Posted on: 16 January 2020
Karen Jackson is the CEO Lead for Locala Community Partnerships, Richard Parry is the Strategic Director for Adults and Health at Kirklees Council and Fatima Khan-Shah is our Unpaid Carers Programme Lead. Karen and Richard are co-chairs of the Partnership’s Supporting Unpaid Carers Programme.
Hello
As leaders in community health and social care we recognise the huge contribution that unpaid carers make across our local areas. We are working hard with partners, including voluntary, community sector colleagues to aspire to be a region where the 260,000 carers living across West Yorkshire and Harrogate are recognised, and importantly given the support they need to manage their caring role and have a good quality of life, including remaining in employment or education.
Although caring can be extremely rewarding, evidence shows (Carers UK and others) that carers experience poorer physical and mental health in comparison to those who are not caring. Not surprisingly, the impact is greater if you are providing a higher level of care or caring for more than one person – which many people do.
When we think of carers we often revert to a stereotypical view, for example a middle-aged person caring for their parents or an older person caring for their spouse, what we all too often overlook is that there are hundreds of young carers.
A young carer is someone under the age of 18 who helps look after someone in their family, or a friend, who is ill, disabled or misuses drugs or alcohol. In West Yorkshire and Harrogate we have carers as young as five years old. Clearly we need to do something about this, so they have every chance possible to share the same life opportunities as many other young people.
For many carers, the biggest priority is the health and wellbeing of those that they care for and so are more likely to neglect their own health and are known to put off treatment for themselves. This is even truer for our young carers who can experience difficulties in their education as a result of their caring role. Without support, young carers struggle to attend school, make progress, and are often bullied. They also say they feel invisible and often feel in distress, with up to 40% reporting mental health problems arising from their experience of caring.
One of the biggest barriers is that young carers don’t always see themselves as such and don’t recognise their caring responsibility, and those who do recognise themselves as being a carer do not know who and where to turn for help. It’s important that no young person feels as though they are struggling to cope alone. The world can be scary enough.
We recognise that more needs to be done to support these young people, and so on Thursday 30 January we are proud to be supporting Young Carers Awareness Day and raising awareness of the challenges they face, as well as celebrating the great work taking place across West Yorkshire and Harrogate communities already.
We are encouraging our colleagues working in children services and education (and schools) to continue to proactively identify young carers and ensure that they receive the recognition and support they both need and deserve. Our experience tells us that there is a real willingness to get behind this important work.
Finally, it wouldn’t be January if we didn’t reflect on the work that has already taken place across West Yorkshire and Harrogate, for carers of all ages and backgrounds. Take a look at the West Yorkshire and Harrogate unpaid carers programme - year in review presentation, 2019 below to find out more. But most importantly do get involved in Young Carers Awareness Day if you aren’t already and please help us to build on the positive work taking place locally to support young carers.
Karen, Richard and Fatima
What else has been happening this week?
West Yorkshire Association of Acute Trusts (WYAAT)
WYAAT brings together the six acute trusts in West Yorkshire and Harrogate: Airedale NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, Harrogate and District NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust and Mid Yorkshire Hospitals NHS Trust.
The Association delivers the Partnership’s “Hospitals Working Together” programme which currently includes nine programmes (procurement, workforce, Scan4Safety, pharmacy, radiology, pathology, vascular, orthopaedics and ophthalmology) and five clinical service networks (dermatology, gastroenterology, urology, maxillofacial surgery and cardiology).
The WYAAT CEOs met for the first time in 2020 last week. They were joined by Tim Ryley, Chief Officer Leeds CCG, Ian Holmes, Director WY&H HCP, Damien Kay, Bradford CCGs to discuss the future of commissioning in West Yorkshire and Harrogate. The group supported the principle of commissioning services, where appropriate, at a West Yorkshire and Harrogate level and discussed the links to the developing clinical strategy. The group also discussed the new emergency care standards being trialled by Mid-Yorkshire Hospitals NHS Trust and received updates on the work of the Local Maternity System and Cancer Alliance.
The WYAAT Medical Directors also received an update last week from the Mental Health, Learning Disabilities and Autism Programme, with colleagues attending the meeting to discuss the interface between mental health and acute services for people with eating disorders. The group agreed that the WYAAT Gastroenterology Network should develop a standard approach and guidance for all WYAAT trusts on managing eating disorder patients on acute hospital wards.
Mat Mathai and Reena Basu from Bradford Teaching Hospitals NHS Foundation Trust, Paediatric Ambulatory Care (also known as ACE); and Sue Rumbold from the Partnership’s Children and Families Programme attended to share the work of ACE. There is a lot of enthusiasm for the work and agreement to ensure it is supported through the trusts.
The Personalised Care Programme
The Personalised Care Programme brought together 20 senior leaders from across the Partnership with two members of our community with lived experience of long term health conditions at a special workshop last Friday. The aim was to work together on developing a shared narrative which outlines what we mean by personalised care, what it means for people, the challenges and the difference we want make for people, including our workforce. We were expertly facilitated and all acronyms and technical language were banned from the room as we tried to focus on describing the change we want to bring about. The next step is to draft a shared narrative from the work of the group. We will keep you posted.
West Yorkshire and Harrogate Shadow System Leadership Executive Group
The group met on Monday. It includes representatives from across all partner sectors. The programme builds on the successful work of the Shadow Board Programme last year. It is all about developing our system leaders of the future, increasing the sphere of influence and understanding of the Partnership and adding value and challenge to the topic of conversation discussed by the System Leadership Executive Group. This week the meeting was chaired by Madi Hoskins, WYAAT Programme Manager. The Board reviewed the papers ahead of the System Leadership Executive Group meeting on Tuesday (please see below).
West Yorkshire and Harrogate Clinical Forum
The Clinical Forum met on Tuesday. The meeting is chaired by Dr Andy Withers. It includes medical directors, GPs, pharmacists, allied health professionals, lead nurses and NHS England colleagues.
Members received an update on the work our Urgent and Emergency Care Programme (UEC) has been doing over the last three months. This includes refreshing the UEC Programme Board’s Terms of Reference, revisiting and resetting key programme work streams and engaging with important stakeholders, including Delivery Board chairs, the West Yorkshire Association of Acute Trusts and commissioners about the programme’s future priorities. This involves access to unplanned health and care services, shifting care from unplanned care to planned care, as well as early help in our communities. This includes adopting a population health management approach to ensure we make the most of data around the rising demand of need and how we can better support people earlier and with alternatives to A&E – as well self-care where appropriate. ‘Out of hours’ help and understanding our local place offer, for example urgent treatment and ‘walk in’ centres, are high on the programme’s agenda. The role of the programme is to support the urgent and emergency care system across West Yorkshire and Harrogate to be as effective and responsive as possible. It’s not about replacing local work. The programme is focused on where it can add the greatest value to partners. Working alongside our other priority programmes, including mental health and the Clinical Forum, is essential to improving access to care for people.
Forum members also received an update on the Primary and Community Care Services Programme Strategy. Programme colleagues have co-developed a strategy which sets the vision and plans for transforming primary care in the future for West Yorkshire and Harrogate. This builds on the General Practice Forward View (GPFV) and reflects the National GP Contract Reforms. It’s important to note that the strategy does not replace the work taking place in our six local areas. It reflects the vision, aims and role of the Partnership, and the ambitions set out in our draft Five Year Plan. It was agreed that the Primary and Community Care Services Programme Board will now provide strategic direction, oversight and be responsible for delivery of the commitments outlined in the strategy, whilst working closely with our 56 Primary Care Networks.
Joint Committee of Clinical Commissioning Groups (CCGs) – meeting in public
The Joint Committee met in public on Tuesday, chaired by Marie Burnham, our independent lay chair. The Committee is made up of the nine West Yorkshire and Harrogate Clinical Commissioning Groups (CCGs). It has delegated powers from the CCGs to make decisions on specific work programmes. You can read the papers and find out more here.
Urgent and emergency care (UEC)
Dr Adam Sheppard, Chair of Wakefield Clinical Commissioning Group and Clinical Lead for the Urgent and Emergency Care (UEC) Programme Board introduced an update on the programme’s work streams, including access to appropriate care and working with our Population Health Management Programme to address health inequalities, which can mean people don’t always access the right care, at the right time, in the right place.
As discussed at the Clinical Forum (please see above) looking at the support available in our six local places whilst understanding the wider West Yorkshire and Harrogate position as a whole. Pat Keane, Senior Programme Director (and Deputy Chief Officer for Wakefield Clinical Commissioning Group) explained that this is about adding value to our local places (Bradford district and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield), working and supporting partners – it is not about replicating / duplicating existing work. It’s important that home from hospital and delayed discharge are kept in view, especially the work with our local council partners.
There was also an update on the development of the winter room. This involves closer partnership working between Accident and Emergency Boards, West Yorkshire Association of Acute Trusts, Yorkshire Ambulance Service and NHS England. It is based upon sharing good practice between our six local places with agreement to standardise approaches where possible to improve quality, patient experience and outcomes.
Hip policies
Dr James Thomas (Clinical Lead for the Improving Planned Care Programme presented policies for hip replacement surgery (hip arthroplasty) and arthroscopic hip surgery (a type of keyhole surgery) for adoption across West Yorkshire and Harrogate. The policies have been developed to align with the wider musculoskeletal (MSK) pathway that was agreed by the Joint Committee back in May 2019. Having single policies ensures a consistent approach across the region and helps to remove any unnecessary differences in care that may currently exist.
In addition, having evidence-based clinical thresholds for these policies that are consistently applied will mean that surgical procedures are only carried out when they will be clinically effective and beneficial for people, and where alternative ‘non-surgical’ options have been ineffective. The emphasis on shared decision-making and supported self-management will require additional staff development to make sure that all clinical staff within MSK and elective orthopaedic services has the skills for this approach. The Committee agreed the policies, with a 12-month timescale for implementation.
Cataract surgery
James also presented a paper on a single pathway and policy for cataract surgery for adoption across West Yorkshire and Harrogate. Cataract surgery is the most commonly performed planned surgical procedure in the UK today. Across West Yorkshire and Harrogate this accounts for around 25,000 procedures every year – a figure that is expected to increase as we are all living longer and the local population continues to rise. The Committee approved the cataract surgery pathway and policy.
The Joint Committee also agreed the principle of making better use of the many community optometrists that are based in primary care services, including high street opticians. Under the new pathway, referral for cataract surgery will come directly from a community optometrist rather than a GP. This means that people are being assessed by eye care specialists – and it frees up GP time too.
Many people already make regular visits to their local opticians so the opportunity to be assessed in a familiar environment offers a more personalised service usually much closer to home. Community optometrists will spend more time evaluating an individual’s suitability and willingness for cataract surgery, discussing options with them before a shared decision is made whether to go ahead with the surgery or not.
People who have had uncomplicated routine cataract surgery will have their follow-up checks carried out by a community optometrist too. This will reduce the number of times people need to visit a hospital which will result in a more convenient and timely appointment. A further advantage of making better use of our community optometrists is that it releases capacity within challenged hospital eye services and frees up hospital consultants to be able to see higher risk patients with potentially sight-threatening conditions. The Committee agreed a timescale for implementing the cataract pathway of up to three years.
Joint Committee governance
The Joint Committee agreed proposed amendments to the Memorandum of Understanding for Collaborative Commissioning. These included proposals for the Committee to have delegated responsibility for agreeing future commissioning arrangements at West Yorkshire and Harrogate level.
The Committee agreed proposed changes to its work plan relating to cancer and elective care and agreed to bring the following services into the Committee’s work plan:
- The Urgent and Emergency Care Programme proposals to align the Joint Committee work plan with the new approach to collaborative commissioning at Yorkshire and Humber level
- The Mental Health, Learning Disability and Autism Programme commissioning decisions around assessment and treatment units (ATUs) for people with learning disabilities are delegated to the Joint Committee
- Commissioning decisions relating to the Local Maternity System (LMS) programme. All of the proposed changes will be presented to the individual CCGs for consideration and approval. The next meeting in public of the Joint Committee is on Tuesday 7 April 2020.
System Leadership Executive Group
The Executive Group met on Tuesday. This includes leaders from all partner sectors, including councils, hospitals, clinical commissioning groups, Healthwatch and community organisations. It is chaired by Rob Webster, our Partnership CEO Lead.
Rob gave an update on the work of the Black Asian and Minority Ethnic Network and the important recommendations coming forward for support from the leadership. He also gave an update on the National Interim People Plan development.
There was an update on commissioning health services, which involves working through 56 neighbourhoods of 30-50,000 people, seven integrated care partnerships, covering our six places (Bradford district and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield), West Yorkshire Association of Acute Trusts and the Mental Health, Learning Disability and Autism Collaborative. We are fully committed to our six local places being the focus of planning health services for people and our culture of improvement. This area of work firmly aligns to the work of care providers, including hospitals, and the ambitions set out in our draft five year plan.
Leaders were asked for their views on finalising the Partnership’s Five Year Plan. We began our process to develop our Plan in spring 2019. The draft Plan has been co-produced with partners and been shared with Health and Wellbeing Boards, governing bodies and other stakeholders, including the West Yorkshire Joint Health Overview and Scrutiny Committee for their views. their views.
At our Partnership Board meeting on 3 December 2019 the draft Plan was discussed. Amendments included strengthening the ambitions and making stronger links to the industrial strategy. These amendments are reflected in the final draft. A suite of information products have also been produced to support the Plan. This includes a public summary version, easy read document and animated film. The public summary is also available in audio and British Sign Language. All will be included on our website with easy to navigate chapters. Printed copies will also be produced.
A number of factors will contribute to the timing of the publication of the final version, including approval from our Partnership Board. Further conversations are also taking place nationally with the new government about delivery of their manifesto commitments. In light of this, national colleagues have asked all Integrated Care Systems and Sustainability Transformation Partnerships to hold off from actively promoting their plans to allow space for this. We will keep you updated.
There was also an update on the progress of the Yorkshire and North East (Y&NE) Genomic Laboratory Hub. Leeds, Newcastle and Sheffield have been awarded one of seven national genomic laboratory hubs. Genomic testing for rare diseases and cancer will be commissioned from April 2020 across the Y&NE geography, covering several care partnership arrangements.
The NHS as the single biggest integrated healthcare system in the world is in a unique position to harness the potential of whole genome sequencing to benefit people but also, through the life sciences industrial strategy, demonstrate the nation’s competitive advantage in enhancing understanding of diseases, and developing products for earlier detection and treatment. The national ambition is to ensure access to genomic testing from secondary and primary care to accelerate diagnosis. A clinical genomic service model is expected to be shared by NHS England in the near future. There was a good conversation about the pace of this work, training and ethics. There are real opportunities to work together more closely to align the work to that of our ambitions and existing programmes, for example workforce and cancer.
Mental health was firmly on the agenda, including an overview of The Mental Health Prevention Concordat. The Concordat is underpinned by an understanding that taking a prevention-focused approach to improving the public’s mental health is shown to make a valuable contribution to achieving a fairer and more equitable society. The concordat promotes evidence-based planning and commissioning to increase the impact on reducing health inequalities – a priority to our Partnership Board and us all. To sign up to the concordat we are required to complete a Prevention Concordat Commitment plan which will be assessed by Public Health England. System leaders approved the development of the submission of the Mental Health Concordat for our Partnership.
Reducing suicide by 10 per cent across West Yorkshire and Harrogate by 2020/21 and achieving a 75 per cent reduction in targeted areas by 2022 is one of our Partnership’s 10 big ambitions. It is highlighted in the Partnership’s draft Five Year Plan and the Mental Health, Learning Disability and Autism Five Year Strategy. This ambition supports and complements the work taking place in our six local places (Bradford district and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield).
We have been working together to reduce suicide across West Yorkshire and Harrogate since 2016/17. As a result we have successfully secured national funding from NHS England/NHS Improvement (August 2019) to enable pathfinder support workers to provide advice, training and support for up to 600 men in the area, drawing on voluntary organisations like State of Mind and Luke’s Lads to help. We have also secured funding to improve suicide bereavement services across the area (November 2019). Our approach includes working with public health colleagues to create a high-risk decision support tool for primary care and non-mental health services to identify people at risk of suicide so we can better target support.
There has been a significant increase in rates of suicide in the UK, with Yorkshire and The Humber recording the second highest levels behind only the north east (ONS, 2019). The age-standardised rate of suicide nationally has seen a sharp increase from 10.1 in 2017 to 11.2 deaths per 100,000 people. With this firmly in view, leaders at the meeting considered a proposal to develop a West Yorkshire and Harrogate Suicide Reduction Campaign. Losing someone to suicide is an experience that no-one should have to go through and it’s important that we work with communities so they are aware of the warning signs, to enable them to support people and to help build resilience. By working across the Partnership and with communities we can hopefully raise awareness of this subject and most importantly help to save more lives. This is one of the many reasons why it is one of our Partnership’s big ambitions.
Rob asked all those at the meetings to consider doing the Zero Suicide Alliance’s 20minute ‘Save a Life’ training. You can do the free online training here.
Our system leaders also received an update on digital and interoperability (the way systems talk to each other). There was an overview on a list of prioritised schemes for the Health System Led Investment (HSLI) in Provider Digitisation for Year two of a three year funding stream. An update on allocated funds to the Partnership for cyber security was also discussed. As a cyber-attack on one part of our systems would be detrimental for our whole system, it is essential that we share and spread learning.
Finally, and importantly, a paper on workforce was discussed. This highlighted the proposal to establish a programme structure with capacity to deliver the work at pace with programme funding. This approach is in line with the National People Plan. It draws on what is happening in our six local places and at West Yorkshire and Harrogate system level, and covers the whole workforce – not just those parts of our system with NHS employees. A hub model was proposed to take forward the work and deliver the ambitions for our workforce, as set out in ‘A healthy place to live, a great place to work: Our workforce strategy’ and our draft Five Year Plan.
West Yorkshire and Harrogate Mental Health, Learning Disabilities and Autism Programme Board
The Programme Board meets today. Chaired by Sara Munro, CEO Lead for the Collaborative Board and CEO for Leeds and York Partnership NHS Foundation Trust, the programme is made up of colleagues from the NHS, council and community sector. The programme board will discuss learning disabilities (the Transforming Care Programme and assessment and treatment units), proposals on suicide prevention Wave 3 funding and signing up to the mental health concordat, autism and early reflections from psychiatric intensive care modelling work.
South West Yorkshire Partnership NHS Foundation Trust have developed a new scheme to bridge the gap between being referred and receiving treatment, which is proving really helpful for young people in South and West Yorkshire. Participants in the ‘safety net’ programme have showed an average improvement of 39 per cent in the Warwick Edinburgh Short Scale which measures mental wellbeing. You can find out more here.
Maternity Voice Partnerships launch new website
Part of the national Better Births strategy, Maternity Voices Partnerships (MVPs) are working groups operating in each of our six local places, comprising teams of women and their families, commissioners and maternity staff who review and contribute to the development of local maternity care. We have now brought the groups together under one digital roof at www.maternityvoices.co.uk and on twitter using the hashtags #WYHMVP and #MatVoices where you can find information about their work, together with opportunities to get involved. You can read more here.
What’s happening next week?
- Local area planners (Bradford district and Craven, Calderdale, Harrogate, Kirklees, Leeds, Wakefield) meet on Tuesday 21 January.
- West Yorkshire and Harrogate System Oversight and Assurance Group meet on Tuesday 21 January.
- Urgent and Emergency Care Programme Board meet on Tuesday 21 January.
- West Yorkshire and Harrogate Programme Oversight Group meet on Thursday 23 January.