1. Corporate Objectives 2011-12 Shaping the Future Together

2. It is important that the new Brent and Harrow sub-cluster organisation understands what is expected of it in the coming year and we can give staff a clear sense of purpose. Our corporate objectives set out to achieve these two aims. We enter 2011-12 having gone through a major reorganisation which has resulted in both a reduction in management staffing of over 50% and a redefining of roles at Borough, sub-cluster and cluster levels. Our new commissioning structures were designed with GP input, and aim to align staffing resources with the needs of GPs for support as they develop their commissioning arrangements. We will need to adopt new ways of working which support the shift of the PCT’s staff to a role where they act as a supporting resource to GP leadership. Public health will transfer to the local authorities and PH England at some point in the next two years. We will work with partners to continue our health improvement work and ensure a successful transfer of functions. This year will see changes in key leadership positions, the rapid devolving of responsibility of budgets to GPs and a new relationship developing with the local authorities and their health and well being boards. It is all the more important therefore that we are clear what we are setting out to achieve and what responsibilities are placed on each part of the system. The two PCTs have had a similar vision of working to improve the health and well being of their local populations. That objective must remain our core purpose, but we need to recognise that a major part of our work this year will be working with the emerging GP consortia and local authority colleagues to support them to develop their vision of how this work is carried on into the future. The main themes of our objectives this year will be: Agreeing and delivering the 2011/12 financial plan for both Brent and Harrow; Developing a sustainable medium term service and financial strategy for both Brent and Harrow, ensuring its financial turnaround; Re-Commissioning identified services with the intention of improving quality, patient experience and effectiveness; Working with the GPs to develop GP commissioning and by year end devolving all of the budgets they will be responsible for to them; Undertaking the preparation required with the local authorities to transfer public health responsibilities to them; Working with the local authorities to develop the health and well being boards and ensuring integration of health planning across the system; Improving priority performance targets; Working with cluster to improve the effectiveness of acute commissioning; Managing proactively threats to business continuity; Offering our staff the best opportunity to develop their skills and experience, and supporting them in positioning them for a future role. In undertaking these objectives we must recognise that we are part of a complex system undergoing significant change. We will play our part in supporting the whole system, recognising that we can only succeed if other parts of the NHS and social care landscape are clear about their responsibilities and undertake them successfully.

3. Objective 1 Financial Sustainability Lead 1 Deliver the 2011/12 QIPP and financial plan for Brent JO 2 Deliver the 2011/12 QIPP and financial plan for Harrow TS 3 Develop a sustainable medium term service and financial strategy for Brent for 12/13 onwards by 30 September 2011 JO/JW 4 Develop a sustainable medium term service and financial strategy for Harrow for 12/13 onwards, addressing Harrow’s underlying financial position by 30 September 2011 TS/JW 5 Present the Harrow medium term service and financial strategy to the NW London Challenged Trust Board for its support and sign-off by 31 October 2011 RL

4. Objective 2 Re-Commissioning identified services with the intention of improving quality, patient experience and effectiveness Lead 1 For Harrow: - Develop and implement an intermediate care, case management and EOLC strategic plan that significantly reduces the need for emergency admissions to acute settings. - Review primary care urgent care and re-define services such that they meet the agreed modal of care, including improvements to primary care services and re- specifying the UCC at NPH. - Review the mental health services commissioned for Harrow residents and introduce a new model of care that places greater emphasis on out-of-hospital services and care closer to Harrow. - Systematically review community services to deliver productivity and service improvements by October 2011. - Undertake a fundamental review of elective care pathways across providers, introducing new pathways with appropriate tariffs and levers. - Review the existing continuing care arrangements to ensure that people’s needs are provided for in the most appropriate setting and offer value for money. TS 2 For Brent: - Review mental health services to deliver service and financial benefits - Review community services to identify QIPP opportunities -Implement a revised diabetes pathway to deliver more care in a primary care setting and improve outcomes across a range of diabetes-related health indicators -Implement case management in the District Nursing Service to reduce avoidable admissions through active management of patients at high risk of admission -To establish an integrated intermediate care service (across health & social care) to promote faster recovery from illness, and to reduce unnecessary acute hospital admissions JO

5. Objective 3 Support the Development of GP Commissioning Lead 1 Work with the GPs to develop consortia constitutions and governance agreements with the PCT JO/TS 2 Support the pathfinders in taking on delegated budget responsibilities progressively through the year with the aim of complete delegation by year-end JO/TS 3 Ensure staffing resources are aligned so GPs feel they are supported by, and getting value from PCT staff RL 4 Support GPs in the use of the £2 per head development allocation JO/TS 5 Ensure GPs get the best possible access to management development resources, aligned to their needs JO/TS

6. Objective 4 Undertaking the preparation required with the local authorities to transfer public health responsibilities to them Lead 1 Work with LAs to map public health workstreams and finances to there is a shared understanding of the current function AH/SB 2 Work with the local authorities to develop the health and well being boards and ensuring integration of health planning across the system AH/SB

7. Objective 5 Improving priority performance targets Lead 1 Deliver improvements in key performance priorities in Brent including immunisation, screening, patient experience of primary care and NHS Health Checks. SB/JO 2 Deliver improvements in key performance priorities in Harrow including immunisation, smoking and screening. AH/TS

8. Objective 6 Working with cluster to improve the effectiveness of acute commissioning Lead 1 Ensure the successful implementation and in-year management of the 11/12 acute contract with NWLH AG 2 Ensure the successful implementation and in-year management of all acute contracts AG 3 Work with the ACV to ensure accurate and timely information on acute activity and spend is available to GPs JW 4 Ensure the successful implementation of in-year management of all out of Sector acute contracts AG

9. Objective 7 Managing proactively threats to business continuity Lead 1 Ensuring a smooth transition to cluster, sub-cluster and borough arrangements RL 2 Ensuring we maintain a focus on improving safeguarding and implement SIT recommendations JO/TS 3 Ensure we maintain full emergency preparedness AH/SB 4 Systematically review the contracting, decision-making and governance processes of NHS Harrow, ensuring robust arrangements are in place 5 Maintain a clear focus on improving health and addressing health inequalities AH/SB

10. Objective 8 Offering our staff the best opportunity to develop their skills and experience, and supporting them in positioning them for a future role. Lead 1 Secure improvements in the staff survey by ensuring: - The progress we have made on staff communication is continued through regular team meetings, all staff briefings and away day events - Regular staff engagement through the establishment of a staff forum RL 2 Ensure all staff have the benefit of a clear set of objectives and a regular appraisal RL 3 Ensure staff have the opportunity to support GP consortia and other future career paths such as the NHS Commissioning Board or a local authority RL