Posted on: 5 July 2019
Hello, my name Is Ian.
This week we have been discussing the development of our Partnership’s Five Year Plan which we hope to publish by the end of the year.
You may recall that in 2018, the government announced that the NHS budget would be increased by £20 billion a year. In January 2019, the NHS in England published a Long Term Plan for spending this extra money, covering everything from making care better to investing more money in technology and helping more people stay well.
Alongside other Partnerships like ours (also known as integrated care systems and sustainability transformation partnerships) we are developing a Five Year Plan which will set out how we will achieve the ambitions of the NHS Long Term Plan for the 2.6million people living across West Yorkshire and Harrogate.
Now is the right time to do this. Our Partnership published ‘Our Next Steps to Better Health and Care for Everyone’ in February 2018. In the past 18 months our Partnership has developed significantly – both in terms of what we have achieved so far, and in the scope of our ambitions for the future.
Alongside our current priority programmes, which include cancer, urgent care, mental health, and maternity, our Plan will include a stronger focus on supporting carers and preventing ill health. It will also set out how we intend to support children and families more, whilst tackling health inequalities and improving the lives of the poorest, the fastest. This will ensure our existing work aligns fully to the ambitions of the NHS Long Term Plan and that of our Partnership Board.
The importance of joining up services for people at a local level in Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield will remain at the heart of our refreshed Five Year Plan. This will ensure all decisions on services are made as locally and as close to people as possible.
With this firmly in view, our Five Year Plan will describe 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 people living across the area. The approach we will take is in line with the recently published ‘Interim NHS People Plan’ and also our own workforce plan ‘A healthy place to live, a great place to work’.
Our Plan will also recognise 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 our paid workforce.
As work on our Plan gets under way over the summer, ambition must be joined with realism, transformation and sustainability. Framing the ambition around improving people’s health and working with staff and the public offers the best opportunity for the future.
So with public involvement firmly in view…
Our system leadership group welcomed the Healthwatch NHS Long Term Plan engagement report findings this week. You can also read our Partnership response to this important report alongside other supporting work on our website.
NHS England and NHS Improvement funded Healthwatch England to support integrated care systems and sustainability and transformation partnerships to engage with their communities and patients groups via their local Healthwatch; the West Yorkshire and Harrogate report outlines local Healthwatch findings from Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield.
Our thanks go to all Healthwatch partners and engagement colleagues for their hard work in developing and delivering this important, timely piece of work. The engagement findings sit nicely alongside our other public involvement work – both at a local and West Yorkshire and Harrogate level.
We are delighted that Healthwatch colleagues reached over 1,800 people with the local survey on digitalisation and personalisation, as well as many others for the long term health conditions national survey. It’s also helpful to read further comments gathered on other areas of our health and care work, including the importance of: ‘partners working together to make it easier and affordable for people to stay fit and eat healthily’, as well as ‘more pro- active support around weight loss’; and concerns around ‘better emergency support for people in mental health crisis’ – an area we are working hard to address together.
It’s also heartening to hear that as well as the surveys, local Healthwatch colleagues have coordinated over 15 focus group sessions across the area with seldom heard people from different equality groups such as those with mental health conditions; dementia and carers, LGBTQ, disability, faith groups and young people. The voice of carers taking part in the focus groups endorses our programme approach that: ‘carers need more support to keep them safe and healthy including regular health checks, respite care and flexible appointments to fit round caring responsibilities’.
We recognise and value the significance of having peoples’ voices at the very heart of all we do and remain fully committed to actively listening whilst taking into consideration these views wherever possible. One report example being around preventing ill health which highlighted: ‘more awareness for both children and parents of long-lasting problems from living an unhealthy lifestyle and the benefits of being healthier’ would be beneficial.
Engaging and communicating with partners, stakeholders and the public in the planning, design and delivery of all our work is essential if we are to get this right. The findings set out in this report will help us to achieve this where we aren’t addressing this already, for example: ‘better use of IT and electronic records’ and ‘to have all trusts having the same computer systems or ones that talk to each other’. You can see examples of the work we are doing to address this here.
It’s interesting to note that people said they wanted to be: ‘listened to, trusted and taken seriously as experts of their own bodies’. This is central to the work we are doing on personalised health care and joined up services. Working alongside partners, stakeholders and the public in the planning, design and delivery of all our work is essential if we are to get this right’.
Effective public involvement, particularly with those who are seldom heard, will ensure that we are truly making the right decisions about our health and care services. We are delighted that Healthwatch has reached so many diverse groups of people. We will be sharing this eagerly awaited report with all our priority programme leads and asking for their response on how they intend to make best use of the findings in their work plans.
This approach is central to our communications and engagement strategy. It’s important to note we are not starting from scratch. West Yorkshire and Harrogate engagement and consultation mapping documents and timelines have been updated and there is a wealth of other expertise via our West Yorkshire and Harrogate priority programmes and local place engagement networks, for example public assurance groups, patient reference groups, and community champions - an asset based approach. We need to make sure we maximise all existing engagement mechanisms without duplication of effort and cost, whilst making the very most of this important Healthwatch engagement report.
All of the above will stand us in good stead as we develop and implement our Five Year Plan.
Finally, following the publication of the NHS Long Term Plan, NHS England and NHS Improvement published an implementation framework last week. The Implementation Framework summarises national commitments alongside further information to help us as a Partnership refine our planning and prioritisation where needed. It is intended to be an operational document to support us to plan. This includes continuing to ensure our Plan is:
- Clinically led with senior clinicians leading development of implementation proposals
- Locally owned, building on existing engagement with local communities with local government as a key partner
- Has realistic workforce planning
- Meeting financial goals set out nationally
- Delivering on all commitments in the Long Term Plan
- Based on local need
- Reducing local health inequalities and unwarranted differences across the area
- Focussed on prevention and preventing ill health
- Joining up health and care services
- Driving innovation.
All individual system plans will be brought together and published as part of a national implementation plan by the end of the year.
I personally welcome the implementation framework and the focus on system working to better join up health and care services for people living across our area, and importantly the emphasis on local place-based partnerships. Put simply a less centralised framework that will help meet the needs of local communities - built by local partnerships from the bottom up. It’s also encouraging to see health inequalities and preventing ill health continue to feature in the framework and the wider determinants of health, such as housing included. The framework also contains several references to the upcoming spending review, and the unclear impact on central government funding in the future. The role of our eight council partners is critical to the delivery of any effective health and social care and improving people’s health and well-being – and this cannot be seen in isolation of one another.
We will keep you posted as our Five Year Plan develops.
Have a good weekend,
Ian
Looking out for our neighbours
We'd really appreciate your feedback so we can improve our campaign to tackle social isolation. The ‘Looking out for our neighbours’ campaign has been running across West Yorkshire and Harrogate since its launch on the 15 March to raise awareness of social isolation in the area and encourage people to do simple things to help their neighbours. The survey should take no longer than 15 minutes of your time. Thank you for your continued support towards the campaign. We will share the campaign evaluation in August.
What else has been happening this week?
Local Government Association Conference 2019 (LGA)
The LGA annual conference took place this week in Bournemouth. It’s the biggest event in the local government calendar, attracting over 1,400 delegates, 130 speakers and more than 100 exhibitors, including council partners, elected members and ward councillors. It provides an opportunity for colleagues to engage in a range of sessions on how innovation and good practice can deliver some of the best local public services for our communities. Guest speakers included the
Communities Secretary Rt Hon James Brokenshire MP at the Local Government Association Annual Conference (read his speech here). There were discussions on ongoing funding pressures, which included concerns over funding statutory children services and other front line community services.
The Local Government Association report ‘What a difference a place makes’ was also published this week. This draws together learning from a number of Health and Wellbeing Boards (including Bradford and Leeds) and contains coverage of the West Yorkshire and Harrogate Health and Care Partnership.
A report on Wednesday was also published on Wednesday regarding the delays to the publication of the social care green paper: One year on: the LGA green paper for adult social care and wellbeing. This includes a section written by Calderdale Council’s Chief Executive, Robin Tuddenham (page 21), where he describes the impact on Calderdale. The LGA has also issued a press release Councils set Government ten-week deadline to publish much-delayed social care green paper to promote the publication of the report.
Working together to develop disability health champions
We want people with learning disabilities in West Yorkshire and Harrogate to receive the best possible care. They are the experts when it comes to knowing what help, support and personalised care they need. We want people with learning disabilities to feel supported to have their say. To help achieve this, we are working with BTM to develop a group of health and care champions with learning disabilities from across West Yorkshire and Harrogate. The work is being supported by a number of partner organisations as well as our priority programme leads, including maternity, hospitals working together, cancer and improving planned care. BTM’s role will be to support specific areas of work where we need the expertise of those with lived experience of learning disabilities to develop our plans and put them into action. Key to this work is breaking down the health inequalities which exist for people with learning disabilities. The first meeting took place on Monday to scope the work and set the priorities for the next 12 months. We will keep you updated as the work develops.
West Yorkshire and Harrogate Clinical Forum
The Clinical Forum met on Tuesday. The meeting is chaired by Dr Andy Withers. It includes medical directors, GPs, pharmacists, allied health professionals and lead nurses.
Forum members received an update from the recent system oversight assurance group meeting. This included the approach to the allocation for flexible transformation funding which was discussed at the Partnership Board meeting in June. There was also a discussion on improving planned care and also mental health – specifically our Partnership approach to suicide prevention.
Kathryn Giles, West Yorkshire and Harrogate Primary Care Programme Director updated Forum Members on the development of the Partnership’s Primary Care Strategy.
GPs are the first point of contact with the NHS for most people and this strategy relates to those services provided by general practice. Primary care is often described as the ‘front door of the NHS’ and provides people with community-based access to medical services for advice, prescriptions, treatment or referral, usually through a GP or nurse. Other primary care providers include dentists, community pharmacists and optometrists. It has been estimated that around 90 per cent of interactions in the NHS take place in primary care. Our strategy goes much further than this – it is all about communities, carers and the work we do alongside our voluntary and community partners.
Every Partnership likes ours must have a Primary Care Strategy covering 2019/20 to 2023/24 in place and approved through their governance structure/programme board. The strategy will be assured by NHS England and NHS Improvement and a draft will be submitted at the end of July 2019.
This strategy is the first West Yorkshire and Harrogate Primary Care Strategy that has been produced. Primary and community care has formed an important chapter in the various Partnership documents that have been produced, including ‘Our next steps to better health and care for everyone’. It is recognised that primary care is locally led in our six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) and Clinical Commissioning Groups have continued to progress the primary care agenda in accordance with their own local commissioning strategies. Working with our eight councils is central to this. Comments and views from the Clinical Forum were sought ahead of the system executive leadership group in the afternoon. Views included ensuring the offer to people who access care is clear whilst taking into consideration the Healthwatch engagement report finding i.e. what will be better for people.
You may have also seen the news this week that around 7,000 surgeries across England have come together to form more than 1,200 primary care networks to deliver a wider range of specialist care services. Local surgeries, where they don’t already, will recruit teams including pharmacists, physiotherapists, paramedics, physician associates and social prescribing link workers – to help people with their wellbeing.
Fatima Shah-Khan, Programme Lead for the Unpaid Carers Programme gave colleagues an update on the work taking place across West Yorkshire and Harrogate. As well as the great work taking place locally, there are various projects delivering integrated support for unpaid carers across health and care to better support unpaid carers across our six places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield).
Our Partnership has been identified by NHS England as an exemplar site and was nationally recognised in last year’s HSJ for its approach to supporting carers. The publication of the NHS Long Term Plan recognises the need to identify and support carers. It also identifies that carers are twice as likely to suffer from poor health compared to the general population as shown in the 2018, GP Survey. The ‘supporting carers in general practice: a framework of quality markers’ was published on 11 June 2019. A key area of focus for the Partnership will be supporting the adoption of the quality markers for carer friendly GP practices developed in collaboration with the Care Quality Commission, GPs and other primary care professionals across the country, to help carers identify GP services that can accommodate their needs.
In alignment with the NHS Long Term Plan, our programme has a clear delivery plan for 2019/20 and beyond which includes primary care as a priority work stream. A key outcome of the primary care work stream will be to ensure carers are identified and supported earlier in their caring role resulting in reduced risk of carer breakdown and ability to maintain their health and wellbeing. Fatima discussed the importance of the quality markers and the programme’s implementation plan across West Yorkshire and Harrogate and it was agreed that a clinical lead would be identified to support the programme.
Matt reminded the Clinical Forum of the strong case for change in pathology, including more rapid testing, adoption of the latest technology, increased efficiency and productivity, and greater opportunities for staff to develop specialist and enhanced skills. The programme is currently developing its future operating model and various workshops have been held with pathology colleagues at all levels to consider the options. The operating model will include a laboratory on each hospital site to support its urgent and acute work, plus a number of larger, hub labs. Over 160 pathology staff attended three workshops at the end of May to consider the options and briefings have been held in every laboratory. A clinical user group is also being established.
Forum members noted the further development of the West Yorkshire and Harrogate Pathology Network; and agreed to provide GP contacts for each clinical commissioning group to enable further engagement with the network. We will keep you updated as the work develops.
West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups (CCGs)
The Committee met in public on Tuesday – chaired by Marie Burnham, independent lay chair. You can view the webcast, agenda and papers here.
Committee members approved a commissioning policy for flash glucose monitoring for West Yorkshire and Harrogate.
On 7 March 2019, NHS England issued new guidance for CCGs around the funding of flash glucose monitoring for some people with type 1 diabetes. Flash glucose monitoring is a new way of checking the glucose levels of people with type 1 diabetes. This condition occurs when the body can’t produce enough of a hormone called insulin which controls blood glucose (sugar). This causes the level of glucose in the blood to fluctuate. If the level of glucose in the blood becomes too high, this can result in nausea, vomiting or even loss of consciousness. When blood sugar levels are too low this is called hypoglycaemia which can be life threatening. People with type 1 diabetes need daily injections of insulin to keep their blood glucose levels under control and their blood sugar needs to be monitored regularly to assess when an intervention is necessary.
Flash glucose monitoring requires two devices, a small sensor and the monitor itself. The sensor is inserted just under the skin on the upper arm where it remains for 14 days. It measures glucose levels in the interstitial fluid which is the thin layer of fluid that surrounds the body’s cells.
This method of monitoring gives the person with diabetes a much clearer picture of their glucose levels throughout the day and overnight compared to the traditional ‘snap shot’ finger prick blood test. It gives the current glucose reading and indicates if glucose levels are stable, or if they are going up or down, enabling the user to make an informed decision about any action they need to take.
Flash glucose monitoring is not suitable for all people with type 1 diabetes so NHS England has specified who it is suitable for in its document ‘Flash Glucose Monitoring: National Arrangements for Funding of Relevant Diabetes Patients’. It is estimated that the criteria applies to about 20% of people with the condition.
This single policy for flash glucose monitoring was approved by the Partnership’s Joint Committee on Tuesday and will be implemented by all nine CCGs in West Yorkshire and Harrogate.
It’s important to note that the Joint Committee also approved a slight difference in the commissioning policy for NHS Leeds CCG and NHS Harrogate and Rural District CCG. In Leeds and Harrogate, flash glucose monitoring is currently available for some women with diabetes who are planning to become pregnant and for some additional women with diabetes during pregnancy.
The Joint Committee agreed that Leeds and Harrogate can maintain their existing policy position on the basis that they are evaluating the impact of this over the next 12 months and depending upon the outcome of that, either they will move their position back to that of others, or the others will move to theirs.
Dr James Thomas, Clinical Lead for the Improving Planned Care Programme, explained that as with all our standardised commissioning policies, this single policy for flash glucose monitoring is based on clinical evidence, expert guidance and best practice. The work in Leeds and Harrogate and Rural District will give us the opportunity to consider both approaches and ultimately decide on the best option for people with diabetes across West Yorkshire and Harrogate.
A number of questions were raised from members of public who attended the meeting. We welcome all public questions and are committed to openness and transparency in our work. We’d like to thank those who attended the meeting. You can view the papers and film from the meeting here.
An update on the Quality Equality Impact Assessment (QEIA) tool was also on the agenda. The development of the tool was based on a number of different approaches in use across West Yorkshire and Harrogate CCGs. It was developed and supported by a policy which set out the framework for the ‘do once and share’ approach to QEIAs, and a user guide which provides step by step instructions on how to use the tool and complete an assessment.
An evaluation of the tool has been undertaken following a six month pilot of using the tool on a range of commissioning polices. The evaluation focuses on the approach to using and completing an assessment and the tools that underpin it. It is too early at this stage to evaluate the outcomes from a completed assessment. However, a number of next steps have been identified to further improve the tool and the overall approach, including reflecting the impact on reducing health inequalities. It’s helpful to note that partners are using the tool well, including the Improving Planned Care Programme and Kirklees Adult Social Care. The Committee agreed that a learning and development session with all quality and equality leads should take place.
The Committee approved the use of the QEIA for all of the work programmes reporting to the Joint Committee, and advocated its use across the range of programmes across the area.
West Yorkshire Association of Acute Trusts (WYAAT – hospitals working together)
The WYAAT Chief Executives met at their monthly programme executive meeting on Tuesday. The group discussed the progress of the West Yorkshire Vascular Service, noting that the public consultation on the changes to arterial centres, led by NHS England, is expected to start soon. Owen Williams, CEO for Calderdale and Huddersfield NHS Foundation Trust, provided a briefing on the Calderdale and Kirklees places comparing and contrasting the population, economy and health and care system in each. Matt Graham, WYAAT Programme Director, updated the group on the progress of the West Yorkshire and Harrogate Pathology Network (please see Clinical Forum) describing the development of options for the future operating model and organisational structure. He also highlighted the development of a business case for a single, shared Laboratory Information Management System to connect all pathology services in West Yorkshire and Harrogate which will be considered by the WYAAT Committee in Common at the end of July. Demonstrating the programme executives continuing focus and priority on improving the delivery of cancer care, Carol Ferguson, Programme Director for West Yorkshire and Harrogate Cancer Alliance joined the meeting to provide a regular update on cancer performance and improvement. Carol briefed the CEOs on plan for the Cancer Improvement Collaborative event on Friday 5 July and their roles in it. CEOs asked Carol to ensure that those attending the event left with clarity on what they had to do next and how they would be supported. They also asked her to plan a second event in the autumn to follow up on progress.
Mental health, Learning Disability and Autism - Committee in Common
The Mental Health, Learning Disability and Autism Provider Collaborative discussed some important areas of work at its Committee in Common last week. This included how to keep Non-Executive Directors and Governors engaged in the work programme, ensuring appropriate links to our work on dementia, the development of the new West Yorkshire Transforming Care Programme and the development of commissioning arrangements for specialised services such as eating disorders, child and adolescent mental health services and forensic services. The Committee in Common will discuss the development of the West Yorkshire and Harrogate five year strategy for the Mental Health, Learning Disability and Autism Provider Collaborative in September.
System Leadership Executive Group
The Executive Group met on Tuesday. This includes leaders from all partner sectors, including councils, hospitals, clinical commissioning groups, Healthwatch and community organisations. It is chaired by Rob Webster, CEO Lead for the Partnership.
System leaders had a further conversation on the flexible transformation funding 2019/20 (£8.75million) following the Partnership Board meeting in June. The funding proposal includes money to support the children and young people’s programme as a priority and also additional funding for our harnessing the power of communities work. Further approval will be sought by the Chair and Vice-Chair of the Partnership Board (as delegated by the Partnership Board at the meeting in June 2019).
Julian Hartley, CEO for Leeds NHS Teaching Hospitals updated leaders on the NHS Interim People Plan. Julian worked on the initial development of the plan with national colleagues earlier this year. The starting point is how we make the NHS the best place to work for staff and bringing the NHS Constitution to life. The plan is structured into key themes, with each having a number of immediate actions that need to be taken by organisations to enable colleagues who work in the NHS to deliver the Long Term Plan.
Themes include the growing pressure on people working in the NHS; BAME staff reporting the poorest workplace experiences; financial challenges and the fact that 1 in 11 staff are leaving the NHS permanently each year.
One of the biggest challenges facing the NHS is retaining good staff and skills, for example the shortage of nursing in hospitals, mental health and communities; and the impact this has on people’s quality of care. We are working with Health Education England to supply more student placements. We will also be looking at ensuring a stronger representation of people from minority communities – whilst keeping in view the opportunities available through management programmes and apprenticeship work.
NHS organisations will be asked to develop their approach to making their organisation the best place to work and to contribute ideas to the development of a new offer for staff which sets out the support they can expect from the NHS as a modern employer. Staff engagement is key. There is also an emphasis on new roles such as care navigators.
Rob, our Partnership CEO Lead is on the national programme for workforce planning and development. The national work sits nicely alongside the work of the Local Workforce Action Board; our workforce plan and the devolved responsibility Partnerships such as ours are receiving. We have also been asked to pilot a tool developed to inform development of the interim workforce plan at a West Yorkshire and Harrogate system level. You can read the Interim People Plan here.
All of the above is critical to the development of our Partnership’s five year strategy, due to be published by the end of the year.
Leaders also discussed the West Yorkshire and Harrogate Capital and Estates Programme. NHS England and NHS Improvement requested all Partnerships like ours (also known as Sustainability Transformation Partnerships and Integrated Care Systems) to update on the progress of their draft capital and estate strategies. The Capital and Estates Programme Board is chaired by Owen Williams, CEO for Calderdale and Huddersfield NHS Foundation Trust. The programme has made significant progress on a number of areas including securing capital investment for eight schemes totalling £270m and a commitment of almost £200m to support the reconfiguration of the hospitals at Calderdale and Huddersfield NHS Foundation Trust.
Developments on other successful funding bids continue, including Leeds Teaching Hospitals NHS Trust consolidation of pathology services; Leeds and York Partnership NHS Foundation Trust (West Yorkshire Mental Health Trusts) rehabilitation and recovery for people with mental illness.
Brendan Brown, CEO for Airedale NHS Foundation Trust and Partnership CEO Lead for the Partnership and Kay Butterfield from Health Education England, gave an overview on the Apprenticeship Levy Project and the benefits of utilising this more flexibly across the area in order to make the most of the opportunities this brings to ensure a diverse workforce and our work with schools. So far over 100 nurse associates have been recruited and there is potential to work more closely with council partners who have management apprenticeship programmes on shared health and care modules. There is a real opportunity to break down health inequalities and this is one area of work leaders were keen to address going forward.
Leaders also heard about the development of a Memorandum of Understanding with healthtech industries to drive forward new approaches in improving health and care through better and faster innovation. The Leeds City Region already has a world-leading concentration of excellence in healthtech. Partnership leaders were keen to show their support. We will keep you updated when we know more.
Yorkshire and Humber Care Record Showcase
A wide range of representatives from across health and social care services within Yorkshire and Humber came together at an event on Wednesday in Leeds to focus on the Yorkshire and Humber Care Record. Secretary of State for Health and Social Care, The Rt Hon Matt Hancock MP opened the event and praised the work of the team. You can watch the film here.
Sessions were held to showcase the benefits of a single record, with a session specifically focussed on cancer - the difference that could be made by providing people with access to their own data utilising the Helm app - the wider range of opportunities by having access to a wealth of data for population health management. These sessions will be repeated in due course as the programme progresses. You can read more here.
The NHS Assembly
The second NHS Assembly meeting takes place today. Representatives from across our area include Rob Webster, our CEO Lead for the Partnership; Richard Stubbs, CEO for Yorkshire and Humber Academic Health Science Network and Fatima Khan-Shah, Programme Lead for Unpaid Carers. The morning session will cover the NHS Interim People Plan and workforce. The afternoon includes sessions on health and employment – how do we create a workforce that reflects our Community; and health and environment – how the NHS achieves zero net carbon by 2050.