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.
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.
As well as being Chief Officer for Airedale, Wharfedale and Craven, Bradford City and Bradford Districts CCGs, Helen is the Partnership CEO Lead for Organisational Development and the commissioning lead for mental health.
Hello my name is Helen
What is ‘it’...?
An important conversation took place at a recent meeting of the West Yorkshire and Harrogate Health and Care Partnership Organisational Development Network, which is made up of colleagues from across all partner sectors. We spent a lot of time talking about whether everyone got ‘it’. Some people weren’t getting ‘it’ and others were only getting ‘it’ from their own perspective. There was a lot of frustration in the room. But what is ‘it’?
The discussion focused on the asks of our West Yorkshire and Harrogate priorities - many of which boiled down to people not getting it and those who believe they have got it being frustrated with those who haven’t.
The solution is for us all to cast aside vested interests and work collectively to deliver joined-up services that wrap round communities. ‘It’ is a common purpose, a will to work differently, to do what’s right and best for local people. ‘
So how do we move on so we all get ‘it’?
The answer of course is to use interventions – put simply: designed activities which will help those who don’t get ‘it’, get it quicker, so we can all move on to achieve our goal of pulling in the same direction with a culture that breaks down organisational barriers and puts those we serve at the very heart of everything we do.
Some colleagues believe that it is hard to do ‘it’ when they’re busy with the day job while others say it is the day job. So what is ‘it’?
To me it is the culture. An overused word perhaps which I believe is loaded with various meanings depending on your organisation, team and personal point of view.
But when we front up that ‘it’ is culture - behaviour and style - we often get argued down that ‘it’ is direction of travel. So then we spend time debating the ‘what’ when perhaps our time would be better spent on ‘how’.
When reading the NHS Long Term Plan and our West Yorkshire and Harrogate Partnership papers I think the ‘what’ is pretty much nailed.
You may be familiar with Peter Drucker’s phrase ‘culture eats strategy for breakfast’ then ‘structure is for lunch’ (made famous by Mark Fields, President at Ford, as an absolute reality). This phrase doesn’t suggest that strategy isn’t important - it is. However what we need is for culture to overcome any structural chart or any reorganisation.
If we believe that cultures are created by people who work in organisations, systems and teams, then we can change cultures if we support people to create something different which is meaningful and of value.
Around 20 years ago I remember being set an objective by my CEO at that time to ‘change the culture by October’ - it was June! I laughed at the time but I ate my words later when by the autumn of that year there had been a significant step change. What shifted was permission to act, decision making arrangements, funding priorities - and above all - a behaviour change which led to a shift in culture.
Johnson and Scholes (1992) argue that culture is not one dimensional but is made up of a number of components - stories (and myths); rituals and routines, symbols, structures, both organisational and power based, and control systems. Put simply if you can expose cultural assumptions and practices, and set to work aligning organisational elements with one another and alongside strategy, positive change will happen. We have some great examples where this is happening.
In Bradford District and Craven we have changed our annual ritual of agreeing our commissioning intentions - moving these conversations to our health and care partnerships and away from being clinical commissioning group based decisions. In Wakefield a different structure to support the development of mental health services is in place through their Partnership Board and in Leeds we hear about the positive benefits of moving to an aligned incentive approach in hospital contracting which has resulted in stories of clinicians (and other colleagues) feeling empowered.
Calderdale use five words that represent the values and character of the area and people they serve. These are ‘kindness, talented, resilient, enterprising and distinctive’. They have a series of breakfast meetings planned and themed around these important words to which existing, new and aspiring leaders across the Partnership are invited. A guest speaker brings issues for debate and discussion. The annual 'We are Calderdale' event takes a word for its theme. This year it’s 'kindness'. What a powerful story.
In Harrogate they have developed with Tees Esk and Wear Valleys NHS Foundation Trust an Accountable Care Partnership approach to improve service delivery and health outcomes for people with mental health concerns and learning disabilities. This moves away from the traditional commissioner (organisations that buy health services for people in an area) and provider relationship, to one with a shared focus on improving health outcomes, sharing skills and expertise across the whole care system, and in Kirklees they have agreed a single approach to quality, with the Clinical Commissioning Groups working with colleagues in Adult social care and public health. They’ve agreed a shared vision, values and are now working through processes to use their collective intelligence, better use of skills and experience and avoid duplication.
Through the West Yorkshire and Harrogate priority programmes we have developed new structures and arrangements which give rise to a different sort of decision making. You can see examples of this in the way hospitals work together (West Yorkshire Association of Acute Trusts) in a world of co-operation and collaboration – when at one time they may have been competitors. In mental health we have new models of care for children adolescent mental health services and eating disorders which changes the power, the control and the organisation structures as well as challenging the commissioner/provider dynamic.
The partnership goes well beyond just NHS partners and has cast a different relationship with local government which means work programmes look beyond the NHS - such as the work on care homes and learning disabilities. The Harnessing Power of Communities programme is as its name suggests looking at the power of citizens across West Yorkshire and Harrogate and how they can influence thinking, as experts in their own right. That is all-important if health and care services and communities are to be sustainable. Achieving alignment of strategy, goals, and where meaningful purpose reinforces one another is a common thread in all these examples.
The challenge of getting ‘it’ right therefore seems to be about whether people are supported in their operating environment - teams, departments, organisations - to work differently. Leaders from Canterbury in New Zealand told us when they visited West Yorkshire in 2017 that it was an empowering culture that was the ‘magic’ in their transformation when their health system was under pressure and beginning to look unsustainable. It’s both inspiring and impressive how they made the transition from fragmented care towards integrated care with a degree of measurable success. Canterbury has been working to create ‘one system, one budget’ for a number of years.
It takes many people to transform a system. A small number of leaders were at the heart of Canterbury’s transformation, but this leadership rapidly became collective, shared and distributed. Their equivalent of our commissioner explained that it was almost impossible nowadays to keep a handle on the changes that were happening as they were just the routine way of working. People saw transformation and change as their day job. This culture is nothing less and nothing more – it’s the way it is.
In December 2018 we had an innovative and engaging session led by Myron Rogers. Myron is an author, speaker in large-scale organisation change and leadership development. Myron talked about the practical reality of system leadership ‘changing the way we change’. My personal favourite of Myron’s Maxims is that ‘real change takes place in real work’. We can all make choices about how we behave. We have rules and frameworks but we don’t have to be slaves to them. We have power and we can use it differently. We are all busy doing our doing - let’s use our day job to create a new future and create this special ‘it’ that we are all seeking and which our citizens expect of us.
Have a good weekend,
The Shadow System Leadership Executive Group met on Monday chaired by Dr Matt Walsh, Chief Officer for Calderdale Clinical Commissioning Group and CEO Lead for Improving Planned Care. Comprising twenty senior clinicians and managers from across the Partnership, it meets every month ahead of the System Executive Group. This month the group discussed operational planning, the Long Term Plan, the developing clinical strategy and the forthcoming ‘Looking after our Neighbour’ and Breathe 2025 campaigns. The key messages from these discussions were fed into the Executive Group meeting on Tuesday.
The Forum met on Tuesday. The meeting is chaired by Dr Andy Withers and includes medical directors, GPs, pharmacists, allied health professionals, and lead nurses. Members received an update from the West Yorkshire and Harrogate System Oversight and Assurance Group which took place in January. This included programme updates on urgent and emergency care, improving planned care, capital and estates, stroke and innovation/improvement.
There was also an update from Robin Jeffrey, Clinical Lead for the West Yorkshire Association of Acute Trusts (WYAAT - hospitals working together) on the development of the clinical strategy. A project group has been set up to take forward this work; this includes GPs, and colleagues from hospitals. Forum members emphasised the importance of embedding integrated working in our six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield). It was agreed that social, mental, voluntary, hospital and primary and community care as well as other issues such as long term conditions, children and frailty are important areas for the strategy. Key themes were identified in the NHS Long Term Plan - for example outpatients, improving planned care, the importance of children and young people in the work of mental health, community care and maternity programmes. The development of the strategy across West Yorkshire and Harrogate Health and Care Partnership will build on the direction of travel set out in ‘Our next steps to better health for everyone’ and the work we will be doing over the coming months on the Partnership’s five year plan.
There was also an update on dermatology services with a focus on workforce retention, service demand and sustainability. Stroke care regarding the development of the network was also discussed.
Dr James Thomas and Catherine Thompson (members of the improving planned and reducing variation programme) gave an overview on the standardisation of commissioning policies programme and in particular around the policies and pathways covering spinal services and the prescribing commissioning policy for liothyronine for the treatment of primary hypothyroidism (underactive thyroid). It was agreed to discuss this further with colleagues in clinical commissioning groups.
The Committee met on Tuesday – chaired by Marie Burnham, independent lay chair. Members received reports on improving planned care, dermatology and the West Yorkshire and Harrogate Healthy Hearts work.
The Improving planned care and standardisation of policies work programme addresses clinical thresholds and criteria for clinical procedures. Dr James Thomas, the Clinical Lead presented proposed policies and pathways covering spinal services and liothyronine commissioning. The pathway for spinal services aims to ensure that only people who will benefit from a consultation with a spinal surgeon will enter that pathway and that other people access appropriate treatments more locally. The new ‘do once and share’ quality and equality impact assessment process has been applied to this policy.
A liothyronine commissioning policy was published in 2017 by NHS England. The policy has not been adopted by all CCGs in West Yorkshire resulting in variation in access. There was a lengthy discussion about the clinical and financial implications of adopting a consistent policy across West Yorkshire.
Amanda Bloor, senior responsible officer for the West Yorkshire and Harrogate Healthy Hearts work presented proposals for simplified treatment guidance to help identify and treat people at risk of heart disease and high blood pressure. Many people don’t know they have high blood pressure and it’s important that people are helped sooner to prevent heart attacks and stroke.
Further reports on the spinal pathway, liothyronine commissioning and healthy hearts will be brought to the Joint Committee meeting in public on 5 March.
The Committee considered a report on a possible system-wide approach to dermatology services and there was also an update on vascular services which will be discussed on Monday at the West Yorkshire Joint Health Overview and Scrutiny Committee.
Rob Webster, our Partnership CEO lead chaired the meeting of the executive group on Tuesday. This is made up of senior representatives from across all partner sectors.
Councillor Tim Swift, leader of Calderdale Council and chair of Calderdale Health and Wellbeing Board (who will be chair of our Partnership Board) attended the meeting to meet colleagues he will be working alongside in his new role. The Partnership Board will meet in public for the first time in June.
Leaders also welcomed Donna Hall who is the CEO at Wigan Council and Chief Officer at Wigan Borough Clinical Commissioning Group. Donna shared her experiences and reflections on forging “The Wigan Deal”. Donna describes The Wigan Deal as a “psychological contract” between residents and the town hall. This way of working in partnership has been replicated by many other public sector bodies since it began – including Denmark.
The Deal was the council’s response to government cuts which reduced the budget by £160m. To address this, the council invested £10m into community groups and froze council tax for five years to help those most vulnerable. Donna explained the approach they took in partnership with other public sectors and communities and how this saw a step change in the way they work alongside communities and people in their own right.
Wigan is the fourth best performing adult social care service in the country. By investing in community initiatives, and stopping what doesn’t work, they have seen life expectancy in the most deprived areas of Wigan increase by seven years. Donna also talked about the move to an asset-based approach to commissioning. Put simply, the area has focused on the needs of people and their families’ first rather than more traditional ways of delivering health care. You can see examples of this in Wigan’s digital ‘community book’.
Donna praised the workforce and explained how they been instrumental to the changes that have happened, especially around joined up care, care home partnerships and the relationships with communities. In particular, she talked about six fundamental areas: different conversations with staff and communities, knowledge and understanding of communities and connecting organisations together, place based communities and asset based approaches - looking at the strengths in all communities; staff behaviours, values and permission to innovate - to ‘be the Wigan experience’.
By not investing in things that don’t work, the funding of 500 groups is really making a difference. Donna emphasised that a balanced financial book is all about being courageous and doing things differently.
Ian Holmes, director for the Partnership updated colleagues on the NHS Long term plan, which was published on 7 January 2019. This is an important document which helps set the context for the next phase of our Partnership working. There was a conversation on the process to review and refresh the scope and objectives of our priority and enabling programmes; and the need to identify any potential new priorities which have emerged through our partnership way of working, for example housing and health. It was agreed that we would review and refresh existing programmes to reflect our new priority areas and any alignment needed to the Long Term Plan.
There was also a discussion on our approach to communications and engagement and the support available from Healthwatch. We are currently mapping engagement activities to ensure we focus on the right areas and Ian will be discussing areas for further engagement with programme leads over the coming weeks.
The five year plan will be our plan and will build on the work of ‘Our next steps to better health and care for everyone’, where needed it will include our response to the Long Term Plan; for example the work of children and young people, wider determinants of health, for example poverty and employment; and health inequalities.
A five-year GP (General Medical Services) contract framework from 2019/20 was published last week and it was agreed that primary care would be the focus of a future meeting.
Finally there was an update on two campaigns. First the ‘Looking out for our neighbours’ campaign (please see above) which will launch in March and the Public Health England campaign ‘Breathe 2025” which is all about the impact of smoking on your health. This will be seen on the TV and other media outlets from May. Please encourage colleagues to support these important campaigns.
As it is child mental health week we thought it would be useful to share some of the work taking place across West Yorkshire by the Mental Health Services Collaborative. This is made up of the chief executives and chairs of Bradford District Care Foundation Trust; Leeds and York Partnership FT; Leeds Community Healthcare Trust; and South West Yorkshire Partnership FT.
It’s reassuring that the national long term plan includes children and young people’s mental health as a priority. Our new £13million child and adolescent mental health unit is set to be built in Leeds after it was announced as one of 12 successful bids to receive NHS England capital funds in 2017. Building work is expected to begin this year.
The successful bid, led by Leeds Community Health Care NHS Trust on behalf of the West Yorkshire and Harrogate Health and Care Partnership, will see a new purpose built specialist community child and adolescent mental health (CAMHS) unit to support young people suffering complex mental illness, for example severe personality and eating disorders.
Our ambition is to make sure that no child or young person within West Yorkshire goes out of area for treatment. This is better for them, their families and better for the local health and care economy. Building this new unit supports both national and regional priorities - to reduce the area that children, young people and their families have to travel to receive specialist mental health care.
We also want a consistent offer of service for crisis/intensive home based care across the area provided as close to home as possible – so that no matter where a child or young person lives they receive the same level of care and attention. There are too many children and young people waiting too long to access specialist care and going out of area for care and we want to stop this. We need more long term funding to help children and young people sooner rather than later so they have better health and wellbeing as adults. We are doing all we can to address this.
The money saved means we can commit funding to organisations across the area for £500k worth of investment in community services - ensuring more children and young people are cared for closer to home. Albeit this is progress, we know much more needs to be done to support children, young people and their families. We will continue to build on this progress for as long as needed.
Through the introduction of the new care navigator role children and young people have also been supported locally without hospital admission.
Working in partnership with other organisations, including the police, local authorities and community organisations is critical to further improving care for children and young people in communities. You can see a good example of this in the work of Bradford’s safer spaces for children and young people in mental health crisis. This provides an alternative to hospital bed days whilst reducing unnecessary A&E attendance. It has the potential to be rolled out across other Partnership areas.
We have also adopted a ‘zero’ suicide approach, where every death by suicide is viewed as preventable. This includes young people. There is an ambitious plan to reduce suicide by 10% across the area and by 75% in targeted communities. The task is to identify those at risk sooner rather than later - and importantly before it’s too late.
Loneliness is also a big problem that can predispose young children to immediate and long-term negative consequences. There are clear links between loneliness and poor mental and physical health, and between loneliness and lower academic attainment for young people. Loneliness can affect all young people, though some more than others: young carers, young parents, children in poverty, and children in care. In Yorkshire & Humber, 29% of young people feel lonely, the highest figure in England Wales. We need to reduce that figure starting now. This is one of the reasons why our Partnership is developing a campaign to tackle loneliness with the potential to roll this out wider for children and young people in the future.
The first in a series of career events to support young carers will be held by West Yorkshire and Harrogate Health and Care Partnership in the spring. There are around 260,000 adult carers living across West Yorkshire and Harrogate in Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield. This number includes thousands of young carers taking on a caring role from as young as six years old. Often they are caring for parents who have long term health conditions, mental health difficulties, experience alcohol and substance use/misuse.
Many young carers find it difficult to cope with the added pressure of education and exams with many feeling socially isolated and unable to take part in after school and weekend activities. Juggling caring responsibilities with their school work and social development puts them under tremendous pressure when it comes to studying for their exams or considering their career aspirations and opportunities. This can result in lack of confidence, low self-esteem and in some cases depression or mental health problems – areas of concern we very clearly want to address.
Rob Webster, our Partnership CEO lead took part in an evening healthcare and technology panel on Monday. Rob gave a presentation on local growth, health as a driving factor in the economy and the importance of bringing innovation into the area to secure employment opportunities for sustainable communities.
The Primary Care and Community Service Programme Board met on the 6th February. The meeting presented an opportunity to review the board’s work streams and priorities reflecting on recent publications including NHS Long Term Plan and Planning Guidance and GP Contract Framework. Primary care networks / communities featured heavily in the discussion and how the board can add value to the system maintaining breadth across Primary Care and Community Services. The board agreed to work up the refreshed priorities for May.
High risk smokers in the North Kirklees area are to benefit from a £4.5million targeted lung health check scheme, designed to identify a range of health problems and speed up access to potentially life-saving treatment, an NHS England announcement has confirmed today (February 8).
One of 10 schemes being launched today by the NHS England Cancer Programme, North Kirklees is part of the £70million Targeted Lung Health Checks project – and one of the first to be rolled out following the recent publication of the NHS Long Term Plan. People in parts of North Kirklees aged between 55 and 74, who currently smoke or who have ever smoked, will be offered a free lung health check in the community close to their home, along with access to specialist stop smoking advice and appropriate follow-up, including low dose CT scanning, if needed.
This brings to four the total of lung health check schemes already in place or planned across WY and Harrogate, although there are variations in the way they have been developed, will be managed and delivered at local level.
The WYH Cancer Alliance announced in early 2018 that it would be developing two lung health check schemes under its Tackling Lung Cancer programme in Bradford and Wakefield. Like North Kirklees, both areas have a high proportion of smokers and high lung cancer mortality rates. The Leeds Lung Health Check is a multi-million pound research project, launched in November last year, and developed in partnership through Leeds Teaching Hospitals, Yorkshire Cancer Research, the University of Leeds and Leeds City Council.
Cancer Alliance Clinical Lead, Professor Sean Duffy, said: “Lung health check schemes bring huge benefits in spotting a wide range of illnesses, including bronchitis and emphysema – not just cancer – and it’s an opportunity to access support, advice and potentially treatment much earlier than might otherwise be the case. However, it does also move us towards our ambition of making more cancers curable by increasing the number of patients diagnosed at stages 1 and 2, at which point treatment leading to cure is more likely.” Please contact email@example.com for more info.
West Yorkshire and Harrogate’s Healthy Hearts scheme aims to help reduce the risk of heart attack and stroke for people at highest risk. Find out more on the new website at West Yorkshire and Harrogate Health and Care Partnership here