Hello my name is Matt…
Welcome to my first blog for West Yorkshire and Harrogate Health and Care Partnership. As well as being the CEO for Calderdale Clinical Commissioning Group, I am also the CEO lead for the Elective Care and Standardisation of Policies Programme.
Elective care is pre-arranged, non-emergency care, including scheduled operations, such as hip and knee replacements and cataracts. People are usually referred by their GP.
Standardisation of policies sounds like we are going to move to an approach where one size fits all and we will do everything exactly the same way. And, in some ways it is, and in others, it’s very much the opposite. My hope in leading this programme of work is that we move away from a ‘one size fits all’ approach and one much more about tailoring care to peoples’ needs and choices.
What I’d like to talk about here, in my mind is the most interesting. This is the work we are doing to ensure that people have the best possible chance of a good outcome from their surgery. We know that if you smoke or are overweight, you are more likely to develop post-operative complications. The trouble is, the evidence is patchy. The size of the risk depends on who you are and what sort of surgery you are having.
It’s just not possible to follow both the evidence and to apply blanket policies which would stop people who smoke or are overweight from having their surgery. The evidence tells us that in fact, if we need it, we can all benefit from surgery or other interventions, whether we smoke, are overweight, or not. It’s just that the level of risk changes.
It is far better to enable people to make an informed choice about how they can improve their health, and to do this long before they may need surgery. One way to do this is by following an ‘every contact counts’ approach. This means that every health and care professional makes the most of every opportunity to achieve health and wellbeing for everyone they see. For example signposting people who might benefit and want to benefit into a local place where they can get the support they need to improve their wellbeing, for example healthy cookery classes.
Of course, we need all our local services to be in place and working well before we can really achieve this and we need to work closely with our local authority partners, i.e. care navigators, social care, public health and housing colleagues, and community organisation for this to work well. We also need to change the way we think – including communities and those working in health and care. That’s the bit I personally find the most interesting. With this in mind our programme is working with the Academic Health Science Network to find out from them about behaviour change and what the evidence tells us we need to do to support people to change their own minds. The advertising industry does this every minute of every day and public health campaigns such as ‘One You’ and ‘Change4Life’ are great examples.
The West Yorkshire and Harrogate Joint Committee of the 11 Clinical Commissioning Groups has agreed that we will move forward with this approach over the next couple of years. It will take time to build the support we need in our communities. We are not starting from scratch. We already have some fantastic smoking cessation and weight reduction services in place, but they need to be able to meet the needs of a larger number of people and we will need to change the way in which that support is offered. I’m sure that technology will help us. Look at the number of people who now wear technology to count their steps and monitor their fitness. Initiatives like the one we are involved with in Calderdale through our successful Sport England bid will help to change the experience of many and create new opportunities to support health and wellbeing.
We serve a diverse range of communities and recognise that people have different needs which require different solutions. A big part of this is not presuming we know what people think, but asking, involving and listening instead.
Each year in the NHS there are ‘follow-up’ outpatient appointments where people are asked to return to hospital to have their progress checked, to undergo tests, or to get results. Whilst some of these appointments are needed, a large amount could be done differently. We want to re-think how these follow ups are done. This will mean fewer face-to-face visits to the hospital, and instead using telephone calls, online services, Skype or an appointment closer to home. This would free up time for the treatment of new people, and would save patients time and money by not having to attend the hospital when there is no real need. We are going to start to test out some of these new ideas in elective orthopaedics and eye-care services in the first instance.
As a programme team we are deeply committed to ensuring that the work we do improves the opportunity for everyone to get better care. We are particularly concerned that people in poverty get the right deal and we will work hard to ensure that the changes that emerge as a consequence of this work will reduce the existing inequalities in care. This is a priority to us all.
It is true to say that the financial position of the health and care system is part of the reason why we need to change the way we do things, but that’s not the primary reason for me. I believe that the financial return on the investment that we are talking about here might take some years to materialize and I’m realistic about this. In the meantime our conversation is more about a refocussing of the way we work together with people to prevent ill health and improved health outcomes. This way of working will also help to ensure colleagues are better supported and that care is delivered at the right time in the most appropriate place for everyone.
Have a good weekend
What else has been happening this week?
Public health leadership group
Public health colleagues met on Monday. The group is chaired by Dr Ian Cameron, Director of Public Health at Leeds City Council. They discussed promoting good mental health and reducing inequalities. Drawing on recommendation two of the Five Year Forward View for Mental Health, the aim is to encourage action to increase the adoption of effective prevention planning arrangements across England. Public Health England is running a series of regional learning events, supported by the Kings Fund and Centre for Mental Health. The regional events will provide a good opportunity to maximise peer-to-peer learning and provide opportunities to explore the prevention agenda further. You can register here.
National webinar for supporting young carers
A young carers’ webinar was held on Monday with colleagues coming together to support shared learning and opportunities to further understand the current climate of activity. There was a good discussion around how we can support young people who care for family members and siblings who have cancer, and the need to work with schools to further develop a young carers charter. A presentation from Fatima was given which focused on innovation, improvement and working together with community organisations.
WY&H priority programme check and confirm sessions
These aim to offer peer support to programme areas such as stroke, cancer, urgent care and elective care. The first ones took place this week and more will follow over the next two weeks.
Regional lay member assurance group
The West Yorkshire and Harrogate regional lay member assurance group for the 11 clinical commissioning groups met on Thursday with members of the team to discuss the work to date and opening up the group to include other representatives from across our partnership.
Members of the partnership leadership, including medical directors met with Kathy McLean, Executive Medical Director for NHS Improvement last week to talk about our plans for the future and the importance of clinical leadership.
Dr Bryan Gill, Dr Andrew Withers, Matt Graham (programme director for hospitals working together) and Ian Holmes met this week to discuss further development of the clinical strategy – including clinical engagement across all areas of work including, hospital doctors, GPs and nurses.
Stroke stakeholder event
Over 60 health and social care professionals, community organisations, councillors, people who have experienced stroke and carers attended an event organised by WY&H HCP in Bradford today [Friday 2 February]. More information will follow soon.
Voluntary and community sector programme
The partnership has recently taken part in a leadership programme supported by the National Council for Voluntary Organisations with our VCS leads including Soo Nevison, Hannah Howe and Rory Deighton (make links) alongside Salma Yaseen (make link) and WY&H programme leads. The programme has given our partnership the opportunity to reflect and develop as a group of partners, learn and share with others and develop a shared understanding of the challenges, barriers and possible solutions to how we work effectively together moving forward, namely that partnerships should be nurtured and further developed in our six local places, with some actions being taken at WY&H level to support this approach.
What’s happening next week?
- The Clinical Forum meets on Tuesday. They will be discussing diabetes and cardiovascular disease and elective care and stroke.
- The Leadership Executive Group will discuss the next steps for the partnership on Tuesday.
- The wider leadership group will discuss mental health, commissioning and sharing from Vanguards on Tuesday.
- On Tuesday the Joint Committee will meet to discuss cancer, elective care and the development of the memorandum of understanding.
- The check and confirm meetings will continue throughout the week.