The way we commission services is changing …. And I believe for the better.
It’s been a while since I wrote a West Yorkshire and Harrogate blog and I wanted to take the opportunity to update you on the work of commissioning across the area and locally in Wakefield where I am the Chief Officer for Wakefield Clinical Commissioning Group.
I am also the Strategic Lead of Health and Care Transformation and Integration for Wakefield District. Put simply, my role is all about ensuring that Wakefield Clinical Commissioning Group and Wakefield Council work alongside partners to join up health and care services for people. It makes perfect sense and so far so good – more on that later.
The Joint Committee, which is made up of nine clinical commissioning groups and part of the West Yorkshire and Harrogate Health and Care Partnership, also has a shared programme of work that aims to join up care and further improve the health and wellbeing of the 2.6 million people living across the area.
The way we commission health services at a West Yorkshire and Harrogate and local place level is changing and our relationships with providers of care, such as hospitals and community organisations is changing too. Organisational relationships are better now than ever before and we need to positively build on this as we move forward together. We already have a strong sense of common purpose i.e. commissioning and delivering the best care possible, and it’s important we make the most of future opportunities.
This work is complementary to the work happening in our six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) to align commissioning more closely with council partners to develop integrated care models where organisations work side by side with community organisations and often as part of one virtual team. It’s also important to note that all our six local constituent places are different and local leaders in each area will be ensuring the optimum models to align both commissioning and service delivery to focus on improving people’s health outcomes locally. This is key to the way we work.
At a West Yorkshire and Harrogate level we are rolling out best practice care for people with atrial fibrillation (AF) in every GP practice, with the aim of preventing over 190 strokes over the next three years. This includes detecting, diagnosing and treating people who are at risk of stroke so that around 9 in 10 people with atrial fibrillation are managed by GPs with the best local treatments available to save people’s lives.
We are also reducing other risk factors linked to stroke. For example the treatment of hypertension (high blood pressure) which has the potential to reduce a further 620 strokes within three years.
Another example can be seen in our work to reduce CVD (heart disease) and diabetes. The number of people who could be supported is very powerful; for example targeting people where statins (statins are prescribed to lower the level of cholesterol in the blood) could make a huge difference. The Joint Committee recommended that all the clinical commissioning groups work across the area to increase the number of people with or at risk of CVD and diabetes so they receive support to prevent ill health.
A different conversation about health and care focused on what is important to each person, through personalised care and support planning; choice and control is also high on our agenda. This is all about a shift in control over the resources available to people, carers and families, through personal budgets, personalised commissioning and payment. This is not new to our council partners – they have been working in this way for a while.
Joint funding arrangements have, to some extent, supported the drive toward joint commissioning but practical application of this has varied across our areas and we want to look at how we can make this consistent across West Yorkshire and Harrogate.
Taking into account all of the above - I think it’s fair to say the way we commission health services is changing – at both a local and West Yorkshire and Harrogate level.
Our work with housing colleagues, public health and community organisations to tackle health inequalities is also very important. We know that many causes of ill health and early death are preventable and that life chances are also shaped in our early years of life.
The wider environment, e.g. green spaces, air pollution and how we design our towns and cities as has one of the biggest impacts on a person’s health and wellbeing from childhood through working life and into older age. Good quality housing is critical to a healthy community. The Building Research Establishment (BRE) estimates that the cost to the NHS nationally of poor housing is £1.4bn. Looking at how we commission services that take into account all these important factors is essential in a new commissioning world.
This way of working is not unusual – it’s becoming the norm and I know a lot of this is already taking place in our six local places. The important thing is to learn from one another as commissioners and avoid unnecessary duplication and costs to the tax payer.
Most importantly this way of commissioning services makes life easier and better for those we serve and our workforce.
Closer to home, Wakefield’s Accountable Care Partnership (New Model of Care Board) is ensuring a clearer vision for health and care, which will lead to a credible, locally managed system with resources used collectively to strengthen our communities. The Partnership has published their three year business plan and you can read it here
Connecting Care Hubs in Wakefield is where health, social care, housing, voluntary and community organisations work side-by-side - helping those people most at risk stay well and out of hospital. The Hubs are funded by Wakefield Council and Wakefield Clinical Commissioning Group. They have multiple agencies working together, all under one roof, offering seamless support to people with health and/or social care needs who could otherwise receive fragmented care, with multiple referrals and handovers.
Since December 2017 Wakefield has been testing a new system one template in our Hubs which ensures colleagues in general practice can directly refer to a care co-ordination team by electronically referring a patient to our Connecting Care Hubs from their IT system. This has led to 343 direct referrals from GP’s across the nine practices that are soft testing this new technology. Wakefield has just completed an evaluation of this work and we are happy to share this across the Partnership, if anyone is interested.
Once referred and assessed, the person might be visited by a nurse, occupational therapist, physio, social care worker, voluntary worker, housing officer or mental health worker. In six months they’ve seen almost 2,000 people including 636 urgent referrals. It’s great team work.
Other areas of work that are underway in Wakefield include a new shadow Mental Health Provider Alliance which has recently taken a case for change to all the Boards of these providers and who have agreed to work collectively on key areas of transformation. The first piece of work is looking at developing a personality disorder pathway. By late autumn all our mental health providers will have signed up to an Alliance Agreement.
Tina Turner from Wakefield Hospice has uniquely pulled partners together to develop an exciting work programme for end of life care (EOL). This has been driven by our EOL providers. This is already having a real impact on ensuring people are able to die with dignity in their place of choice.
So all in all – a lot is going on to ensure we commission the right health care, whether at a local or West Yorkshire and Harrogate level.
It’s definitely the future and I for one am looking forward to seeing more great results for the people we serve not only in Wakefield but across West Yorkshire and Harrogate too.
Have a good weekend
What else has been happening this week?
West Yorkshire Joint Health and Overview Scrutiny Committee (WY JHOSC)
We had two items on the agenda. This included an update on stroke care and a wider Partnership overview.
Providing the best stroke services possible across West Yorkshire and Harrogate to further improve quality and stroke outcomes is a priority for us all and something we are committed to achieving through the work that has been taking place in each of our six local areas (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield). Working closely with our partners, stakeholders and communities is an essential part of our stroke work and as well as the JHOSC, colleagues have also been updating their local overview and scrutiny committees so they have the opportunity to discuss developments as they progress. We have worked closely with West Yorkshire Association of Acute Trusts (hospitals working together), West Yorkshire and Harrogate Clinical Forum, medical directors and the Yorkshire Ambulance Service who have access to the skills and expertise we need to advise on operational sustainability of the hyper acute stroke unit services across the area (the care people receive in the first 72 hours). A report will be taken to the Joint Committee of the Clinical Commissioning Group meeting held in public in November.
Ian Holmes, Director for the Partnership updated JHOSC members on the work of the Partnership since joining the integrated care system development programme in May. Our work at the moment includes the development of a West Yorkshire and Harrogate Health and Care ‘Partnership Board’ which will meet in public. This will include executive, non-executive and elected member representation, along with clinical, public and voluntary sector people. This will ensure greater transparency and democratic accountability in our work.
Local overview and scrutiny chairs (who make up the JHOSC) were keen to understand how the Partnership Board would work. There was also a conversation around the amounts of funding coming into the area. We will be writing to the JHOSC to update them on these points and other work moving forward. Working closely with JHOSC members is an essential part of our work and we want to ensure they are fully sighted on Partnership developments as they progress so they have the opportunity to ask questions.
Primary and community care work stream
The primary and community care work stream met on Wednesday. This is chaired by Carol McKenna, who is also the CEO for the North Kirklees and Greater Huddersfield Clinical Commissioning Group. Primary and community care includes a wide range of services supporting the health and wellbeing of everyone in the community, including local GPs, pharmacies, community mental health teams and social care. This week’s meeting focused on workforce (the workshops led by NHS England and Local Workforce Action Boards which were facilitated by colleagues at National Association of Primary Care), improving access, self-care and preventing ill health. This included an update on the national social prescribing pilot and the work taking place in each of our six local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield).
Yorkshire Ambulance Service new website
The Yorkshire Ambulance Service NHS Trust has launched a new website which is designed to be more accessible on all devices including mobile phones and tablets. It has intuitive navigation and new updated content with an increased focus on its staff. It also features a ‘Recite.me’ accessibility toolbar which can customise the content to suit users and includes:
- Dyslexia software
- An interactive dictionary
- A translation tool with over 100 languages
- Colour contrast settings
- The ability to make fonts larger or have the content read out.
The website address is: www.yas.nhs.uk
What’s happening next week?
- The Public Patient Assurance Group for the nine clinical commissioning groups meets on Monday.
- The Shadow System Leadership Executive Group meets on Tuesday.
- The Joint Committee of the Nine Clinical Commissioning Groups meet on Tuesday for a development session.
- On Tuesday the Clinical Forum meets. This is chaired by Dr Andy Withers.
- The West Yorkshire and Harrogate Health and Care Partnership planning event takes place on Wednesday. This has been organised by NHS England.