Today’s leadership message is from Sayma Mirza

Today’s leadership message is from Sayma Mirza, Interim Director of Nursing and Quality, NHS West Yorkshire Integrated Care Board (ICB).

Hello, my name is Sayma.

High quality palliative and end-of-life care matters. This is because it protects something profoundly human; the right to comfort, dignity and meaning at one of the most vulnerable stages of life. It is not only about the clinical interventions delivered, but also about how we safeguard the way people live until they die. While this can be an emotive area of discussion, real improvement will only be realised when we collectively strive for better access, choice and equity of care. Not just at the end-of-life, but throughout someone’s journey of living with a life‑limiting illness.

I have had the privilege of leading the transformation of paediatric palliative and end-of-life care services across West Yorkshire, in partnership with colleagues across the NHS, local authorities and the voluntary and community sector. Together, we have shifted from a reactive model to one rooted in strategic planning, which is informed through data, evidence and locally held insight. The strength of partnership working, combined with the voice of our communities, has provided the traction needed to genuinely shift the dial. This is something I am immensely proud of, because it means we have the opportunity to reduce health inequalities whilst delivering better outcomes for the people of West Yorkshire.

The evolution of the ICB’s role into that of a strategic commissioner has been timely. It has enabled a structured, sustainable approach to commissioning palliative and end-of-life care services. As we work towards our ambition of achieving 100% fully commissioned services by 2030, the progress made over the last year has positioned us strongly to meet both national standards and local need. And as we anticipate the development of a national Modern Service Framework for palliative and end-of-life care, alongside the emerging neighbourhood health models of care, we are not standing still. We are addressing needs now while preparing for the future.

So how have we done it?

We have applied the NHS strategic commissioning cycle and national policy frameworks to understand local context, develop a long‑term population health strategy, and work towards delivery of the strategy through payer functions and resource allocation, and establishment of oversight processes that support evaluation, value‑based resource use and improved outcomes.

In partnership with key stakeholders, this has included a comprehensive health needs assessment for West Yorkshire, a Healthwatch report capturing community insights and people’s experiences of end-of-life care in West Yorkshire. We have also mapped existing palliative and end-of-life care provision, and undertaken analysis of activity over the last three years. The themes emerging from this work have directly shaped our commissioning intentions, from how we use data to drive oversight and investment, to improving access to out of hours services, strengthening workforce development and enhancing service co-ordination.

Our collaboration with the West Yorkshire Hospice Collaborative has been pivotal. Agreeing comparable hospice tariffs means a move away from grant based agreements to enabling progress towards sustainable commissioning arrangements. This supports our ambition of having services that help to identify palliative patients in the last twelve months of life, reduce avoidable hospital admissions and length of stay, lower non-elective activity, and increase patient choice including preferred place of death. The strategic approach we have taken has informed the design of a comprehensive strategic commissioning plan.

In addition to the work described, last year the ICB also funded a series of tester projects to improve paediatric palliative and end-of-life care and an ‘out of hours advice and guidance’ pilot led by our children’s hospices. These projects have helped us build a clearer picture of current provision, identify gaps, and understand where investment will have the greatest impact. Priorities have included strengthening out of hours community nursing, expanding home‑based care, increasing access to specialist paediatric palliative support and ensuring equity of provision.

Some feedback from a family at the time included: “All went really well, kept my daughter out of hospital, gave her antibiotics at the right time and was treated quickly so kept her out of hospital. The family were able to go on holiday together, so it was a huge help.”

Following the tester projects, we are now actively working on plans to commission an out-of-hours: single point of access advice and guidance service that includes a call‑out offer. This will mean that, irrespective of being registered with a children’s hospice or not, all babies, children, young people and their families in West Yorkshire will be able to access specialist support out-of-hours, with community visits available when needed.

We anticipate this will reduce avoidable hospital admissions, improve access to services including care closer to home, and increase patient choice in how and where families receive support. It will also ensure more effective use of resources and strengthen access to specialist paediatric palliative care.

I often talk about the power of a shared ambition, strong leadership commitment and a relentless focus on improving services for local communities - well this is exactly what that looks like in practice. In West Yorkshire, we have a saying: “We don’t just stand around admiring a problem, we do something about it.”

I hope this leadership message demonstrates exactly what we have done, and continue to do, to improve palliative and end-of‑life care for the people of West Yorkshire.

Thank you for reading

Sayma