Our Partnership is made up of organisations working closely together to plan services and address the challenges facing health and care services across the area.
In this section you will find links to useful information and publications about our partnership.
We are committed to meaningful conversations with people, on the right issues at the right time. We believe this is an important part of the way we work.
Engagement gives people an opportunity to have their say on services. By gathering people's views, it helps us understand what matters to people.
In this section you will find all Freedom of Information (FOI) requests made to our Partnership. You can also ask a question of your own.
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1. Has West Yorkshire and Harrogate Integrated Care System (WY&H ICS) received any advance direction from their Locality Director, NHS England and NHS Improvement about elective recovery and reset?
2. If so, does it contain the same instruction as NHSE London's?
3. Are WYH ICS and West Yorkshire Association of Acute Trusts planning to do the same, ie make effective use of residual elective capacity as key to eliminating the waiting list backlog of patients waiting more than 54 weeks?
NHS England/Improvement issued guidance on 23 December 2020, Operational Priorities for Winter and 2020/21, which asked systems to continue to maximise their capacity in all settings to treat non-COVID patients. We have sought to do this while COVID-19 pressures have placed significant limitations on capacity in our hospitals, and will continue to do so as we begin the recovery process.
4. If so, will they be, or are they, subcontracting to private "insourcing" companies? Such as Totally Healthcare, which provides staff that they employ to carry out medical services/procedures including diagnostics, day-case surgery and outpatients, in NHS hospitals, using their NHS premises and equipment during downtime
As part of our recovery planning we are exploring all opportunities for additional capacity from NHS hospitals, the Independent Sector, VCSE, community providers and primary care.
5. If so, which insourcing companies will they be, or are they considering, subcontracting to for the purpose of elective recovery?
We have no definite plans at present.
6. (what is) the timeframe for WYC ICS/WYAAT decisions on whether to subcontract to an insourcing company or companies, for the purposes of elective recovery?
All local acute hospitals are working hard to ensure all people in need of care receive this as soon as possible. In order to manage this in the most effective way, each will be looking at what they need to do to make this possible. Timelines and approaches may vary and change depending on what each hospital needs to do at a given time.
I would like to see the estates strategy - I want to know what evidence has been used to support the plan.
We are currently reviewing our estates strategy and will publish this once complete
* West Yorkshire and Harrogate Health and Care Partnership
The financial planning information described in the West Yorkshire and Harrogate Health and Care Partnership 5-year plan focussed on the NHS financial position. The surplus position described in the plan is an aggregation of individual financial plans across NHS providers and Clinical Commissioning Groups within the Partnership. Financial surpluses in NHS providers allow the generation of cash resources that can be used to spend on capital, for example, new and replacement CT/MRI scanners, improvements and extensions of buildings, and equipment. In addition, some Clinical Commissioning Groups also had to make in-year surpluses in order to pay off historical deficits.
Yes, the Partnership delivered its financial plans in 2019/20.
Given the Covid-19 pandemic, the financial arrangements put in place across all of the NHS have been revised for 2020/21. For the first half of the year all organisations have been reimbursed for reasonable additional costs incurred in providing the NHS response to Covid-19. This returned all to a break-even position. For the second half of the year organisations have been provided with a fixed value of resources which were calculated nationally as being sufficient to enable organisations across the Partnership to continue to deliver a breakeven position. There is no plan to deliver a surplus in 2020/21.
Particularly when the West Yorkshire and Harrogate Health and Care Partnership 5 Year Plan 2019-24 says that "delivering" these "efficiencies" is subject to a lot of potential risk, as it requires "efficiencies higher than the 1.1% minimum; an average of 2.81% for the system as a whole (a total of £224m)...Continuing to deliver efficiencies locally will present a challenge..." (p161)
The reasons why it is important to plan for surpluses is set out in the answer to (a). Furthermore, there is an expectation nationally that the NHS seeks to deliver improvements in the way that we provide services to ensure that the finite resources we have available are put to the best use. In this context, efficiencies don’t equate to “cuts”. Efficiencies may be secured through changing clinical pathways, for instance, same day emergency care facilities allow patients to bypass emergency departments and access the right level of care more quickly, or improving discharge processes to ensure that when people no longer require hospital care, they are discharged quickly with the right level of support into their own homes or other facilities, or review of medications for patients with long-term conditions on multiple medications to ensure that the combination and dosage of medicines is clinically appropriate and supporting people in a way that suits their lives. These are just three examples.
Yes, this is the level of estimated efficiencies or productivity improvements that we expected to have to secure over that four-year period. The Comprehensive Spending Review announced in November 2020 covered the NHS financial settlement for 2021/22. This will have to be re-assessed in due course.
Given the changes to the financial regime as a result of the Covid-19 pandemic, there is a national review of the NHS financial framework from 2021/22 onwards, and we are awaiting national guidance.
See answer to (e).
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.
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.
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.
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.
Clinical commissioning groups
NHS care providers
Other organisations involved
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.
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.
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.
The Partnership's 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.
The development of the plan is coming from existing health budgets, supported by a small programme management office.
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.
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.
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.
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.
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.
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:
We will shortly begin conversations with staff, public and stakeholders. Public engagement will be used to shape and develop formal consultation.
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.
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.
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.
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.
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.
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.
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
WY&H Joint Committee of Clinical Commissioning Groups
Clinical Commissioning Group Members
Bradford (Airedale, Wharfedale and Craven, Bradford City and Bradford Districts)
Harrogate and Rural
Leeds (Leeds North, Leeds West and Leeds South and East)
· 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
West Yorkshire Association of Acute Trusts (WYAAT) CEO Meeting
West Yorkshire Association of Acute Trusts (WYAAT) Committee in Common
· 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
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.
No decision has been made. Our leadership team have discussed the benefits of greater autonomy and control over resources, including money, from national bodies, including NHS Englanda that this would bring to West Yorkshire and Harrogate. We believe that this is a route we should consider taking.
Our ambition is to move towards this in shadow form from April 2018. 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.
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:
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.
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 Joint Health and Overview Scruitny Committee on the 28 November 2017 and is also in our November blog 2017 which is publically available. You can read this here.
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-...
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 organisations may have their own plans but this information is not held at West Yorkshire and Harrogate level.
There are no reviews at West Yorkshire and 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...
Part of strengthening our partnership approach is the development of a Memorandum of Understanding (MoU). This will be an agreement between the West Yorkshire and Harrogate 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.
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.
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.
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 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.
The Joint Committee of the Clinical Commissioning Groups 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).
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.
This will be available on the West Yorkshire and Harrogate Health and Care Partnership website following approval.
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:
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:
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
The vast majority of work on obesity across the West Yorkshire and Harrogate (WY&H) Partnership is carried out within the places that make up the Partnership – Bradford District and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield. The WY&H Public Health Coordination Group oversees this placed-based work and is Chaired by Dr Ian Cameron, Director of Public Health for Leeds City Council. Contact details: Ian.Cameron@leeds.gov.uk
The WY&H Partnership also supports a specific programme of work at place level to reduce variation and equalise investment in bariatric surgery. The Director of this work is Michelle Turner, Director of Quality for Airedale, Wharfedale and Craven, Bradford City and Bradford Districts CCGs. Contact details: Michelle.Turner@bradford.nhs.uk
In the new Integrated Urgent Care and Core Clinical Advisory Services, how does the NHS111 bit work with the Core Clinical Advisory Services? Will NHS 111 route patient calls to clinical teams who will actually see the patient? Or will that clinical consultation be on the phone/ video/online? And how realistic is the requirement that the clinical team completes the patient’s consultation without passing them on or referring them to another clinician, at A&E or elsewhere? Has the practicalities of turning intentions into reality started? What is Attains involvement and how much are they being paid?
The procurement process is underway and will confirm in due course which organisation will be awarded the contract. The new contract will deliver key elements of the nationally specified integrated urgent care service, in particular 111 call handling and clinical advice. It will take effect during 2019. Attain have been commissioned on an interim basis to work alongside existing NHS staff, to support the procurement process using a competitive dialogue process through to mobilisation of the new service. Attain are working closely with existing staff to build both capacity and capability to support to the Yorkshire and the Humber project. The cost of this engagement is £238k.
The various standardisations of services plans rely on the Right Care ‘Go Compare’-type tool - but are you aware of the criticisms that Right Care is based on dodgy statistics? These criticisms were published in the Journal of Public Health, in an article called Right Care, Wrong Answers, on 3 Nov 2017. How do you intend to respond to this peer-reviewed criticism of the Right Care methodology in future?
RightCare should not be viewed as providing directives to health economies as to how to act; rather it is intended as a tool to support enquiry by health economies as to opportunities to improve NHS quality and provision. While a powerful tool, it needs to be combined with other data, including local environmental knowledge, to evaluate possible opportunities for improvement.
The Next Steps on the Five Year Forward View signalled a new approach to integrating care locally, referred to as ‘integrated care systems’. An ICS will be the most developed version of a sustainability and Transformation Partnership (STP). It will be given greater autonomy and financial backing from the centre in return for taking greater responsibility for delivery and finances across the patch.
We are only one of four partnerships to join wave two. This is national recognition for the way our WY&H partnership works - it means we can join the cutting edge of health and care policy, gaining more influence and more control over the way we deliver services and support for the 2.6 million people living across our area.
This was announced on the 24 May 2018.
You can read NHS England and NHS Improvement Board Meetings in Common – agenda and papers from the 24 May 2018 here for more information.
An ICS is a partnership that is given flexibility and freedoms in return for taking responsibility for the delivery of high quality services now and in the future. It brings together some elements of NHS regulatory functions with health and care commissioning and service provision.
With these new governance and accountability arrangements in place, our partnership would be able to take on greater responsibility for:
WY&H Health and Care Partnership leadership team discussed the benefits of securing greater autonomy and control over resources, including money, from national bodies that an ICS would bring to the area. Joining the development programme is a natural progression for our partnership and allows us to take on these responsibilities at a time that is right for us. It sits with our ethos of being ambitious for the people we serve and demonstrates our commitment to improving health and care for everyone.
As a network of leaders running the second biggest partnership in the country (2.6 million people, £5 billion budget), we feel we have the leadership needed as well as the opportunity to contribute significantly to this way of working. It will also mean we receive a fair share of new national resources to deploy locally, rather than having to bid for money in small lots.
Our Partnership is made up of over twenty organisations, including Healthwatch, care providers and community organisations. Working with and for communities is also a priority to us. You can see a list of some of our partners here
Each of our local places is working through how they will work together more closely to further develop their partnership approach. It’s clear that our local places will have different plans and what is right for one may not be for another. In line with our WY&H plan, (a public summary is available here) all decisions on services need to be made locally as close to people as possible. Our move to becoming an ICS is predicated on this continuing to be the case.
The WY&H ICS will therefore focus on the work that can only be done at this level i.e. the nine programmes, for example cancer, mental health, stroke, urgent and emergency care.
The importance of joining up services for people at a local level in Bradford District and Craven; Calderdale; Harrogate and Rural District; Kirklees; Leeds; and Wakefield is at the heart of our local plans and our WY&H programmes. All decisions on services are made as locally and as close to people as possible. Our move to becoming an ICS is predicated on this continuing to be the case.
This integrated approach to health and care continues much closer working between our organisations, rather than traditional, top down approaches based on mergers or the creation of a new organisation. This demonstrates our distributed model of leadership and focus on prevention, wellbeing, communities, primary care, mental health, acute services and world class innovation is being supported.
This recognition allows us to continue strengthening our partnership. It also means we can begin to develop the formal delegation of money and resources to WY&H over the coming year. This is very important to us.
Joining up health and care will improve the health and wellbeing of our communities. New ways of working will improve care we offer to people – integrated teams are good news. The Partnership are working together in a much more joined up way than ever before.
We have good working relationships and shared goals across our local areas and wider WY&H work. This is the way the NHS will consider funding in future and we know this is important to secure investment across WY&H to improve health outcomes and prevent ill health.
The ambitious proposals set out in our plan are firming up into specific actions, backed by investments. This is being done with the help of our staff and communities, alongside their representatives, including voluntary, community organisations and local councillors. Our bottom up approach means that this is happening at both a local and WY&H level, which puts people, not organisations, at the heart of everything we do.
Part of strengthening our approach is the development of a 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.
This is different to be being an ICS.
The MoU is expected to commit the NHS organisations in the West Yorkshire and Harrogate Health and Care Partnership to move towards collective oversight of the region’s annual £5bn healthcare budget. It is important to note that these arrangements are still in development so nothing has been agreed at this stage. It will only be finalised once partners have agreed.
Over the past 18 months there has been considerable focus nationally on terminology for this way of working with various names being used, for example ‘sustainability transformation partnerships (STPs)’ and more recently ‘accountable care systems/organisations/integrated care systems’. Some of the terms are close to those used by the system in the USA, which has led to suggestions of privatisation and insurance style models. This is incorrect.
We remain clear that we are working towards greater autonomy and more flexibility in the way we manage so we can further develop and deliver high quality health care services now and in the future. This means national labels like being an integrated care system may be applied, but what we actually want to achieve is far more than a name. We are proud to remain the West Yorkshire and Harrogate Health and Care Partnership.
There is absolutely no intention to move healthcare away from being entirely publically funded. What we really want is to make ways of working for staff much easier – something that we have heard loud and clear, more local control and freedom to make decisions for people and additional funding to support our plans, at both a local place level and across our West Yorkshire and Harrogate priorities. So we have the whole system working for the whole system with one budget and so people don’t have to repeat their story over and over again.
The main participants involved in developing integrated care are NHS organisations and partners in the public sector and they are making progress by collaborating not competing.
What we hope people will see over the coming months is evidence of the trust and collective leadership across our partnership so that together we can effectively support many more people in their homes, whilst reducing hospital demand and fully supporting GP practices and community services so they are able to become the first point of contact for health no matter what time of day.
We want to further develop services to help people stay well, whilst delivering more care in the community, so together we free up specialist hospital care to concentrate on what only they can do.
Considerable effort and commitment from many partners has helped us to get to this point and we are now in an even stronger position to move forward together as one health care system.
It will also mean we have a simplified and streamlined set of relationships with national bodies, i.e. NHS England (NHS E) and NHS Improvement (NHS 1) so that our partnership working becomes easier. To help us achieve this NHSE and NHSI have provided us with staff to support our journey to become an integrated care system in shadow format.
Following our principles of openness and transparency we are continuing to have conversations with partnership employees and stakeholders, including local people and their representatives i.e. MPs, councillors, members of the West Yorkshire Joint Health Overview Scrutiny Committee, local Health Overview Scrutiny Committees and Health and Wellbeing Boards, we will continue to work together as we develop our integrated approach.
West Yorkshire and Harrogate Health and Care Partnership will publish their workforce plan ‘A healthy place to live, a great place to work’ in June 2018.
The publication describes how the health and social care workforce of over 100,000 in West Yorkshire and Harrogate is changing to meet the current and future needs of the 2.6 million people living across the area.
Reshaping healthcare requires a reshaping of the health and care workforce. New teams are emerging with an increased role for non-medical staff to work alongside medical staff; non-registered staff to work alongside registered professionals and new roles alongside traditional ones.
The Workforce Plan also recognises the huge contribution community organisations and volunteers make; and the vital role of the 260,000 unpaid carers who care for family and friends day in day out and whose numbers are more than that of the paid workforce. Supporting working carers is also an important partnership priority. You can read more about our approach to improve the support for unpaid carers in West Yorkshire and Harrogate here.
A single LIMS for all the pathology services in West Yorkshire and Harrogate (WY&H) will provide a much deeper level of integration than provided through the NPEx lab to lab messaging system. A LIMS manages the entire pathology process: receiving requests for tests, tracking the passage of samples through the laboratory, capturing the raw results from the tests, enabling pathology clinicians to validate and analyse the results, and providing the analysed results to other clinicians to inform their treatment and care decisions. A LIMS captures quality assurance and process data to ensure laboratories are providing a high quality, timely and efficient service.
A single LIMS for WY&H will mean that all this data will be captured consistently in one system. For patients this means all pathology tests, wherever the test is done in WY&H, will be available to their clinicians reducing the need for duplicate testing and ensuring clinicians have visibility of all results. For pathology services it will mean that samples moving between laboratories (for instance specialised tests which only a few laboratories perform) can be tracked across the whole of WY&H. It will also enable standardised approaches to testing across WY&H.
NPEx only enables the sharing of test requests and results between labs. Although it enables samples to be tracked between laboratories through a web interface, it does not give clinicians a single consolidated view of all results for a patient from labs in WY&H.
Our intention is to replace all the LIMS currently used by the six trusts in WY&H with the single LIMS. A number of the current LIMS need replacing now and all will need replacing in the next few years. Replacing LIMS is a significant undertaking and we expect it to take a number of years to complete with trusts being moved to the new system in a phased approach.
The CHFT Health Informatics Service with continue to provide The National Pathology Exchange (NPEx) to pathology services across the UK and internationally. The funding provided in 2018 was to develop the NPEx system to improve its resilience and offer more functionality (such as the ability to connect point of care testing and laboratories outside the NHS) for all its users, not just those in WY&H. Even with a single LIMS, the WY&H pathology services will continue to use NPEx to share requests and results with trusts outside WY&H.
Please find attached the minutes relating to the item discussion about Pathology
The six trusts in WY&H collaborate together in a number of areas through the West Yorkshire Association of Acute Trusts (WYAAT). The pathology services in WY&H have been collaborating informally since early 2017.
Building on the recommendations from Lord Carter’s reviews in 2008 and 2016, in September 2017 NHS Improvement signalled to all acute hospital trusts in England that they should form pathology networks to drive out unwarranted variation in services. For WY&H, NHS Improvement proposed a network covering the WYAAT trusts. They published a national case for change highlighting variation in costs and prices for pathology services, variation in efficiency, lack of investment in advanced technology, lack of estates capacity, pressure to maintain quality accreditation, competition from private pathology providers, increasing demand, the need to contribute to financial sustainability and staff issues (e.g. ageing workforce, staff shortages).
The same drivers for change also apply to WY&H and in January 2019 the trusts agreed that collaborating on pathology services by forming a WY&H Pathology Network would better enable them to address challenges and improve pathology services for both staff and patients.
The network is not about centralising all of pathology into a single “hub” laboratory, its aim is to enable the laboratories in the five pathology services in WY&H to collaborate to improve quality, sustainability and efficiency, for instance by reducing unwarranted variation, enabling investment in technology and facilities, managing demand, addressing workforce shortages and developing new roles. The network is clinically led by the consultant clinical leads and senior pathology scientists from the five services. Patient safety and clinical effectiveness are fundamental requirements of the network.
The £12m funding allocated to WY&H is to implement a single LIMS to connect all the laboratories together which was identified by pathology clinicians and scientists as a critical enabler of the network.
The procurement of a single LIMS will be managed jointly by the six acute trusts in WY&H. The procurement approach has not yet been finalised; there are a limited number of supplier frameworks available for LIMS.
At this stage, our expectation is that the full £12m will be spent on purchasing the LIMS.