Executive Directors Report

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					ITEM:        6

TITLE:       Executive Directors’ Report

MEETING: NHS Haringey Board Meeting
         28th January 2009


Please find attached the January Executive Report. The purpose of the
report is to bring the Board up to date with key issues or areas of work that
at this moment do not merit fuller Board discussion.

ACTION:      For information.

LEAD OFFICER:         Executive Directors Report
                      Tracey Baldwin
                              January 2009

                        Executive Directors’ Report
                              January 2009

This report updates the Board on issues that Executive Directors would like to
bring to members’ attention but do not warrant a separate paper.

IMR/SCR Update

The Board will recall that the Secretary of State for Children Schools and
Families requires the new Serious Case Review to be with him by the end of
February. The independent author will be Alan Jones, chair of Sheffield and
also Barnsley LSCB, and an experienced ex- Assistant Chief Inspector of social
care and child protection. The LSCB serious case review sub-group is on
track to deliver on this expectation. The Health individual management review
(IMR), is being undertaken independently by Verita. So far, 17 individuals
have been interviewed as part of the process agreed by the LSCB. The IMR
will be signed off by senior Board members and SIG.

                                         Lead Director – Penny Thompson

JAR Change programme

The Local Authority is leading the partner organisations locally, in the
development of an ambitious yet deliverable change programme whose aim is
to develop best in class children’s services over the next few years. It is
expected by Government to meet the test of addressing how the “staying
safe” and “being healthy” outcomes will be achieved, and public confidence
won over. Penny Thompson is leading on the NHS Haringey contribution to
this programme, and an early draft is available for electronic consultation this

An open meeting will be arranged to discuss it as soon as possible. Again the
timescale for delivery of this plan is very challenging. It must be signed up to
by partners and with the Minister by the end of February.

                                         Lead Director – Penny Thompson

World Class Commissioning

The PCT submitted its self-assessment against the World Class Commissioning
competencies, as well as an extensive set of documentary evidence, at the
end of November 2008. On 15 January this year, a team of ten from the PCT
attended an all-day assessment panel at NHS London, chaired by Trish
Morris-Thompson of NHS London. The assessment day consisted mainly of
interviews, with the Chairman and Chief Executive of the PCT and two other
groups interviewed separately. At the end of the day, the panel gave brief,
informal feedback, including positive comments on leadership, working
relationships with partners, strategy and financial management. Suggestions

included considering whether infant mortality should be included within the
PCT’s ‘top 10’ key health outcome measures. Publication of the national
results of the World Class Commissioning assurance process is expected in
February, at which time the PCT also expects to receive formal, written
feedback on the assessment.

                                           Lead Director – Keith Edmunds

Healthcare for London – Acute stroke and major trauma services

A Joint Committee of PCTs will hold a meeting in public on 27 January 2009
to discuss Healthcare for London’s proposals for introducing specialist care for
acute stroke and major trauma services, and determine the options for

                                           Lead Director – Keith Edmunds

Healthy Communities programme

The Community Health Workers programme is due to start in spring 2009.
Recruitment to an initial training programme has begun and will continue with
an event on 30th January 2009 at the Laurels Health Centre and advertising
has generated a high level of interest.       A training company has been
commissioned to provide 16 participants with the required competencies to
achieve a City and Guilds level 3 qualification. Twelve of the qualified
participants will be recruited on to the temp bank and will start work in the
community by May 2009. They will be deployed in a variety of settings and
support people to engage in healthier lifestyles as well as provding
information and advice on where to access health and wellbeing resources in
communities. A coordinator post is being advertised currently.

NHS Haringey has commissioned the Life Channel to install TV screens in GP
practices in order to provide health improvement information in waiting
rooms. Six campaigns will be screened per year. The first one on
immunisation will be seen from February 2009. Other topics which have been
discussed are: flu, chlamydia screening, smoking cessation and mental health.
So far screens have been installed in 38 practices.

                                           Lead Director – Eugenia Cronin

Teenage pregnancy

Following the National Support Team recommendations and the areas
highlighted in a Ministerial letter seeking a progress report from Haringey
Council (dated 18 September 2008), we are making progress in the following

      Reviewed the terms of reference, membership and chairing of the
       Steering Group;
      Refocused the Teenage Pregnancy Coordinator role to be more
      Improved the data we have on teenage pregnancy: developing a more
       timely database in order to better inform service changes; developing
       the Local Monitoring Dataset to improve performance management;
       piloting a process to identify and support teenagers at greater risk of
       becoming a teenage parent;
      Reviewing and enhancing access to sexual health and contraception for
       young people, including long acting reversible contraception and
       emergency hormonal contraception;
      Reviewing and strengthening sex and relationship education in schools;
      Improving communications: information on access to services as well
       as health promotion materials.

                                             Lead Director – Eugenia Cronin

Vascular Risk

The PCT is developing a programme of systematic vascular risk assessment
and management, in line with national guidance. This screening programme
aims to identify primary care patients at risk of vascular diseases: heart
disease, stroke, diabetes and kidney disease, and to ensure appropriate
advice, support and follow up. It is focused on those aged 40-74 years and is
based upon good evidence of effectiveness and cost effectiveness, for
example, nationally it could prevent 4000 people a year developing diabetes.
If appropriately delivered it would have a major impact on inequalities in life

NHS Haringey initiated CVD (cardiovascular disease) screening in primary care
over a year ago, through a tool called OBEROI in primary care. This has
variable uptake and will be built upon to develop this systematic “vascular
checks” screening programme. The programme, including a call re-call
system according to identified level of risk, and the infrastructure of advice
and support to individuals at risk must be developed and rolled out in a
phased way over the next few years (complete roll out required by 2012-13).

A PCT lead (Dr Fiona Wright) and project manager (Irene Babalola, recent
interim appointment) are in post, an informal steering group established and
initial funding identified. Next steps include: modelling the roll out, identifying
further costs for implementation of the screening programme, development of
the care pathway and stakeholder engagement.

Mapping is underway to identify gaps in supporting service e.g. weight
management advice and statin prescription as it is essential to have
appropriate support available for individuals, who may previously have
believed they were well, once identified as at risk.

                                           Lead Director – Eugenia Cronin

World-class Primary Care Update

Gateway Review

As previously reported, Department of Health guidance on reconfiguration
programmes now includes a requirement for a “gateway review” of the
programme prior to launch of formal consultation. The TPCT has met twice
with Ridgeway Consulting (appointed by DH as reviewers). A number of key
people will be interviewed as part of the process in February & March,
including primary care leads & clinical leads, as will members of the Overview
& Scrutiny Committee. The review is expected to be completed by mid-March
2009 and will be reported to the Board at its March meeting.

Transport & Access Study

Board members had the opportunity to attend a brief presentation on the
early findings of this work by Mott McDonald. The project is currently being
finalised and we anticipate concluding the work by early February. The final
report will be brought to the Board meeting in March 2009.

Residents’ Health Survey

This project is subject of a separate paper within this Board agenda.

Neighbourhood Development Planning

Work continues upon the Neighbourhood Development Plans described to the
Board at the last meeting. We envisage presenting the Plans to the Board in
March 2009 for sign-off prior to commencing public consultation &

Hornsey Central

Construction of the building at Hornsey remains on track, with hand-over
scheduled for March 2009. After necessary hand-over & commissioning work,
it seems likely that services will relocate from May 2009, with a phased
approach spreading over 6 months to October/November 2009.

Health Link has completed its pre-consultation work with local patients and is
currently planning the final “reporting back” event scheduled for February

The Laurels

The procurement of a new provider for The Laurels PMS Practice (and the
extension of services to comply with “GP-led health centre” criteria continues
and is broadly on track.

In December 2008, the joint selection panel reviewed the Pre-qualification
Questionnaire (PQQ) submissions and short-listed to create two short-lists of
6 applicants (one list each for Enfield & Haringey).

Work by Health Link in running two consultation events with patients at The
Laurels has been completed. Other work, namely to select & support a
patient to join the selection panel at the interview phase, continues.

The Overview & Scrutiny Panel has concluded its review of the consultation

Future project milestones include:

   9 February 2009 – deadline for return of tender documents;
   18-20 February 2009 – interview panels;
   31 March 2009 - contract signed with the new provider - service to start
   “as soon as possible thereafter”.

PMS Contracts Re-negotiation

After the Board’s approval of the revised PMS contract, work has begun to
implement the new contract with effect from 1 April 2009.

PCT officers are currently working with PMS practices to achieve sign-off of
the new contracts or resolution of disputes (through an agreed process) prior
to sign-off.

In addition, work in regard to the issue of “growth monies” has begun, with a
view to completion by July 2009.

                                             Lead Director – James Slater

Race Equality Scheme Review 2009 – 2012

Like all PCTs NHS Haringey is charged with 3 main tasks with regard to the
health of Black and Minority Ethnic Communities.

        Know and understand the health needs of our people
        Achieve measureable outcomes for combating health inequalities
         rooted in ethnicity
        Implement the law on race equality

Plans for delivering these tasks will be set out in a review of our Race Equality
Scheme which will be presented to the Board in February 2009. There is a
legal requirement to publish such a document, as the duration of the previous
RES was until 31st December 2008. In the light of changes due to take place
it is necessary to place the review in the context of the organisation as a:

1.        Provider of health services
2.        Commissioner of health services

These two issues will be explored in depth in the review currently in progress.

It is also important to examine our changing relationship with Haringey
Council, which has an Equalities Team and to investigate how our efforts
might be combined to achieve the 3 main tasks outlined above.

Next steps:

        A draft document will be presented at a cross directorate meeting to
         discuss tasks, roles and responsibilities.
        After additions and amendments this document will be sent out to
         relevant stakeholders such as HAVCO, The Race Equality Council and
         Well Being Partnership Board from 29th January 2009 to 16th February
         2009 for comments.
        The final document will be included with the February Board papers.

The Board is asked to endorse the proposed process and note the final review
of the RES will be presented at the Board meeting in February 2009, and to
request any further action.

                                            Lead Director – Eugenia Cronin

Update on BEH Clinical Strategy Implementation

1. Introduction

Following the endorsement of the BEH Clinical Strategy proposals by the
Secretary of State in September, work has been underway to prepare for
implementation, incorporating the recommendations of the IRP and the
Gateway review.

2. Preparation for Implementation

The Project Executive held its last meeting in December 2008. It will
reconvene as the BEH Implementation Programme Board on 23rd January

2009. The Commissioning Board for the Implementation Programme will also
have its first meeting in January 2009.

The leads for the four service-related work streams in the Implementation
Programme (Women’s and Children’s services, Primary Care, Planned Care
and Urgent Care) will meet with the Programme Board in February.

Work is currently underway to develop specifications for a Stand-alone
Midwife-led Birthing Unit at Chase Farm Hospital. Work is also underway to
develop a service model for the provision of urgent care on the Chase site,
taking account of the need to provide a local A&E service during the daytime,
a primary care led urgent care service out of hours and to have assessment
units for paediatrics and older persons during daytime also.

An Interim Programme Director is in place since late September. The posts of
Programme Director and Programme Manager will be advertised shortly.
A senior post for Stakeholder Engagement is being developed, which will be
shared between the BEH Implementation Programme and Enfield PCT. This
will be advertised as soon as the details are finalised.

Further work is also underway to finalise the Business Case for the Strategy,
with a target end date of March 2009. KPMG have carried out a review of the
capital and transition costs funding proposals and made a number of
recommendations which will be taken forward as the work on the Business
Case continues. Key actions between now and the end of March include:
    a) Finalisation of capital costs at BCF
    b) NMUH to conclude agreement on PFI variation, based on confirmation
        of funding through Public Dividend Capital (PDC) route
    c) Outline workforce strategy to be developed
    d) Revision of relevant tables in the Business Case
Revised, site specific Business Cases for the necessary capital developments
to support the Implementation Programme will be developed by NMUH by
May 2009 and by BCF by end July 2009.

3. Judicial Review

London Borough of Enfield (LBE) is challenging the Secretary of State and the
3 PCTs decision on the BEH Clinical Strategy, primarily on the grounds of the
consultation process. The Council’s initial contact on this matter, the “Letter
before Claim”, was received on 24th November. Without waiting for the PCTs
to respond to this, LBE served us with formal proceedings on 4th December
and an order granting permission for a full Judicial Review was given by the
Court on the 9th December. As this was well before the time allowed for filing
our response had expired, it was very unexpected. The Court’s order
granting permission for the JR required us to file our defence (“Summary
Grounds of Resistance”) with the Courts by the 5th January 2009.

On the 10th of December, we applied to have the order granting permission
set aside, so that we would have an opportunity to put forward our case.

Notwithstanding our application to have the order granting permission for the
review set aside, we were still required to comply with the 5 th January
deadline for filing our defence to the challenge. Capsticks have filed our main
defence documentation, the “Summary Grounds of Resistance”, with the
Court on 5th January 2009.

An oral hearing about the request to have the permission order set aside is
now scheduled for 28th January.

Further updates about the progress of the JR will be provided when we have
new information.

4. Gateway Review:

As recommended by the IRP, a Gateway Review was undertaken during
December last. Following consideration by the Implementation Programme
Board, the output from the review will be used to assist the development of
the BEH Implementation Programme.

5. Next steps:

The key next steps are to:
    Hold initial meetings of Commissioning Board and Implementation
      Boards and agree work programmes with Working Group leads
    Finalise the relevant elements of the Business Case (target date March
      2009) and agree way forward on outstanding issues (see Section 2)
    Finalise the high level programme plan, showing targets,
      interdependencies and milestones
    Advertise and recruit Programme Director and associated staff
    Finalise job description for shared Stakeholder Engagement lead post
      to be shared between Enfield PCT and the BEH Implementation
    Continue to progress our legal defence in the Judicial Review process.

                                          Lead Director – Tracey Baldwin


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