Scrutiny Commission 3 Scrutiny of Health 30 September 2002 Jane Lewington Chief Executive North East Lincolnshire PCT

Structure of the NHS PRIMARY CARE Primary Care Trusts (303) GPs Pharmacists Dentists Opticians SECONDARY CARE NHS Trusts: Acute and specialised hospital services Mental Health trusts & Ambulance trusts NHS DIRECT Planning USERS & CARERS PERFORMANCE MANAGEMENT Strategic Health Authorities (28) GOVERNMENT Department of Health Special Health Authorities

Primary Care Trusts ROLES & RESPONSIBILITIES Planning and securing health services for the local population Improving the health of the local population and tackling health inequalities Develop primary care and community services Integrating health and social care services

Background North East Lincolnshire PCT Co-terminous with unitary authority Established April general practices ( 82 GPs ) 7 Primary Health Care Teams ( PHCTs ) Budget - £144 million Main providers: Northern Lincolnshire & Goole Hospitals Hull & East Yorkshire Hospitals Met all service and financial targets in first two years of operation

PRIMARY CARE North East Lincolnshire PCT North Lincolnshire PCT SECONDARY CARE Northern Lincolnshire & Goole Hospitals Acute secondary care provider Doncaster & South Humber Mental health trust Lincolnshire Ambulance Emergency ambulance & PTS trust NHS DIRECT South Yorkshire / South Humber Local Structure of the NHS North and East Yorkshire & Northern Lincolnshire Health Authority

NHS Plan 10 Year Plan for NHS NHS Priorities Access Cancer Capacity Coronary Heart Disease ( CHD ) Childrens services Mental health Older people Health inequalities Workforce

NHS Plan 2002/03 Must Do’s Access: Improve access to care in line with patient’s needs Key themes Reducing maximum waiting times for inpatient and outpatient treatment Abolish waiting lists and replace them with booking systems Reduce wait for primary care appointments Cancer waiting times

NHS Plan 2002/03 Must Do’s Emergency Care: Improve the organisation and delivery of emergency care services across primary care, community, social and secondary care Key themes Implementation plans for single telephone access, through NHS Direct, to GP out of hours care 90% of patients spend no more then 4 hours in A&E from arrival to admission, transfer or discharge Ambulance services to respond to 75% of category A calls within 8 minutes

Local Health Needs Diabetes Teenage pregnancy Child and adolescent mental health People with learning disability People with physical disability Substance misuse Smoking Dental health

Increasing NHS accountability Commission for Healthcare Audit and Inspection (CHAI ) Inspect NHS organisations Conducting NHS value for money audits Validating performance assessment statistics, including waiting lists Publishing star ratings ( Health & Social Care ) Independent scrutiny of patient complaints Decentralisation InspectionRegulation

Increasing NHS accountability Patients Forums Commission for Patient & Public Involvement in Health Overview & Scrutiny Committees (OSCs) Patient Advisory & Liaison Service (PALS )

Patient’s Forums Independent forum for every NHS and Primary Care Trust tasked with monitoring and reviewing services and influencing management decision-making To represent views of local communities Monitor service delivery from a patient’s perspective Inspect NHS premises from the perspective of a patient’s experience of services Specific aims: To elect one of their members as a non- executive director on the trust board To monitor the quality of PALS

Local challenges: New strategic health authority and new region Local health needs Workforce issues NHS funding formula New roles and responsibilities Building the PCT network

Current PCT Priorities PCT estates strategy Capacity plan Partnership Board Mental Health Local Strategic Partnership Delayed transfers of care Prescribing

Performance Management Measures applied to the PCT Strategic Health Authority Annual Accountability Agreement  Sets out the PCT’s proposals to meet NHS plan targets and specifically:  Emergency care,  Reduced Waiting Times  Cancer  Coronary Heart Disease  Mental Health  Older People  Capacity  It also includes finance targets on cash limits, resource limits and breaking even

Performance Management Measures applied to the PCT Resource Accounting & Budgeting  Monthly reports to the StHA on PCT financial and activity performance as well as waiting time and access targets  Monthly reports to the Board and Executive also report on NHS Plan targets such as activity and waiting times

Performance Management Measures applied to the PCT Performance Management Framework This PCT document identifies reporting mechanisms in several key areas, including;  Commission for Healthcare Audit & Inspection (CHAI )  Controls Assurance, RPST & CNST  Korner Reporting  Local Implementation Strategy  Surestart  Macmillan & Marie Curie

Performance Management Measures applied to the PCT Audit Performance management  Audit of Annual Accounts by Audit Commission  VFM and Ad Hoc reviews by the Audit Commission  Review of Internal Controls by Internal Audit  Review of Executive Compliance with Audit by the Audit Committee

Containing costs to within the overall financial envelope Achievement of National Targets (or better) for Inpatient & Outpatient Waiting Lists and Times Achievement of the Cancer 2 week wait target * Where NEL PCT is main commissioner Performance Management Measures applied by the PCT Indicators of Demand and Pressures: Number of Delayed Transfers of Care Number of Trolley Waits in excess of 4 hours* Number of cancelled operations* * Where NEL PCT is main commissioner