Posted on: 7 February 2020
This week’s leadership message comes from Dr Andy Withers, Chair of Bradford Districts Clinical Commissioning Group, Chair of the Partnership’s Clinical Forum and Clinical Lead for the Personalised Care Programme, and Jo Webster, Chief Officer for Wakefield Clinical Commissioning Group. Jo is also the Lead Commissioner for our Personalised Care Programme.
Hello, this is Andy and Jo
As we head into February, we find ourselves thinking about New Year resolutions, the ones we made in January, the ones we’re trying hard to keep, and whether the goals we set are doable. I’m sure many of you reading this blog would have set some targets for yourself, whether it’s getting healthier, fitter or spending more time with loved ones.
So with this in mind, we write this blog, with a focus on the roles we have for the Partnership’s Personalised Care Programme and our ambitions for the year.
Personalised care is all about people and their carers being supported to manage their physical, mental health and wellbeing, and ensuring they are in a position to make informed decisions and choices when their health changes. Put simply our aim is for people with long-term physical and mental health conditions to be better supported to build knowledge, skills and confidence to live well with their health condition. This includes people with more complex needs feeling empowered to have greater choice and control over the care they receive.
With all of the above in mind, we think it’s fair to say that this programme is about everyone.
Only 55% of adults living with long-term health conditions feel they have the knowledge, skills and confidence to manage their health and wellbeing on a daily basis and yet 70% of the health service budget is spent on people who are living with long-term health conditions. An evaluation of 9,000 people by The Health Foundation (August, 2018) found that people who had the highest knowledge, skills and confidence had 19% fewer GP appointments and 38% fewer A&E attendances than those with the lowest levels. This has to better for everyone.
Working with other Partnership’s programmes, including urgent care, mental health and cancer – we have an ambition to embed personalised care into all the work we do. There is also a real opportunity to learn from those areas with high success rates of better health outcomes and our council partners who have been working in this way for many years.
Further evidence of why this approach is needed can be seen in The Healthwatch Engagement Report (June 2019). Findings showed that people were interested in support from the NHS and its partners to make it easier to keep fit and healthy. It identified that people were unsure of what ‘personalised care’ is all about.
Over the coming months we will be raising awareness of what personalised care means so that we can change the relationship we have with people and support them to be active partners in their health, wellbeing and care. Ruth Twiggins, our Senior Manager Personalised Care, will be continuing her work with colleagues to put in place support to move forward.
Our programme is also about the way we work with people, in its truest sense – changing the conversations we have with them from the beginning and adopting the support of our organisational development colleagues, for their help in how best we do this. It’s a real cultural shift. Changing the way we work, on top of huge work pressures, whilst staff do their day job isn’t easy and will take time to develop. The more advice we get from colleagues, who really understand the practicalities of our ambitions, the better.
Most of us can see how the increasing demands on our health and social care colleagues is pushing people to breaking point. Many feel they do not have the headspace to take on board something new or different. We have a large number of people working in healthcare services, who interact with all communities on a daily basis. It would be easy to think if we enhance the skills of staff working within these services we could greatly improve the experience for all people receiving care.
If we are to positively make a difference the ethos of the programme needs to apply to staff as well as the people they support. We need to work alongside colleagues to understand the challenges they face so we can work with them to personalise the care they provide, where it isn’t happening already. To support staff we need to take action on a number of levels. This includes providing more opportunities for skills development, empowering people to work in a different way, whilst adopting the values of personalised care in service commissioning.
Put simply, personalised care recognises that there are two experts in the room - the practitioner with their knowledge and skills, and the person who is an expert in their own life. For this to happen we need a different kind of relationship between all involved - one where people have more of a voice, and are involved in the decisions that are being made about them.
At the heart of personalised care is a better conversation. A better conversation is more than a transactional exchange of information. It’s all about focusing on ‘what really matters to people’ not ‘what is the matter with people’. Thinking in this way can really transform relationships and health outcomes for people and colleagues, not just locally but across West Yorkshire and Harrogate too. Across West Yorkshire and Harrogate there is lots of great work taking place to support personalised care, for example with people with learning disabilities. This has been reflected in our Partnership being selected by NHS England to be a demonstrator site.
Over the past year we have been working hard to change the relationship we have with people, including those with learning disabilities and people who have respiratory problems. We have also picked up pace and are working closely with the developing primary care networks.
This includes working with two Bradford primary care network to co-produce what good personalised care look like.
Our respiratory work stream is working with a Wakefield primary care network and the Yorkshire and Humber Academic Health Science Network to test and embed personalised care approaches with a group of people with COPD. Put simply we want to know if we can support people better to manage their health, so they remain independent at home, to live the life they chose without frequent visits to hospitals.
Our 'changing the relationship’ work stream is exploring the skills people need, both staff and the public, so that we work differently together for the better.
In the two years the personalised care demonstrator programme has been running we have increased the number of personal health budgets, giving people more choice over how their needs are met. We are making progress.
In June 2018 we had made a difference to 251 people’s lives through working this way. By the end of 2019, 2,152 were involved in personalised care programmes. We are also proud to say that personalised care and support plans have increased from 18,000 in March 18 to 44,000 at the end of 2019.
This is just a snap shot of some of the work taking place. What we hope you will see over the coming year, is a clear direction of travel which will help change the relationship between people and practitioners; embedding of personalised care across West Yorkshire and Harrogate; a strong network of colleagues and community champions to drive the work forward and a real case for investment and change.
Finally, our health belongs to us all; we all have a role to play in keeping well and asking the questions that are important to us (where we are in a position to do so). Personalised care and support planning, health coaching, better conversations, shared decision making personal health budgets and supported self-management will become part of usual care and we are very much looking forward to watching this unfold in 2020.
Have a lovely weekend,
Andy and Jo
What else has been happening this week?
Health and care champions
The Health and Care Champions Project Group met this week. BTM, who we have commissioned to do the work, gave an update on the projects underway since last summer.
So far, 19 meetings and presentations have been made to Learning Disability Partnership Boards across the area. Partners have agreed the project priorities and further meetings have taken place with 94 people with learning disabilities at self-advocacy groups across West Yorkshire and Harrogate. Several common themes have emerged. There is a real interest across the patch in working with the health and care champions to map the work taking place and 14 more people have expressed interest in becoming involved.
More sessions for people who are interested in becoming health and care champions are being arranged. These will involve them getting to know other health and care champions and deciding which themes they are interested in. Training will be offered to those who lack experience of going to meetings and doing presentations so they feel more confident when attending, while people who have experience of chairing and attending meetings will be encouraged to help train those who are less experienced. The first of these ‘getting to know you’ meetings takes place in Calderdale in March. A timetable of other activities is in development to cover the first and second quarters of 2020 and will be communicated shortly.
West Yorkshire Association of Acute Trusts
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 ‘Hospitals Working Together’ programme which currently consists of nine programmes (procurement, workforce, Scan4Safety, pharmacy, radiology, pathology, vascular, orthopaedics and ophthalmology) and five clinical service networks (dermatology, gastroenterology, urology, maxillofacial surgery and cardiology).
WYAAT Committee in Common (CIC)
The WYAAT Committee in Common (which comprises the Chairs and Chief Executives of the six trusts) met on 28 January. The group was briefed on the progress of the Yorkshire Imaging Collaborative. The Collaborative is currently implementing a new radiology imagery system, Agfa Enterprise Imaging, which is live in four out of the six WYAAT trusts and includes “Xero” which allows seamless sharing of imagery within the trusts and soon across West Yorkshire and Harrogate. The Collaborative is also procuring a system to allow radiologists to report images anywhere in West Yorkshire and Harrogate, supported by £6m of national capital funding.
The CIC also discussed the development of the West Yorkshire Vascular Service with the management team. NHS England / Improvement have recently completed a public consultation on the future configuration of vascular arterial centres in West Yorkshire and Harrogate. Colleagues are attending the West Yorkshire Joint Health and Overview Scrutiny Committee in February.
WYAAT Programme Executive
The Programme Executive (the six Chief Executives) met on Tuesday. The group was really pleased to welcome Fatima Shah-Khan and David Melia, from Mid Yorkshire Hospitals NHS Trust to talk about the West Yorkshire and Harrogate Carers Programme. The programme has made good progress on improving the NHS offer to carers across the area and the group supported in principle a number of recommendations from the programme.
A significant proportion of the meeting was spent discussing the development of the West Yorkshire and Harrogate Clinical Strategy, which has been led by the WYAAT Medical Lead, Dr Robin Jeffrey. The strategy aims to set a high level framework for acute hospital services, with trust and local place strategies aligned within it to ensure they are coherent and consistent. The Chief Executives welcomed the development of the strategy so far and supported its further development. They emphasised the important connection between the Clinical Strategy and Commissioning Futures.
Mental Health, Learning Disabilities and Autism Programme
Improving outcomes in mental health, learning disabilities and autism is a priority for our Partnership. In our draft Partnership Five Year Plan we describe how one of our big ambitions is to achieve a 10% reduction in the gap in life expectancy between people with mental health conditions, learning disabilities and/or autism and the rest of the population by 2024.
Our specific Mental Health, Learning Disability and Autism Strategy describes in more detail the work taking place within this important programme to deliver that ambition. This covers not just the provision of care but how we work together to address wider determinants of poor health. It has also been produced in easy read.
Whilst our strategy describes the totality of work happening and the importance of delivery within each of our six places (Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield), the programme currently has some specific priority work streams where we focus our energy together across all areas.
These priorities include autism/ADHD; improving determinants of health; children and young people; supporting people with learning disabilities; secondary care pathways; complex rehabilitation; specialist hospital care and tracking the performance and quality of care provided. Our West Yorkshire and Harrogate Programme aims to do at least one of the following:
- Support our six places to share good practice
- Help standardise how services are provided
- Decide how we work together to better improve people’s lives.
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 NHS Operational Planning and Contracting Guidance 2020/21 published last week. This includes delivering the 2020/21 elements of the NHS Long Term Plan commitments, for example mental health, cancer, and learning disability and autism. It also includes expanding primary and community services through investment of the additional Long Term Plan funding, for example primary care network staff. Preventing ill-health and embracing the opportunities offered by technology and the implementation of the People Plan, such as increasing the number of nurses, recruitment and retention are also included.
Respiratory disease
Following an update to the forum members in August 2019, there was an update on the respiratory project. Respiratory disease affects one in five people and is the third biggest cause of death in England (after cancer and cardiovascular disease). Lung cancer, pneumonia and chronic obstructive pulmonary disease (COPD) are the biggest causes of death. Respiratory disease kills 115,000 people each year, the equivalent of one person every five minutes. The Clinical Forum has initiated a collaborative project across the Partnership to achieve our respiratory ambitions across our six local places. This will accelerate improvement in respiratory outcomes and reduce unwarranted variations in peoples’ care.
The work builds upon existing good practice within the Partnership, whilst bringing learning from outside the area to further inform improvement. The development process will be underpinned by a bottom up clinically led improvement model, designed to improve the confidence of primary care staff in tackling respiratory issues with the aim to improve people’s experience and reduce health inequalities.
Age related macular degeneration (AMD)
Age related macular degeneration (AMD) was on the agenda; this is a general term applied to degenerative changes that occur in the retina which is responsible for central vision. The purpose of the eye care work stream is to standardise clinical pathways for a range of conditions so that we adopt a ‘right care, right place, right time’ approach to the planning and delivery of planned care services.
Improving Population Health Programme
Dr James Thomas (co-chair of the Programme Board) and Sarah Smith (Programme Director) gave an update on the Improving Population Health Programme. Our Partnership is placing a greater emphasis around population health needs with a greater knowledge of data and wider issues that impact on people lives, for example the ageing population.
The aim of the programme is to harness partnership working to contribute towards an improvement in health and a reduction in health inequalities for the 2.7 million people living in West Yorkshire and Harrogate. There is a strong emphasis on the determinants of health, including employment, housing, violent crime and the climate emergency.
The Programme has also made a commitment to the delivery of a number of ambitions in the Partnership’s Draft Five Year Plan. Since the programme began a number of network events have taken place, including an anti-microbial resistance summit; a health inequalities workshop; established joint working relationships for health and housing, West Yorkshire Violence Reduction Unit and the Local Enterprise Partnership.
Joint Committee of the Clinical Commissioning Groups (CCGs) development session
The Joint Committee of the CCGs held a development session on Tuesday, chaired by Marie Burnham, our independent lay chair. The Committee is made up of the nine West Yorkshire and Harrogate CCGs. It has delegated powers from the CCGs to make decisions on specific work programmes.
Jo Webster, Chief Officer for Wakefield Clinical Commissioning Group (CCGs), gave an update on the commissioning futures work. This work seeks to build on success to date in commissioning strategically across West Yorkshire and Harrogate.
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.
Working with universities
Rob and Tom Riordan, CEO for Leeds City Council, talked about the importance of working with universities. As a Partnership we have worked hard to build strong collaborative arrangements to support our shared priorities for health and care. We are already working with key health and local authority leads, and that there are many projects already being delivered in partnership such as Born in Bradford, the suicide prevention work at Huddersfield University and the Leeds Academic Health Partnership. There are significant benefits to be had from closer strategic alignment between our Partnership and the University sector across the region. This could include closer working on health tech and digital innovation; applied research and development; workforce planning and education. We will keep you posted.
BAME network
Rob gave an update on the work of the Black Asian and Minority Ethnic Network and the important recommendations being presented for support from the leadership; following the second BAME (Black, Asian and Minority Ethnic) network meeting in January.
Fatima Khan Shah and colleagues presented a paper on the ambition to increase the diversity of leadership across the Partnership. It set out proposals on how we make the ambition set out in our draft Five Year Plan a reality, that: ‘We will have a more diverse leadership that better reflects the broad range of talent in West Yorkshire and Harrogate, helping to ensure that the poor experiences in the workplace that are particularly high for Black, Asian and Minority Ethnic (BAME) staff will become a thing of the past’.
Our workforce is more diverse than it has been any other time previously; unfortunately, across some levels of our organisations particularly in leadership positions, our workforce still does not reflect our population. Evidence suggests that tackling workforce race and equality improves staff experience, organisational efficiency and also improves the outcomes for the people using services. Furthermore, it is important that our staff should be able to look at the leadership and see themselves and communities represented. This is a long standing issue - we have made a good start but there is more to do to make the transformational change needed.
Population Health Management Programme
Robin Tuddenham, CEO Lead for Calderdale Council; Dr James Thomas, Clinical Chair of Airedale, Wharfedale and Craven Clinical Commissioning Group (co-chairs of the programme) and Sarah Smith, Programme Director set out our ambitions to reduce climate change and the impact on people’s health. Three ambitions for the programme are highlighted in our draft Five Year Plan as part of our ten big ambitions. You can find out more about the programme here.
Robin explained that all of our six local areas have increasing health inequalities. There are some fundamental health and care needs we need to tackle together.
Rob highlighted the work of the West Yorkshire - Finding Independence (WY-FI), which aims to improve the lives of people who have multiple needs. The service, which is a partnership of specialist organisations led by Humankind covers, Calderdale, Leeds, Bradford, Kirklees and Wakefield. It aims to reach disengaged and disconnected people. Beneficiaries of the project will have at least three of the following needs:
- Homelessness
- Addiction (drug or alcohol)
- Re-offending behaviour
- Mental ill-health
Climate change
We can also improve population health at the same time as making climate friendly choices, such as improving walkways, promoting active travel to offset reliance on cars or investing in local food growing. Round table conversations included delivering a scoping exercise in the context of carbon reduction, the green economy and the work already underway to address areas, such as air quality. Younger colleagues have real concerns around this agenda – they have innovative ideas for what the future workforce would look like, explained Thea Stein, CEO for Leeds Community Healthcare NHS Trust. There is the potential to set up a network. There are practical things we can all do, regarding sustainable organisations, for example procurement and buying locally. The Capital and Estates Programme gives us the opportunity to accelerate this work. You can view the Population Health Management Programme presentation slides here.
Thinking differently about commissioning: learning from new approaches to local planning
A King's Fund report and film series featured Bradford District & Craven CCGs featured Chief Officer Helen Hirst.
'Britain Thinks' research
NHS England has asked Britain Thinks to conduct some NHS public research. The overall aim of the research is to provide insight to inform the support given to systems on how best to communicate and engage with the public when going through change. Two public focus groups were held in Harrogate on Tuesday to add a more rural dimension to the overall mix of people they are speaking to (the other two areas are Birmingham and Solihull, and Weston-super-Mare). We will share the report once completed.
Digital programme secures funding
Over £1million has been awarded by NHS England and NHS Improvement to West Yorkshire and Harrogate Health and Care Partnership to improve cyber security across the area. There are six organisations who will receive funding as part of this scheme. The digital programme has also been successful in securing funding for e-rostering and e-job planning, to help workforce scheduling. This will bring in over £3million for the next two years. These resources will support advancement through workforce deployment systems, to ensure the right staff are in the right place at the right time, delivering high quality patient care. You can find out more here.
What's happening next week?
- West Yorkshire and Harrogate Health and Care Partnership Public Patient Involvement Group meet on Monday.
- The 2020 Innovation and Improvement Programme Board meet on Tuesday.
- On Tuesday the Harnessing the Power of Communities Leadership Group meets.
- The Primary and Community Care Board meets on Tuesday.
- Local Place Based Planners from Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield meet on Thursday.
- The Priority Programme Leads meet on Thursday.
- On Friday the Mental Health, Learning Disability and Autism Programme Board meets.