‘The giants are still learning to dance’

Those of you who have been involved in organisational life as long as I have may recognise the title of Rosabeth Kanter’s hugely influential book ‘When Giants Learn To Dance’ on leadership, management and organisational culture published nearly thirty years ago (gulp!). That striking image of major American corporations seeking to reimagine their futures as the world changes around them still resonates today in our world of delivering health and social care. The giants are still dancing and it’s probably fair to say that work remains in progress.

But I am optimistic and hopeful. The pretty constant shuffling of organisational structures, legislative, policy and shifts have not dimmed the richer and deeper working relationships already developed and developing between us in the West Yorkshire and Harrogate Health and Care Partnership.

I joined Calderdale Council in 2010 and came into post as Chief Executive in June 2017. Over the past year, Tom Riordan, Chief Executive at Leeds City Council and I have sought to ensure effective representation of local government in the regional health and social care strategic conversations. In those settings, I have experienced a genuine parity of esteem, mutual respect, a sense of the urgency of now, and a determination to not let how tough it is stop us from shaping what it may become.

I understand that through an NHS lens the world of local government can look perplexing. The political context can be challenging, but the democratic mandate is at the heart of ensuring a legitimate voice is firmly in place. What we are doing to reshape health and social care matters. I’d actually go further than that; I regard it to be the most important issue in public services for the next ten years.

Health and social care begins in place (whether it is Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds or Wakefield). We are all tethered to the fabric of locality. We all live and work somewhere. Local government starts from this point, touching the lives of everyone, everyday; all the 2.6 million people who live across West Yorkshire and Harrogate. For this reason, we want to play our part in shaping the system. A system that is delivering both highly skilled and specialist interventions to small populations of people in specialist centres of excellence, whilst each and every day responding to wider determinants of health and wellbeing (such as employment, environment and housing), and the inequalities which exist at all stages of lives between and within our places.

We often say that collaboration is harder work than competition, especially when the system in many ways is configured to make the latter our default mode. In Calderdale Council, our budgetary spend on the roughly 600 different services we commission or provide has shifted radically in recent years. From spending around half our budget at the start of the decade on targeted children and adults services for about 4% of our population the figure is now approaching 70p in the £1. Everything else we do, most of which is the universal visible provision for all residents, is funded from the remaining 30p. In that context, I talk about the ‘collaboration imperative’, this isn’t optional!

I have been working closely with health colleagues in Calderdale to strengthen trust and collaboration across our worlds. I have benefited from working with dedicated health colleagues who get it and want to make it better. I think we have formed, stormed, normed and performed at a good pace, driven by a recognition that this has to be our shared future not just because of the money, not just because of the demand, but because it reflects the lived experience of the people we serve who expect the system to work as one. Why shouldn’t it?

Calderdale Cares, like other locality models across our region, has evolved as a way to bring together leaders and practitioners who start from place, where prevention, and early help can be given the focus required; where how we spend our collective resource and what we do in localities has to be as connected as possible.

Parag Khana, the economic geographer, has recently suggested that the level of connectivity in a place will be the single most important factor in making a locality resilient, sustainable and enable it to thrive in our globalised digital world. How our health and social care system connects itself is a core element of achieving that. Our Calderdale Cares model has been through all our governing bodies in the past three months, the Council’s Cabinet, and the governing bodies for Calderdale Clinical Commissioning Group, South West Yorkshire Partnership NHS Foundation Trust, and Calderdale and Huddersfield NHS Trust. It’s now time to act, to make different decisions which illustrate the leadership impetus to realise our vision. And this is starting to happen, in our commissioning decisions, and in addressing the wider determinants of health and wellbeing, for example, in the role of our housing strategy in influencing health outcomes.

I have been in discussions with the Kings Fund as part of their recent work on housing and health. Their focus on critical areas such as prevention, discharge and mental health, give us a valuable route map. You can read their report here

As the cultural commentator, Pat Kane, has recently said “Many possible worlds lie before us – the best way to predict the future is to invent it.”

I hope we can invent it together. I’m confident we can.

Have a good weekend


What else has been happening this week?

Communication and engagement network

Over twenty communication and engagement colleagues across West Yorkshire and Harrogate met on Thursday. They received an update from Rob Webster, our partnership CEO, on the work of the Partnership. There were presentations from Aimee Haggas on NHS Digital, Tony Rider and Danniella Houston on Connecting Care Wakefield and Paul Cartwright from South West Yorkshire Partnership Trust on the work to prevent suicide. There was a discussion on general data protection regulations (GDPR), communications for maternity, stroke and the More in Common social movement (part of the Jo Cox foundation), who are encouraging people to organise events or get involved in the Great Get Together which takes place from 22-24 June.


You may recall the event in December 2018 (the report is here) where over fifty carers organisations came together to find out more WY&H programmes, since then work has progressed. This includes mapping out the work taking place by voluntary and community organisations that support unpaid carers across our area. The report provides a summary of the working takes place in our six local places (Bradford District and Craven; Harrogate, Leeds, Kirklees, Leeds and Wakefield).

Carers organisation representatives are also being invited to get involved in the four West Yorkshire and Harrogate programmes of work which are:

  • Children and young people carers
  • Acute care
  • Primary care
  • Workforce

Recognising the importance of social care in the work of carers is also an important area.

You can read the latest update here. Please contact Fatima Khan-Shah if you would like to know more.

Organisational development

Work has begun on an organisational development programme for the West Yorkshire and Harrogate partnership. The initial phase will focus on how the system can transform together to work differently to achieve our ambitions at all levels.

We are also partnering with The Inspiring Leaders Network to introduce The Shadow Programme, which aims to support organisations and systems to develop diverse and aspirant future executive level leaders. Nominees from across our partnership will participate in a ‘Shadow System Leadership Executive’, which offers an experiential approach to development. The SSLE will meet the day before system executive group does, starting on Monday.


Our West Yorkshire and Harrogate Local Maternity System Board received good feedback from NHS England on Tuesday about the plan for the area. In particular colleagues were praised for their demonstration of partnership working, locally, regionally and nationally. WY&H plan will be used as a national exemplar.

Stroke programme

The stroke programme met on Wednesday. This is chaired by Dr Andy Withers and includes colleagues from hospitals, clinical commissioning groups, the Stroke Association and a patient representative. A local authority rep will also be joining the group to provide expertise and support to the work taking place to further improve stroke care for the people of West Yorkshire and Harrogate.

There was an update on the public sessions which took place in February and March 2018. Comments raised included the importance of raising awareness of the signs and symptoms of stroke with the public and health professionals. It was felt the national FAST campaign had raised awareness but that it should go further and talk about the whole pathway for e.g. raising awareness of how to further reduce the risk factors of stroke. Any campaign should have a co-ordinated approach across all organisations including the voluntary and community sector.

There was a discussion on how some communities are at a higher risk of stroke and the need to tailor our communications and further work to raise awareness of these risk factor. The sessions also highlighted the importance of supporting our carers, for example signposting carers to where they can receive information about finances. Carers have also told us they want to be involved in discussions about the care of the person they care for and we need to ensure the information provided is accessible and appropriate for all communities.

People also want consistency in the quality and availability of specialist stroke care (the care people receive in the first few hours and days after stroke), ongoing support and access to stroke services across the area. People also praised the high level of care they had received in hospital following their stroke, but were concerned with issues around workforce, such as retention of staff, a skilled workforce, career possibilities and staff being over worked. People also want to see recognition of the whole workforce not just specialist staff or consultants.

We will be arranging a further session on the 30 May 2018 to update everyone and to seek their views on the weighting of criteria to inform the development of options for our specialist stroke services. More information will follow.

A report from the public sessions will be published soon.

Local Health and Care Record Exemplar

On Wednesday we submitted a Yorkshire and Humber proposal to NHS England to become a Local Health and Care Record Exemplar [LHCRE]. This initiative has sign-up from West Yorkshire and Harrogate Health and Care Partnership, South Yorkshire and Bassetlaw Integrated Care System, The Humber, Coast and Vale Sustainability and Transformation Partnership, which make up the Yorkshire and Humber.

This represents a significant piece of collaboration work over the last three months across the whole region. It has included NHS technologists, clinicians, senior leaders, patient representatives, local authorities, universities and technology suppliers.

Whether this bid proves successful or not, it will remain a clear statement of our strategy to join up clinical systems across the region to support integrated clinical care. We will keep you updated.

What’s happening next week?

  • The Joint Committee of the Nine Clinical Commissioning Groups meet on Tuesday for a development session.
  • On Tuesday the clinical forum meets. There will be a discussion on urgent and emergency care; innovation and improvement.
  • The leadership group meets on Tuesday to hear more about the More in Common movement from the Jo Cox Foundation and also innovation and improvement.
  • The lay member assurance group for the nine clinical commissioning groups meet on Thursday.
  • There is a meeting with Care Provider Alliance to discuss how we engage with the independent care sector next week.