Posted on: 8 March 2019
This week’s leadership message comes from Kersten England, CEO of Bradford Council. Kersten is also Chair of Bradford, Airedale, Wharfedale and Craven Health and Care System Leaders Board.
Hello my name is Kersten…
Preparing for all outcomes of the current Brexit negotiation process has become an increasingly demanding task for public sector partners. Essential work is going on across West Yorkshire and Harrogate to ensure, as far we are able, that our organisations and places are resilient - socially, economically and environmentally; and can function effectively whatever does or doesn't happen on March 29, 2019.
Part of this is supporting valued colleagues who are nationals of EU countries. Last Friday afternoon I met with a group of Bradford Council employees. They were from a range of European nationalities - Polish, Latvian, French, Italian and Spanish - working across many council services. There were school catering and cleaning staff, architects, clerks to school governors, social workers and enforcement officers. All of them concerned for themselves and their families, but also for the wider EU community resident in our district as they, and we, live and work through this period of uncertainty.
So many questions arose - can I access healthcare after Brexit? Will I need an international driving licence? What's the status of my children who were born here? How long can I leave the UK for and still be able to return? They had many more questions too. It was a sobering conversation.
From talking to our partners I know that there are many people in similar situations. I am proud that as West Yorkshire and Harrogate Health and Care Partnership partners we have committed to supporting our valued EU staff and residents.
Here in Bradford District and Craven we are working on shared communications that emphasise this while offering practical support and advice, particularly on settled status and its requirements.
Aside from Brexit there are few more important priorities for local government chief executives right now: ensuring we play our part in the development and delivery of the NHS Long Term Plan locally; preparing to make submissions to the government's comprehensive spending review and looking at what the impact of the long awaited social care green paper might be. It's a critical piece of policy making on one of the most challenging issues facing our society - how do we individually and collectively fund a system of long term care and support for our elders and adults with physical or learning disability?
The most recent Sunday papers carry stories of people who are lonely, isolated, with unmet care needs and of a system working hard but struggling to meet demand with insufficient resources and shortages. In Bradford, as I know across the Partnership, we are playing our part in building new models of care which prioritise choice and independence, build support around an individual and family and deploy assistive technologies appropriately. But the structural fragilities remain and we continue to lobby and hope that the green paper may bring some welcome thinking on system viability and quality.
Whatever is within the green paper the final financial envelope for social care is unlikely to be resolved until the comprehensive spending review. It's still anticipated that we will have a review of spending and investment across all government departments this autumn. In recent weeks many of us have had meetings and discussions with civil servants from across Whitehall in which it seems that there is an increased acknowledgment of the significance of place (in West Yorkshire and Harrogate this equates to: Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) and the potential for greater impact of joined up working and investment on key challenges on a place basis. This is combined with a shared sense that the profile of investment, between upstream and preventing ill health and the downstream work on chronic long term health problems is out of kilter and willingness to consider how investment might be rebalanced. This is music to our ears and we hope signals willingness for government departments to work more collaboratively and align/co-invest/share rather than competing for scarce resource and at times duplicating effort or embarking on contradictory policy approaches.
Here in Bradford some of the most significant progress we are making - whether on educational attainment, cultural renewal, health and wellbeing or economic growth - is being achieved through purpose led cross sector partnerships.
It's easy to say the only way is partnership; it's sometimes harder to evidence the case for or the impact of this work. Our Born in Bradford (BiB) data sets and analysis are beginning to bring a much needed rigour to the table. For example through correlating consented health and education data BiB identified a significant issue for our children with eyesight difficulties who may have had an eye test at school but did not go on to get their prescription glasses. More recently the doubly negative impact for premature babies born in summer who are the youngest group in their age group was also highlighted. Both these insights have led to changes in policy and practice which we believe will significantly improve some of our young people's education outcomes. All areas I personally welcome.
Our comprehensive spending review submission will make the case for an understanding of the importance of place, place leadership and what can be achieved through effective leverage of all assets of a place but also a re-profiling of investment to enable effective work on wellbeing.
Meantime work on our system contribution to the NHS long term plan is gathering pace. We are lucky to work in Partnership which has always welcomed the collaboration between the NHS, local government, and communities. We acknowledge the importance of local accountability. Our Health and Wellbeing Board has grappled with the year one planning and financial parameters and is debating how far we can shift investment through joint commissioning for wellbeing outcomes as well as securing the viability of our providers.
Our community partnerships are bedding in, our one workforce collaboration on the current and future viability of our health and care workforce is gathering pace and a strategic partnership agreement is working its way through the decision making bodies of our constituent parts. The Care Quality Commission was very complimentary about our system and the common purpose displayed at every level across every part of it. But it's not easy or straightforward. There are misunderstandings, anxieties and differences of opinion at times; particularly when money is tight, regulators are at the door and targets are missed. But we keep at it!
Finally it's International Women's Day today. I hope you will be celebrating all the amazing ways in which women contribute to the world! Here in Bradford we are seeing the emergence of a new generation of younger women leaders. They are energetic, optimistic and ambitious. They want change and don't want to be on the side-lines, they want to be making the change. Our job is to put wind in their sails and follow their lead. I think it will be an exciting journey.
Have a good weekend
Kersten
We're very excited to share the 'Looking out for our neighbours' campaign support pack which has more information and links to all campaign resources to help your organisation spread the word. This includes:
- Campaign logos and assets
- Posters (digital and print)
- Flyers (digital and print)
- Social media tweets and posts
- Social media images
- Plasma screen content
- Editable posters, plasmas and social media images (including a space to personalise with your place/community name)
All resources are free to use. Organisations can still sign up and pledge their support at Ourneighbours.org.uk Please help us raise awareness of key campaign messages from launch day on the 15 March onwards.
What else has been happening this week?
Workforce development
West Yorkshire Local Workforce Action Board (LWAB) met last week with a focus on new roles including physicians’ associates, nurse associates and advanced clinical practitioners and how these can help improve the care offered to people. There was also a conversation on the changing role of technology and how this would influence the education and training needed for future trainees.
Career campaigns are being developed to increase the number of people applying to be a mental health and learning disability nurse and the LWAB are looking to commission a careers hub which will focus on promoting additional specialties where recruitment is an issue.
The LWAB is also working with the Local Maternity System Board to look at joint recruitment of midwives across West Yorkshire and Harrogate and how we can improve the consistency of training for the maternity workforce.
Funding has also been agreed to appoint a programme manager to focus on mental health and cancer, particularly around the diagnostic workforce.
The LWAB is also exploring how to fully utilise the apprenticeship levy across West Yorkshire and Harrogate. An agreement has been given to appoint a project manager to take forward this piece of work.
Dr Tolcher, CEO for Harrogate and District NHS Foundation Trust (hospital) and the CEO lead for workforce is retiring in April 2019. Special thanks to Ros for her leadership role on the workforce agenda. The LWAB looks forward to welcoming Brendan Brown, CEO of Airedale NHS Foundation Trust (hospital), who will be taking over this role and LWAB co-chair from April 2019.
Clinical Strategy Steering Group
The Clinical Strategy Steering Group met on Tuesday. The group, which includes people from all sectors and places in our Partnership, heard feedback from the frailty workshop held on Monday which was attended by almost 50 staff. The workshop discussed the findings from over 150 interviews with staff and people who use services. This highlighted best practice and common themes for people with frailty across all places. A second workshop will be held on 28 March on children and young people. The steering group also heard from Robin Jeffrey, Clinical Lead for WYAAT, about the 24 “Service Profiles on a Page” which have been developed for acute specialties with clinical teams. The profiles describe the current services from prevention to tertiary care, and identify potential future models. The themes and findings from this work will be fed back to the System Leadership Executive, our programmes and incorporated into our Five Year Plan.
Future work will include a frailty workshop with people who access services and the public, plus further development of the ‘Service Profiles on a Page’ and work to understand the future models for elective care and urgent and emergency care.
WYAAT Programme Executive (hospitals working together)
The West Yorkshire and Harrogate Association of Acute Trusts (WYAAT) Chief Executives, chaired by Clive Kay (Chief Executive of BTHFT) met on Tuesday. Dr Robin Jeffrey (Clinical Lead for WYAAT) presented a paper proposing a collaborative WY&H programme for dermatology, involving WYAAT, the Improving Planned Care Programme and the Cancer Alliance. The aim of the programme would be to develop a new model for dermatology services in WY&H which addresses the challenges of increasing demand and workforce shortages. The chief executives supported the proposal.
The meeting also received an update from the Pharmacy Regional Supply Chain Collaborative Programme. Professor Liz Kay, Chief Pharmacist LTHT, and Andy Alldred, Clinical Director and Chief Pharmacist, HDFT presented the current position on the programme. The chief executives commended the programme for completing a very robust and objective assessment and asked that the full business case is developed for the WYAAT Committee in Common at the end of April.
The meeting concluded with thanks to Dr Ros Tolcher, Chief Executive of HDFT, and Clive Kay, Chief Executive of BTHFT, who are both leaving their roles at the end of March.
The Shadow System Leadership Executive Group
The Shadow System Leadership Executive Group met on Monday chaired by Dr Matt Walsh, Chief Officer for Calderdale Clinical Commissioning Group and CEO Lead for Improving Planned Care. Comprising twenty senior clinicians and managers from across the Partnership, it meets every month ahead of the System Executive Group. This was the final meeting of the group. Everyone agreed it has been a great and useful experience. Their role has been valued by the Partnership’s executive group. Special thanks to Dr Matt Walsh who chaired the meetings and also to Thea Stein deputy chair. We are planning cohort 2 for 2019/20.
West Yorkshire and Harrogate Clinical Forum
The 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 embedding personalised care in West Yorkshire and Harrogate. For many years the NHS has talked about the need to shift towards a more personalised approach to health and care. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations. Chapter one of the NHS Long Term Plan, published in January 2019 makes personalised care business as usual across the health and care system. West Yorkshire and Harrogate Health and Care Partnership is working with NHS England as one of 11 national ‘Level 1 Personalised Care Demonstrator Sites in 2018/19’. This means that the six places across our area (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) are working together to build person and community centred approaches to health care. Forum members were asked to consider how we best engage clinicians in implementing personalised care consistently across the area. Clinical forum members emphasised the importance of health colleagues working together to further enhance person choice. This area of work clearly links to community based support, the role of voluntary and community organisations and public health colleagues. There was a clear appetite to move forward. Dr Withers will work with the programme leads to identify themes for further forum discussion.
Members also received an update on developing the West Yorkshire and Harrogate Five Year Strategy and the approach we are taking to refresh our programmes, including key performance and transformation metrics. Forum members welcomed the approach – highlighting that it is important we demonstrate what improvement looks like and that each part of the system knows what their contribution is with clear targets for the West Yorkshire and Harrogate programmes. With this in view Anthony Kealy (WY&H Locality Director, NHS England) discussed our organising framework and the check and confirm sessions which will take place from the end of May.
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. Members considered spinal policies and pathways; a liothyronine commissioning policy; a commissioning policy for surgery for severe and complex obesity and simplified treatment guidance to support the Healthy Hearts work.
Dr James Thomas presented the spinal policy and pathway, as part of the improving planned care programme. Waiting time pressures in the specialist spinal pathway are significant with high numbers of people waiting over 52 weeks for treatment. The pathway and policy has been developed to ensure that only people who will benefit from a consultation with a spinal surgeon will enter that pathway and other patients access more appropriate treatments locally. This will also help to reduce any differences that exist across the area. The Committee agreed to adopt the spinal pathway and policy across West Yorkshire and Harrogate. We don’t anticipate any savings – this is about improving the process and reducing waiting times for people.
A commissioning policy for liothyronine was published in 2017 by NHS England as part of their low value medicines programme. This was identified by West Yorkshire and Harrogate Pharmacy Leadership Group as one of the prescribing projects for 2018-19. The drug is used for people with under active thyroid. Clinicians and medicine management colleagues have been involved in the work. The liothyronine policy was agreed for use across West Yorkshire and Harrogate. This would be implemented over a 12 month period with monitoring and guidance in place to ensure we are clinically assured and that people are well supported. The Programme will be communicating with stakeholders about the changes.
Amanda Bloor and Steve Ollerton presented simplified treatment guidance to support the West Yorkshire and Harrogate Healthy Hearts project, pioneered successfully in Bradford. This project will contribute to the Partnership ambition to reduce CVD incidents by over 1,100 (10%) by 2021.
A key part of the project is improving the identification and treatment of adults with hypertension. The new ‘do once and share’ quality and equality impact assessment process had been applied to the guidance. You can find out more about the work here. This work is all about reducing people’s blood pressure to prevent ill health and give people the best chance of a long and healthy life. The Committee agreed to adopt the guidance across West Yorkshire and Harrogate.
Michelle Turner presented a standardised commissioning policy and service specification for surgery for complex and severe obesity. All individual clinical commissioning groups have aspired to commission at the rate of 4% of the eligible population.
The aim of the new commissioning policy is to establish a common approach, which reduces variation across the area. This is an evidence based policy with clear benefits in terms of saving people’s lives.
The Committee agreed the Obesity Surgery Commissioning Policy and service specification to take effect from 1st April 2019. It was recognised that close working would be needed with WYAAT (hospitals working together) to ensure that there was sufficient capacity. It was also recognised that this was an ambitious approach that would take time to implement. An update from our six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) will come to a future Committee meeting.
Partnership Board development session
The first development session of the Partnership Board took place on Tuesday. This includes members of our executive group; Health and Wellbeing Chairs; council elected members; chairs of NHS Trusts and other providers, and Chairs of Clinical Commissioning Groups. We are also recruiting four members of the public onto the Board. The Board is chaired by Cllr Tim Swift, Leader of Calderdale Council and Chair of Calderdale Health and Wellbeing Board. The Board will meet for the first time in public from June. The Partnership Board is an important next step in our evolution. It brings greater democratic accountability and transparency to our work at West Yorkshire and Harrogate level. The arrangements also reflect our model of distributed leadership and equal partnership between health and care.
The purpose of the session was to spend some time thinking about the role of the Partnership Board, and how we can work together to improve health and care for the people of West Yorkshire and Harrogate. Sir Chris Ham and Nicola Walsh from The Kings Fund facilitated the session.
Cllr Swift welcomed everyone to the meeting. He outlined how pleased he was that the Partnership is working inclusively together and that the principles of working at a local place level, with a shared understanding on areas of West Yorkshire and Harrogate where there are clear benefits to the 2.6million people who live across the area is key.
Board members watched a short film to provide further background to our Partnership’s work.
Key points included the importance of working with communities; preventing ill health, tackling loneliness and links to other partners such as West Yorkshire Combined Authority – to ensure an inclusive approach, whilst ensuring residents are aware of the positive difference we make.
It was clear we have come a long way already and the Board is built on solid foundations and strong leadership. It was clear from the round table discussions that there are real benefits for working together to solve and work through the big issues for West Yorkshire and Harrogate, for example funding and workforce. It was also clear that relationships and trust are as important as structure. We are one of the largest health and care partnerships in England and if we work together we can be influential at all levels and importantly improve people’s experience of care.
There was a panel discussion with Soo Nevison (CEO for Community Action Bradford and District and CEO Lead for Harnessing the Power of Communities). Soo gave an update on working with communities to prevent ill health, whilst recognising the importance of VCS funding to support work. Dr Andy Withers, Chair of the Clinical Forum spoke about how evidence influences the work we do together at a WY&H level, for example Healthy Hearts. Andy’s ask of the Partnership Board is to ensure we look at the wider determinant of health and the impact this has on people’s wellbeing, for example housing, employment and poverty.
Dr Matt Walsh explained the role of the Improving Planned Care and Standardisation of Commissioning Policies and how the investment in the work we do across West Yorkshire and Harrogate has been built from good relationships and trust. As Chair of the Shadow Executive Leadership Group he spoke about how our leaders need to be ‘brokers of hope’ and the critical role the Board will have in creating hope for the staff and public we serve.
Martin Barkley, CEO for Mid Yorkshire Hospitals NHS Trust gave board members an overview on the work of WYAAT (hospitals working together) programmes of work, including estates, buildings and workforce; Robin Tuddenham, CEO for Calderdale Council spoke about the importance of the Partnership in terms of tackling health inequalities, the importance of children and young people work and the emotional wellbeing of communities.
Health inequalities are a key driver for us all and this was clear in Sara Munro’s explanation of the WY&H Mental Health and Learning Disability Collaborative work, including prenatal work with women, eating disorders; and supporting adults, the fact that people with learning disabilities often have shorter lives and the importance of supporting adults, children and young people closer to home.
Nichola Esmond, CEO for Wakefield Healthwatch talked about the ongoing challenge to make sure messages reach people and the need to thoughtfully engage with communities to ensure people’s voices are in the room.
Having elected members in the room alongside other leaders and colleagues was the start of something meaningful – a Partnership Board we can all be proud of and make a real positive difference to all those we collectively serve. Having a Board that people across our areas can both observe and feed into was deemed as essential and a key part of our principles to be honest, open and transparent.
Mental health
Leeds Community Healthcare NHS Trust has been awarded a four-year contract by the Office of the Police and Crime Commissioner (PCC) West Yorkshire, acting on behalf of regional PPC’s across Yorkshire and the Humber, to deliver regional healthcare and forensic services in Police Custody settings across Yorkshire and Humberside. Following a competitive tender process, the Trust has been awarded a contract to provide a newly integrated and transformed service that supports and cares for people within Police custody settings. The Trust’s Police Custody Healthcare Team provides; physical assessment and treatment, substance misuse assessment and treatment, mental health assessments and assess fitness for people to be interviewed and/or detained. The team also take forensic samples and undertake blood screening for alcohol and drug levels. You can find out more here.
Supporting people with learning disabilities
The National Transforming Care Programme (TCP), the Government and health and social care organisations are working on transforming care for people with learning disabilities and/or autism, and in particularly those who also have a mental health illness.
Transforming care is all about improving health and care services so that more people can live in the community, with the right support, and close to home.
There are three TCP partnerships in West Yorkshire including Barnsley. These TCPs, underpinned by the Winterbourne Review, have a common objective to improve the community response to prevent people going into hospital wherever possible. This includes reducing admissions to hospital unless needed and the length of time people stay there. It is also about making sure people don’t spend time in hospital hundreds of miles from their home – which can be distressing and difficult for family, carers and friends to visit.
A proposal has been agreed in principle to establish one TCP board for West Yorkshire and Harrogate from April 2019. This will be chaired by Helen Hirst, Chief Officer for Bradford District and Craven Clinical Commissioning Groups, who is also the WY&H HCP commissioning lead for mental health, learning disabilities and autism. The TCP Board will report into the Mental Health, Learning Disability and Autism Collaborative Programme Board.
Our ambition is for anyone with a learning disability and/or autism living in West Yorkshire and Harrogate to have the right to the same opportunities as everyone else so they can live a long and healthy life and be treated with dignity and respect. It is also important that people can develop and maintain relationships and to have a place they call home within their community.
Over the coming months we will be looking at the way in which care is provided across the three assessment and treatment units (ATUs) and how as a region we make the best collective use of our services. There are currently 22 specialist hospital beds in West Yorkshire. We need to look at reducing this number of beds, so that we can support people with learning disabilities and acute complex needs/challenging behaviour in their local community.
Engagement activity for this work will be delivered over a 4 week period (started 18 February 2019). The engagement is an essential part of our process and is part of a planned approach to seek the views of people who access services, carers, families, staff and key stakeholders who have experiences of ATUs across West Yorkshire to further to inform the next stage of our work which will be how to reconfigure ATU provision in the region to ensure maximum benefit for both people who use these services and the system.
National meeting for Partnership leads
On Wednesday, Rob Webster, our Partnership CEO and Robin Tuddenham, CEO for Calderdale Council, attended the national Partnership lead meeting on Wednesday (also known as Sustainable Transformation Partnerships and Integrated Care Systems). Rob and Robin presented on the importance of what makes collaboration between NHS and local government so essential.