Posted on: 22 May 2020
This week’s leadership messages come from Richard Stubbs, CEO for Yorkshire and Humber Academic Health Science Network and Jo Farn, Programme Director for System and Leadership Development at West Yorkshire and Harrogate Health and Care Partnership. And from Professor Sean Duffy, Clinical Lead for the West Yorkshire and Harrogate Cancer Alliance.
Recovery, Restoration, Reset and more; since the onset of coronavirus there have been many words used to describe the act of restarting our mainstream health and care services. But from early on in the pandemic it was clear that, despite the tragedy of the daily death count, this was a moment to rethink before we restarted. In West Yorkshire and Harrogate (and across the country) aspects of our service delivery have been transformed more in the last six weeks than in the last decade. Not all of these transformations will endure (or should endure) but there are certainly changes that have been made through the necessity of Covid-19 that point the way to a more modern, responsive and flexible model of delivering services to people; these changes should be identified, evaluated and , where appropriate, rapidly adopted across the region.
Working in partnership with the Yorkshire and Humber Academic Health Science Network, the West Yorkshire and Harrogate Health and Care Partnership, System and Leadership Development Team are leading work on this across the patch, with two areas of focus:
- A continual learning, innovation, improvement and evaluation process, balanced with a practical need for rapid implementation of change as we move forward
- Identifying behavioural, culture change and specific innovations we want to leave behind or embrace.
We are currently seeking colleagues’ views so that we can understand and capture the learning and innovation that is emerging. If you wish to contribute, please click here for more details. Our thinking has been helped by this simple yet effective diagram which has been produced by Ian Burbidge from the Royal Society of Arts (RSA).
Using the diagram, we can identify those transformations that live in the top right box, things that have been started as a result of the pandemic that now need to be captured and amplified. However it is equally important that we pay attention to the bottom left box, what is it that we need to let go, what have we stopped as a result of coronavirus pressure that now should not be restarted? We need to be as focused on decommissioning as we are on amplification of the new if the NHS is to truly transform.
It is also important that we capture the ‘software’ of learning and innovation; behaviours, leadership styles, values, as it is to capture the ‘hardware’ and new ways of working. Technical innovations and service delivery models are equally important because understanding this software is key to implementing and embedding the hardware innovations we want to keep and will also be key in creating a great place to work and receive care. A key to leadership is starting with oneself; to understand what has gone on around us, we need to reflect on our own role and influence in the learning and innovation we’ve experienced; quite often we are more predisposed to identify the factors external to us that have enabled change.
Thinking about what behaviours and skills you’ve developed personally is key for growth and continual learning. The reset also allows us to think deeply about our wider mission of delivering health and care services to people. The pandemic has laid bare the stark inequalities in our society and as a Partnership we need to show leadership in several key challenges:
- Health inequalities: how can our experience of the pandemic influence a new approach to preventative interventions for long term health inequalities?
- Equality and diversity: Covid-19 is not the great leveller’ – the disproportionate deaths of Black Asian and Minority Ethnic (BAME) health and care staff during the pandemic cannot be forgotten when ‘resetting’
- Economic growth and health: we know health and wealth are intrinsically linked; the coming recession is a future health challenge which calls for commitment and leadership
- Prevention and wellbeing: are we as a society redefining our relationship with health, as well as health care, and how does the Partnership best support this?
Above all, the challenge of reset is a cultural one. Are the recent cultural conditions that have supported service transformation sustainable in the longer term? The effort by front line has been, and continues to be, herculean. Much of the transformation has been possible because the entire machinery of the NHS and government has been focused on one specific challenge. As we reset, we need to be aware of the temporary nature of these conditions, but also seek to nurture those that are sustainable, such as the empowerment of clinically led front line teams and the supportive intent of lighter touch regulation.
The final question in our survey is our favourite: "In ten years’ time what one thing do you hope will have come out of the Covid-19 response?"
Jo’s response: I hope we will have achieved a mind-set shift towards continual learning and improvement; where pausing, reflecting and adapting is how we do things round here.
Richard’s response: I hope that the country will have reset its definition of success, with physical and mental wellbeing forming a major part of our measurement of the government’s purpose and outcomes.
Have a safe and well bank holiday weekend everyone,
Richard and Jo.
Public confidence in cancer services is crucial to future outcomes
Hello, my name is Sean Duffy and I'm the Clinical Lead for West Yorkshire and Harrogate Cancer Alliance
Across West Yorkshire and Harrogate, the Cancer Alliance and our six hospital Trusts – Airedale, Bradford, Calderdale & Huddersfield, Harrogate, Leeds and Mid Yorkshire – are continuing to collaborate on ways of working that have enabled the ongoing delivery of cancer surgery, treatment and diagnostic tests – prioritised by clinical need - during the COVID-19 outbreak and into the current restoration and recovery phase.
To date in West Yorkshire and Harrogate, we have managed to maintain around 60 per cent of cancer surgical activity during the COVID-19 outbreak, across all six hospital Trusts. As the demand for treatment of COVID patients begins to decrease, with fewer patients requiring hospital treatment being admitted and capacity being released for non COVID-related work, every organisation is planning how to do more.
In West Yorkshire and Harrogate, the model of a single cancer ‘hub’ – the model used in London and Manchester - was never the best option for us. Our hospital Trusts – working as a Cancer Alliance - have committed to supporting system-wide resilience and recovery, while recognising that the offer of treatment at their usual hospital, closer to home, is better for patients and their families.
Leeds Teaching Hospitals will continue to offer the majority of surgery for rare and intermediate cancers. Mid Yorkshire – through Pontefract – and Bradford will provide surgery for common cancers and their existing specialist work, while Calderdale, Airedale and Harrogate will continue to manage their own common cancer surgery. Either stand-alone COVID protected sites – like the dedicated care centre at Pontefract Hospital, announced this week - or isolated COVID protected zones within hospital estates (both in the NHS and independent sector) are being created and used to undertake more surgical treatment in a safe way. Pontefract Hospital – part of Mid Yorkshire Hospitals Trust – is a great example, providing cancer services for 550,000 citizens of Wakefield district and North Kirklees. To keep the risk of staff or patients being exposed to COVID-19 to an absolute minimum, all other inpatient other services will be moved off the hospital site temporarily and the hospital will be zoned to enable separate access to the cancer centre.
The Urgent Treatment Centre (UTC) and GP Out of Hours’ Service which is based at Pontefract will remain open with patients and staff using the separate entrance to the UTC.
As in all our hospitals where cancer surgery is to be carried out, there are agreed Alliance-wide safety guidelines for pre-operative self isolation, pre-operative testing for COVID-19 and separation of patients from potential contact with anyone who has not been screened.
Excellent modern facilities, including consulting rooms and theatres, and the physical layout of the site, mean that Pontefract is ideally placed to manage the risk of infection and drive forward the recovery of cancer services in Mid Yorkshire. The real life experiences of patients who receive a positive experience of care there will help us to change the perception that the NHS is totally devoted to coronavirus patients at the expense of all other treatment.
Receiving a cancer diagnosis, awaiting or undergoing cancer treatment is an intensely worrying time for every patient, but even more so against the backdrop of concern and uncertainty generated by the current COVID-19 situation.
Across the country, evidence is showing us that many people are opting not to engage with cancer services at this time, are reluctant to visit hospital when invited to attend and instead are choosing to defer their diagnostics or treatment – either because they are worried about what they perceive to be an additional burden on an already overstretched NHS, or they are afraid of contracting the virus during the course of their treatment.
Primary care, too, has seen a drastic reduction in the numbers of people coming forward with concerning signs and symptoms that might be cancer. For many people, contacting their GP to talk about a lump they have found, a change in bowel habits, unexplained weight loss or any other possible cancer symptom is a step they find difficult to take at any time. Add the fear of contracting coronavirus into the mix, and the likelihood of them seeking early help- thereby increasing their chances of a positive outcome - is dramatically reduced.
Securing public confidence in the availability and safety of cancer care is therefore essential to ensure we reverse these concerning downward trends. The earlier the diagnosis, the more likely cancer is to be treated. The longer a patient defers the treatment they need, the greater the potential deterioration in their condition.
Helpful campaigns #StillHereToHelp and #HelpUsHelpYou have been designed at regional and national level to promote the message that the NHS is still open for business and well able to deal with non-COVID related conditions such as chest pain, heart attacks, strokes and suspected cancer. I’m one of a number of clinicians who have recorded personal messages to support the campaign objectives.
We’re also grateful to patients like Lynne, a retired teacher from Ossett, for sharing with us their first hand experiences of accessing care at this time. You can read Lynne’s story – Don’t Sit On Your Symptoms, Act Now - here.
But these important high level messages can only go so far, and as a Cancer Alliance we have begun to gather insight about what patients need in order to feel reassured before they make that important decision to access services at this time.
Around 40 members of our Cancer Alliance community/patient panel are being asked their views What information would help them make the choice? Which sources of information would they be most likely to Trust? Would they only be willing to be treated at their local hospital or would they attend elsewhere in West Yorkshire and Harrogate if it meant they could receive their treatment more quickly? Would they expect their clinical team to remain unchanged irrespective of their treating hospital?
We are also working with our colleagues in the Yorkshire Cancer Community and patient support groups across West Yorkshire and Harrogate to widen this patient engagement and ensure that any changes in attitudes over time are reflected in our operational approach and our communications activity.
We consider that our approach for recovery and restoration in West Yorkshire and Harrogate offers the safest, most effective way to maintain and increase cancer treatment at this present time and in the months ahead. However, this is a fast moving situation and our plans will kept under constant review to ensure we can respond to prevailing pressures at any given time, and based on feedback from our colleagues in local hospitals and our patients.
One message will, of course, remain unchanged - the safety and wellbeing of our patients remains our overriding concern at all times.
Have a safe and well weekend,
Sean
What else has been happening this week?
West Yorkshire and Harrogate Children and Families Programme Board
The programme board met last Friday. It was chaired by Tim Ryley, CEO for NHS Leeds, who is one of two co-chairs, supported by Sue Rumbold, our programme director. It included colleagues from the NHS, councils, including public health and community organisations. The meeting focused on end of life care for children; hospital care; long term health conditions and the importance of improving life chances for young people.
The programme includes a number of work streams, including mental health, young carers, family resilience, early help and best start in life. Mat Mathai, from Bradford Teaching Hospitals NHS Trust gave an update on the work of the ACE programme in supporting children and young people at home and in hospital during the Covid-19 pandemic.
Making sure children and young people receive the level of their care they need across all health conditions, such as diabetes, obesity and epilepsy and meeting standards during these uncertain times was discussed as well as the transition between health and care services.
The impact on children with additional needs has been significant; many of these children are unable to follow the social distancing guidelines and can be vulnerable due to their health and care needs.
The shielding guidance has created some challenges for parents and schools. The recent guidance on returning to school published last week is clear that this is creating some real challenges for families.
There is also the potential for young carers to be experiencing heightened anxieties about the health of those they care for, especially if they are caring for somebody who is elderly or who has ‘underlying health issues’ or mental health concerns.
Mental Health, Learning Disabilities and Autism Programme
We are seeing a great deal of work going into the development of resources by the Partnership and other organisations designed to help communities with maintaining and improving their health, including help for people in or approaching crisis.
NHSX is a joint unit bringing together teams from the Department of Health and Social Care and NHS England and NHS Improvement to drive the digital transformation of care, and together with the Ministry of Housing, Communities and Local Government (MHCLG) has announced 18 digital solutions that offer support to vulnerable people who need to stay at home or need other help in the community for extended periods of time. Among these solutions are Neurolove.org, a platform provided by Chanua that offers a friendly ear and human support for young people to help them to keep virtually social and safe online, and the RIX Multi Me toolkit that provides highly accessible and secure social networking for people with learning disabilities and complex mental health problems.
The Samaritans have partnered with Shout, Mind, Hospice UK and The Royal Foundation to launch Our Frontline, a round-the-clock, 1:1 support service for health, care, emergency and key workers.
Equally Well UK has produced a guide to looking after your health during Covid-19 for people living with severe mental illness.
A survey on access to and experience of using urgent and crisis care for autistic people in West Yorkshire and Harrogate is in the testing phase and will be launched to the public shortly. It includes questions about:
- NHS 111 phone or online service
- Urgent treatment centres
- GP surgeries
- A&E departments
- Mental health crisis services
- Yorkshire Ambulance Service
Looking ahead, the West Yorkshire and Harrogate Mental Health, Learning Disabilities and Autism Programme has identified a number of areas including data collection (particularly including voluntary community sector activity (VCS); supporting continued VCS funding streams; how to capture the personalisation agenda to take forward holistic physical/mental health support and how we enhance our use of people with lived experience/advocacy to supplement traditional care support. More information on these important strands of work will emerge over the summer.
Improving Population Health
The West Yorkshire and Harrogate Improving Population Health Programme is establishing a co-ordination and working group focused on the population health impacts of the Covid-19 pandemic and the health inequalities impacts of the Covid-19 pandemic, to develop an Improving Population Health: response and reset plan for West Yorkshire and Harrogate. The Programme held a webinar last week to allow potential applicants to find out more and ask questions about the Health Inequalities Grant Funding . Based on feedback from local places and emerging evidence base we have decided to expand the focus of the grant funding to include ethnic minority population groups. £450,000 of funds has been made available to voluntary and community organisations to help tackle the impact on people’s health affected by Covid-19. The deadline to apply is 5pm on Monday 8 June 2020. Decisions will be made by a virtual panel and applicants will be notified before 30 June 2020. More information can be found here.
New resources on Covid-19 and health inequalities have been published on the Local Government Association website. The COVID-19: Place based approach to reducing health inequalities resources include a summary of guidance, suggestions to mitigate health inequalities and a Health Equity Assessment Tool. Work has started on planning intelligence around Covid-19, ethnicity and deprivation, bringing together data from across West Yorkshire on Covid-19 infections and outcomes, with a focus on inequalities by ethnicity and deprivation. We plan to analyse data on hospital care and outcomes for Covid-19 infection to understand overall rates and inequalities, and use this intelligence to inform action across the system.
Cancer care
Pontefract Hospital is to be temporarily developed as a dedicated cancer centre to care for people who need diagnosis or surgery for suspected cancers during the COVID-19 outbreak.The West Yorkshire and Harrogate Cancer Alliance has been working with hospital trusts to develop plans so that people who are referred for tests for suspected cancer, or whose condition could deteriorate if treatment was delayed, can be seen at a hospital where the risk of exposure to the Covid-19 virus is kept to the absolute minimum. The centre at Pontefract will mainly provide a service for the 550,000 citizens of Wakefield district and North Kirklees. You can read more here.
System Leadership and Development
Coronavirus has affected all of our lives - challenging our ability to adapt and be resilient. With the outbreak of Coronavirus being declared a pandemic we are facing a major challenge both personally and professionally. Coronavirus has significantly affected our lives, it is also challenging our ability to adapt and be resilient. We are in a state of rapid change, and must respond with different ways of working, learning and communicating. Online working and virtual meetings are no longer new to us. However, Covid-19 is reviving the need to explore learning opportunities, our behaviour and culture as a Partnership. With the support of the Yorkshire and Humber Academic Health and Science Network, we want to hear colleagues’ views, so we can understand and capture the learning and innovation that is emerging. The West Yorkshire and Harrogate Health and Care Partnership System and Leadership Development Team, with the support of the Yorkshire and Humber Academic Health Science Network, want to hear Partnership colleagues’ views, so we can understand and capture the learning and innovation that is emerging. We’re inviting you to get involved and share your views in several ways:
- An online survey to be completed by Friday 5 June – AVAILABLE HERE
- Inviting us to one of your programme or place based meetings to facilitate as group conversation (please contact Peter.Wyllie@nhs.net with the date you’d like us to attend).
- Sharing with us any capture of learning you’ve already done.
The work we are doing is not intended to replace or duplicate existing work taking place. It’s intended to support existing work whilst following the Partnership’s principles of sharing learning and good practice and scaling up what has worked well across West Yorkshire and Harrogate. Report findings will be shared by the end of June on our website.
What is R?
Reproduction number (or R) is one of the most important numbers of the coronavirus pandemic. So what is it? And how is it estimated? The ‘R’ number is a number that says how many people each person who has a disease will infect. The ‘R’ number can change, depending on how many contacts people have, such as during an epidemic lockdown. The number is always an average. It is the rate of new people infected when it is passed on.
Dr Sebastian Funk, Associate Professor and Director of the Centre for the Mathematical modelling of infectious diseases, explains it on the BBC Radio 4 Today Programme here on Friday 15 May (48.41mins). Put simply, as long as the ‘R’ number is less than 1, every person with Covid-19 will infect less than one person so the outbreak will decrease in size until it ends. However, if the ‘R’ was to go back above 1, the number of cases could increase, potentially leading to a further outbreak. You can read this briefing paper here.