This week’s leadership message comes from Andrew Furber, Centre Director at Public Health England, Yorkshire and the Humber

Posted on: 23 August 2019

Whose job is it?

I met her during my first job as a junior doctor at Newcastle General Hospital. For the sake of confidentiality, here we’ll name her ‘Margaret’. It was the middle of the night and I’d been called in as the duty doctor. The building’s architecture betrayed its workhouse origins. The curtains drawn around Margaret’s bed did little to give her the privacy she deserved. Her shallow, laboured breathing would have been distressing for her had it not been for her diminished consciousness. The nurse gave me an update and I quickly scanned her notes but before either of us could do anything, Margaret literally breathed her last.

None of us like being told how to live our lives. I’m as against the nanny state as anyone. We impose our middle-class sensibilities on those in very difficult circumstances at our peril. Margaret died of chronic obstructive lung disease in her early 60s. Her smoking habit of more than 40 years had taken its devastating toll, not only in an early death but decades of increasing disability. Many years of healthy life she was denied with her husband, children and grandchildren.

Whose job is it to prevent such tragedies being repeated? Is it up to the government by controlling price and regulation? Or is it up to Trading Standards by controlling illicit tobacco? Or Public Health England through our marketing work? Local authorities through their commissioning of stop smoking services? Individuals by the choices they make?

The international evidence is very clear. Tobacco control strategies need to be comprehensive to be effective. The NHS Long Term Plan now presents a brilliant opportunity to build on the existing work across West Yorkshire and Harrogate, such as that led by local councils, which has helped support around 23,000 people to no longer smoke. Work is on track to deliver the ambition of a reduction in smoking rates to 13% by 2020/21, including campaigns like Don’t Be The One and the North wide Quit 16 campaign launched recently. Seeing stop smoking support as part of good clinical care, ensuring our sites are all smoke-free, helping staff who smoke to quit and adding the NHS voice to the coalition of partners working to ensure the next generation grows up smoke-free will all make a big difference to help everyone working in the NHS to be a part of this cultural shift to incorporate prevention.

The Long Term Plan ambitions go well beyond smoking. It describes the support the NHS will provide to help those with drinking problems, reduce the risk of Type 2 diabetes, with a focus on the communities and groups of people most affected by these problems.

The Alcohol Liaison Service at Mid Yorkshire Hospitals NHS Trust (Pinderfields) is an example of the good work, already estimated to have saved the NHS £1.5 million, that could be rolled out across the rest of West Yorkshire and Harrogate to help save lives and reduce harm for people, their families and wider society (read more here). And we also look forward to the Yorkshire and Humber Alcohol Alliance launching the first TV-led alcohol health harms campaign in our region in September. The campaign, supported by national charity Breast Cancer Now, highlights the links between alcohol and breast cancer and encourages people to reduce their alcohol consumption to reduce the risks.

We know that our health is determined by the circumstances in which we live. The Long Term Plan acknowledges this by recognising the contribution the NHS can play in improving air quality, through procuring in a way that contributes to local economic development and as a major employer giving young people their first step on a fantastic career in health and care.

Can the NHS deliver all this alone? I doubt it, which is why the partnership arrangements in West Yorkshire and Harrogate are so fundamentally important. Local authorities and our voluntary and community sector are the experts at lots of this stuff.

Smoking rates are falling but it remains our leading cause of premature ill health, death and inequalities. If asked, three out of four smokers will tell you they want to quit. Whose job is it to help them? We all have a part to play. Let’s make sure there are fewer families like Margaret’s who lose their loved ones too soon.

Have a good bank holiday weekend,
Andrew

What else has been happening this week?

Urgent and Emergency Care Programme Board check and confirm session

These aim to offer peer support to programme areas such as cancer and mental health. The urgent and emergency care ‘check and confirm’ session took place this week. The Programme has been developing over the last 3 years and we have been looking at what other integrated care systems have been doing. Our programme has a significant role in supporting relationships across the Partnership and sharing good practice is a key part of the programmes work in terms of identifying implemented changes and how findings be replicated. The programme also agreed to support phase two of the ‘Looking out for our neighbours’ campaign. More information will follow.

West Yorkshire and Harrogate Local Maternity System

The role of the Local Maternity System (LMS) is to bring together maternity services across West Yorkshire and Harrogate. This includes working with a large number of partners including neonatal services, Yorkshire Ambulance Service, councils and primary care. The Board met on Monday and was chaired by Carol McKenna, Chief Officer of Greater Huddersfield Clinical Commissioning Group and North Kirklees Clinical Commissioning Group. Carol is one of two chairs for the Board – the other is Anne-Marie Henshaw, Assistant Director of Quality and Safety at Calderdale and Huddersfield Foundation Trust. The Board discussed the following:

The West Yorkshire and Harrogate LMS has been updated in response to the NHS Long Term Plan.
The LMS Board heard about the work around Networked Maternal Medicine with the Yorkshire and Humber Clinical Network to produce a vision for this specialist service across the region.
The LMS have been undertaking some work on preventing Pre Term Births and the Board acknowledged the need to set up a task and finish group to ensure the ambitions of the programme are met. Dr Chris Day provided an update on neonatal provision across West Yorkshire and Harrogate and highlighted the importance of the working together with the LMS.
The Board acknowledged the significant amount of work that has taken place to achieve the LMS ambitions. It was noted that achieving the target of placing 35% of women on a continuity care pathway is a challenge for all Trusts in West Yorkshire and Harrogate and on all risk registers. It was noted a significant amount of work was taking place to address this.
The Placental Growth Factor test is a blood test which allows improved diagnosis if Pre- eclampsia is suspected. The test offers clinical teams the ability to better manage risk and provide appropriate care to the woman and her unborn baby. The Board discussed the potential of delivering this test across the system. Further work will be undertaken with clinician’s and hospital trusts to explore the implementation of this concept.
An update on the workforce included developments on standardisation of preceptorship, entry level midwife recruitment and leadership opportunities. A business case to progress preceptorship work was submitted to the Local Workforce Area Board. As a result of this the LMS was successfully awarded £45,000. There was also an agreement to proceed with work on a system wide approach to maternity support workers.

Over the next three months LMS Roadshows will be held in each Trust to share the work and engage staff.

You can find out more about the LMS on our website here.

West Yorkshire and Harrogate Personalised Care Programme

The West Yorkshire and Harrogate Personalised Care Programme Board met on Wednesday. Personalised care means that people will have choice and control over the way their care is planned, based on what matters to them. It recognises the valuable contribution of communities and voluntary and community organisations to support people and help build resilience. There was good representation at the meeting from across the area with colleagues working in councils and for the NHS in the room. There was a discussion on plans to engage with other programme areas, including hospital trusts and the opportunities for embedding shared decision making; social prescribing and community links into the work. There was also an update on COPD and the work of the Academic Health Science Network to explore how we can add value and prevent unplanned hospital admissions by introducing shared decision making in use of medications. The importance of working with people with learning disabilities to explore what good social prescribing looks like and the role of personalised care and support plans to add value to health checks were also discussed. Thanks to colleagues for their presentations on maternity, cancer and theunpaid carers programme.

System Oversight and Assurance Group (SOAG)

The Partnership’s System Oversight and Assurance Group (SOAG) meet today. This group has been established to take an overview of progress with our shared priority programmes, and to agree collective action to help tackle shared challenges. This week’s discussion will include an update on cancer; maternity, West Yorkshire Association of Acute Trusts (hospitals working together), unpaid carers and the work of the digital programme. There will also be an update on finance.

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