the operational plan

for oldham PCT 2008/09

working with our communities to improve health
Introduction

This is the 2008/09 Operational Plan for the Oldham PCT. It sets out the PCT’s commissioning plans for the coming year and demonstrates what the PCT will achieve, by when and how it will be delivered.

The plan follows the framework suggested by the SHA and thereby mirrors closely the format of the Operating Framework for the NHS in England 2008/09 issued by the Department of Health in December 2007.

1.Context

1.1.There are a number of key principles that underpin the vision and approach to the commissioning and provision of primary, secondary and community care services for Oldham. The health and social care needs of communities and individuals, and views of local people, people who use services and their families will contribute to setting priorities and developing service models. These will form the basis upon which all-future decisions about service development, investment and, where necessary, disinvestment will be made.

1.2.Service developments will be planned and delivered on the basis that they will improve health and well-being and will take account; not only of need, but the diversity of the population they intend to serve. Services will be evidenced-based and take account of good practice and be accountable to the local population.

Our Population

1.3.The census of 2001 showed that the Oldham population was 217,273, and was made up of 105,036 males and 112,237 females. Compared to the rest of England, the Borough has a higher proportion of young people; 23% is aged between 0-15 years. People aged 75 and over make up 6.8% of Oldham’s population compared with 7.5% of the population nationally. The population is made up of many different communities with different identities, 15.04% are from ethnic minority communities, the second highest in Greater Manchester.

1.4.Where there are high rates of deprivation, unemployment and social exclusion then there tends to be poorer health and greater a greater need for social and health care services.

1.5.For example, Oldham:

  • Is ranked 42nd in a list of the 354 most deprived local authority areas in England. Within this figure there are significant variations between the twenty wards with seven within the 10% most deprived in the country.
  • has a proportion of lone parent households with dependant children (8.3%) higher than the England average (6.4%).
  • Compared with the England average has less people aged 16-65 in employment.
  • Have similar levels of homeownership to England and Wales as a whole through higher levels of council (ALMO) housing and lower levels of private rented and housing association.
  • Lower levels of housing without central heating and without sole use of bath, shower or toilet than the England and Wales average.
  • Significantly higher levels of household reliant on public transport because they are without a vehicle than the England and Wales average.
  • Have higher crime rates than England and Wales.

1.6.Taking into account the information on lifestyles it is no surprise that deaths from smoking, heart disease, stroke and cancer are considerably higher than the regional and national average. Oldham is ranked in the top ten worst authorities in the North West for these three indicators.

1.7.Other areas that warrant attention include:

  • The teenage conception rate in Oldham is 12.8% per 1000, compared to 9.1% in both the North West and England and Wales.
  • A higher number than average of infant deaths under one year; and low birth weights.
  • There is poorer health locally amongst people over 19 years old than the average for the North West and England as a whole.
  • There are inequalities of health across the Borough and between ethnic minority communities compared with the indigenous population.
  • The proportion of people providing unpaid care is higher in Oldham (10.8%) than nationally (9.9%) with 2.4% of people in Oldham providing care for 50 or more hours a week.
How Services are Currently Provided

1.8.Services are currently provided in a number of ways and by a number of organisations to the residents of Oldham.

1.9.The main secondary provider of acute services is Pennine Acute Hospitals NHS Trust; the main site for service delivery for Oldham is the RoyalOldhamHospital, but the Trust also manages, with the exception of mental health care, the services provided at Fairfield GeneralHospital in Bury, the Rochdale Infirmary and the NorthManchester GeneralHospital.

1.10.Pennine Care NHS Trust, provides specialist and some primary mental health services for residents of Oldham, with inpatient beds at the RoyalOldhamHospital.

1.11.The PCT has invested significantly in the independent sector opening up new markets and providing contestability to existing ones. Services are provided (for Oldham and all other Greater Manchester PCTs) at Netcare UK’s Greater Manchester Surgical Centre in Trafford following the Independent Sector Treatment Centre procurement process.

1.12.Local ICATS services have been commissioned by the PCT for musculo-skeletal services and urology.

1.13.Oldham Community Health Services (PCT provider unit), deliver the majority of community health services.

1.14.Oldham residents receive their specialised services from a range of providers locally and nationally but primarily at teaching hospitals in Greater Manchester including Salford Royal Hospitals FT, Central Manchester & Manchester Children’s University Hospitals, the Christie FT and University Hospitals of South Manchester FT.

1.15.The organisation of services in the North East Sector of Greater Manchester has been subject to significant review and consultation. The Healthy Futures and Making it Better programmes will result in the reconfiguration of acute services in the North East Sector, supported by service redesign and investment in primary care and community-based alternatives to hospital services where clinically appropriate.

Performance Headlines

1.15.The following outlines some highlights from 2006/07

  • To offer more people with diabetes an annual screening test to detect retinopathy (a progressive eye disease to come about as a complication of diabetes). Significant improvements have been made in this regard, from 66.35% in 2005/06 to 97.5% in 2006/07. The achievement is partly due to investment in new screening technology.
  • Maintaining a maximum waiting time of two months from urgent referral to treatment for all cancers. The target is 93%, and the PCT achieved 95.01% (a 3.78% increase on the previous year).
  • To improve the quality of life and independence of vulnerable older people by increasing the proportion of older people being supported to live in their own home. There are two indicators for this target, and both were met. One includes assessment of older peoples’ mental health needs and services. The second includes improving access to community equipment, such as wheelchairs. Delivery of such equipment within seven days has increased from 90.44% in 2005/06 to 96.3% in 2006/07.
  • To achieve year-on-year reductions in MRSA levels, expanding to cover other healthcare-associated infections as data from mandatory surveillance becomes available. This target includes ensuring robust plans are in place to prevent healthcare-associated infections.
  • Reduced deaths from suicide and undetermined injury. This target aims to reduce deaths from suicide and undetermined injury by 20% by 2010 from the 1995/97 baselines. It actually measures the number of follow-up calls made after people with a mental health problem have returned home from hospital, as well as the way people with serious mental health problems have their care delivered by specialist mental health services. A number of initiatives have been implemented in order to secure improvement against this target including the completion of suicide audits and a services tailored towards reducing drug-related deaths.
  1. Priority Areas for 2008/09

2.1.This section highlights, on an exception basis, where performance in previous years has been less than optimal, and identifies the consequent commissioning changes required to remedy this.

Existing Commitments

2.2.The following paragraphs set out the commitments that the PCT is working towards which will result in improved performance against previous years’ indicators.

  • All ambulance trusts to respond to 95% of category B calls within 19 minutes.

The target was 95% and Oldham PCT achieved 91.19%.

Along with other PCTs in the North West, Oldham PCT has made additional investment in North West Ambulance Service NHS Trust to ensure performance improves.

  • All patients who need to have access to crisis services, with delivery of 100,000 new crisis resolution home treatment episodes each year.

Oldham PCT target of 628 will not be achieved.

The PCT has invested of £315,000 recurrently that will guarantee the delivery of this target from April 2008 onwards.

  • Booking hospital appointments for the convenience of the patient, so that it is easier for patients and GPs to choose a hospital and consultant that best meets their needs. The target states that patients should be able to choose a hospital and consultant that best meets their needs. The target state that patients should be able to choose from at least four healthcare providers for planned hospital care.

The target was 90% but the PCT achieved 41%

Investment and training in new technology has been rolled out. The latest figures demonstrate that the PCT has reached 77%.

  • Updating practice-based registers so that patients with coronary heart disease and diabetes, and the majority of patients at high risk of coronary heart disease, continue to receive advice and treatment in line with national service framework standards.

The PCT underachieved this target.

There are enormous challenges in Oldham to reduce the incidence of heart disease. The PCT has invested significantly in a number of health improvement measures. Investment has been made into a number of new services and has recently recruited a new nurse to support practices to ensure patients are given the most appropriate medication at the earliest opportunity.

  • Guaranteed access to GUM clinic within 48 hours of contacting a service.

The PCT achieved 32% of the 72% target.

The PCT are fully committed to achieving this target. Across the North East sector a triage service and additional clinic sessions have been commissioned from Pennine Acute Trust. This contract is monitored through the PCTs sexual health-commissioning group.

The PCT is full committed to the Greater Manchester Sexual Health network

Health Care Commission Improvement Reviews

2.3.The following five areas were subject to review:

  • Adult community mental health services – Fair
  • Substance misuse services – Good
  • Tobacco control – Excellent
  • Diabetes – Fair
  • Heart Failure - Fair

Improving Cleanliness and Reducing Healthcare Associated Infections (HCAIs)

2.4.The PCT is rightly investing significant time and resource on improving cleanliness and reducing healthcare associated infections through a range of on-going work including the implementation of programmes of work funded towards the end of 2007/08. Specific areas of progress include:

  • The two mandatory targets have been agreed with the provider and are included within the contract. This will be monitored through the North East Sector Quality Partnership and Contracting Board.
  • The PCT has Board level representation of infection prevention and control.
  • Development of infection control teams within both the commissioning and provider arms of the PCT.
  • As the lead commissioner for the Pennine Acute Hospitals Trust, the PCT reports and responds on behalf of all the other PCTs.
  • There is senior PCT representation on the acute trust’s HCAI monitoring group.
  • In-house monitoring mechanism has been developed that complies with the HCAI Code of Practice.
  • A detailed action plan has been developed with the acute trust, which addresses screening.
  • A cleanliness strategy has been developed with the acute trust.
  • Additional deep clean compliance is monitored on a two-weekly basis.
Improving Access

2.5.The following paragraphs describe the work being undertaken to deliver and maintain the 18-week referral to treatment standard. Further detail is set out in the section headed Commissioning and Delivery Arrangements.

  • The PCT is implementing patient experience measurements and referral to treatment measures. The 18-week template, patient questionnaire will be used in future service reviews.
  • The 18 weeks from referral to treatment target will continue to be monitored on a regular (initially weekly) basis through the Referral to Treatment and the Patient Tracking List (PTL) returns.
  • Working with providers on pathway redesigns and demand management will be undertaken through the quarterly contract review meetings.
  • 90% admitted pathways by December 2008 will continue be monitored through Referral to Treatment and PTL returns.
  • 95% non-admitted pathways by December 2008-02-29 continue be monitored through Referral to Treatment and PTL returns.
  • The operational standards allowing for patient choice have been included in a clause in all-contractual agreements.
  • The inter-provider transfer rules and use of the minimum data forms has been communicated to our providers. Appropriate steps for ‘breach sharing has been included as part of the contracting arrangements.
  • Additional capacity to deliver and maintain 18-week RTT has been commissioned and is set out in local delivery plans.
  • 2008/09 activity plans have not been adjusted at this stage to reflect any impact of Oldham PCT Diagnostics Strategy and Mobilisation Plan.

2.6.The following paragraphs describe the work being undertaken by the PCT to secure improvement in access to primary care during 2008/09.

  • In collaboration with the Local Medical Committee the PCT will implement extending opening in the local area in a number of practices.
  • Commitment has been given through the national Equitable Access to Primary Care programme to the procurement of new GP practices and a GP-led Health centre during 2008/09.
  • The PCT has developed a comprehensive plan to improve patient satisfaction as measured through the GP patient survey.
  • The PCT uses the equitable commissioning tool to support needs-based

planning as well a drawing on the analysis of information from the PCT

dental line. The recent percentage increase in the dental allocation willfurther support an expansion of NHS dental services according to need.

  • Integration between health and social care as well as other local services will continue to be achieved through the extensive PCT LIFT programme and New Deal for Communities.

The following paragraph describes the work being undertaken by the PCT to secure improvements in the Chlamydia screening programme.

  • Incentivisation scheme to increase uptake of screening in primary care settings (including pharmacies)
  • Training and support to primary care
  • Chlamydia screening special events/hit squad to deliver screening in settings accessed by young people
  • Incentivisation scheme to increase uptake of screening in youth services/workplaces
  • Social marketing campaign to increase awareness of the availability of Chlamydia screening in the target group

2.7.The following paragraphs summarise the work being undertaken by the PCT aimed at keeping adults and children well, improving their health and reducing health inequalities.

2.8.Cancer services:

  • The implementation of the Cancer Reform Strategy with major focus on prevention, earlier treatment, screening, improved access and the implementation of NICE guidance.
  • The ongoing implementation of Improving Outcomes Guidance compliant services for the residents of Oldham and the North East Sector.

2.9.Stroke services:

  • Implementation of the Greater Manchester Stroke Strategy.
  • The development of a local vascular control programme.
  • Completion of Joint strategic needs assessment has highlighted specific local priorities.
  • Master control plan has set actions against local priorities that intend to improve the stroke care pathway locally including prevention, promotion, early diagnosis, intervention and treatment supported by effective community based services.
  • Local membership of the newly formed stroke care network has been agreed.

2.10.Children’s services:

  • The PCT has a universal service from birth, progressive universalism that is focussed on evidence-based practice.
  • Senior PCT input to the Every Child Matters programme and the Children’s Plan ensuring that local services develop jointly, and in line with locally assessed needs.
  • The PCT has an Obesity Strategy in place, which is currently being reviewed under NICE 43 guidance. The PCT is compliant against the Department of Health child base programme. Health Improvement Team provides specialist input into families on nutrition and physical well-being.
  • Implementation of the Making it Better programme in Oldham and the North East Sector.

2.11.Maternity services:

  • A self-assessment matrix has been completed by a sub-group of the Maternity Services Liaison Committee. The commissioning framework describes the PCT’s approach to improving access and choice in maternity care.
  • Implementation of the Making it Better programme in Oldham and the North East Sector.

2.12.Suicide prevention:

  • To reduce the rate of suicide and undetermined death the PCT has commissioned a compliant Crisis Resolution and Home Treatment Service that will deliver 628 episodes of home treatment in 2008-9.
  • The PCT has established a suicide audit group that has developed a process of gathering individual case audits and developing the local action plan.

2.13.Smoking cessation services:

  • A review of the smoking in pregnancy service has been completed and additional capacity has been commissioned from Pennine Acute Hospitals Trust
  • A social marketing programme has been carried out with additional and new capacity commissioned from Oldham Community Health Services.

2.14.Experience, satisfaction and engagement.

a.Staff satisfaction and engagement.

An action plan has been produced jointly with staff side representatives that focuses on improving staff satisfaction and engagement. Including: