Adding life to yearsand years to life

2008/09 AnnuAl RepoRt

Your healthcare partner

Contents
1. Welcome and introduction...................................5 2. Our key achievements..........................................7 3. Our aims and objectives.......................................8 4. Health in Northamptonshire................................12 5. Highlights from this year.....................................14 6. Adding years to life and life to years...................20 7. Working with patients and the public.................28 8. Areas for continued improvement.......................32 9. Our people.........................................................36 10. Looking ahead....................................................42 11. Regulatory environment......................................46 12. Accounts............................................................50

Welcome and introduction

We are delighted to present our first annual report as NHS Northamptonshire and what an exciting year its been. With the help of our patients, the public and clinicians, we developed an ambitious plan of action to deliver the best quality healthcare for the people of Northamptonshire. At the same time we have laid solid foundations on which we can continue to build a leading health organisation in the East Midlands. One of our main focuses has been to explore how to meet the health needs of our growing and diverse population, especially as we head into a challenging economic era. Our priorities are to tackle the biggest causes of premature death, such as cancer and stroke, and also to help people live healthier and longer lives. We are also improving access to health and wellbeing services. One highlight of the year was the opening of the East Midlands first GP-led 8-8 health centre in Corby. In just four months, over 1350 patients used this walk-in service, greatly improving access to healthcare in Corby and the surrounding areas. We are also delighted that our patients are now receiving treatment more quickly than ever after a GP referral. 95.4% of patients who were admitted to hospital for treatment during December 2008 had waited less than 18 weeks. In addition, we have invested in helping people live healthier, longer lives. Our first 12 health trainers are out in the community spreading healthy lifestyle messages. Over 1400 patients have already been referred by their GPs to local gyms and leisure centres to help with conditions such as mild depression, obesity and stress. Weve listened to what patients and the public think could be most improved, including access to NHS dentists, hospital cleanliness and end-of-life care. We have responded and put in place a range of initiatives to address these concerns, for example we are investing to provide at least 5, and potentially 9, new NHS dentists across the county. The views of our patients and the public are vital to the way we design and deliver quality healthcare services closer to home, and we will continue to seek their opinion and views in the future. This year we were proud that NHS Northamptonshire was recognised as one of the top performing NHS organisations in the country within the World Class Commissioning framework. However, looking to the future, we know we can improve further and we relish the challenges that lie ahead. This report is a snapshot of the year and an opportunity to showcase our work. We would like to thank all of our colleagues who continue to work with dedication, commitment and passion. And we are continuing to work closely with our partners and residents as we strive to become the healthiest county in the country.

John Parkes Chief Executive

Professor William Pope Chair

NHS East Midlands

Derbyshire

lincolnshire nottinghamshire

Our location

Nottinghamshi r e

leicestershire

Corby
northamptonshire

Oundle

Kettering

East Northamptonshire

Rushden

Wellingborough

Northampton Daventry

NHS Northamptonshire
Towcester

South Northamptonshire

Brackley

Our key achievements in 2008/09

What We are Proud of
We launched the east Midlands first Gp-led 8-8 health centre in Corby and within four months, over 1350 patients used this walk-in service. 89% of Gp practices across northamptonshire offer extended opening hours to their registered patients achieving our target two years ahead of schedule. patients are waiting a shorter time from Gp referral to consultant-led treatment 95.4% of patients who were admitted to hospital for treatment during December 2008 had waited less than 18 weeks from their Gp referral. Kettering General Hospital opened a new 4.7million cardiac centre, enabling the majority of heart attack patients to receive their specialist treatment within 48 hours of admission. Over 1400 people with conditions such as obesity, diabetes and mild depression were referred by their healthcare professional to the new activity on referral scheme to undertake a 12 week, fully supported physical activity programme delivered by specially trained gym and fitness staff. northampton General Hospital opened the northamptonshire Kidney Centre and northampton Heart Centre in June 2008, both of which bring vital services for local people closer to home. Two major research partnerships have been launched to ensure that our patients receive healthcare services based on the best medical research and evidence. NHS Northamptonshires first health trainers are now fully qualified and out in the community, spreading healthy lifestyle messages, providing tips and signposting people to services that will improve their health. More patients are able to choose a hospital or specialist appointment time and place that suits them through our electronic choose and book system. Over 90% of our patients have access to this system through their Gp surgery, placing us in the top 10 performing primary Care trusts in england (February 09 figures). our move to new premises, Francis Crick House, has brought all staff under the same roof for the first time, helping us to work together more closely and also reducing our carbon footprint by an estimated 121 tonnes per year equivalent to the output of 39 cars.

This section explains what we are here for that is to improve the health and wellbeing of the population of Northamptonshire. It also explains the work we are prioritising over the coming years.

Our aims and objectives

Our vision:
With the input of our local stakeholders, who include patients, the public, our partner organisations and the community of healthcare professionals, NHS Northamptonshire has developed a three-part vision for the future:
Reduce overall mortality adding years to life Help people to live healthier lives and improve their wellbeing adding life to years Improve patient satisfaction with nHS services

Our role:
NHS Northamptonshire is responsible for making sure that everyone living in the county has the same opportunity to be fit and well. Part of this involves identifying current and future health needs and making decisions about how best to provide the healthcare services that meet those needs. In charge of the local National Health Service (NHS) budget, we buy (or commission) services from family doctors (GPs), pharmacists, dentists, opticians, hospitals and a range of other healthcare providers. We also work closely with councils in Northamptonshire, especially their social services departments, as we collaborate to improve health, reduce inequalities and integrate health and social care services.

Our history:
Northamptonshire Teaching Primary Care Trust (PCT) was formed on 1 October 2006 from the three previous PCTs Daventry and South Northamptonshire, Northampton Teaching and Northamptonshire Heartlands. Research showed that the public did not have a clear understanding of the term Primary Care Trust and the role they play in providing healthcare for the population. To resolve this, all PCTs changed their name to NHS County so we became NHS Northamptonshire. The section of the PCT that provided healthcare services to patients Provider Services will become a separate organisation as of 1 October 2009. This administrative change has taken place to ensure that the best quality and value for money services are available to the people of Northamptonshire. The services include community nursing, physiotherapy, podiatry, chlamydia screening and wheelchair services. These changes do not affect the way in which patients access and receive their healthcare across the county. For more information on Provider Services call 01536 480300.

Our 5-year strategic priorities:

This year saw the launch of our new 5-year strategy to improve the health of Northamptonshire. There are a number of significant factors that affect the way we plan future healthcare for the county including:
projected 50% population growth in the 30-year period between 2005 and 2035. A significant increase of migrants from eastern european countries. pockets of high deprivation and relatively low life expectancy which tend to concentrate predominantly in urban areas, especially Corby. the over-85 age segment will experience the largest growth in the period to 2012. the whole country is facing an economic downturn.

the findings and recommendations of the final report High Quality Care For All from Lord Darzis Next Stage Review of the NHS. To gain an in-depth understanding of our population, its health status, and associated lifestyle issues, NHS Northamptonshire carried out a broader and deeper analysis of current and future health needs than has ever been undertaken previously.

This work gave us a clear mission: to reduce the main killers of today heart disease, cancer and stroke and the main killers of tomorrow smoking and obesity. This is summarised in the following four strategic aims.
Improving outcomes for the major causes of premature death: heart disease, cancer and stroke. Reducing key risk factors which contribute to premature death and ill health: smoking and obesity. Commissioning better quality services closer to home: chronic disease, childrens services and mental health. ensuring that the key commissioning enablers of service improvement are in place: models of care, and patient and public engagement.

We listened to you
As our local response to the NHS Next Stage Review, in 2008 we ran a series of workshops and conferences to listen to the views of patients and medical professionals about every aspect of current and future healthcare across the county. We used this information to get a better understanding of the health services local people use, what is important to them, and what changes would give added value through improved access, improved convenience or improved quality of service.

Our strategic priorities outlined on page 10 were developed in response to identified local need (explored more in Section 4), and

Summary of vision, strategic themes and priorities

The Vision
Reduce overall mortality Help people to live healthier lives and improve their wellbeing

The Priorities The Strategic Themes

Improving outcomes for the top 3 killers Heart disease Cancer Stroke

tackling the top 2 longer term killers

Smoking obesity 23 Strategic Initiatives Chronic disease Childrens Services Mental Health

Improve patient satisfaction

Commissioning better quality services in 3 key areas

Focusing on the top 2 enablers of improvement delivery

Models of care public and patient engagement

Strategic Priority and Next Stage Review initiate

Strategic Priority only

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How will we know if we have succeeded?

As we embark upon this journey, it is important to have a clear idea of what success will look like:
our citizens will be more satisfied, with individuals feeling that they are treated with dignity and respect, and that they are receiving the highest quality of care. our partnerships will be more effective, working together in a meaningful way to deliver equality in outcomes. our staff will feel valued, supported and personally empowered to make the improvements that are required. our providers, including the primary care providers and trusts in northamptonshire, will lead their own future in developing innovative, world class services.

How will we monitor progress?

Well continue to ask the public what they think we are doing well and what we need to improve. this will be through events, surveys and formal consultations. Importantly we will further develop our partnership working so we have a better dialogue with our key stakeholders such as local authorities, voluntary organisations and patient groups, so their views can influence our decision-making.

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Here we explain a little more about what health is like in Northamptonshire and the key factors affecting how we plan future healthcare services.

Health in Northamptonshire
Northamptonshire has a population of around 700,000 people. Although the county is often perceived as predominantly rural, over 85% of our population live in towns and urban areas. Minority ethnic groups constitute less than 5% of the population of Northamptonshire, but over the past five years there has been a significant increase of migrants from Eastern European countries. As a county, Northamptonshire has relatively low deprivation some 97% of the rural population and 50% of urban dwellers belong to the least deprived or second least deprived areas in the country. However, these figures hide pockets of high deprivation and relatively low life expectancy which tend to concentrate predominantly in urban areas. For example, a man in Corby can expect to live for 74.5 years, 5.5 years less than in South Northamptonshire with likely causes of death being cardiovascular disease and cancer. The county can expect a projected 50% population growth in the 30 year period between 2005 and 2035. This is due to a significant increase in large scale inward migration, increasing life expectancy and birth rate. Northamptonshire is part of the Milton Keynes South Midlands region, a designated government area for major housing expansion, which will be a significant driver of planned population growth. The county age profile is slightly younger than the UK average with only 14% of people aged 65 or over and with a greater proportion of young children than the UK average. However the population of Northamptonshire will increasingly become older over future years. The over 85 age segment will experience the largest growth in the period to 2012.
Important health issues for the county include:

Infant mortality has improved over recent years, and most measures show it is at or near the national average, but there is still clear room for improvement. Breastfeeding levels are below national average levels. Childhood obesity is still high compared with international benchmarks northamptonshire has 8% obese children aged 4-5 and 16% aged 10-11. obesity prevalence in the county is considerably higher than the national average.

5-year survival rates and overall mortality rates are poor for certain types of cancer, including colo-rectal, prostate and breast cancer. 30-day stroke mortality rates are high, specifically in areas such as Corby and northampton.

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Corby

oundle

Kettering

Rushden northampton Daventry Wellingborough

NHS Northamptonshire Facilities

District Hospital Gp Main Surgery Gp Branch Surgery

towcester

Community Hospital Minor Injury unit Hospice Main Road Motorway

Brackley

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In this section we celebrate in more detail a selection of the achievements we are most proud of this year.

Highlights from this year

Better Access to Services
The following examples illustrate how NHS Northamptonshire is working to improve access to services. First 8-8 GP Surgery in East Midlands launched in Corby

During the first four months, over 1350 people used the walk-in service mainly for minor ailments such as minor injuries, sore throats, chest infection/chest pain, eye problems and contraception. Currently 89% of practices offer extended hours to their registered patients, meaning weve achieved our target for 2010/11 two years ahead of schedule.

Corby Minor Injuries Units weekend service launched in April 2008.

A highlight of our year was the launch of Lakeside Plus, the first new GP-led 8-8 health centre in the East Midlands, which opened in Corby in December 2008. The centre, which sees patients from 8am to 8pm, seven days a week, is part of a Government programme to increase access to family doctor services. Any member of the public can use the additional services provided by the Lakeside Plus centre while staying registered with their local family doctor, or patients can register at the Lakeside Plus centre to receive the same high quality services as at any GP practice.

Minor Injuries Units provide a more convenient local service for patients, whilst also reducing pressure on A&E departments, enabling staff there to deal with more acute medical problems. The extended service, a joint initiative between NHS Northamptonshire and Kettering

General Hospital, means that patients in Corby and the surrounding area can now be treated for minor injuries at the unit between 9am and 6pm on Saturdays and Sundays as well as normal hours. The unit is for patients who have suffered a minor injury such as a cut, sprain, strain or burn within the last 48 hours and it also offers X-ray facilities and the treatment of simple broken bones. The first ever two robot community pharmacy using top of the range automated pharmacy dispensing machines was unveiled at the official launch of Prospect House Medical Centre in Kettering in May 2008.

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NHS patients can now expect the shortest waits for treatment since records began.

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End Waiting, Change Lives

NHS patients can now expect the shortest waits for treatment since records began.

Symptoms, pain and discomfort are relieved earlier. the service is more streamlined, making more efficient use of nHS money.

From December 2008, no patient will wait more than 18 weeks from GP referral to consultant-led treatment (unless there is a clinical reason or the patient chooses to wait longer than 18 weeks). This delivers earlier diagnosis, reduces non-clinical delays and moves care closer to home where appropriate.
What 18 Weeks means for patients

During December 2008 all organisations that provided acute services for the people of Northamptonshire were monitored against the national 18 week targets:
90% of admitted patients from Gp referral to start of treatment (Rtt) within 18 weeks 95% of non-admitted patients Rtt within 18 weeks

NHS Northamptonshire achieved the December 2008 target by November 2008 and has sustained this performance. This would not have been possible without all the hard work by our partners in GP practices, Kettering General Hospital, Northampton General Hospital and Provider Services.

Putting patients at the heart of their healthcare

We are currently working to improve the healthcare services for patients with Chronic Obstructive Pulmonary Disease, or COPD, which is a long-term respiratory condition affecting about 7,000 people in Northamptonshire. The project involves a complete review of the patients journey from diagnosis to treatment and will examine the number of clinicians seen by each patient and will also cover rehabilitation. A crucial factor is to look at ways in which patients could have avoided developing COPD so we can support other patients to change their lifestyle accordingly.

Diagnostic tests and outpatient appointments are closer to home as more services are provided in the community and by Gps. Increasingly, patients will only need to go to hospital for specialist treatment. tests and treatments are co-ordinated, meaning fewer hospital visits. patients experience reduced anxiety due to earlier diagnosis and treatment.

Figures show that 3,654 people who were admitted to hospital for treatment during December 2008 had waited less than 18 weeks from their referral, which is 95.4% of the total of 3,829. For those patients who received their treatment in a setting other than during an inpatient stay, 7,553 were treated within 18 weeks of referral, which is 97.3% of the total of 7,762.

The aim of the project is for commissioners and clinicians to work together to create the very best or gold standard care pathway for COPD patients based on strong evidence. It also enables future investment decisions to be driven by accurate data and by what works best for patients and clinicians. We are aiming to develop COPD pathways and other services which result in improved patient experience and greater patient satisfaction. This will lead to a redesigned service and to a better quality of life for patients.

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Listening to our patients

The people of Northamptonshire told us that the areas they most wanted us to improve were access to NHS dentists and hospital cleanliness, so here are some examples of what were doing in response:
Dental health

Hospital cleanliness

In 2008 NHS Northamptonshire launched an oral health strategy to give everyone in the county the opportunity to have great teeth and gums through adoption of a healthy diet and by sensible use of simple preventive measures. We are developing dental services that are patient-led, accessible and aimed at preventing oral disease. We have invested in improving access to dental services across the county. At least five new dental practices will be established in the summer of 2009/10 and these will open for longer hours in response to patient feedback.

We know how important this is for patients and over the last year we have done a lot of work with our providers to improve their levels of cleanliness and response to infections. Cases of Clostridium difficile (C.diff) have decreased over the year in both hospitals, but there is still more to do to reduce MRSA cases as both hospitals missed their targets. We are continuing the good work that was started this year and you can find out more about our plans for further improvement in Section 8 below.

We are encouraging the public and staff to help us combat healthcare acquired infections through the NHS East Midlands Hand in Hand, fighting infection together campaign. As the first public campaign for hand hygiene, it promotes washing hands regularly and correctly as one of the easiest ways to prevent the spread of infections such as MRSA and C.diff. From the end of March 2009 all NHS trusts introduced MRSA screening for patients undergoing elective procedures. Compliance guidelines were published and NHS Northamptonshire supported organisations providing healthcare to fulfil this requirement. As a result, Northampton General Hospital has also become an early achiever in the screening of emergency patients a requirement that does not come into force until 2010/11.

Working in partnership
We know that to improve the health and wellbeing of the people of Northamptonshire, we need to tackle this collectively with other organisations that also have the countys best interests at heart. This includes Northamptonshire County Council, Northamptonshire Police, the district and borough councils, voluntary sector organisations and hospitals.
Alcohol

One example of successful partnership working this year is alcohol harm reduction. This is a major priority for all agencies in Northamptonshire, and the countys Local Area Agreement (LAA) has a focus of reducing harm caused by drugs and alcohol across our communities. The LAA is a commitment by partners from all parts of the community (the public, private, voluntary, community and faith sectors) to act on the issues that will have the greatest impact on quality of life for residents.

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One of the main ways of making this happen is through another partnership, the Drug and Alcohol Action Team (DAAT), which is made up of organisations from across the county (such as councils, health, police and voluntary organisations) who commission or pay for services which help reduce drug and alcohol problems. During 2008/09, A&E attendances for glass related injuries have reduced by over 40%, and we aim to continue this success across the county working closely with our partners.

Northamptonshire Partnership

Partnership board

Using our research

2008/09 saw the launch of the Northamptonshire Sustainable Communities Strategy 2008-13. Key partners including councils, health, police and many others in Northamptonshire have come together to improve the quality of life and health of the population of the county. This includes improving the environment, physical infrastructure and employment opportunities. All these factors have significant implications for the health and wellbeing of the population.
Our vision for the county

Another example of our collaborative working is the Partnership Board, which has executive membership from all of our main health providers and the local authority. A key priority for us is to deliver care closer to home where possible and appropriate, and develop centres of specialist care where necessary. The Partnership Board is charged with driving forward our shared health agenda and the development of countywide pathways of care.

Research must be used to update everyday health services as quickly as possible, and that means that researchers, practitioners and managers must work together to achieve a co-ordinated approach. One way we are working towards this is through the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) in Leicestershire, Northamptonshire and Rutland which was launched in October 2008, with NHS Northamptonshire as one of the partners. CLAHRC aims to bring together universities and their surrounding NHS organisations to test new treatments and new ways of working in specific clinical areas, to see if they are effective and appropriate for everyday use in the health service. CLAHRC will help NHS staff incorporate new treatments into their everyday working practices.

Research driving health improvement

We all want to be sure that healthcare services and treatments are supported by the best medical research and evidence but this is usually the part of the service that patients do not see. This year saw the launch of two major innovation partnerships that aim to achieve just that.

Corby Substance Misuse Group hosted a conference focusing on Sensible Drinking in Corby in November 2008, which brought together 100 representatives from national, regional and local partner organisations and community groups. They considered the latest alcohol-related health and crime data for Corby, heard about successful projects and, most importantly, helped construct a strategy and action plan to educate and support people to drink sensibly and without harm.

By building on the skills and ambition of our varied and growing population, and by making the most of our location, by 2030 we aim to become one of the top five counties in England in terms of health and environmental quality of life.
Extract from the Northamptonshire Sustainable Communities Strategy 2008-13

The full document can be found at www.northamptonshire.gov.uk.

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An example is the PSP-CKD Study which will explore intensive primary care led disease management programmes for Chronic Kidney Disease (CKD), supported by input of secondary care specialists. The study will investigate if this will improve blood pressure control, slow progression of CKD and reduce cardiovascular event in patients on the CKD register.
Launch of Research Centre in Northamptonshire

United in improving health

Current projects include a study on the longer-term benefits of Activity on Referral, and research into the effects that essential oil vapour can have on healthcare-associated infections such as MRSA and Clostridium difficile (C.diff).

Four initial themes have been identified for the centre: Staying healthy Mental health and wellbeing public and patient engagement, including healthcare-associated infections Innovation and evaluation

December 2008 saw the launch of the Centre of Health and Wellbeing Research (CH&WR) at the University of Northampton. NHS Northamptonshire has invested in the development of the centre, which has the vision:
to build a sustainable partnership for research that will support and develop a culture of using research to inform the evidence base for practice and improve the health and wellbeing of the population of Northamptonshire.

NHS Northamptonshire became one of the first Primary Care Trusts in the country to sign an agreement with an external partner to help improve the way we commission health services for local people and to build our own skills and expertise. After a rigorous selection process under the Framework for Securing External Support for Commissioners (FESC), UnitedHealth UK were chosen as our FESC partner for three years. Working as an integrated part of the NHS Northamptonshire team, UnitedHealth UK colleagues are providing external expertise and innovation in four key areas:
Health needs assessment this is the way we analyse current and future health needs of our population and redesign care for patients accordingly.

Performance management when nHS northamptonshire commissions a healthcare service from any provider, it is crucial that we monitor and evaluate the care provided so that it meets the standard of care we expect. Patient experience new and innovative tools are being developed to help nHS northamptonshire collect the views of patients and their experiences when receiving care. Communications and social marketing commercial marketing techniques are being used to influence and persuade people to change their lifestyle behaviours for example to give up smoking, eat healthily and exercise more.

The CH&WR will work with the local health community to pass on the findings of research and provide research training. Already the centre has run themed networking events, training events and initiated a lunchtime seminar series.

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Here we outline some of the examples of the work weve done to tackle the major causes of premature death and improve access to treatment.

Adding years to life...

Cancer waits
99.9% of NHS Northamptonshire patients with suspected cancer were seen within 2 weeks by a cancer specialist, and 99.5% were treated within 31 days following the decision to treat. Cancer is the second biggest killer nationally. In Northamptonshire, cancer resulted in 785 premature deaths in 2006. Our objective is to reduce premature deaths from cancer by 20% by 2012/13, in line with national targets. We have continued to improve cancer wait times from 2007/08, and the latest figures available show that from April December 2008 we achieved the following:
Two week target for referral to an oncologist (cancer specialist) 62-day urgent GP referral to first definitive treatment target

Northamptonshires Hospital Trusts

Kettering General Hospital (KGH) New Cardiac Centre

In total, 6,989 Northamptonshire patients with suspected cancer were urgently referred by their GP to see an oncologist, and 6,982 were seen within two weeks. This means 99.9% of patients were seen within two weeks by an oncologist 0.1% below the national target of 100%.
31-day target for decision to treat to first definitive treatment target

In total, 980 patients received a definitive treatment following an urgent GP referral and 951 waited less than 62 days. This means 97% of Northamptonshire patients were treated within 62 days after being urgently referred by their GP 2% above the national target of 95%. Both Kettering and Northampton General Hospitals have continued to meet and sustain cancer waiting time targets through the year. This has been due to dedicated clinical, nursing and managerial effort working across the Hospital Trusts and NHS Northamptonshire. The care patients receive is continuously monitored and reviewed to ensure that these waiting times are met.

The Hospitals new 4.7m Cardiac Centre which opened in January 2009 enables the majority of heart attack patients to receive specialist treatment within 48 hours of admission. Since May 2008 the Trust has also begun to perform coronary angioplasty a special procedure for clearing blocked arteries in the heart. The artery is expanded using a balloon and a small metal sleeve called a stent is inserted to keep the artery open.

In total, 2,067 patients received a definitive treatment following a decision to treat and 2,056 waited less than 31 days. This means 99.5% of Northamptonshire patients were treated within 31 days following a decision to treat 1.5% above the national target of 98%.

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The Trust carried out more than 200 angioplasty treatments in its first seven months. The treatments can significantly improve the quality of life for people who have suffered severe chest pain or had a heart attack. The operations are very successful and there is a 90-95% chance that the patient will have no further problem with the artery that has been treated.

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Breast reconstruction service

In January 2008, Kettering General Hospital launched a six month surgical breast reconstruction pilot service for patients being treated for breast cancer. The new service reduces the need for women to travel to specialist centres such as Leicester Royal Infirmary or Nottingham City Hospital to have reconstructive surgery following treatment to remove cancer.

have had to travel to Leicester to receive. The service has had excellent feedback from patients who have benefited from it. 2009 will be the services first full year and it is estimated that some 240 patients will be seen regarding breast problems of whom 30% may undergo breast reconstruction surgery at Kettering.
Foundation for success

Northampton General Hospital (NGH) Opening of Northampton Heart Centre and Northamptonshire Kidney Centre

These new centres, based in a new 14m extension to the hospital, opened their doors to patients in June 2008. Both bring vital services for local people closer to home, meaning that patients no longer have to travel outside the county for treatment. The Northampton Heart Centre provides a full range of cardiology services enabling heart problems to be diagnosed more accurately, and treated more quickly. It is estimated that the new centre will save a minimum of 20 lives a year.
By having doctors, support staff, rehabilitation, and heart failure teams all in one place, we can provide a completely seamless service which previously involved many different locations, often outside the county.
Dr Patrick Davey, consultant cardiologist

The Northamptonshire Kidney Centre is the first acute renal ward to be opened in England and Wales for 15 years. For the first time we are able to diagnose and treat new renal failure cases, and conditions in patients who already have significant existing chronic kidney disease.
It is an essential asset to the hospital, because this disease is now recognised to affect one in ten people to some degree.
Dr Warren Pickering, consultant nephrologist

Overall, during the calendar year 2008, the Trusts breast service saw 17,481 patients for screening or treatment and diagnosed 255 new cases of cancer.

The pilot was so successful that it was extended to 12 months during which time 12 women received reconstruction and many more benefited from advice and care which they would otherwise

KGH became a Foundation Trust on 1 November 2008. A Foundation Trust is a new type of NHS body that has greater independence from Government and which is designed to be more responsive to local peoples needs. So far about 7,000 local people and KGH staff have become members of the hospital as part of the Foundation Trust application process and the Trust is actively encouraging more people to join. www.kgh.nhs.uk

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New bereavement suite

March 2009 saw work start on a new bereavement suite at NGH. The project was enabled by a contribution of 30,000 from the Kings Fund, and some preliminary building work is already under way on site, with the project on schedule for completion in September. When it opens, the new suite will form part of the hospitals Patient Advice and Liaison Service (PALS).
This will be a huge improvement. A purpose built suite will enable us to treat grieving families with respect, privacy and dignity at the end of life. Our team will be able to provide a comprehensive bereavement advice and support service in a more appropriate environment.
Eileen Ingram, Head of PALS

New service to help women with endometriosis

The Northampton Endometriosis Centre (NEC) was launched in August 2008. It provides a specialist service to assess, diagnose, treat and manage endometriosis locally in a centre of excellence. The condition affects up to ten per cent of women in the UK and is associated with pelvic pain, which can reduce quality of life.
Our aim is to provide women with all the necessary information, support and advice they need. We have all the facilities and expertise here to offer every available treatment, including advanced laparoscopic surgery.
Gillian Smith, nurse consultant

www.northamptongeneral.nhs.uk

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This section explains more about how we are trying to improve the quality of life for people in Northamptonshire. We also focus here on the biggest killers of tomorrow smoking and obesity.

and life to years

MEND Mind, Exercise, Nutrition . . . Do it!
NHS Northamptonshire has invested in a countywide MEND (Mind, Exercise, Nutrition, Do it!) programme to combat childhood obesity. The programme equips 7 to 13 year olds, parents and carers with knowledge and skills to establish and maintain a healthy lifestyle. NHS Northamptonshire is working in partnership with councils and leisure centres to run the MEND courses, in which families take part in fun 2-hour sessions, twice a week for 10 weeks. Rather than focusing on weight loss, the programme uses a practical interactive learning approach to teach children and parents weight management skills. This includes inspiring families to adopt a healthier lifestyle and enjoy preparing and eating healthy foods as well as reading food labels and healthy shopping on a budget. There are also simple but exciting sessions which focus on making exercise fun again especially for children who are not fans of traditional school sports.
We have also committed to a two year pilot of MINI-MEND which has been developed to meet the needs of 2 to 4 year old children at risk of obesity, and their families.

Out of shape?

The Healthy Dozen!

NHS Northamptonshires first 12 health trainers are now fully qualified.

Get active with Activity on Referral.

Activity on Referral is a programme aimed at using exercise to support people who are overweight. It includes a reduced rate gym membership, support system and a 12 week plan.

Talk to your GP, or click on www.exercisecanhelp.com

48835_NHS_ad_obe_hr.indd 1 9/4/09 13:14:12

Activity on Referral
This NHS Northamptonshire-funded scheme lets healthcare professionals refer people to local gyms or leisure centres to undertake a 12 week, fully supported physical activity programme delivered by specially trained gym and fitness staff. Over

1400 people were referred to the programme by their healthcare professional during the year. The scheme is run in partnership with all seven of the countys borough and district councils, and is suitable for those with conditions such as stress, mild depression, obesity and diabetes.

The role of the health trainer is to go into the community and spread the healthy lifestyle message, providing tips and signposting members of the public to services that will improve their health, such as Stop Smoking and weight management. The aim is to bring the NHS to the people, which is why health trainers are based at a range of community sites including libraries, Sure Start Centres and community cafes, from Corby to Daventry and many locations in between.

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What are people saying?

I felt things were getting a little out of control at home and I needed some help from outside.

I found it really positive coming to the MEND programme, because theyre making better choices with their diet and nutrition, theyve made friends, theyre far livelier and more energetic, and they seem to be a lot more positive in themselves.
Parents of children taking part in the MEND programme

Changing lifetime habits and behaviours is really difficult for most of us and we hope that Health Trainers will provide that ongoing support that makes the difference. Its a fantastic new initiative as it means that our new dedicated Health Trainers will be at the very forefront of promoting health and wellbeing in the local community and will actively be making a difference.
Fiona Grant, Specialist in Public Health for NHS Northamptonshire

I certainly look at it as a life saver! In four months of regular exercise and a change in diet I successfully lowered my [cholesterol] level to 4.4. I enjoy feeling fitter, I enjoy the challenges, I enjoy life all of which is, in no small way, thanks to Redwell Leisure Centre and the Activity on Referral Scheme.
Reg, a recent participant

Northamptonshire meets national healthy schools target

I truly believe it has saved my life, and I really would like it to save someone elses.
Chris, Activity on Referral user

The most rewarding thing about being a Health Trainer is being able to make a real difference in peoples lives.
Charlotte, Health Trainer, Northampton

Most young people in Northamptonshire are getting the healthy lifestyle message, as 65% of schools in Northamptonshire have achieved National Healthy Schools Status, reaching the national target. With the support of Provider Services Healthy Schools Team, 208 of the 320 schools across Northamptonshire have now achieved healthy schools status, paving the way for them to work towards enhanced healthy schools status.

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Mental Health & Wellbeing

I feel calmer, good about myself. I even feel more confident to meet people and return to work.
Ray, participant in My Journey to Wellbeing Course

2008/09 saw the launch of the Wellbeing Teams as part of NHS Northamptonshires Changing Minds Centre. The Wellbeing Teams support the recovery of people experiencing mental and emotional distress through wellbeing evaluations, short term guided self-help, and extended sessions of psychologically based support. The new national initiative, Increasing Access to Psychological Therapy (IAPT), will also be part of the Wellbeing Teams, increasing the 40 new posts already created to potentially 80 posts by 2011. The teams also offer a range of social support through the Learn2b courses to help people improve their mental and physical wellbeing with activities to suit their interests.

From an early sample, 96% of people using the service who experienced low mood, anxiety, phobia, trauma or emotional distress said that their situation had improved. The teams also include:
peer Supporters people who have experience of emotional distress that help others to talk about their situation and explore the possibilities and opportunities available. practitioners with a wide range of experience both in primary and secondary care including clinical psychologists, nurse consultants, senior mental health staff and occupational health staff.

the parental Mental Health team promotes mental health and wellbeing for parents. Services offered through the team include infant massage, groups for mothers with long term mental health issues and social groups for mothers who are experiencing mild to moderate mental health distress.

The Changing Minds Centre which opened in 2008 is also a leading provider of mental health training and education, locally, regionally, nationally and internationally. Other partners with Changing Minds include GPs, Northamptonshire County Council, Northamptonshire Healthcare NHS Foundation Trust, Mind and a range of other voluntary organisations.

26

There is no health without mental health and mental health is everybodys business.

27

Working with patients and the public

Understanding patients experiences
In collaboration with colleagues at UnitedHealth and with patient and provider groups, NHS Northamptonshire has developed a new patient experience programme to ensure that the views of patients are properly listened to and that their experience drives future service provision. The overarching goal of the patient experience strategy is to improve the quality of patients experience of care. The data will aid the commissioning of healthcare services, assist with provider contracting and fulfil a vital reporting requirement. Importantly, it will also serve to provide information back to the public. There are two main categories of information at the heart of this new initiative:
Patients experience the unique experience of each patient gathered through surveys, focus groups, complaints and other methods. Patient Reported Outcome Measures (PROMs) measuring treatment outcomes and improvement in general health status.

This section lets you know more about the work we are doing to actively engage and listen to our patients and the public.

PROMs are designed to directly measure the effectiveness of care or intervention by using before and after measurements of patient health and wellbeing. PROMs are a fairly new focus for the NHS, with the Lord Darzis Next Stage Review calling for the implementation of PROMs by 2009 related to four specific areas: hips, knees, hernias and varicose veins.

Patient and public engagement

We are working hard to develop ways of better engaging with the people of Northamptonshire on a range of healthcare issues. Formal consultation is only one part of the type of engagement we are committed to improving, but here are a couple of examples where feedback from patients and the public have helped us shape future services.

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Willowbrook Health Campus

NHS Northamptonshire has ambitious plans to redevelop the Willowbrook Health Campus in Cottingham Road, Corby. Improvements are expected to include better diagnostic facilities, 60 beds and doubling the size of outpatient facilities. As part of our commitment to consult with residents, a public event was held at the Willows Arts Centre in Corby in December 2008. The event was a great success and was attended by around 70 members of the public.

In addition, NHS Northamptonshire distributed leaflets across the community, and also met with local NHS staff, employers, travellers groups, Corby Older Persons Health Forum and community groups such as Corby Community Partnership. The feedback raised a number of points that we will be looking to address in the plans, including transport and access to the site, and the range of services provided. The expected opening date for the Corby project is late 2012.
Out of Hours Services

to December 2008. Whilst three months is the standard consultation period, we decided to extend the period to the end of the year to ensure everyone was able to have their say on this important issue. We talked to residents, GPs, current providers, potential bidders, councillors, the ambulance service, pharmacists, dentists, opticians and voluntary sector organisations. We received 1070 completed questionnaires, over 20 letters and emails and had over 100 attendees at the various events. Overall, the feedback from the consultation was that the quality of the existing service is seen as good but there are issues with accessibility for some patients.

Some of the areas highlighted to be addressed by the bidders (companies who bid for the contract) include:
Having a single contact telephone number More patient choice in selecting which centre to access Issues around rural locations accessing services More information for patients about services offered by out of Hours, and how to access them

Our vision is to have a single provider of high quality and responsive Out of Hours Service across the county, so the decision to tender for this service was made last year, with the anticipated contract start date for the service of 1 October 2009. As this is such an important issue for our residents, we undertook an extensive consultation from August

The consultation report including the list of areas to be addressed by the bidders in their specification forms part of the tender process, and bidders will have to consider how they can address patient comments in their tender submissions.

During 2008/09 NHS Northamptonshire and Northamptonshire County Council collaborated to produce the countys aiming high for disabled Children Joint Commissioning Strategy. This was finalised following extensive consultation with disabled children and young people and their parents and carers.

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Working with patients to resolve their concerns

Complaints

In total, NHS Northamptonshire received 179 written complaints over the 12-month period. Out of these, 125 complaints concerned Family Health Service Practitioners (GPs, dentists, pharmacists and opticians). The other 54 were about corporate commissioned services examples include the introduction of 28 day prescribing and issues around funding for treatment. These complaints are those sent directly to NHS Northamptonshire and do not include those sent to individual practices.

During 2008/09 there were 10 cases referred to the Conciliation Service for resolution. Of these 7 cases were resolved, 2 were unresolved and 1 is ongoing. There were no investigations carried out by the Health Service Ombudsman. Service improvements following complaints include:
A community pharmacy reviewed their staffing levels to ensure that prescriptions were dispensed on time for collection. A reminder was disseminated to Gps about good practice in recording patients vital signs during home visits.

Policy will provide improved and consistent arrangements for making complaints across health and social care.
Complaints to Provider Services

Patient Advice and Liaison Service (PALS)

99% of all complaints were acknowledged within 2 working days and 98.5% of complaints were responded to within 25 working days.

NHS Northamptonshires Complaints Policy reflects the Health Service Ombudsmans Principles for Remedy. In 2009/10 the Complaints Policy and procedure will be reviewed and updated to reflect new regulations which came into effect on 1 April 2009. The new Complaints

Provider Services received 128 complaints in 2008/09. 96% were acknowledged within 2 working days, and 86% of complaints were responded to within 25 working days. One complaint was referred to the Healthcare Commission, and is still ongoing.

The Patient Advice and Liaison Service (PALS) provides confidential advice and information for patients, their families and carers about NHS services, listens to their concerns and helps sort out problems on their behalf. During 2008/09 there were a total of 3340 enquiries to NHS Northamptonshires PALS an increase of more than 50 per cent on the previous year, when we received 1635 enquiries. This is

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due to advertising the service more widely, a consistent staff base and full staff complement. Of these enquiries, 2105 were signposting, and 942 were concerns. The remainder consisted of advice, information and comments from the public. PALS liaises with staff, managers and, where appropriate, other relevant organisations to negotiate speedy solutions to issues raised by the public. It will also refer patients and families to local or national-based support agencies as appropriate. PALS also has an important role in advising providers and commissioners of services in order to make service improvements, particularly when enquiries received are indicating certain trends within Northamptonshire. In particular, PALS has advised dental contractors about enquiries from certain areas in the county with regard to obtaining an NHS dentist action taken due to this advice will improve public access to dentists in Northamptonshire.

PALS can be contacted on 0800 5870 879 or e-mail at pals@northants.nhs.uk. National Patient Safety Agency (NPSA)

NHS Northamptonshire has regularly reported patient safety incidents to the NPSAs Reporting and Learning System database. Information released in March 2009 showed that there were 1.18 patient safety incidents per 1,000 bed days at NHS Northamptonshire between April and September 2008.
The latest data shows that 55.6% of all NHS Northamptonshires patient safety incidents resulted in no harm to the patient. The most common problems are patient accidents, safety of treatments and procedures, and medication-related incidents.

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Areas for continued improvement

Treatment time in Accident and Emergency (A&E)
The national target is for 98% of patients to be assessed, treated and then discharged, admitted, or transferred within four hours of arriving at A&E at a hospital, or at a minor injuries unit. We have two A&E departments one at Northampton General Hospital (NGH) and the other at Kettering General Hospital (KGH) and two minor injuries units in Corby and Northampton. Overall, in 2008/09 we achieved the 4-hour target in 97.8% of cases. We are committed to helping both hospitals improve on these targets next year and lots of hard work has meant that improvements are already being seen. Extra measures were introduced to help both hospitals through the winter period. As a result, since mid-March 2009 they have both achieved the target.

While we are delighted with our achievements this year, we are very much aware of the areas that need more work.

have decreased over the year in both hospitals; however neither of our hospital trusts met their targets for MRSA cases.
MRSA Bacteraemias

Infection control
We know that healthcare associated infections such as MRSA are a key issue for public confidence in the NHS and, along with the associated issue of cleanliness, greatly impact on our patients experience and perception of care. Over the last year, NHS Northamptonshire has done a lot of work with our providers to improve their levels of cleanliness and response to infections. There have been mixed results, the good news being that cases of C.diff.

In 2004, the Department of Health set a target of reducing the number of MRSA bacteraemias by 60% by the year 2008. The chart below shows the numbers of cases in Northamptonshire during this period.

During 2008/09, Northampton General Hospital had 20 cases of MRSA bacteraemia against a target of 11 and Kettering General Hospital had 12 against a target of 11. Investigations have been undertaken to establish reasons for these cases and ongoing work will ensure actions are taken to reduce this number. The whole health economy is working actively together to make this happen.

MRSA Bacteraemias April 2003-March 2009

Northampton General

Kettering General

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Some of the initiatives introduced this year include:

Whole health economy infection control group meetings to discuss infection prevention and control issues and to share information and good practice. Infection Prevention and Control Associate Director post to ensure strategic direction and provide a supportive element to our commissioned services through effective communication, closer working relationships and clinical input. Actively increasing infection control audit and training in nursing and residential homes across the county. Joint working party set up to review management of urinary catheters, after analysis established that they are a contributory factor to the development of a bacteraemia in the community. Supporting the participation in NHS East Midlands Hand in Hand campaign to improve compliance with hand hygiene across provider organisations.

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Stop Smoking
Stop Smoking is a major priority for NHS Northamptonshire and we are making considerable investment in two key areas stop smoking services and social marketing campaigns. In 2008/09 we were delighted to surpass our national target of 4366 4-week quitters. In the end we helped 4586 Northamptonshire residents to stop smoking. A combination of factors worked together to raise awareness of our services and encourage people to quit smoking. These included a major research and advertising campaign across all local media and continued engagement with GPs, pharmacies and health trainers making stop smoking services available closer to home, and easily accessible.
One of the recent successful Stop Smoking groups was held at Bellinge Community House in Northampton.

I did it for my health and Ive also realised that I can save myself 35 a week by not smoking. I feel healthier and coming to the group sessions has really helped me I havent smoked now for seven weeks and Ive no intention of ever starting again.
Mrs Montgomery, who gave up smoking after 46 years

Stop Smoking Service

NHS Northamptonshire commissions a Stop Smoking Service from Provider Services which aims to ensure that stop smoking support is easily available throughout the county. The team provides ongoing training to health professionals and support to smokers wishing to quit including those who are pregnant, in prison, in hospital or within workplaces. Stop smoking support is widely available not only from the specialist service, but also from GP Practices and pharmacists. Complementing this network, health trainers and Building Capacity for Health staff in the Neighbourhood Management areas of Northamptonshire are also trained to offer support to smokers wishing to quit.

Give your baby the best start in life... Stop smoking.

With the support of NHS Northamptonshire Stop Smoking Services, youre 4 times more likely to succeed in stopping smoking.
For free advice call 0845 6013116
talk to your local GP or pharmacist, or click on

A New Approach Social Marketing

Social marketing uses commercial marketing techniques to influence and persuade people to change their lifestyle behaviours, including stopping smoking. The key to successful social marketing is to get accurate insight into the beliefs and motivations of individuals to try and understand why they behave in a given way. This informs the way in which marketing campaigns are designed, and the communications techniques used. We are using research techniques to better understand why smokers continue to smoke and what would motivate them to quit. Having identified four key risk groups

www.northamptonshire.nhs.uk

www.smokefree.nhs.uk
48157_NHS_ad_hires.indd 1 16/3/09 14:43:18

Kiss This?
Theres nothing attractive about smokers breath.

Stop smoking.
With the support of NHS Northamptonshire Stop Smoking Services, youre 4 times more likely to succeed in stopping smoking.
For free advice and support, including

free Nicotine Replacement Therapy

call 0845 6013116

talk to your local GP or pharmacist, or click on

www.northamptonshire.nhs.uk

www.smokefree.nhs.uk

48157_NHS_ad_hires.indd 2

24/3/09 16:29:50

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pregnant smokers, manual workers, new communities and young people the research revealed an interesting insight into why people smoke. Here are some comments from the research: I smoke when I havent got
anything better to do

Sexual Health
June 2008 saw the opening of the Ashwood Centre for Sexual Health in Kettering by Northamptonshire Healthcare NHS Trust. The Centre provides a comprehensive range of sexual health services including genito-urinary medicine and contraceptive services. It includes modern consulting rooms, spacious treatment and waiting areas, as well as office space for 24 members of staff.

When Im bored Ill have a fag Habit, its just habit sometimes
I dont even like it, I smoke for the sake of it which is stupid

NHS Northamptonshires target for 2008/09 was to conduct 14,175 screenings 17% of the target population. We achieved 10,842 screenings 13% of the target population. However this is a massive increase from 2007/08 when we screened 524 people 0.7% of the target population. This significant increase has been achieved through the work of Provider Services Chlamydia Team bringing in a number of innovations, such as: Young people can now order
home testing kits from our chlamydia screening team.

40,000 was invested in a new

pilot scheme with the university of northampton. every student who screened received a 10 book voucher to spend in the universitys bookshop.

We launched a competition,
Wii for a wee, which gave young people the chance to win a nintendo Wii when they were screened.

I wake up in the morning and

I need a fag I dont want to quit, Ive been there and done it

Chlamydia: fighting the love bug

Chlamydia is the most common bacterial sexually transmitted infection in Northamptonshire. One in ten people aged 15 24 who are screened test positive, but the good news is that its easy to treat.

We are also engaging with clinicians, partners and other service providers to ensure we deliver the best possible stop smoking services for the people of Northamptonshire.

the love Bug website and

Facebook page were launched which provide information about the Chlamydia screening service, contact details for testing sites and the facility to order home testing kits online.

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Our people
We are committed to improving all aspects of staff engagement and communications. Currently, communication with staff is via team meetings, the intranet and email. Staff said in their annual survey that they would prefer their newsletter talking Points in hard copy, so this is now distributed monthly to all staff on their desks. Everything we do should reflect these values, and one way of ensuring this is through organisational development. We are a growing organisation, and we value the skills, knowledge and experience of our staff. NHS Northamptonshire recognises our duty and responsibility to work with our staff to make them the best that they can be, so we can deliver the highest quality, patientfocused services possible. Thats why our forthcoming organisational development plan will reflect our journey and include opportunities for all. We are strengthening our management model and the new organisational development programme will reward our top performers, make more room for talent across the organisation and develop the next generation of NHS leaders.

NHS Northamptonshire employs around 350 staff who are now based at Francis Crick House in Northampton.

NHS Constitution

Organisational Development
Our core values are:

The NHS Next Stage Review and the NHS Constitution have brought a renewed focus on the NHS as an employer. The latter includes four pledges to staff that set out, for the first time, what the NHS expects from its staff and what staff can expect from the NHS. They are part of the commitment of the NHS to being a good employer and helping staff feel valued, and we fully embrace these pledges.
Pledge 1 To provide all staff with

Pledge 3 To provide support and opportunities for staff to maintain their health, wellbeing and safety. Pledge 4 To engage staff in

decisions that affect them and the services they provide individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward better ways of delivering better and safer services for patients and their families. For the first time this year, the NHS National Staff Survey which provides trusts with valuable information about the views and experiences of employees has been structured around these four pledges. According to the results, 90% of staff feel that their role makes a difference to our patients.

A can do attitude anything

is possible with focus and drive

Respecting and valuing people

staff and patients

Integrity in how we plan

services and engage

clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers, and to communities.
Pledge 2 To provide all staff with personal development plans, access to appropriate training for their jobs and the support of line management to succeed.

Teamwork common purpose

and collective synergy

Striving for excellence quality

at the heart of all that we do

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A better environment for everyone

Additionally our staff are telling us that our strengths are:
providing a safe working environment, with reducing levels of physical violence, harassment and bullying providing the training they need to perform their role

In January 2009, NHS Northamptonshire moved into new headquarters at Francis Crick House, Moulton Park, Northampton a move that allowed all our staff from various locations in Northamptonshire to come together under one roof. This move to a single building has brought immediate benefits including the ability to work more efficiently, and more much-needed space. It is also enabling us to reduce our costs and carbon footprint with less travel required between buildings and with economies of scale. It also gave us the opportunity to renew our datacentre, which is the facility used to house computer systems and associated components, such as telecommunications and storage systems.

What our staff would like us to focus on in the future:

even better communication between senior managers and staff a more robust approach to appraisal and feedback from managers greater opportunities to contribute towards improvements at work

For the NHS, cost-efficiency and green information technology are vital. As the government sets carbon emission targets, power and cooling in the datacentre are an increasing focus. One example of the new datacentres energy saving is that the fans in the cooling units operate at variable speeds according to demand, so that energy isnt expended needlessly e.g. they slow down at weekends, but go back up to speed on Monday morning when staff return to work. We are also helping our staff become more green by introducing initiatives such as bicycle purchase and car-sharing schemes.

Thanks to the datacentre project, our energy costs and carbon footprint are expected to fall by up to 24%, with the infrastructure efficiency set to rise by around 16%. Our carbon footprint will drop by approximately 121 tonnes per year equivalent to the output of 39 cars.

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Human Resources policies

Policies on equal opportunities

NHS Northamptonshires Human Resources Policies are available in full on our website www.northamptonshire.nhs.uk.

Equality and Diversity

Training

Mandatory and statutory training covers 17 subjects and the delivery is dependent on whether the post holder is clinical or non-clinical. Training is timetabled in the Mandatory Prospectus or tailored for teams around specific dates and time and delivered in a blended format of e-learning and tutor-led classes. In addition to mandatory training, the department facilitates funding for university courses, access to NVQs and IT training, along with many role specific courses such as Leadership, Immunisation and Prescribing. The Joint Investment Funding initiative is also co-ordinated from this department for Trust, surgery and dental employees.

NHS Northamptonshire is committed to providing equal access to health services for all groups and communities as well as promoting equality, diversity and human rights. We will do this by identifying and overcoming barriers to access and inclusion across the range of health services commissioned. We will promote and champion a culture of diversity, fairness and equality for all our employees, potential employees, service users, carers and members of the public. We will do this by valuing and celebrating individual difference and acknowledging potential contribution to the continued development of the organisation which will in turn improve the services we commission.

NHS Northamptonshire respects and works to promote equality and diversity. The organisation has a number of schemes and policies in place to address inequalities based on disability, gender and race, both for our staff and the public we serve. Equality and Diversity is part of the mandatory training at NHS Northamptonshire. Data on staff accessing training by ethnicity, disability, gender and age will be available shortly to help ensure all staff are able to access training programmes and have the opportunity to develop and progress in the organisation.
Policy on disabled employees

The Scheme was published in line with the Disability Discrimination Act (2005) legislation which was introduced to remove the barriers that disabled people can face when accessing employment or services.
Equality Schemes

In addition to the Disability Equality Scheme, NHS Northamptonshire has also developed a Race Equality Scheme and a Gender Equality Scheme. We are currently developing a Single Equality Scheme encompassing all six Equality strands Race, Disability, Gender, Age, Sexual Orientation and Religion/Belief. The Disability, Gender and Race Equality Schemes, and Race Equality Duty can be found on our website www.northamptonshire.nhs.uk.
Equality Impact Assessment

The Disability Equality Scheme was published in December 2006 and sets out how NHS Northamptonshire fulfils its duty to promote disability equality. It contains an action plan that identifies agreed prioritised objectives and sets out steps to achieve them.

All NHS Northamptonshires policies and functions are in the process of being examined for their potential impact on all areas of equality.

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NHS Northamptonshire is required to, and is currently, publishing equality impact assessments for all new and reviewed policies. Impact assessments have been undertaken on several corporate policies including the five year Strategic Plan 2009-14.
Complaints Equality Impact Assessment

a scoping of best practice meetings to gather local evidence from service users staff working group established

NHS Northamptonshire has always had a robust complaints policy that states clear aims and objectives, with the emphasis on resolution and learning. New regulations that came into effect on 1 April 2009 have unified and reformed the arrangements for making complaints across Health and Social Care. The new approach to complaints handling gives greater flexibility in how we manage and consider concerns and complaints. The revision of the complaints policy has included the completion of a full Equality Impact Assessment and this has been an important piece of work for the complaints team. This has involved:

The assessment has highlighted the need to further ensure that the complaints process is accessible and responsive and meets the needs of all members of our community. An ongoing action plan of community engagement has begun and involvement has already resulted in changes to the way we present information in our complaints leaflets.

Northamptonshire and Provider Services staff faced challenges getting into work in the first place but they made heroic efforts to ensure patients who needed our services were not let down. Some staff walked miles during heavy snow, equipped with wellies and shovels. Others, unable to reach their office base, covered their own residential areas on foot for other teams within their area. Some staff gave up annual leave to walk to patients homes, and made their numbers available to Out of Hours services.
I was very proud to be part of the team at Cransley Hospice. I was getting text messages from 6.30am from nursing teams who were trying to get to work from outside of town some were turned back by police, others were having unplanned off-road experiences!
Jo Craddock, Matron at Cransley Hospice,

The snow must go on

Northamptonshire was subject to the worst snow for over ten years in February 2009 causing major disruption and putting considerable pressure on health services as more people had accidents. Almost all of our GP surgeries remained open during the worst of the snow even in very remote areas and both hospitals in the county coped extremely well with the conditions. Many NHS

There was excellent team spirit and camaraderie throughout, with staff offering to walk wherever necessary and offers of support for our evening nursing colleagues to keep telephones on each evening in numerous villages where nurses lived.
Jill Beckett, District Nurse Team Leader for Kettering

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Non-Executive Team
The non-executive directors on the NHS Northamptonshire Board are drawn from the local community. They bring their expertise and experience to the work of the Board. Non-executives work as a member of the Board team with the executive team. Their responsibilities are: helping to plan for the future
to improve healthcare services

Professor William Pope Chair

William is currently non-executive chairman of several health, safety and environmental businesses and is on the board of the East of England Development Agency. He was formerly Chief Executive Officer of Bedford-based The Casella Group Ltd.

Susan Hills
Susan was Chair of the former Northamptonshire Heartlands PCT and is also a lay member with the Employment Tribunal Service.

Executive Team
NHS Northamptonshires executive team are the senior managers responsible for the running and day-to-day operations of the organisation.
John Parkes Chief Executive
John has been Chief Executive of NHS Northamptonshire since its inception in October 2006. Prior to leading a commissioning body, John spent his career running hospitals and improving organisations in challenging situations. Johns hospital experience includes 15 years working in university hospitals across England, including MidYorkshire Hospitals NHS Trust. John is also a member of the national Independent Reconfiguration Panel which provides advice to the Secretary of State on disputed or controversial service reconfigurations.

Kate Page
Kate has retired as Chief Executive of Milton Keynes Council and now runs her own company. She has been appointed Chair of the Provider Services Board.

Philip Dearing
Philip is Chair of the NHS Northamptonshires Audit Committee and Deputy Chair of the Board. He was previously a non-executive director of Leicester, Northamptonshire and Rutland Strategic Health Authority.

Diana Wright
Diana is the founder of No Limits Consultancy, which advises organisations on diversity management and related issues.

making sure that the

management team meets its performance targets

Richard Aveling
Richard is a qualified accountant and was Director of Finance at the University of Northampton from 1989 but is now retired.

making sure that the finances

of the organisation are managed properly with accurate information

Clinical Cabinet
Dr David Brown
David is a GP in a large practice in Corby, and has been part of the clinical team in the various Northamptonshire PCTs for the last ten years. He was recruited to NHS Northamptonshire in June 2008 to lead the new-style Clinical Cabinet. Replacing the old Professional Executive Committee, the Clinical Cabinet of five members exists to provide clinical input into the heart of the PCT by working closely alongside directors and assistant directors.

helping the Board to be sure

that it is working in the public interest and keeps its patients and the public properly informed

Tansi Harper
Tansi was a non-executive director with the former Leicestershire, Northamptonshire and Rutland Strategic Health Authority, and before that with Northamptonshire Health Authority.

Gill Scoular Director of Finance and Deputy Chief Executive

Gill was previously Director of Finance and Corporate Services for Leicestershire, Northamptonshire and Rutland Strategic Health Authority. Acting as deputy to John Parkes, Gills responsibilities include finance, performance, and information management and technology.

serving on important board

committees

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Louise Proctor Managing Director of Provider Services

Louise joined NHS Northamptonshire from the former Melton, Rutland and Harborough PCT where she was Director of Primary Care and Community Services. Her responsibilities include community hospitals, adult community services (including physiotherapy, occupational therapy, community nursing, wheelchair service etc), child and family services, estates and facilities, and information management and technology.

Dr Stephen Horsley Director of Public Health

Professor Horsley is responsible for producing the Joint Strategic Needs Assessment for Northamptonshire with the local authorities. In addition, other responsibilities of the Public Health Directorate include Choosing Health, dental public health, emergency planning, health development, health intelligence, health protection, Medical Director, NICE guidance, partnerships, public health, public health analysis, and research and development.

Due to a restructure, the following Directors are joining the establishment from April 2009. Jan Norman Director of Safeguarding
Directorate responsibilities include: safeguarding, clinical quality and standards, equality and diversity, childrens services, stroke and clinical workforce reform.

Alistair Blane Director of Operations and Policy

Alistair has worked in a variety of senior positions in different health organisations during his 27-year NHS career. Most recently, he was Deputy Director of Commissioning & Strategy Development at NHS East Midlands, where he was responsible for world class commissioning and PCT development. His responsibilities at NHS Northamptonshire include: corporate services and board assurance, world class commissioning development, and estates and planning functions including the Milton Keynes & South Midlands population growth project.

Richard Alsop Director of Strategy and System Management

Prior to joining NHS Northamptonshire, Richard was Director of Service Improvement and Performance at Northamptonshire Heartlands PCT. The Strategy and System Management directorates responsibilities include the development of overall health strategy for the county, and the delivery of improvement via annual plans and investments in all care sectors. In addition the directorate is responsible for developing provider markets to meet the needs of local people through the provision of high quality, value for money services.

Jan Norman Director of Quality, Standards and Learning

A trained nurse, Jan has been involved with the NHS all her life and previously worked as East of England Area Manager for the Healthcare Commission. Directorate responsibilities include: clinical quality and standards, clinical/health outcomes, equality and diversity, clinical workforce reform.

Jane Meggitt Director of Communications and Human Capital

Jane has worked in communications and engagement in the NHS for 17 years. Before joining NHS Northamptonshire, she was Director of Communications and Engagement at NHS East Midlands for two years, and has previously worked in teaching hospitals in Cambridge and London. Janes responsibilities include communications, patient and public engagement, and human capital, which includes HR and organisational development.

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10

Looking ahead
Same-sex accommodation
The Safeguarding of Privacy and Dignity remains one of the key priorities for NHS Northamptonshire and this can significantly affect the experience patients have when receiving care. Privacy and dignity provided in single sex accommodation is fundamental in delivering high quality care, which we as commissioners are committed to delivering for our community. Achieving this, and making sure our patients have privacy and dignity during their stay in hospital, is very important to us and we work closely with our providers to continually improve this aspect of care for our patients. This year, for the first time, we negotiated contracts with Kettering General Hospital, Northampton General Hospital and Northamptonshire Healthcare NHS Trust that included provision of more single sex accommodation, and identified standards to be met. We have also supported bids by both hospitals to NHS East Midlands for capital funding to improve their single sex accommodation. Both bids were successful NGH will receive 1.181m towards improvements to over 15 wards for changes such as additions of en-suite toilets and extending partitions. KGH will receive 710,000 for improvements such as providing single sex bays, and installing new signage.

This section highlights just a few of our projects for 2009/10 which will help to improve the health and wellbeing of Northamptonshire people.

the end-of-life, including the choice of place of care and place of death. The aim is for all services to meet the quality standards set by the Gold Standard Framework, and to support patients, their carers and families through this experience. Our plans include: Key workers programme
every patient who is at the endof-life will have an identified key worker who will co-ordinate their care across multiple settings

Community Support services

such as night sitters and day sitters

education and training

programmes for health professionals including Advanced Communication Skills to increase expertise in discussing death with patients and their families and to raise awareness of end-of-life issues

Increasing quality of care in all

settings, including care homes, through universal provision of the Gold Standard Framework, the preferred priorities in Care and the liverpool Care pathway

A central point of access linking

with key workers to co-ordinate services centred around the individual needs of patients and to provide telephone advice and support

End-of-life care
How people die remains in the memory of those who live on
Dame Cicely Saunders, Founder of the Modern Hospice Movement

An end-of-life care network to

ensure clinical and stakeholder input, including patient and public involvement in planning and improvement of services and to help monitor standards of care and the patient and carer experience

expanding Hospice at Home

services, including a Rapid Response service so that where possible people can continue to be cared for and treated at home

Developing and improving End-oflife care services is a high priority for 2009/10. We want to ensure that the wishes of patients are met at

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Employee Wellness thrive

Working in partnership with UnitedHealth, NHS Northamptonshire is significantly investing in the health and wellbeing of staff through the development and implementation of an all-employee wellness programme, based on global best practice. The first programme of its kind, thrive will link healthier lifestyles with productivity through better wellbeing and we hope to see a reduction in absenteeism as a result. Global studies show that worksite health promotion programmes reduce absenteeism and related medical costs by improving health and creating a positive culture of health at the worksite. Similar UK initiatives have also shown positive results (e.g. significantly reduced absenteeism at the Post Office). The sickness absence rate for NHS Northamptonshire staff in 2008/09 was 4.02%, better than the national average, and better than our target of 4.22%. The first phase of the thrive initiative includes:

Teenage Pregnancy
Rates of teenage pregnancy in Northamptonshire are now lower than the national average but there is still work to do. Next year we will be investing 317,000 into projects including:
An innovative Mystery Shopping exercise in northampton to identify any barriers young people may face in accessing our services. the continued development and delivery of voluntary sector activity in northampton will be expanded to include access to emergency contraception and contraception. Across the county districts there is a plan for delivery of long Acting Reversible Contraception for under 25s in a co-ordinated way, and access to contraception pre and post termination and pre and post birth for the under 20s will be commissioned through a tender process.

A programme to identify and give Youre Welcome status to providers of services to under 25s that are assessed as young people friendly. the Department of Healths Youre Welcome quality criteria lay out principles that will help health services get it right and become young people friendly.

Cultural health audit employee health needs assessment and personal support tools Flexible exercise-at-work programme and related activities tax-efficient/salary-sacrifice cycle purchase Reduced-rate local gym membership employee education Comprehensive promotion, employee communication and information support, news and on-line interactive features

Maternity and Newborn

Our primary objective for the Maternity programme for 2009/10 is the successful delivery of the Maternity Matters Choice Guarantee which means all women and their partners are able to access choice around antenatal care, postnatal care, and in respect of birth options. These will include the choice of home birth, midwifery led care, or maternity team care. This choice guarantee must be in place for the end of December 2009.

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Learning Disability Programme

NHS Northamptonshire is investing 1.4 million to provide personalised housing support for people with learning disabilities meaning that by March 2010, 90 people will be rehoused in accommodation of their choice, with support and care provided. We have also received 183,000 from the Government to provide annual health checks for people with learning disabilities

Northamptonshire Integrated Care Partnership has been chosen by the Department of Health as one of 16 pilot sites nationwide to develop new models of long term condition management. 250,000 over 2 years will be invested in the PAC (Pro-Active Care) programme which delivers a system of case management allowing patients who are at high risk of emergency hospital admission to remain at home. This enables patients to remain independent for longer and have more choice in their end-of-life care.

A pilot obesity project in Corby, drawing from international best practice, is planned for 2009/10, as well as a pilot Mini-MenD programme. the launch of a major new website aimed at encouraging the people of northamptonshire to take an active interest in healthy living. the website will focus on residents and will connect them directly with health experts in the county, friends and people with similar conditions. the Run 09 takes place on Sunday 4 october 2009 a brand new mass participation event which offers an achievable challenge to people of all ages, abilities and sporting desires.

We are investing 1.75m into our Maternity Services for 2009/10 to deliver this, and are planning increases to our midwifery staffing numbers to help reduce unnecessary antenatal admissions and impact on our Caesarean Section rates. 50,000 is also to be invested in staff training around breastfeeding, to increase breastfeeding rates which will improve life chances for children born in Northamptonshire. We have received 350,000 from the Department of Health will deliver a pilot project for the Family Nurse Partnership a programme aimed at delivering intensive targeted support for young, more vulnerable parents and their families.
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Long term Conditions

A telephone survey conducted at the end of 2008 which covered long term conditions (such as diabetes or COPD) gave NHS Northamptonshire a wealth of information, including the fact that 81% of those people surveyed with long term conditions did not recognise they had a written care plan. This obviously identifies a service gap which is being addressed in the Strategic Plan for example one major initiative calls for providing personalised care plans and designated case managers to all eligible chronic disease or long-term care patients.

Staying Healthy
We are investing over 1m in 2009/10 to help people stop smoking and tackle childhood and adult obesity. You can read about our plans for stop smoking in Section 8, here are just some of the projects around healthy living and physical activity.

www.the-run.org

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Regulations that NHS Northamptonshire must abide by include considerations such as health and safety, management of risk and other governance arrangements.

11

Regulatory environment
Protecting health through emergency planning
Major emergency planning forms an important part of health protection by assessing and addressing the needs of the population in extreme situations and in major emergencies. These may take many forms, from severe weather conditions and flooding to transport crashes or infectious disease epidemics. NHS Northamptonshire is required by the Civil Contingencies Act to: Assess the risk of emergencies
occurring and use this information to inform planning

Make arrangements for

information to be made available to the public about civil protection matters, including warning, informing and advising the public in the event of an emergency

Emergency planning partnerships

Share information with other

local responders

Co-operate with other local

responders to enhance co-ordination and efficiency

We are also responsible for assessing local risk and for commissioning, supporting and monitoring the development of integrated pandemic flu response plans. NHS Northamptonshires revised Incident and Major Emergency Plan was approved by our Governance Committee in October 2008, and the current version of our Pandemic Flu Plan was published in December 2008.

A great deal of partnership working underpins emergency planning across the county. NHS Northamptonshire works closely with the Emergency Planning Unit of Northamptonshire County Council and is a member of the Northamptonshire Local Resilience Forum. We have contributed to planning across a number of areas including plans to meet the needs of people who may be vulnerable in an emergency, the welfare response, flood planning, training and exercising and Chemical, Biological, Radiological and Nuclear response planning. Public Health also works closely with the Health Protection Agency (HPA) to ensure the safety of the public. The HPA aims to protect people from infectious diseases, to prevent harm when hazards involving chemicals, poisons or

radiation occur and to help prepare for new and emerging threats, such as a bio-terrorist attack or a virulent new strain of disease.
Training and exercising

Over the last year, Public Health has led or participated in an emergency planning training programme that has included several live exercises. These tested the health response to an air crash and pandemic flu. The communications cascade has also been tested several times through exercising or live (actual) events. Subsequent to live events, NHS Northamptonshire has undertaken single agency and multi-agency debriefing. Lessons identified from live events are incorporated into emergency plans and shared with partners.

put into place emergency plans put into place business

continuity arrangements

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Fire Safety Management

Standards for Better Health

Risk Management

Health and Safety

In 2008/09 the prime focus of attention in relation to health and safety was firstly managing the asbestos release on the Isebrook Hospital site and secondly, ensuring that we investigated the incident to gain a thorough understanding of how it occurred and how we can prevent it from happening again. As a result there is a much closer working relationship forged between the Estates and Health and Safety teams and significant changes have been made in the way we manage health and safety generally, but in particular in relation to construction projects, materials containing asbestos and contractors across our sites.

Work continues in maintaining compliance with the Regulatory Reform (Fire Safety) Order. This has been greatly assisted by a thorough and detailed survey having been undertaken of all our premises, followed up by site specific Fire Risk Assessments. The appointment of a new Health, Safety and Fire Advisor has helped with the planning of major works for 2010 including the installation of a new Fire Alarm system, and for structural improvements on the Isebrook Hospital site. Changes at Board level and the separation from Provider Services have meant that lines of accountability and responsibility have had to be redefined, while advice and support continues across the whole of NHS Northamptonshire from Provider Services Risk Team.

Every NHS Trust in England is responsible for ensuring that it complies with the Department of Healths Standards for Better Health. All trusts assess their performance against the core standards and publicly declare this information. For the 2008/09 period, NHS Northamptonshire has declared compliance with 42 of the 43 standards that make up the core standards framework an improvement on the 2007/08 position in which compliance was declared in 39 of the 43 standards. An action plan is already in place to address the areas that need further improvement, and details of this can be seen on the Core Standards Declaration which is published on our website www.northamptonshire.nhs.uk.

Risk Management is the process used by NHS Northamptonshire to methodically address the risks attached to the commissioning and provision of healthcare services and to achieving its aspirations. This year substantial pieces of work have been carried out to further develop the Board Assurance Framework and the associated Risk Registers.

Every NHS Trust in England is responsible for ensuring that it complies with the Department of Healths Standards for Better Health.

NHS Northamptonshire takes a proactive approach to reducing risk to patients, employees and others through appropriate management and control. It is accepted that some risk will always be inherent and this is identified accordingly.

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Use of Resources

Use of Resources is an Audit Commission assessment of how well organisations are managing and using their resources to deliver value for money, as well as better and sustainable outcomes for local people. Auditors will produce a judgement for each of the following three themes: managing finances focusing
on sound and strategic financial management

NHS Northamptonshire undertook a Use of Resources assessment between January and March 2009, which was subsequently submitted to our external auditors. The results of this assessment will be published in the autumn of this year as part of the Annual Health Check. From 2009, the assessment will form part of the new comprehensive area assessment (CAA) framework. CAA is an assessment of how well-run Northamptonshires local public services are, how effectively they use taxpayers money, and how well local services are working together to improve the quality of life for local people.

governing the business

focusing on strategic commissioning and good governance

managing resources focusing

on the effective management of natural resources, assets and people

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49

12

Accounts
NHS Northamptonshire is responsible for ensuring that the funding we receive for local health services is spent effectively and with a focus on achieving good value for money for the people of Northamptonshire. We began 2008/09 with a financial surplus brought forward from 2007/08 of 4.2m. NHS East Midlands, the Strategic Health Authority, then provided NHS Northamptonshire with a control total for the financial year of 4.4m underspent. This formed Northamptonshires part of the overall control total for NHS East Midlands. The accounts set out in this report are a summary only and not a complete set of financial statements. A full set of our Annual Accounts are available free of charge on the request to the Director of Finance and Performance (telephone 01604 651400), or they can be downloaded from our website at www.northamptonshire.nhs.uk. These accounts incorporate a full set of notes which provide a more detailed analysis of expenditure and can help the reader gain a wider understanding of our financial policies.

NHS Northamptonshire is responsible for ensuring that the funding we receive for local health services is spent effectively and with a focus on achieving good value for money. The summary financial statements and commentary that follow provide a picture of our results for the year ended 31 March 2009.

Financial Targets
NHS Northamptonshire has the following financial targets:
STATUTORy TARGET To achieve our operational financial plan ADMINISTRATIvE TARGETS To recover our full costs in relation to the provider function To remain within our capital resource limit To ensure all invoices are paid in line with the Better Payments Practice Code (BPPC) OUR PERFORMANCE Revenue resource limit underspent by 4.4m as planned OUR PERFORMANCE The PCT fully recovered its full costs in relation to the provider function Capital resource limit underspent by 1.4m We paid 95.89% of non-NHS and 80.09% of NHS invoices within 30 days based on number of invoices processed

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OPERATING COST STATEMENT FOR THE yEAR ENDED 31 March 2009

STATEMENT OF RECOGNISED GAINS AND LOSSES FOR THE yEAR ENDED 31 March 2009 2007/08 000 Fixed asset impairment losses Unrealised surplus/(deficit) on fixed asset revaluations/indexation Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets Additions/(reductions) in the General Fund due to the transfer of assets from/(to) NHS bodies and the Department of Health Additions/(reductions) in other reserves Recognised gains and (losses) for the financial year Prior period adjustment other Gains and (losses) recognised in the financial year

2008/09 000
Commissioning Gross Operating Costs Less: Miscellaneous Income Commissioning Net Operating Costs Provider Gross Operating Costs Less: Miscellaneous Income Provider Net Operating Costs Net Operating Costs Before Interest Interest Receivable Interest Payable Net Operating Cost for the Financial year

2008/09 000
0 (2,973)

2007/08 000 (446) 4,399

857,854 (30,387) 827,467

787,964 (23,578) 764,386

73,192 (9,055) 64,137 891,604 0 65 891,669

65,263 (7,187) 58,076 822,462 0 65 822,527

0 0 (2,973) 0 (2,973)

0 0 3,953 0 3,953

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BALANCE SHEET AS AT 31 March 2009 31 March 2009 000 FIXED ASSETS Intangible assets Tangible assets 60 67,932 67,992 CURRENT ASSETS Stocks and work in progress Debtors Cash at bank and in hand TOTAL CURRENT ASSETS Creditors: Amounts falling due within one year NET CURRENT ASSETS/(LIABILITIES) TOTAL ASSETS LESS CURRENT LIABILITIES Creditors: Amounts falling due after more than one year Provisions for liabilities and charges TOTAL ASSETS EMPLOyED FINANCED By: TAXPAyERS EQUITy General fund Revaluation reserve Donated asset reserve Government grant reserve Other reserves TOTAL TAXPAyERS EQUITy (2,134) 22,152 1,557 433 0 22,008 1,479 24,802 1,585 635 0 28,501 617 27,877 31 28,525 (72,822) (44,297) 23,695 (228) (1,459) 22,008 755 26,145 24 26,924 (61,209) (34,285) 31,402 (258) (2,643) 28,501 107 65,580 65,687 31 March 2008 000

John Parkes Chief Executive

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CASH FLOW STATEMENT FOR THE yEAR ENDED 31 March 2009 2008/09 000 OPERATING ACTIvITIES Net cash outflow from operating activities SERvICING OF FINANCE AND RETURNS ON INvESTMENT: Interest paid Interest received Interest element of finance leases Net cash outflow from servicing of finance and returns on investment CAPITAL EXPENDITURE Payments to acquire intangible assets Receipts from sale of intangible assets Payments to acquire tangible fixed assets Receipts from sale of tangible fixed assets Payments to acquire fixed asset investments Receipts from sale of fixed asset investments Payments to acquire financial instruments Receipts from sale of financial instruments Net cash outflow from capital expenditure Net cash outflow before financing and management of liquid resources MANAGEMENT OF LIQUID RESOURCES (Purchase) of other current asset investments Sale of other current asset investments Net cash outflow from management of liquid resources Net cash outflow before financing FINANCING Net Parliamentary Funding Other capital receipts surrendered Capital grants received Capital element of finance lease rental payments Cash transfers (to)/from other NHS bodies Net cash inflow from financing Increase/(decrease) in cash 887,143 0 0 0 0 887,143 7 815,884 0 0 0 0 815,884 6 53 0 0 0 (887,136) 0 0 0 (815,878) 0 0 (13,700) 10 0 0 0 0 (13,690) (887,136) 0 0 (1,896) 1,491 0 0 0 0 (405) (815,878) 0 0 (62) (62) 0 0 (65) (65) (873,384) (815,408) 2007/08 000

Operational Financial Balance

NHS Northamptonshire has a statutory obligation to achieve its operational financial plan. For 2008/09, we planned to underspend by 4.4m, in line with the control total provided to us by NHS East Midlands. This was delivered in full during the financial year, maintaining our sound financial footing. The table below shows our performance against the operational financial balance duty for 2008/09 and 2007/08.

2008/09 000s Total Revenue Budget Total Revenue Expenditure Over/ (Underspend) 891,089 886,702 (4,387)

2007/08 000s 822,115 817,956 (4,159)

Within the 2008/09 financial year, there have been a number of items which have impacted upon this financial position or which have resulted in significant items of expenditure/saving. Firstly, NHS Northamptonshire again received above average growth from the Department of Health, enabling it to invest in key service areas. Most notably, additional funding has again been invested in local health services to reduce the total patient journey time to 18 weeks and to maintain these levels of service. In addition to this, there has also been significant new investment in learning disability services, particularly in relation to the NHS campus reprovision, mental health services and continuing care. Clearly, the financial environment has become more complex over the financial year, and longer term financial planning is more critical than ever to ensure that health services within Northamptonshire remain appropriate for the population and of a high quality. It has been confirmed that

future government investment in healthcare will reduce from that seen in recent years, and long term financial planning is a key tool in identifying early warning signs that finances may be stretched. This allows NHS Northamptonshire to identify more cost-effective treatment alternatives and plan for more efficient future developments, leading to improved financial resilience in times of challenge. Stemming from this, there are a number of financial risks which have been anticipated, and mitigated where possible. One of the key risks relates to the anticipated increase in population for the county over the next 15 years. Since revenue allocations are based on forecast registered GP populations, there may be a risk that funding allocated to NHS Northamptonshire is not sufficient to keep up with population growth, leaving us with a financial problem. Work is ongoing within NHS Northamptonshire to quantify this risk, and secure funding from alternative sources, such as Section

106 monies, which are paid by developers to statutory agencies (including health bodies and local government) to support additional infrastructure costs which arise as part of large residential building projects, and which would help us support the new population until they become included in the population count used to determine our allocations.

Capital Resources
NHS Northamptonshire has a financial target to remain within its Capital Resource Limit. In 2008/09, our capital resource limit was 14,133,000. Following capital expenditure in year of 12,772,000, this gave an underspend against the Capital Resource Limit of 1,361,000. In comparison, for 2007/08 we had a limit of 5,717,000 and spent 1,293,000 of this, giving an underspend of 4,424,000. The capital programme included a number of large schemes which initially were anticipated to be completed during 2008/09 but due to unforeseen

54

issues, completion dates slipped thus resulting in the underspend against the capital resource limit. As at 31 March 2009, NHS Northamptonshire had no capital commitments (0 in 2007/08).

Director of Finance to ensure areas of concern are identified and resolved as required. Financial risk is also monitored using the above processes, with identified risks quantified and addressed clearly within the body of the organisations Board papers. Risk in the broader sense is also monitored via NHS Northamptonshires Audit Committee, which reviews and monitors performance against financial, operational and organisational risks identified during audit processes. Further information on the Audit Committee is provided below.

Management of Financial Resources

In order to most effectively manage the financial resources of NHS Northamptonshire, approved budgets are delegated to budget holders on an annual basis, in line with the Standing Financial Instructions (SFIs). Budget holders are responsible for the performance of budgets under their control, and these are monitored and reported upon on a monthly basis to both the budget holders and NHS Northamptonshire and its Committees. This enables early identification of financial pressures and risks within the system, and allows corrective action to be taken as necessary. In addition to this, quarterly reviews of Directorate budgets are undertaken by the

working throughout 2008/09 to ensure that the transition is smooth, and that all areas which are affected by IFRS have been appropriately reviewed and can be correctly accounted for in the future. As part of this process, the Trust has participated fully in the SHA-wide IFRS group, and has provided regular updates and returns to the SHA, the Department of Health, and the external auditors, which have highlighted no significant areas of concern. In December 2008, we submitted the 2007/08 closing balance sheet on an IFRS basis to the DH as required, and during the summer of 2009 will undertake a restatement exercise on the 2008/09 Annual Accounts on an IFRS basis to ensure preparedness prior to the first IFRScompliant Accounts submission in April 2010. Throughout the IFRS transition work, our external auditors KPMG LLP have been working closely with the Trust to ensure an appropriate

level of preparedness is achieved, and this will continue throughout 2009/10, including the audit of the 2008/09 Annual Accounts restatement in the summer.

Asset Management
As at 31 March 2009, NHS Northamptonshire holds fixed assets of 67,992,000 (65,687,000 as at 31 March 2008). These assets support us in achieving our objectives through providing premises and equipment (including IT hardware and software) to enable us to carry out our core duties. In addition to these assets, we lease a range of buildings and equipment. More detail on both the fixed assets and the operating and finance leases held is available in the full Annual Accounts.

Preparedness for IFRS Reporting

For the financial year 2009/10, the NHS will be adopting International Financial Reporting Standards (IFRS) for the first time, which will affect the way financial information is disclosed and presented. As part of the preparation for this move, NHS Northamptonshire has been

55

Cash Management & Liquidity

Every year NHS Northamptonshire receives a cash allocation, known as the cash limit, which represents the total cash available to us in year. Department of Health/Treasury cash management guidance states that this should not be drawn down before it is needed, that we should not hold excessive bank balances at the end of any accounting period, and that we must fully spend our cash limit in year. For 2008/09, NHS Northamptonshire had a cash limit of 896,381,000 (2007/08 = 820,777,000), and as at 31 March 2009, we held cash and cash equivalents of 31,000, an increase of 7,000 on the previous year. For 2008/09, our robust cash management ensured that we had sufficient cash to pay our creditors and no payments were delayed due to liquidity. Information on the our performance against the Better Payments Practice Code (BPPC) is presented later in this report.

Other Resources
The main non-financial resource employed by NHS Northamptonshire is the staff body, which comprised 1,964 whole time equivalents (WTEs) in 2008/09 (1,808 WTEs in 2007/08). In total, the staff body (which includes Provider Services employees such as community nursing and therapies staff) cost us a total of 70,827,000 in 2008/09. NHS Northamptonshire takes the development and welfare of its human resource seriously, and during the year an organisational development programme for staff has begun, to ensure that everyone has the skills necessary to conduct their duties. More detail on staff costs is provided below.

range of schemes and policies to promote best value for money. These include the introduction of benchmarking to measure best practice against peer organisations, the use of performance information in identifying and improving areas of inefficiency, and a number of demand management schemes, to ensure that patients are treated in the most appropriate setting.

Council. We also contribute to pooled budgets hosted by Northamptonshire County Council for community equipment services in both the north and the south of the county, and the Northamptonshire Drug & Alcohol Action Team (DAAT). Details of the joint income and expenditure for these budgets can be found in the full set of accounts.

Charitable Funds
NHS Northamptonshire has charitable funds, which are held in separate charitable funds accounts, and are submitted and audited to the guidelines and timetable set down by the Charities Commission. The balance of the charitable fund at 31 March 2009 is 1,653,541 (1,331,753 at 31 March 2008).

Audit Committee
NHS Northamptonshires Audit Committee, a committee of our Board, comprises Non-Executive Directors Philip Dearing (Committee Chair), Tansi Harper, and Kate Page.

External Audit
NHS Northamptonshires external auditors are KPMG LLP. The total value of their audit services in 2008/09 was 275,000. This related to the auditing of the final accounts and also included work done around this Annual Report. The total value of other services provided by KPMG was 15,000.

Value for Money

NHS Northamptonshire actively seeks value for money in all its business activities. As part of our continuing review of organisational efficiency, we have reviewed all key areas of commissioned and provided services and have identified and implemented a

Pooled Budgets
NHS Northamptonshire hosts a pooled budget for the commissioning of adult mental health services across Northamptonshire in partnership with Northamptonshire County

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Better Payment Practice Code (BPPC)

NHS Northamptonshires policy is to comply with the CBI Prompt Payment Code and the Government accounts rules. These state that the timing of payment should be stated in the contract. Where this is not the case, departments should pay within 30 days of receipt of goods and services, or upon presentation of a valid invoice, whichever is later. Performance against this target is as stated below.
Number NON-NHS CREDITORS Total Bills Paid in the Year Total Bills Paid Within Target Percentage of Bills Paid Within Target NHS CREDITORS Total Bills Paid in the Year Total Bills Paid Within Target Percentage of Bills Paid Within Target 3,661 2,932 80.09% 519,664 509,906 98.12% 251,857 241,509 95.89% 185,944 166,564 89.58% 000s

Staff Costs
The average number of whole-time equivalent staff employed by NHS Northamptonshire in 2008/09 was 1,964. Costs associated with employing those staff were as follows:
2008/09 000 Salaries and wages Social security costs Employer contributions to NHSPA Other pension costs Total 59,674 4,104 7,049 0 70,827 2007/08 000 53,333 3,781 6,329 0 63,443

NHS Pension Scheme

The NHS Pension Scheme is an unfunded, defined benefit scheme that covers NHS employers and other bodies. The scheme is accounted for as a defined contribution scheme and the cost is equal to the contributions payable to the scheme for the accounting period. Further information can be found in the full set of accounts. The annual NHS Pension Scheme can be viewed at www.nhsbsa.nhs.uk/pensions.

Significant Interests
A number of our Board members belong to organisations or agencies with which NHS Northamptonshire does business. These organisations and agencies have received payments from NHS Northamptonshire and include: Richard Aveling, Non Executive Director Director of The Castle, Wellingborough Susan Hills, Non Executive Director Husband is a Consultant at Northampton General Hospital Kate Page, Non Executive Director was Chief Executive at Milton Keynes Council William Pope, Chair Research supervision and sponsorship at the University of the West of England
57

Management Costs
NHS Northamptonshire measures its management costs according to the definitions provided by the Department of Health. The management cost per head of weighted population is shown below:
2008/09 Management Cost (000s) Weighted Population (number) Management Cost per Head of Weighted Population () 13,973 612,721 22.80 2007/08 13,785 588,035 23.44

To improve our performance, budget holders have been reminded of their responsibility to process invoices in a timely fashion, and directors/ managers will now receive information on the BPPC performance of their areas. Key Performance Indicators have also been introduced into the Financial Shared Services contract for 2009/10, as they are responsible for processing invoice payments.

Political & Charitable Donations

NHS Northamptonshire did not make any political or charitable donations during the financial year 2008/09.

Remuneration Report
Remuneration and terms of services committee membership

Summary of policy on duration of contracts, notice periods and termination payments

Professor William Pope, Chair of NHS Northamptonshire Richard Aveling, Non Executive Director Philip Dearing, Non Executive Director Tansi Harper, Non Executive Director Susan Hills, Non Executive Director Maggie McCutcheon, Non Executive Director (left October 2008) Kate Page, Non Executive Director Diana Wright, Non Executive Director
Policy on remuneration of senior managers

NHS Northamptonshire adheres to Agenda for Change terms and conditions for duration of contracts, notice periods and termination of payments. NHS Northamptonshires Chief Executive is recruited through national advertisement and is appointed by the Chair. The Executive Directors have been recruited through local and national advertisement and were appointed by the Chief Executive and Chair.
Details of service contract for each senior manager who has served during the year

Executive Directors are subject to the standards set out in NHS Northamptonshires Standing Orders, Code of Conduct and Human Resources policies.
Explanation of any significant awards

There have been no significant awards made between 1 April 2008 and 31 March 2009.

The Remuneration and Terms of Services Committee sets the salary for all Directors. All other staff remuneration rates are set nationally.

Executive Directors (including the Chief Executive) have permanent contracts, which include a notice period of three months. NHS Northamptonshires Remuneration and Terms of Services Committee, a committee of the Board, determines payment and terms of service for senior managers in accordance with national Very Senior Managers guidance.

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DIRECTORS SALARIES AND ALLOWANCES FOR THE PERIOD APRIL 2008 MARCH 2009 2008/09 Salary (bands of 5,000) 000 190-195 135-140 115-120 135-140 115-120 Other Remuneration (bands of 5,000) 000 Benefits in Kind (Rounded to nearest 00) 00 125 Salary (bands of 5,000) 000 155-160 100-105 90-95 130-135 90-95 2007/08 Other Remuneration (bands of 5,000) 000 Benefits in Kind (Rounded to nearest 00) 00

NAME & TITLE John Parkes Chief Executive Gill Scoular Director of Finance (see note 2) Richard Alsop Director of Commissioning (see note 2) Dr Stephen Horsley Director of Public Health Louise Proctor (see note 2) Managing Director of Provider Services Jan Norman Director of Quality Standards & Learning (started July 2007/08) Sue Basham Director of Corporate Services & HR Phil Hurd Director of IM&T Professor William Pope PCT Chair (see note 1) Susan Hills Non Executive Director Richard Aveling Non Executive Director Philip Dearing Non Executive Director Margaret McCutcheon Non Executive Director (Left 31/10/08) Kathleen Page Non Executive Director Tansi Harper Non Executive Director Diana Wright Non Executive Director

100-105

65-70

80-85 85-90 35-40 5-10 5-10 10-15 0-5 5-10 5-10 5-10

90-95 85-90 40-45 5-10 5-10 10-15 5-10 5-10 5-10 5-10

Note: 1. In 2007/08 Professor William Pope received an additional months pay, as during 06/07 he was only paid for 11 months. 2. Within the Salary figures for Gill Scoular, Richard Alsop and Louise Proctor there are payments which relate to and were accounted for in 2007/08 but have been paid in cash terms within the current financial year 2008/09. 59

PENSION BENEFITS Real increase in pension at age 60 Real increase in pension lump sum at aged 60 Total accrued pension at age 60 at 31 March 2009 (bands of 5000) 000 70-75 40-45 30-35 non pensionable 15-20 Lump sum at age 60 related to accrued pension at 31 March 2009 (bands of 5000) 000 215-220 130-135 90-95 non pensionable 55-60 Cash Equivalent Transfer value at 31 March 2009 000 1404 771 434 non pensionable 263 Cash Equivalent Transfer value at 31 March 2008 000 934 455 266 non pensionable 172 Real increase in Cash Equivalent Transfer value Employers contribution to stakeholder pension

NAME & TITLE John Parkes Chief Executive Gill Scoular Director of Finance Richard Alsop Director of Commissioning Dr Stephen Horsley Director of Public Health Louise Proctor Managing Director of Provider Services Jan Norman Director of Quality Standards & Learning (started July 2007/08) Sue Basham Director of Corporate Services & HR Phil Hurd Director of IM&T

(bands of 2,500) 000 7.5-10 10-12.5 5-7.5 non pensionable 2.5-5

(bands of 2,500) 000 27.5-30 30-32.5 17.5-20 non pensionable 10-12.5

000 447 304 162 non pensionable 87

000 313 213 113 non pensionable 61

2.5-5 (0-2.5) (0-2.5)

12.5-15 (0-2.5) (0-2.5)

30-35 20-25 35-40

100-105 60-65 110-115

633 343 685

* 283 618

200 54 51

140 37 36

Note: That the information contained within this table is based on pension information provided by the NHS Pension Agency. The entry marked with an * has been queried with the NHS Pension Agency who were unable to resolve it in time for inclusion within this report.

John Parkes Chief Executive

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The information in these pages is a summary only. A full set of our Annual Accounts which also contains the full Statement on Internal Control can be found on our website at www.northamptonshire.nhs.uk.

The Director of Finance and Performance is responsible for the management of financial risk and organisational probity and to monitor estates and performance of services provided or commissioned by the Trust. The Director of Corporate Services and Human Resources was responsible for the strategic development and implementation of risk management including health and safety and security but with the exception of financial risk and clinical risk for the first 9 months of this year, latterly responsibility transferred to the Director of Quality, Standards and Learning. The Managing Director of Provider Services has overall responsibility for risk management within Provider Services, including clinical, corporate and financial risk. The Director of Information Management and Technology (IM&T) was responsible for ensuring effective IM&T governance across the organisation and local health community.

The Director of Strategy and Systems Management is responsible for ensuring compliance of commissioning processes and commissioned services to national standards. The Director of Quality, Standards and Learning is responsible for clinical risk through validating and regulating the delivery of quality components of all contracts with providers including the independent contractor contracts, providing the lead for Safeguarding Children and Adults, providing the lead for Equality and Diversity and Infection Control issues, responding to and managing interface governance issues with other providers. Committees operate to provide assurance and challenge to the operating processes of the PCT (Primary Care Trust), such as the Audit Committee, Remuneration and Terms of Service Committee, Finance and Performance Committee, Governance Committee, and Strategic Commissioning Executive and others such as the Charitable Funds Committee, the Reference

Committee and the Pharmacy and Dispensing Committee. The Board also receives reports from each of the Directorates and minutes from the Audit Committee, Finance and Performance Committee and Governance Committee. NHS Northamptonshire has strong links with the Strategic Health Authority (NHS East Midlands) through such meetings as Quarterly Review, Leadership Strategy Group, the Local Safeguarding Childrens Board, East Midlands Strategic Commissioning Board, Director of Finance meetings, Chief Executive Officer Meetings, Specialised Commissioning and a variety of other strategic meetings as appropriate. The PCT also meets regularly with other partner organisations including Northamptonshire Police, Healthier Communities Scrutiny Committee, commissioning meetings with main providers including the Acute and Mental Health Trusts, the Local Area Agreement and the Drug Action
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Statement on Internal Control

Structure of Internal Control

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 organisations policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisations assets for which I am personally responsible as set out in the Accountable Officer Memorandum. Although I, as Chief Executive have overall responsibility for risk management, clinical, corporate and financial, the following organisational delegations have been made at Director level.

Team. There are also formal Section 75 Partnership Agreements in place between the PCT and Local Government in order to improve services through closer working between the NHS and Local Government, pursuant to the obligations for the Partners to co-operate with each other in the provision of services. Assurance on the control of partnerships is gained through the accountability arrangements for that particular partnership, which can either be through reporting into a higher level of committee, or through Board level membership of the particular partnership. For example the Mental Health and Learning Disabilities Partnership Board is accountable to the Joint Commissioning Board and as such formally reports to provide assurance on its activities. The Local Safeguarding Childrens Board has Board level membership from across the health community, which enables members to assure their respective organisations.

Key Issues

There has been one high level serious untoward incident (category 3 as defined by the Department of Health referring to a breach of confidentiality affecting up to 100 people) during 2008/09 involving the loss of patient data held within a nursing paper diary, when a motorbike belonging to the community nurse was stolen during a patient visit. The police were involved and the incident fully investigated according to local procedures. Work has begun around assessing the risks on the use of paper diaries with a view to implementing changed processes. A declaration of core standards was made to the Healthcare Commission on 1 May 2009, which was agreed and signed off by members of the PCT Board. The Trust declared all core standards as being compliant with the exception of a significant lapse against Core Standard C20a, for both the Commissioner and Provider Arms of the organisation. On 9 June 2008 it was identified that an uncontrolled but relatively low level, release of asbestos had occurred as a result

of building works. A significant and thorough response followed to assess, manage, and recover from the incident.
Summary of the Head of Internal Audit Opinion

reported throughout the year. This assessment has taken account of the relative materiality of these areas and managements progress in respect of addressing control weaknesses 3. An assessment of the process by which the organisation has arrived at its declaration in respect of the Standards for Better Health 4. Any reliance that is being placed upon third party assurances.

The overall opinion of the Head of Internal Audit is as follows: Significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisations objectives, and that controls are generally being applied consistently. However, some weaknesses in the design and/or inconsistent application of controls put the achievement of particular objectives at risk. The basis for forming this opinion is as follows: 1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes 2. An assessment of the range of individual opinions arising from risk-based audit assignments contained within internal audit risk-based plans that have been

John Parkes Chief Executive

Audit Opinion
Independent auditors statement to the Board of Directors of Northamptonshire Teaching PCT I have examined the summary financial statement set out on pages 51 to 57. This report is made solely to the Board of Northamptonshire Teaching Primary Care Trust, as a body, in accordance with Section

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2 of the Audit Commission Act 1998. Our audit work has been undertaken so that we might state to the Board of Northamptonshire Teaching Primary Care Trust, as a body, those matters which we are required to state to them in an auditors report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than Northamptonshire Teaching Primary Care Trust and the Board of Northamptonshire Teaching Primary Care Trust, as a body, for our audit work, for this report, or for the opinions we have formed.
Respective responsibilities of directors and auditor

inconsistencies with the summary financial statement.

Basis of opinion

Statement of the Chief Executives responsibilities as the accountable officer of the Primary Care Trust

I conducted my work in accordance with Bulletin 1999/6 The auditors statement on the summary financial statement issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of our audit opinion on those financial statements.
Opinion

The Secretary of State has directed 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

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.

The Directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material

In my opinion the summary financial statement is consistent with the statutory financial statements of the Trust for the year ended 31 March 2009. I have not considered the effects of any events between the date on which I signed my report on the statutory financial statements of 11 June 2009 and the date of this statement.

John Parkes Chief Executive 8 June 2009

Saverio Della Rocca (Senior Statutory Auditor) For and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 2 Cornwall Street Birmingham 1 September 2009

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