This week’s leadership messages are from Dr Sara Munro and Robin Tuddenham

Posted on: 19 June 2020

This week’s leadership message comes from Dr Sara Munro, CEO for Leeds and York Partnership NHS Foundation Trust and CEO Lead for West Yorkshire and Harrogate Health and Care Partnership's Mental Health, Learning Disabilities and Autism Programme.

There is also a special message from Robin Tuddenham, CEO for Calderdale Council, about the importance of Refugee Week, which takes place this week. Robin is also Co-Chair of our Population Health Management Programme.

Hello, my name is Sara,

Looking back over the past three months so much has had to change and I am reflecting on how many times I have heard colleagues and friends remark on not knowing what day, week or month it is – myself included! We have been through an intense period of uncertainty and throughout this have needed to adapt and adjust with the primary goal of keeping ourselves, our loved ones and the citizens we serve safe from Covid.

Whilst the phrase of returning to normality is appealing, what we all agree is we won’t return to how we did things before the pandemic. We can’t unlearn what for many has been the biggest learning curve of our lives and as a Partnership we are already seeking and sharing the learning to inform how we shape the future.

As an NHS Trust Chief Executive and a leader in the Partnership’s Mental Health, Learning Disability and Autism Programme, I have seen many examples of how we have adapted and changed how we provide our services. Throughout our sector we have been very conscious of the direct risks to peoples’ mental health in how we respond to Covid. This is even greater for the most vulnerable people we support who have learning disabilities, autism or severe mental illness. Psychological stress, physical illness and significant disruption to daily routines and support networks can trigger relapses in people that otherwise had been well and stable. The additional pressure on carers (who are vital to supporting our service users) is also considerable putting them at greater risk of mental ill health too.

At the same time there is a sense of us all being in this together, pulling together in our local communities and our virtual ones - which in the short term can be a protective factor. This very much depends on being able to maintain connections with others and the world around us in a way that is meaningful.

Mental Health strategy As we learn more about the coronavirus, we learn more about each other and the society in which we live and work. The inequalities in our society are more visible than ever with Covid following the patterns and trends we already know were there. This gives added impetus and indeed wider support to the work that we do as a care system. Our Partnership’s strategy for Mental Health Learning Disability and Autism points out that a lot of work is needed by a lot of different organisations in partnership with service users to transform care, to improve lives - to address the inequalities we see. These inequalities account for the significantly reduced life expectancy for people with Serious Mental Illness and Learning Disabilities and the over representation of BAME citizens in some services such as crisis and inpatients, whilst conversely under-representation in services such as perinatal mental health. Some of this requires a conscious shift both in mind set and service configuration - from delivering care in traditional hospital settings and into the community where possible, investing in dedicated roles and research which we are doing in our learning disability and perinatal services.

The impact of Covid-19 has also been to drive the digital agenda, empowering us to add a new dimension to many of our services. It is fair to say as sector we have been slow to embrace digital due to concerns about the ability to provide therapeutic care in ways that don’t depend on face to face. However, for many service users this is working well. Initial feedback from early intervention and Children and Young People services is that engagement overall has increased. However digital innovation can also lead to digital exclusion and if this further disadvantages those communities we already do not serve well, my personal view is that we will have failed our most vulnerable.

One of the reasons I have always been proud of our sector is that we do know our service users well and this knowledge and those relationships have been at the heart of how our collaborative has been managing through Covid. We have continued to provide face to face direct support where this is needed, and where it is safe to do so, used alternative methods such as digital platforms and telephone support. This is early days for our sector and evaluating this is key to planning the future transformation of our services. We have to get it right for staff too. Providing therapeutic support remotely often means from your own home with other family members in the house. This is definitely not sustainable.

Thinking beyond our current service provision and the increased need for mental health support there are a number of measures we have and are putting in place through the collaborative. For the wider community last month we launched a new freephone 24/7 helpline for all ages to be able to access if they are worried about their mental health and in need of support. In the first month the helpline received over 1000 calls and we expect this to increase.

We are already half way through our Keeping Connected programme which has seen a coalition of VCS organisations provide targeted outreach support to people with a learning disability and/or autism that don’t currently receive services. This was explicitly intended to overcome the risks of further disadvantaging this group during the pandemic and being proactive in providing support. There is already some rich learning from this that will inform the longer term priorities of our collaborative. At the end of this month a new grief and loss helpline will be launched for West Yorkshire and Harrogate which will provide much needed additional capacity and will work hand in hand with place based organisations who are then better placed to provide more complex and intensive support.

Throughout all of this, like in all sectors, our staff are our biggest asset and they have been simply amazing. Not only have they changed the way they work, where they work and how they work – they have readily come forward and been trained in how to care for our own service users who have Covid.

We have put all these skills into action with many of our inpatient units dealing with Covid whilst at the same time providing the same standards of mental health and learning disability support. We know this will be a feature in our services for the foreseeable future. We need to continue to keep our staff safe from Covid and adhere to the same standards of infection prevention and control as our acute trust colleagues, and we also need to look after the mental health of our staff.

Burnout is a real and present risk for our colleagues. Even before the pandemic the health and wellbeing of staff was on all our agendas but it has come into even sharper focus. I won’t go into all the different steps we have all taken to support our staff – it is a big list and I reflect on why we didn’t do all of these sooner! The call to action to better support and protect our BAME staff is the most powerful it has been in my NHS career and the discussions and actions in my own organisation have been emotional and inspiring. So in addition to questioning why we didn’t take action sooner – the test is to make sure we never let this shift from our focus because there is so much we have to do.

My final personal reflection is for our leadership community. What I would like us all to do today and every day is to role model self-care and self-compassion and this includes acknowledging our own vulnerabilities and being honest when we simply do not have the answers. I think I have said I do not know more in the past three months than in the past 10 years and it has been both uncomfortable but liberating. For many working in the health and care sector it is a vocation where we want to always be there for others, to have the answers and make everything better. So many colleagues talk about how they worry about and want to support their fellow colleagues - the best way you can do that is to care for yourself and be visible in doing so. Telling stories of working seven days a week and all hours of the day runs the risk of piling on the pressure (and making our jobs look unattractive!!) especially when I know lots of people are actually feeling guilty and that they are not doing enough. I have shared that guilt and will continue to do so. But that won’t help me and it won’t help those around me.

So with that in mind, my final message to my colleagues in the Partnership is that if you truly want to look after your staff so they are here for the long haul and are ultimately here for our citizens, you need to make sure you look after yourself, your own physical and mental health, show your vulnerability, take a break and take time off because not only will you be better for it, what you do sets the example on which others will follow.

Have a good weekend everyone and stay safe,
Sara

Celebrating Refugee Week 2020

Robin Tuddenham This week is Refugee Week, an annual UK-wide festival celebrating the contributions, creativity and resilience of refugees, focusing this year on the theme of ‘imagine’. World Refugee Day is on 20 June. It’s a week when I remember the stories and experiences of local asylum seekers who have often fled torture, persecution and hatred, like the two young men, Adaam and Murat, who at the age of thirteen years old walked 5000 miles to flee from the Taliban in Afghanistan, sleeping in forests, foraging for food and walking through war zones. They are now studying at Calderdale College.

Our region has a long history of welcoming refugees for over a century, including in more recent times being the first part of the UK to welcome refugees evacuated from Kosovo in 1999 and the first to resettle Syrian refugees in 2015. Most come here through the asylum system where they are dispersed around the UK first as asylum seekers before the Home Office either grants them status as refugees or refuses their claim. Some also come as unaccompanied asylum seeking children (UASC) looked after by children’s services.

In West Yorkshire there are currently around 4,000 asylum seekers, 400 UASC and care leavers, 1,300 refugees through resettlement programmes, and thousands more people who have become refugees following the asylum process and then onto becoming British citizens.

Refugees and asylum seekers face many challenges in the UK, including poverty, exclusion and loneliness, surviving torture and trauma, mental health issues, low levels of English language and lack of knowledge of UK systems and society.

Refugee voulunteer Those still in the asylum system face further challenges through not having permission to work, low levels of financial support and no-choice housing, including high levels of temporary accommodation for long periods. We know that asylum seekers face real difficulties accessing health and care, and lack of basic facilities and no access to digital communication represents a barrier which can lead to relatively low levels of GP registration and poor health outcomes compared to the general population.

There are services across the region which provide support to refugees and asylum seekers, and support to organisations to work with them. Further information can be found from Migration Yorkshire and there is also a new Migrant Information Hub providing Covid-19 information for migrants and services in Yorkshire and Humber, including translated materials.

There are many ways in which refugees have enriched our region, and ahead of World Refugee Day here are some recent examples from Calderdale, Harrogate and below.

Have a good, safe weekend,
Robin

What else has been happening this week?

Test, Trace and Isolate Programme

Self-isolate when alerted The fourth West Yorkshire and Harrogate COVID-19 Test, Trace and Isolate Programme meeting took place last Thursday. The programme includes colleagues from Public Health England, public health directors / colleagues from councils, NHS England, primary care and clinical commissioning groups. The WY&H HCP SRO for the programme is Martin Barkley, CEO for Mid-Yorkshire Hospitals NHS Trust. Martin is also the regional lead for the testing programme in the North East, Yorkshire and Humber. Dr Kevin Smith, Deputy Director Health Care from Public Health England (PHE) in Yorkshire and the Humber joined the meeting to give an update on PHE work.

In the UK there have been 289,140 people testing positive to COVID-19. In West Yorkshire this figure is 5,078. In the last 7 days there have been 65 new cases and although there is still growth within the care homes this has reduced significantly with five new case reported in the last seven days compared to 10 the week before (accurate at 10 June). Pillar 2 testing across West Yorkshire and Harrogate is just over 58,000 tests (accurate at 10 June). This includes the regional testing sites, satellites and mobile units. It does not include home testing kits, which are ordered via the national booking site.

The Personal Protective Equipment (PPE) Programme Group

Wear a face covering on the bus The PPE Programme Group met last Friday. 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.

Progress has been made on looking at building up stocks and looking at local manufacturers with the clinical reference sub-group establishing a testing menu for manufacturers. Following the recent announcement all hospital staff must wear masks and visitor, a type of face covering. Guidance on the use of face masks and coverings in hospital settings to prevent COVID-19 transmission was shared last Friday. This will cover all staff working in hospital, it will apply at all times - not just when colleagues are doing life-saving work on the front line - and it will apply in all areas, except those areas designated as COVID-19 secure workplaces. Work is underway with the West Yorkshire Association of Acute Trusts (hospitals working together) to consider what the PPE requirements will be.

Joint Committee of the Clinical Commissioning Groups Public, Patient Involvement Group

Lay members from the clinical commissioning groups which make up the Joint Committee met on Monday. There was an update on the stabilisation and reset work as we enter the next phase of the COVID-19 pandemic and the approach to gathering community voices via Healthwatch and other partners. A collation of feedback received from its partners including but not exclusively from all West Yorkshire Healthwatch organisations, Yorkshire Cancer Community, Carers UK and Bradford Talking Media was discussed. An early report has been produced regarding the impact of coronavirus on individual people and communities. Our thanks go to all engagement colleagues for sharing early findings to contribute to this important, timely piece of work. This report is an early draft, a live document which will be updated accordingly. You can read it here. All notes from the meeting are published here.

Mental Health, Learning Disability and Autism Programme Board

West Yorkshire & Harrogate Mental Health Learning Disabilities and Autism Programme Board met on 16 June 2020. Chaired by Dr Sara Munro, CEO Lead for WY&H HCP Mental Health, Learning Disabilities and Autism; and CEO for Leeds and York Partnership NHS Foundation Trust, the Board received a number of high-quality reports about the work of the programme and plans for the months ahead.

Supporting people with autism

Plan Together.png Work towards improving the lives of people with autism continues, with a focus on addressing waiting times. With regard to children, it has been agreed through the Children and Young People Programme to develop a task and finish group to initially work with commissioners and discuss whether there is opportunity for a common approach to address the build-up of waiting times.

Services are reviewing how they will formally re open their face to face assessments, with some providers having sourced online assessments. All adult services have been able to adapt their service to provide some continuity of care.

Keeping Connected pilot project

In partnership with Inclusion North we have developed a regional Covid-19 specific project to support neurodiverse people who are not routinely supported by health and social care and are living fairly independent lives.

This pilot scheme has helped provide support to a number of individuals by linking them into local services, yet has also revealed that there are challenges around building relationships with people who cope well in normal times, but who are currently experiencing high levels of anxiety and poor mental health and wellbeing. The Covid-19 pandemic is likely to have increased levels of anxiety in many, and an initial scoping exercise with a number of adults with autism revealed that many were finding the national guidance difficult to interpret and were struggling to make sense of the situation we are in. So far more than 500 contacts have been made and the scale of this project will help us better understand the needs of autistic people and shape future service provision.

Suicide prevention

Much positive work is being done in suicide prevention, assisted by the supply of £1.5million of Wave funding over the next three years recently announced and covered by local and regional media.

Our fully staffed Suicide bereavement / Postvention service continues to meet high demand and has taken almost 100 referrals to date. The service has been maintained throughout lockdown with staff working from home, establishing online groups and other network meetings.

Our rewarding partnership with State of Mind Sport continues, making positive mental health messages accessible to men at risk of self-harm and suicide, with face to face sessions planned for the post lockdown period.

Prevention and Management of Violence and Aggression

Work is being developed to review and seek standardisation of approaches across the providers in the Partnership to benefit the collaborative working of partners and the development of a more flexible workforce. This work will form the basis of further work on a collaborative bank for the West Yorkshire and Harrogate Mental Health, Learning Disability and Autism provider collaborative.

Homelessness

The Health and Housing event planned for earlier this year which was lost to the Covid lockdown will be rescheduled to take place as soon as possible, whilst new work is being taken forward to focus on support to homeless people who have been supported in temporary accommodation during the COVID period.

Partnership Grief and Loss Support Service

We are working together to support people who are experiencing grief and loss of life in the difficult circumstances brought about by Covid-19. It is very likely that due to the restrictions that has been / is in place, people may not be with their loved ones at the time of their death or they may have witnessed traumatic scenes, which could have happened very quickly. These restrictions also mean that the usual practical and emotional support people physically receive from family and friends following bereavement may not be there.

A central grief and loss support service provided through a free 7 day a week helpline, available from 8am to 8pm, is being developed as a first point of contact for anyone experiencing grief and loss across West Yorkshire and Harrogate. It will help people who are experiencing the death of family and friends, members of their community and even those feeling impacted by the deaths of those in public life.

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 is delivered by a collaboration of providers, including West Yorkshire and Harrogate Independent Hospices Consortium (as lead provider), Bradford Bereavement Services Consortium and Leeds Mind.

The service aims to be operational in the next two weeks and will last for nine months initially, with potential to extend for longer, if needed. We will keep you updated.

Grief and Loss Support Service

Digital tools help more people to access health and care

Access to health and care services has been a huge challenge with demand for services ever increasing. Following the coronavirus pandemic healthcare organisations across West Yorkshire and Harrogate Health and Care Partnership have further embraced
the opportunity to reach more people through digital technologies to prioritise, support and, where possible, treat people remotely and help clinicians, and health care workers to work safely and more effectively.

Across the area, almost 95% of GP Practices are offering people access to online consultation services and of these 99% have seen video consultation rapidly rollout in the last few months. You can read more here.

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