Posted on: 5 May 2022
Hello, my name is Carol
Over the last few months, I’ve told many people that in January this year I hit the milestone of 30 years’ NHS service. The same month also marked 22 years since I started work in Kirklees – for the Huddersfield Central Primary Care Group to be exact. In January 2000 when I began work in Kirklees, society was breathing a sigh of relief that our worst fears about the Millennium Bug had not come to pass and we could sail into the new decade with our information systems intact. In writing this, I realise that many of our younger colleagues may have to reach to Google to find out what the Millennium Bug was, which only illustrates further how long I have been on the patch!
Apart from the fact that 30 years’ service is a decent achievement by anyone’s standards, the main reason I have been in reflective mood recently is that once again we find ourselves in the throes of organisational change. Looking back over my years in the NHS and in Kirklees I realised that I have been through approximately eight such reorganisations, generally going from smaller to larger organisations and back again. Most significantly, when I joined the NHS in 1992, the internal market was the new show in town, and the ‘commissioner provider split’ was seen as the answer to the challenges we faced. Several decades on, it finally feels like we are bringing this period to a close, and that our experiences over the last couple of years have demonstrated once and for all that it is collaboration, not competition that yields results.
Since September 2021, I have had the privilege of undertaking the role of senior responsible officer for the West Yorkshire COVID-19 vaccination programme and this spirit of collaboration has been instrumental to our success.
In Kirklees, we considered the evaluation of our Community Champions Programme recently. Community Champions in Kirklees have worked to promote COVID safety and increase vaccine uptake within identified communities – Black African Caribbean, South Asian, other ethnic communities, unpaid carers, living with a disability. Over a six-month period last year, they held over 20,000 conversations with local people, connected with 58 voluntary organisations, and undoubtedly contributed to increases in vaccine uptake in some of our most deprived and ethnically diverse communities. Many of the learning points described – the importance of trust, being flexible and adaptable, building strong relationships – are fundamental to effective collaboration.
However, back to the subject of organisational change.
As ever, any change is complicated. During our NHS careers, most of us have only ever worked in the internal market environment. Moving from old habits and thought processes takes time and we need to constantly challenge ourselves. Like several of my colleagues, I have spent many hours in the last year or so discussing how this new world will look, how things will work and how it will differ from our current organisations – and most importantly for local people. It’s important to stress that in Kirklees many of the characteristics of a place-based partnership are already present and this feels like evolutionary, not revolutionary change as we approach the 1 July. Nonetheless, there is a question I have been asked several times – by colleagues, partners, and patient representatives – and that question is ‘so who is the commissioner?’.
It's a great question, and the more frequently it is asked, the more I think about what lies behind it. I often think that what I am really being asked is ‘who is in charge?’ or ‘who will make the difficult decisions when we don’t have consensus?’
Over time, it feels like our view of commissioning has become increasingly aligned to the notion of a single organisation – a clinical commissioning group or a council for example - who has this as their job. I think that what is important to return to is the idea of commissioning as a set of processes – needs assessment, delivering services to meet these needs, continuous quality improvement based on evidence and experience, whilst ensuring best value for money. All these elements should be everyone’s business, not just the remit of the person with a particular name badge. That is one of the strengths of integrated care systems (ICS) and place-based partnerships – we all take shared responsibility for the decisions we make collectively, creating the conditions for mutual accountability and building an environment where we can tackle the difficult questions together. So, whenever anyone asks me the question ‘who is the commissioner?’ my answer is ‘we all are’.
To operate effectively in this new environment will require high levels of trust, openness, and transparency. Of course, there will still be contracts and memorandum of understanding between organisations, however we can expect to see these agreements being used more as enablers, for example to support the objectives of provider collaboratives and alliances both in the ICS and our places. Likewise, a collaborative way of working does not mean we lose the need for good governance, of which I am a strong advocate. Getting the governance right means we do business in the right way, we make decisions openly and transparently, and by doing so we build trust across our systems.
In Kirklees, we held first shadow meeting of our integrated care board committee in mid-April. After all the months of hard work to bring together our new place-place based partnership, it was fantastic to see everyone together in the new committee. Kirklees is a very diverse place, made up of many care providers, and it was clear to me when we met that there is a strong commitment to working together for the benefit of our residents. We spent some time getting to know each other and understanding our new environment. We also heard some sobering messages about the health inequalities faced by local people and the very real risk that these are worsening because of the current cost of living increases and other economic factors. We know that there are huge challenges ahead, but one thing was clear – our population will remain at the centre of all we do, and we will hold onto this as we move forward. Oh, and I am very pleased to report that no one asked who would be doing the commissioning!
Have a good weekend
Carol
Mental Health Awareness Week
Dr Sara Munro, CEO for Leeds and York Partnership NHS Foundation Trust and CEO Lead for our Mental Health, Learning Disabilities and Autism (MHLDA) Partnership, and Keir Shillaker, Programme Director, MHLDA, share their thoughts ahead of Mental Health Awareness Week.
Next week (9 -15 May) is Mental Health Awareness Week and we are thinking about everyone who works in the West Yorkshire mental health system, as well as the people they care for.
The health and care system has been under unprecedented pressure for the past two years and we all continue to work in challenging circumstances, particularly as Covid-19 is still with us. The mental health system is responding to changing patterns of need, making the most of the available resources and taking action to address workforce challenges. This covers the short-term (going live with a Collaborative Bank for the NHS Mental Health Trusts and hosting interviews at our virtual recruitment fair), the medium term (developing new roles and promoting diversity in the workforce) and the longer term (working with schools and organisations such as The Princes’s Trust to raise awareness of mental health careers). Our voluntary, community and social enterprise sector (VCSE) has been delivering services in communities including counselling, helplines, activities, and support groups – all enabling people with mental health issues to maintain or improve their mental health and wellbeing.
An exciting development in our programme is the appointment of a Public Health Consultant, bringing a new and important skillset to our team, particularly in the drive to reduce inequality and respond to future demand. The commitment to this role highlights the importance of our providers of services supporting the prevention of ill-health, something we work closely with our Improving Population Health colleagues on. Another key part of our work in 2022-2023 is an all-age neurodiversity (Autism and ADHD) deep dive across West Yorkshire, which will work with people with lived experience and our partners across all sectors to understand what service provision is really like and where there are opportunities to work together to improve things for the future.
The theme for this year’s Mental Health Awareness Week is loneliness. We know that the isolation that many people have experienced during the pandemic has had a huge impact on physical and mental health. Our connection to other people and our community is fundamental to protecting our mental health and this applies just as much to our colleagues as to the people they serve. Our Partnership understands the need, and our campaigns include Looking after our neighbours – now in its third year – and its offspring Looking out for each other and a new campaign in development which extends the Check-In concept to the wider public, specifically men, through projects such as Offload with Featherstone Rangers. Our VCSE sector is enabling social connection in communities through groups such as Battle Scars , Leeds Mind and the Words in Mind programme in Kirklees -to name just a few.
We also recognise how difficult it can be for people who work in the caring professions to reach out and seek help for themselves, and there is great work going on across the Partnership, for example the Men’s Group at Leeds Teaching Hospitals offers a safe space for men to bring their feelings, concerns and challenges. The staff Check-In campaign reached almost 200 organisations in West Yorkshire and beyond, providing a direction and support for our people during the depths of the lockdown period.
The West Yorkshire People Plan recognises that to deliver high quality health and care to our population, our top priority is “to ensure we look after, value and develop our workforce.” In other words, people can and should expect support for their mental health and wellbeing from their line manager and their organisation. Looking After Our People is a core pillar of our plan and the Staff Mental Health and Wellbeing Hub has a key role in nurturing, enabling, supporting and delivering staff wellbeing, as well as treating people who need clinical interventions to help them recover their mental health.
The Hub has helped more than 850 people since it opened in January 2021 and today offers a range of free, confidential support for everyone who works or volunteers in the West Yorkshire health and care system.
We urge everyone to take a mental health check next week, use the support available and #bekind to yourself, just as you are to the people you care for.
Have a good weekend all
Sara and Keir
The Joint Committee of Clinical Commissioning Groups
The Joint Committee met on Tuesday the 3 May. It was chaired by independent lay member Marie Burnham. You can read the papers and watch the live stream here. The Committee has delegated powers from individual CCGs (Bradford District and Craven; Calderdale, Kirklees, Leeds, and Wakefield) to make collective decisions around specific work programmes, for example mental health, planned care, urgent care, and cancer. The meeting on Tuesday discussed the harmonisation of 19 commissioning policies across West Yorkshire.
As part of the transition process from CCGs to the integrated care board (ICB) as the statutory body, it is necessary to ensure that commissioning policies and clinical thresholds are harmonised across our five West Yorkshire Places. Some of this work has already been undertaken as part of the Improving Planned Care Programme of work, including the national Evidence Based Interventions Programme, over the past five years.
System Leadership Executive Group
The System Leadership Executive Group met on Tuesday. The meeting was chaired by Rob Webster, our CEO-Designate for the Partnership. Updates from the hospital discharge working group, funding to tackle health inequalities, support for working carers and NHS planning were all discussed.
Partnership’s Clinical Forum
The Clinical Forum met virtually on Tuesday. The meeting was chaired by Dr James Thomas, our Medical Director-Designate for the West Yorkshire Integrated Care Board. Forum members include medical directors, GPs, pharmacists, allied health professionals, lead nurses and NHS E colleagues. Forum members discussed a coproduced set of principles for resourcing clinical and professional leadership across our Partnership. Members also discussed targeted approaches to addressing health inequalities and support for people leaving hospital (discharge).
Trauma informed
Thank you to over 600 people who joined our second annual Adversity, Trauma and Resilience Knowledge Exchange in partnership with the West Yorkshire Violence Reduction Unit last week. With a focus on prevention, early intervention, and mitigating harm from preconceptions throughout life, the event showcased the work that is taking place across our system. Throughout the three-day event attendees took part on a journey from theory to practice, joined workshops and Q&A sessions and heard reports on the progress towards reaching our collective ambition as well as early findings from our research, evaluation, and development of resources. For more information see the Adversity, Trauma and Resilience Annual Knowledge Exchange website. Copies of the presentations and other resources are available on the Partnership’s Knowledge Exchange pages
Digital Programme
The Digital Programme team hosted a GP Online Consultation re-procurement workshop on the 26 April. Having secured the extension of current arrangements for 2022/2023, the workshop was part of a range of activities towards procuring a combined digital solution which includes online consultation, video, and SMS capabilities for April 2023 onwards. The team were looking for initial expressions of interest and feedback from clinical and non-clinical colleagues from GP practices and primary care networks to be involved in the procurement process.
The Yorkshire & Humber Academic Health Science Network (AHSN) is working with Kirklees Clinical Commissioning Group and Kirklees Council to introduce the award winning TytoCare into several care homes in the area.
The hand-held device and app that connects with a patient’s clinician for an on-demand assessment, diagnosis, and prescription is now being used in the first of these care homes, allowing more residents to be assessed without the need to leave their home.
New provider for diabetes prevention
Ingeus has been awarded the contract to run the NHS Diabetes Prevention Programme (NDPP) in West Yorkshire for the next three years. This follows a procurement exercise led by NHS England and in which the Partnership was involved. The contract will start from 1 August 2022 when the current one ends. The Diabetes Programme Team will work closely with clinical commissioning groups and GP practices as well as the current and new provider to ensure a smooth transition. There should be no change for patients. For more information, please contact Adele.
International Day of the Midwife
Thursday 5 May was the annual celebration of International Day of the Midwife. The partnership’s Local Maternity System (LMS) shared a special bulletin with the maternity workforce to recognise the great work undertaken each and every day whilst acknowledging it also been a difficult couple of years.
Beverley Geary, West Yorkshire Integrated Care Board (ICB) Director of Nursing-Designate shared the following message:
“On International Day of the Midwife, I would like to and thank all of our midwives, student midwives and maternity support workers for the care and compassion they provide to women and families across West Yorkshire and Harrogate. I would also like to recognise the wider maternity and neonatal teams who work with our midwifery services to provide safe personalised care, acknowledging that; the last couple of years have been extremely challenging for everyone in maternity and neonatal services.
Having recently joined the West Yorkshire Integrated Care Board (ICB) as your Director of Nursing, I will be working with colleagues on all aspects of quality. Our Local Maternity System now sits within the new Clinical and Professional Directorate of the ICB; and I look forward to meeting many of you over the coming months and working together collectively to champion the midwifery agenda and improve the care and safety of women and families in our system. I hope you enjoy your local celebrations today.”