What are Sustainability Transformation Partnerships (STPs)?

The NHS Shared Planning Guidance asked every local health and care system in England to come together to create their own ambitious local plan for accelerating the implementation of the Five Year Forward View (5YFV).

These blueprints, called Sustainability and Transformation Partnerships (STPs), are place-based, multi-year plans built around the needs of local populations.

STPs will help drive a genuine and sustainable transformation in health and care between 2016 and 2021. They will also help build and strengthen local relationships, enabling a shared understanding of where we are now, our ambition for 2021 and the steps needed to get us there.

These plans are also described as the local version of a national plan called the Five Year Forward View, published in 2014. This sets out a vision of a better NHS, the steps we should take to get us there, and how everyone involved need to work together.

However they are described as the local place-based plans written with the aim of ensuring that we all receive better care, are healthier, and have health and care services which run more efficiently by early 2021.

How many STPs are there?

To deliver these plans NHS providers, Clinical Commissioning Groups (CCGs), local councils, and other health and care services have come together to form 44 STP ‘footprints’. These are established within ‘geographical’ areas, in which people and organisations will work together to develop the plans to transform the way that health and care is planned and delivered for their populations.

These footprints are of a scale which should support transformative change and the implementation of the Five Year Forward View vision of better health and wellbeing, improved quality of care, and stronger NHS finance and efficiency.

What is happening in West Yorkshire and Harrogate?

Health services, local councils and care providers have been working across West Yorkshire and Harrogate to develop a region-wide Sustainability and Transformation Plan (STP).

Closer partnership working is at the very core of our STP. Over the past six months the leadership and staff of the West Yorkshire and Harrogate health and care organisations have been working hard on how we respond to the challenges we face, whilst delivering quality care and working towards achieving our vision.

West Yorkshire and Harrogate STP area covers eleven Clinical Commissioning Groups (which design, specify and buy care for local people), six local council boundaries, as well as services provided by a number of health and social care organisations, such as mental health, community and hospitals. Over time these organisational differences will become less important as we want to put people and communities above individual organisational boundaries.

The West Yorkshire and Harrogate STP is built from six local area place-based plans; Bradford District and Craven, Calderdale, Harrogate and Rural District, Kirklees, Leeds and Wakefield.

This is based around the established relationships of the six Health and Wellbeing Boards and builds on their local health and wellbeing strategies.

What is the vision?

Our vision for West Yorkshire and Harrogate is for everyone to have the best possible outcomes for their health and wellbeing. At the heart of this are the following ambitions:

1. Healthy places

  • We will improve the way services are provided with a greater focus on preventing illness, or identifying and managing this at an early stage wherever possible
  • We will support people to manage their own care, where safe to do so, with peer support and technology provided in their communities to help with self-care
  • Care will be person centred, simpler and easier to navigate
  • There will be joined-up community services across physical and mental health as well as much closer working with social care.

2. High quality and efficient services

  • Hospitals will work more closely together, providing physical and mental healthcare to a consistently high standard by organisations sharing knowledge, skills, expertise and care records, where appropriate
  • The way that services are designed and contracted will change. We will move to a single commissioning arrangement between Clinical Commissioning Groups (CCG) and local councils. This will ensure a stronger focus on local places and engagement. There will also be a stronger West Yorkshire and Harrogate commissioning function for some services
  • We will share our staff and buildings where it makes sense to do so; to make the best use of the resources we have between us and to help further service investment.

3. A health and care service that works for everyone, including our staff

  • West Yorkshire and Harrogate will be a great place to work
  • We will always work with people in how we design, plan and provide care and support
  • West Yorkshire and Harrogate will be an international destination for health innovation.

What will the West Yorkshire and Harrogate approach be?

To support our six local places we are carrying out a range of work collectively across the STP wide area. When we work in this way it is for one or more of three reasons:
  • Services cut across the area and beyond the six local places. For example, some services are not provided everywhere and require people to travel across local places i.e. stroke and cancer support.
  • There are benefits from doing the work once and sharing, so we make the best use of the skill and expertise we have.
  • Working together can deliver a greater benefit than working separately.
On this basis we have identified nine priorities for which we will work across a larger area. These are:
  • Prevention
  • Primary and community services
  • Mental health
  • Stroke
  • Cancer
  • Urgent and emergency care
  • Specialised services
  • Hospitals working together
  • Standardisation of commissioning policies

We plan to better organise and simplify urgent and emergency care so people get the very best care at the right time in the right place. This will mean clearer coordination and better organisation of urgent care services (including primary care, mental health, ambulances and urgent care centres) so they work together and people know where they can get the help you need.

We aim to improve on our four hour accident and emergency standard by March 2017 to ensure everyone is seen within this time, and we will continue to improve on this.

The demand for planned care (when you have a booked appointment to see a specialist or have an operation) is placing ongoing pressure on services. Unfortunately as a result people are waiting longer for appointments - we aim to meet our 18 week referral to treatment standard over the next five years across the area.

Improving patient experiences, choice and delivering high quality, safe care across seven days of the week is also a priority.

Which organisations are involved in producing the West Yorkshire and Harrogate STP?

Clinical commissioning groups

  • NHS Airedale, Wharfedale and Craven CCG
  • NHS Bradford City CCG
  • NHS Bradford District CCG
  • NHS Calderdale CCG
  • NHS Greater Huddersfield CCG
  • NHS Harrogate and Rural District CCG
  • NHS Leeds North CCG
  • NHS Leeds South and East CCG
  • NHS Leeds West CCG
  • NHS North Kirklees CCG
  • NHS Wakefield CCG

Local authorities

  • Bradford Metropolitan District Council
  • Calderdale Council
  • Craven District Council
  • Harrogate Borough Council
  • Kirklees Council
  • Leeds City Council
  • North Yorkshire County Council
  • Wakefield Council

NHS care providers

  • Airedale NHS Foundation Trust
  • Bradford District Care NHS Foundation Trust
  • Bradford Teaching Hospitals NHS Foundation Trust
  • Calderdale and Huddersfield NHS Foundation Trust
  • Harrogate and District NHS Foundation Trust
  • Leeds Community Healthcare NHS Trust
  • Leeds and York Partnership NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Locala Community Partnerships
  • The Mid-Yorkshire Hospitals NHS Trust
  • South West Yorkshire Partnership NHS Foundation Trust
  • Tees Esk and Wear Valleys NHS Foundation Trust
  • Yorkshire Ambulance Service NHS Trust

Other organisations involved

  • NHS England
  • Public Health England
  • Local Health and Wellbeing Boards, including representatives from West Yorkshire Police,West Yorkshire Fire and Rescue Service, Local Care Direct and Locala Community Partnership
  • Healthwatch

How were the STP footprints agreed?

The NHS Shared Planning Guidance asked each area to develop a proposed STP ‘geographical footprint’ by 29 January 2016, engaging with local councils and other partners on what this should look like. The footprints should be locally defined, based on communities, existing working relationships, patient flows and take account of the scale needed to deliver health and social care services, transformation and public health programmes.

Will the footprints replace other local NHS governance structures?

No – the local, statutory architecture for health and care remains, as does the existing accountabilities for Chief Executives of Local Councils, care provider organisations and CCG Accountable Officers.

This is about ensuring that organisations are able to work together at scale and across communities to plan for the needs of their population, and help deliver the Five Year Forward View – improving the quality of care, health, and NHS efficiency by 2020/21.

How does the STP fit with other health and care footprints?

The boundaries used for STPs will not cover all planning eventualities - as with the current arrangements for planning and delivery, there are layers of plans which sit above and below STPs, with cross overs and dependencies.

For example, neighbouring STP areas will need to work together when planning specialised ambulance services or working with more than one local council or where there are cross overs on work such as stroke, urgent care and mental health.

How will other partners be involved?

STPs are being developed with the close support and input of clinicians, staff and wider partners including local councils. We will engage with people about the operational ideas in the plan – we know we cannot transform health and social care without the active engagement of the clinicians and staff who actually deliver it, nor can we develop integrated care services, such as care closer to home, without understanding what our communities want and without our partners in local government.

There is also a Clinical Forum which is made up of GPs, and specialist consultants from whom we seek advice and guidance on clinical decisions and what this would mean in the medical field. We will also build on existing engagement through all the channels available to us and use this feedback to shape proposal for consultations. This will include actively seek wider partner involvement from the voluntary and community sector and the public in the development of our plan.

How is this work being funded?

The development of the STP is coming from existing health budgets, supported by a small programme management office.

Information, engagement and consultation – what will that mean?

We believe that to improve care for people, health and care services need to work more closely together, and in new ways. This means the public, carers, GPs, hospitals, local councils, provider organisations, the voluntary sector and commissioners all coming together to agree a plan to improve local health and care services. Helping people and families to plan ahead, stay well and get support when they need it in the most appropriate way with the resources and money we have available.

Engaging and communicating with partners, stakeholders and the public in the planning, design and delivery is essential if we are to get this right.

Effective communication and engagement is a two-way process. Our activity will focus on informing, sharing, listening and responding. Being proactive is central to our communications and engagement strategy.

What does the future success look like?

Our vision for West Yorkshire and Harrogate is for the whole population to have the best possible health and wellbeing. To achieve this, our health and care system needs to change.

In 2016, we face the most significant challenges for a generation. We know that we must keep innovating and improving if we are to meet the needs of our population in a tough financial climate. Demand for services is growing faster than resources. Services in some places are not designed to meet modern standards, and local people want things to be better, more joined up, and more aligned to their needs. This is clear from the continuous engagement we have with local people, as well as the changing world we live in.

If we get this right, together we will engage patients, people who access health and social care, carers, staff and communities from the start, allowing us to develop services that reflect their needs so that we can improve outcomes by 2020/21, closing all three gaps.

This will require a different type of planning process. It will require the NHS at both local and national level to work in partnership across organisational boundaries and sectors, and will require changes not just in process, but in culture and behaviour.

What role do local councils play?

The NHS shared planning guidance, published in December 2015, explained that the success of STPs will depend on having an open, engaging process that harnesses the energies of clinicians, patients, carers, citizens, and local community partners including the independent and voluntary sectors, and local government through Health and Wellbeing Boards.

Indeed, around the country, a number of STP footprints are being led by local government leaders.Health and Wellbeing Boards also have a crucial role to play in this. Since 2012 they have been developing local health and wellbeing strategies based on the needs of local people. They bring together the NHS, public health, adult social care and children's services, including councillors and local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health. They provide a way of ensuring that local people have a strong voice.

What is the role of the Health and Wellbeing Boards?

Health and Wellbeing Boards have a crucial role to play in this. Since 2012 they have been developing local health and wellbeing strategies based on the needs of local people.

They bring together the NHS, public health, adult social care and children's services, including councillors and local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health. They provide a way of ensuring that local people have a strong voice.

The West Yorkshire and Harrogate STP is built from six local area place-based plans; Bradford District and Craven, Calderdale, Harrogate and Rural District, Kirklees, Leeds and Wakefield. This is based around the established relationships of the six Health and Wellbeing Boards and builds on their local health and wellbeing strategies.

What are submission plans?

Health and care partner organisations across West Yorkshire and Harrogate have been working together to develop the five year STP for seven months now. As the STP develops, updated versions have to be submitted to a group of national bodies including NHS England, NHS Improvement and the Local Government Association.

There have been two such checkpoint submissions so far, the most recent was on 30 June 2016, with a more detailed plan being drafted for 21 October.

This is a five year plan and the focus is on providers and commissioners collectively returning a currently unsustainable health and care system to long-term sustainability by 2020/21.

It’s great news that people are living longer than previous generations, but the reality is that up to two thirds of people in the UK could spend their retirement years in ill-health. An ageing population, people living longer with complex health and social care needs, means we have to change if we want to improve people’s quality of life and meet the challenges we face together with the money we have available.Although extra money has been made available nationally to support the NHS, this is not growing as fast as demand for care.

Budgets in social care, training, and public health are under additional pressure and have not been increased in the same way that some NHS funding has seen. Our workforce is also changing. We need to improve the way we do things if we are to meet changing needs whilst improving the health and wellbeing of people and fully supporting our staff.

Our planning for the STP is therefore emerging as we understand better how we collectively deliver sustainability, and our submissions to date represent checkpoints on how our plan is evolving.

Our work to date and what will happen next?

Year one (2016/17) and planning to date as a system has been about jointly understanding gaps and variations in outcomes, the pressures on services which are making them unsustainable and the contribution that collaborative programmes and local place-based plans can make to close the following three gaps over the next five year:

  • Health and wellbeing
  • Care and quality
  • Finance and efficiency

We will shortly begin conversations with staff, public and stakeholders. Public engagement will be used to shape and develop formal consultation.

Where can I read the plan?

The draft plan can be read here. On this page you can also read the public summary and watch a short film. There is also information on recent engagement and consultation work carried out across the area.

Are social care pressures and demand recognised in STPs?

Some two thirds of the 44 STP June submissions across England acknowledged the funding pressures on social care. It is essential that plans are whole-system and recognise the totality of the health and social care funding gap.

Are prevention and public health adequately resourced in STPs?

Although all draft plans recognise the importance of investing in prevention, few describe in detail what this would look like, and some focus more narrowly on health prevention such as smoking cessation. The strongest prevention workstreams have clear leadership from health and wellbeing boards and local council senior officers including Directors of Public Health. They draw too on wider public sector reform, tapping into economic growth agendas.

Are the West Yorkshire Association of Acute Trusts (WYAAT) meetings open to the public?

The Board of each of the WYAAT trusts has agreed to form a Committee in Common which is responsible for leading the joint work programme and the development of the workstreams. The Chief Executive and Chair from each trust are members of the Committee in Common.

Each workstream has a number of projects underneath supported by a lead Chief Executive from one of the six trusts. The projects will put together a case for change that sets out how things are done now, what good or best practice is, how things need to change and the risks and benefits associated with this change. The cases for change will be considered by the Committee in Common before being recommended to each of the individual trust boards for approval.

The Committee in Common is a sub-committee of each of the Trust Boards and therefore as the Boards meet in public, the Committee doesn’t need to. It is a different model than the CCG Joint Committee where the final decision lies with the Joint Committee. WYAAT is more of a vehicle for the acute trusts to work together for the greater good of the WY community, but sovereignty remains with the individual NHS Trusts.

What evidence do you have that the mental health priorities you have chosen, for example, autism and eating disorders are priorities that would be agreed by people who use services and their carers?

The West Yorkshire and Harrogate (WY&H) mental health priorities have been informed by where it makes sense to do the work once across WY&H due to scale, or because it is an area challenging each local area and therefore there is strength in working together. Our priority areas are in the main national service improvement priorities too.

We know from the engagement work undertaken locally to date that people would like to see improvements in such areas as crisis services, children and young people's mental health services and more timely access to autism assessments. In addition to the WY&H priorities there is considerable work going on in each of the six local places e.g. Leeds, to improve mental health services with a strong focus on mental health wellbeing. As we acknowledged at the last Joint Committee of the 11 Clinical Commissioning Groups, there is more we need to do across the partnership to engage fully with people and we are in the process of developing an engagement plan to support our work on mental health.

As mentioned in the Joint Committee papers on the 7 November, the elective care programme will provide the right care, at the right time, in the right place in order that the best outcomes for the population of West Yorkshire and Harrogate.

The aim of the programme is to reduce the variation in access to, and experience of services that currently exists across the West Yorkshire and Harrogate (WY&H) area. There are currently significant differences in how long people have to wait for certain services and also in what is available, for example the 'clinical threshold' applied before referral for some surgical procedures or the types of things that are available on prescription (e.g. gluten free foods or medicines that are available over-the-counter). By ironing-out this variation we will produce greater fairness and a reduction in the 'postcode lottery' in access to and availability of care. The significant savings to be made from this programme are longer term rather than short term, and come from reducing future demand for health care services by improving the health and well-being of the population of WY&H.

The programme is committed to undertaking a thorough equalities assessment, the findings of which will be used to shape the further development of the programme. This will include information from joint strategic needs assessments from across the whole area as well as other equalities information. The intention is that the findings of the equalities assessment will be applied in a way that enables the programme to work towards reducing existing health inequalities, rather than just protecting disadvantaged groups from being further disadvantaged.

Who are the members of the WYH STP leadership team?

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Current members – please note the information is correct as at 8 December 2017. We are revising the membership as part of the development of the Memorandum of Understanding (MoU) and our work towards increasing local autonomy.

West Yorkshire and Harrogate, Health and Care Partnership (WY&H HCP), System Leadership Executive Group

  • Rob Webster, WY&H Health Care Partnership CEO Lead (Chair)
  • Jo Webster, representing CCGs (and Wakefield place)
  • Tom Riordan, representing local authority
  • Ian Cameron, representing public health
  • Julian Hartley, representing acute trusts
  • Nicola Lees, representing mental health providers
  • Professor Sean Duffy, Clinical Lead for Cancer Alliance
  • Rory Deighton, Healthwatch
  • Kirsty Baldwin, representing Royal College of General Practitioners (RCGPs) and member of the primary and community care work stream
  • Soo Nevison, representing voluntary and community sector
  • Moira Dumma, NHS England
  • Warren Brown, NHS Improvement
  • Matt Walsh representing Calderdale place
  • Amanda Bloor, representing Harrogate place
  • Helen Hirst, representing Bradford place
  • Carol McKenna, representing Kirklees place
  • Phil Corrigan, representing Leeds place
  • Cath Roff – representing adult social service
  • Rod Barnes – Yorkshire Ambulance Service
  • Ros Tolcher – workforce

Additional attendees:

  • Ian Holmes, WY&H Health and Care Partnership Director
  • Jonathan Webb, WY&H Health and Care Partnership, Finance Director

WY&H Joint Committee of Clinical Commissioning Groups

Lay members

  • Marie Burnham, Independent Lay Chair
  • Fatima Khan-Shah, Lay Member
  • Richard Wilkinson, Lay Member

Clinical Commissioning Group Members

Bradford (Airedale, Wharfedale and Craven, Bradford City and Bradford Districts)

  • Dr Akram Khan, GP Chair, Bradford City CCG
  • Dr Andrew Withers, GP Chair, Bradford Districts CCG
  • Dr James Thomas, GP Chair, Airedale, Wharfedale and Craven CCG
  • Helen Hirst, Chief Officer, Bradford District and Craven CCGs

Calderdale

  • Dr Alan Brook, GP Chair of Calderdale CCG
  • Dr Matt Walsh, Chief Officer, Calderdale CCG

Greater Huddersfield

  • Dr Steve Ollerton, GP Chair, Greater Huddersfield CCG
  • Carol McKenna, Chief Officer, Greater Huddersfield CCG

Harrogate and Rural

  • Dr Alistair Ingram GP Chair, Harrogate and Rural District CCG
  • Amanda Bloor, Chief Officer, Harrogate and Rural District CCG

Leeds (Leeds North, Leeds West and Leeds South and East)

  • Dr Alistair Walling, GP Chair, Leeds South and East CCG
  • Dr Gordon Sinclair, GP Chair, Leeds West CCG
  • Dr Jason Broch, GP Chair, Leeds North CCG
  • Phil Corrigan, Chief Executive, for Leeds CCGs

North Kirklees

  • Dr David Kelly, GP Chair, North Kirklees CCG
  • Carol McKenna, Chief Officer, North Kirklees CCG

Wakefield

  • Jo Webster, Chief Officer, Wakefield CCG
  • Dr Phillip Earnshaw, GP Chair, Wakefield CCG

Additional attendees:

· Ian Holmes, WY&H Health and Care Partnership Director

· Jonathan Webb, WY&H Health and Care Partnership Finance Director

· Lou Auger, Director of Delivery, West Yorkshire, North Region NHS England

· Stephen Gregg, Joint Committee Governance Lead

West Yorkshire and Harrogate Clinical Forum

  • Dr Andy Withers, GP Chair, NHS Bradford Districts CCG (Chair)
  • Dr Bryan Gill, Medical Director, Bradford Teaching Hospitals NHS Foundation Trust
  • Dr Adam Sheppard, Assistant GP Chair, NHS Wakefield CCG
  • Dr Alan Brook, GP Chair, NHS Calderdale CCG
  • Dr David Birkenhead, Medical Director, Calderdale & Huddersfield Hospitals NHS Foundation Trust
  • Dr David Kelly, GP Chair, NHS North Kirklees CCG
  • Dr Gordon Sinclair, GP Chair, NHS Leeds West CCG
  • Dr Jason Broch, GP Chair, NHS Leeds North CCG
  • Jo Harding, Director of Nursing & Quality, NHS Leeds CCGs
  • Dr Julian Mark, Medical Director, Yorkshire Ambulance Service NHS Trust
  • Dr Phillip Earnshaw, GP Chair, NHS Wakefield CCG
  • Dr Adrian Berry, Medical Director, South West Yorkshire Partnership NHS Foundation Trust
  • Dr Akram Khan, GP Chair, NHS Bradford City CCG
  • Dr Alistair Ingram, GP Chair, NHS Harrogate & Rural District CCG
  • Dr Alistair Walling, GP Chair and Director of Primary Care, Leeds South and East CCG
  • Dr Andy McElligott, Medical Director, Bradford District Care NHS Foundation Trust
  • Dr Chris Welsh, Senate Chair, North Region (Yorkshire and the Humber), NHS England
  • Dr David Black, Joint Medical Director North Region (Yorkshire and the Humber) and Deputy National Clinical Director for Specialised Services, NHS England
  • Dr David Scullion, Medical Director, Harrogate and District NHS Foundation Trust
  • Dr James Thomas, GP Chair, NHS Airedale, Wharfedale and Craven CCG
  • Karen Dawber, Chief Nurse, Bradford Teaching Hospitals NHS Foundation Trust
  • Dr Karen Stone, Medical Director, Mid Yorkshire Hospitals NHS Trust
  • Karl Mainprize, Executive Medical Director, Airedale General Hospital
  • Dr Steve Ollerton, GP Chair, NHS Greater Huddersfield CCG
  • Dr Yvette Oade, Executive Medical Officer, Leeds Teaching Hospitals NHS Trust

West Yorkshire Association of Acute Trusts (WYAAT) CEO Meeting

Members:

  • Julian Hartley, Chief Executive, Leeds Teaching Hospitals NHS Trust (Chair)
  • Bridget Fletcher, Chief Executive, Airedale NHS Foundation Trust
  • Clive Kay, Chief Executive, Bradford Teaching Hospitals NHS Foundation Trust
  • Owen Williams, Chief Executive, Calderdale and Huddersfield NHS Foundation Trust
  • Ros Tolcher, Chief Executive, Harrogate and District NHS Foundation Trust
  • Martin Barkley, Chief Executive, Mid Yorkshire Hospitals NHS Trust

Additional attendees:

  • Matt Graham, WYAAT Programme Director

West Yorkshire Association of Acute Trusts (WYAAT) Committee in Common

Members:

· All six WYAAT CEOs (see list above)

· Michael Luger, Chairman, Airedale NHS Foundation Trust

· Professor Bill McCarthy, Chairperson, Bradford Teaching Hospitals NHS Foundation Trust

· Andrew Haigh, Chairman, Calderdale and Huddersfield NHS Foundation Trust

· Harrogate and District NHS Foundation Trust currently recruiting to a new Chair

· Dr Linda Pollard, Chair, Leeds Teaching Hospitals NHS Trust

· Jules Preston, Chairman, Mid Yorkshire Hospitals NHS Trust

Mental Health Trust Collaborative Executive Group

Members:

  • Rob Webster, Chief Executive of South West Yorkshire Partnership NHS Foundation Trust
  • Dr Sara Munro, Chief Executive, Leeds and York Partnership NHS Foundation Trust
  • Nicola Lees, Chief Executive, Bradford District Care NHS Foundation Trust
  • Thea Stein, Chief Executive, Leeds Community Healthcare NHS Trust

How were they appointed and who appointed them?

The leadership is made up of existing health care leaders already working across West Yorkshire and Harrogate organisations. The only appointment made was for Ian Holmes, Director of West Yorkshire and Harrogate, Health and Care Partnership. Ian was appointed in August 2016 by a partnership panel.

When did they decide to turn the WYH ST Partnership into an ACS from April 2018?

No decision has been made. Our leadership team have discussed the benefits of greater autonomy and control over resources, including money, from national bodies that this would bring to WY&H. We believe that this is a route we should consider taking.

Our ambition is to move towards this in shadow form from April next year. This is subject to all parties, including NHS England, being content that the freedoms, flexibilities and resources match the requirements for delivery in our partnership plan.

Who are the WYH ST Programme Directors?

Catherine Thompson, Elective Care and Standardisation of Commissioning Policies

Karen Poole, Maternity

Linda Driver, Stroke

Carol Ferguson, Cancer

Emma Fraser, Mental Health

Kathryn Hilliam, Primary and Community Care

Keith Wilson, Urgent and Emergency Care

Matt Graham, Acute Care Collaboration

Corinne Harvey, Prevention at Scale

Soo Nevison, Hannah Howe, Rory Deighton, Harnessing the Power of Communities


We also have enabling programme leads, these are:

Chris Mannion, Kate Holiday, Workforce:

Alastair Cartwright, Digital

Jonathan Webb, Capital and Estates

Jonathan Booker, Business Intelligence

Dawn Lawson and Matt Ward, Innovation and Improvement:

When and where was their "priority meeting" held, that discussed the ACS Memorandum of Understanding and any other matters relating to the proposed ACS?

The programme directors meet as a group on a monthly basis. An important part of the way we work will be an agreement (or Memorandum of Understanding (MOU) between partners and with national bodies. This will underpin the next phase of our development, setting out shared governance and accountability arrangements, and highlighting shared commitment to working together. This is part of ongoing conversations across the WY&H leadership meetings.

Who has been discussing the proposed ACS with NHS England and NHS Improvement, when and where?

Preliminary, exploratory discussions have taken place between the leadership team and NHS England. These discussions are ongoing.

What papers/emails/minutes of meetings have been produced for those discussions and please will you send them to me?

The discussions held to date have been exploratory and have been held in private. Minutes and other papers are not publiclly available.

Why have these meetings been held in secret, without notifying or inviting the public to attend?

The discussions to date have been exploratory and for this reason have been held in private. We are committed to openness and transparency and when firmer proposals have been developed these will be presented to the appropriate forums in public.

A progress update was given to the West Yorkshire JHOSC on the 28 November and is also in our November blog which is publically available. You can read this here.

How many hospital beds have you found are available at trusts within your footprint as part of the STP’s planning?

In this context, ‘available’ should mean ‘which are available for patients to have treatment or care’, per the NHS England guidance for the KH03 bed availability and occupancy data collection. This should include overnight beds and day beds, and the number of beds by sector where possible (e.g. general and acute, maternity, mental illness & learning disability). This should be the latest available data (either quarter one or quarter two of 2017/18).

This information is available through the NHS England KH03 collection which can be found here: https://www.england.nhs.uk/statistics/statistical-...



How many community beds are currently available within the footprint?

This information is available through the NHS England KH03 collection which can be found here: https://www.england.nhs.uk/statistics/statistical-...

What plans are there to increase or reduce the number of beds (community and hospital) available within the footprint by 2020/21? How many beds are projected to be available by then (and again, please provide this information by sector if possible).

There are no current plans or projections in relation to the total number of beds across the West Yorkshire and Harrogate Partnership Footprint by 2020-21. Individual organizations may have their own plans but this information is not held at West Yorkshire and Harrogate level.

Please also send me any reviews, consultations, impact assessments carried out regarding the increase/decrease in the number of beds, and any evidence/clinical engagement that has been gathered or carried out to support both the assessment and the plan.

There are no reviews at West Yorkshire & Harrogate level that make a direct assessment of the number of beds required. Individual organisations may have carried out reviews / consultations on this, for example the Calderdale and Huddersfield FT public consultation includes information on future bed capacity. More information is available here http://www.cht.nhs.uk/about-us/right-care-time-pla...

It has been reported that several areas of the country that have been in discussions to be designated in a second wave of ACSs were initially told decisions would be announced by early 2018. They have now been told this has been delayed and although they

  • 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.



Developing a Memorandum of Understanding (MoU)

Part of strengthening our partnership approach is the development of a Memorandum of Understanding (MoU). This will be an agreement between the WY&H health and care partners, setting out the details of our commitment to work together in partnership to realise our shared ambitions. The MoU does not introduce new hierarchical arrangements. Rather, it builds on our current ways of working and will provide a new model of mutual accountability to underpin collective ownership of delivery. The MoU is at an early stage of development. We are discussing it with a range of stakeholders with the aim of finalising it later in the Spring.

Control total

The MoU is expected to commit the NHS organisations in West Yorkshire & Harrogate Health and Care Partnership to move towards a shared control for the region's annual £5bn healthcare budget. This will bring together the financial control totals that are currently set and agreed with individual CCGs and NHS providers. Financial control totals represent the minimum level of financial performance that organisations must deliver each year and for which they will be held accountable. Delivery of these financial control totals determine access to other incentive-related funds that are received by organisations in West Yorkshire and Harrogate. It is important to note that this is still in development - nothing has been agreed at this stage.

What are WY & H Partnership doing for stroke care - Frequently Asked Questions

What are WY&H doing for stroke care across the area?
West Yorkshire and Harrogate Health and Care Partnership (WY&H HCP) are looking at how we:
  • Prevent strokes happening across the area;
  • Deliver effective care when people have a stroke; and
  • Make sure there is good support and rehabilitation for people after a stroke.
Why are we looking at stroke care?
The NHS Shared Planning Guidance asked every local health and care system in England to come together to create their own ambitious local plan for accelerating the implementation of the Five Year Forward View (5YFV).

These blueprints, called Sustainability and Transformation Plans (STPs), are place-based, multi-year plans built around the needs of local populations.
You can read more here.

These plans are also described as the local version of a national plan called the Five Year Forward View, published in 2014. This sets out a vision of a better NHS, the steps we should take to get us there, and how everyone involved need to work together.

What has been happening over the past fourteen months with stroke care?

Our focus over the past fourteen months has been on improving ‘hyper acute’ stroke and ‘acute’ stroke services (hyper-acute refers to the first few hours and days after the stroke occurs) and making sure all stroke care services are ‘fit for the future’. This is one of the priority areas of work highlighted in the draft West Yorkshire and Harrogate plan. You can read more here.

Our work to date has highlighted the importance of ensuring our stroke work also focuses on the ‘whole stroke pathway’. This includes stroke prevention, community rehabilitation and after care support delivered in local places to meet the needs of specific populations, locally planned with a consistent approach determined by clinicians and key stakeholders working together across the area to further reduce variations and improve quality and stroke outcomes.

Our work is also about detecting and treating people who are at risk of stroke so that around 9 in 10 people with atrial fibrillation are managed by GPs with the best local treatments available to save people’s lives.

Why do we need to change stroke care?

We are using evidence from the stroke strategic case for change and our own engagement with patients, carers, staff and the public to support this work. For example, there is strong evidence that outcomes following stroke are better if people are treated in specialised centres, which treat a minimum number of strokes per year, even if this increases travelling time. This is also in line with the 7 day hospital standards specific to hyper acute stroke. In parallel, ongoing care and support should be provided at locations closer to where people live and they should be transferred to these services as soon as possible after initial treatment.

The ambitions of the West Yorkshire and Harrogate Health and Care Partnership are focused around achieving improved outcomes to address the health and well-being gap, the care and quality gap and ensuring we utilise our resources effectively.

What conversations have you had with patients, carers, staff and the public about stroke care?

In February and March 2017 we carried out initial stroke engagement work. This was led by Healthwatch and over 1,500 comments were received. You can read the report and supporting information here.

A clinical summit, made up of specialist stroke doctors, nurses, therapists etc., took place in May 2017. This highlighted there were opportunities to standardise how we provide care. Over 50 people attended this event.

On the 4 July 2017 the outcome of the engagement work and strategic case for change was presented to the West Yorkshire and Harrogate Joint Committee of the 11 Clinical Commissioning Groups (meeting in public). You can find out more about the work of the Joint Committee here.

On the 3 October 2017 the outcome of progress to date and next steps were considered by the West Yorkshire Association of Acute Trusts (WYAAT) Committee in Common.

The Joint Committee of the 11 Clinical Commissioning Groups met in public on the 7 November 2017. A stroke update was given. You can read this here.

A paper was also presented to the Joint Health and Overview Scrutiny Common the 28 November 2017.

Stroke care was also discussed at the WY&H HCP voluntary and community event in November and the unpaid carers’ event in December 2017.

2018 and ongoing

We continue to talk to staff throughout the programme of the work

On the 2 February 2018 we held an Improving Stroke Outcomes workshop to seek people’s views on our work to date and the development of decision making criteria for specialist stroke services. The workshop brought together a range of people from across West Yorkshire and Harrogate including colleagues working in health and social care, voluntary and community organisations, councillors, carers and people who have experienced a stroke. The outcome of these discussions are informing the next phase of our work.

We continue to incorporate feedback from other key stakeholders into our work. This includes West Yorkshire and Harrogate Clinical Forum, West Yorkshire Association of Acute Trust (WYAAT Committee in Common), medical directors and the Yorkshire Ambulance Service who provide care to our patients and also have access to the skills and expertise to carry out travel time analysis.

We are also working with stakeholders in other areas e.g. South Yorkshire and Bassetlaw and Humber Coast and Vale to learn from their work. We have had further discussions with the Yorkshire and Humber Clinical Senate to seek their views and expertise on clinical evidence to inform our work. Our work to date has been subject to review by NHS England as part of the assurance process.

What will happen next regarding stroke care?
Further workshops in each of our six local areas (Bradford District and Craven, Calderdale, Harrogate and Rural District, Kirklees, Leeds and Wakefield) will be taking place week commencing 26 March 2018. The sessions will include health care professionals, community organisations and importantly
people who have experienced stroke and carers who were unable to attend the 2 February 2018 workshop. The aims of these sessions are to seek people’s views on our work to date and gain their views on the development of decision making criteria for specialist stroke services to further inform our next steps;

A report will be developed summarising the February and March 2018 workshop outputs to further inform our work and will be published on our website.

The Joint Committee of the 11 Clinical Commissioning Groups will meet in public in June 2018. A stroke update will be given.

Further work with partners, stakeholders including voluntary and community organisations, public, patients and unpaid carers will follow. We will involve as many people as possible in these conversations so that everyone can have their say.

We have drafted some timelines for the coming months work. Please note these are subject to change. You can read them here (make link)

It is also important to note that no decision at this stage of our review process has been made about the number of units across West Yorkshire and Harrogate. We will progress the work over the coming months with the view to making a decision in the next few months on the readiness to consult with the public if appropriate.

Are you planning to consult on the proposals for stroke care?
Establishing what people, their families and carers and members of the public feel and experience about stroke care is very important to us. We are currently carrying out further analysis and developing criteria to inform the appraisal of options for specialist stroke services. No decision has been made on readiness to consult. Consultation will follow across the area as and when appropriate. Involving staff and communities in our plans is a priority to the partnership and we are committed to being open and honest throughout.

How are local issues related to specialist stroke services currently being addressed?
As the West Yorkshire and Harrogate stroke programme is still work in progress, local operational issues and actions to address them will continue to be addressed locally by the lead commissioner and provider colleagues. There will continue to be ongoing dialogue to ensure there is a shared understanding of the work taking place at both local and West Yorkshire and Harrogate levels. Any decisions taken locally to address local issues will be factored in to the West Yorkshire and Harrogate wide work.

If the WYH STP/HCP submitted a bid to NHS England to be part of the second wave of Integrated Care Systems , If so, was the bid successful or not


The partnership has been having an ongoing discussion with the NHS regulatory bodies over recent months about whether joining the Integrated Care System Development Programme would be an appropriate step for WY&H to take. No decision has been made to whether we will do this. We expect to reach agreement on whether or not to proceed by early summer.


The role of the local place-based planners


The place-based planners group is not a decision-making forum. It is an informal management group which meets monthly. It brings together colleagues working on the local plans for each of the six places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) which make up the WY&H partnership, including from the councils and clinical commissioning groups. These place-based partnerships, overseen by Health and Wellbeing Boards, are key to achieving the ambitious improvements we want to see. The group provides a regular opportunity for colleagues to share with each other the details of some of the work taking place in their local areas to transform health and care services, and for the members of the West Yorkshire and Harrogate partnership team to update them on work taking place across the whole area.

Please can you advise me if your CCG is planning to commission one or more Hyper Acute Stroke Units (HASU) for your patients? 

Our CCG is working with key stakeholders in the West Yorkshire and Harrogate Health and Care Partnership (WY&H HCP) Stroke Programme to look at how we:

• prevent strokes happening across the area;

• deliver effective care when people have a stroke; and

• ensure there is good support and rehabilitation for people after a stroke.

The focus of this work over the past fourteen months has been on improving ‘hyper acute’ stroke and ‘acute’ stroke services (hyper-acute refers to the first few hours and days after the stroke occurs) and making sure all stroke care services are ‘fit for the future’. This is one of the priority areas of work highlighted in the draft West Yorkshire and Harrogate Sustainability and Transformation Plan (STP). 

Has a business case been prepared for HASUs in your area?  If so, please list any organisations who were paid to support the preparation of the business case and how much they were paid?

The West Yorkshire and Harrogate stroke programme are using evidence from the Stroke Strategic Case for Change and engagement that has taken place across the West Yorkshire and Harrogate area to support this work.  The next phase of the work will be to develop a business case which will inform discussions with key stakeholders as part of the NHS England Stage 2 Assurance process. 

Please can you send me a copy of the business case?

This will be available on the West Yorkshire and Harrogate Health and Care Partnership website following approval.

If you already have one or more HASUs in place, please can you send me any internal or external evaluations that have taken place?

West Yorkshire and Harrogate has five HASUs: 

• Bradford Teaching Hospitals NHS Foundation Trust – Bradford Royal Infirmary;

• Calderdale and Huddersfield NHS Foundation Trust – Calderdale Royal Hospital;

• Harrogate and District NHS Foundation Trust;

• Leeds Teaching Hospitals NHS Trust – Leeds General Infirmary; and

• Mid Yorkshire Hospitals NHS Trusts – Pinderfields Hospital.
 

A Strategic Case for Change was developed and has been published on the West Yorkshire and Harrogate STP website:
https://www.wyhpartnership.co.uk/application/files/3715/0296/6970/WY_HF_Stroke_HAS_SCfC_v6.0_approved_final_final.pdf

 
Before the publication of the Strategic Case for Change, the Yorkshire and Humber Strategic Clinical Networks published the Hyper Acute Stroke Services Yorkshire and the Humber ‘Blueprint’ for Yorkshire and the Humber Clinical Commissioning Groups. This is available from their website:
http://www.yhscn.nhs.uk/previous/Strokelegacy/stroke-documents-and-links.php
 

We have also engaged with people, including those who have experienced a stroke, carers and community organisations. You can read the findings in our reports at https://www.wyhpartnership.co.uk/get-involved/engagement