Posted on: 28 February 2020
Hello, my name is Sean.
Every month in West Yorkshire and Harrogate, between 10,000 and 12,000 people are referred by their GP for investigation of cancer symptoms. Between 600 and 700 will go on to be diagnosed and treated for cancer, and to experience the roller coaster of emotions that this inevitably introduces to their lives and their personal journey.
Two weeks ago, 150 patients, clinicians and leaders from across West Yorkshire and Harrogate came together to celebrate and share good practice in enhancing patient experience and outcomes through improving cancer waiting times performance, with a particular focus on our most challenging tumour sites, prostate and lung.
Each of us was in the room because we are committed to delivering the best possible care and outcomes for all our patients. Cancer does not discriminate, and so it’s a given that many of the health professionals and managers there on the day had also experienced the personal impact of a cancer diagnosis and the importance of putting each individual person affected at the very forefront of our ambitions – wrapping services around our patients.
The event was a follow up to our launch last year of the WYH Cancer Improvement Collaborative, which heralded a new way of working together across our area, breaking down the artificial barriers that exist from the patient’s perspective between our organisations and approaching performance improvement as a system, rather than simply by individual provider Trust.
It was encouraging to hear from patients Richard Seddon and Sara Williamson – in conversation on stage with Cancer Alliance Board Co-Chair Julian Hartley – about some of the changes they are seeing from their perspective. Thought-provoking too as they reiterated their challenge to those not yet converted to the power of patient engagement in delivering improvements; their plea to develop a language that is common to all and to overcome the ever-present temptation to overcomplicate our information and our communications.
It was great to hear David Fitzgerald, National Cancer Programme Director and keynote speaker for the day, highlight West Yorkshire and Harrogate Cancer Alliance as an exemplar of good practice in terms of its integration with the wider WYH Health and Care Partnership, and its support for system-wide working to drive performance and improvement.
It was inspirational to hear from colleagues across our acute Trusts and local places as they outlined both the specific work they have been doing over recent months since the launch to support the collaborative, and also the daily efforts of our clinical teams and managers to improve our pathways.
System-wide analysis of the prostate and lung cancer pathways has been supported by the NHS Intensive Support Team, and each Trust has developed improvement plans which have been shared across the system. These include the delivery of MRI scans before biopsy across all our Trusts, introducing more targeted biopsies and increased diagnosis of medium and high risk prostate cancer. Three out of six Trusts are planning to implement trans perineal biopsy, which gives more accurate diagnosis. In lung cancer, early access to CT scans and clinic triage in secondary care are among the successful developments.
A series of workshops, led by local clinicians and managers from local places, partner organisations and the Cancer Alliance Project Management Office team, facilitated shared learning across key elements of local improvement work.
Topics included prostate transperineal biopsy (Leeds Teaching Hospitals NHS Trust); pathway improvements in pathology (Mid Yorkshire Hospitals NHS Trust); personalised care in action (Cancer Support Yorkshire/Bradford Teaching Hospitals NHS Trust); workforce and new roles (Calderdale and Huddersfield NHS Foundation Trust). System-wide working towards pathology networks; radiology (CT and MRI) demand and capacity work, and new models of care, such as Rapid Diagnostic Centres, also featured on the agenda.
Across West Yorkshire and Harrogate, the Cancer Alliance is also using transformation funds to develop a network of dedicated improvement facilitators based in local places. Along with the Optimal Pathways team now hosted within Calderdale and Huddersfield NHS Foundation Trust and the three Macmillan-funded posts already supporting the system to offer personalised support post cancer diagnosis, they form a strong place-based improvement resource to drive and co-ordinate change at local level.
Despite this excellent progress, we have to acknowledge, that we are still some way short of achieving our ambitions and the desired impact on the number of patients treated within 62 days of an urgent referral – one of the national cancer waiting time standards which are viewed as a touchstone for the performance of the NHS. From talking with our patients, we know that for many of them, this element of their cancer journey creates the greatest distress and psychological impact.
The Cancer Alliance Board provides system leadership for delivery of the overall strategic plan for cancer across WYH. In relation to operational performance, the Alliance works closely with WYAAT leadership and its constituent six local Trusts. Together, we have set out our strategy for how we will build on the firm foundations now in place and effect a significant change in performance, and therefore patient experience and access.
Next steps include:
- Taking continued ownership as a system of the challenge to recover – across West Yorkshire and Harrogate, this means improving access for the 40 – 50 patients each month who are currently facing unacceptable waits beyond the performance standard
- Over the next month, each Trust will work up its improvement plan for demonstrable and quantified service improvement. Where additional investment is required, this will be clearly identified and costed
- Plans will focus in the first instance on the most challenged pathways – prostate, lung, lower and upper gastrointestinal cancers, but not at the expense of other pathways
- Organisational teams will support each other to test the robustness of local plans to come up with the best system-wide solutions to addressing gaps in capacity.Based on this, we will develop a West Yorkshire and Harrogate plan for 2020/2021that identifies the support we require over and above that which can be achieved through Alliance transformation funding.
Colleagues in the Cancer Alliance Programme Management Office will work closely with senior leadership teams within our acute Trusts to agree the most cost effective strategy for delivering improved performance without adversely affecting current pathway performance, or impacting negatively on patient experience or outcomes.
The strategy will be shared with the Health and Care Partnership’s System Leadership Executive for discussion, support and agreement, particularly in relation to securing commissioning support or calls against wider ICS transformation funding where required.
Together, as a system, we can allow ourselves some collective pride in the way the system has come together in a committed, open and transparent way from Board level (with the commitment of all six WYAAT Chief Executives) across organisations through to the ‘shop floor’ – our NHS frontline.
Through a willingness to strengthen quality improvement methodologies and to be transparent about gaps and areas for improvement, our organisations have facilitated an appreciation of how best to use the resources available and an emerging understanding of how any additional funding available could be used to support further operational performance improvement. The quality and maturity of relationships across our WYH Integrated Care System has been key to what we have achieved so far – and stands us in good stead for the future.
Have a good weekend,
Sean
What else has been happening this week?
Area Partnership Group (working with the unions)
West Yorkshire Area Partnership Group met last Friday. The meeting was chaired by Rob Webster, our Partnership CEO Lead. The group is made up of union representation, HR and workforce leads.
Agenda items included the work taking place around assessment and treatment units for people with learning disabilities. ATUs provide specialist hospital support for adults with learning disabilities, who also have mental health problems and/or behaviour that challenges. The care needs of people mean that they cannot always be supported appropriately at home, in the community or in other adult mental health wards. ATUs are designed to be short-term specialist hospital placements for people with learning disabilities to receive specialist mental health treatment so they can return home as quickly as possible. You can read more here. Further engagement with people who access care, their families and carers will take place this spring. A staff workshop was held on Wednesday to look at future ways of working.
Rob updated members on the NHS staff survey and the work of our workforce strategy ‘A healthy place to live, a great place to work’. One of our big ambitions is to support Black Asian and Minority Ethnic colleagues into more leadership roles, where their talent is fully recognised. We have been asked to do a case study about this important work for the National People Plan, due out soon. Other areas discussed included making better use of the apprenticeship levy. Rob explained that we are developing our own ‘People Board’ to cover all sector partners.
There was an update on how we will work more closely with all universities around workforce planning, as well as research and innovation.
There was also an update on the work of West Yorkshire Association of Acute Trusts and an update on the Partnership’s Five Year Plan.
System Oversight Assurance Group
The Partnership’s System Oversight and Assurance Group (SOAG) met on Monday. This group takes an overview of progress with our shared priority programmes, and seeks to agree collective action to help tackle shared challenges. This month’s meeting received updates from six programmes: cancer, maternity, hospitals working together (WYAAT), unpaid carers, digital and leadership and organisational development. A paper on Partnership finances confirmed that the most likely forecast for the end of 20219/20 is that the aggregate financial position for NHS partners will be in line with plans. The group also received an update on a review to develop plans to ensure that services in Harrogate remain clinically and financially stable. The group also discussed proposals on how hotspots and pressures in local government finances can be reported alongside the reports from NHS organisations. SOAG received the NHS Workforce Race Equality Standard data analysis report for 2019, and considered the variation between West Yorkshire and Harrogate trusts on a number of key indicators.
West Yorkshire and Harrogate Communication and Engagement Network
Colleagues from the communication and engagement network met on Thursday – this time in Leeds. Over 30 people attended from various partner sectors, including councils, the NHS and charities. The agenda included hearing from Daniel Reynolds, Director of Communications for NHS Confederation, about a new national report on working in the profession, skills and roles. There was a sneak preview from Tony Beman from NHS England transformation team on the recent national research led by Britain Thinks on people’s perception of NHS terminology, communication and change. Colleagues heard from Leeds Teaching Hospitals communication team on dealing with reactive media and there was also a programme update from Keith Wilson about the work of the Partnership’s Urgent and Emergency Care Programme. Thank you to all guest speakers and colleagues who attended. The session was well received with some great feedback. The next network meeting will take place in May.
West Yorkshire and Harrogate dementia pilot
West Yorkshire and Harrogate Health and Care Partnership is one of three national dementia pilot sites exploring what work can be done collectively across an integrated care system (like ours) to reduce non-essential hospital admissions for people living with dementia.
A key part of our work has been focused on improving opportunities for people affected by dementia and/or frailty (including family carers) to have a conversation about their wishes for future care, to record these and to share them with staff involved in their care.
It's particularly important for people living with dementia that they are offered these opportunities in a timely way. This ensures that, if they choose to, people are able to make their wishes known regarding future care, helping the people who care for them and about them to understand what they would have wanted if they are no longer able communicate this themselves.
A new document, My Future Wishes – Advance Care Plan has been developed with health, social care, voluntary sector staff and people who are affected by dementia. It can be downloaded here. The document is designed for people to write about their future wishes for care, including what, who and where is important to you.
We have been working with the Alzheimer’s Society to develop a resource pack which can help. The topics covered are: what’s important to me? Lasting powers of attorney; wills, medical decisions and my care preferences. We will keep you updated as the work develops. Please contact penny.kirk@nhs.net or colinsloane@nhs.net.
Improving population health programme
The programme board met on Thursday and took highlight reports from across the wide scope of work in the programme.
The Prevention Network is active in addressing harms such as tobacco, alcohol and obesity with ambitious trajectories in place. The focus of obesity work is on preventing and reducing the incidence of Type 2 diabetes and the programme is working to deliver its aims via the National Diabetes Prevention Programme.
The population health management work stream welcomed its new Chair Tim Ryley, Chief Executive Officer for Leeds NHS (Clinical Commissioning Group). The PHM group is focusing on improving and developing links with Partner Organisations including the Health Inequalities Network and the West Yorkshire Violence Reduction Unit. The Academic Health Science and National Association of Primary Care have held workshops to support place-based implementation in Harrogate, Wakefield and Kirklees, with the Bradford workshop coming up on 24 March.
The Health Inequalities network also has a new Chair, Sohail Abbas, Clinical Director of Population Health and Wellbeing for Bradford. A Health Inequalities Workshop for members of the West Yorkshire Health Inequalities Network, the Harnessing Power of Communities Programme Board and the Improving Population Health Programme Board takes place in Leeds today 28 February.
The Health and Housing Conference for the Partnership is taking place in Leeds on 31 March. Dr Sara Munro, CEO for Leeds and York Partnership NHS Foundation Trust and CEO Lead for the Mental Health, Learning Disability and Autism Programme is a keynote speaker. Feedback from the conference will be used to identify priority areas for action for a Health and Housing Network.
Recruitment is underway for a climate change lead for the Partnership. A Climate Change Network will be convened to support work towards the Partnerships ambition to become a global leader in responding to the climate change emergency through increased mitigation, investment and culture change throughout our system.
The Anti-Microbial Resistance (AMR) workstream is planning for the first meeting of its steering group scheduled for 17 March. The meeting will agree a system action plan for AMR based on feedback from previous planning events.
The Mental Health Concordat was presented for sign-off, and a paper about the programme’s approach to communications and engagement was shared for discussion. We will be developing a plan with the support and expertise of local communication and engagement leads.
NHS Assembly
The NHS Assembly meets today. The agenda includes the focus in 2020; the work of the NHS Assembly in its first year and proposals for action; clinical review of standards around what is important to patients? Population health, working in partnership for social, economic and environmental development; and people powered NHS - enhancing the role of people and communities in healthcare is all on the agenda.
Coronavirus update
The NHS England website has been updated with new coronavirus pages, bringing guidance to the system and healthcare colleagues in one place. NHS England are working with Public Health England to change posters to reflect the new case definition. These will be uploaded on the Campaign Resource Centre where the existing materials can be found.
Harnessing the Power of Communities in Leeds
Social isolation and loneliness is an emerging issue right across the country, which is a major health and wellbeing risk for our most vulnerable residents. This is why it is a priority for the West Yorkshire and Harrogate Care Partnership, as well as in many of our local place based plans.
You will have seen our ‘Looking out for our neighbours’ campaign, which is aiming to create a social movement among local people, to make us all a bit more neighbourly, and help to look out for some of our most vulnerable residents, who are particular risk of being isolated and lonely. You can show your support for the Our Neighbours campaign by visiting ourneighbours.org.uk, pledging your support, and find out how you can help.
Tackling social isolation and loneliness is a complex challenge, hwoever, and requires several different approaches. Therefore, in 2018 the West Yorkshire and Harrogate Care Partnership committed £1m of funding to empower community organisations to tackle social isolation and loneliness – it is known as the ‘Harnessing the Power of Communities Programme’.
In Leeds, where there is a thriving community sector, with a many organisations having an established track record of trust and achieving positive health outcomes with the communities they serve. Therefore, working in partnership with Leeds Community Foundation, £250k worth of grants to nine local organisations thanks to the Harnessing the Power of Communities Programme.
It’d be a dis-service to their hard work and achievements to summarise their outcomes in a few bullet points, so over the next few weeks each of the organisations will be invited to create a vlog about their projects, and tell the story about the impact of their work. These will be made available on the partnership website, so watch this space!
The nine projects that received funding in Leeds through the Harnessing the Power of Communities programme are:
- Oblong: Mental wellbeing groups in Yeadon, Beeston & Armley
- Orion Partnership/Space2 Leeds: Men’s groups focusing on peer support, health and wellbeing and health campaigns led by men for men
- Solace Surviving Exile and Persecution: Refugee and Asylum Seeker triage service (pain management therapies, improving access to MH services)
- Community Links: Holistic approach to improve physical, mental and social outcomes among people with MH issues, younger people with Dementia and carers
- Dial Leeds Ltd: Peer support for foodbank users with any impairment and/or long-term conditions
- GIPSIL: Wellbeing outreach support for young people aged 16-25 around MH, accessing appropriate services, positive transition between MH services
- Hamara Healthy Living Centre: 5 Ways to a Healthy Heart – physical & emotional wellbeing, isolation, health inequalities in the local community.
- Holbeck Together (formerly Holbeck Elderly Aid): Out-of-hours befriending service, therapeutic Wellbeing Space, carer's group and Seasonal Health Campaigns.
- Leeds 14 Trust: Target loneliness and health inequalities through activities including Sporty Snacks, Family Food Clubs and Cafés with different focuses (carers, world culture, arts).