This week’s leadership message comes from Emm Irving, Head of Improving Population Health and Partnership Lead for the West Yorkshire Violence Reduction Unit about our work to become a trauma informed and responsive system by 2030.

This week’s blog to celebrate Black History Month comes from Cherill Watterston, West Yorkshire Health and Care Partnership System Development Lead for Leadership and Talent

Hello, my name is Cherill.

It is now two years since the launch of our racial inequalities training. I was one of the people that volunteered from the West Yorkshires Race Equality Network to design and deliver it to leaders across the system. This followed the murder of George Floyd and the momentum and  international attention gained on the Black Lives Matter movement. It highlighted the ongoing injustice faced by those people for which one part of their identity means that they experience racism.  During Black History Month 2020 the workshop provided the opportunity for leaders across the partnership to increase knowledge, awareness and build change into our programmes. The resources were subsequently made available online for anyone across the partnership to access.

Why is this training and creating the space for discussion like this as important as ever?  We look at our data, we hear from our colleagues and those people within our communities that experience racism and we know that their experiences remain unchanged. Health inequalities exist, difference in workforce experience still exists. There is a huge amount of work happening across West Yorkshire as a result of the independent review into health inequalities. We are taking this seriously.

Systemic racism is a societal construct that has been woven into the infrastructure of the way we experience the world.  We certainly cannot dismantle this in two years. The ideology of whiteness as the prevailing narrative shapes our consciousness, influencing our decisions, our behaviour, how we see and treat other people. It also blinds us to uncomfortable truths.

What Is Whiteness? | Psychology Today Let me explain that when I say whiteness, I am not referring to skin colour. I mean the socially constructed process of defining identity and belonging to a particular social group and this happens to be the culturally dominant group in Britain. Social Identity Theory in Social Psychology - iResearchNet  And it is also important to point out that race is  another socially constructed idea that influences the opportunities and experience people have but has no basis in biology. Anthropologists' views on race, ancestry, and genetics - PMC (nih.gov)

Changing the way systemic racism permeates society starts with personal responsibility. We are all part of the system that perpetuates inequality. All of us. If you are uncomfortable thinking about your racial identity this might be a good place to start. Why? Why does it make you feel uncomfortable? The historical context within which whiteness sits can make it easy to ignore. Choosing to sprint from those uncomfortable feelings when discussing whiteness reinforces the disconnect between understanding how it creates barriers and disadvantage for others that are marginalised because of this omnipotent racial construct. Clever blog explains white privilege using real-life examples | Metro News

So, what does all this have to do with the racial inequalities training? 

1. To support the Big Ambitions of the Partnership of increasing representation in leadership and improve the experience of those people within the system that experience racism EVERYONE has to understand that racism is pervasive and it comes from an ideology that has long historical legs that was created to give power to some and dehumanise others. It has been a part of the way we experience the world for so long that many people don’t see that it is there. We cannot truly know where we are without understanding the past and its influence. Does Colonialism Have Anything to Do with Racism and Other Discrimination? | by Harsh Badera | Equality Includes You | Medium . Interim Report on the Connections between Colonialism and Properties now in the Care of the National Trust Including Links with Historic Slavery
2. Meaningful personal reflection is required to look at how the wider historical and societal context influences our own thoughts, feelings and behaviour, our interactions with society and the social groups within which we identify. We do not exist in sterile bubbles immune from the conditioning that society provides.
3. Systems are made up of people and the interactions of those people within these systems determine individual and collective experience and outcomes (New report celebrates diversity in health innovation – AHSN Network) . How we understand each other, how decisions are made, how we understand what is important, how we involve people… We all have a part to play in creating the conditions where equity is fundamental, and everyone is valued and respected. 

Preparing and delivering these sessions is not easy. They may be impactful, and I know from feedback that the initial session in 2020 certainly was. However, there is emotional labour involved. Colleagues that experience racism are connecting with parts of their lives that may be extremely painful. This is their reality and people bear emotional scars that they are willing to share with the hope that they can ease the burden and create change for others in the future.

Discussing experiences of racism is difficult. Addressing the ideology of whiteness and what that means is difficult. It requires a level of vulnerability for everyone. Brene Brown talks about times when we are pulled between fear and our call to courage and the importance of leaning into vulnerability with an open heart and mind so that we can genuinely work with each other.

We can and must do this together. We can give hope of change through meaningful interventions. Through supporting leadership behaviours that are both brave and vulnerable, we can foster connection and understanding that results in equity and improved experiences for our people.

‘Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek’. Barack Obama

Thank you for reading, Cherill.

West Yorkshire Community Collaborative Quarterly meeting

Local community care providers from across the area met on Tuesday. The meeting was chaired by Brodie Clark CBE, Chair of Leeds Community Healthcare NHS Trust. The group meets to discuss shared learning, development of good practice and where they can work together to tackle challenges. There were agenda items on work across the area, virtual wards, and the community care workforce.

The NHS West Yorkshire Integrated Care Board (ICB) sector lead for the collaborative is Karen Jackson, CEO for Locala Community Partnership. Karen discussed how the work of the collaborative aligns to the ICB in terms of governance and the value of having a strong community care provider voice present at the board.

It’s important to note that community care is delivered in our five local places (Bradford District and Craven, Calderdale, Kirklees, Leeds, and Wakefield District) and group members only discuss areas where a collective approach is helpful. This way of working is reflected in the work of the collaborative on shared agendas, such as the hospital discharge working group. The West Yorkshire Discharge Executive Group brings together places and providers to support improvements to discharge including the 100-day challenge. A multiagency discharge group continues to meet weekly to work through joint actions, commission new pieces of work and share practice as part of developing our resilience ahead of winter. They have been meeting since winter 2021.

The collaborative discussed the priorities for discussion at the ICB board, which includes community care workforce, and their vital role in delivering services. A joined-up partnership approach across all sectors, for example hospitals and councils, to help people get the care they need, was also discussed. Community district nursing, their skills, pressures, and challenges were covered in the meeting. This follows earlier discussions with registered nurses. Retention, the variety of roles, record keeping and building the workforce in partnership with primary care networks, higher education as well as international recruitment and links to social care / home care agencies and self-care were covered. Group members also discussed the complexity of district nurses working in inner city versus rural community care.

Virtual wards was also discussed. Virtual wards support patients who would otherwise be in hospital to receive the acute care, monitoring, and treatment they need in their own home. This model prevents avoidable admissions into hospital, supports early discharge out of hospital, and can help release hospital capacity for elective recovery.

There are two main types of virtual ward:

• Mostly remote – based on technology-enabled remote monitoring and self-management, with minimal face-to-face provision
• Mostly face-to-face (‘Hospital at Home’) – based on a blended model of technology enablement with face-to-face provision, delivering acute-level interventions at home. 

Across our Partnership, all Virtual Wards will have a core focus on admissions avoidance and early supported discharge, initially for frailty and respiratory (with further scoping activity required on how models could be extended to other pathways and conditions). The models are being developed in an integrated way. This involves joining virtual wards together with wider services such as urgent community response and same day emergency care, with shared care and monitoring across acute and community services and teams, development of acute and community multi-disciplinary team models (plus input from social care and the voluntary community social enterprise sector) and expansion in technology and digital care hub type arrangements. All models will operate 8 to 8, 7 days a week, with out-of-hours arrangements.

Colleagues are identifying any gaps and are working with NHS England for highlighting reporting to demonstrate the value of the funding and the positive difference this way of working brings to people, communities, and staff. Group members discussed the various areas which must be in people’s homes for it to be achievable, for example digital, against the backdrop of health inequalities and recruitment.

Connecting people is key to connecting care

Last Friday (21 October) Jo Webster, Place-Lead for Wakefield District alongside colleagues from across Wakefield Council Adult Social Care and The Mid Yorkshire Hospitals NHS Trust Community Services, which included therapy leaders, community matrons, social care workers, the lead for integrated equipment services, a Geriatrician and senior nursing leadership, took time out to get to know each other’s work areas more and to plan how better they can support local people living across the area, including agreeing priority areas of collective action together.