This week's leadership messages come from Ashley Moore, Becca Spavin, Pat Keane and Keith Wilson

Posted on: 19 November 2021

This week’s leadership message comes from Ashley Moore, Partnership Programme Director for Ageing Well and Becca Spavin, Programme Lead for Kirklees Urgent Community Response. This week’s blog comes from Pat Keane, Senior Responsible Officer for the Urgent and Emergency Care Programme and Keith Wilson, Programme Director. They share how the partnership are preparing for winter and the work happening to help support.

Ashley Moore Hello everyone, my name is Ashley.

I am part of the Partnership Programme Team, where I work on transforming community health services for adults, with a specific focus on improving services and outcomes for older people.

I spent the first half of my career working for national organisations, but my eyes were opened to where real change happens when I was fortunate to be part of the ‘Five Year Forward View’ which set out a future for new models of integrated population-health based care. This took me outside the walls of NHS England and enabled me to work directly with local organisations in Wakefield, and in Bradford district and Craven. It’s here where I gained a huge appreciation for both the complexities and breadth of joined up care but also the knowledge and skills, drive and passion of teams working to transform quality, outcomes, and experience for those we serve.

The longer I spent working closely with colleagues in Wakefield and Bradford district and Craven, the more I was struck by the levels of energy and enthusiasm, and the strength of partnerships across the NHS, local councils, and the voluntary community social enterprise sector. But I also became increasingly aware that often the legislation, national frameworks and funding in which organisations and teams were operating at the time perversely seemed to work against the spirit of integrated care.

Being part of local initiatives demonstrated clearly to me there was a way to genuinely transform and bring together services, based around the needs of local communities, and where care was more proactive, preventative and personalised. It needed the national legislation and policies to catch-up. When the NHS Long Term Plan was published in 2019, the vision for integrated care systems completely resonated with me. As a West Yorkshire lad born and bred, it’s the opportunities we have in the Partnership to deliver more care at home and close to home, investing in joining up services that are co-produced with local communities, that really excites me. Therefore, I count myself as very privileged to now be part of the journey of the West Yorkshire Health and Care Partnership, though I joined at the start of the pandemic, so I’ve not yet been able to meet many colleagues in person! My role is to support development of models of care that help people to age well, and the specific contribution of community health services within that. As with all the programmes at the West Yorkshire level, it is though very much on based on a principle of ‘team of teams’ and guided by our ‘three tests’.

With all this in mind, for me it is how the developments at the West Yorkshire level encompass and help connect all that we do across the Partnership that informs our approach to ‘ageing well’. So much of the credit in this blog really should go to the teams leading the integration locally, through the Bradford and district and Craven ‘Act as One’ Programme, Calderdale Cares and the work of Calderdale Collaborative Community Partnership Board, Kirklees’s Ageing Well Programme, Leeds’s Population Board and Partnership for Frailty, and Connecting Care in Wakefield. One of the regular highlights of my role is when I am part of those place discussions and how that helps continually shape and evolve how we progress together across West Yorkshire, whether that is how we can best improve outcomes and reduce health inequalities for older people, work collectively on addressing common issues within community health services, or by forging more integrated ways of working around local populations through primary care networks.

To put this in a more practical context and illustrate with a specific example, I am delighted to be sharing this message with Becca Spavin, who is part of the Kirklees Provider Alliance, one of seven national accelerator sites developing a new model of urgent community response. The development of the Kirklees Urgent Response Service, which is now being mirrored with similar approaches across West Yorkshire, reflects how working together across organisations, around a shared ambition to keep people well in their own homes, both benefits patients and our wider population, fosters multi-professional team working, and strengthens the values of cooperation and collaboration at the heart of integration.

Integrating care can often feel complex, with a vast array of interconnectedness between different sectors, services and teams, almost like the biggest ‘dot to dot’ puzzle you can imagine. But I draw energy and strength from the true sense of team that is palpable when working with my colleagues in the five places, and with my peers leading other programmes at the system level. I am motivated by how the arrangements being developed for next year can both continue and significantly enhance the journey the Partnership has been on since its inception, and whilst connecting via MS Teams has been a revelation to me during the pandemic, I do hope one day to be able to finally meet more of my colleagues for a cuppa. I’ll put the kettle on!

Have a great weekend

Ashley

Becca Spavin - "one of the keys to rolling out 2-hour crisis response at scale is collaboratively produced pathways that improve patient journeys" Hello, my name is Becca, and I am part of the Kirklees Provider Alliance that has been working together since last year to establish a new and innovative model for urgent community response.

The development of urgent community response (UCR) was one of the national ambitions set out in the NHS Long Term Plan to boost ‘out-of-hospital’ care, through increasing capacity and responsiveness of community and intermediate care services, so that more people experiencing a health or care crisis could be cared for at home, reducing the need for emergency admissions to hospital. As in other parts of West Yorkshire, we had in Kirklees existing community services and social care teams that provided rapid support to keep people well in their own homes and in care homes, but the development of UCR has enabled us to significantly enhance and connect together how those teams work, and how this integrates more widely with primary care, secondary care and the ambulance service. Our urgent response teams give those who need it fast access to a range of qualified professionals who can address both their health and social care needs and deliver a crisis response within two hours and reablement care within two days.

A key part of the delivery of the national UCR priority was to first test the model with a number of different pilots or ‘accelerator sites’ across England, ahead of wider national-rollout, and in 2019 Kirklees was selected as the accelerator for the North-East and Yorkshire Region – which was a fantastic honour and opportunity.

In Kirklees the service we wanted to pilot was a clinical model that could provide short term input to recover from an ‘acute episode’ within the community, therefore avoiding a hospital admission or where input for a short-term intervention could reduce the length of their hospital stay. This included how teams from different professions and organisations can work together in a more integrated way that wraps proactive urgent care around patients, and in how referrals to crisis services can be more streamlined, with a single point of access. A further aim of being an accelerator was to build and develop an emerging alliance of health and social care providers willing to work together to create efficiencies in health and social care delivery for the benefit of Kirklees residents. So, in effect, UCR was both a way of creating a more joined-up integrated model of urgent care and in parallel continue to support our local approach to partnership working and collaborative service design across our Alliance.

We commenced our accelerator programme early in 2020, but at a time when the country was also experiencing the first wave of the pandemic, and it is testament to the commitment of colleagues within our Alliance that we were able continue developing the service despite these wider external challenges. Rather than stop the pilot, we adopted a phased approach to the service mobilisation based on ‘plan, do, study, act’ (PDSA) cycle, learning and improving as changes were implemented.

The new service was launched in November 2020, and over the past year we have gradually refined how it works following an on-going PDSA approach. Since the launch we have:

Expanded the service criteria from frail to all age adults,
Increased the number of referral routes into the service,
Amended service capacity based on actual demand modelling to show real opportunity for UCR around admission avoidance into hospital,
Created a ‘one stop shop’ pathway for referrals into the service from road paramedics,
Managed through a lot of effort and tenacity to (eventually) get all the UCR providers to submit to the community services data set, which will further help demonstrate the impact the service is making and
Have evolved from a five day to seven-day service.

Not everyone wants to be bombarded with stats – so the headlines from the first year of the Kirklees UCR service are:

There have been over 3200 calls into the hub
Over 600 calls were managed virtually by the triage hub via remote consultation, production of a script or advice
Over 1400 face to face 0-2hr visits have been undertaken
81% of people seen by the Kirklees UCR team have not had an A&E attendance or an emergency admission within 2 days of a visit.

There is still plenty to do to develop the service further –particularly around further integration and efficiencies and to drive up referrals from 111 and 999. That said, it is important to recognise the efforts already made and successes to date. Getting positive feedback from our care homes in Kirklees has been a real morale booster for the UCR Provider Alliance and staff. One family member got in touch to tell us “The response from the UCR team on Friday was amazing – my grandma had a chest infection and district nurses are going to do bloods, but she is so much brighter over the weekend and was singing and playing the piano yesterday – like a completely different person They have certainly prevented a hospital admission and carer breakdown”. The best bit about this feedback is that it helps us know we are doing what we set out to do. It has not been an easy time for any colleagues across health or care over the past couple of years, but knowing we have been a small part of supporting improved outcomes for our residents is wonderful.

Have a good weekend everyone

Becca

Blog: Preparing for winter 2021

Keith Wilson Pat Keane Hello, our names are Pat and Keith.

Last week the Partnership published an open letter asking for support as we head into what is likely to be the busiest and most challenging winter the sector has faced. At the current time we are seeing pressures across the entire system and this is only likely to increase as we move further into the winter period. Calls to our 999 service in September 2021 compared to September 2019 had increased by 26.5% and overall demand pressures on NHS 111 in Yorkshire and Humber is currently 28% above initial forecasts. All of our emergency departments have reported increases in attendances above pre-covid levels. Indeed, all our health and care services are seeing unprecedented increases in the number of people needing help. This means most of our services are dealing with a huge increase in the numbers of people accessing care whilst operating with significant staff shortages. COVID-19 infection rates across our area remain high with significant numbers of people requiring hospital treatment. This winter, flu and respiratory illness are back with us and are likely to be extremely infectious after last year’s lockdown as our immunity will be much lower.

Planning for winter is something we have been doing for many years, with A&E Delivery Boards taking a key lead on developing winter plans which tie together all of the key strands of work and knitting together plans which focus on any learning from previous years. For all of our places this started in the summer and in recent weeks local plans have been produced to demonstrate how prepared we are and underpinned by resilience planning which takes place 365 days of the year.

We have robust multi-agency command and control structures and processes, devised at place and locally managed. ICS level collaboration and partnership working across all programmes is strong and continues to support the integration journey at place. System assurance has been undertaken and is evident from the plans, exercises and continued engagement. Live system assurance is taking place throughout the whole week and driven through up-to-date and robust data. Robust whole system escalation processes are in place with a proactive approach to ensure we keep our population safe. Throughout the winter we will continue to develop initiatives to support winter pressures, using additional funding for primary care, mental health service, our ambulance and NHS 111 service. We have also allocated an additional £11 million to our places and A&E Delivery Boards have been identifying their priorities areas to utilise these funds.

Our urgent and emergency care programme has worked hard since COVID-19 appeared and has developed a West Yorkshire clinical hub with Local Care Direct who also provide our Primary Care out of hours service. This means that some callers who contact NHS 111 are referred to the clinical hub, where local clinicians speak to the callers and work out how best to meet their needs. The main group of callers we first identified were people who were identified by NHS 111 as needing to have contact with primary care within 1 or 2 hours. For a significant number of these people when they have been in contact with our clinical hub their needs have been met and the majority of people have not needed to be referred on to other services. T

his winter we have begun to pilot users of NHS 111 online who have been recommended to attend an Emergency Department. In week one of our recent pilot in Leeds and Wakefield, 111 patients were contacted in the first week and 81% of these were redirected to other services which could better meet their needs and therefore help reduce the number of people attending our emergency departments.

A collaborative campaign will also run across West Yorkshire this winter. “Together We Can” will be a joined-up communications approach to help to alleviate the impact of additional demand being placed on services over the winter period. It will also allow us to continue to have an honest conversation with the public and help us to manage expectations, whilst equipping people with the knowledge they need to choose the most suitable health service for their needs. The campaign will help us to promote messaging around togetherness, collective responsibility to all ‘choose well’, and empowerment to self-care when appropriate for example. The campaign will also compliment national messages such as the uptake of vaccinations, using online services wherever possible and winter well messages.

The partnership working at place and at West Yorkshire level is built on solid fountains and our close working with partners and communities has never more important in the months to come. It is by working together as a strong partnership that we will tackle the current challenges we are facing, just as we did in delivering a response to the pandemic.

We want to thank our colleagues and volunteers who continue to work hard during the busiest time on record and to everyone living across West Yorkshire for your patience and kindness.

Pat and Keith

Anti-Racism Movement letter to supporters

Thank you for standing in solidarity with your colleagues. Racism is more than what you see. Let's root it out. On Thursday, Rob Webster our CEO, Cllr Tim Swift, Chair of our Partnership Board, Jackie Marsh, Chief Superintendent, Director of the West Yorkshire Violence Reduction Unit and Fatima Khan-Shah, Partnership Programme Director for Unpaid Carers and Personalised Care and Convener for the Partnership’s Race Equality Network wrote to over 580 organisations / community allies supporting our anti-racism movement. They thanked supporters for being part of the movement. Over the last few days, we have been reminded of the very clear need for movements like ours. Many of you will have seen the powerful testimony by Azeem Rafiq in Parliament on Tuesday 16 November and the high-profile media coverage around racism in sport and wider society. We would like to thank Azeem for his courage and his determination in speaking up. Not everyone in every organisation has the opportunity to be heard. One of the benefits of a movement like ours is that we can help to address issues of racism in our actions and in terms of the support that we offer to others. Critically, we can create the safe spaces for people to speak up. This might include promoting the free resources and racial equality training that we’ve made available on the Partnership’s website so that more people can access these at a time when there is much greater interest in the issue. You can read the letter to supporters here.

Planet Earth was blue

A collage of images representing World Diabetes Day images posted on social media Even the sky was blue for last Sunday’s World Diabetes Day where we saw partnership colleagues across the region and beyond shine a light on the diabetes community across the globe and get behind our Let’s DiaBEAT this campaign. People showed their support in so many ways from exercising in blue, getting in touch with friends and family affected by diabetes, changing their profile pics, spreading the word on social media and painting nails blue as part of Diabetes UK’s nailing diabetes initiative.

We had some terrific engagement and great coverage in the Yorkshire Post of John Ebo’s journey through the NHS Diabetes Prevention programme. If you haven’t already, check out Adele Graham, our Diabetes Programme Manager’s, blog in last week’s weekly update and please do continue to share and promote the video where we’ve animated Dr Waqas Tahir, our Clinical Diabetes Lead.

World Diabetes Day, the world’s biggest diabetes awareness campaign, was set up in response to the growing health threat posed by diabetes. By encouraging health care and other organisations to come together it aims to help people with diabetes feel more seen and heard.

World Antimicrobial Awareness Week

"Take antibiotics exactly as prescribed, never save them for later, never share them with others. Become an antibiotic guardian." World Antimicrobial Awareness Week is celebrated from 18th-24th November every year. This year's theme is Spread Awareness, Stop Resistance. Throughout World Antimicrobial Awareness Week, the West Yorkshire Research and Development team, in partnership with the medicines optimisation teams across the West Yorkshire CCGs, will be marking the week by sharing resources, blog posts and research papers related to antimicrobial resistance.

Blogs will be shared daily on the West Yorkshire Research and Development team website throughout World Antimicrobial Awareness Week: https://www.westyorksrd.nhs.uk/blog. You can also follow @nhswyrd to access research papers and resources. research@bradford.nhs.uk

Red Kite View

The latest issue of the Leeds and York Partnership NHS Foundation Trust newsletter reports exciting progress at Red Kite View, the futuristic in-patient unit for the Children and Young People’s Mental Health Service, and the moving-in plans set for early in the New Year.

Non-stop work has been underway to ensure the bedrooms and therapy rooms, curtains and carpets, beds and desks, kitchens, and classrooms, will all be ready. There’s a lot to read in this newsletter – please encourage anyone you know who would find it useful to subscribe at communications.lypft@nhs.net particularly for the bumper ‘Special’ edition in early January.

Adversity, trauma, and serious violence

Adversity trauma and resilience report front cover Three reports were published on Monday 15 November which aim to help tackle the root causes of adversity, trauma, and serious violence across West Yorkshire. Commissioned by the West Yorkshire Violence Reduction Unit (VRU) and our Partnership, they include.

Addressing the root causes of serious violence and exploitation of young people in West Yorkshire: Summary of key findings and recommendations: June 2021, CREST
Adversity Trauma and Resilience in West Yorkshire – a review of life-course evidence, approaches, and provision to support the transformation to a trauma informed health and care system by 2030: September 2021, Mark Crowe, Jim Devereaux and Molly Jobson on behalf of Humankind
Violence Against Women and Girls: A literature review, September 2021, Megan Bennett.

The reports have a specific focus on inequality, as well as women and girls. Each will underpin our future partnership strategy for a ‘trauma informed’ response. This approach offers an awareness of the effects of trauma, placing it at the forefront of support. You can read more on the West Yorkshire Combined Authority website.

Dad Pad - the essential guide to new dads

It’s Movember and we’re thinking about all aspects of men’s mental health – including that of new dads and dads-to-be. The latest report from DadPad for West Yorkshire is available to download here, showing the top five topics that dads have been interested in the last quarter. There’s also a report on new technical features on the app and some great ideas for 10 ways to engage, 10 reasons to engage and 10 best practices to engage dads. Please can you support this project and encourage downloads.

The app is free until April 2023. Watch this short video to hear what a new dad and a support worker have to say about DadPad.

Alcohol Awareness Week

This week is #AlcoholAwarenessWeek, which is all about the link between alcohol and relationships. Visit the Alcohol Change UK website for resource and more information.

Urgent and emergency care programme update

The urgent and emergency care (UEC) programme board met on 16th November. Based on conversation at the October Board members heard there had been a rapid review of the UEC delivery programme priority areas to focus on transformational work which could have the best outcomes in reducing system pressures during winter. The pre-hospital focus will be on increased clinical assessment for NHS111 calls; NHS 111 online clinical validation where users have been recommended to attend an emergency department, ambulance clinician access to Urgent Community Response services and a consistent approach to communication messages across West Yorkshire during winter.

The in-hospital main focus will be on access to Same Day Emergency Care and are working on a set of principles for our system. The safer transfer of care workstream will focus on supporting operational delivery of mandatory discharge priorities during winter and will come together in spring 2022 to review transformation priorities. The meeting was focused on the whole system approach to winter planning. The Board discussed the system responses available when the whole system is operating under a level of pressure which is beyond our current winter plan and where we would want to secure an appropriate and proportionate regulatory response to any exceptional actions from NHSE/I and CQC.

The plan will be discussed and ratified at the West Yorkshire System Oversight and Assurance Group on 22nd November. Representatives from our A&E Delivery Boards presented their draft plans for utilising urgent and emergency care monies for the second half of the year and how this is intertwined with plans to utilise the primary care winter access fund and mental health monies. There were similar themes across the presentations given in terms of alignment to the national 10-point plan on urgent and emergency care service recovery requirements and how they will use the money to meet local needs and gaps in provision. It was highlighted that workforce pressures remain key. The Board also supported proposals for a collaborative campaign that will run across West Yorkshire this winter. Together We Can will be a joined-up communications approach to help to alleviate the impact of additional demand being placed on services over the winter period.

HSJ Awards

HSJ Awards 2021 - presenter Sue Perkins with Heather McKnight, Sarah Smith, Sayma Mirza, Karen Coleman, Mary Jo Pearson and Kez Hayat West Yorkshire Health and Care Partnership was named 'Integrated Care System of the Year' at the 2021 HSJ Awards on Thursday evening.

Our Partnership was shortlisted for five awards in total, including Staff Engagement, the 'Connecting Services and Information Award', System-Led Carers Support (for which we were highly commended), and NHS Race Equality.

The awards recognise outstanding contribution to healthcare – in what has been an exceptional and challenging period across the sector. Despite the demanding circumstances of the past 18 months, over 1000 entries were received for this year’s HSJ Awards, with 205 organisations, projects and people making it to the final shortlist. Across the area, many organisations were shortlisted for a range of awards, including the Airedale Digital Care Hub which has become an invaluable resource to Bradford District and Craven (BDC) Integrated Care Partnership (ICP) for Digitising Patient Services Initiative.

Bradford Teaching Hospitals NHS Trust was short-listed for three awards including for Patient Safety and Acute Sector Innovation of the Year. Calderdale and Huddersfield NHS Foundation Trust were shortlisted twice; for 'Acute Sector Innovation of the Year' for Transforming Outpatient Care and 'Digitising Patient Services Initiative' for Transforming Outpatient Care. Congratulations also to Leeds Shielding Support Programme who were shortlisted for the Partnership with Local Government Award and were highly commended and to Leeds Teaching Hospitals NHS Trust, shortlisted for the Environmental Sustainability Award. Leeds Children's Hospital and DigiBete CIC, DigiBete Diabetes App for Children and Young People were also shortlisted.

Great to have recognition for the work of the partnership, leadership, colleagues and communities.