Support in turbulent times

Reducing hospital admissionsSupporting leadersImproving care for older people

ANNUAL REVIEW 2005/06

THE KING’S FUND IS ANINDEPENDENT CHARITABLEFOUNDATION WORKING FOR BETTER HEALTH,ESPECIALLY IN LONDON.Our goals are to help develop informed policy by undertaking original research andproviding objective analysis; effective servicesby fostering innovation and testing out ideas inpractice; and skilled people and organisationsby building understanding, capacity andleadership. There are five values underlying our work: independence, integrity, relevance,quality and social justice.

01Achieving change

02Developing ideas and policy

04Developing services

06Developing people and organisations

08Key facts and figures

Main picture: Sir Cyril Chantler and Niall Dickson.Below: The Prime Minister, the King’s Fund, Sir Derek Wanless, the Leader of the Opposition,Bernard Ribeiro CBE, Rosie Winterton MP.

We don’t just produce a report,we use research and analysis to stimulate debate.

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King’s Fund Chairman Sir CyrilChantler and Chief ExecutiveNiall Dickson share their visionfor the organisation and pick out highlights of the past year.

‘We are aiming to ensure that the King’sFund is the think-tank that does. Whatis different about us is that we don’tjust produce a report; we have a realcommitment to use research and analysisto stimulate debate. And we follow throughon our ideas and recommendations. Thatcan mean initiating change on the groundor the development of policy, but what isimportant is that we do achieve change.

‘One of our most high-profile pieces ofwork in the past year has been a majorinquiry into the future of social carefunding for older people by Sir DerekWanless. This was a ground-breaking, in-depth piece of work that has alreadymade a difference. The government haschanged its policy and accepts that thecurrent level of resourcing for social careis not realistic.

‘We are genuinely proud that the PrimeMinister came here during the GeneralElection campaign and the Leader of theOpposition, David Cameron, came here to make his first speech on health. Mr Cameron confirmed his party’scommitment to a tax-funded NHS, which is something that we welcome, and thatwill have resonance far beyond the nextday’s headlines.

‘The politicians see this as a place whereideas can be tested out because we are an independent organisation. We welcomepolitical parties but don’t always agreewith them.

‘We are also very proud of our workdeveloping software for primary caretrusts (PCTs) and general practices. Thisis being used by nurses and doctors toimprove the management of long-term

ANNUAL REVIEW 2005/06 . 01

ACHIEVING CHANGEconditions by targeting services to keeppeople out of hospital wherever possible. It is a practical tool, which grew out ofour academic work, and has been taken up widely across the NHS.

‘As the King’s Fund for London we have a particular responsibility for the capital.Our Partners for Health in Londonprogramme has moved away fromtraditional grant-making to working in partnership with communityorganisations. We learn with them andtransfer those lessons to the wider world.We are concentrating on areas that areunder-resourced such as end-of-life care,mental health advocacy, sexual health and integrated health care.

‘Our work in the capital can also act asa catalyst for nationwide change. OurEnhancing the Healing Environmentprogramme was pioneered in London but is now being extended throughout thecountry, engaging staff and patients atward level. At the Princess Marina Hospitalin Northampton, our initial funding of£30,000 has led to a million-poundperforming arts project within their newPrivate Finance Initiative redevelopment.

‘We take seriously our responsibilityto help the NHS to become better managed. If, through one of our leadership development programmeswe help someone running a £300 million organisation change the way they operate, then we are affecting millions of people.

‘Our role becomes more importantin times of turbulence. We offer support through organisationaldevelopment to those coping with

major change. We can be a haven wherepeople feel secure in talking through theirchallenges and getting help.

‘The facilities here – the café, library andmeeting rooms – are a resource for thehealth and social care world. We housethe management section of the NationalLibrary for Health and this year we willlaunch the national patient and publicinvolvement library. We have revamped our website, turning it into a virtualKing’s Fund.

‘The King’s Fund itself has to be wellmanaged. More and more, we will have to earn our living – rather than rely on our endowment – in order to guarantee the independence that is so importantto our role.’

We welcome political parties but we don’t always agree with them.

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2005 saw the conclusion of a majorinquiry into London’s care services forolder people, and the commissioning of a review, led by Sir Derek Wanless, to consider the future funding of long-term care for older people. Sir Derek’sfindings, published in March 2006, arealready having a significant impact. We also ran the largest ever surveyof NHS nurses from overseas to feed into recommendations for ensuring asustainable, high-quality NHS workforce.

We played a key role in raising health and social care issues during the springGeneral Election campaign, producing a major audit of the NHS in partnershipwith The Sunday Times and welcominghealth spokespeople from the mainparties, as well as the Prime Minister, to events in our building. During theAutumn, we opened up the debate on the opportunities and challenges of theemerging NHS market with publicationsand events considering the future ofregulation, commissioning and primarycare, and the role of incentives.

We continued to help shape the agenda on improving care for people with long-term conditions, as well as producingsignificant reports on the evidencearound community-based treatmentorders in mental health, the role of thestate in promoting healthy behaviour, and an evaluation of the London patientchoice project.

Improving care for older people

The Business of Caring – the report of theKing’s Fund’s inquiry into care services inLondon published in June 2005 – painteda worrying picture of the shortfalls inservices for older people in the capital.

Inquiry chair Julia Unwin commented: ‘This inquiry shows that care and supportservices for older people in London are ina sorry state. Many older people simplyaren’t getting what they need and steps toimprove this situation are being hamperedon several fronts.’ The report’s analysisof shortfalls in funding fed into our majorreview of social care funding by Sir DerekWanless, published in March 2006.

The Business of Caring was welcomed bykey players in social care. David Behan,Chief Inspector of the Commission for SocialCare Inspection, said it would inform the work of the CSCI in assessing theperformance of councils in commissioningthe right quality of services.

The inquiry had made a ‘significantcontribution’ to the debate on the futureof social care, Mr Behan added. ‘I amdelighted that the King’s Fund now has afocus on the contribution that social caremakes to improving outcomes. Marketdevelopment is one of the big strategicissues that we will take forward.’

London Mayor Ken Livingstone promisedto take action on several of the inquiry’srecommendations, particularly on planningpermission for care homes, investing inthe social care workforce and addressingolder people’s mental health needs in his strategic framework for mental health.

Martin Green, Chief Executive of theEnglish Community Care Association, said the analysis was a ‘wake-up call’ forthe social care sector as well as central

Combining original research withobjective analysis puts us in a strongposition to influence health and social care policy and generateinformed debate.

This inquiry showsthat... support servicesfor older people inLondon... are in a sorry state.

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DEVELOPING IDEAS AND POLICY

02 . ANNUAL REVIEW 2005/06

Sir Derek Wanless

We produced 27publications in 2005,generating debate onpolicy and practice

Our most downloadedpaper was about helpingpatients to manage their own long-termconditions

government. ‘The report focused on thefact that we have a mixed economy ofcare. But no one had been looking athow we develop that market to focus onall the quality issues that are coming outof government.’

Mr Green added: ‘The report demandsthat we change our understanding of therole of the state in improving social caredelivered in the independent sector.Commissioners haven’t come to termswith that and if we don’t attend to thatthe services we need will not be there.’

Mr Behan particularly welcomed theinquiry’s findings on mental health andold age. ‘There is under-provision ofservices for people with mental illnessbut we know demographically that therewill be increasing numbers of people whowill develop age-related mental illness.’ He added that the report had made itclear that the market was not meetingthose needs and challenged councils toplan for tomorrow.

Mr Green pointed out that the inquiry’sfindings resonate beyond the social caresector. ‘Many of these lessons need to beheard by government in relation to themarket in health care which is beingbrought in. No-one seems to be looking at how we need to develop that market.’

He paid tribute to the King’s Fund forgoing beyond expert analysis, bringingkey players together to work on solutions.‘The King’s Fund maintains the momentumof their reports, thinking strategicallyabout how they move things on. That isone of the things that defines it now.’

The King’s Fundmaintains the momentumof their reports, thinkingstrategically about howthey move things on.That is one of the thingsthat defines it now.

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ANNUAL REVIEW 2005/06 . 03

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In 2005, we moved from traditionalgrant-giving to the Partners for Health in London programme, providing fundingand support to specific services or projectsto help answer particular questions. We are focusing initially on four areas– end-of-life care, sexual health, mentalhealth advocacy and integrated healthcare. In addition, in partnership with NHSDirect, we piloted a confidential helpline to support both people who are dying orliving with an illness that may shorten their life and the people caring for them.Early feedback shows the service is filling a genuine gap. We partnered up with theLondon Development Centre for MentalHealth to run an acute care collaborativefor mental health trusts in the capital.

Our Enhancing the Healing Environmentprogramme – which provides financialand development support to teams offrontline staff and patients to improve the environments in which care is given – continued to flourish. With funding fromthe Department of Health, we have beenable to roll the programme out to mentalhealth and learning disability trusts acrossEngland. Another highlight, featuredopposite, was working with PCTs and GPsand developing a tool to help the NHSidentify patients most at risk of beingadmitted to hospital.

Reducing hospital admissions

PCTs around the country are now using a software tool developed by the King’sFund, New York University and HealthDialog to predict patients at high risk ofhospital admission. The Patients at Riskof Re-hospitalisation (PARR) case-findingsoftware underpins the role of communitymatrons and case managers, helping themto support the right patients, in particular,by managing the complex needs of peoplewith long-term conditions. Commissionedby Essex Strategic Health Authority onbehalf of the 28 strategic healthauthorities, the Department of Health and the NHS Modernisation Agency, itis available free to PCTs. More than 500users had downloaded it by the end ofMarch, just two months after its release.

Southwark PCT was a pilot site for thePARR system. Mabli Jones, AssociateDirector of Modernisation Services, said:‘We were data-hungry and we felt theKing’s Fund had a good strategic fit forlong-term conditions.’ The King’s Fund ran the tool, analysed the data, and heldsix sessions taking PCT staff through the key findings, showing them how tobroaden the database and supportingthem in learning to use the tool.

Predicting patients at risk is complex andrequires a high degree of accuracy to targetresources effectively. The tool is triggeredby an emergency admission and usesdata from previous hospital admissionsday case care, clinical specialities, andelectoral wards to provide a score showinghow likely it is that an individual patientwill be admitted as an emergency in thenext year.

The PCT’s three community matrons areusing the PARR data to find the patientswho need intensive support. MariannaSaville, Southwark’s Service Facilitator for Long-Term Conditions, said that it has‘kick started’ case management. Previouslythere was insufficient information for thecommunity matrons to work effectivelybut the PARR tool has built their initialcaseloads. ‘It is clinical intelligence.It has helped the community matronsto get out there and live their new roles.’ The PARR tool has been ‘brilliant in gettingthem up and running and giving themsome confidence in starting discussionswith GPs’.

Uniquely, we are able to build on andinform our policy work by testingideas out in practice and supportinginnovation to generate learning.

DEVELOPING SERVICES

04 . ANNUAL REVIEW 2005/06

EHE project, Royal Brompton Hospital

By the end of 2005,63 hospital settings hadbeen improved throughour Enhancing theHealing Environmentprogramme

During 2005, weinvested £2.36 million toprovide better services

Deanna Tennancourt, Clinical Lead forDistrict Nursing, said that without the tool, case managers would have to spend a lot of time identifying patients – timetaken away from their clinical roles. ‘It isa sign of light in a big maze of confusion.Without it you would have to communicatewith many different individuals in manydifferent places to get this data. This justmakes something very easy in the midstof a system that is very complex.’

‘We now have a way of communicatingwith the GPs and the wider team aboutthe people who are at risk so we can bemore proactive in providing care.’ A keyadvantage is that it is simple to use,categorising patients in ways that arelogical and useful, by surgery, localityand by diagnosis. It also enables the PCTto take a strategic view of their population,comparing localities and informing serviceredesign and resource allocation.

A further version of the PARR is beingdeveloped that will help to pre-emptemergency admissions by using GP and social care data to identify high-risk patients in the community, even if they have never had an admission to hospital before.

ANNUAL REVIEW 2005/06 . 05

Annabella Franco, Community Matron, SouthwarkPCT, with Audrey Williams, patient.

We now have a way of communicating with the GPs and the widerteam... so we can be more proactive aboutproviding care.

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Through our leadership programmesand our range of resources andservices, we aim to build theunderstanding, capacity and skills of people working in health.

We continue to be a major provider ofleadership development programmesfor senior managers and clinicians in theNHS. We work on a number of programmesthat are contracted to the King’s Fund bythe NHS Institute for Improvement andInnovation, reflecting our strong reputation.

The Board Leadership Programme,provided on behalf of London’s NHS, had its most successful year in 2005.Some 64 per cent of non-executivedirectors in London attended one of itsevents. King’s Fund staff also worked with a range of health organisations to helpthem provide services more effectivelyand cope with specific challengescreated by NHS reforms.

We launched our new website in July,giving free access to thousands ofresources, including publicationsand links. Up to 15,000 people use it each month. Our information and library service provides access to acomprehensive catalogue of health andsocial care management publicationsand a growing range of online resources.We also provide conference and meetingspace, run events and facilitate networking.

Nearly 2,000 nurses,doctors and managerstook part in ourleadership developmentprogrammes in 2005

06 . ANNUAL REVIEW 2005/06

Participants, Senior Manager Programme

We dealt with more than 5,000 information enquiries

DEVELOPING PEOPLE AND ORGANISATIONS

Supporting leadersThe King’s Fund has more than 30 years’experience of providing distinctiveleadership programmes for people workingin health and social care. And we helporganisations to identify and understandthe complex challenges they are facing andto develop creative ways to address them.Often, this will involve working directlywith individuals and teams to enhancetheir managerial and leadership capacityfor the benefit of the organisation.

Great Ormond Street Hospital has beenworking with the King’s Fund for a numberof years to build the leadership capacity of

its senior managers and clinicians. ChiefExecutive Jane Collins said: ‘King’s Fundprogrammes have helped create ourleaders of today. All the current headsof department have taken part anddeveloped enormously as a result.

‘They learned a lot about their own style,gained an understanding of the dynamicsof teams, and returned with improvedleadership qualities as well as better day-to-day management skills.’

Neil Shah, a paediatric gastroenterologist,took part in the Management forConsultants programme in 2005. He said:‘I have the same frustrations as any other

consultant facing major government-directed organisational change. It is a very unsettled time in the NHS and I waslooking for an understanding of the biggerpicture rather than merely what goes on in my trust or my unit.’

The course included participants from a wide range of backgrounds, from A&E to obstetrics, general medicine andpsychology. ‘It was fascinating to see what people from other specialties andhospitals are doing and how they areresponding to the demands being madeon them. And just to discover that we areall in the same boat was useful.’

The programme directors didn’t just talkabout leadership – they demonstrated it,he added. ‘There was a wisdom about thecourse leaders that was very helpful. Theybrought out the best in every individualand the group. People were encouraged to talk about issues ‘that are blindinglyobvious when you have time to think aboutthem but which you don’t see when youare busy with the day-to-day demands ofyour job. It made participants think aboutthe challenges they face in a fresh way.’

One particularly valuable element wastransferability – that people wereencouraged to take ideas and put theminto practice immediately. ‘It’s not justan abstract exercise; you actually do itin the real world,’ Dr Shah commented.

The course included occupationalpsychology. ‘It helps you think throughhow you and your colleagues analyse and respond to problems,’ he said. And it was of practical use. ‘Because we wereencouraged to do things immediately, youtake the ideas and put them into action so it becomes real.’

Dr Shah is still in touch with fellowmembers of the programme – who haveturned into a support network. ‘The groupwas fantastic. I would recommend theprogramme to anyone who has done the job for a few years so you have some knowledge of the obstacles thatconsultants face.’

Dr Jane Collins, Chief Executive, and colleagues,Great Ormond Street Hospital.

ANNUAL REVIEW 2005/06 . 07

In 2005, we improved our financialposition by increasing income frominvestments and activities and reducingmanagement and support costs. Netexpenditure (spending in excess of ourincome) was less than half the equivalentfigure for 2004. Net expenditure is fundedfrom growth in the value of our investmentswhich increased by 13 per cent over 2004.

We had a planned increase in spending on programmes and projects, mainlyin policy, reflecting an expanded workprogramme. The apparent reduction in grants expenditure is largely a resultof a one-off accounting change in 2004. Excluding this change, there wasactually a small increase, principally

related to the Enhancing the HealingEnvironment programme.

Looking to the future, we have put in place a financial strategy that aims toensure we match net expenditure toavailable resources over the short-to-medium term, helping us avoid majorfluctuations in spending, and to protectthe underlying value of our endowmentfor the longer term.

The full audited accounts are included in the Trustees’ Report and FinancialStatements for the year ended 31December 2005, available atwww.kingsfund.org.uk/about_us/annual_review.html or fromPublications on 0207 307 2591.

The King’s Fund is ultimately governed by its General Council, which is made up of key figures from the healthcommunity and public life. Its Presidentis HRH The Prince of Wales. Hands-ongovernance has been devolved to aManagement Committee of Trusteeschaired by Professor Sir Cyril Chantler, and day-to-day management to a Board of Directors headed by Chief ExecutiveNiall Dickson.

For full details of our governance and management, visitwww.kingsfund.org.uk/about_us/governance.html

*Year to 31 December 2005

KEY FACTS AND FIGURES*

Grants payable

Programmesand projects

Leadership development

Publications and information services

Other charitable activities

Support and investmentmanagement

Senior management andprofessional services

2005 – £12.52 million

2004 – £15.30 million

2005 – £9.40 million

2004 – £8.25 million

£2.36 million

£1.96 million

£2.33 million

£2.18 million

£2.21 million

£2.60 million

£1.26 million

£1.18 million

£0.89 million

£0.97 million

£2.99 million

£3.44 million

£0.48 million

£0.47 million

(plus £2.50 million one-off charge)

Income from activitiesand donations

Income frominvestments

£6.40 million

£5.42 million

£3.00 million

£2.83 million

Spending

Income

08 . ANNUAL REVIEW 2005/06

OUR IMPACT IN 2005

OUR NEW WEBSITE ATTRACTED 13,000VISITORS PER MONTHOUR COMPUTER SYSTEM TO IMPROVE CAREFOR THE MOST VULNERABLE PATIENTS WITHLONG-TERM CONDITIONS IS BEING USED BYNEARLY 750 NURSES AND OTHER HEALTHPROFESSIONALSALMOST 2,000 HEALTH AND SOCIAL CARESTAFF TOOK PART IN OUR DEVELOPMENTPROGRAMMESMORE THAN 60,000 PEOPLE VISITED OURBUILDING OR USED OUR FACILITIESWE PROVIDED REGULAR EMAIL BRIEFINGS TOMORE THAN 5,000 MANAGERS, CLINICIANS ANDOTHERS WORKING IN HEALTH AND SOCIAL CARENHS STAFF ACROSS ENGLAND ACCESSED OUR LIBRARY DATABASE AT A RATE OF60,000 SEARCHES A MONTH

Interviews: Kaye McIntoshDesign: The Forster CompanyImages: ColorBlind Images/Getty Images, Hedley Finn, Joanne O’Brien, Michael Heffernan(including cover image), www.sarahannant.comwww.justinedesmondphotography.co.ukPrinted on Take 2 Silk which is made from 75% recycled fibre.

Entrance to the King’s Fund building, Cavendish Square, London

The King’s Fund is an independent charitable foundation workingfor better health, especially in London. We carry out research,policy analysis and development activities, working on our own,in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadershipdevelopment courses; conferences, seminars and workshops;publications; information and library services and conference and meeting facilities.

Registered charity: 207401

11–13 Cavendish Square London W1G 0AN Tel 020 7307 2400 www.kingsfund.org.uk