Posted on: 4 January 2021
As an Integrated Care System we welcome the NHS England/Improvement proposals for future arrangements. This welcome sits alongside a desire for greater flexibility that must survive the development of the legislation as well as the impact of structural change for our clinical commissioning groups.
Changes to organisational form may be necessary in light of legislative changes yet the skills and experience we have amongst us will continue to be important at place and system level.
Much has been made of how we treat #OurNHSpeople and we now have an opportunity to demonstrate we mean it, with any staff transition from one organisation to another set with purpose and a sense of belonging.
The proposals rightly set out that people’s day-to-day care and support needs will be met locally in the place where they live. What has emerged in West Yorkshire and Harrogate, built on over four years of working together, is this very model, one that tackles problems faced by people in our communities by seeing our local places as the building block for action. One where services come together and 80% of our business is done, and where the ICS is the servant of place.
Recognising that some services, such as hospital and specialist mental health, are better organised through provider collaboration that operate at a system-level, we have real evidence of how this is improving outcomes for people through their collective force.
Our committees in common including the West Yorkshire Association of Acute Trusts have improved the delivery of stroke care, vascular services and established a pathology network. Our commissioners working together have produced award winning programmes such as ‘Healthy Hearts’ and our Mental Health, Learning Disabilities and Autism Collaborative, has developed award winning eating disorder services; suicide bereavement care, grief and loss support.
We are a system with distributive leadership, where effective governance, accountabilities, financial flows and shared responsibilities are firmly in place through an agreed memorandum of understanding. Our directors of finance group delivered a single control total in 2019/20 and plans for 2020/21 have been agreed with joint capital prioritisation, planning and shared risk.
With regulation and oversight via our system oversight assurance group, we have an approach based on mutual accountability. Our Partnership Board, which meets in public and includes council political leaders and health and wellbeing board chairs, ensures shared decision making responsibilities. Our combined strength can improve the health of residents, provide early help, prevent illness, tackle variation in care, and deliver joined up services.
Clinical leaders gather at a system level to share ideas and evidence-based approaches to improve population health and equity as part of the Clinical Forum. They have agreed ethical frameworks and supported our planned care alliance. Their expertise, supported by cancer, stroke and respiratory networks, will continue to be essential as we deliver better outcomes for people, supported by legislative change. Further development of primary care networks, which is instrumental in the vaccine programme delivery, provides an opportunity for better GP leadership.
During the past year our approach has withstood the challenge of COVID-19. There has been mutual aid around lab testing, the sharing of staff, cancer sites, and PPE with better planning and support in our places.
Crucially, it has helped us keep in view the wider social and economic consequences of the pandemic. NHS commissioners, providers, local councils, VCSE and hospices work collaboratively - all taking collective responsibility for resources and population health at a local and system level.
We know that most of what keeps people healthy and well is a wider set of factors than health and care services. And so, as set out in the proposal paper, we continue to target factors that cause some people to experience significantly worse health – because of where or how they live.
A key part of how we tackle health inequalities is to use our collective strength in improving the lives of the poorest, the fastest via our improving population health programme who work across local places and priority programmes, including cancer, maternity care, children and young people.
Challenging traditional ways of working we see the whole needs of people, and what factors are causing or exacerbating ill-health alongside what will help them to stay well long term. Examples include the Partnership’s hard hitting BAME review, ‘housing for health’ and our ambitions to tackle climate change.
VCSE partners are at the forefront of delivery at a neighbourhood level, with many commissioned to deliver health and care services. We have invested over £2.5m of additional resource to support their community asset based approach: assets on show in the award winning ‘Looking out for our neighbours’ campaign and unpaid carers programmes.
Listening to what people tell us informs the development of services and the role of the public, lay members, patient voice will remain at the heart of our work with the support of partners such as Healthwatch.
The relationships we have with the West Yorkshire Combined Authority for the area’s economic recovery plan, Health Education England, the Academic Health Science Network, med-tech and the skills sector, including universities, helps us to look at what we can do together to develop and grow our workforce and support people into better jobs via our People Board work.
There is much to support West Yorkshire and Harrogate in these plans. For us they are not a concept, they are a reality. If we can retain the flexibility inherent in the proposals, the focus on both system and organisation, and support our staff, then we can deliver better care for all.