Posted on: 29 March 2019
This week’s leadership message comes from Matt Graham, Programme Director for West Yorkshire Association of Acute Trusts (hospitals working together).
Hello my name is Matt...
As the Programme Director for the West Yorkshire Association of Acute Trusts (WYAAT - hospitals working together), my role is to work with colleagues in the six acute hospital trusts in the West Yorkshire and Harrogate Health and Care Partnership.
The hospital trusts set up WYAAT in 2016 because they recognised that they could do more together to improve services and deliver the best possible care for the people in our area. We’ve come a long way since then and the scope of collaboration between the trusts has expanded.
We are now running 12 programmes covering all areas of hospital services, from shared procurement of supplies, through pathology and radiology, to clinical services such as vascular and orthopaedics.
This week I wanted to share with you how the trusts are creating a single vascular service, the West Yorkshire Vascular Service (WYVaS), for the whole of West Yorkshire. Currently five hospital trusts provide vascular services to people living in West Yorkshire: Airedale, Bradford, Calderdale and Huddersfield, Leeds and Mid Yorkshire, with three trusts, Bradford, Calderdale and Huddersfield, and Leeds, providing ‘arterial centres’ delivering the most complex vascular surgery such as major amputations and aortic aneurysm repairs (surgery to repair weak areas in the body’s major blood vessel which takes blood away from the heart). Like many of our hospital services, the care the arterial centres provide to people is highly specialised and while we already deliver excellent outcomes for patients, working as a single service will allow us to improve our resilience and sustainability, and ensure that patients in all areas have access to specialist skills.
In 2018 the trusts agreed that it would be best for people needing vascular care if all vascular services in West Yorkshire (except Harrogate, who work with York Teaching Hospitals NHS Foundation Trust to provide vascular services for people in their area) were brought together into a ‘single service’ under one management team. This will create one of the largest vascular services in England covering a population of over 2million and with almost 40 specialist vascular consultants (surgeons and interventional radiologists). This scale gives us the opportunity to make West Yorkshire a centre of excellence for vascular care, and offer staff both greater flexibility and development, including opportunities to sub-specialise and pursue interests in research and teaching. This is not only better for people receiving care but also importantly enables us to attract, recruit and retain great staff.
To make the single service a reality the hospital trusts have appointed three people to lead the West Yorkshire Vascular Service. Neeraj Bhasin, a consultant vascular surgeon from Calderdale and Huddersfield, has been appointed as Regional Clinical Director; Clare Vickers, currently Arrhythmia and Complex Cardiac Device Clinical Nurse Specialist at Calderdale and Huddersfield, as Head of Nursing and Jane Lang, currently Head of Diagnostics at Airedale, as General Manager. We’re really excited to have them lead this new service and between them they bring a great deal of expertise and experience which we know will lead to better health outcomes for patients – which is after all what it is all about.
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Neeraj Bhasin |
Clare Vickers |
Jane Lang |
Alongside my work leading the WYAAT programmes, I have also been working with colleagues from across the Partnership to develop a West Yorkshire and Harrogate, whole system, clinical strategy. This important piece of work has seen colleagues from our six places - Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield - and all health sectors come together. Our aim has been to build on the vision and objectives set out in ‘Our next steps to better health and care for everyone’. The findings will influence and be captured in the Partnership’s five year strategic plan being developed in response to the NHS Long Term Plan – and due to be published in the autumn.
Our first step has been to try and understand better the overall picture of clinical services in West Yorkshire and Harrogate. As you can imagine it’s a big complex piece of work. To begin with we are doing this in three parts: patient journeys for frailty; children (young people and their families), and developing “service profiles on a page”.
We have drafted over 20 service profiles for hospital specialties (covering the whole scope of the service from prevention and wellbeing, through primary and community care, to specialised hospital services) and are also developing profiles for specialist mental health services. The profiles capture the current shape of the services – their size, configuration and challenges - as well as an indication of future opportunities – including new technology and digital.
This in itself has been really helpful. Pulling all this information together has given us a richer understanding of the overall health and care system in West Yorkshire and Harrogate. It has also shown us how little we know and identified lots of areas for further investigation to understand the system more clearly. It’s a challenge worth embarking on and we’re really getting to grips with it.
Looking across all the ‘profiles’ suggests potential consistent ways to organise services and think about the interfaces between parts of the system differently, particularly between acute hospital services and primary care networks and community services, for example GPs. In individual specialties they help make the ‘left shift’ real by identifying specific activity, currently in hospital, which could, if we develop the right services with sufficient staff, be done differently and closer to home.
Tellingly for me, they also demonstrate clearly the importance of properly investing in key areas of preventing ill health – smoking, alcohol, exercise and obesity – and tackling health inequalities - because they affect future demand in so many different services and conditions. .
That brings me on to the patient journeys…
Working with our multi-disciplinary steering group, the team developed four (fictional but representative) patients and their families’ stories for frailty and another four for children and families. The intention being to use structured interviews with health professionals and people receiving care in each to understand how their journey would be experienced in each place.
Over the last few months, our brilliant team from Harrogate and District NHS Foundation Trust have interviewed over 200 professionals, as well as people who access care, covering our six local places and all sectors to describe the services and other assets available for each journey in each place. And the results have been fascinating!
On the 4 March, we held a workshop with around 50 professionals from across West Yorkshire and Harrogate to share the results of the frailty patient journeys. A number of themes came across loud and clear. They reinforce many of the approaches we are trying to embed across the Partnership. For instance there was a really strong sense that, despite talking about ‘asset based’ approaches (building on people’s strengths and support networks), our default setting is to focus on the deficits (their problems), not the assets. Our language reflects this – we talk about people being ‘frail’ and ‘socially isolated’ and we focus on dealing with what they can’t do rather than supporting them to build on what they can do. Even our services are named negatively – a ‘frailty service’ or a ‘falls service’. Language is important, especially when trying to empower people, and we need to be more conscious of its impact on people’s lives.
The other, overwhelming, message was the value people get from meeting others working in similar services across our system, and even within the same place. On my table, two ladies from different, but complementary, services within the same place met for the first time – as a result of this they will be bringing their teams together to find ways to support each other. We shouldn’t underestimate the benefit of networking and using the Partnership as a catalyst to link individuals and services together. This for me is one of the great benefits.
We held our second workshop for children, young people and their families yesterday. Over 60 people attended and I’m excited to hear about the ideas and insights it generated.
Over the next month we will be pulling together all the work we have done and we will be reporting back to the Clinical Forum and System Leadership Executive in May with our findings and recommendations. A key recommendation is likely to be that we need to build on the work to date to refine our understanding of the current system and define the future more clearly, with further involvement and engagement with even more people across the system, including colleagues and of course the public.
I’ll keep you posted as the work develops.
Have a great weekend.
Matt
What else has been happening this week?
Yorkshire and Humber Delivery Board - update
The Yorkshire and Humber Care Record (YHCR) team are working at pace to deliver the milestones set within the NHS England’s funding agreement which has resulted in a further release of over £2m in capital. A total of £3.15m capital has been released in 2018/19.
We are now sharing patient information across Rotherham NHS Foundation Trust, Leeds NHS Teaching Hospital and Humber Teaching NHS Foundation Trust. The success of pilot allows the team to further develop the technology and involve more organisations across the patch. Data is shared using the systems of systems technology. The pilot sites are:
- Yorkshire Ambulance Service
- Leeds Teaching Hospital Foundation Trust
- North Yorkshire Council (replacing Rotherham NHS Foundation Trust)
- Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust
- Humber Teaching NHS Foundation Trust
The procurement for professional services contract has been awarded to PA Consulting and new team members are being recruited.
The Yorkshire and Humber population health procurement has been approved by the Yorkshire and Humber Digital Care Board. The procurement will end in April 2019.
The Helm product is being reviewed in conjunction with the NHS app. A revised approach is to be developed in April 2019 to ensure they work together.
The Yorkshire and Humber Digital Care Board agreed to recruit two new posts to support the Yorkshire Health Care Record (chief technology officer and technical architect). They will be hosted by the Yorkshire and Humber Academic Health Science Network.
It has also been agreed that our area will bid for further funding for the Yorkshire and Humber Digital Innovation Hub.
Innovation and Improvement Programme
The programme board met on Tuesday. It is chaired by Martin Barkley, CEO for Mid-Yorkshire Hospitals and includes colleagues from the Partnership and Yorkshire and Humber Academic Health Science Network. Part of the boards remit is strengthening the way we work with the Medtech and pharmaceutical sectors. Board members discuss innovations which benefit people across West Yorkshire and Harrogate - including innovations which are ‘early adopters’ and those supported by improved ways of working. You can see examples of this in work taking place to support people with atrial fibrillation (this is a heart condition that causes an irregular and often abnormally fast heart rate); the spread of ‘Healthy Hearts’ for cardio-vascular disease and the transfer of care around medicines. West Yorkshire and Harrogate’s Healthy Hearts programme aims to help reduce the impact of heart disease and prevent the number of heart-related illnesses, including heart attacks, strokes and diabetes.
West Yorkshire and Harrogate GP Federation leads session
Ian Holmes welcomed colleagues from GP Federations to a second workshop on Tuesday. This was a follow up session to the one held last October where it was agreed that colleagues would work with primary care commissioners to develop a package of support across the area. GP contract changes and the NHS Long Term Plan were discussed. There was also an opportunity to reflect on national policy and the difference this will make to federations as well as agreeing local priority actions.
West Yorkshire and Harrogate Cancer Alliance
The bi-monthly meeting of the West Yorkshire and Harrogate Cancer Alliance was held last week. Items on the agenda included:
- 2019/2020 Cancer Alliance 12-month delivery plan which has been submitted to NHS England, with a strong focus on the delivery of cancer waiting time standards and key deliverables from the Long Term Plan. All money allocated to the Alliance is non-recurrent revenue funding, but it was acknowledged by the Board that there are significant capital and workforce funding requirements.
- Cancer waiting times update/dashboard – the Board is looking to identify specific data/information that could usefully be reported to help them drive improvement; to ensure an ongoing focus on the appropriate pathways and issues, and ensure the Board is adding value over and above what is reported and analysed elsewhere. Backlog information, internal performance data and 38 day metrics for patients on the inter provider pathway were among suggestions put forward.
- Macmillan funding has now been confirmed for three fixed term band 7 posts as part of a rapid intervention team – providing hands-on support for the Living With and Beyond Cancer programme. Recruitment will begin shortly and the programme of work will be developed in conjunction with Trust Lead Cancer Nurses across WYH.
- The seven northern Cancer Alliances are seeking approval to work more collaboratively across a range of strategic areas, including mutual accountability, peer review and support, and activity focused on patient outcomes. Board members gave their support in principle and a more detailed proposal will now be developed for consideration by leaders within the Health and Care Partnership.
- The Board agreed proposals to enhance the existing Alliance-wide model of clinical networking to further drive improvements in patient outcomes, patient experience and operational performance. The proposals take account of similar clinical networks in other Partnership priority programmes, including stroke and maternity. The works involves the expansion of what has predominantly been a task and finish approach around priority pathways and will create a stronger infrastructure to deliver 12 – 14 cancer site specific optimal pathway groups. These will include common cancers, intermediate cancers, rarer cancers, children, teenage and young adult cancers, bringing together clinicians from primary and secondary care, as well as clinical commissioning colleagues.
A Clinical Advisory Group, accountable to the Alliance Board, will provide oversight, direction and challenge to the groups. The Alliance Board and all the groups to which it provides a steer will continue to be governed through the leadership of the Health and Care Partnership with accountability to NHS England.
Two new radiotherapy service specifications, setting out the function and form of radiotherapy operational delivery networks (ODNs) and also the responsibilities of each individual radiotherapy provider, were discussed. Eleven ODNs have been established across England, following extensive consultation, with each network hosted by a single radiotherapy provider and overseen by a Network Oversight Group.
In the West Yorkshire/South Yorkshire/North Derbyshire/Bassetlaw/Humber Coast and Vale network, Leeds Teaching Hospitals will partner with Hull and East Yorkshire Hospitals NHS Trust and Sheffield Teaching Hospitals NHS Trust – constituent members of the West Yorkshire and Harrogate; Humber, Coast and Vale and South Yorkshire, Bassetlaw and North Derbyshire Cancer Alliances respectively.
Each Cancer Alliance has been working to determine the appetite amongst other providers locally to host and/or chair the ODN. There is also potential to explore opportunities for sharing or rotating functions between providers. The Network Oversight Group must be chaired by a provider Chief Executive or Executive Director drawn from the Board of one of the Cancer Alliances covered by the network. The Chair must be from a different provider to that of the ODN host. The long-standing informal radiotherapy network which already exists across the Yorkshire and Humber will begin to undertake some of the key functions until the ODN oversight group is formally established.
Programme Manager Hazel Taylor presented a one-year progress report on the Tackling Lung Cancer programme. Targeted lung health checks are scheduled to begin in selected GP practices in Bradford and Wakefield around early June. North Kirklees Clinical Commissioning Group has been invited to join the roll-out of the new national targeted lung health check programme. A plan for sustainability for Bradford and Wakefield through a potential partnership with Yorkshire Cancer Research is being explored.
A change to the existing governance arrangements – i.e. through the Early Diagnosis group – will involve the establishment of a programme-wide steering group bringing together partners from all three projects and ensure that they all meet the requirements of the national protocol.
Data sharing – a mechanism has now been identified by which information can be received and shared appropriately with members of the Board and wider Alliance infrastructure, with full information governance and legal compliance. This will now be used as a prototype for other Partnership programme areas.
The next Board meeting will be held on Wednesday 8 May.
NHS Assembly announced on Thursday to help deliver the Long Term Plan
Building on the collaborative approach to developing the Long Term Plan, the NHS Assembly has been created to advise the Boards of NHS England and NHS Improvement on delivery of the improvements in health and care it outlined. More than 500 people applied / or were invited to sit on the Assembly, with the successful applicants chosen based on their individual knowledge, skills and experience. The Assembly members are drawn from national and frontline clinical leaders, patients and carers, staff representatives, health and care system leaders and the voluntary, community and social enterprise sector.
We would like to confirm that Rob Webster, CEO for South West Yorkshire Partnership Foundation Trust and our Partnership CEO Lead has accepted a position on the Assembly and Fatima Khan-Shah has also received notification.
You can find out more here.
Looking out for our neighbours campaign
- We really value your continued support promoting the online version of the helpful neighbour pack at OurNeighbours.org.uk
- Please continue to share and promote the campaign resources that are available here
- We have also set up a Facebook account for targeted social media. This is here. Please share with your contacts if you use Facebook.
What's happening next week?
- West Yorkshire and Harrogate Clinical Forum meets on Tuesday.
- The CEOs for West Yorkshire and Harrogate Acute Trusts meet on Tuesday (WYAAT - hospitals working together).
- There is a development session of the Joint Committee of Clinical Commissioning Group on Tuesday.
- Both the Executive Group and the Leadership Group meet on Tuesday afternoon.
- On Thursday we will be hosting an event to discuss how the NHS Long Term Plan can support better outcomes for unpaid carers across the area. The workshop will be held in Wakefield. The event will also be digitally interactive to give carers who are unable to attend the event the chance to take part and be part of the digital conversations. To access the event live please click on the link.