This week’s leadership message comes from Alistair Walling and Justin Tuggey

Posted on: 31 July 2020

This week’s leadership message comes from Alistair Walling and Justin Tuggey, joint Chief Clinical Information Officers (CCIOs) for the West Yorkshire and Harrogate Health and Care Partnership. Alistair is a GP and the CCIO for the city of Leeds, whilst Justin is a respiratory consultant and CCIO for Airedale NHS Foundation Trust.

Hello our names are Alistair and Justin

Justin Tuggey Alistair Walling The last few months have been challenging times for all of us; but they have also shown the value of working together and working together across the whole Partnership has never been more important to support the people and populations we serve.

We have witnessed incredibly rapid clinically led acceleration of digital transformation to meet the needs of people. We also saw a wholescale change to digital first primary care within a week and massive increases in none face-to-face contacts across the entire health and care system. In secondary care most outpatient consultations have moved rapidly overnight to telephone and video. Solutions have been implemented that meet the clinical need of people and staff.

In primary care one example of this is the widespread use of a simple solution for video - one in many ways less advanced than more integrated offerings from major primary care suppliers, but one which in its simplicity delivers ease of use for all clinicians and people who access care. Most prefer to utilise the telephone but e-consultations, video calls and some masked face to face contacts all play their part.

Teams meeting Times of crisis are not the best time to undertake completely new ways of working but this approach actually feels more like accelerated evolution. Online consultation in Alistair’s practice increased 1000% at the start of the pandemic and has continued at this level as patients engage in this new approach. Video for working beyond the immediate clinical use has been rapidly rolled out, supporting colleagues working remotely and transforming the way we meet and interact. Love it or hate it, Microsoft Teams is likely to be here to stay!

Many community teams already worked remotely and have responded well, managing their patients in this way and seeing only when essential. Mental health services have again moved to large scale remote consultation options, largely continuing their normal caseloads. Secondary care, for example hospitals, has had to manage the seriously ill cases from COVID-19, and has steadily increased its use of phone and video consultations to manage the outpatient work and continues to remove paper from its workflows.

There are huge opportunities to overhaul how we manage the triage of referrals from primary to secondary care, with faster turnaround with virtual advice (Advice and Guidance, eConsults), straight to test, and telephone/video consultations and leaving only face-to-face secondary care consultations when it is absolutely necessary and adds value to the clinician-patient interaction. Triage is a process of determining the priority of patients' treatments by the severity of their condition or likelihood of recovery with and without treatment.

Clinical staff using computers We have started to see some early progress of technologies such as home monitoring devices and use of voice recognition software to support clinicians. These tools are showing promising signs for the future. Care homes have come under the spotlight during the pandemic, and we must ensure that care homes are truly integrated into the health and care system. Fully cross sector multi-disciplinary teams have been established virtually with primary, secondary, community and social care as well as care home staff. Digital capacity tracker for care homes, including occupancy, COVID-19 prevalence and personal protective equipment (PPE) availability are one of the initiatives that was enabled to be rolled out in some areas rapidly during the pandemic.

As we move into stabilisation and reset phases it is vital that we take stock and evaluate these new adaptations to see what changes should continue to our way of working. It is vital we respond as an entire system and understand each other’s challenges as well as strengths. With social distancing, PPE use, self-isolation rules and concerned patients not to mention tired staff, it has never been more vital to work together effectively to help people as best we can.

We must also be mindful of the new challenges that are expected over the coming weeks and years- late presentations, a surge in mental health cases, patients with long waits for specialist care (getting potentially sicker), and the consequences of an increase in unemployment and a recession to list just a few.

With all of this and relentless focus on patients comes the need to ensure that we tackle digital literacy and exclusion. We must support our citizens to take advantage of the digital opportunities (both through access and skills development), including the third sector organisations that provide invaluable support. We must also be mindful that digital literacy and exclusion also extends to our staff. We must make sure that people who can’t use digital solutions are able to access the same level of health and care and that our changes do not widen the deprivation gap or indirectly discriminate against people. It’s really important that we keep this firmly in view and not widen health inequalities.

Yorkshire Imaging Collaborative True system working needs digital systems sharing structured data that is accessible to clinicians; when and where they need it through better integration and interoperability. We need to help patients to have access to appropriate information so they can understand their conditions and be supported to make the right decisions and be empowered to care for themselves when safe and appropriate. We need accurate up to date information to help us evaluate and understand our services and plan our care intelligently. We need to work with our research colleagues to utilise data safely and appropriately to continuously improve the care we are able to provide. Through the Yorkshire and Humber Care Record, Yorkshire Imaging Collaborative and other projects across our region we can make strides to improve these areas if we focus together on improving the care of people. We must also work together to increase the digital maturity across our six local places (Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield), implementing and enabling tools to truly deliver integrated care.

Despite all the challenges we also have an opportunity, both at a local and West Yorkshire and Harrogate level. Not to restart where we were before but to deliver truly integrated person centred care - not because of an ideal but because it is more effective and better for people (both our patients and staff). We can use technology in a way that makes a positive difference to us and the lives of our patients; challenging the need for appointments and long waits, supporting home working where appropriate and changing our processes to deliver the best care for people. We have a lot going for us in our region, and we believe together we can come out of the current pandemic even stronger.

Stay safe and have a good weekend,
Alistair and Justin.

What else has been happening this week?

Government restrictions across parts of West Yorkshire

The government has imposed additional restrictions across Bradford, Calderdale and Kirklees mainly around mixing of households from Midnight Thursday. The areas that these changes apply to are:

The Greater Manchester area
Pendle
Hyndburn
Burnley
Rossendale
Blackburn with Darwen
Bradford
Calderdale
Kirklees
Leicester City

Local councils are waiting for further guidance. You can read more here. There is also more information on what it includes here.

Primary and Community Care Programme

Partner colleagues from our Primary and Community Board took part in a North East and Yorkshire accelerated solutions event last week. Organised through the North East and Yorkshire Primary Care Cell and led by Helen Bevan, a well-known transformation leader, and her team, there was the opportunity to showcase some of our programme’s work in response to COVID-19. This included recognising the partnership efforts of colleagues to support people who were shielding and the importance of joined up care across all sectors.

West Yorkshire, Test, Trace, Isolate Programme

The West Yorkshire, Test, Trace, Isolate Programme met on Friday. It includes colleagues from public health and the NHS. The senior responsible officer for the programme is Martin Barkley, CEO for Mid-Yorkshire Hospitals NHS Trust.

Bradford, Calderdale, Kirklees and Wakefield are in the top 10 most watched list in the country. This is based on various indicators and assessment of local response and plans. This includes area outbreaks which cross geographical boundaries, positivity rates from high number of tests etc. You can read the latest reports here. There is a lot of hard work taking place across the area, led by councils and Public Health England to inform and give national assurance.

The Personal Protective Equipment (PPE) Programme Group

The Personal Protective Equipment (PPE) Programme Group met last Thursday. The meeting was chaired by Mel Pickup, CEO for Bradford Teaching Hospitals NHS Foundation Trust. The purpose of the group is to ensure PPE supply chain arrangements are in place to maintain, manage and forecast need. The group includes colleagues from across the Partnership, including clinicians, procurement /supply specialists and representation from West Yorkshire Local Resilience Forum (LRF) and NHS England. The work also covers primary care, smaller healthcare providers and new representatives will be joining the group. Clinical reference and procurement sub-groups support the programme.

Across West Yorkshire and Harrogate, work is underway to project the amount and type of PPE required in different health and social care settings as we restore the system and plan from now until March 2021. The PPE Programme Board will continue to meet until at least March 2021.

An update on the programme’s work will be shared with WY&H HCP System Leadership Executive Group in August. This will include an overview of the way we worked before the programme board was established without a coordination process in place. Supply chains, supply routes and supply disruption will be discussed.

The “Adopt & Adapt” Surgery Programme

The “Adopt & Adapt Surgery” Programme has been established as part of the National Incident Response Board strategy to accelerate recovery – with a particular focus on the acute hospital sector.

The approach is similar to that taken in Phase 1 to rapidly increase critical care capacity. Using short time frames and incident co-ordination methodology, the programme will work with five lead regions across five priority areas; including outpatients, surgery and cancer.

Within the North East and Yorkshire region, West Yorkshire and Harrogate has been asked to be the lead system for surgery as part of the programme. Our work will focus on how we can safely increase surgical capacity to mitigate the capacity reductions due to COVID-19. This is a rapid piece of work with the outputs for adoption by other regions completed in early August. There will be workshops taking place over the next few days and an update to our System Leadership Executive Group Meeting on 4 August 2020.

Improving uptake of bowel, breast and cervical screening

cancer screening survey As reported on the comms and engagement network call on Friday, the West Yorkshire and Harrogate Cancer Alliance will be launching a number of surveys to gain insight into how the numbers of people taking up bowel, breast and cervical screening can be increased across West Yorkshire and Harrogate. This work forms part of the Alliance’s Healthy Communities work programme - more here. The surveys went live on Wednesday.

The Alliance has worked with Leeds-based creative communications/behavioural change agency Magpie on three surveys to capture knowledge, attitudes and opinions from targeted groups on the screening programmes. These will then be followed by a series of co-creation sessions based on the survey responses. The insight will then be used to support the development of three separate campaigns to raise awareness of the individual screening programmes, and the importance of being screened. The earlier cancer is diagnosed, the more likely it is to be treatable or curable.

The surveys take around 20 minutes to complete, and their final format has been determined in partnership with members of the Cancer Alliance patient panel. For each survey completed, we will be donating £5 to a chosen charity (selected by participants) up to a total of 200 responses.

A ‘supporters pack’ is being finalised, which will outline briefly the purpose of the surveys; direct links to all the surveys, and also the associated graphics and sample social media post content. The graphics will be kept under review and developed as the timeline progresses. Note that the surveys will NOT be Cancer Alliance branded. These packs will be provided to all members of the West Yorkshire and Harrogate communications and engagement network in the next day or so, and your support would be appreciated in promoting the surveys.

West Yorkshire Vascular Service (WYVaS)

Vascular surgeon Neeraj Bhasin The aim of this programme is to establish a single, shared West Yorkshire Vascular Service for Airedale, Bradford, Calderdale and Huddersfield, Leeds and Mid Yorkshire NHS Trusts, with two arterial centres in line with the recommendations of the Yorkshire and Humber Clinical Senate. Read more about the aim of this programme here.

A virtual 'WYVaS - One Year On' event was held on Thursday 9 July, 2020 via Microsoft Teams, with 40 colleagues in attendance. The event marked a year on from the WYVaS launch event in May 2019 at NHS Horizons in Leeds. At this informal event, colleagues from across WYVaS shared some of the work completed to this point and also discussed future plans for the service.

A Shared Competency Portfolio for WYVaS Nurses is in development. A competency portfolio is being designed to help identify the development needs of vascular staff nurses across WYVaS. The team is developing a standardised package for use in both arterial centres.

Yorkshire & Humber Care Record

Yorkshire and Humber Care Record logo We’re successfully maturing the Yorkshire & Humber Care Record with some further developments which will also help provide some key benefits in supporting COVID-19 care. Yorkshire & Humber Care Record (YHCR) is joining up health and care organisations across the region to support patient care. Due to our current national situation we have accelerated the work around automating vital document transfer that can be shared and viewed by frontline health and care workers. The significant development is:

Digital Access to Yorkshire Ambulance Service (YAS) Transfer of Care Documents

We have now connected Leeds Teaching Hospitals NHS Trust to the Transfer of Care documentation that Yorkshire Ambulance Service (YAS) creates when conveying patients across the region. This automates the transfer of the YAS electronic Patient Record (ePR) (pre-hospital care record) into the Leeds patient records and allows for a rapid and smoother process in administration when receiving a patient into acute care – saving time and resource. It also helps to ensure the clinical and care staff are provided with up-to-date information at an appropriate time which will benefit the patient’s care.

Andy Webster, emergency medicine consultant and Chief Information Officer at Leeds Teaching Hospitals NHS Trust said, “A&E is fast moving and we require the technology we use to help us do our job efficiently and safely. Receiving the Transfer of Care documentation as an automated process speeds up the process considerably from transferring the patient from the care of the paramedics to the A&E team. It also removes a manual process our reception team have been doing saving them valuable time. Congratulations to the team who have worked diligently to ensure what we’ve achieved improves clinical safety and is secure.”

Tara Bain, assistant patient services coordinator for A&E at Leeds Teaching Hospitals NHS Trust added, “Since implementing the new system within the Emergency Department, the feedback I have received has been nothing but complimentary – it takes the reception staff a fraction of the previous time to save an ePR record allowing them to deal effectively with patients whilst clinical staff have access to the clinical information required from ePR on PPM+ without any delay. From planning to implementation we have felt really supported by the wider teams and are confident that this will continue to be successful.”

Dr Steven Dykes, Deputy Medical Director at Yorkshire Ambulance Service NHS Trust, said: “This is a great example of partnership working between health and social care organisations as part of the Yorkshire & Humber Care Record (YHCR) programme. The sharing of patient information supports better patient safety, experience and outcomes and is a valuable extension of the excellent in-house development of our electronic Patient Record (ePR). This is just the start of our collaboration with YHCR and in the future it will include accessing care plans which will further benefit patient care.”

It is anticipated that Rotherham NHS Foundation Trust will be next to join up to the system so they can also benefit from this development.

West Yorkshire and Harrogate Grief and Loss Support Service

Loss and grief support service The Grief and Loss Support Service launched across the area at the end of June is available for anyone needing help. It provides a free 7 day a week helpline, operating between 8am-8pm, for anyone experiencing grief and loss across West Yorkshire and Harrogate. The helpline will offer practical and emotional support to people who have lost loved ones and are understandably struggling with their grief, at this sad time. It will also be available to anyone else bereaved during this period.

Developed in partnership across the six local places (Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) which make up the Partnership area, the service will offer both practical and emotional support and be well connected to local place-based specialist bereavement support services. The service will be delivered by a collaboration of providers, including West Yorkshire and Harrogate Independent Hospices Consortium (as lead provider), Bradford Bereavement Services Consortium and Leeds Mind. All information about the service can be found at www.griefandlosswyh.co.uk

Here is one person’s feedback from the support received:

‘I had my call with your service yesterday and all went well. The member of staff (she didn’t give her name) was kind, listened and gave me some helpful suggestions. It’s very good to know that I can get back in touch with the service at any time.

I think it’s made me realise that I need some specialised help. Writing to you both has helped to clear my head a bit. Seeing things written down in black and white like that has shown me that the counselling, the call yesterday etc. that I’ve had, though all very good and helpful, haven’t been enough for me.

Thank you for your help, kindness and compassion. It’s meant the world to me and has really helped me such a lot. The service is so much needed and I feel sure that it will help a great number of people in West Yorkshire. We are very fortunate to have you all’.

Local Maternity System shares good practice to benefit women and families

My Pregnancy Journey The West Yorkshire and Harrogate Local Maternity System (LMS) is launching a new set of recommendations brought forward by the LMS Prevention Steering Group and developed by professional expert groups that aim to improve the health and well-being of women, before, during and after pregnancy. The recommendations are intended to lay the foundations of lifelong health for children and families.

Colleagues from across all six local councils Public Health Teams, maternity, health visiting, NICE, Public Health England and community and voluntary organisations across West Yorkshire and Harrogate have been sharing good practice on a range of topics including smoking in pregnancy, alcohol use and abuse, infant feeding, maternal nutrition and more. These approaches will form the basis of the recommendations that will be implemented across the LMS over the coming months.

Local Maternity System Programme Director Karen Poole said: “We hosted a virtual conference attended by more than 100 people that successfully brought these ideas and approaches to the team of people who work with women and families across the six places that make up the West Yorkshire and Harrogate Health and Care Partnership.

Our Health and Care Partnership is committed to enhancing our focus on reducing health inequalities, supporting what is being delivered in place and as set out in our five year strategy. We are looking forward to seeing how these best practices are adopted across the whole area and how the benefits filter through to the women and families who need them the most.”

Watch this film to find out more about the recommendations and the work of the Prevention Steering Group.

We are the NHS: People Plan for 2020/21

NHS people plan NHS England, NHS Improvement and Health Education England published the Interim People Plan in June 2019. Its central themes – more people, working differently, in a compassionate and inclusive culture – are even more important now than they were then.

The pandemic has created real difficulties, laying bare how our NHS people’s lives can be deeply personally and professionally challenging. It has further revealed inequalities, shining a spotlight on the urgent need to address the safety and experience of our colleagues from ethnic minorities.

We are the NHS: People Plan for 2020/21: aims to make real and lasting change, building on the creativity and drive shown by our NHS people in their response to the pandemic. It is practical and ambitious, setting out the focused action that NHS people have told us they need right now, and for the rest of the financial year. It includes specific commitments around:

Looking after our people – with quality health and wellbeing support for everyone
Belonging in the NHS – with a focus on tackling the discrimination that some staff face
New ways of working – effective use of the full range of our people’s skills and experience
Growing for the future – how we recruit, train and keep our people, and welcome back colleagues who want to return.

Published alongside the People Plan, 'Our NHS People Promise' challenges us all to make the NHS a better place to work. Its themes and words come from colleagues who work in the NHS, who told us what would improve their working experience. Colleagues, line managers, employers and central bodies must work together to make these ambitions a reality for everyone over the coming years. Further action for 2021/22 and beyond is expected to be set out later in the year, once funding arrangements for future years have been confirmed by the government. The arrival of COVID-19 acted as a springboard, bringing about an incredible scale and pace of transformation, and highlighting the enormous contribution of all our NHS people. The NHS must build on this momentum and continue to transform – keeping people at the heart of all we do. You can read the report here.

There are also some case studies here. They include:

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