Posted on: 5 April 2019
Hello, my name is Fatima
I’m delighted to be able to write this week’s Partnership’s message. Thanks for the opportunity.
As Partnership Lead for the Unpaid Carers Programme I’m in a very privileged position. Working with both national and local colleagues has given me the chance to put my personal experience of caring to the forefront of action for change – and I’m determined to make a positive difference in any way I can –whether large or small (preferably large).
There are around 260,000 unpaid carers of all ages living in West Yorkshire and Harrogate. As public services continue to face financial pressures, increasing demand, the introduction of new legislation and approaches, and changing expectations of citizens, increasing numbers of unpaid carers are taking on responsibility for more intensive levels of care. From personal experience I know this can be exhausting, especially if you are trying to hold down a paid job, raise a family and run a home.
So with this in mind, I’m pleased that West Yorkshire and Harrogate Health and Care Partnership have been recognised by NHS England as one of twelve exemplar site for developing support for unpaid carers. You may also remember we were highly commended for our work by the Health Service Journal last year – which reflects this. Put simply we have the opportunity to shape and influence national policy to help current and future carers. In attempting to make positive change at pace, we have set up a project group made up of colleagues from across the area to develop, deliver and implement our carers’ plan of action. More later.
There is some great work taking place across West Yorkshire and Harrogate to support carers living in Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield. There is much to do, lots to learn and share. You don’t need to look far to see some excellent examples across the whole of the area.
Yet there is still much to do…
Evidence from Carers UK shows people who are carers are more likely to be in poorer health than those who are not in a caring role. Carers may have fewer opportunities to do the things other people may take for granted, such as having access to paid employment or education, or having time to themselves or with friends. Many carers including children and young people are hidden; caring for those with a long-term health condition often providing the majority of care without formal support. Albeit many carers do this willingly, and out of love – the pressure on them is great and often comes at a high cost – their own health and wellbeing suffers and they end up missing out on life opportunities. You can watch this short film here, where Kirsty explains the pressure she faced as a young carer.
For young carers, it can often mean their life chances are severely limited. Clearly this is something we want to address. As a starting point we will be holding a young carers career workshop in June. The first event, called ‘Couldn’t Care Less’ will take place in Huddersfield and will have young carers attending from Kirklees and Calderdale. These young people are often caring for parents or siblings who have long-term health conditions, mental health difficulties or experience alcohol and substance use and misuse; the workshop aims to expose young carers to how their skills can be transferred into exciting and varied roles in the health and care sector (roles that are much needed). Supported by role models from across local business and the NHS they will have the chance to hear first-hand from colleagues who may have been a young carer themselves and who understand the challenges they face.
As a Partnership we recognise the contribution all unpaid carers make across our local area regardless of age and we aspire to be a place where all carers are recognised and given the support they need to both manage their caring role and remain in work and/or education.
The publication of the NHS Long Term plan in January 2019 brings exciting opportunities to accelerate our support for carers at pace. It emphasises the importance of supporting carers and sets out key areas for transformation of the NHS which will strengthen our work across the partnership. One priority is to strengthen support using best practice through implementation of quality markers and personalised care approaches that identifies and addresses the health and wellbeing needs of unpaid carers across the who of the health care system.
You may recall last September we held an event where over 60 health and care professionals working in primary care including GP practices, social care and the community sector came together to find out how they can contribute to the Partnership’s vision for unpaid carers. The event, supported by NHS England, focused on improving the quality of life and well-being of carers living across the area. You can read more here.
That quite nicely brings me to our most recent event held on Thursday where around 70 people including carers came together to discuss what the NHS Long Term Plan means for them. In particular we talked about our four key priorities:
- Supporting carers in the workforce
- Supporting young people who are carers
- Identifying carers through primary care
- Making sure hospital care is carer friendly
At the event we heard from Jen Kenward, NHS England, National Experience of Care Lead; Michelle Turner a local carer, and from colleagues who have been nationally recognised for their work on the carer agenda from Surrey and Hertfordshire. It also gave us the opportunity to ensure the West Yorkshire and Harrogate carers’ strategy is aligned with the NHS Long Term Plan and represents the voice of our local carers and organisations across the Partnership. It was a great opportunity to share the progress we have made in our work to support unpaid carers, and to set out our direction of travel together as well as hear first-hand from both national and local speakers about good practice taking place – and importantly Michelle Turner from Carers Wakefield, who is also a carer. It was also extra special because we did a live web cast, to ensure that those who couldn’t make it could still watch and ask questions (a first for us). You can view the presentations on our website here. The draft strategy is here.
I am proud to be representing the needs of carers as part of a Partnership that recognises the significant role they all play in delivering and supporting health and care. As we know without them the health and care system would be overwhelmed. Carers are recognised in a number of our Partnership priorities and I’m very fortunate to work alongside a project team who are as equally passionate as I am. We want to raise carers profile and share the excellent work taking place across the area. In addition we also want to celebrate the difference this is making in our communities on a regional and national level – and most importantly ensure that this is applied for all carers no matter where they live in West Yorkshire and Harrogate.
Have a good weekend
Fatima
What else has been happening this week?
Go live of Integrated Urgent Care (IUC) Services for Yorkshire and Humber
Yorkshire Ambulance Service NHS Trust (YAS) had been awarded the contract for NHS 111 telephony, call handling and core clinical advice service (referred to as IUC) in Yorkshire and the Humber. The jointly commissioned IUC service for Yorkshire and the Humber contract began on Monday 1 April for an initial five-year term. The Y&H IUC Mobilisation Steering Group established on behalf of the 21 clinical commissioning groups (CCGs) and NHS England North Region has overseen preparations.
The new IUC service will replace the old NHS 111 service. The main changes from Monday 1 April are:
- Increase in clinical advice and direct booking
- Clinical validation for emergency department referrals
- Managing dental calls for children under five only and working with the new dental clinical assessment and booking service (CABS) provider who will manage callers aged five and over
- Additional patient pathways utilising local clinical advice services
- Greater collaboration and integration with locally commissioned services.
You can find out more here.
Long term plan engagement
NHS England has commissioned, via Healthwatch England, each local Healthwatch to undertake a piece of engagement work on the NHS Long Term plan, particularly focusing on hearing the voices of the seldom heard. This is designed to feed into the development of our Partnership’s 5-year plan. There are two questionnaires that people can fill in. One is a generic survey designed between local Healthwatch and the Partnership; the second has been produced by Healthwatch England aimed at people with long term health conditions. Both questionnaires are being promoted. People can complete the survey until 3 May via their local Healthwatch. A series of focus groups are also being planned in our local areas. The focus of the discussions will be around digitisation, personalisation and wider relevant locally long-term plan priorities. These will also be completed by 3 May. The intention is for Healthwatch to complete a report for June to share with Healthwatch England and the Partnership. You can find out more here.
Clinical Forum
The Clinical Forum met on Tuesday. The meeting is chaired by Dr Andy Withers and includes medical directors, GPs, pharmacists, allied health professionals, and lead nurses.
Members received an update on the West Yorkshire and Harrogate Local Maternity System from programme lead Karen Poole. The latest version of the plan can be found here. The plan is currently been re-written in response to the NHS Long Term Plan. The Maternity Voices Network continues to be central to the co- production of the work.
Since the last update to the West Yorkshire and Harrogate Clinical Forum in August 2018 there has been significant progress. This is due to the commitment of all the maternity services across the area. Developments to date include meeting with local authorities and clinical commissioning groups to promote the LMS and the community hub and prevention work which is being led by public health colleagues. The LMS Public Health Steering Group will work towards improving outcomes for women and families to ensure they are fit before, during and after pregnancy.
This includes task and finish groups for: smoking, alcohol and drugs, physical activity, maternal nutrition, infant feeding, screening and immunisations; reproductive health, consanguinity and parenting. These groups will produce evidence based implementation plans, which will include reducing health inequalities and addressing wider determinants, for example housing and employment.
Safety is the golden thread of the programme. A safety forum is in place, and colleagues across the LMS are developing shared guidelines. All Trusts were compliant with ‘Saving Babies Lives’. Work is progressing with Yorkshire Ambulance Service reviewing incidents, looking at training and learning from practice in other areas.
The LMS continue to work on the choice agenda. Personalisation is also central to this programme, and work on continuity of care continues with different models across the system. A staff health and wellbeing project – ‘Joy in Work/What Matters’ has begun with a focus on continuity of carer, this supports staff through the transformation.
The workforce task and finish group is focusing on recruitment, leadership and preceptorship (in-depth induction for newly qualified midwives). Perinatal mental health and post-natal care are new areas the LMS will be focusing on in the coming months.
There was also an update on the first of our West Yorkshire and Harrogate policies to be agreed for implementation across all nine clinical commissioning groups - spinal services and liothyronine (for hypothyroidism) as well as an update on information about the evidence-based interventions (EBI) policy. There is more information about the EBI policy and its implementation, including a ‘mapping and gapping’ document which details the changes across all nine clinical commissioning groups, on the Partnership’s website here. Forum members were also updated on the standard approach to bariatric surgery. It is anticipated that the policy will support the commissioning of more bariatric surgery over the next two to five years.
The musculoskeletal service pathway (bones and joints) and how best we reduce variation in access to care across West Yorkshire and Harrogate whilst ensuring care is evidence based was also discussed.
There was a conversation around workforce challenges and Brendan Brown, CEO for Airedale NHS Foundation Trust will attend a future meeting of the Forum to discuss progress made by the Local Workforce Action Board (LWAB) on the workforce strategy. Brendan has replaced Dr Ros Tolcher, the previous CEO Lead for workforce.
Forum members also discussed the progress being made to establish primary care neighbourhood networks / communities - local approaches to integrating NHS and other local services are in place or are emerging.
West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups (CCGs) Development Session
The Committee held a development session on Tuesday, chaired by Marie Burnham, the independent lay chair.
Members discussed a presentation by Helen Hirst setting out options for developing mental health commissioning across West Yorkshire (different arrangements apply in Harrogate). Members noted progress on developing child and adolescent mental health services in partnership with providers. They also discussed the move to a single West Yorkshire Transforming Care Partnership for commissioning learning disability and autism services.
Members supported work to further strengthen partnership working by agreeing a range of services that should be commissioned at West Yorkshire level, where this would lead to better outcomes for people - highlighting the need to learn from good practice locally and ensuring that new approaches help to improve wellbeing and reduce health inequalities.
Members also discussed a presentation by Matt Walsh and Catherine Thompson on improving planned care and reducing variation. Members welcomed the successful adoption of national evidence-based interventions, new spinal services policy and the ‘do once and share’ approach to quality and equality impact assessment.
They also heard that new approaches were needed to meet the challenge of commissioning high quality services, which met access targets and addressed health inequalities within financial allocations. The proposed new approaches discussed included expanding the scope of services that would best be commissioned once across West Yorkshire and Harrogate. This approach could be further strengthened by contracting once for these services, working in partnership with a network of providers.
Members also supported work to strengthen the implementation of agreed policy in all our places. This could involve a greater role for the Joint Committee in scrutinising implementation plans and ensuring consistent approaches across West Yorkshire.
Members agreed that more detailed propositions on both mental health and planned care be brought back to a future meeting of the Committee.
West Yorkshire and Harrogate Association of Acute Trusts (WYAAT - hospitals working together)
The WYAAT Programme Executive (the six Chief Executives of the acute trusts in West Yorkshire and Harrogate) met on Tuesday. The group welcomed Steve Russell, the new Chief Executive of Harrogate and District NHS Foundation Trust, and John Holden, interim Chief Executive of Bradford Teaching Hospitals NHS Foundation Trust.
Carol McKenna, lead for the Primary and Community Care Programme, joined the group to discuss primary care networks and the new GP contract. There was a good discussion about how acute trusts, particularly those providing community services, can support and work with primary care networks in the future.
Professor Sean Duffy and Carol Ferguson, from the West Yorkshire and Harrogate Cancer Alliance, briefed the chief executives on 62-day cancer waiting times. The chief executives decided that WYAAT needs to take a systematic, quality improvement approach to this issue and to re-emphasise the need for a collaborative, system wide approach. It was agreed that the Cancer Alliance will organise a West Yorkshire and Harrogate Cancer System Improvement Event for the cancer teams from all the trusts, with leadership from the chief executives.
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, CEO Lead for the Partnership.
Julian Hartley, CEO Lead for WYAAT (hospitals working together) and CEO for Leeds Teaching Hospitals NHS Trust gave an update on national workforce implementation plan he has led with NHS England and NHS Improvement.
You can read the proposals and our response here.
The plan creates a stronger emphasis on the role of integrated care systems in workforce planning locally. As a Partnership we are very supportive of the recommendations made. Workforce development is a priority area for all partners, including nursing, graduate placements and the new roles in primary care. It’s essential this is backed with future financial investment. Key to this is the support NHS staff receive in their work place - as reflected in the recent NHS staff survey.
Leaders also received an update on the waiting times for cancer and reducing waiting times. With this in mind, an event for cancer clinicians and leaders will take place to focus on the 62 day waiting times and how these can be improved across the whole of the system rather than from an individual organisation’s view point. There is a strong commitment to work together to improve waiting times to improve people’s lives in West Yorkshire and Harrogate.
The leadership discussed operational planning for 2019-20. As we near the end of the process, we reflected on progress to date. It’s clear that there has been a much more integrated and collaborative approach to planning this year – and this has been evident in the quality and credibility of plans. However, as a system we face a number of challenges around finance and performance. It is really important that there is a clear focus on these through our collaborative working arrangements.
Carol McKenna, CEO Lead for Primary Care, and Chief Officer for North Kirklees Clinical Commissioning Group and Greater Huddersfield Clinical Commissioning Group, led a discussion on the development of primary care networks (also known as primary care home/community partnerships) and the GP new contract reform. Locally however some networks may refer to themselves differently reflecting their model and maturity. For example; Bradford has community partnerships – describing an integrated service offer for communities that include NHS, social care and VSC. Leeds has local care partnerships describing their primary and community care system approach.
Carol gave an overview on the requirements and timescales for the primary care strategy; and funding.
The NHS Long Term Plan described how all GP practices will be expected to join a Primary Care Network (PCNs) by July 2019. Networks will have expanded neighbourhood teams of GPs, pharmacists, district nurses, community geriatricians, physiotherapists etc., joined by social care and the voluntary sector. The core network agreement will define how GP practices will work together and with other partners such as community services and will provide the structure and funding for how services are developed locally. The network agreement is due to be published at the start of April.
We recognise the vital role that general practice plays in providing services, and the significant pressure that it has faced in recent years. In West Yorkshire and Harrogate we have invested £2.6m of transformation funds into working with practices to develop local improvements which address the specific challenges. This equates to £1 per head of population to each clinical commissioning group, to accelerate and develop local approaches to the delivery of PCNs.
We are working with NHS England and Health Education England through our Local Workforce Action Board and the West Yorkshire and Harrogate Workforce Steering Group to find solutions to improve recruitment and retention of staff into these vital services. It is important that GPs, nurses, therapists, social care staff, families and carers start to see a real and meaningful improvement in the next few years.
Julian Hartley, CEO Lead for WYAAT (hospitals working together) and CEO for Leeds Teaching Hospitals NHS Trust gave an update on national workforce implementation plan he has led with NHS England and NHS Improvement.
There was also an update on the first West Yorkshire and Harrogate Partnership Board Development Session which took place in March. This brings together chairs, elected member representatives and executive members. Four new co-opted public members have recently been recruited. The Partnership Board meets for the first time in June. You can find out more here.
The NHS Long Term Plan committed £4.5 billion more for primary medical and community health services by 2023/24. This will support better care for patients outside hospital in their local communities. In January, NHS England and the British Medical Association’s General Practitioners Committee agreed a five-year GP (General Medical Services) contract framework from 2019/20. The new contract framework marks some of the biggest general practice contract changes in over a decade and will be essential to deliver the ambitions set out in the NHS Long Term Plan through strong general practice services.
NHS England has now published more detailed supporting guidance, which is available here.
Wider leadership meeting
The wider leadership group met on Tuesday. This includes representation from across the Partnership. It is chaired by Rob Webster, our CEO Lead for the Partnership. There was an update on the ‘Looking out for our neighbours' campaign. Over 320 organisations have pledged their support and people can download the free resources here. 255 resource packs were downloaded in the first week. Please continue to support and encourage others to back the campaign. The campaign will run until June. Evaluation will be completed in the summer.
There was also an update on NHS, Library and Knowledge Services which hosts a wide range of information to help providers and clinical commissioning groups make evidence based decisions, for example around frailty; maternal choice in perinatal care and physical exercise in preventive healthcare. It’s a great service with lots of expertise available locally.
Rob introduced the final session on supporting good health services for people with learning disabilities. This was coordinated by Change, a national human rights organisation led by disabled people, based in Leeds. They employ people with learning disabilities as part of their core staff team. The session was led by people with learning disabilities. Rob explained that the Long Term Plan talks about services for people with learning disabilities and delivering a set of consistent standards with and for them.
The session was led by Catherine, Philippa, Shaun and Joanne. Catherine is a mum with learning disabilities who does a lot of international and national work on training people with learning disabilities to be expert advisors whilst working to ensure services are inclusive. There are 1.5million known people with learning disabilities in the UK. The average age that people with learning disabilities die is 58 years old.
There has been a recent review of deaths of people with learning disabilities carried out by Public Health England and the Norah Fry Research Centre. They found that the life expectancy of people with learning disabilities is 19.7 years lower than those who do not have a learning disability. We need to create a culture underpinned by rights based values that promote empathy, inclusion and supported decision making at its core so that everyone receives the right information at the right time.
Catherine explained she ‘wants to live long and healthy life – like everybody else – and wants to receive a birthday card from the Queen’. All agreed it’s everyone’s responsibility to change this shocking figure. Philipa highlighted that most policies and strategies are made without the input of people with learning disabilities. It’s important we involve people with learning disabilities throughout the design and developments of services to ensure they are inclusive. High quality, accessible information is also important and people with learning disabilities could be leading on this.
Change has developed a whole system approach with NHS England to employing people with learning disabilities. They are introducing new ways of understanding and supporting decision making in the UK with people with learning disabilities. This also includes work to tackle health inequalities.
It was a powerful session which aimed to support colleagues to think about what good inclusive services look like for people with learning disabilities. Together we can change the health outcomes for people with learning disabilities so that they live longer, heathier lives. We need to engage with people with learning disabilities from the start to make it better.
The session ended with leaders making a pledge for one area they can change. Over 30 pledges were made. These included understanding how we can increase employment opportunities for people with learning disabilities; reviewing the standard of our communications and letters in accessible formats and helping people with learning disabilities to speak up for themselves.