality issues including policies and protocols, admission practices, advocacy, complaint handling and staff development.
• We have reviewed and evaluated all Trust services and implemented action plans to support improvements where needed.
• Across both Dudley and Walsall, we have made some significant improvements in our estates and facilities to ensure they are fit for the future and provide an excellent environment for both staff and patients. Work undertaken includes the installation of video conferencing facilities, landscaping and development of patient outdoors areas, the development of a patient place of safety and redecoration in a variety of our community sites.
• We have significantly reduced waiting times for Child and Adolescent Mental Health Services (CAMHS)
• We have worked closely with our stakeholders to develop our Clinical and Social Care Vision which sets out the Trust’s plans and direction for the next five years. Our vision embraces change and innovation ensuring we continue to provide services which meet the needs of our communities.

Over the last twelve months we have continued to deliver high quality mental health services and we would like to thank everyone who has worked for and with the Trust over the past twelve months for their tremendous commitment and hard work.

We look forward to working with our staff, service users, carers, partners and other stakeholders over the coming year to achieve the very best of mental healthcare within our boroughs and truly become ‘Better Together’.

Gary Graham
Chief Executive

5.3 The Dudley Group of Hospitals Foundation Trust

The Dudley Group of Hospitals NHS Foundation Trust is the main provider of hospital services to the populations of Dudley and significant parts of the Sandwell borough.

Currently we serve a population of around 400,000 people from three sites at Russells Hall and Guest Hospitals in Dudley and Corbett Hospital in Stourbridge, providing a range of inpatient and outpatient services including: surgery, medical conditions, emergency services, midwifery, diagnostics and cancer services to list a few.

Since joining The Dudley Group of Hospitals in October 2009, I have been struck by the dedication of the staff to providing the best possible service to our patients. This dedication has been recognised during the year with awards being received by many of our teams, for example midwife of the year and patient safety winner, which is a real testament to the fantastic work going on every day in the hospitals.

But 2009/10 hasn’t been without its challenges. Achieving the target to see, treat and admit or discharge 98% of Accident and Emergency (A&E) patients has been the result of the hard work of every member of staff across the Trust as well as partnership working with our Primary Care Trust and I would like to take this opportunity to thank you all.

We are rightly proud of the reductions we have made this year in healthcare associated infections. During 2009/10 only two of the ten cases of MRSA were considered to be hospital acquired (those which have developed after being in hospital more than 48 hours), achieving our target of no more than 12 pre and post 48 hour cases for 2009/10.

This is a very important matter to us and our patients so we have included further reductions in MRSA and Clostridium difficile (C difficile) in our quality report for 2010/11.

Priority: Reduce our MRSA rate in line with the national and local priorities. We will only be measured in 2010/11 on post- 48 hour cases and our target is no more than two.

Priority: Reduce our Clostridium difficle rate in line with the national and local priorities - this is no more than 161 for 2010/11.

Going forward the Trust will continue to focus its efforts on quality, patient safety and infection control to ensure that all patients coming into our hospitals are pleased with the service they receive.

The Trust has a strong vision to be the hospital of choice for local people. Excellent work has already taken place to ensure that this becomes a reality and over the coming months I am looking forward to leading our organisation to build on these foundations and take our hospitals to the next level.

Paula Clark
Chief Executive

5.4 Primary Care

“For the majority of people seeing your local GP, pharmacist, dentist or optician is the first port of call if you have concerns about your health and we want to ensure that you can do this as quickly as possible.

We know that local people in Dudley want to receive high quality health care services in the right place, at the right time and by the right people. At NHS Dudley we are committed to working with our partners to ensure that Primary Care services are fit for the 21st Century and are truly centred around Dudley borough people.

We aim to ensure that the majority of patients in Dudley are cared for as close to home as possible, in their own communities, avoiding the need for a visit to the hospital. This is known as Primary Care. In Dudley there are some really excellent examples of the way in which patients receive their care from the GP, Dental, eye and Pharmacy services within Primary Care. The way in which these services are delivered has changed over the past few years and our clinicians and their staff have shown dedication, professionalism and commitment to make sure our services benefit as many patients as possible.

However, we know that we need to continue to make significant changes to ensure that all Primary Care services are able to meet the changing needs of our population and provide high quality care to people in the borough.

The people of Dudley have told us that they want the future of primary care in the borough to support the prevention of ill health with the ability to respond to people’s needs when they are poorly. Because of this we have a vision to improve access to services and to have a workforce that is empowered and trained to help people to not become ill but to support them when they are.

We want our patients to be cared for as close to home as possible and we are now looking to a future healthcare system that will ensure people stay at home and avoid hospital admission where ever possible.

Sometimes it may not be possible for people to cope with their illness on their own or with their family’s support which is why we are committed to working with all our partners to ensure that services are delivered in a joined up way.

As a patient you should not see the various organisations that contribute to your care and we know that by working more closely together and embracing innovation and excellence we can provide a service that will prevent duplication, unnecessary costs, draw on the widest professional expertise available and above all improve the heath and wellbeing for the people of Dudley.”

Kimara Sharpe
Director of Community Engagement and Primary Care

5.4.1 General Practice

2009/10 has been busy for General Practice in the Dudley borough. Thanks to the Equitable Access to Primary Care initiative the borough saw the opening of a new GP Practice in Pensnett and the opening of the first Walk-in Centre locally. Both have proved hugely successful with over 22,000 benefiting from the Dudley Borough Walk-in Centre since it’s opening in July 2009. In April 2010, the final EAPC supported practice will open at Kates Hill, offering a range of family health services in addition to a BME outreach facility.

Dudley borough residents have more choice than ever when it comes to seeing their GP, as in addition to the new surgeries and Walk-in centre, 74% of practices offer extended opening hours, either early morning, evening or weekend sessions.

To support this level of choice, we have focused on improving the information available to patients regarding GP services throughout the year. The ‘Going for Gold’ project has been successful in supporting 100% of local practices to achieve the highest possible standard of information regarding GP practices on NHS Choices.

This year has also seen a review of the PMS contracts with local GPs to ensure the highest level of quality is provided to Dudley borough residents. The initiative has resulted in a bronze, silver and gold rating for quality of services for local GP services and for the first time directly links the amount paid to GPs with the quality of service that is provided.

5.4.2 Opticians

We have been driving up the quality of ophthalmic services for Dudley people through performance management. The new contract was introduced in 2008 for which we helped to develop the national toolkit and then localised with additional clinical governance elements to ensure that we are stringently monitoring our providers.

We are also engaging with local people through Social Marketing- We recognized that our over 60 population were not accessing sight tests and began a programme of research to understand why. The research showed that eye sight was ‘precious’ to local residents, in fact the word was used over 20 times by participants. This became the basis of the campaign that focused on the precious things in life that eye sight enabled such as reading, driving and watching family grow up. The campaign has resulted in a 4% increase in the amount of eye examinations undertaken in comparison to a national increase of 2%.

5.4.3 Dentists

This year for dental services we have been working to ensure that we get best value for your money. We have successfully negotiated more productivity from our providers for the same contract value to ensure that everyone in the borough can have access to an NHS dentist when they need it.

We are also focused on driving up Quality through Orthodontic Accreditation; this 3yr scheme has been developed in collaboration with our Consultant for Orthodontics.

We know that in all we do, ensuring that we are meeting local need is essential, this year we have done significant engagement through Social Marketing. We conducted a mix of 1-2-1 interviews, focus groups and semi structured interviews to gain insight into why children in the borough were not visiting the dentist regularly. The research informed us that parents were not aware of the right age to start to taking their child to the dentists, that they assumed there was an associated cost involved and that their own fear of the dentist was creating a barrier to their children accessing dental care. To tackle these issues a coordinated campaign was launched including advertising, direct mail initiatives and incentives to encourage initial visits.

5.4.4 Pharmacists

Developments in pharmacy this year have included:

• Appointed pharmacists specialising in medicines for older people and those with neurological problems. These pharmacists are working with the hospital, GPs and specialist teams to help people get the best out of their medicines.
• Ensured that young patients with sickle cell disease have access to a new drug which can be taken daily as a tablet rather than given by an infusion overnight, five nights a week.
• Improved safe use of medicines through checking that patients have had the right blood tests and other investigations to make sure that the medicines are still right for them.

5.4.5 GP Out of Hours Service

Our GP Out of Hours service is provided by Nestor Primecare and offers appointments to Dudley borough residents from 8pm- 8am, 7 days per week. The contract was rewarded to Nestor Primecare in 2009/10 following a full tender process.

NHS Dudley has an excellent working relationship with the Nestor Primecare and holds regular clinical quality review meetings for the service. These are meetings led by clinicians and doctors and nurses scrutinise the clinical aspects of the services including any complaints or serious untoward incidents.

5.5 Specialised Commissioning: Working together to improve patient care

Specialised services, which tend to be high in cost and often only provided in specialist centres to a population of more than one million people, are constantly developing and changing; new specialised services are introduced whilst other services become commonplace and cease to be specialised.

The West Midlands Strategic Commissioning Group commissions specialised services on behalf of the 17 West Midlands Primary Care Trusts. Key achievements for 2009/2010 include:

• The introduction of the West Midlands Paediatric Retrieval Service which despatches specially trained doctors and nurses to provide specialist intensive care for critically ill children before, during and after their transfer to an available paediatric intensive care bed.
• Commenced the production of a region-wide strategy for children of the West Midlands to receive high quality, safe and most technologically advanced surgical services. Over 50 surgeons and anaesthetists and other key health professionals worked together at a deliberative event to fast-track the strategy.
• The development of a Secure Services strategy for the next five years to ensure that people from the West Midlands with complex specialised mental health needs can access the most appropriate services at the right time and as close to home as possible at the right price.

6. Meeting our Targets

We know that patients want access to the care and treatment they need as quickly a possible and that they want to be seen in clean, safe environments. We work hard to ensure that the services we commission and provide have the best possible access to care in the right place, at the right time and from the right people. For example, from a pharmacist, GP or nurse practitioner, the Dudley Borough Walk In Centre, a hospital consultant or Accident & Emergency.

6.1 Access and Waiting Times

When the people of the Dudley borough need medical attention we are here to ensure that they are able to access the most appropriate services for them, be that urgent care, routine elective surgery or an appointment with a podiatrist.

This year we have made great progress towards ensuring that no patient will wait over 18 weeks for treatment from the point of referral.

Throughout 2009/10 we have consistently performed over the targets for the following:

• of admitted patients seen within 18 weeks
• of non-admitted patients seen within 18 weeks
• of audiology patients treated within 18 weeks

Getting access to urgent care when needed is very important. We should achieve this target in the 2009/10 Periodic Review with 98.1% of patients treated within 4 hours compared to the national target of 98%.

When people are diagnosed with cancer, it can be a very distressing time.

In the period April to March 2010 98.06% of patients waited no more than two weeks from urgent GP referrals to their first outpatient appointment. In the same period 99.34% of patients waited no more than one month from diagnosis of cancer to receiving treatment. Also a new target for 2009/10 was to achieve, by December 2009, 93% of patients with breast symptoms referred to a specialist to be seen within two weeks of referral. Dudley PCT achieved 88.4% in December 2009 and has exceeded the target between January 2010 and March 2010.

At March 2010, there were 4,300 people on the inpatient waiting list but through out 2009/10 eleven patients had to wait more than six months for an inpatient appointment.

74% of GP practices in the Dudley borough are operating extended opening hours for their patients.

6.2 Healthcare Associated Infections (HCAI)

At NHS Dudley we recognise that reducing HCAI is everyone’s responsibility.

We achieved our MRSA target in respect of Dudley Group of Hospitals NHS FT, the Trust’s main supplier of hospital services. In 2009/10 there were 10 cases against a target of 12.

We have achieved our targets in respect of Clostridium Difficile. Up to the end of March 2010 there had been 251 recorded cases against the PCT target of 255. In respect of Dudley Group of Hospitals NHS FT, there had been 126 against a target of 238.

6.3 Choice and Choose & Book

In the past, most people in Dudley used local hospitals, especially Russells Hall, The Guest and Corbett, but from 1st April 2008 they had a choice of hospitals in Birmingham, Worcester, Wolverhampton, Walsall or anywhere in England provided that the hospital treats their particular condition. This is known as Free Choice at the Point of Referral.

Under Free Choice, a number of non-NHS hospitals are extending their services to treat NHS patients. So, in some cases, patients may be eligible to be referred to a private provider hospital such as West Midlands Hospital or Wolverhampton Nuffield Hospital. Even though these hospitals are not NHS hospitals, patients do not need to pay for their out patient appointment, treatment or follow up, just as if patients received their treatment from an NHS hospital.

All Dudley borough GPs had access to the computerised Choose and Book system

7. Our Governance

“The people of Dudley, rightly, expect that their NHS provides them with the highest quality of care that is possible, and our role is to ensure that we govern services to ensure that they are safe.

I firmly believe that having appropriate governance arrangements in place is crucial to not only ensuring the services we commission are safe and effective, but allows us to hear real life patient experiences. This allows continual improvements to services here in the Dudley borough.”

Kimara Sharpe
Director of Community Engagement and Primary Care

7.1 Annual Health Check

The Annual Health Check is a comprehensive ratings system from the Care Quality Commission and considers a wide range of information.

The overall performance rating for organisations is made up of two parts:

• ‘Quality of financial management’, which looks at how effectively a trust manages its financial resources; and
• ‘Quality of commissioning’, which is an aggregated score of performance against national standards, existing commitments and national priorities.

They are retrospective, so they cover the period April 2008 - March 2009 and are for both NHS Dudley and Dudley Community Services.

The results are given in four categories; weak, fair, good and excellent. This years performance ratings are as follows:

	Dudley PCT 2009
Quality of Commissioning	Good
Quality of Financial Management	Good

7.1.1 Quality of financial management

The ‘Quality of financial management’ indicator is based on an assessment of the organisation undertaken by the Audit Commission and looks at how primary care trusts manage their resources and deliver value for money. For 2008/09, these assessments have been based on Use of Resources (UoR) for primary care trusts.

Auditors make assessments in a number of themes using key lines of enquiry. There are three themes for UoR:

• Managing finances
• Governing the business
• Managing resources

The criteria for these areas was very challenging with no organisation in the West Midlands receiving an ‘excellent’ rating. 52% of PCT’s in the region, including Dudley PCT were rated as ‘good’ for their quality of financial management.

The Care Quality Commission commented, “Dudley PCT is performing well in relation to the management of it’s financial resources, with arrangements embedded across the organisation.”

7.1.2 ‘Quality of Commissioning’

The ‘quality of commissioning’ score covers a range of areas including the safety of patients, cleanliness, access to services and ensuring people’s individual needs are met. A range of information is considered including:

• Performance against the ‘Standards for Better Health’ core standards.
• Achievements against existing commitments.
• Achievements against new national priorities.

Core standards for commissioning

The core standards cover seven key areas of health and healthcare, including safety, patient focus and clinical and cost effectiveness. The PCT submitted a declaration against these standards, and the report confirms the results as follows:

	Dudley PCT 2009
Compliant	23
Insufficient Evidence	1
Overall Rating	Fully met

A fully met score means that the Trust met all the core standards set by the government by the end of the assessment year. A trust can only receive this score if it declares no more than four failings during the year, these failings must have been corrected by the end of the year.

The standard that the PCT could not provide sufficient evidence that it had achieved was Standard C11b which covers mandatory training for its staff. Significant work has been undertaken to ensure the Trust’s compliance with C11b and the Trust is now confident this standard is being met.

7.2 Risk Management

We believe that patient and staff safety concerns everyone at NHS Dudley. Our culture is one of fair blame and staff are encouraged to report incidents. We continue to work to minimise risk and embed our Risk Management strategy across the organisation.

We have a dedicated Security Manager to improve security throughout the organisation for patients and staff.

7.3 Serious Untoward Incidents (SUIs)

Any incident involving the actual, or potential, loss of personal information that could led to fraud, or have other significant impact on individuals, should be considered as serious.

All SUIs are reported appropriately and handled effectively following robust organsiational policies and procedures. They are reported to the Strategic Health Authority as soon as practically possible (and no later than 24 hours after the incident occurring during the working week).

The definition of a serious untoward incident (SUI) is ‘An incident (or series of incidents) when a patient, member of staff (including those working in the community), or member of the public suffers serious injury, or permanent harm or unexpected death (or the risk of death or serious injury) on either premises where health care is provided, or whilst in receipt of health care, or where actions of health service staff are likely to cause significant public concern.’ A serious untoward incident is an event which is likely to produce significant legal, media or other interest and which, if not properly managed, may result in loss of the Trust’s reputation or assets.

There were 14 SUIs between 1 April 2009 and 31 March 2010. A number of these involved injury or death of patients, but also included a security risk and confidential information leak. All were reported to the Strategic Health Authority and investigated appropriately.

7.4 Complaints

The PCT Complaints Procedure reflects the six principles for remedy as outlined in The Parliamentary and Health Service Ombudsman report, October 2007. The PCT has, in accordance with the Principles, taken action to ensure that we are:

• Getting it right.
• Being customer focused.
• Being open and accountable.
• Acting fairly and proportionately.
• Putting things right.
• Seeking continuous improvement.

During the period 1st April 2009 to 31st March 2010 a total of 210 complaints were received by the Primary Care Trust and these can be broken down as follows:

Of the 210 complaints received, 161 were responded to within the national timescales at the local resolution stage, which equates to 77% of complaints within the national standard. Of the remaining complaints, 33 were responded to outside of the national timescales as the issues contained in the complaints were complex, 11 were withdrawn and 5 were still under investigation at the time of this report.

As from 1st April 2009, the Primary Care Trust implemented The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, and are pleased to report that there has been a seamless transition to the new arrangements, which was attributed to the preparatory work already undertaken by the Complaints Team. These new regulations have served to strengthen the links between the other health agencies in the Dudley borough, and also our colleagues within Social Care.

7.4.1 Outcomes and Lessons Learnt

Comparing the above results to 2008/09, there has been an increase in the amount of complaints received by the Primary Care Trust (178 received in 2008/09 to 210 in 2009/10) with a noticeable increase in the complexity of the complaints received. There has also been a slight improvement in the number of complaints responded to within the timescale of 25 working days (from 75% in 2008/09 to 77% in 2009/10).

The following actions have been implemented as a result of complaints:

• Review and update of clinical practice, procedures and risks.
• Reflective practice review.
• Record keeping - ensure notes are comprehensive and contemporaneous.
• Improvements in communications with patients.
• Involving patients in consultations concerning service improvements.
• Importance of reporting incidents and complaints to staff immediately.
• Importance of honest and open communication.
• Staff to be more aware of patients’ feelings.

7.5 Keeping Information Confidential

At NHS Dudley we are committed to ensuring that the information we are responsible for is treated with due care and respect. Be that personal data or sensitive business information, we expect our staff and staff contracted to services to ensure that information is kept safe.

We reported two incidences of data breaches for 2009/10, one of which was corporate documents that were in a car which was stolen and the second one was documents left insecurely overnight.

For the year 2009/2010 the annual mandatory Information Governance toolkit return saw a 10% improvement across the 54 standards.

A total of 300 Freedom of Information requests were made for the year 2009/2010 which was an increase of 1% from the year 2008/2009. The information requested ranged from corporate details, financial information and service specific data.

During the year, the organisations Information Governance Team implemented the national Think Privacy campaign which is aimed at staff to consider how they handle sensitive information.

7.6 NHS Dudley Committees

The NHS Dudley Board is made up of Executive and Non Executive Directors and meets in public every six weeks to discuss strategic and operational issues and make decisions on behalf of the organisation. The Board is supported by a number of sub-committees, including the Professional Executive Committee (PEC) and management team, which meet every six weeks.

The PEC is chaired by a local GP, Dr Steve Cartwright, and is attended by other clinicians and managers of the organisation. Dr Cartwright’s role is to advise the Board on strategic commissioning and clinical issues.

The following are sub-committees of the Board:

• Finance and performance
• Professional Executive Committee
• Business Case
• Strategic Partnership Board
• Audit
• Quality and Safety
• Remuneration Committee
• Family health services
• Infection control
• Dudley Community Services
• Black Country LCCB
• West Midlands Strategic Commissioning Group

7.6.1 Dudley Community Partnership Representation

NHS Dudley is also a key member of the Dudley Community Partnership - a body made up of representatives from the public, voluntary and private sectors, charged with making services work better together and developing a community strategy for Dudley. NHS Dudley is represented on six ‘theme partnerships’:

• Economic Development and Regeneration
• Children’s Trust
• Heritage, Leisure and Culture
• Health and Wellbeing
• Safe and Sound
• Strategic Housing and Environment

The organisation’s Chief Executive, Sarah Dugan, currently chairs the Dudley Community Partnership.

7.6.2 Strategic Partnership Board

NHS Dudley is represented on this Board, which acts as a monitoring body for the work of Dudley Infracare LIFT Ltd. Dudley MBC is also represented.

7.7 Quality Improvement

We continue to focus on patient safety and quality of care. This involves scrutiny of a wide range of information including feedback from patients through the PALS and complaints processes and clinical information on the quality and outcomes of care. We have strengthened the quality requirements within our main contracts for providers from whom we commission services. Contracts now include key quality priorities identified by clinical staff and highlighted in patients’ feedback, for example stroke care and the quality of discharge information.

We have commenced formal Clinical Quality Review meetings with our main providers to review quality information and review progress on quality improvement initiatives. We have been preparing for the introduction of the new Commissioning for Quality and Innovation Scheme (CQUIN) which for the first time financially rewards providers who can demonstrate quality improvement in key areas.

During the year, we have held two public events focusing on quality which were attended by over 200 people in total. The later of these events held in March 2010 will help inform our Quality Accounts which evidence what quality improvements have been made.

7.8 Safeguarding

One of the most important areas of patient safety and quality is ensuring we have systems in place to safeguard and protect our most vulnerable children, young people and adults. There have been a number of high profile cases this year including the well publicised case of ‘baby P’ in Haringey and findings at Mid Staffordshire Hospitals from which NHS Dudley is committed to learning from. Throughout 2009/10 we have strengthened safeguarding requirements within all of the main provider contracts, and monitor issues through the Clinical Quality Review process. In addition we have implemented best practice in recruitment systems and a robust training strategy to strengthen the clarity of the level of training required by the staff groups. NHS Dudley now has a Lead Nurse for Safeguarding Adults, while the Lead Nurse for Safeguarding Children transferred from DCS in October 2009.

Safeguarding Children

The Care Quality Commission (CQC) carried out a safeguarding children review at the direct request of the Secretary of State following the legal case relating to the death of baby P in November 2008. They were asked to look specifically at:

‘Board Assurance around Child Protection Systems, including governance arrangements, training, staffing and around arrangements for organisations to work in partnership to safeguard children’.

At NHS Dudley we have a Board level Executive Director for safeguarding and the Board reviews safeguarding across the organization at least once a year and has robust audit programmes to assure that safeguarding systems and processes are working.

Throughout 2009/10 our work has included:

• Undertaking of mapping exercise of all safeguarding children training enabling an understanding of the quality, availability and impact of current safeguarding training for healthcare professionals.
• Joint working with all agencies in Dudley providing services to children and families to implement the Children and Young People’s Plan.
• Membership of the Local Safeguarding Children’s Board
• Work with the Integrated Services Team Manager to implement the Common Assessment Framework.
• Participated in the Multi Agency Risk Assessment Conferences (MARAC) which has increased the safety, health and wellbeing of victims - both adults and any children in high risk domestic abuse situations.

We are committed to ensuring that those involved in safeguarding have access to immediate advice and support from the Safeguarding team. This Safeguarding supervision includes scrutinizing and evaluating individual case records for children with a Common Assessment (CAF), auditing one set of case notes at each supervision contact, providing coaching, development and pastoral support, enabling practitioners to work effectively within the field of child welfare and Child protection and identifying any training needs.

The Top Three Priorities for Safeguarding Children

Priority 1: Improve early responses intervention and prevention in respect of Children and Young People suffering from emotional abuse and neglect

Priority 2: To work with partner agencies to consolidate interagency responses to Domestic abuse where there are children within the household

Priority 3: Training, to ensure that all staff know how to respond to Safeguarding and Welfare concerns about a child or young person regardless of their position in the organisation

Safeguarding Adults

Throughout 2009/10 we have strengthened our focus on adult safeguarding and now have a Lead Nurse for Safeguarding Adults. NHS Dudley is committed to the Safeguarding agenda and we are represented on the Safeguarding Vulnerable Adult Board by the Director of Strategy and Innovation (Executive Nurse).

The Safeguarding Boards Business Plan was developed throughout 2009 and contains key themes:

• The Effectiveness of the Safeguarding Board.
• The Responsibility of Partner Agencies in understanding their roles and responsibilities for the Safeguard Agenda.
• Promotion of the Safeguarding Agenda.
• Training.
• Quality and Performance.

A Summary of Work of the Board in 2009/10 includes:

• A Baby P information sharing seminar with Adult Services in April 2009; Safer Recruitment Updates in September 2009;
• Consultation Event with Black & Ethnic Minority Groups and a Joint Publicity Campaign throughout the Borough in November 2009.
• The Board developed a Communication Strategy, a revised Training Strategy and a Protocol for responding to Incidents of Repeated Abuse in May 2009. These strategies became operational in 2009.
• In 2009, the Safeguarding Board agreed the commissioning of two Serious Case Reviews. The first review was completed in late 2009 and a report of its findings made to the Safeguarding Board in March 2010.
• The Board approved recommendations for important changes to the Safeguard and Protect Procedures and commissioned training on these new Procedures in 2010.
• The Board ensured that links with Community Safety were improved in 2009. Strategic data set information is now shared and a strategy for Hate Crime is being prepared.
• Clearer pathways for referrals to and from the Community Safety Team and Adult Social Care are now operational and the Community Safety Team is contributing to Induction and Procedural Training.
• The Board commissioned an audit of Partner Agency compliance with Safeguarding requirements in conjunction with the Adult Social Care Commissioning team.

8. Our Staff

“I enjoy working for an organisation that is committed to both the improved health and wellbeing of Dudley residents and my ongoing personal development.”

Ben Collins
Emergency Planning Officer, Governance

“I have worked for the Trust since November 2002 and as a working mom to two little boys have always found the Trust to be understanding and flexible to the various ‘challenges’ that a working mom faces trying to achieve that ‘perfect work-home life balance’.“

Tracy Dunleavy
Web Services Team Manager

“Quality and performance have always been issues that are central to both my personal and professional ethos. I have always believed that central to the NHS core values of ‘free at the point of need’ is the basic tenant that all services should be ‘fit for purpose’. On that basis I enjoy my role, because it is central to fulfilling this fundamental aspiration and also to aid delivery of better quality, efficient service to the patients.”

Terrance Chikurunhe
Quality and Performance Manager, Primary Care Commissioning

“The most enjoyable aspect of my job is being able to work so closely with the public. The experience I have gained from the Healthy Retail Project using a social marketing approach has changed my attitude towards health promotion for the better. Spending time engaging with the families on the Hawbush estate has given me an extremely valuable insight into the needs and motivations of the community when it comes to health.”

Stacey Jones
Food for Health Advisor

8.1 Involving Our Staff

We recognise that staff feel valued if there is a culture of twoway communication. In order to involve, engage and communicate with our staff we have:

• A web-based forum where members of staff can directly ask the Chairman and Chief Executive questions.
• A paper based monthly newsletter to ensure staff who do not have regular access to computers are kept up to date on organisational developments.
• The weekly bulletin detailing new stories to all our staff.
• An internet based polling facility where staff can vote on a wide range of issues.
• Senior managers’ leadership events.
• Team Brief System.

8.2 Education and Development

Effective education and development provides the Trust with the knowledge and confidence that staff are operating at the highest levels of efficiency, effectiveness and safety. NHS Dudley considers that the continual development of all staff, whether clinicians or support staff, is key to the delivery of high quality services. As an organisation we make sure that all development activities undertaken by staff have the patient or public as the focus of learning and wherever possible, opportunities to involve the public and other organisations in developing education programmes, are encouraged.

We also ensure that the focus of learning activity is aligned to the Trust’s Local Operating Plan and the Strategic Health Authority’s ‘Investing for the Workforce’ programme, around areas such as World Class Commissioning, Healthcare Associated Infections, Care Closer to Home, 18 Week Wait, Equality of Access to Primary Care and Effective Leadership.

The organisation continues to support the national ‘Skills Pledge’ commitment to ensuring that all of our employees have the basic knowledge and skills to perform their role effectively and this extends to ensuring that all staff have the opportunity to gain a qualification to at least Level 2 (which equates to 5 GCSEs at grade C or above). We also provide work experience and apprenticeships to increase access to work opportunities.

Internally NHS Dudley has a dedicated and innovative education and training department. The team develops an annual training directory which is available to teams across the organisation and offers over 120 different training courses. This team organises a range of learning activities ranging from basic skills such as literacy and numeracy training provided by Dudley college, soft skills training such as customer care, providing extended clinical skills training, supporting staff at higher educational establishments and providing opportunities for postgraduate and masters degrees at university, to name but a few.

The education and training team works closely with local colleges and universities to develop and commission learning activities that meet PCT requirements and has a good relationship with the local workforce deanery in identifying resources for workforce and service development with its associated educational requirements.

This year has seen the launch of a number of innovative development courses within the organisation including:

• The Productive Leader which focuses on developing high performing leadership teams to help drive a high performing NHS. The programme utilises the principles of Lean Thinking and Six Sigma to enable leadership teams to reduce waste and variation in personal work processes.
• Developing Our Talent which offers a modular based programme to staff within the commissioning arm of the organisation. The programme will develop the potential of our staff and aims to equip them with the skills and knowledge that will help them in their future successful careers within our Trust.

8.3 Electronic Staff Record

During the last year the organisation has further implemented and improved the Electronic Staff Record system to include all staff in NHS Dudley and Dudley Community Services.

The system is a national single system that aims to make the payment and management of staff much more efficient whilst at the same time improving the amount and quality of workforce information that is available to managers. Better quality information increases the ability of the organisation to plan its workforce of the future.

During the last year NHS Dudley focused on introducing new online training facilities within the Electronic Staff Record and all staff have been issued with access to the new e-Learning system. Plans have been made for Employee Self Service to be introduced later on in May 2010. With Electronic Staff Record being used by all members of staff in the borough, the new system will greatly improve the daily management of staff data.

8.4 Celebrating Success

Our staff were recognised for their commitment to improving the health and wellbeing of Dudley borough residents in a ceremony held at the Village Hotel, Dudley on September 24th.

Over 120 staff attended the annual ‘Celebrating Success’ event which saw locally produced awards presented in the following seven categories:

• STAR Award (Staff/Team Achievement Recognition)
• The Partnership Working Award
• Patient and Experience Award
• Team of the Year Award
• Community Award
• Inspirational Role Model Award
• The Chairman’s Award

Judging for the event took place in early September and a judging panel from the PCT were joined by two members of the public in deciding the winning entries. Each winning entry was presented with a specially commissioned piece of glass produced by local artist Caroline Scully, who is based at the Red House Glass Cone in Stourbridge.

8.5 Long Service Awards

The 2009 Long Service Awards were held at The Village Hotel in September. The event saw 22 staff with a total of 598 years service to the NHS honoured. Three members of staff were recognised for over 40 year’s continuous service.

8.6 Sickness Absences

The annual sickness rate for staff at NHS Dudley and Dudley Community Services in the year 1 April 2009 to 31 March 2010 was 3.79%.

8.7 Equal Opportunities

We have developed an Equal Opportunities Policy to eliminate all workplace discrimination. We are building a workforce which reflects the diversity of our communities and provides them with the best possible healthcare. The organisation is also committed (as shown in 9.2) to enabling all employees to make full use of their skills and to achieve their full potential.

9. Working with Patients and the Public

We are committed to engaging with patients, carers, service users, communities and interest groups, to help people be as healthy as possible and shape health services to meet people’s needs. We have a number of ways for people to give their views and help us improve health services in the Dudley borough, and we track patient and community feedback on services provided.

We remain committed to engaging people as early as possible in our plans - and keeping people’s views fed into the whole cycle of commissioning, from early planning to service design, improvement and review.

We are also building our networks with community and voluntary sector organisations and forums, to ensure that we are hearing all voices - not just the loudest. We have plans in 2010 to engage with people we do not usually hear from so that the feedback is balanced and we understand the different viewpoints of our communities.

9.1 Community Engagement

9.1.1 Dudley Borough Healthcare Forum

The Healthcare Forum has been busy over the last twelve months and discussed various topics including

• Dentistry
• Patient Information - making information about the Trust more accessible.
• Cancer Services
• Ask the Chief Executives with Sarah Dugan from the Trust and Paula Clark from The Dudley Group of Hospitals NHS Foundation Trust taking questions and answering them.

Members have also been involved in the selection process of the organisation’s new Chief Executive and judging staff entries for Celebrating Success.

9.1.2 Going for Gold

During 2009 we received funding from the Strategic Health Authority to improve the information available to patients. In an audit some practices had reached a bronze standard but the Trust decided to strive to get all practices to achieve a Gold standard.

We have been working with the GP practices in the Borough to update each individual practices’ information on NHS Choices website. Patients can log onto www.nhs.uk and search for their GP and view various information about their own practice from surgery times to the various clinics at the surgery.

In March 2010, a presentation event was held to present all practices that had achieved the Gold standard with a Certificate. 100% of practices in the Borough have achieved the Gold standard.

We are now working with local libraries to provide access to NHS Choices for those who do not have access to a home computer. This will provide laptop computers for residents to use, as well as trained professionals on hand to guide and advise.

9.1.3 Section 24A of the NHS Act 2006 - Duty to Report

From 1st April 2010, all Primary Care Trusts in the country will have a new legal duty to produce a public report demonstrating the engagement they have had with the public, and showing how the feedback from this engagement has been taken into account before commissioning(purchasing services) or service decisions have been made. The report must be published by September 2010, but must cover all past engagement activity since April 2009, current engagement activity (at the time the report is published), as well as planned engagement.

NHS Dudley and our partner health organisations in the borough are now collating all this useful evidence in order to prepare the report for September 2010.

9.1.4 Quality Accounts

We held two events looking at quality and what quality meant to the people of Dudley borough. Over 150 people joined us in a series of interactive workshops which explored their views on quality. We wanted to know whether we were getting it right with the services we commissioned on behalf of the population. We also wanted to know what improvements we should be concentrating on so we asked people what mattered most to them. We had a very positive response to both events and the information provided has fed into lots of different pieces of work, including the Quality Strategy and Quality Accounts. Throughout the coming year we will be working in close partnership with our providers as they develop Quality Accounts for their organisation.

9.2 How Engagement has influenced the development of services in Dudley borough

We understand that listening to what local residents want and need is key to ensuring that we commission the most appropriate services to meet these requirements. During 2009/10 the involvement of local people has influenced the development of services in many areas including:

• The appointment of an Hospital Carers Co-ordinator providing practical support and advice to carers
• The introduction of an e-learning tool to support consistent advice regarding breastfeeding following concerns raised to the PALS service
• Development of a community Dermatology service utilising the knowledge of a local patient panel
• Consideration of how the Healthcare Forum can develop to ensure the views of local people are fed into decision making at NHS Dudley

9.3 Patient Advice and Liaison Service

We understand that navigating around the NHS can be confusing at times and that there are occasions when our patients, their relatives or carers may need advice on particular issues they may have.

PALS (Patient Advice and Liaison Service) is a confidential and free service, providing information, advice and support to patients, service users, carers and relatives with the aim of resolving local difficulties on-the-spot. The role of the Patient Advice and Liaison Service is to:

• Advise and support patients, service users, families and carers
• Provide information on NHS Services
• Listen to concerns, queries and suggestions
• Help sort out problems quickly on behalf of patients and their carers
• Act independently when handling patient or family concerns.
• Liaise with staff, managers and health professionals with the aim of improving services

The table below gives information regarding the amount of calls received during each quarter of 2009/10.

Quarter	Number of Issues Raised
1st April 2009 to 30th June 2009	142
1st July 2009 to 30th September 2009	142
1st October 2009 to 31st December 2009	139
1st January 2010 to 31st March 2010	186
Total	609

We are aware that contacts from members of the public may outline areas for improvement in service accessibility and provision and is committed to receiving reports from the PALS service at Trust Board to ensure that any problems are given the priority they need.

Highlights from this year include:

9.3.1 Learning Disability Helpline

Over the last year PALS has helped to set up the Learning Disability Helpline, supporting volunteers to run a service for those with learning difficulties or those looking after them to be signposted to information sources. The Service will run as an offshoot of PALS for Learning Disabilities services, to escalate more concerns to PALS and to monitor trends and look for learning. PALS has set up a freephone number and email address. PALS is working with the Communications group in Learning Disabilities to progress this work. A considerable amount of work has gone into to setting up the programme, induction and training for volunteers.

9.3.2 Health Visiting

PALS has been working with staff developing questionnaires, collating and analyzing results to gain patient feedback on maternity services focusing on health visiting. Issues raised have been echoed by certain concerns raised via the PALS so PALS has been able to put these together feeding them into the Maternity Services Liaison Committee who used the information to influence commissioning decisions. Issues were also fed back to the Health Visitor Clinical Lead who drew up an action plan to address the issues. The main outcome was to ensure all Health Visitors were up to date with their training around breastfeeding directly in response to mothers’ concerns about advice. The MSLC are now entering the collaborative work done into the ‘Maternity Services Awards 2010’.

PALS has been visiting the Asian Elders Community Group in Halesowen on a quarterly basis as the group have had regular concerns for PALS including those relating to podiatry.

9.4 Equality and Diversity

NHS Dudley serves the diverse population of Dudley. Equality to us is central to everything we do, as a provider and commissioner of services and as an employer. We value equality and diversity and human rights and strive to ensure that we treat everyone with respect.

We have a single equality scheme which incorporates our race, gender and disability equality schemes. We regularly monitor our progress against our action plan. We publish all our equality impact assessments on our website and we also publish the ethnic make-up of our workforce, as required by the Race Relations Amendment Act.

In the past year, we have taken action to further strengthen our strategic approach to equality and diversity issues, particularly with regard to our relationships with ethnic minority communities:

• All new employees to the organisation receive mandatory training on equality and diversity issues and we have increased the time devoted to this during induction.
• We have commissioned BRAP - a not-for-profit training organisation based in Birmingham - to deliver equality ‘refresher’ training. So far nearly 100 staff have received this with at least 250 staff due to receive training during 2010.
• We have re-emphasised the importance of equality impact assessments as a critical business tool for our organisation by making it a priority in our engagement strategy.
• BRAP will also work with us to deliver tailored training to 30 staff who will then, as ‘Fairness Champions’ support the organisation to ensure that the quality and consistency of equality impact assessments is of a consistently high calibre.

Also in the past year, we have acted to improve service delivery issues for minority populations:

• An initial consultation on the proposed Health and Social Care Centre in Lye was concluded at the end of July 2009. This involved sending out over 8,000 questionnaires to patients registered with the 3 practices involved in the proposed move.
• We co-sponsored the BME (Black and Minority Ethnic communities) conference organised with Dudley Council in November 2009; ran a health workshop with colleagues from the Dudley Group of Hospitals and the Dudley and Walsall Mental Health Partnership Trust and developed an action plan to respond to patients’ concerns.
• We have commissioned a BME outreach service based at the new Kate’s Hill Practice to address health inequalities in minority populations.
• Specific work with the Chinese community by Public Health leading initially to a tailored Expert Patient Panel course for the Chinese community.
• PALS liaison with Halesowen Asian elders at a quarterly meeting

Public Health Programmes have supported health events in diverse communities such as Lye, Woodside and St Thomas’s, as well as specific events such as International Women’s Week which brought together women from all faiths, cultures and communities in Dudley borough through these community events our Public Health team has successfully engaged with:

• Yemeni Women of all ages in Halesowen, around improving their health and well-being
• The African Caribbean community in Dudley, to raise awareness about prostate cancer and key health messages
• Refugees and asylum seekers, about healthy eating and barriers to healthy living/accessing services.
• The Bengali & other minority ethnic communities, around Diabetes and healthy lifestyle advice and support.
• Those whose first language is not English, to raise awareness of the Expert Patients Programme.

9.5 The Place Survey 2008

In 2009/10 results from The Place Survey 2008 were published. This is a National Survey commissioned by the Government but run by our Local Authority to collect data on the way people feel about their local area (such as community safety, local services etc). In Autumn 2008 a total of 3,000 questionnaires were mailed out to randomly selected addresses in the Borough and 1,031 valid responses were returned (a 35% response rate).

The Place Survey captures self reported health in the general population. For this survey residents were asked to provide a self-reported measure of their general health. Just over 70% of Dudley residents consider their health to be ‘good’, with the remainder stating their health was fair or bad.

The Place Survey also provides new data on the Governments ‘Citizens Perspective’ indicators - 18 indicators relating to satisfaction with the area and quality of life.

In Dudley, there is a good overall satisfaction with the local area, but participation is lower. The level of crime emerges as the top public priority in Dudley followed by clean streets.

Residents felt that one of the priorities for improvement and changes over time should be Civic Participation. Less than 10% of Dudley residents say that they have been a member of some form of decision making body and at NHS Dudley we will continue to encourage local people to share their views and contribute to the development of the organisation. For example 2010/`11 will see the launch of an interactive website called ‘Your NHS Dudley’ which will facilitate a two way online dialogue between NHS Dudley and local residents.

10. NHS Dudley Being a Good Corporate Citizen

The phrase “Good Corporate Citizenship" describes how NHS organisations can reduce their negative impact on the environment, take an active role in local sustainable development, improve health and reduce inequalities in health through their day-to-day activities.

This means using the resources of the NHS in ways that benefit rather than damage the social, economic and environmental conditions in which we live and reducing our carbon footprint.

How we at NHS Dudley behave - as an employer, a purchaser of goods and services, a manager of energy, waste and water, as a landholder and commissioner of building work and as an influential neighbour in many communities - can make a big difference to people’s health and to the well being of society, the economy and the environment.

By operating as a "good corporate citizen", we know that we can contribute to a healthier local population, improved staff morale and better support for local businesses. We know that it can also lead to the services we buy being more efficient, which means that financial resources can be reinvested in local services.

At NHS Dudley we are already working in environmentally friendly ways to reduce the impact we have on the environment, reduce waste and save the energy we use across our offices.

We employ a waste manager who explores waste recycling opportunities and the Trust now recycles or offers for reuse numerous items that may have been disposed of previously. Items such as paints to a local charity, metals to recycling facilities, furniture for metal reclamation and timber reuse or use as fuel and waste electrical and IT items sent for materials recovery. All of these items are disposed of in compliance with current legislation.

10.1 Better Payments Code

The target of the better payments practice code is to pay all NHS and non-NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed.

We recognise that it is important to our suppliers, especially those small to medium sized businesses that we pay promptly.

In the last year we have achieved the following:

	2009/10 number of invoices	2009/10 value of invoices
Percentage of Non- NHS Trade Invoices Paid Within Target	94.11%	95.21%
Percentage of NHS Trade Invoices Paid Within Target	90.84%	97.77%

11. Our Board and Committees

11.1 Our Chairman and Non Executive Directors

The Board is the governing body of the organisation, and is held to account for the organisation’s performance in delivering healthcare and health improvement in Dudley borough.

Membership includes part-time Chairman and Non Executive Directors as well as full time Executive Directors (NHS staff). In general, the board aims to provide leadership, to look ahead and set the organisation’s strategic aims, and to identify and maintain our values.

Changes to our structure
This year has seen some significant changes to the structure of our board. Mark Cooke, Chief Executive, left the organisation in January 2010 and Sarah Dugan was appointed to the role. In March 2010, Chairman Rachel Harris stepped down from her position to stand for Political Office in the General Election Mrs Harris returned to her role in June 2010. During this period, Gill Cooper was Interim Chair. 2009/10 also saw the retirement of Bryan Richens from his post as Non Executive Director, while we welcomed Hilary Walker and Steve Wellings to the organisation.

Our board membership is outlined below and you can find out more about the board at www.nhsdudley.nhs.uk.

• Chairman - Rachel Harris
• Non Executive Director / Interim Chairman - Gill Cooper
• Non Executive Director - Michael Shaw
• Non Executive Director - Shameem Akhtar
• Non Executive Director - Julie Jasper
• Non Executive Director - Jason Hall
• Non Executive Director - Judith Deakin
• Non Executive Director - Steve Wellings

11.2 Our Executive Board

• Chief Executive until January 2010 - Mark Cooke
• Chief Executive from February 2010 and Director of Strategy and Innovation until January 2010 - Sarah Dugan
• Director of Public Health - Valerie Little
• Managing Director of Community Services - Tessa Norris
• Director of Partnership and Service Improvement - Sue Roberts
• Director of Community Engagement and Primary Care - Kimara Sharpe
• Director of Finance and Performance - Kevin Gaffney
• Director of Strategy and Innovation (Executive Nurse) from March 2010 - Hilary Walker

11.3 Our Committees

Our board is supported by a number committees that focus on specific areas and provide assurance to the Trust board.

• The Audit committee has responsibility to ensure that the organisation applies consistent financial reporting and internal control procedures. The committee is chaired by Julie Jasper and is attended by Gill Cooper and Mike Shaw.
• The remuneration committee is responsible for advising the Board about performance, development, succession planning and appropriate remuneration and terms of service for the Chief Executive and all Executive Directors, guided by NHS policy and best practice. Advice to the Board on remuneration includes all aspects of salary as well as arrangements for termination of employment and other contractual terms. The committee is chaired by Gill Cooper/Rachel Harris and is attended by all Non Executive Directors. The Chief Executive and other Executive Directors may be invited to attend.

12.0 Our Finances

In this section, we give you a glimpse into our finances. The details can be found over the next few pages and in our full accounts which are available at www.dudley.nhs.uk.

12.1 How did we spend your money?

This pie chart displays how your money was spent in 2009/10. As you would expect the majority of spend is on NHS healthcare, but this also shows a big spend on drugs and GP services.

12.2 Where were our patients treated?

This map shows where our patients were treated. In the NHS, wherever you as a patient choose to be treated - at Russells Hall in Dludley, New Cross in Wolverhampton or at one of the private hospitals such as Ramsay Healthcare’s West Midlands Hospital - the money follows you.

As you can see, the majority of Dudley people choose to be treated locally at Russells Hall but a larger proportion are starting to use choice and pick a hospital a little further afield.

12.3 What do you get for every pound we spend?

12.4 Statement of the Chief Executive’s Responsibilities as the Accountable Officer of the PCT

The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that:

• there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance;
  
  
• value for money is achieved from the resources available to the primary care trust;
  
  
• the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them;
  
  
• effective and sound financial management systems are in place; and
  
  
• annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Signed: Chief Executive
Date: 9th June 2010

12.5 Statement on Internal Control 2009/10

1. Scope of responsibility

The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.

I am accountable to the Chairman of the Primary Care Trust and my performance is appraised and managed by the Chairman on behalf of the PCT Board. I took up my post on 1 February 2010. The previous chief executive left on 31 January 2010. There was no gap in the position of chief executive and I am confident that I was given an adequate handover in the management of internal control by the previous chief executive.

On 2 March 2010, the Chairman of the Primary Care Trust temporarily stepped down due to being selected as a Parliamentary candidate for the general election on 6 May 2010. The vice chair immediately took up post as Interim Chair with the agreement and determination of the Appointments Commission and was provided with a comprehensive handover. I am confident that there was adequate handover and that there was no gap in the management of internal control. The PCT has been informed that the Chairman has decided not to return to the PCT and the interim arrangements will continue until further notice.

The performance of the PCT is monitored by the NHS West Midlands by assessing how it is meeting its obligations as set out in the NHS Operating Framework 2009/10. This is undertaken by the submission of data, by declarations of compliance and by meetings between NHS West Midlands and PCT staff.

The PCT works as an equal partner within Dudley Community Partnership (local strategic partnership). Since November 2008, the Chief Executive of Dudley PCT has been chair of the Dudley Community Partnership and I am continuing in that role. Senior staff are members of the partnership boards and the work of the partnership boards are presented to the PCT Board. The PCT has a good working relationship with the Dudley Health and Social Care Scrutiny Panel. The PCT continues to work with LINks (Local Involvement Networks) and has offered a non-voting place on the board for a member of Dudley LINk. The PCT regularly meets with the Dudley Healthcare Forum and has discussed a range of issues with them during 2009/10 including the dental issues, quality, choose and book, Healthy Towns and the Public Health Annual Report. A major conference was held in Dudley in June 2009 regarding the public’s perception of Quality. The PCT was a joint organiser of the Black and Minority Ethnic Group conference in November 2009 and has participated in the setting up of the faith leaders’ network for the borough. The Strategic Plan was developed based upon the consultation undertaken in 2007/08 which developed the Joint Commissioning Framework. The Joint Director of Public Health is a member of the Dudley MBC Executive Management Team and has actively been involved in the development of the Local Area Assessment. A close working relationship has been developed between the PCT and Dudley Group of Hospitals NHS Trust and formal as well as informal meetings are regularly held. A board to board development programme has commenced this year and a joint seminar on negotiation skills has taken place with both executive teams. I am the chair of the Black Country Local Collaborative Commissioning Board as was my predecessor. The PCT supports and coordinates the work of the local implementation groups for national service frameworks.

During 2009/10 the PCT has worked to separate Dudley Community Services from the commissioning arm of the PCT. New governance arrangements were put into place in April 2009 after involvement with the Board and Dudley Community Services has been operating as an arms length provider during 2009/10. NHS Dudley was launched on 1 October 2009 to emphasise this separation and in the last quarter of 2009/10 work has commenced to ensure that NHS Dudley is a pure commissioning organisation by 31 March 2011. A programme board was established by the Primary Care Trust Board at its meeting on 31 March 2010, chaired by a non-executive director, to oversee the transition process and part of its remit will be to manage the risk register for the project. The Board is aware of the key strategic risks associated with the transformation of community services, namely the loss of community provider staff, the resources required to ensure the project runs smoothly, risk of the inability to ensure that the public health agenda is adequately executed, in particular the role of category 1 responder, public health programmes such as immunisation and vaccination and the format of the community contract within which strong commissioning is difficult.

Throughout 2009/10 the chief executive had responsibility for the systems of internal control for the Commissioning Business Services Agency (CBSA). I continue to have responsibility for the systems of internal control for a number of services provided to Dudley & Walsall Mental Health Partnership Trust including IT; finance and accounting; procurement and estates and facilities.

2. The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to:

• identify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives,
• evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control has been in place in Dudley Primary Care Trust for the year ended 31 March 2010 and up to the date of approval of the annual report and accounts.

3. Capacity to handle risk

The PCT Risk Management Strategy (approved by the Board in November 2007 and reviewed by the Quality and Safety Committee in March 2010) sets out the role and responsibility of the Chief Executive and other key officers in relation to Risk Management. I have delegated the operational responsibility of Governance (clinical, information and corporate) to the Director of Community Engagement and Primary Care. The Quality and Safety Committee, chaired by a non-executive director, meets monthly and is accountable to the PCT Board. This Committee assures the Board of the management of risk within the PCT. It monitors the work of the Clinical Quality Review meetings with our main providers and the work of the Care Quality Commission locally (for example their assessments of nursing homes). It also reviews the red risk register and the serious untoward incident reports. The Audit Committee gives assurance to the Board that risk is being managed appropriately within the PCT. The Quality and Safety Committee was formed in response to the Mid Staffordshire review and took over the responsibilities of the Governance Committee. Within Dudley Community Services, the integrated governance committee manages risk within the provider arm. This committee reports to the Dudley Community Services Committee which in turn assures the Board of the management of risk within the provider. Dudley Community Services has developed its own Assurance Framework which is managed by Dudley Community Services Committee and also reported to the Audit Committee, along with the red risk register for Dudley Community Services.

The PCT continues to review its governance arrangements and has taken account of its responsibilities in respect of arms length provider services. Decisions relating to the management of risk therefore are now able to occur as close as practicable to the risk source. Risk assessment processes are in place and Dudley Community Services manage their risks through their integrated governance committee as detailed above. Root cause analyses are undertaken for all serious untoward incidents (SUIs). SUIs occurring within commissioned services are monitored as are the resulting root cause analyses. Independent contractors are encouraged to report SUIs to the PCT.

The PCT has reviewed the mechanism for learning lessons to ensure that this happens across the health economy. The PCT employs a Local Security Management Specialist in accordance with Secretary of State Directions. Compliance with the Health and Safety at Work Act is monitored through the Health and Safety Consultative Committee, chaired by the Managing Director of Dudley Community Services with NHS Dudley representation which reports to the Board through my Chief Executive’s report. During 2010/11 the management of health and safety will be reviewed in the light of the transfer of community services.

The PCT has a Policy on the Standards of Business Conduct which includes declaration of interests and the registration of gifts and hospitality The PCT has this year ensured that all senior managers have completed declaration of interest forms alongside those for the Board and Professional Executive Committee.

The PCT recruited an Emergency Planning officer in early 2009/10 and as a result has undertaken a desk top business continuity exercise as well as two communication exercises. The PCT has also responded to the national swine flu pandemic and redeployed staff to an antiviral collection point (ACP). This meant the deployment of the business continuity plans. I am in the process of being trained to be able to manage serious incidents across Birmingham and the Black Country (ERMA 2). The PCT had to urgently evacuate one of its administrative premises during 2009/10 which was undertaken without disruption to patient services.

The PCT will be undergoing its assessment on World Class Commissioning in May 2010. In preparation for this, the PCT has undertaken a self assessment against all the elements within the 11 competencies. This assessment is shown in the table appended to this document.

NHS Dudley has assessed itself as ‘green’ for the governance elements.

As a result of the World Class Commissioning assessment which took place in November 2008, the board has undertaken an extensive development programme and has worked with the board of Dudley Group of Hospitals Foundation Trust including a two day workshop on negotiation skills. I have also strengthened the resources in the management of the market and procurement skills.

4. The risk and control framework

The Assurance Framework provides the overall mechanism for the PCT Board to manage its strategic risks. The Assurance Framework is structured so that it links directly to the Strategic Objectives for the PCT. It was developed by the whole board during a facilitated planning event and each of the risks identified has a lead director whose responsibility it is to ensure that the risk is mitigated. Action plans are in place to mitigate the risks identified and embedded within the day to day working of the PCT for example the mitigation of the risk relating to the achievement of the accident and emergency department four hours target is being dealt with through the project management set up to review urgent care within the borough of Dudley. Equality impact assessments are embedded within the work of the PCT by processes in place which ensure that no policy or strategy can be approved until the impact assessment has been signed off by the responsible director. Within the Assurance Framework, there are two outstanding areas where there are gaps in controls. These are the provision of medical advice to Dudley Community Services and the lack of suitable accommodation for the walk in centre. The former has now been addressed and the latter remains outstanding. The former was a clinical issue and the latter an operational issue.

The red risk register holds the high operational risks and the financial consequences of the risk are identified where appropriate. These are categorised as ‘red’ on the 5x5 risk scoring matrix. Again, there is a lead director identified who puts an action plan in place and ensures that the risk is mitigated. The red risk register is reviewed regularly at the Quality and Safety Committee.

At the year end, if the risk remains it is updated to reflect the new financial year with a clear audit trail linking it back to the previous risk. Major risks identified on the risk register for 2009/10 include the availability of scans for people who have had a stroke within 24 hours. This was mitigated through working closely with the acute trust and ensuring the data collected are robust. Meeting the four hour target in Accident and Emergency is also another risk for the PCT and the actions to mitigate this have been described above. Infection control issues such as the MRSA target and c difficile target have also featured on the risk register and work has been ongoing with the infection control team to mitigate these across the health community. Outcomes of these performance risks are monitored through the Finance and Performance Committee.

The PCT has had two serious untoward incidents relating to loss of secure data during the year 2009/10. One involved the theft of a computer server at one of the local dental practices. The local dental practice had installed all the required protection against theft. The second incident related to the theft of a member of staff’s car in which there were personal payroll details (name, personnel number and salary) of approximately 250 staff. The car was recovered within 48 hours by the police and all the data were found. Staff whose data were lost were notified and all staff were reminded about how personal information should be held.

There is a strong security culture within the organisation backed up by mandatory training for all staff. Sanctions would be applied if staff wilfully disregarded basic security measures. All patient databases have been identified through a data mapping exercise and there is an active pseudonomisation project chaired by the Senior Risk Information Officer. All laptops and blackberries are encrypted and the PCT is currently looking at a complete solution for USBs.

Risks which are deemed to be borough wide and impact on other stakeholders are addressed through the Dudley Community Partnership for example through the safe and sound partnership or through the health and well being partnership. Other risks are addressed through other routes for example the emergency planning partnership work.

Internal Audit has during the year provided assurances on the operation of the Assurance Framework. Dudley Community Services has its own Assurance Framework as detailed above.

In support of the management of risk, there are several key policies including:

• Incident reporting
• Serious untoward incidents
• Handling complaints
• Handling claims
• PALS operational policy
• Health and Safety policies
• Information governance policies.

Trends of incidents are presented to integrated governance provider committee and the health and safety consultative committee for action to be taken. Risk training takes place every month and on each induction session.

Every year the Care Quality Commission CQC conducts a health check of NHS organisations, looking at a set of standards called Standards for Better Health. The standards cover the following areas:

• Safety
• Clinical and cost effectiveness
• Governance
• Patient focus
• Accessible and responsive care
• Care environment and amenities
• Public health.

For 2009/10, the CQC undertook a mid-year assessment of the PCT’s Community Provider Service in terms of its performance against the Standards for Better Health. In November 2009, NHS Dudley undertook a self assessment of its Community Provider Service against the Standards for Better Health and subsequently declared insufficient assurance against standard C4e, disposal of waste. All other standards were declared fully compliant.

Dudley Community Services registered in January 2010 with the Care Quality Commission without any declared lapses. This registration was live on 1 April 2010.

As an employer with staff entitled to membership of the NHS Pension scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

The PCT has Single Equality Scheme which includes an action plan. Impact assessments and an annual break down by ethnicity of the staff employed are published on the website. Extensive update training for all staff on equality and diversity commenced in March 2010. An annual report on equality and diversity will be published outlining the actions the PCT has undertaken. The PCT therefore considers that control measures are in place to ensure that all obligations under equality, diversity and human rights legislation are complied with.

The PCT Board has considered a carbon reduction plan that includes plans to reduce the PCTs carbon footprint(particularly energy and waste reduction). Progress over the last three years to demonstrate improved energy conservation and waste management has been included in the Strategy. Further work associated with this plan will include partnership working with the local authority. This will include assessment of climatic change scenarios on health outcomes.

NHS Dudley was assessed against the World Class Commissioning competencies in May 2010. In preparation for this, the board undertook a self assessment against the competencies and governance elements. The board also reassessed its outcomes for world class commissioning and as a result of this, agreed to include an outcome relating to smoking cessation. The full assessment can be found here.

NHS Dudley PCT World Class Commissioning Self-Assessment Competencies, February 2010

(scale of 1 to 4 where 4 is high)

Competency	Measure	1	2	3	4
Competency 1 Are recognised as the local leader of the NHS	Reputation as the local leader of the NHS Reputation as a change leader for local organisations Position as an employer of choice
Competency 2 Work collaboratively with community partners to commission services that optimise health gains and reduce health inequalities and deliver increased productivity	Creation of Local Area Agreement based on joint needs Ability to conduct constructive partnerships Reputation as an active and effective partner
Competency 3 Proactively build continuous and meaningful engagement with the public and patients to shape services and improve health	Improvement in patient experience Public and patient engagement Influence on local health opinions and aspirations
Competency 4 Lead continuous and meaningful engagement of a broad range of clinicians to inform strategy and drive quality, service design, and efficient and effective use of resources	Clinical engagement Dissemination of information to support clinical decision making Reputation as leader of clinical engagement
Competency 5 Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements	Analytical skills and insights Understanding of health need trends Use of health needs benchmarks
Competency 6 Prioritise investment of all spend in line with different financial scenarios and according to local needs, service requirements and the values of the NHS	Predictive modelling skills and insights to understand impact of changing needs on demand Prioritisation of investment and disinvestment to improve population’s health Incorporation of priorities into strategy investment plan to reflect different financial scenarios
Competency 7 Affectively stimulate the market to meet demand and secure required clinical and health and wellbeing outcomes	Knowledge of current and future provider capacity and capability Alignment of provider capacity with health needs projections Creation of effective choices for patients
Competency 8 Promote and specify continuous improvements in quality (e.g. CQUIN, IQI) and outcomes through clinical and provider innovation and configuration	Identification of improvement opportunities Implementation of improvement initiatives Collection of quality and outcome information
Competency 9 Secure procedures skills that ensure robust and viable contracts	Understanding of provider economics Negotiation of contracts around defined variables Creations of robust contracts based on outcomes
Competency 10 Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvement in quality and outcomes and value for money	Use of performance information Implementation of regular provider performance discussions Resolution of ongoing contractual issues
Competency 11 Ensuring efficiency and effectiveness of spend	Measuring and understanding efficiency and effectiveness of spend Identifying opportunities to maximise efficiency and effectiveness of spend Delivering sustainable efficiency and effectiveness of spend

12.6 Independent auditor’s report to the Board of Directors of Dudley Primary Care Trust

Opinion on the financial statements

I have audited the financial statements of Dudley PCT for the year ended 31 March 2010 under the Audit Commission Act 1998. The financial statements comprise the Operating Cost Statement, the Balance Sheet, the Cash-flow Statement, the Statement of Changes in Taxpayer’s Equity and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out within them. I have also audited the information in the Remuneration Report that is described as having been audited.

This report is made solely to the Board of Directors of Dudley PCT in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies published by the Audit Commission in April 2008.

Respective responsibilities of Directors and auditor

The Directors’ responsibilities for preparing the financial statements in accordance with directions made by the Secretary of State are set out in the Statement of Directors’ Responsibilities. The Chief Executive’s responsibility, as Accountable Officer, for ensuring the regularity of financial transactions is set out in the Statement of the Chief Executive’s Responsibilities.

My responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).

I report to you my opinion as to whether the financial statements give a true and fair view in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I report whether the financial statements and the part of the Remuneration Report to be audited have been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I report to you whether, in my opinion, the information which comprises the commentary on the financial performance included within the Operational and Financial Review, included in the Annual Report, is consistent with the financial statements. I also report whether in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

I review whether the directors’ Statement on Internal Control reflects compliance with the Department of Health’s requirements, set out in ‘Guidance on Completing the Statement on Internal Control 2009/10’, issued February 2010. I report if it does not meet the requirements specified by the Department of Health or if the statement is misleading or inconsistent with other information I am aware of from my audit of the financial statements. I am not required to consider, nor have I considered, whether the directors’ Statement on Internal Control covers all risks and controls. Neither am I required to form an opinion on the effectiveness of the Trust’s corporate governance procedures or its risk and control procedures.

I read the other information contained in the Annual Report and consider whether it is consistent with the audited financial statements. This other information comprises [the Foreword, the unaudited part of the Remuneration Report, the Chairman’s Statement and the remaining elements of the Directors’ Report]. I consider the implications for my report if I become aware of any apparent misstatements or material inconsistencies with the financial statements. My responsibilities do not extend to any other information.

Basis of audit opinion

I conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit Practice issued by the Audit Commission and International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements and the part of the Remuneration Report to be audited. It also includes an assessment of the significant estimates and judgments made by the Directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Trust’s circumstances, consistently applied and adequately disclosed.

I planned and performed my audit so as to obtain all the information and explanations which I considered necessary in order to provide me with sufficient evidence to give reasonable assurance that:

• the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error;
• the financial statements and the part of the Remuneration Report to be audited have been properly prepared; and
• in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

In forming my opinion I also evaluated the overall adequacy of the presentation of information in the financial statements and the part of the Remuneration Report to be audited.

Opinion

In my opinion:

• the financial statements give a true and fair view, in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England, of the state of the Trust’s affairs as at 31 March 2010 and of its net operating costs for the year then ended;
• the financial statements and the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England;
• in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them; and
• information which comprises the commentary on the financial performance included within the Operational and Financial Review included within the Annual Report, is consistent with the financial statements.
  Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources

Directors’ Responsibilities

The Directors are responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in the Trust’s use of resources, to ensure proper stewardship and governance and regularly to review the adequacy and effectiveness of these arrangements.

Auditor’s Responsibilities

I am required by the Audit Commission Act 1998 to be satisfied that proper arrangements have been made by the Trust for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires me to report to you my conclusion in relation to proper arrangements, having regard to the Use of Resources Guidance issued by the Audit Commission. I report if significant matters have come to my attention which prevent me from concluding that the Trust has made such proper arrangements. I am not required to consider, nor have I considered, whether all aspects of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Conclusion

I have undertaken my audit in accordance with the Code of Audit Practice and having regard to the Use of Resources Guidance published by the Audit Commission in May 2008 and updated in October 2009, I am satisfied that, in all significant respects, Dudley Primary Care Trust made proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2010.

Certificate

I certify that I have completed the audit of the accounts in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Anthony Corcoran

Officer of the Audit Commission
Audit Commission
Suite 1, Observer House
Abbey Foregate
Shrewsbury
SY2 5DE
09 June 2010

12.7 Operating Financial Review 2009/10

The organisation has achieved another successful year regarding financial performance. As custodians of nearly £500m of public money the PCT has achieved all statutory financial targets in 2009/10. This has been at a time of significant demand on health services and the desire to develop services to meet key health plans. The PCT achieved all statutory and non-statutory financial duties as summarised below:

Statutory

• Remain within the Revenue Resource Limit
  achieved £251,000 surplus
• Remain within the Capital Resource Limit
  achieved £395,000 surplus
• Remain within the Cash Limit
  achieved

Non Statutory

• Better Payment Code - pay creditors in 30 days
  achieved - exceeded the 90% target
• Ensure Provider Services achieve full cost recovery
  achieved £432,000 surplus

In 2009/10 the PCT spent £496.5m, an increase of 10% compared to 2008/09. After taking account of technical adjustments associated with the revaluation of assets under the national policy for International Financial Reporting Standards (IFRS), the net increase in expenditure was 7%.

During 2009/10 the PCT increased expenditure in a number of areas, some of which were:-

• Increase the number of patients treated at the Dudley Group of Hospitals - 4% increase in elective patients, 8% increase in emergency cases and 2.9% increase in outpatients
  £11.5m
• Increased investment in two new GP practices and a walk in centre
  £2.1m
• Increased investment in weight loss programmes.
  £165,000
• Expansion of the smoking cessation service
  £50,000

2009/10 was a difficult year that saw the PCT continue to invest in services to meet increasing demand to reduce the number of patients waiting more than 18 weeks for hospital treatment. In addition, the PCT invested in services to improve the health of the local population, including healthy lifestyle programmes and immunisation take up rates.

The PCT implemented a number of cost improvements and utilised reserves in year to meet the financial consequences of meeting the health needs of the local population, particularly the increased hospital activity.

2009/10 saw the publication of the PCT’s Strategic Plan together with the Five Year Financial Plan as part of the PCT’s aspiration to become a World Class Commissioner. The PCT has set itself challenging goals within the Strategic Plan to help improve the health of the local population.

Outlook 2010/11

The PCT faces a very difficult time over the coming years as Public Expenditure plans are scrutinised in the face of difficult economic conditions. Dudley PCT believes it can respond to the need to maximise health benefits from the resources available to it from central government to allow it to achieve key health objectives. The PCT has set out plans to improve the value for money it can obtain from its planned expenditure by striving to meet the best levels attained in other parts of the NHS. The PCT can best achieve this by working closely with its partners including Dudley MBC and Dudley Group of Hospitals to achieve maximum use of the health budget in Dudley. We have set out in our 2010/11 budget plans the need to achieve £10 million efficiency savings this year to ensure we can deliver our health plans. As we move into a period of financial restraint the PCT believes it is well prepared to be able to plan effectively to improve the health and well-being of the local population. Robust plans are in place to achieve cost effective investments in healthcare services within Dudley.

The Five Year Financial Plan of the PCT sets out the intended expenditure plans for the PCT for the period 2010/11 to 2013/14 together with the planned efficiency savings required to achieve a balanced budget over this period.

New investments planned for 2010/11 include:

• Screening of heart conditions for the adult population - £570,000
• Cancer screening initiative - £56,000
• Improved levels of immunisation for children - £104,000
• Increased investment in obesity reduction initiatives - £165,000
• Partnership working with Dudley MBC to tackle alcohol related problems - £225,000
• Improving the emergency care pathway to improve the patient experience during an emergency episode of care - £100,000 to £200,000
• Diabetes Enhanced Service - £180,000

12.8 Operating cost statement for the period ended 31st March 2010

	2009/10 £000	2008/09 £000
Commissioning
Employee benefits	18,145	16,908
Other costs	456,575	396,282
Income	(18,362)	(12,328)
Provider
Employee benefits	28,747	37,544
Other costs	12,822	16,489
Income	(3,971)	(4,892)
PCT net operating costs before interest	493,956	450,003
Investment income	(70)	0
Other (Gains)/Losses	0	0
Finance costs	2,447	1,147
Net operating costs for the financial year	496,333	451,150

12.9 Statement of Financial Position as at 31st March 2010

	31 March 2010 £000	31 March 2009 £000	1 April 2008 £000
Non-current assets:
Property, plant and equipment	47,218	41,112	74,818
Intangible assets	1,182	626	674
Other financial assets	669	669	669
Trade and other receivables	0	0	100
Total non-current assets	49,069	42,407	76,261
Current assets:
Current assets:	52	33	36
Trade and other receivables	4,219	4,391	4,650
Other financial assets	0	0	0
Other current assets	0	0	0
Cash and cash equivalents	17	9	14
	4,288	4,433	4,700
Non-current assets classified ‘Held for Sale’	0	0	0
Total current assets	4,288	4,433	4,700
Total assets	53,357	46,840	80,961
Current liabilities:
Trade and other payables	(38,229)	(33,907)	(35,844)
Other liabilities	0	0	0
Provisions	(647)	(708)	(270)
Borrowings	(387)	(251)	(229)
Other financial liabilities	0	0	0
Total current liabilities	(39,263)	(34,866)	(36,343)
Non-current assets plus/less net current assets/liabilities	14,094	11,974	44,618
Non-current liabilities:
Trade and other payables	(1,483)	(1,072)	0
Provisions	(2,067)	(2,163)	(2,775)
Borrowings	(30,766)	(13,530)	(13,777)
Other financial liabilities	0	0	0
Other liabilities	(0)	0	0
Total non-current liabilities	(34,316)	(16,765)	(16,552)
Total assets employed:	(20,222)	(4,791)	28,066
FINANCED BY:
TAXPAYERS’ EQUITY
General fund	(28,479)	(13,775)	4,340
Revaluation reserve	7,509	8,192	22,924
Donated asset reserve	748	792	802
Government grant reserve	0	0	0
Other reserves	0	0	0
Total taxpayers’ equity:	(20,222)	(4,791)	28,066

Signed: Chief Executive
Date: 9th June 2010

12.10 Statement of Cash Flows for the Year Ended 31st March 2010

	2009/10 £000	2008/09 £000
Cashflow from operating activities
Net operating cost before interest	(493,956)	(450,003)
Other cash flow adjustments	12,759	6,203
Movements in Working Capital	5,767	(466)
Provisions utilised	(212)	(257)
Interest paid	(2,407)	(1,104)
Net cash outflow from operating activities	(478,049)	(445,627)
Cash flows from investing activities
Payments to purchase property, plant and equipment	(3,282)	(2,607)
Payments to purchase intangible assets	(525)	(264)
Proceeds of disposal PPE & intangible assets	0	24,853
Purchase of financial investments (LIFT)	0	0
Sale of financial investments (LIFT)	0	0
Loans made in respect of LIFT	0	0
Loans repaid in respect of LIFT	0	0
Payments for other financial assets	0	0
Proceeds from disposal of other financial assets	0	0
Interest received	70	0
Rental Income	0	0
Net cash inflow/(outflow) from investing activities	(3,737)	21,982
Net cash inflow/(outflow) before financing	(481,786)	(423,645)
Cash flows from financing activities
Net Parliamentary Funding	482,045	423,865
Other capital receipts surrendered	0	0
Capital grants received	0	0
Capital element of payments in respect of finance leases, on-SoFP PFI and LIFT	(247)	(229)
Cash transfers (to)/from other NHS bodies	0	0
Net cash inflow/(outflow) from financing	481,798	423,636
Net increase/(decrease) in cash and cash equivalents	12	(9)
Cash (and) cash equivalents (and bank overdrafts) at the beginning of the financial year	5	14
Effect of exchange rate changes on the balance of cash held in foreign currencies	0	0
Cash (and) cash equivalents (and bank overdrafts) at the end of the financial year	17	5

12.11 Financial Performance Targets

Revenue Resource Limit	2009/10 £000	2008/09 £000
The PCTs’ performance for the year ended 31 March 2010 is as follows:
Total Net Operating Cost for the Financial Year	496,333	450,711
Non-Discretionary Expenditure	3,277	3,198
Net Operating Cost less Non Discretionary Expenditure	493,056	447,513
Revenue Resource Limit	493,418	449,568
Under/(Over)spend Against Revenue Resource Limit (RRL)	362	2,055
The figures given for periods prior to 2009/10 are on a UK GAAP basis as that is the basis on which the targets were set for those years.
Capital Resource Limit	2009/10 £000	2008/09 £000
The PCT is required to keep within its Capital Resource Limit.
Total Gross Capital Expenditure	20,549	2,798
Loss in Respect of Disposals of Donated Assets	0	0
less: Net Book Value of Non-Current Assets Disposed of to NHS Bodies	0	(24,853)
less: Net Book Value of Non-Current Assets Disposed of to non-NHS Bodies	0	0
less: Net Book Value of Financial Instruments (Investments) Disposed Of to NHS bodies	0	0
less: Net Book Value of Financial Instruments (Investments) Disposed Of to Non-NHS bodies	0	0
less: Capital Grants Received	0	0
less: Donations	0	0
Charge Against the Capital Resource Limit (CRL)	20,549	(22,055)
Capital Resource Limit (CRL)	25,250	(21,993)
(Over)/Underspend Against CRL	4,701	62
£4.697m of the underspend against the CRL relates to the difference between the Department of Health funding of £21.0m for the take-on of the Brierley Hill LIFT scheme and the actual take-on value of £16.303m.
Provider full cost recovery duty	2009/10 £000	2008/09 £000
The PCT is required to recover full costs in relation to its provider functions.
The performance for 2009/10 is as follows:
Provider gross operating costs	41,569	54,033
Provider Operating Revenue	(3,971)	(4,892)
Net Provider Operating Costs	37,598	49,141
Costs Met Within PCTs Own Allocation	(38,030)	(49,336)
Under/(Over) Recovery of Costs	(432)	(195)
The performance in the above tables in respect of financial year 2008/09 have not been restated to IFRS and remain on a UK GAAP basis.

12.12 Better Payment Practice Code

Measure of compliance	2009/10 Number	2009/10 £000	2008/09 Number	2008/09 £000
Non-NHS Payables
Total Non-NHS Trade Invoices Paid in the Year	35,534	102,674	37,412	94,240
Total Non-NHS Trade Invoices Paid Within Target	33,441	97,761	34,600	87,912
Percentage of Non-NHS Trade Invoices Paid Within Target	94.11%	95.21%	92.48%	93.29%
NHS Payables
Total NHS Trade Invoices Paid in the Year	2,369	310,783	2,074	281,176
Total NHS Trade Invoices Paid Within Target	2,152	303,843	1,667	267,573
Percentage of NHS Trade Invoices Paid Within Target	90.84%	97.77%	80.38%	95.16%
The Better Payment Practice Code requires the PCT to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is earlier.
The PCT is an approved signatory to the Prompt Payment Code, joining 14th October 2009. Approved signatories undertake to pay suppliers on time; give clear guidance to suppliers and encourage good practice.

12.13 The Late Payment of Commercial Debts (Interest) Act 1998

	2009/10 £000	2008/09 £000
Amounts included in finance costs from claims made under this legislation	0	0
Compensation paid to cover debt recovery costs under this legislation	0	0
Total	0	0

12.14 Management costs

	2009/10	2008/09
Management costs (£000s)	9,924	9,604
Weighted population (Number)	313,200	313,200
Management cost per head of weighted population (£)	31.69	30.66

The PCT measures its management costs according to the definitions provided by the Department of Health.

This requires the total management costs to be divided by the weighted population of the PCT to give a management cost per head.

The 2009/10 management costs recognise that there are a number of services which the PCT provides as a shared service. In line with the guidance, only the share relating to the PCT has been included. This includes CBSA provided to all PCTs in the West Midlands and a number of other NHS organisations and corporate services provided to Dudley & Walsall Mental Health Partnership NHS Trust.

12.15 Staff Sickness Absence

	2009/10 Number
Days Lost (Long Term)	4,854
Days Lost (Short Term)	4,707
Total Days Lost	9,561
Total Staff Years	1,178
Average working Days Lost	8.12
Total Staff Employed In Period (Headcount)	1,600
Total Staff Employed In Period with No Absence (Headcount)	606
Percentage Staff With No Sick Leave	37.9%

Note: No prior-year figure available as this note is a new requirement for 2009/10

The figures in this note are based on data drawn for 1st January 2009 to 31st December 2009 from the ESR national data warehouse. Underlying figures have been converted to the ‘Cabinet Officeî measurement base by applying a factor of 225/365 to adjust for different base years. This approach is to support national aggregation by providing data on a consistent basis.

12.16 Declaration of interests

Below are the declaration of interests for the PCT Board (non-executive directors and directors) and the Professional Executive Committee.

Name	Designation	Interest
Rachel Harris	Chairman until March 2010	Advisor/consultant (self employed) Expert Health Scrutiny Advisor With the CFPS (Centre for Public Scrutiny). Peer member/Advisor with the IDeA Elected member, Dudley MBC, Brierley Hill ward Chair, Peter Harris Trust Democratic Health Network - Associate Governor of Dudley Group of Hospitals
Gillian Cooper	Non-executive director Interim Chairman from March 2010	Director of Dudley Hope Justice of the Peace Chair of Dudley Children’s Trust
Mark Cooke until 31 January 2010	Chief Executive	Governor of Dudley Group of Hospitals
Sarah Dugan from 1 February 2010	Chief Executive	None
Sarah Dugan until 31 January 2010	Director of Strategy and Innovation	Governor Dudley Group of Hospitals
Dr Steve Cartwright	PEC Chair	GP partner, Keelinge House Surgery Parish councillor, Trysull and Seisdon Parish Council, South Staffs
Kevin Gaffney	Director of Finance	Marks and Spencer shares Non-remunerated Director of Dudley Infracare Lift Co. as the Public Sector Director (on behalf of PCT)
Valerie Little	Director of Public Health	Trustee of Castle High School Foundation registered charity number 527526 Director, Ephraim Estates Ltd Co-opted member of Central Dudley Area Committee
Tessa Norris	Managing Director - Community Services	Trustee of Graceworks Trust
Kimara Sharpe	Director of Community Engagement and Primary Care	Trustee, Redditch Nightstop until Feb 2010 Company Secretary, MS Consulting and Research Ltd Director - Railway Walk (Breme Park) Management Committee Independent Member, Bromsgrove District Council Standards Committee from January 2010
Sue Roberts	Director of Partnerships and Service Development	None
Hilary Walker	Interim Director of Strategy and Innovation	None
Shameem Akhtar	Non-executive director	West Midlands Probation Service - Board Member First Tier Vat and Duties Tribunal - 1.4.09 ( as non legal tribunal member) Home Secretary’s Representative (as and when required): Selection Panel for Independent Members of West Midland Police Authority Ambassador - Government Equalities Office from October 2009 Employed by Crown Prosecution Service
Judith Deakin	Non-executive director	Director of J Deakin Consultancy Ltd Employed by Citizens Advice
Jason Hall	Non-executive director	Employed by BT plc
Julie Jasper	Non-executive director	Shares in National Express Group Director - Westlands Associates Ltd
Bryan Richens until 30 Sept 2010	Non-executive director	Trustee, Age Concern, Sedgley Vice Chair, Board of Governors, Nethertonbrook School, Netherton
Michael Shaw	Non-executive director	Spouse - manager of Crossroads Caring for Carers
Stephen Wellings from Feb 2010	Non-executive director	Managing Director, Well Improve Associates Ltd Deputy Chairman, Birmingham Hippodrome Theatre Trust Ltd
Dr Sandra Brindley	PEC Member	GP - Moss Grove Surgery
Dr Dominic Faux	PEC Member	Drs Bundred and Partners, AW Surgeries, Albion House
Dr P D Gupta	PEC Member	Self-employed PMS Contractor with Dudley PCT Elected Governor of Acute Trust, Russell’s Hall Hospital Member of the Labour Party Primecare Medical Director - Walk-in Centre Chair of Dudley Beacon and Castle Cluster Director of St Thomas’ Partnership with spouse
Dr David Hegarty	PEC Member	GP - Wychbury Medical Centre University of Birmingham NHS Trust Dudley PCT General Medical Practitioner Chair of SLK Cluster
Tony Ivko until Sept 2009	Head of Older People’s Services - DMBC	None
Adam Pickles	PEC Member	None
Maggie Venables from Sept 2009	PEC Member	Assistant Director, Directorate of Adult, Community and Housing Services, DMBC Assistant Director, Older People & Physical Disability Services
Sue Weston	PEC Member	None
Danielle Oum	Lay Chair, Dudley Community Services	Director/owner Inclusion Solutions Ltd
Tony Cooke	Lay member, Dudley Community Services	Anthony Cooke Associates Magistrate

12.17 Senior Managers - Salaries and Allowances

12.18 Senior Managers - Pension Benefits

Glossary

13.1 Abbreviations

Abbreviation - Meaning

#NOF - Fractured Neck of Femur

£K - £1,000 equivalent

A&E - Accident and Emergency

ABC / ABCD - Above and Beyond the Call of Duty

ACS - Acute Coronary Syndrome

AD - Assistant Director

AfC - Agenda for Change

ALE - Auditors Local Evaluation

ALOS - Average Length of Stay (in hospital)

AMI - Acute Myocardial Infarction

Anti-D - An antibody occurring in pregnancy

Anti-TNF - Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

ARIF - Aggressive Research Intelligence Facility

ASAP - As soon as possible

AVE - Advertising Value equivalent

BACs - Bank Automated Credit

BCG - Bacillus Calmette-Guerin

BFT - Behavioural Family Therapy

BLCCB - Black Country Local Collaborative Commissioning Board

BME - Black Minority Ethnic

BMJ - British Medical Journal

BPAS - British Pregnancy Advisory Board

BSCCP - British Society of Colposcopy and Cervical Pathology

CAB - Citizens Advise Bureau

CABG - Coronary Artery Bypass Graft

CAMHS - Children and Adolescent Mental Health Service

CASH - Contraception and Sexual Health

CAT - Change Agent Team

CBSA - Commissioning Business Support Agency

CCBT (CBT) - Computerised Cognitive Behavioural Therapy

CCF - Capable Care Forum

CEO - Chief Executive Officer

CHADD - The Churches Housing Association of Dudley & District Ltd

CHD - Coronary Heart Disease

CIS - Community Investment Strategy

CMO - Chief Medical Officer

CNST - Clinical Negligence Scheme for Trusts

CNT - Community Nursing Team

CONNECT - Mental Health information website for staff

COSHH - Control of Substances Hazardous to Health Regulations 2002

CPA - Care Programme Approach

CPN - Community Psychiatric Nurse

CRL - Capital Resource Limit

CSSD - Central Sterile Services Department

CT - scan Computer Topography

CVD - Cardio Vascular Disease

CWAS - Coventry and Warwickshire Audit Services

DACHS - Directorate of Adult Children and Housing Services

DCS - Dudley Community Services

DCVS - Dudley Community Voluntary Service

DES - Directed Enhanced Service

DfES - Department for Education and Skills

DGoH - Dudley Group of Hospitals

DNA - Did not attend

DoH - Department of Health

DTC - Diagnostic and Treatment Centre

DXA - Dual X-ray Absorptiometry (measures bone density).

E&D - Equality and Diversity

EBME - Electro Bio-Mechanical Engineer

ECA - Extra Care Area

ECM - Every Child Matters

ECT - Electroconvulsive Therapy

ED - Emergency Department

EI - Early Implementer

EI - Early Intervention

EMI - Older People with Mental Illness (Elderly Mentally Ill)

EPP - Expert Patients Programme

EPR - Electronic Patient Record

ERMA - Emergency Response & Management Arrangements

ERT - Enzyme Replacement Therapy

ESR - Electronic Staff Record

FCEs - Finished Consultant Episodes

FED - Forum for Education and Development

FHS - Family Health Services

FIP - Computerised data collection facility used by community health teams.

FMC - Facility Management Centre

FOI - Freedom of Information

FYE - Full Year Effect

GMS - General Medical Services

GOWM - Government Office for the West Midlands

GP - General Practitioner

GPAQ - General Practice Assessment of Quality

GPwSI - GPs with Special Interest

GU - Genito-urinary

GUM - Genito-urinary Medicine

HENIG - Health Economy NICE Implementation Group

HF - Heart Failure

HIC - Health Improvement Centre

HIV - Human Immunodeficiency Virus

HPA - Health Protection Agency

HPS/S - Health Promoting Schools / Service

HPU - Health Protection Unit

HR - Human Resources

HSC - Health and Safety Commission

HSCQC - Health and Social Care Quality Centre

HSE - Health and Safety Executive

HT - Home Treatment

HV - Health Visitor

IC - Infection Control

ICAS - Independent Complaints Advocacy Service

ICNA - Infection Control Nurses Association

ICP - Integrated Care Pathway

IFR - Individual Funding Request

IG - Information Governance

IOSH - Institute of Occupational Safety and Health

IT - Information Technology

IUCD - Intrauterine Contraceptive Device

JCAB - Joint Clinical Advisory Board

JCC - Joint Consultative Committee

JD - Job Description

JE - Job Evaluators

JM - Job Matching

KLOE - Key lines of enquiry

KSF - Knowledge and Skills Framework

LAA - Local Area Agreement

LAC - Looked After Children

LBC - Liquid Based Cytology

LD - Learning Disability

LDP - Local Delivery Plan

LEA - Local Education Authority

LIFT - Local Improvement Finance Trust

LIG - Local Implementation Group

LIT - Local Implementation Team

LMC - Local Medical Committee

LNG - Local Negotiating Committee

LPS - Local Pharmaceutical Scheme

LRF - Local Resilience Forum

LTC - Long Term Conditions

LVD - Left Ventricular Dysfunction

LVSD - Left Ventricular Systolic Dysfunction

MAPA - Management of Actual and Potential Aggression

MAU - Medical Assessment Unit

MBC - Metropolitan Borough Council

MDT - Multi Disciplinary Team

MIMT - Major Incident Management Team

MIRE - Major Incident Response Executive

MLSOs - Medical Laboratory Scientific Officers

MRSA - Methicillin Resistant Staphylococcus Aureus

MSS - Medium Secure Service

NCA - Non contract activity

NCRS - National Care Record System

NELHI - National Electronic Library for Health Information

NGMS - New General Medical Services

NHS - National Health Service

NHSCPT - NHS Community Practice Teacher

NHSCSP - NHS Cancer Screening Programme

NHSLA - NHS Litigation Authority

NHSP - National Healthy Schools Programme

NICE - National Institute for Clinical Excellence

NOF - New Opportunities Fund

NPfIT - National Programme for IT

NPSA - National Patient Safety Agency

NRF - Neighbourhood Renewal Fund

NRLS - National Reporting and Learning System

NRT - Nicotine Replacement Products

NSF - National Service Framework

OAT - Out of Area Treatment

OBD - Occupied Bed Day

OD - Organisational Development

OOH - Out of Hours

OSC - Overview and Scrutiny Committee

OT - Occupational Therapist

PALS - Patient Advice and Liaison Service

PAS - Patient Administration System

PAU - Paediatric Assessment Unit

PBC - ??

PbR - Payment by Results

PC - Personal Computer

PCDB - Primary Care Delivery Board

PCT - Primary Care Trust

PDF - Portable Document Format

PDP - Personal Development Plan

PDS - Personal Dental Services

PDSA - Plan, Do, Study, Act

PDU - Professional Development Unit

PE - Pulmonary Embolism

PEAK - Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT - Patient Environment Action Team

PEC - Professional Executive Committee

PEPP - Pooled Budget External Placement Panel

PFI - Private Finance Initiative

PICU - Psychiatric Intensive Care Unit

PID - Project Initiation Document

PIN - Personal Identification Number

PMLD - Profound and Multiple Learning Difficulties

PMS - Primary Medical Services

PPA - Prescription Pricing Authority

PPIF - Patient and Public Involvement Forum

PSA - Public Service Agreement

PSHE - Personal and Social Health Education

PTCA - Percutaneous Transluminary Coronary Angioplasty

Q&A - Questions and Answers

QA - Quality Assurance

QMAS - Quality Management and Analysis System

QOF - Quality and Outcome Framework

QPDT - Quality and Practice Development Teams

RACPC - Rapid Access Chest Pain Clinic

RAS - Respiratory Assessment Service

RCA - Root Cause Analysis

RES - Race Equality Scheme

RHH - Russells Hall Hospital

RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO - Responsible Medical Officer

RRL - Revenue Resource Limit

RSL - Register Social Landlords

RTT - Referral to Treatment Target

SAP - Single Assessment Process

SEPIA - Mental health computer system

SFBH - Standards for Better Health

SFI - Standing Financial Instructions

SHA / StHA - Strategic Health Authority

SIC - Statement of Internal Control

SLA - Service Level Agreement

SRE - Sex and Relationship Education

SSD - Social Services Department

SSDP - Strategic Services Development Plan

STI - Sexually Transmitted Disease

STRW - Support, Time & Recovery Worker

TB - Tuberculosis

THUNDERBURDS - The High User Number Delivering Early Referrals By Urgent Right Direction System

TIA - Transient Ischaemic Attack TP - Teenage Pregnancy

TPT - Teenage Pregnancy Team

UHBT - University Hospital Birmingham Trust

Vaccs & Imms - Vaccinations and Immunisations

WAN - Wide Area Network

WCC - World Class Commissioning

WMAS - West Midlands Ambulance Service

WMHTAC - West Midlands Health Technology Advisory Committee

WMSCG - West Midlands Strategic Commissioning Group WMSSA - West Midlands Specialised Services Agency

wte - Whole Time Equivalent

13.2 Useful Terms

A

Acute - Used to describe a disorder or symptom that comes on suddenly and needs urgent treatment. It is not necessarily severe and is often of short duration. Acute is also used to describe hospitals where treatment for such conditions is available.

Acute Trust - NHS organisation providing mainly hospital based medical and surgical care, including emergencies

Ambulatory - Referring to patients who are able to walk to appointments etc.

Audit - A systematic review and evaluation of health care procedures and how successfully they are undertaken.

Audit Commission - A freestanding government body which audits local government authorities and health authorities. They were formed to promote the best use of public money.

B

Board - The directing legal body of a Primary Care Trust.

C

Caesarean section - The delivery of a baby through an abdominal incision

Cancer - The general term used to describe a tumour which could be in many different parts of the body.

Capital Expenditure - On the acquisition of land, premises (including new and refurbished), equipment and vehicles etc. Expenditure is regarded as capital if it is in excess of £5,000.

Cardiac - To do with the heart.

Care Pathway - This term describes all the processes of diagnosis, treatment and care that a patient goes through, from the beginning to the end of their treatment. Chairman - The Chairman’s role is to provide leadership to the Board and lead the development of the strategic direction and long term vision for the Primary Care Trust.

Chief Executive - The Chief Executive is the named Responsible Officer for the Primary Care Trust, taking personal responsibility for leading the performance of the organisation in meeting its statutory obligations and implementing Government policy.

Chronic Disease Management - Caring for a person with an ongoing illness such as diabetes or asthma.

Clinical Governance - An initiative to assure and improve clinical standards at local level throughout the NHS. This includes action to ensure that risks are avoided, adverse events are rapidly detected, openly investigated and lessons learned, good practice is rapidly disseminated and systems are in place to ensure continuous improvements in clinical care.

Clinician - A health professional who has undergone medical, nursing or other healthcare training and is directly involved with the care and treatment of patients.

Commission for Health Improvement (CHI) - Government body that monitors clinical governance in every NHS Trust

Commissioning - This is the process that PCTs go through to agree health services which a provider (such as an NHS Trust) will provide for a specified sum of money. Commissioning also involves monitoring these contracts to ensure best value for money.

Community Care - A way of providing services to people to help them stay in their own homes as long as they are able, or in other settings in the community such as residential homes.

Community Health Care - A range of treatments provided in the community such as health visiting and district nursing.

Community Health Council (CHC) - CHCs are statutory bodies independent from Health Authorities and NHS Trusts. They represent the health interests of local people and provide advice on health services.

Consultant - A senior doctor who takes full responsibility for the clinical care of patients. Most head a team of junior doctors.

Continuing healthcare nurse - A nurse who works in the community, visiting patients to check that the equipment they have been given, such as mattresses, meet their needs.

Continuing Professional Development - An approach that looks to ensure employees continue to develop their work skills into the future and to update them to meet changing needs.

Controls Assurance - A process by which an organisation satisfies itself it meets its legal responsibilities and statutory functions.

Corporate Governance - Systems and processes for ensuring proper accountability, probity and openness in the conduct of an organisation’s business. Corporate Governance is a core responsibility of all NHS organisations including PCTs.

Corporate Services -Services provided by an organisation to ensure effective operation, e.g. human resources, finance services.

Co-terminosity - Having the same geographic boundaries, for example Dudley PCT and Dudley Council cover the same area.

Critical Care - Care of the most ill patients in hospital who have potentially recoverable conditions.

D

Department of Health (DoH) - Central Government department responsible to parliament for the NHS, led by the Secretary of State for Health

Deprivation - A measure of an individual or group’s lack of normal social amenities such as proper housing, diet and warmth.

Dermatology - To do with the skin.

Diagnosis - The art of distinguishing one disease from another.

Dialysis - Purification or filtering of the blood to remove harmful elements when kidneys, which normally perform this function, have failed.

Disease Register - A register put together from GP records to highlight people with common health problems - e.g. diabetes, high blood pressure - to ensure they all receive the best treatment for their condition.

District Nurse - Provide care to patients in their own homes

E

Elective - Used to describe operations, procedures or treatments that are planned rather than carried out in an emergency.

Electronic Health Record - An electronic record of current and past health care provided to patient

Electronic Patient Record - An electronic record of a patient’s basic details - e.g. name, address, telephone number.

Epilepsy - Condition resulting from disordered electrical activity of brain.

Estates and Facilities - The property owned by an organisation, which has a value transferable to another organisation, e.g. land, buildings, contracts. Evidence-based practice - Ways of working based on the best available evidence.

Executive Committee - The committee working under a Primary Care Trust Board, undertaking the main day to day decision-making work of an organisation.

F

Falls prevention - This is a programme in which Health Services work together with Social Services, councils and community organisations to reduce the likelihood of older people falling.

G

General Medical Services (GMS) - General Medical Services (GMS) Services provided by GPs as independent contractors.

General Practitioner (GP) - The doctor who provides care at a surgery/health centre or in a patient’s home, ie outside a hospital. Usually providing the first point of contact for NHS patients.

Gynaecology - A branch of medicine dealing with the diseases and routine physical care of the reproductive system of women.

H

Health Act 1999 (Section 31 partnership arrangements) - The act provides new powers to enable health and local authorities to work together better for users and came into force on 1st April 2000. Pooled funds, lead commissioning and integrated provision are operational flexibilities that allow the focus of attention to be on the response to users rather than the boundaries of organisation responsibilities.

Health and Social Care Economy - The different organisations that work together to improve the health and social care of the population.

Health Authority - Health Authorities provide local strategic leadership in the new NHS. They lead the development of local Health Improvement Programmes. Health Authorities work closely with NHS Trust, the Primary Care Trusts, Local Authorities, academic and research interests, voluntary organisations and the local community to devise a new strategic approach to the planning and delivery of health care.

Health Improvement Programme (HImP) - A rolling three-year, strategic plan developed jointly be all partner organisations that have an interest in or an impact on health related issues. This is part of the new requirements introduced as part of the December 1997 Government White Paper, The New NHS. Involves NHS Trusts, Primary Care Trusts and other primary care professionals, working in partnership with the local authority and engaging other local interests.

Health Inequalities - A situation where people are suffering worse or better health due to an outside factor such as the area in which they live or their economic status or lifestyles. Health Promotion Giving people and communities the resources and information they need to make choices about their health (eg measures to help people give up smoking, eat more healthily, adopt healthier lifestyle, etc) and to make their environments safer.

Health Visitors - Qualified nurses who have extra qualifications in child and family health, and public health.

High Dependency - An intermediate level of critical care e.g. patients who no longer need intensive care or are recovering from major surgery who need close monitoring

Host PCT (Primary Care Trust) - The PCT that will employ a group of health professionals, or a service that will work across the county but is too small in numbers to be employed by a single PCT.

I

Infrastructure support - Support services such as information technology and buildings maintenance and equipment that allow organisations to provide healthcare and carry out their functions.

Inpatient - A patient who undergoes a stay in hospital during treatment.

Integrated services - Services that are provided across professions and organisations according to people’s needs.

Intensive care - The highest level of care which patients need when two or more of the body’s vital life processes fail

Intermediate Care - Services intended to bridge hospital and home based care by helping people recover and resume independent living more quickly. It is often given to patients who are unable to return home immediately and require some form of rehabilitation.

IVF - In vitro fertilisation The process by which an egg is fertilised in a test tube before implantation in the mother’s womb.

J

Jarman Index - An index of deprivation developed for use in health service research in the 1980s. Combining eight variables, it was initially designed to measure GP workload rather than the level of deprivation in an area. A score of 0 indicates the average for England. Scores above 0 indicate deprivation. Scores below 0 indicate affluence.

Joint Investment Plan - A plan that is jointly produced by health and local authority staff as members, working on a health and social conditions.

Junior doctor - A doctor undertaking his or her final years of training in a hospital either as a house officer, senior house off

L

Lay Member - A member of an official committee who has responsibility to represent the views of the population affected by the committee’s work.

Local Authorities - This term refers to county councils, borough, district, town and parish councils.

Local Implementation Strategy - A plan produced by every Health Authority, showing how all local health organisations will work towards Government targets for developing information management and technology in their organisations.

Local Medical Committee (LMC) - The statutory group of locally elected GPs that represents local GPs’ interests in relation to pay and conditions.

Low-risk - Often applied to maternity services and means that a normal birth with no complications for mother or baby are expected.

M

Morbidity Rate - The rate of long-term sickness in the population.

Mortality Rate - The death rate within the population.

MP - Member of Parliament.

Multi-Disciplinary - Involving representatives from a number of different services and organisations, with different skills.

N

National Institute for Clinical Excellence (NICE) - A national body set up by the Department of Health to oversee standards of clinical practice throughout the country and to pass judgement on the cost-effectiveness and value for money of new drugs.

National Service Framework (NSF) - Evidence-based national strategy setting out what patients can expect to receive from the NHS in major care areas or disease groups such as Mental Health, Older People and Coronary Heart Disease.

Joint Strategic Needs Assessment - An estimation of the health of a population and what it needs to improve its health.

Neonatal - To do with new born babies, up to the age of four weeks.

Neoplasm - Any abnormal new growth of tissue or tumour.

Neurology - Study and treatment of nerve systems.

NHS - National Health Service founded in 1948. Provides free health care at the point of delivery.

NHS Direct - This is a 24-hour confidential telephone helpline staffed by qualified and experienced nurses. It offers round-the-clock advice from a trained health professional for the cost of a local call. Telephone 0845 4647 or www.nhsdirect.nhs.uk.

NHS Executive (NHSE) - The NHS Executive is part of the Department of Health, with offices in London and Leeds and eight Regional Offices across the country. It supports Ministers and provides leadership and a range of central management functions to the NHS.

NHS Plan - A plan outlining the Governments intended investment and the outcomes expected in the health service.

NHS Trusts - Public bodies providing NHS hospital and community health care.

O

Occupational Therapy - Mental or physical activity to assist recovery from disease or injury.

Oncology - Cancer The study and treatment of tumours.

Ophthalmology - The study and treatment of eyes.

Opticians - Eye specialists There are three kinds: ophthalmic medical practitioners who are specialist doctors, ophthalmic opticians (also known as optometrists) who carry out eye tests and prescribe glasses, and dispensing opticians who supply and fit glasses.

Organisational boundaries - Working across organisational boundaries involves looking at the whole issue regardless of which organisation is responsible.

Orthopaedics - To do with bones and muscles.

Outpatient - A patient who does not stay in hospital overnight, or who visits a hospital, clinic or associated facility for diagnosis or treatmenT.

P

Paediatrics - To do with children’s diseases.

Palliative Care - Care which gives relief from symptoms but does not cure diseases. It is often given to people who are terminally ill.

PALS - Patient Advice and Liaison Service - set up to provide information and help patients solve problems and concerns quickly.

Paramedics - Ambulance staff who are qualified to provide pre-hospital care.

Partner Agencies - Organisations we work closely with including Social Services, district and county councils and voluntary organisations.

Pathology - The branch of medicine that deals with laboratory examination of samples of body tissue for diagnostic and forensic purposes.

PCTs - Primary Care Trusts - Locally managed free-standing NHS organisations responsible for improving health, commissioning and delivering health care for local residents, eg: Southampton City Primary Care Trust.

Performance Assessment Framework - This national framework, produced by the department of health, provides a structure and benchmarks for NHS organisations to use to assess its performance. It covers fair access to services, effective delivery of healthcare, efficiency and the patient and carer experience.

Perinatal - The medical term for the care of a foetus/baby from three months before to one week after birth.

Personal Medical /Dental Services (PMS/ PDS) - New form of contractual arrangement for GPs and dentists, allowing greater flexibility to meet local needs.

Pharmacist - People who are qualified to dispense medicines on prescription and advise people about over-the-counter medical products.

Phlebotomy - Phlebotomists are trained to take blood samples.

Primary Care - The first stage of treatment when you are ill and usually provided by your GP or at a community clinic.

Primary Care Investment Plan (PCIP) - A rolling 3 year document produced by PCTs outlining the priorities for developing and investing in primary care. It covers areas such as Information Management and Technology, the development of surgery premises and staffing development.

Primary Health Care Team - A group of health care professionals - e.g. General Practitioner, nurse, health visitor, working together as one team, even though they are employees of different organisations.

Professions Allied to Medicine (PAMS) - These include dieticians, speech and language therapists, podiatrists, occupational therapists, physiotherapists and others.

Protected learning time - Time provided for all GP surgery staff, including GPs, practice nurses, receptionists, district nurses and health visitors, to take time out for training.

Provider - An organisation that provides health or social care services, e.g. hospital, hospice, nursing home.

Psychology - The study of human behaviour Public Health - A speciality, which works to prevent disease, prolong life and promote health in the population.

Pulmonary - To do with the lungs.

R

Radiology - The use of Xrays and radioactive substances for diagnosis and treatment of disease.

Renal - To do with the kidneys.

Ring Fenced Monies - Usually refers to funds or other resources that can only be used for a defined purpose.

Risk management - A systematic framework for assessing, managing and reducing the risks connected with providing healthcare.

Royal College of General Practitioners (RCGP) - The Royal College of General Practitioners is the academic organisation in the UK for general practitioners. Its aim is to encourage and maintain the highest standards of general medical practice.

Royal Collage of Nursing - The professional association of nurses.

S

School Nurses - Qualified nurses some of whom have extra qualifications. They work with school-age children, monitoring their eye sight, hearing, growth and development and their physical and emotional health. They can also work with families.

Seamless care - Care that is provided across the health service and Social Services, without delay or barriers caused by different organisations providing services to one individual

Secondary Care - Also known as acute care, this refers to specialist medical care or surgery provided in a hospital setting either as an in-patient or outpatient service. Patients seen in hospitals are generally under the care of a consultant, not a GP.

Service Level Agreement - These are contracts agreed between PCTs and service providers such as NHS Trusts. They are agreed on an annual basis.

Skill Mix - The balance of skills available in a group of people, viewed as a whole.

Social inclusion - A policy designed to make sure that people can get access to education, work, leisure and housing opportunities.

Social Services - A Council department commissioning and providing a range of care and protection services for adults and children.

Specialist coronary heart disease nurses - Nurses who have been recruited to help GP surgeries meet national standards of care for patients with coronary heart disease.

Specialist Services - Services provided for illness that are likely to affect fewer people in the population and therefore need services concentrated in fewer centres.

Stakeholder - An individual or organisation with an interest in health and health initiatives. Stakeholders can be organisations such as local authorities or individuals such as residents.

Strategic Health Authority (SHA) - A statutory NHS body providing strategic leadership and ensuring the delivery of improvements in health, well being and health services locally

Stroke - The interruption of blood flow to an area of the brain caused by a blood clot blocking a blood vessel or artery or a blood vessel breaking.

Supported Discharge - Medically stable patients who are able to finish recovery at home are discharged either intensive support such as continuing nursing care and therapy as well as personal care. Supported discharge could be provided by community rehabilitation team or dedicated outreach team from local rehabilitation unit.

T

Tertiary care - The third and highly specialised stage of treatment, usually provided in a hospital centre which may not be local.

Trauma - The effect on the body of a wound or violent impact.

Triage - This is a system of sorting patients according to their illness or injuries so that patients can be steered to the most appropriate health worker.

Tandrusti - A community based programme that addresses the health needs of minority ethnic communities in Dudley

U

Ultrasound Scanning - A non invasive technique involving the formation of a two-dimensional image used for the examination and measurement of internal body structures and the detection of bodily abnormalities

Urology - To do with the urinary system.

V

Vascular - To do with the vessels carrying blood around the body.

Ventilation - with breathing by mechanical means.

Virtual Ward - A pilot scheme in Dudley that is managing patients care in the community to avoid admission to hospital.

W

Walkzone - Web based walking route planner to encourage people to walk more in their local community.

X

X-ray - Part of a group of technologies collectively known as radiology. Used to produce images from inside the human body.