Posted on: 8 January 2019
This week’s leadership message comes from Corinne Harvey, Public Health Consultant in Health and Wellbeing at Public Health England.
Public Health England provides leadership across West Yorkshire and Harrogate to local government, the NHS and partners, to protect and improve the nation’s health and wellbeing; a key part of this is working to reduce health inequalities and preventing ill health.
Rob Webster, our CEO Lead for the Partnership shares his thoughts on the NHS Long Term Plan, published on Monday 7 January.
Hello my name is Corinne
Preventing ill health is a major priority for our Partnership. A key strand of this work is alcohol misuse. The issue contributes significantly to a wide range of conditions including cardiovascular disease, cancers, mental health issues and accidental injuries.
Following the NHS Long Term Plan publication on Monday I thought it may be helpful to set out what is taking place across West Yorkshire and Harrogate and how dedicated new services for problem drinkers highlighted in the NHS Long Term Plan are very much welcomed.
With budget reductions in public health spending, public health partners are concerned that this will make it more difficult to improve people’s wellbeing and life chances, as well as put further pressure on NHS services and social care.
There is some good news, however. As part of new NHS prevention measures set out in the NHS plan publication, people who are alcohol dependent will be helped by new Alcohol Care Teams.
The schemes come alongside action on stopping smoking, obesity and diabetes as part of a renewed focus on prevention that will benefit patients and make the NHS fit for the future, by curbing demands on the health service.
Alcohol Care Teams will be rolled out in hospitals across the country with the highest number of alcohol-related admissions and will support patients and their families who have issues with alcohol misuse.
This will be delivered in the 25% worst affected parts of the country and could prevent 50,000 admissions and almost 250,000 bed days over five years. Mums to be will also benefit from NHS-funded one-to-one support to improve their own health and give their new-born babies the healthiest start in life.
These expert teams will work in up to 50 hospitals across the country to deliver alcohol checks and provide access to health within 24 hours if problems are found - including counselling, medically assisted help to give up drink and support to stay off of it. Based in hospitals, the teams will work with local community services to ensure all needs, including any other health needs, are met.
We will keep you posted once we know more about these new schemes and what it means for West Yorkshire and Harrogate.
Across England, 25% of the population (33% of men and 16% of women) consume levels of drink that increase their risk of alcohol-related ill health. The annual cost of alcohol-related harm to the NHS in England is £3.5 billion, a third of which is due to hospital admissions.
Excessive alcohol consumption causes misery for those affected and their loved ones; it also places a burden on NHS, local authorities, police, social care services and wider society. And all of this is entirely preventable.
In West Yorkshire and Harrogate there are around 455,000 heavy drinkers. Collectively we spend millions dealing with alcohol-related health issues, particularly in our acute hospitals. Our ambition as a partnership is to reduce the number of people admitted to hospital due to alcohol consumption by 500 every year.
A great example of the work in our Partnership is the alcohol liaison service (ALS) which is based at Pinderfields Hospital in Wakefield. This began in 2013, and has been extended after an initial two year period. The ALS currently employs two full-time nurses.
The service provides advice, support and treatment for alcohol-related health problems including alcohol reduction, managing alcohol-related health conditions and signposting to agencies that provide support to friends and family. It provides brief interventions, treatment advice and follow-up care to people who have an alcohol -related illness or injury and are admitted to the emergency department and hospital wards.
The team helps colleagues by overseeing discharge planning between acute care, recovery services, community and primary care services. It also works with frontline staff in departments that see the highest levels of alcohol-related admissions.
The team develops and delivers training to nursing and medical staff across the hospital to enable them to undertake their roles in the service, for example how to screen, what tools to use, how and where to refer people and how to give brief advice.
The ALS’s work has led to some impressive outcomes. There were 34% fewer alcohol-specific hospital admission episodes in 2016/17 compared to 2013/14. Over the same period, the number of hospital readmissions reduced by 36% and the number of associated bed days per year by 26%. An estimated £1.5 million has been saved in the past 4 years.
It’s made a big difference. Go back a few years and hospital admission episodes for alcohol-specific conditions were significantly higher than average in Wakefield between 2011/12 and 2014/15. If you look now, Wakefield now had a significantly lower rate of admissions than England in 2015/16 and 2016/17. Between 2013/14 and 2016/17 the number of admissions for mental and behavioural disorders due to alcohol has reduced by 39% and for ethanol poisoning by 51%.
There’s also a social return on investment (SROI). Every £1 spent on the service generates an average SROI of £13.67 – a total social value of over £300,000 per quarter.
Most important are the benefits for local people affected by alcohol misuse. These include: improved physical health, improved psychological health and wellbeing, reduced involvement in crime, more secure and stable housing situation, improved family relationships, ability to work or volunteer, positive changes in behaviour and an improved relationship with alcohol.
So what’s the secret of this success? Firstly, it’s a true partnership effort - funded by Wakefield Council, run by Spectrum CIC in Mid Yorkshire Hospitals, working with Mid Yorks staff. Secondly, the service is a great example of the right care, at the right time, in the right place. 87% of the Wakefield residents admitted for alcohol-related issues are treated by The Mid Yorkshire Hospitals Trust. Within Mid Yorkshire Trust, 88% of the alcohol-specific admissions were at Pinderfields. The service is therefore in exactly the right location to have the most benefit to local people.
So what are our next steps? Well, there are still major issues around alcohol misuse – particularly alcoholic liver disease where we have seen no change in the number of hospital admissions. The ambitions set out in the Long Term Plan will help with this. We also need to look at the wider determinants of health, for example whether someone is homeless, unemployed or lonely – all of which can have an impact on whether someone is a heavy drinker.
Work will continue with recovery, community and primary care services to transform lives for people, their families and communities. This will not only save money but will help to make sure people get the right care at the right time by health and care services working together. This is what we’re all about after all.
We will continue to give more training to staff that work in hospital departments that see the highest levels of alcohol-related admissions, so they champion action on alcohol harm in their workplace. We will be sharing this good practice and learning across West Yorkshire and Harrogate. A Partnership priority is waiting to hear more about the implementation of the new services highlighted in the NHS Long Term Plan.
Have a good weekend
Corinne
The NHS Long Term Plan
Health and care leaders have come together to develop a Long Term Plan to make the NHS fit for the future, and to get the most value for people out of every pound of taxpayers’ investment. The Plan, published on Monday 7 January has been drawn up by frontline health and care staff, patient groups and other experts.
The plan sets out some of the ways that we want to improve care for people over the next ten years; including making sure everyone gets the best start in life; reducing stillbirths and mother and child deaths during birth by 50%; taking further action on childhood obesity; increasing funding for children and young people’s mental health; bringing down waiting times for autism assessments. It also includes the importance of delivering world-class care for major health problems; preventing 100,000 heart attacks, strokes and dementia cases; investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital and delivering community-based physical and mental health care for 370,000 people with severe mental illness a year by 2023/24.
Supporting people to age well and increasing funding for primary and community care by at least £4.5bn; coordinating care better and helping more people to live independently at home for longer are also highlighted in the Plan alongside improving the recognition of carers and support they receive and making further progress on care for people with dementia.
The Plan also sets out how we can overcome the challenges that the NHS faces, such as staff shortages and growing demand for services, by doing things differently and giving people more control over their own health and care whilst preventing illness and tackling health inequalities.
The plan also recognises the importance of the NHS workforce, training and recruiting more professionals – including thousands more clinical placements for undergraduate nurses, hundreds more medical school places, and more routes into the NHS such as apprenticeships. We will also make the NHS a better place to work, so more staff stay in the NHS and feel able to make better use of their skills and experience for patients. Digital technology is also high on the agenda. We will keep you updated on what’s next in terms of workforce and public engagement over the coming weeks. This means that over the next few months, whether you are NHS staff, a patient or a member of the public, you will have the opportunity to help shape what the NHS Long Term Plan means for your area, and how the services you use or work in need to change and improve.
You can view the plan here A summary is also available here. Further information about the NHS Long Term Plan, including case studies can be found here.
The Equality and Health Inequalities Impact Assessment (EHIA) explains how NHS England has considered and addressed these ‘equality duties’ in developing the NHS Long Term Plan. This EHIA has assisted, and will assist, decision-makers to make informed decisions about the NHS Long Term Plan and these legal obligations.
We will also keep you updated on the publication of the Adult Social Care Green Paper when we know more.
What else has been happening this week?
The Shadow System Leadership Executive Group
The Shadow System Leadership Executive Group met on Monday (1st cohort) ahead of the meeting of the executive group on Tuesday. The meeting was chaired by Dr Matt Walsh, Chief Officer for Calderdale Clinical Commissioning Group and CEO Lead for Improving Planned Care. The Shadow Executive Leadership Group meets every month ahead of the System Executive Group. Twenty colleagues across the Partnership are involved in cohort 1. The outcomes of the first cohort went above and beyond any expectations we had. We are in process of planning cohort 2 as part of our wider system leadership approach. This month the group discussed a paper on the West Yorkshire and Harrogate approach to planning and the apprenticeship levy.
West Yorkshire and Harrogate Clinical Forum
Clinical Forum members met on Tuesday. The meeting is chaired by Dr Andy Withers and includes medical directors, GPs, pharmacists, allied health professionals, and lead nurses. Forum members received an update on the respiratory programme. Yorkshire and Humber Partnership leaders (also known as STP and ICS) have agreed a number of areas for collaboration including two priorities for improving health and reducing inequalities: cardiovascular disease (CVD) and respiratory.
Respiratory disease affects one in five people. It is the third largest cause of death in England after cancer and cardiovascular disease. The respiratory work stream builds on the work with NHS RightCare. Sir Andrew Cash is the sponsor and lead for the North Region Respiratory Programme and is chair of the North Regional STP/ICS Respiratory Collaborative. Shane Hayward-Giles (NHS RightCare Delivery Partner for West Yorkshire and Harrogate) and Katherine Hickman (Leeds and Bradford Clinical Lead for Respiratory) represent our area on the programme.
Dr Adam Sheppard and Dr Mathew Mathai updated colleagues on the work of the Urgent and Emergency Care Programme and in particular the Paediatric Urgent Ambulatory Care. This is all about keeping sick children out of hospital. In the last 10 years there has been a 30% increase in children under 5 years’ olds going to A&E. The vision is to create new models of care for acutely unwell children and young people to reduce avoidable admission whilst ensuring timely early discharge, when safe to do so. The Children and Young People Ambulatory Care Experience (ACE) based at Bradford Royal Infirmary (part of Bradford Teaching Hospitals NHS Foundation Trust), aims to care for young patients in the comfort of their home and empower families to self-manage where safe to do so. More information can be found here.
There was also a discussion on the Preparing for 2019/20 Operational Planning and Contracting Guidance (published on 21 December 2018) and an overview on improving planned care and reducing variation work.
West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups (CCGs)
The Committee met in public on Tuesday – chaired by Marie Burnham, independent lay chair. You can view the webcast, agenda and papers here.
Reports were presented to the Joint Committee on cancer; elective care and commissioning policies; quality and equality impact assessments.
Professor Sean Duffy, Clinical Lead for the West Yorkshire and Harrogate Cancer Alliance gave an update on achievements, which included reduction in smoking prevalence, increase in early stage diagnosis, and improving health and wellbeing support to people living with and beyond a cancer diagnosis - all very much part of the NHS Long Term Plan. The Cancer Alliance Board has two lay representatives - one carer and one patient. This is proving extremely important in ensuring the patient voice is heard.
Dr James Thomas presented a paper on The NHS England Evidence Based Interventions (EBI) Policy which was published in November 2018 as statutory guidance for implementation. The policy has been discussed through the Elective Care and Standardisation of Commissioning Policies (SCP) programme and an approach for adoption across West Yorkshire and Harrogate was discussed. The aim of the policy is to prevent avoidable harm to people and to avoid unnecessary operations. The Joint Committee agreed to adopt the policy in the nine Clinical Commissioning Groups across West Yorkshire and Harrogate and agreed to explore options for a single area approach to implementation.
There were a number of questions from members of the public about the policy. The Committee heard that key to this work is avoiding the perceived ‘post code lottery’ and reducing variation and health inequalities. Responses to all questions will be published on the Joint Committee web pages. West Yorkshire and Harrogate has been accepted by NHS England as a demonstration site for the policy, and would be aiming to ensure that clear messages were sent out to the public about the policy. We will publish a document which clearly explains this for members of the public and work with communications and engagement colleagues in the clinical commissioning groups to progress communications about implementation of these policies.
A ‘Do once and share’ approach to quality and equality impact assessment (QEIA) was also presented to the meeting by Penny Woodhead, Director of Nursing and Quality for the Calderdale and Kirklees CCGs. The Joint Committee had asked CCG Chief Nurses to develop a QEIA model combining national best practice with tools already used across West Yorkshire and Harrogate. The approach is designed to assure the Committee that a consistent, robust approach is taken to QEIA and will avoid unnecessary duplication in CCG assessment and governance processes. The Elective Care and Standardisation of Commissioning Policies (SCP) programme will test the approach.
The Committee approved the ‘Do once and share’ QEIA policy, tool and guidance.
The Committee heard that following unanimous support from all commissioners across Yorkshire and Humber, Greater Huddersfield CCG Governing Body – as lead commissioner - had approved the award of the 111/999 contract to the preferred bidder - Yorkshire Ambulance Service NHS Trust (YAS). Commissioners and Yorkshire Ambulance Service are now finalising the contract documentation and mobilising arrangements to ensure the 1st April 2019 commencement date.
System Leadership Executive Group
Professor Chris Ham and Dr Nicola Walsh from the King’s Fund joined us at the executive meeting and also our wider leadership team meeting on Tuesday. This is part of the ongoing support we receive from the King’s Fund as part of our Partnership development. Chris and Nicola have significant experience in helping leadership teams develop and it was useful in the context of the Long Term Plan. We used the time to start a conversation about how we lead the development of our forthcoming five year strategy to ensure we continue to focus on the right things, for example primary and community care, preventing ill health, inequalities and improving quality and outcomes for adults and children – all of which align to the NHS Long Term Plan.
As a Partnership we will continue to focus on collaboration – working better together at every level and putting the person at the centre of all we do.
Over the coming months, alongside our stakeholders, workforce and communities, we will work through what the Long Term Plan means for us. It’s important that we explain clearly what this means whilst setting out how the local plans, regional and national plans fit together – and most importantly what this means for people.
An editorial board for the 5 year strategy will be set up soon. The strategy will build on the significant work we have already done - as described in our ‘Next Steps to Better Health and Care for Everyone’ publication – to plan for ambitious improvements to health and care. This strategy will belong to us all.
A communication and engagement plan will be developed to support this work. A meeting with local place based communication and engagement colleagues will take place soon.
As a Partnership we will continue to focus on collaboration – working better together at every level and putting the person at the centre of all we do.
Over the coming months with our stakeholders, workforce and communities, we will work through what the Long Term Plan means for us. It’s important that we explain clearly what this means whilst setting out how the local plans, regional and national plans fit together – and most importantly what this means for people.
An editorial board for the 5 year strategy and the operational plan will be set up soon.
Leaders also discussed operational planning; and what further action is needed to support the development of better joined up ways of working. This, alongside the development of the five-year strategic plan, will feed into the meetings of the new Partnership Board which meets in public for the first time in June.
Dr Ros Tolcher, CEO for Harrogate Hospital NHS Foundation Trust and CEO Lead for Workforce gave leaders an update on the apprenticeship levy which was introduced in May 2017.
Leaders from partner organisations discussed various apprenticeship opportunities. This clearly links to the Long Term Plan and workforce. There is a lot of expertise across the area including support from West Yorkshire and Harrogate Excellence Centre (WYHEC), a regional hub of training for support workers in health and care. This gives us the potential to work together across the area to ensure we maximise the resources we have across the system to benefit young people in areas of high unemployment and health care recruitment.
The Truth Project ‘I will be heard’ campaign was also on agenda. This important project / campaign offer victims and survivors of child sexual exploitation the opportunity to share their experience and be respectfully heard and acknowledged. Their contribution is included in recommendations about support needs, as well as challenging assumptions of child sexual abuse to Parliament. Since it began in 2015, nearly 2,000 victims and survivors have shared their experience either through a private face-to-face session, by telephone or in writing. It was agreed that the Partnership would support the campaign via their local organisations safeguarding routes, if they aren’t already, and that Rob Webster our CEO, Partnership Lead would write to The Truth Project to highlight our Partnership support.
Wider Leadership Group
We were pleased to welcome Professor Chris Ham and Dr Nicola Walsh to our wider leadership team meeting on Tuesday. The session was chaired by our CEO Partnership Lead, Rob Webster. Rob emphasised the importance of the NHS Long Term Plan whilst stressing that this should not be seen in isolation of the adult social care green paper. It’s extremely important that the two align if we are to improve the health and wellbeing of people – especially if we are to have sustainable services and adequately funded care. It’s important to note that this is a NHS Plan. We await the publication of the adult social care green paper as each is dependent on the other for any real improvements in care and workforce recruitment and retention.
The Long Term Plan mirrors the direction of travel our Partnership has been heading; for example hospital and providers working together, good community care, wellbeing of staff and preventing ill health.
Other work we are doing and not mentioned in the Plan includes our work on housing and health, and social growth which is also important. We will be looking at the Plan carefully over the coming week with the intention of refreshing our ‘Next Steps to Better Health and Care for Everyone’ publication.
The NHS Plan is a useful framework at both the local and West Yorkshire and Harrogate level. Those we serve should be at the centre of all we do and this is key to our approach in that the majority of the work we do as a Partnership takes place in our six local areas (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield). As Sir Chris Ham said ‘Systems have major role in delivering the plan via partnerships between NHS, local authorities and third sector. It is vital to secure widespread engagement in new five year plans’.
The Long Term Plan also offers us the opportunity to learn from others as well as setting out the direction of our own system. Rob explained that transformation is made up of many small improvements all coming together to make change for the better. It is therefore important that we see what we do as a social movement for improvement – one which enables staff and clinicians to feel empowered to do their work.
Chris praised the work of local authorities in their work in our communities and their approach to seeing people as assets. We need to enhance the power of our communities so people have a changed relationship with their public services.
Systems that work well together with collective leadership have more influence with national bodies for example NHS England. Rob ended the session by thanking Sir Chris Ham and Dr Nichola Walsh for their attendance and by saying that it’s clear from the Plan that we are focusing on the right priorities and that we need to do more together and get better at measuring what we do – our relationship with local authorities is helping us to maximise these opportunities.
Mental health update
The programme board met on Thursday where it received an update from the West Yorkshire Mental Health Urgent Care F. The forum includes mental health provider reps, community organisations, police, Yorkshire Ambulance Service. Colleagues talked about the positive work that has been achieved to date including developing good working relationships with the police to ensure people with mental health concerns are not detained in police cells. Future work will include a focus on ensuring people in crisis have 24/7 support (again highlighted as a national priority in the Long Term Plan).
Forum members also talked about how we improve access to autism assessments for children and young people and how we take forward the development of a new model of care for complex care /rehabilitation. This work will be supported by the recent confirmation of national capital money.
WYAAT hospitals working together
The West Yorkshire Association of Acute Trusts (WYAAT) is an innovative collaboration, which brings together the six NHS trusts (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, Mid Yorkshire Hospitals NHS Trust) who deliver acute hospital services across West Yorkshire and Harrogate. The purpose of the association is for the hospitals to work together on behalf of patients to deliver more joined up, high quality, cost effective care.
Carers’ Programme
At a recent Programme Executive, the Chief executives of the WYAAT organisations lent their support to the West Yorkshire and Harrogate Health and Care Partnership’s Carers’ Programme. Supporting the estimated 260,000 carers in West Yorkshire and Harrogate is a regional priority, and we have also been identified as one of six regions to work in partnership with NHS England to develop an approach to better support unpaid carers. Those in the meeting reflected on how this work would help to build on the success hospitals across West Yorkshire have already seen from campaigns such as John’s Campaign. Programme lead, Fatima Khan Shah will be engaging with quality leads across the organisations to take this work forward.
Financial Times showcases positive partnership work to support hospital discharge in West Yorkshire
Partnership work in Bradford and Calderdale bringing together the NHS, LA and voluntary sector was highlighted in the Financial Times last month.
Regional Ophthalmology event success
The regional eye services event at the end of November was very well attended by staff from across the region and from across health and care boundaries. Presenters included GIRFT, RightCare and the UK Ophthalmology Alliance, and the afternoon workshops generated innovative ideas about collaboration and new ways of working that will form the foundations of a transformation programme starting in the new year. #eyeservicesevent
West Yorkshire Vascular Network
We recently made recommendations to NHS England on where the two arterial hubs for vascular services in West Yorkshire should be based. One was agreed to remain at Leeds General Infirmary , co-located with the Major Trauma Centre and the preferred option for the other, following an options appraisal, was Bradford Royal Infirmary. The hubs will provide all elective arterial and acute work as well as high risk Interventional Radiology (IR). Day case (minor surgery), diagnostics and outpatient clinics will remain at the local hospitals.
NHS England has been going through its own decision making process which includes further engagement with both staff and the public prior to making a final decision later this year.
As part of our recommendation, we also agreed that vascular services in West Yorkshire will be delivered as a single service across the whole of West Yorkshire – bringing together the incredible expertise and resources from all five trusts. To support the further development of this single service we will be appointing three key leadership posts: a Clinical Director; a Head of Nursing; and a General Manager. Recruitment for the Head of Nursing and General Manager Role has begun and can be found on NHS Jobs (you can also see below).
Yorkshire Imaging Collaborative Progress
The business case for a £6m shared radiology reporting system has been approved by all trust boards and submitted to NHS Improvement. The system will allow imagery taken anywhere in WY&H to be reported anywhere in WY&H. It will build on the shared PACS, the Agfa Enterprise Imaging system, which is already being implemented across WY&H. In parallel, clinical special interest groups to agree shared protocols and processes for different areas of radiology (eg paediatrics, urology) are being established and a “kick off” event is being held on 22 January. (www.
Scan4safety Business Case
The business case for the £15m roll out of Scan4Safety has been approved by all WYAAT trust boards and submitted to NHS Improvement. The technology has already been proven to work through a large scale demonstrator project at LTHT. This new funding will implement barcode scanning and data capture technology across all six WYAAT trusts to enable us to track patients in real-time, easily capture information on clinical care direct into patient records and better manage our supplies and equipment.
Website and social media development
Our new website is in development but we expect it to be launched soon – watch this space…….WYAAT has also launched its twitter account, @WYAAT_Hospitals with the hashtag #hospitalsworkingtogether. Follow us and find out more about all the work going on.
What’s happening next week?
- Local area planners meet on Tuesday
- Personalised care group meets on Wednesday
- West Yorkshire and Harrogate programme leads meet on Thursday.
- The communication and engagement network meets on Thursday in Leeds.
- The West Yorkshire and Harrogate personalised care steering group meets on Thursday.