This week’s leadership message comes from Ian Holmes, Director for our Partnership.

Hello my name is Ian

I’d like to use this blog to talk about the changes announced in the NHS white paper last week, and what they mean for Partnerships like ours.

This white paper marks the first major change in health legislation to the 2012 Health and Social Care Act introduced by the coalition government (widely known as the ‘Lansley reforms’).  It follows a consultation document published by NHS England / NHS Improvement setting out options for putting Integrated Care Systems (ICSs) on a legal footing.

The proposed changes reflect much of what has been going on over the past five years through the development of ICSs.  We know that with an ageing population people are increasingly living with multiple ongoing health conditions.  The best way to support and meet the needs of these people is for local services (NHS, care services, and voluntary and community organisations) to work together and join up care which makes it feel as seamless as possible for people.  The 2012 Act placed competition, rather than collaboration as the primary driver for improvement, and this emphasis on competition can make joining up services more difficult.

The new legislation aims to remove some of the unhelpful competition and procurement arrangements that currently exist, and establish in law partnerships like ours which aim to bring together NHS, local government, voluntary and community sector organisations and citizens to help facilitate this joined up working. 

My view is that the vision described in the white paper is closer to how we are currently working than the 2012 Act. It describes strong place level partnerships – with partners working closely together to improve health and tackle inequalities, mature provider collaborations and transparent and inclusive system leadership arrangements.  In many ways the legislation is playing catch up with national policy and the way we work now. Our local places, provider collaboratives and system working has matured significantly over the last five years.  The pandemic has served to further underscore the importance of this partnership approach.

Prior to the white paper being finalised, we asked for there to be flexibility on models to meet local needs and a permissive set of legislation that was not overly prescriptive. This looks like the case, which means we are able to continue to deliver our strategy and make real progress on improving outcomes.  We will continue to push for social care reform and to ensure that our local government colleagues are given greater resources to support the public’s health too.

One important aspect of the proposed legislative changes is that clinical commissioning groups (CCGs) as they currently stand will be abolished, and their functions will be transferred into the ICS.  We know that this announcement has caused real anxiety for people, at an already very difficult time.  Many of the staff in our system work in CCGs, and the majority of the ICS staff are hosted by a CCG and are proud to be so.  CCGs have changed significantly over the last five years.  Their footprints have changed to better align with local authorities, but more importantly the way they work, with a greater emphasis on population health and service integration. 

Our continued focus on place as the primary unit of collaboration will mean that the skills and experience that CCG staff bring will be critical to our future success.  Providing clarity and certainty to these staff and others affected by change as soon as possible is our priority. 

Since before Christmas, we have been having conversations across West Yorkshire and Harrogate about what these changes will mean for us, and how we should respond to them.  We know that we have good foundations to build on, but the way we work will need to continue to evolve to meet the needs of the future.  Specifically we are:

• Reviewing the ICS operating model arrangements to look at the structure and operation of the ICS and the interaction between sectors, programmes and places.
• Developing a framework for place level ‘Integrated Care Partnerships (ICPs)’.  This will describe the essential features and working arrangements of place level ‘integrated care partnerships’ building on best practice across WY&H.  It will also develop propositions for effective governance and accountability arrangements between system and place.
• Developing a new Financial Framework for the ICS. This will cover the flow and distribution of NHS funding; financial accountability; and the payments and incentives regime to support integration and improved outcomes. 
• Developing arrangements for System Clinical Leadership at place and ICS level. 
• Strengthening our Workforce Planning and Leadership arrangements, recognising the increased role that ICSs will take in relation to workforce leadership. In parallel, CCG human resources leads have been working together to develop a common human resources framework to support the organisational change process and most important all colleagues who will be affected by the change.
• Building on our commissioning futures work, and connecting it into the ICS and ICP developments to help inform decisions on what work is best done at each level. 

The strongest and most consistent message that I have heard from all parts of our partnership throughout this work is about relationships and culture.  Alongside good governance, our collaborative approach, our values and the respect we have for one other is clearly something that people who work here are proud of.  We must continue to build on these through these reforms and not let them become a distraction, because it is these relationships and this way of working that will be critical for our future success, rather than the specifics of the legislation.  Personally it continues to be a huge privilege to me to work with leaders who have shown such commitment, values and pragmatic intellect both before and during the pandemic.  It is this that gives me the most hope for the future. 

Have a good weekend.
Ian

Local Maternity System

Our Local Maternity System Board met on Monday 15th February and the meeting was opened by the Chair and SRO Carol McKenna with a big thank you to all involved in the maternity work within the Local Maternity System. Following the recent SOAG West Yorkshire and Harrogate System Oversight Group meeting where recognition was given from Rob Webster for the great work and transformation that has continued by the maternity system. National colleagues from NHS E/I also said well done to everyone and recognised the work achieved improvement in safety and quality outcomes.  The board heard that still births are at their lowest rate since 2016 and overall the maternity system is doing well in a challenging time. A discussion was had about the ongoing work to embed the recent Ockenden review of maternity services. The board members highlighted that the West Yorkshire Local Maternity System was well placed to take this forward as they are already embedded in the West Yorkshire and Harrogate Health and Care Partnership and  the wider system is working well together.  Work continues in addressing health inequalities.

The Maternity Voice Partnerships have all undertaken surveys of women’s experiences of maternity care during the pandemic. 1169 women responded across the Local Maternity System. The demographics of the respondents demonstrate that further work needs to be undertaken to ensure Maternity Voice Partnerships are representative of their communities. Themes included: visiting; emotional wellbeing; loneliness, partners and antenatal preparation.  Some of these themes are being addressed and the results of these surveys are guiding the Maternity Voice Partnership work programme for 2021. In December 20.3% women were booked onto a Continuity of Care pathway and 34.5% of women from Black and Asian communities were booked onto a Continuity of Care pathway.

An update on workforce was given as the board with appreciation that this has been a challenging time for staff and their resilience but we collectively continue to be driven by safety and high quality services. A job advert has now gone out to recruit newly qualified registered midwives at one of the six hospital trusts within the Local Maternity System.  A presentation was given about the role of the Voluntary and Community sector by Masira Hans from Mind in Bradford and the potential opportunities there are to be had in working more closely together to support families by developing relationships and making greater connections. Chris Day representing the Yorkshire and Humber Neonatal Operational Delivery Network gave an overview of the most recent data neonatal data and spoke about better managing prematurity and mortality challenges. He acknowledged the excellent work done by maternity teams to increase magnesium sulphate and steroid uptake and spoke of the new challenge to do the same around deferred cord clamping. A presentation was given on clinical glucose monitoring in pregnancy, was acknowledged as a great piece of collaborative work.

Partnership’s People Board

Our People Board met on Wednesday. The board covers all sectors, including social care, unpaid carers and volunteers. The relationships we have with the West Yorkshire Combined Authority for the area’s economic recovery plan, Health Education England, the Academic Health Science Network, med-tech and the skills sector, including universities, helps us to look at what we can do together to develop and grow our workforce and support people into better jobs via our People Board work. Work is progressing with academia to develop a Health and Care Workforce Observatory to provide insight into an evidence-based approach to workforce planning. This has been given a welcome boost through funding from Health Education England which will allow us to progress at pace. The objective is to change how to deliver workforce development in its broadest sense, across our health and social care workforce. This involves developing talent and a range of access options into work within health and social care as well as developing careers, encouraging inclusivity and wellbeing.

Mental Health Programme Board update

The Programme Board met on 9 February to discuss an agenda that included updates from projects and workstreams such as the Community Mental Health Transformation bid, the Learning Disabilities Challenge, Assessment and Treatment Unit (ATU) reconfiguration, CAHMS, and Autism. The Board received a presentation on plans to reduce serious violence and make West Yorkshire & Harrogate a trauma informed and responsive system. An outline of the results from the Barriers to Access to Urgent and Emergency Care survey of autistic people and their carers was shared, and this will be reported fully shortly. The Board noted the proposed response to the actions to tackle mental health inequality as recommended by the BAME review, undertaking to discuss the response and agree final ownership of the actions. The Programme holds being overall responsibility for eight actions and contributes to nine more whose overall responsibility sits elsewhere. The Programme will respond by the deadline of 23rd February in these areas:

• improving access to safe work for BAME colleagues in West Yorkshire and Harrogate 
• ensuring the West Yorkshire and Harrogate Partnership’s leadership is reflective of communities 
• population planning (using information to make sure that services meet different groups’ needs – such as collecting data, understanding inequalities, equity of commissioning for VCSE and cultural competence of services).

The Programme will work to finalise a workplan comprising:

• setting the expectation that the MHLDA Workforce group sets training ethnicity targets and reviews employment practices
• developing and appointing to a joint public health and/or leadership role within the MHLDA collaborative to focus on health inequalities
• supporting the work of the WY&H Health Inequalities Academy
• confirming the role of the Wellbeing Hub in supporting VCS staff, developing online resources and supporting the roll out of Mental Health First Aid (or similar) training
• understanding current arrangements in each place and establishing any need for collaborative work on VCSE secondment agreements & MOUs for sharing of staff.