Any questions?

March 2017

Q. Are we moving towards Accountable Care Systems?

A. Each of the 6 local places that make up our STP are in discussion around the development of ‘accountable care systems’ (ACS’s). These ACSs bring together different providers to take responsibility for the cost and quality of care for an agreed local population within a defined budget – they are designed to create a more integrated health and care service for local areas.

They can take a range of different forms, from fully integrated systems operating as a single organisation to less formal networks of providers. At present, the conversations happening in each local place are not considering changes to statutory organisational structures as part of the move to an ACS – it is more about providers collaborating more closely around shared outcomes objectives for the population they serve.

March 2017

Q. Please would you also tell me what the activity data are for Calderdale and Huddersfield NHS Foundation Trust and Harrogate stroke services, from hospital episode statistics (HES) and the stroke sentinel national audit programme (SSNAP) for the financial year 2015/16?

A. It’s important to note that HES for 15/16 hasn’t been used in any of our work so far to date. The Blueprint quotes HES for the previous year of 2014/15 in table 1. This shows activity levels of 496 for CHFT and 332 for HDFT.

SSNAP stroke numbers for 2015/16 are 569 for CHFT and 354 for HDFT.

March 2017

Q How and when the planned big changes to NHS governance and commissioning are intended to take place and how and whether the proposed establishment of accountable care organisations or systems is likely to conflict with current legislation governing NHS governance and commissioning, and if so, how that is going to be dealt with?

A. In terms of governance, from a commissioning perspective a joint committee will be in place from April to include delegated powers from the Clinical Commissioning Group with a ‘lay’ chair. In the interest of openness and transparency information from the public section of meeting will be published on the STP website from April. Across West Yorkshire and Harrogate we will be having conversations about accountable care systems. At present there is no intention to change organisation form.

January 2017

Q. Please supply me with the amounts spent on external support/private sector consultants by each individual CCG area on their local plan as part of the overall STP.

A. NHS Wakefield CCG does not hold the information on spends for each individual CCG area and their local plans.

January 2017

Q. A Wakefield MCP market event was scheduled for December 2016. Who attended/is attending this event? What relation does this MCP market event have to the GP contract negotiations that are part of the 2 year operational STP contracts for 2017-19 that are due to be signed on Dec 23rd?

A. The event referenced in the document did not go ahead and there is no further date at this stage for rearranging this session. The contract deadline you reference for 23rd December 2016 Wakefield CCG has no impact on any Wakefield providers in relation to our MCP work as Wakefield will be working with partners through a partnership arrangement known as an alliance agreement to improve closer working for integrated care from April 2017. This does not replace any existing contracts this is simply an agreement that overlays on individual contracts regardless of who the contract is with.

January 2017

Q. Where can members of the public access the West Yorkshire & Harrogate CCG’s 2 year operational plans for 2017-19?

A. The NHS operational planning and contracting processes have been changed to support Sustainability and Transformation Plans (STPs) and the ‘financial reset’. It reaffirms national priorities and sets out the financial and business rules for both 2017/18 and 2018/19. They will be published this year and will be available on organisational websites.

December 2016

Q. Please send me the appendices of the Regional Sustainability and Transformation plan for the West Yorkshire footprint.

I would like appendices covering work force development, estates and finance plans as well as how these plans will impact on current services.

Also any planned changes to NHS governance and commissioning protocols and their impact (eg will operation of so called Accountable Care Organisations be exempt from FOI as private companies are currently exempt under competition regulations?)

How is any likely conflict between current good governance arrangements and openness to public question and scrutiny and likely future 'closed' arrangements to be managed within NHS commissioning?

I would like this information electronically where possible. The information will be used to spread public awareness about the imminent changes to health delivery in our area.

A. We did not produce any formal appendices for the submission of the West Yorkshire and Harrogate STP other than the finance templates. We are currently refreshing our financial plans, from those submitted in October 2016. The October submission was high level proposals that preceded the 2 year planning and contracting round - and aim to have this work completed by the end of March. The information will be made available to the public on our website shortly after.

In terms of governance, from a commissioning perspective a joint committee will be in place from April to include delegated powers from the Clinical Commissioning Group with a ‘lay’ chair. In the interest of openness and transparency information from the public section of meeting will be published on the STP website from April.

Across West Yorkshire and Harrogate we will be having conversations about accountable care systems. At present there is no intention to change organisation form.

December 2016

Q. In relation to reducing demand for elective care, the West Yorkshire & Harrogate STP proposes “Shared decision making – considering what a group consultation would look like, virtual methods supporting shared decision making and links to - and support from - the voluntary sector”. Does this mean patients get consultations in groups? And what links and support from the voluntary sector are intended

A. There is evidence that for some people ‘group consultations’ delivered by a clinician in a supportive peer group setting can be beneficial and empowering. This is already happening in some places. This would not replace the usual 1:1 GP consultation for most conditions. The voluntary sector has an important role to play in the delivery of these services.

December 2016

Q. The STP shows ACOs will be set up to deliver primary/community care at scale. The South Yorkshire & Bassetlaw STP Leader is on record as saying that setting up ACOs requires legislation/regulation. Is there any proposed legislation/regulation for this and if not, how are plans to set up ACOs lawful?

A. Our published documents state that it is not a single plan for service change across the region. It is a collection of proposals built from “place based plans” from each of the six localities in WY&H and a number of region wide initiatives chosen in the belief that it is better to work together across the area on these issues.

December 2016

Q. The West Yorkshire & Harrogate STP can only reduce the funding shortfall by £983m by 2020/1. It cannot eliminate it. The 2020/1 “deficit” or underfunding is projected to be £91m - made up of an NHS surplus of £43m and a £135m social care underfund. So NHS money - supposedly ring-fenced - is going to be diverted to prop up local authorities that the government has starved of funding. How will this take place?

A. Each STP has a financial control total which will be a summation of the individual organisational control totals within each individual footprint. There will be flexibility, following agreement at national levels, for STP partners to adjust organisational control totals within an STP footprint, provided the overall system control total remains in budget and two further rules are met: the provider sector achieves financial balance and the commissioning system continues to live within the statutory resource limit.

November 2016

Q. Relatedly, the STP says that local authorities are statutorily required to break even and the STP are trying to work out “how to mitigate this pressure”. What are they proposing so far and what is the time frame for concluding this work?

A. The draft STP is built on local plans for Bradford, Calderdale, Harrogate, Kirklees, Leeds and Wakefield. We have then supplemented these local plans with work that can only take place at a West Yorkshire and Harrogate level. This means we are working together on best practice, shared solutions to shared problems and the delivery of specialised services across the area.

The local plans have been discussed and shared with Health and Wellbeing Boards and CCG Governing Bodies. Our proposals will offer an opportunity for organisations across the health and social care system to work together and develop an approach suited to local needs.

November 2016

Q. How will the proposal to devolve transformation funding to management at WY& Harrogate level work?

A. Each STP is awaiting national guidance on the treatment of Sustainability and Transformation Funding and how this will be allocated to each STP area. Presently the STP has been asked to assume it will receive its “Fair Share” in 2020/21 but no guidance has been provided to confirm this.

December 2016

Q. Does this mean eg that hospital trusts will not be able to manage their own transformation funding?

A. The methodology has not be released, whether this is to STP, Clinical Commissioning Group or direct to providers such as hospital trusts

December 2016

Q. Are organisations on track to meet their control totals for 2016/17?

A. Each organisation has to provide a financial report at its public governing body meetings and the information is available on the individual organisation websites under the Board Papers section

December 2016

Q. Where is the additional £39m going to come from for providers to achieve NHSI’s control totals in 2017/18?

A. The STP plan was developed prior to the announcement of the final tariff for providers as well as signed contracts for 2017/18. The STP viewpoint was the plan was a position in time that would need to be updated after the conclusion of contract negotiations and discussions between individual organisations and the regulator, NHS Improvement. Those discussions are ongoing at an individual organisation level.

December 2016

Q. Mid Yorks Trust Board meeting of 3rd November 2016 papers show that a memorandum of understanding setting up a “foundation group” of all the acute hospitals in West Yorkshire was due to be signed in early December 2016 based on a recommendation from Price Waterhouse Cooper. Has it been signed now? If not, when will it be? What effect will that have on the West Yorkshire & Harrogate STP?

A. The acute providers in West Yorkshire are developing a collaborative programme of non-clinical and clinical opportunities which are aimed at delivering benefits relating to sustainability, quality and efficiency. This programme is one of the nine West Yorkshire & Harrogate STP work streams. The collaborative programme will be supported by a governance and decision making framework across the Trusts which will enable collaborative decision making. The development of the governance and decision making framework is being delivered according to the expected timescales. This is not a development of a ‘foundation group’.

Q. Where should people send FOI requests for WY&H STP information?

A. Please email FOI.request@wakefieldccg.nhs.uk.

July 2017

Q. Do you have a workforce plan?

The West Yorkshire & Harrogate (WY&H) Sustainability and Transformation Partnership and WY&H Local Workforce Action Board are developing a workforce strategy which will be publically available on this website once complete.

July 2017

Q. What engagement and consultation work is planned over the next few months?

The draft WY&H STP engagement and consultation timeline is available here.

New work will be added as the priority programmes develop. Please note these may be subject to change.

Q. What engagement and consultation work across West Yorkshire and Harrogate has taken place?

This engagement and consultation mapping document highlights work which has taken place across Calderdale, Bradford, Harrogate, Kirklees, Leeds and Wakefield between April 2012 and February 2017.

Stroke services

Across West Yorkshire and Harrogate, healthcare professionals, including doctors and consultants, are working together to look at how we can further improve care for people who are at risk of stroke, or those who have had a stroke, from recovery to after care. A public engagement report and supporting information is available.

• The members of West Yorkshire and Harrogate Health and Care Partnership are working hard to strengthen our approach to collaborating more closely to achieve the ambitions for improving the health and care of people in this area that we set out in our draft proposals in November 2016.
• As part of this we are continuing to discuss with NHS England and NHS Improvement how we might secure greater autonomy and support to progress these ambitions more quickly.
• NHSE and NHSI have not set a firm timescale for any announcement of future accountable care systems. There is no delay. We will discuss with them whether this is an appropriate direction for WY&H to pursue when the time is right for all partners.