Posted on: 26 June 2020
Hello, my name's Jo,
I’m delighted to be writing for the Partnership’s blog this week. There is a lot going on around the world of commissioning health services, so I was pleased to be able to take the opportunity when asked.
As well as being the Accountable Officer for Wakefield Clinical Commissioning Group, I am also the Senior Responsible Officer for the Commissioning Futures Programme. The director for this new programme is Esther Ashman. Esther will be working closely with me and the other West Yorkshire Clinical Commissioning Group Accountable Officers for the foreseeable future.
Together we work on commissioning health services for 2.7million people, with a collective focus on meeting the ambitions set out in the Partnership’s ‘Better health and wellbeing for everyone: Our five year plan’.
I am very proud to work for the NHS and the Partnership. I have spent much of my career commissioning health services in one form or another. Alongside many of you, I have seen much change through the reform of health and social care over the years.
I think it’s fair to say that I personally can’t recall a time when the pace of change and opportunities to transform what we do have been so great – when working alongside and with communities has never been more powerful.
COVID-19 has facilitated and accelerated changes in the way we collaborate as commissioners and providers. Whilst there are many examples across West Yorkshire and Harrogate in terms of good practice, recent work in response to COVID-19 has advanced this for us all. This in turn has given us a refreshed platform for a new approach to commissioning, one which enables us to develop a new vehicle for further transformation.
In the short to medium term this will support us through the stabilisation and reset work we all must do. And above all help us to deliver the ambitions set out in our five year plan. We don’t yet understand the long standing impact COVID-19 will have on people’s lives - what we do know is that it will be significant, especially for those already experiencing the most inequality. Clearly this is an important area we want to address sooner rather than later.
Whilst Commissioning Futures is one of our newer Partnership programmes, it is by no means the newest area of work for commissioners. As a group of accountable officers we have worked together across West Yorkshire since CCGs were established in 2012 as part of the Health and Social Care Act. They replaced primary care trusts.
The establishment of the Joint Committee of the Clinical Commissioning Groups across the area has strengthened our opportunity to take joint decisions that improve the health of people whilst seeking to create a fairer approach for all. The progress made (some examples below) comes down to the fact that we are continuously reviewing all that we do to make life better for everyone living across West Yorkshire and Harrogate.
Clearly we cannot do this alone, nor do we want to. All CCGs work closely with the local councils, voluntary and community organisations and of course with communities - only by doing so can we truly integrate health and social care and provide seamless support for people, where people don’t need to tell their story over and over again and where they get the care they need in the most appropriate place and way.
A must read for us all at the moment is the recent publication by National Voices: Nothing about us without us: Five principles for the next phase of the Covid-19 response. To summarise, this talks about the:
- Importance of actively engaging with those most impacted by the change
- Make everyone matter, leave no-one behind
- Confront inequality head-on
- Recognise people, not categories, by strengthening personalised care
- Value health, care and support equally.
All-important principles, many would agree. You can see an example of this in the work we are doing in our personalised care programme where we are working with people with learning disabilities to support their own decision making so they can articulate the personalised care they need / want. Read more here. This is one particular area of work I want to grasp and move forward at pace.
At this point I think it’s really important to remind ourselves of what strategic commissioning really is? It’s not just about buying health care or transforming services; it’s so much more than that. For me strategic commissioning is a collective activity in which we work together with councils to make the most of our valuable public service resources, agree priorities and make good decisions that have a positive difference on people’s lives.
At this point it’s important to recognise that commissioning is changing, we are placing more emphasis on collaboration within health and care systems and these developments will require us to change how we work within systems.
We are continually moving away from being the contract enforcer to a system enabler. We are placing more emphasis on building strong relationships with care providers, moving from a low level of trust and high bureaucracy to a low bureaucracy and high trust system - built on mutual accountability that achieves system wide performance and above all meets people’s health needs in a fair way.
We are also seeing providers take on a greater role in commissioning and we have examples of integrated provider models or provider alliances across West Yorkshire.
My own experience in Wakefield, particularly with end of life care and mental health, has made real progress. At the beginning, like anything new, this way of working presented some risks and uncertainty regarding how to manage conflicts of interest and ensure transparency - yet the benefits to local people far outweighed the costs of managing the risks. And I for one couldn’t be happier!
Phase 1 of COVID-19 presented us all with significant challenges and also the opportunity to reframe the way we work. There has never been a greater opportunity to reflect on existing commissioning arrangements, alliances and partnerships and to change our direction of travel. While the CCGs’ role will continue to evolve, there will be a stronger focus on their role in the future of system integration.
There is a strong desire not to go back to commissioning pre-COVID-19 and to embrace the new ways of working presented. Key to this is learning through innovation, pace, relationships and the challenges we collectively faced/face so we can best plan ‘people’s health services’ now and for the future – one where people really do have a choice to self-care, make personal choices and stay more in control of their health, where safe to do so.
As part of the Commissioning Futures Programme we have spent the last few months developing a framework on what can be delivered in our local places and what could be delivered at a West Yorkshire footprint. Whilst the framework is still in development, it broadly sets out three levels of commissioning:
- Commissioning which needs to be developed and delivered at a place level, such as primary care networks and integrated community care
- Commissioning which would be better developed at a Partnership level and delivered at a place level to consistent standards and outcomes (such as procedures of low clinical value and the healthy hearts programme)
- Commissioning which could be developed and delivered once across the Partnership through excellence models like the assessment and treatment units for people with complex learning disabilities.
There is undoubtedly going to be a complexity of alignment in this work, there is a willingness and commitment to develop the work whilst remaining agile in our approach, as ultimately it’s all about what is best for people.
It would be remiss of me not to mention the wonderful work of primary care networks (PCNs). They have been amazing in the area where I work. PCNs are a key part of the COVID-19 response and have been essential because they have built on strong local partnerships already in place to keep people as healthy as possible through these uncertain times. They are very much the future.
So what will it look and feel like if we are successful in our work? It goes without saying that everything we do will have a focus on improving people’s health and reducing health inequalities, which is after all what we are all about. Our role moving forward will have a renewed emphasis in light of COVID-19, using our ‘helicopter view’ of the world to best effect to improve population health according to local need. We will have re-energised and increased the level of joint commissioning we have with our local councils (including public health), learning from each other and working together to deliver the best services to people in the most effective way. We have will have built even stronger links with WYAAT (hospitals working together) and also specialised commissioning - working with NHS England and NHS Improvement colleagues. We will have commissioned some services on a West Yorkshire footprint that previously may have been commissioned separately and locally.
Assessment and treatment units for people with complex learning disabilities is a good example of where commissioners and providers have worked together on a West Yorkshire footprint to bring about a better quality of care for those who most need it. You can find out more here.
We know from all of the above, and importantly from learning, that a shared set of values is vital. This refreshed collaborative way of working will mean a different way of working and we need to ensure all our colleagues, partners – and communities - feel well supported and part of the journey. In order to ensure our work is effective and focussed in the right way, we will have easy access to good data that helps us make real time decisions. This will help to ensure we are truly making a positive difference in everything we do.
Lastly to enable this work to happen we need to consider the delegation of functions to the Partnership’s Joint Committee of the CCGs we make. This will build on the approach we have taken around important areas of care, such as hyper acute stroke (the care people receive in the first 72 hours) and healthy hearts.
In 2018/19 there were 3,441 strokes in West Yorkshire and Harrogate. Our ambition is to reduce the number of people who have strokes; save more lives and improve recovery outcomes. Our priority is to provide the best stroke services possible to further improve quality and stroke outcomes. Working together with the West Yorkshire Association of Acute Trust (hospitals working together), work is underway to improve the quality of care and recovery for people who have had a stroke. This includes preventing stroke happening in the first place, improving specialist care, making the most of technology and valuable skilled workforce – and connected high quality support for people recovering from a stroke.
Across our area there are around 12,000 undiagnosed (and therefore unmanaged) atrial fibrillation (AF) patients. Atrial fibrillation is a quivering or irregular heartbeat that can lead to blood clots, stroke, heart failure etc. We know that this increases the likelihood of stroke.
Since spring 2018 we have been working with our partners at the Yorkshire & Humber Academic Health Science Network to more proactively detect, diagnose and treat people who are at risk of stroke so that around 9 in 10 people with AF are managed by GPs with the best local treatments available. This will save lives and contribute to reducing both the health and well-being gap and the care and quality gap. In our local areas, with the full support of the Joint Committee of the CCGs, we have rolled out best practice care for people with AF in every GP practice with the aim to prevent over 190 strokes in the next three years. This is exactly what good commissioning is all about.
As CCG’s continue to develop in the way they work together, so too will the Joint Committee.
Our next steps in developing the future of commissioning will provide more clarity on what we jointly think commissioning will look like in the context of our reset and stabilisation work and how we will use our resources to deliver this to best effect. We will keep you posted.
Have a lovely weekend – stay safe,
Jo
What else has been happening this week?
Partnership’s People Board
The Partnership’s People Board met for the first time on Monday 15 June to discuss workforce priorities and challenges. Board members include local place based workforce leads (Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield, local authority, social care and NHS Improvement and Health Education England colleagues. The group discussed ‘Better health and wellbeing for everyone: Our five year plan’ priorities and how these may have changed since COVID-19. A refreshed priority list is being developed.
Our Partnership has the opportunity to increase the number of nursing and other healthcare students. All universities can recruit 5% more students for this September intake, as well as being able to bid for more places. The limiting factor is often placement capacity and the Board agreed that a system wide approach to this would be beneficial. Conversations have already taken place with universities; and chief nurses had been asked for the demand around additional places. The next step is to coordinate a system wide response to this looking at innovative solutions to providing placements across all sectors.
The Board discussed the recent ‘Bring Back Staff’ initiative, alongside the huge amount of volunteers who had come forward to offer support during the pandemic and how this could be harnessed in the future by providing a reservist model. A small task and finish group will take forward this piece of work.
There was an update on the Leadership Development Programme for Black Asian and minority ethnic staff. This has the full support of the Board.
The group acknowledged that it was coming up 100 days since the outbreak of COVID and a message of thanks should be sent out to all staff to recognise the skill and dedication of all of our colleagues, across all sectors.
100 Days of COVID – a story of ordinary people, extraordinary efforts
Today is 100 days since full lockdown was announced across England, leaders in the West Yorkshire and Harrogate Health and Care Partnership, which covers Bradford district and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield, are thanking over 100 000 people who work as part of England’s fourth largest integrated care system.
Since lockdown began on 23 March, local authorities, NHS, Healthwatch, social enterprises, community organisations and charities have come together as never before with a single purpose in keeping the 2.7million people of West Yorkshire and Harrogate safe, well and restored to health wherever possible.
From care workers moving into their care settings to avoid transmitting the virus from the outside world, leaving their families for weeks at a time, to social workers, refuse collectors and voluntary and community sector workers who have taken time to check on people who are shielding in their communities – right through to teachers, the police, Yorkshire Ambulance and the fire service, to building maintenance workers and cleaners, IT, communication colleagues and finance staff – the list is endless. There are almost uncountable acts of kindness and professionalism taking place every day in the places where we live and work. Many of which goes unseen and unheard.
Cllr Tim Swift, Leader of Calderdale Council and Chair of WY&H Health and Care Partnership Board said:
“We have learned so much during this crisis, but the most important lesson has been to see demonstrated, time and again, the very best of all of our people, regardless of where they work and what they do. Everyone has stepped up and in many cases gone way beyond the limits of their job descriptions to make sure that no one has been forgotten or unnecessarily exposed to danger. I would like to personally thank the entire health and care workforce throughout West Yorkshire and Harrogate for acting as one team for 100 days and beyond”.
Brendan Brown, CEO for Airedale NHS Foundation Trust and WY&H HCP CEO lead for Workforce said:
“The first 100 days of COVID-19 have been challenging beyond all of our lived experience. I want to recognise the skill and dedication of all of our colleagues, across all sectors. Without their commitment we could not have put in place the many measures that are keeping people as safe as possible. The health and care system has never been more focused or proud, with people in every corner of our Partnership delivering their very best, day after day.”
Rob Webster, CEO Lead for West Yorkshire and Harrogate Health and Care Partnership said:
“This pandemic has demonstrated the strength of our partnership and the power of our people. Our colleagues have been outstanding throughout. They have responded quickly to every situation, changing the way they work and making personal and professional sacrifices on behalf of others. They will need out continued support and help – this isn’t over yet. Over the coming months we will be doing all we can to help them as we work to tackle the impact of the virus and bring services back that are different and better than before”.
You can watch some of the films below and the full collection on our YouTube channel. Visit the Partnership's 100 Days of COVID page on our website to find out more.
RECOVERY trial – West Yorkshire Association of Acute Trusts helping to find a cure for coronavirus
The West Yorkshire Association of Acute Trusts are amongst more than 130 NHS hospital trusts in the UK taking part in the national RECOVERY trial to find a cure for Covid-19.
The ground-breaking study, which is the world’s largest randomised clinical trial of potential coronavirus treatments, is now well underway in the UK and is being supported by the National Institute for Health Research (NIHR).
To date, a total of 389 participants from across WYAAT have been recruited to take part in the trial.
A number of treatments are currently being tested on randomised patients:
- Lopinavir-Ritonavir, commonly used to treat HIV
- Dexamethasone, a type of steroid use in a range of conditions to reduce inflammation; and
- Hydroxychloroquine, a treatment for malaria.The drug Dexamethasone has already been found to significantly reduce the risk of death from coronavirus for seriously ill patients who are being treated with a ventilator or are on oxygen. It is now recommended it is used across the country as standard care for high risk hospitalised patients with the virus. The drug however does not appear to help people with milder symptoms of coronavirus who do not need help with their breathing, and so trials will continue to find a suitable drug for these patients.