Hello my name is Cath…
As we head into the New Year I was pleased to accept the invitation from West Yorkshire and Harrogate Health and Care Partnership to write this week’s leadership message. In doing so it has given me the opportunity to reflect on the past 12 months whilst setting out my adult social care ambitions and aspirations for 2019.
I write this blog wearing two hats – one as a Director for Adults and Health in a large city council (Leeds) and the other as regional chair of Yorkshire and Humber Association of Directors of Adult Social Services (ADASS).
You may not know much about ADASS (or even heard about it) so I thought it helpful to firstly give you an overview of the work the membership do.
ADASS is the Association of Directors of Adult Social Services in England. It is a charity and its aims are to further the interests of people in need of social care by promoting high standards of social care services and influencing the development of social care legislation and policy. The membership is drawn from serving Directors of Adult Social Services employed by local authorities. Members play a key role in sector led improvement: constantly promoting best practice and learning from each other. We also play a significant role in shaping and commenting of key national policies, strategies and legislation. For example, we are really busy contributing to the Social Care Green paper, commenting on the relevant chapters of the NHS Plan and also commenting on the proposals relating to the Mental Capacity Act. Regionally we are currently doing a big piece of working looking at the working age adult population, trying to understand the difference in spend and unit cost of services and also how we can develop better services for people.
Much has been made of it being the 70th Anniversary of the NHS. What has had far less publicity is that it is also 70 years since the passing of the National Assistance Act 1948 which abolished the Poor Law system that had been in place since the reign of Elizabeth 1 and established a modern social safety net for those who did not pay National Insurance contributions. We now have the Care Act 2014 which is a welcome overhaul of the existing 60 year old legislation.
The Care Act is a progressive piece of legislation and established for the first time a duty to promote the well-being of carers, a greater emphasis on prevention, encouraging and supporting people to live healthy lives and reduce the chance of people needing more support in the future. It also requires social care to take a “strengths-based” approach to how we work with people with care and support needs.
I was really pleased to see how prominently an asset-based/ strengths-based approach features in the West Yorkshire and Harrogate Health and Care Plan. By beginning a conversation with people about what matters to them rather than what’s the matter with them changes things for the better.
For a start it is a more respectful way to talk to people and not put them in the position of being a “supplicant” to the state for the “professional gift” of a service that meets their needs. It shifts the conversation to be more about working in partnership and that fits with the aspiration of the West Yorkshire and Harrogate Health and Care Partnership.
As Sir David Behan says “From now on we will be judged by how well we collaborate” and for me I see that collaboration as being between local government and health rather than just social care and health. While social care has a key role to play, the influence local government has on the wider determinants of well-being should never been forgotten. I would also like to speak up for the intrinsic merit of social care that does its best to support older and disabled people to have fulfilling lives with dignity and security. Although supporting system flow is really important, social care has a much bigger role to play than just admission avoidance and supporting hospital discharge.
The best way to help people live as independently as possible, as long as possible, is to provide effective support in the communities in which they live. We can only do this together with the NHS, community providers, our workforce and communities themselves.
So, I am going to award myself three Christmas wishes:
- A future for social care that is financially sustainable and has a fair balance between the role of the state and the role of the citizen
- A future for social care that is sufficient to support a fair wage for all those social care staff doing such great job
- A future for social care that is sufficient to extend support to all the people who currently have unmet needs.
(And if I could sneak a fourth wish in, it would be to never hear the word “Brexit” again).
Best Wishes to everyone for Christmas and the New Year.
Cath
What else has been happening?
NHS National Clinical Commissioners Network
The National Clinical Commissioners held a lay members network event on Monday. Marie Burnham, Independent Lay Chair for the West Yorkshire and Harrogate Joint Committee of the Clinical Commissioning Group attended with Richard Wilkinson and Fatima Khan Shah (Committee Lay Member for Patient, Public Involvement). The conference was an opportunity to share information and good practice on the role of Lay Members in Partnerships such as ours (also known as STPs and integrated care systems) how they can add value to system working. The presentations including one from Dan Northam-Jones Deputy Director of System transformation at NHS England who recognised our Partnership as an exemplar in its approach to involving lay members through its work in the Patient and Public Involvement Assurance Group, the Joint Committee, the Cancer Alliance and within other programme boards.
West Yorkshire and Harrogate Clinical Leadership and Involvement Workshop
This workshop took place on Tuesday and was chaired by Dr Andy Withers, Chair of West Yorkshire and Harrogate Clinical Forum. It included medical directors, GPs, pharmacists, allied health professionals, and nurses. The workshop has been supported by NHS England and covered clinical leadership, involvement and why this is important in the context of our Partnership. It was also about building on our work to date; people first, structures last. And you can see real example of our developments in the work we are doing with the Academic Health Science Network to prevent people having a stroke. There was also a discussion on what ‘good’ looks like, where are we now, where do we want to get to and how we can further improve people’s lives, whilst reducing health inequalities.
Dr Andy Withers, Chair of West Yorkshire and Harrogate Clinical Forum give an overview on current work arrangements. We have a Clinical Forum, Joint Committee of Clinical Commissioning Groups, hospitals working together and mental health and learning disability collaborative. Key to all of this is the work we do with social care partners and communities.
Andy highlighted how by working together we aim to have 620 fewer deaths from heart disease across the area in the next three years. Andy also talked about the importance of developing our workforce and giving people the right care locally in our six areas (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield). Primacy of place takes precedence, and we only work across West Yorkshire and Harrogate where it makes sense to do so and most importantly where health and wellbeing can be improved for those we serve.
Claire Fuller from Surrey Heartlands Partnership outlined their programme successes and challenges. This covered what we need to do at neighbourhood, local and Partnership level and the connectivity between all. There was an overview on addressing the wider determinants of health, for example green space and environment; a citizen engagement / panel and the role of community ambassadors for service co-design. They have five pillars for clinical leadership. This includes clinical and citizen engagement; knowledge, management, evidence; quality improvement; innovation and research. Claire explained the changing role of health and care organisations and the importance of joined up care. If we want to evolve health and care systems for the better we need to change together. Organisations can’t work in isolation. Claire gave some clear messages around the value of care, gaining the trust of people, genuine staff involvement and asking staff what is the best method of public engagement/involvement. Claire stressed that it is the responsibility of all leaders to share the vision. We need to continually learn from each other and ‘pinch with pride’ from others good areas of work whilst ensuring the voice of our clinicians is embedded throughout.
Mental Health Programme Board
The programme board met on Tuesday. It is chaired by Dr Sara Munro, CEO for Leeds and York Partnership NHS Trust (LYPFT). Members received an update on the new adult eating disorder service CONNECT from Dr Rhys Jones (clinical lead/consultant psychiatrist, LYPFT). The board heard about the positive impact the service is making and the work to embed the service further including engagement with primary care colleagues. Members also received an update on the national pilot focussed on reducing unnecessary hospital admissions for people with dementia. Improvements identified as advanced care planning, delirium awareness and inpatient care assessments were all discussed. The work will build on the frailty programme underway in our six local places.
West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups
The Joint Committee had a development session on Tuesday, chaired by Marie Burnham (Independent Lay Chair). Marie welcomed Myron Rogers to the meeting. Myron is a specialist in large-scale organisation change and leadership development. The Committee discussed future commissioning arrangements at a local, place and West Yorkshire and Harrogate level and explored the role of the Joint Committee in supporting change. A number of themes came through including the importance of collaboration between providers and commissioners and the need to work effectively with hospitals, local authorities and other stakeholders locally and at a West Yorkshire and Harrogate level. The challenges of working as one health and social care system were discussed. Key issues included the role of primary care networks/communities, workforce development and meeting financial challenges. The Committee focused on how it could support greater collaborative and whole system working going forward.
Myron’s feedback was that Committee members were very open and honest with each other around rethinking and refining their response to the transformation challenge. He felt that it was important to recognise the progress that had already been made in building trust and whole system approaches. It is equally important to mark out future progress in tackling the key challenges.
West Yorkshire and Harrogate System Leadership Executive Group
Leaders from all our Partnership sectors met on Tuesday. The meeting was chaired by Rob Webster, our CEO Partnership Lead.
Our Shadow System Leadership Executive Group met ahead of the meeting on Monday. This meeting is chaired by Dr Matt Walsh, Chief Officer for Calderdale Clinical Commissioning Group and CEO Lead for Improving Planned Care. Matt provided a concise summary of the shadow group discussions after each of the leadership group agenda items had been introduced on Tuesday.
A number of leaders recently met with NHS England and NHS Improvement to discuss the work we are doing. The meeting focused on how we are developing as a system and the progress we are making. We received good feedback on the strength of our leadership across health and care and it was noted that closer partnership working is allowing us to progress on some issues more quickly than would have previously been possible. They were particularly positive about our partnership arrangements with local government, the progress and pace of the acute trust collaboration programme (hospitals working together) and our work on mutual accountability.
All partner organisations have formally approved the Partnership’s Memorandum of Understanding. This will be published on our website soon. Thank you to everyone involved.
Dr Andy Withers gave leaders an update on the stroke programme and to share the next steps in relation to the proposed legacy actions, including establishing a clinical network, after care for people who have had a stroke and workforce. This will conclude the West Yorkshire and Harrogate work on hyper acute stroke services (the care people receive in the first 72 hours following a stroke). A transition plan setting out the next steps of work highlighting support needed to move forward will be brought back to a future meeting.
Helen Hirst, Accountable officer for the three CCGs in Bradford District and Craven – Airedale, Wharfedale and Craven, Bradford City and Bradford Districts, is also our CEO Partnership lead for our organisational development work. Helen gave an overview of the peer review work and pilot in Wakefield. The purpose of the review process is to understand the progress each area (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) is making towards joined up health and care, and to understand the effectiveness of connections between West Yorkshire and Harrogate and place based working. Wakefield health care system felt it was a positive experience. It was a learning challenge and people welcomed the approach. The peer review is also helpful for our Partnership development. Thanks were noted for the support given from Local Government Association and NHS Confederation.
Carol McKenna, Accountable Officer for North Kirklees Clinical Commissioning Group and Greater Huddersfield Clinical Commissioning Group, provided an update on the £2.6m transformation funding allocated to support the development and acceleration of primary care networks / communities (PCNs). Carol set out the progress made so far and the work of the GP Federations and the Primary and Community Care Programme Board around workforce and building resilience. It is clear that this is all about supporting local neighbourhoods to meet their health care needs, for example caring for people who are frail or those with mental health concerns.
West Yorkshire and Harrogate Leadership Group
The wider leadership group also met on Tuesday. This was chaired by Rob Webster, our CEO Partnership Lead. Rob explained that work continues on the development of the NHS Long Term Plan and the social care green paper. These are expected to be published after the Brexit vote on the 12 December. We will keep you informed on the planning guidance when it comes out and the role of our Partnership.
We had an innovative and engaging session led by Myron Rogers about the practical reality of system leadership ‘changing the way we change’. This is something often cited by think tanks, the media and national leaders. We are at the sharp end of doing it. As a large Partnership (also known as an integrated care system) we are well regarded for our approach to date. Internally, we have also highlighted the need for organisational support and help to really move on – so that together we can further improve people’s health and wellbeing across our area.
Large-scale organisational change requires us to work differently together in new ways. Myron has worked on large programmes to integrate health and care across many areas. He talked about his experience of delivering change and the importance of looking at a person’s networks outside of formal care arrangements. He also explained his thoughts in terms of challenges, boundaries and leaders keeping up with changing environments. In particular he talked about the complexity of organising ourselves differently and ensuring people who access services are fully engaged and have a seat and voice at top the table. Something we aim to do on our Partnership Board which meets for the first time in public in June 2019.
Myron explained to the leaders in the room that we live in a world of constant change and our organisations need to constantly adapt to both survive and prosper. He also shared his views on building capability and capacity to deal successfully with change and how to make organisations, teams and department more agile. Helping people deal more effectively with change and people own what they help to create as well as real change only happens in real work was also discussed. Thank you to Helen Hirst for planning the session and to Lauren Phillips and colleagues for bringing everyone together.
West Yorkshire and Harrogate Association of Acute Trusts (hospitals working together)
CEOs from West Yorkshire and Harrogate Association of Acute Trusts (WYAAT) met on Tuesday. They discussed their collaborative approach to workforce issues including the development of a shared medical bank, winter preparedness and the pharmacy supply chain programme. Fatima Khan-Shah lead for the unpaid carers programme also presented a proposal to implement the working carers passport across WY&H. Fatima gave an overview of the benefits of the scheme and potential implementation approaches with the aim of launching the scheme by the end of 2018/19. The proposal was supported by all hospital CEOs. Implementation will be discussed with relevant colleagues, including exploring the potential to create a ‘digital carers passport’.
The International GP Recruitment Programme
This programme was created in support of the GP Forward View (GPFV), which recognises the pressures within primary care and general practice, in particular the challenge of workforce and GP recruitment. Following a successful bid to NHS England, West Yorkshire and Harrogate Health and Care Partnership has embarked on a three-year project to recruit suitably qualified international GP’s to the area. We will keep you posted as the work develops – in the meantime you can find out more about interantional GP recruitment here.
West Yorkshire Joint Health and Overview Scrutiny Committee
West Yorkshire Joint Health and Overview Scrutiny Committee (JHOSC) met on Wednesday in Bradford. The agenda can be viewed here. The Committee brings together West Yorkshire councils to provide an overview of the West Yorkshire and Harrogate Health and Care Plan and the work of the various boards that form part of the overall governance arrangements for our Partnership. It is an important meeting for us as we need to ensure our democratic leaders are kept fully informed in all our work.
JOHSC is made up overview and scrutiny committee chairs from Bradford, Calderdale, Kirklees, Leeds and Wakefield. There was a discussion on the work of West Yorkshire Association of Acute Trusts (hospitals working together) including an update on the twelve programme areas, for example information management and technology; clinical support services; pharmacy; pathology; radiology and planned care. JHOSC members also received an update on the role of the Local Workforce Action Board (LWAB). You can find out more about our workforce plan here.
West Yorkshire and Harrogate Cancer Alliance
Leeds Cancer Programme celebrated its 18 month halfway mark at Shine last week to review the programme’s progress and to present and consult on plans for the future. Over fifty stakeholders from partner organisations, NHS delivery teams, community representations, patient and public panels attended to hear the discussions and presentations given by programme leaders.
The event was opened by Professor Sean Duffy, Clinical Lead for the West Yorkshire and Harrogate Cancer Alliance who gave an overview of cancer in Leeds and the programmes achievements and ambitions. This included the programme bringing £4.5m worth of investment for cancer services into Leeds to create pioneering system change with the patient and public at the heart of its plans.
A short film was shown to highlight the activities the programme delivers, including working with Unique to educate young people with learning difficulties to be aware of the signs and symptoms of some cancers; implementing ‘teledermatology’ equipment across primary care to speed up diagnosis and treat patients within their locality; and nurses rolling out holistic needs assessments following cancer treatment. You can watch the film here or at the bottom of this page.
West Yorkshire and Harrogate Cancer Alliance community/patient panel
The second meeting of the West Yorkshire and Harrogate Cancer Alliance community/patient panel was held in Leeds this week. The panel – which is run by Healthwatch Wakefield on behalf of the Alliance - is made up of patients, carers and others affected by or with an interest in cancer from across the patch.
At this week’s meeting, panel members began working on specific elements of the Tackling Lung Cancer programme – which is currently being piloted in Wakefield and Bradford – and the rapid diagnostic pathway for vague but concerning symptoms, both of which are priorities for the Cancer Alliance.
Click here to find more information about the community/patient panel or contact Panel Co-ordinator Fraser Corry by email to fraser.corry@healthwatchwakefield.co.uk
What's happening next week?
- The Harnessing the Power of Communities Programme members meet on Monday.
- West Yorkshire and Harrogate Healthy Hearts Programme members meet on Monday.
- The West Yorkshire Mental Health Services Collaborative Executive Group (mental health trusts working together) meet next Tuesday
- Local place based planners from Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield meet on Tuesday.
- The unpaid carer’s project group meets on Thursday.
- Population health management group meet on Thursday.
- West Yorkshire and Harrogate priority programme leads meet on Thursday.
- On Thursday there will be a workshop for programme directors on inclusive involvement of people with learning disabilities in their work.
- The West Yorkshire Area Partnership Group meets on Friday. This includes colleagues from staff side and the unions.