This week’s partnership message is sent from Dr Andy Withers, Chair of West Yorkshire and Harrogate Clinical Forum and Chair of NHS Bradford Districts Clinical Commissioning Group (CCG) governing body. You can find out more about our partnership here.

Welcome to my first update for the STP leadership in my role as Chair of the West Yorkshire and Harrogate Clinical Forum. The Clinical Forum is made up of GPs who are the Chairs of the 11 Clinical Commissioning Groups, medical directors from the hospital trusts in the STP area, NHS England representatives and two nurses, one from a commissioning group (Jo Harding) and one from a hospital (Karen Dawber).

Clinicians are often the people closest to the fears, dreams and aspirations of those we serve. As such it is important that we are deeply embedded in both the design and delivery of services. We are often in a prime position to understand the interdependencies between services, and to understand the reasons why things don’t always work as they should. Above all we need to improve health outcomes and how they should be monitored.

We need to have conversations with politicians and the public about potential service change so that together we have a good understanding of a person’s experience and work to promote behaviour change in both clinicians and the public.

The solutions to too many problems are often not health-related and it is vital that we work hand in hand with local authorities and community organisations.

Joanne Crewe (Director of Quality and Governance/Executive Nurse for Harrogate and Rural District CCG) and I attended the first national network of STP and Accountable Care System (ACS) clinical leaders last week in London, held at the same time as a meeting for STP Leads around the corner.

The event was about describing clinical leadership in the STPs/ACSs and the importance of working collaboratively across boundaries to build trust and better outcomes for people. Sir Bruce Keogh, NHS England’s National Medical Director, described the need for a clear clinical narrative about what an STP is for; needing to be clear on what changes need to be made and how we are going about making those changes. He described the ambition of subsidiarity and local freedom but acknowledged that NHS trust is important when things get tough. He felt there is a gap for clinical leadership in the space between central NHS management and local design and accountability.

There was an opportunity to ask Simon Stevens, NHS England’s Chief Executive, and Jim Mackey, Chief Executive of NHS Improvement questions and to discuss clinical leadership in practice with other STP clinicians.

My reflections on the day are that we need a clear clinical narrative to articulate our local ambitions giving people the confidence and assurance that where appropriate our STP is clinically led and evidence based. You can see example of this in the engagement work on stroke. I think there is a challenge for us as clinical leaders to develop and champion this and not just provide an assurance role.

At our Clinical Forum meeting on Tuesday we also discussed the importance of clinical engagement and the importance of working across primary and community care (general practice and social care) and secondary care (hospitals) to ensure we are all on the same page. We agreed that there is more work to be done to deliver that ambition on subsidiarity and local freedom.

Getting the maximum value from referrals made by primary care is important to achieving the ambitions of our STP and most importantly improving health outcomes for people.

Forum members discussed the need for a coherent and consistent planned care programme which works across all care providers and commissioners in West Yorkshire and Harrogate in order to ensure people get the right care, at the right time in the right place across our six local places.

There is a big opportunity to standardise our commissioning policies and reduce unwarranted differences for people receiving health and social care across West Yorkshire and Harrogate – often referred to as a ‘postcode lottery’.

We need to support people to think about managing their own health before they need medical treatment and to optimise their health before they receive elective care in order to improve their outcomes. A good starting point is looking at the conversations we have with people and perhaps the use of motivational interviewing and decision aids.

Clear clinical engagement and leadership is required to create a movement for change, especially if we are to tackle health inequalities. The last thing we want to do is widen the gap and disadvantage people.

Communications between clinicians has never been more important and a shared clinical vision across all sectors of health is vital if we are to improve outcomes. It is all about supporting person-led care, preventing ill health and high quality timely care when you need it, across all of the work we do.

Good conversations are already taking place with commissioners and colleagues representing primary and community care, West Yorkshire Association of Acute Trust, the Academic Health Science Network and NHS England. The STP gives us the opportunity to work together and share learning.

Health care systems only really work where there is real collaboration, trust, and where there is a clear focus on the person. We know system working fails mainly due to culture and trust, and our STP gives us a real opportunity to think how we work as clinicians across the system to develop the trust and shared culture and vision, and how we prioritise the time to work this through.

Have a good weekend

Andy

What else has been happening this week?

Joint Committee of the 11 Clinical Commissioning Groups

Marie Burnham, Independent Lay Chair for the CCGs, chaired the meeting on Tuesday. There was a discussion around the work plan and the role of clinical engagement of primary and secondary care in our decision making throughout all our WY&H programmes. It is important that clinicians are fully engaged in the work of the Joint Committee.

Amanda Bloor, Chief Officer for Harrogate and Rural NHS Clinical Commissioning Group introduced a conversation on cancer and how we can share learning across the area to improve health outcomes for people.

Sean Duffy, Clinical Lead for West Yorkshire and Harrogate Cancer Alliance Board explained that more people are living with cancer than ever before. The Alliance Board are keen to develop their role to deliver a consistent offer to people, including quality of outcomes and experience based on common clinical standards, common pathways, common protocols.

Carol McKenna also gave an update on the new specification for integrated urgent care, which covers NHS111 and West Yorkshire out of hours service. It is important to come to an agreement on key principles for primary care extended services in relation to the impact on the out of hours service currently commissioned.

System Leadership Group

The STP leadership met earlier this week. Rob Webster, CEO Lead for West Yorkshire and Harrogate STP gave an overview on national priorities, including winter planning and the role of our regulators such as NHS England, NHS Improvement and the Care Quality Commission in terms of supporting organisations as well as monitoring care delivery.

Rob also gave an overview on the progress on the draft plan published in November 2016 and the ambitions for our partnership for the future. This must be backed by credible local plans and finances. At the session, people worked together in groups to discuss financial planning and the challenges and potential solutions.

Cancer Alliance Board update

Transformation funding

West Yorkshire and Harrogate’s Cancer Alliance has secured almost £1million of additional transformation funding to support developments in Living With and Beyond Cancer.

In the initial round of bids to the national Cancer Transformation Fund earlier this year, the Alliance secured £12.4million to support work to improve early diagnosis and make more cancers curable through a range of projects and interventions. This second successful bid will support work to improve access to the so-called Recovery Package – part of an overall support and self-management package for people affected by cancer – and also the development of follow-up pathways.

The Recovery Package is recognised in the Five Year Forward View and the National Cancer Strategy, which commits to ensuring that every person with cancer has access to its four elements by 2020. More specifically, these are; a Holistic Needs Assessment and Care Plan; a Treatment Summary; a Cancer Care Review, and access to Health and Wellbeing Events.

Click here for more information on the Recovery Package.

The initial phase of the work between now and March 2018 will focus on assessing the current position, sharing best practice and working with providers on plans to speed up access to the Recovery Package and to tackle significant variations. The focus will be on complete Alliance-wide coverage in the four most common cancers (breast, colorectal, prostate and lung) as a minimum in the first phase. However, places making faster progress will be supported to expand and cover other less common cancer sites and support Alliance wide learning and sharing.

Between January 2018 and March 2019, work will concentrate on designing and developing a business case to deliver personalised holistic health/wellbeing services embedded in local communities, building on existing place-based approaches to supporting people with co-morbidities.

Living With and Beyond Cancer

Living With and Beyond Cancer is one of the priority workstreams of the West Yorkshire and Harrogate Cancer Alliance. Although more and more people are living with the consequences of cancer and its treatment, there is still considered to be a lack of research in this important area.

The National Cancer Research Institute is looking to address this and has opened a new survey for patients, the people who look after or have looked after them, and the professionals who work with them, to identify the most important questions that new research should address.

The survey will be open until 15 October 2017. Click here for more information about the project. Click here to take part in the survey. Please spread the word far and wide to make the survey as relevant and comprehensive as possible.

The sixth national specialist adult cancer nurse census

The sixth national Specialist Adult Cancer Nurse census will take place on Monday (9th October), one of four pieces of work being carried out by Macmillan Cancer Support to provide an overall baseline assessment of the cancer workforce in England and Wales.

This year’s assessment will be more comprehensive than the previous specialist adult cancer nurse census of 2014. More roles and professional groups will be included to help build a better understanding of the size and shape of the NHS employed workforce – based in hospitals and in the community – supporting people with a cancer diagnosis part or all of the time. Roles covered include specialist adult cancer nurses (CNS or equivalent); adult chemotherapy nurses; palliative care specialist nurses who frequently see cancer; registered nurses who frequently see cancer, and healthcare assistants who frequently see cancer. Local Macmillan representatives have been working to ensure that Directors of Nursing, Lead Cancer Nurses and the specialist adult cancer nursing workforce are aware of how to get involved.

A report will be produced in early 2018 to highlight any key changes in the workforce covered by the census and to identify where further workforce development could improve the outcomes and experience of care for people with cancer.

What’s happening next week?
  • The Standardisation of Commissioning Policies Programme Meeting takes place on Tuesday.
  • STP place based planners meeting takes place on Tuesday.
  • West Yorkshire patient experience network meets on Tuesday.
  • WY&H programme leads meet on Thursday.
  • Maternity Voices Partnership Task & Finish Group meets on Friday.