Hello my name is Nigel. Welcome to my first West Yorkshire and Harrogate Health and Care Partnership blog in my role as senior responsible officer for urgent and emergency care. I especially wanted to write it this week so that alongside my colleagues I could recognise the tremendous commitment from everyone working on the urgent and emergency care agenda this winter.
As I write this blog the snow is falling, and if we ever needed a reminder that the work of urgent and emergency care in winter is pressurised, then this is one.
Myself and colleagues working on the West Yorkshire and Harrogate Urgent and Emergency Care Programme Board (UECPB) are doing all we can to ensure that the support provided across the whole of the area really add values to staff and communities.
Commissioners (who buy health services) and care providers are working much closer together to ensure we deliver more aligned urgent care services. You can see examples of this from our NHS 111 teams through to our community pharmacists.
Our A&E departments and social care colleagues are working hard to reduce delayed transfers of care; and colleagues in the Yorkshire Ambulance Service; our NHS 111 services, GP practices and community pharmacists, to name just a few, are going the extra mile to ensure urgent care is given to free up what only hospitals can do. All have a pivotal role to play and each relies on one another. Communities also have an important to play by using A&E wisely.
Despite all our best efforts the number of people requesting an urgent care response continues to put significant pressure on our local health care services. Guidance from NHS England and NHS Improvement was issued on 2 January for our hospitals to defer all non-urgent inpatient elective care to help free up capacity for our sickest patients.
Community based services, such as hospital discharge, are under extreme pressure too and all our six local places have plans for more joined up partnership working to reduce duplication on the system whilst making the most of staff skills.
The importance of keeping ourselves well is crucial too and over the coming months I would like our Urgent and Emergency Care Board work to be more coproduced with people who use our services. Asking and listening to people’s views is an important part of our work.
I am very aware that our urgent care work cannot happen in isolation, and it is essential we work closely with the other West Yorkshire and Harrogate programs; including workforce, technology, mental health, stroke, and harnessing the power of communities.
We have five A&E Delivery Boards in West Yorkshire and Harrogate (Airedale and Bradford, Calderdale and Greater Huddersfield, Harrogate and Rural Districts, Leeds and Mid Yorkshire). These bring together a range of commissioners and care providers who have responsibility for the operational leadership and coordination of local services. Representatives from each of these boards meet monthly as part of the West Yorkshire and Harrogate Urgent and Emergency Care Programme Board. This is chaired by Dr Adam Sheppard. My role is to support him on this agenda. You can find out more about the board’s work here by watching this short film.
We established the UECPB to co-ordinate the way in which the NHS work with key partners, including councils and the ambulance service, to meets the urgent and emergency care needs of our communities. In doing so, we want to ensure that systems are in place which will enable people to get the right care, in the right place at the right time – first time.
We know that there is no magical solution to solving the issue of demand on services; however we have recently taken the decision to spend more time looking at how we are responding to people’s urgent care needs so we can ensure they find it easier to get to the services they need and when they do they are all joined up across all points of access.
Over the past year we have developed a West Yorkshire and Harrogate plan to improve urgent and emergency care including the work of NHS 111, improving access to GPs, evenings and weekends as well as work on flow and discharge within hospitals. We are sharing best practice and working towards a more consistent West Yorkshire and Harrogate approach that allows flexibility in our six local places.
In December we switched on NHS 111 online (during busy times of the day) where a member of the public who has already phoned 111 is given the option to use the online service. Whilst initial feedback is positive, increasing the in-queue message to 24/7 is still somewhat of an unknown quantity, especially given that A&Es are under significant pressures. However, it is an important step forward and we recently had an increase of 4,000 calls to NHS 111 in Yorkshire and the Humber. Giving people the option for an online service should help reduce demand within the NHS 111 call centre.
We are also promoting direct booking from NHS 111 into some GP practices and this will be extended to urgent treatment centres (when they are developed in our area….watch this space). We also have plans to increase the number of care providers linking to the service later this year.
In December we held a workshop to identify key areas for change. This includes improving the range of clinical advice people receive from NHS 111 and improving the ability to use technology within our urgent and emergency care services so that people can be booked into different services. The caller’s care record will also be available and shared so that people do not have to repeat themselves more than once.
When people do need to be in hospital, we want to ensure this is swift and that they return to their own bed as soon as possible. This is what people tell us they want. We know there is much more work to do here and we are aware of the challenges we face.
The needs of staff are also very important and we need to find better solutions to help them work more effectively across a number of urgent and emergency care services so they concentrate on what they do best.
2018 is going to be a busy year. Our ambulance service will continue to implement the new ambulance waiting times standards alongside the impact of service reconfigurations. This is being led by Jo Webster as 999 Lead Commissioner for Yorkshire and the Humber.
As 999 and 111 are both commissioned on a Yorkshire and Humber footprint we will continue to use the Joint Strategic Commissioning Board structures to do business with colleagues in South and North Yorkshire to ensure activity is clear.
We are also in the final year of our existing contracts with Yorkshire Ambulance Service and Local Care Direct for 111 services, clinical advice and our West Yorkshire out of hours service. Myself, Adam and Keith Wilson (our programme lead) will be working closely with Greater Huddersfield Clinical Commissioning Group and Carol McKenna is our lead commissioner for these services. This will help us to make sure we plan for the future and ensure we have sustainable services for people now and in the future.
Most importantly we will learn from our plans and build upon these for the coming year to ensure urgent and emergency care services become more joined up.
If you have ideas how we can make a difference we would love to hear from you.
Very best wishes for 2018.
What else has been happening this week?
Local place based planners meeting
Our six local place planners met on Tuesday to share work across their areas. They also received an update on the development of the memorandum of understanding, the programme check and confirm process and communications regarding our next steps work.
Stroke task and finish group
The stroke task and finish group met on Tuesday. This included an update from Professor Graham Venables on the clinical advisory group meeting held on Monday to discuss thrombectomy. There was an update on the stakeholder event on the 2 February in Bradford which will be facilitated by the Consultation Institute. Marianna Hargreaves from South Yorkshire and Bassetlaw gave colleagues an update on the work taking place across South Yorkshire and Tony Jamieson from the Academic Health Science Network gave an overview on the work of identifying and treating people at risk of stroke. There was also a conversation around workforce recruitment and retention.
Elective care and standardisation of commissioning policies
Programme members met on Wednesday. The board is chaired by Matt Walsh, Chief Officer for Calderdale Commissioning Group, who is also the senior responsible officer for this work. The meeting included colleagues from clinical commissioning groups, NHS England, Healthwatch, hospitals and communications. The four work streams were discussed. These are elective orthopaedics, eye care, medicines, prescribing and procedures.
Colleagues who lead on work to support unpaid carers met on Thursday. This included those working in Wakefield, Leeds and Kirklees Councils. This included a presentation from Fatima Khan-Shah explaining West Yorkshire and Harrogate priorities around this important agenda.
What’s happening next week?
Business intelligence colleagues will meet on Monday.
The Joint Health and Overview Scrutiny development session will take place on Thursday.
There is a digital innovation workshop on Friday.
Our finance directors meet on Friday.