Hello my name is Rob

On Sunday, the Prime Minister announced that by 2023, an extra £20bn a year would be available for the health service in England on top of any rises to keep up with inflation. The money comes with a promise of a 10-year plan around four key areas; NHS workforce; technology; buildings; and productivity.

The Prime Minister’s commitment to NHS funding over the next five years is a positive political gesture of faith in the NHS. As we saw in the NHS Plan in 2000, a combination of political leadership, policy coherence and long term financial investment can genuinely transform care. At that time, long waiting times for treatment were the biggest problem faced by the NHS, closely followed by a workforce crisis and a crumbling estate. Two of those things feel very familiar with workforce under pressure and a backlog building maintenance of £5.5bn across England – our partnership carries its fair share.

Yet, the biggest issue people face today is not waiting but getting support with multiple long term conditions. This multiple morbidity places unprecedented demand on services and must be addressed. The excellent recent report from the IFS and the Health Foundation showed the consequences of failing to do so. They concluded that spend on people with chronic diseases in hospitals will double over the next 15 years if things don’t change. Crucially, they concluded that investment must go into the NHS and a similar level of growth into social care if we are to have a sustainable NHS at all.

Beyond the public narrative of “the National Health Service” which suggests a single structure that operates as a single organisation lies the reality. The NHS is a system not an organisation and it sits within a health and care system that itself reaches deep into every community. Making sense of the system is a challenge faced by carers and patients every day. The complexity is staggering and leads to a “burden of treatment” alongside a “burden of disease”. It’s time to invert our thinking and forget about people being a guest in our organisation and start thinking that we are a guest in people’s lives.

These are people’s lives blighted by ill health that are prevalent in specific communities. They can be improved and we can organise better, simpler and more cost effective care together. This starts in communities, built from partnerships between local people, politicians and good primary care - a priority to us all.

We should be ambitious here too. Modern health and care systems meet the physical, mental and social needs of people. The NHS and care system is no different and the prime minister’s announcement is a start in giving us the tools to do the job. Her welcome focus, for example, on mental health might mean in the Trust where I am CEO that we may no longer have 16 year old children on adult units and that suicides are no longer the biggest killer of young men.

It is a necessary step, a huge step, in the right direction but it is not yet sufficient to meet the needs of the people in the communities we serve. That will require real and sustained financial support for social care. It will require a revolution in how we fund and think about prevention. And it will require genuine recognition that housing, education, employment, lifestyle and the environment are the biggest factors in your health and the biggest drivers of demand. Local Government has as big a role to play as any NHS trust, clinical commissioning group or national leader in a successful future.

Over the coming weeks and months things should become clearer. We can then place additional resources alongside a new and more coherent policy framework for the health and care system. Collaboration is critical to success, but collaboration is a noun, not a coherent policy framework.

The 2000s were defined by bold, often contentious, policies that made change happen. We need to see the development of better policies designed for the issues that face us today. We are already seeing this emerge from the bottom up. Four of the six acute trusts in our Partnership are on aligned incentive contracts that share risk in the system, for example.

Housing and health are also a priority for West Yorkshire and Harrogate building on the work in Wakefield that is transforming help for vulnerable people.

You can also see good examples across all of our six local places in the way they work [Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield] - where health, social care, housing and voluntary and community organisations work side-by-side - helping those people most at risk stay well and out of hospital. Focusing on crisis intervention, this way of working prevents avoidable hospital admissions whilst supporting services to enable people to be discharged from hospital as soon as they are well enough.

All relevant when you consider the recent Health Select Committee inquiry into integrated care and the progress being made to join up local health and care services.

General practices are being transformed with learning from vanguards and integration pioneers. This is being led by a network of local leaders bound by shared commitment in the face of conflicting policy and financial landscapes. Imagine what we could do if incentives, regulation and policies were aligned to support us.

With this firmly in mind we look forward to welcoming Professor Don Berwick and Sir Chris Ham next week to West Yorkshire and Harrogate. Don Berwick is a visiting fellow of the King’s Fund and a leading authority on health care quality and improvement. Chris Ham is the CEO of the King’s Fund and an authority on all aspects of Health Reform. We will be using the session to explore how we put into practice the idea of moving towards a ‘self-governing system’, how we work to ensure that improving outcomes and tackling inequalities are at the heart of the approach, and to do some practical thinking on the barriers and challenges we face.

Ultimately, delivery will require the commitment, effort and energy of our biggest cost and our biggest asset – our staff. Our long term workforce strategy starts with truly valuing staff who work in health and care right now and improving their working lives. It extends beyond them to every carer and every volunteer. Their efforts are what makes the health and care system work, because beyond the policies and the politics, this is all about people.

The next few months in the run up to the 2018 budget will be critical, with councils questioning why the increased funding only applies to front-line NHS services such as hospitals, GPs and mental health care and does not include additional funding for social care and public health.

It is essential our partners in local government and social care are included with a deal backed by a more coherent policy landscape.

To quote, Niall Dickson, CEO of the NHS Confed: “The government says it will make sure the NHS does not come under more pressure as a result of social care pressures - that must mean major public investment in social care”.

Have a good weekend

Rob

 

What else has been happening this week?

The Local Workforce Action Board [LWAB] The LWAB met recently. The Board discussed the workforce strategy and the clinical priority programmes. There was also an update on the work of the West Yorkshire and Harrogate Cancer Alliance led by Professor Sean Duffy. An event will be held on the 5 July organised by the LWAB and the Cancer Alliance. This will focus on recruitment and retention and new roles.

The LWAB also received an update from Dr Andrew Sixsmith on the completion of the three primary and community care workforce workshops. These have been well attended. A report on the workshop is being prepared and will be shared with the LWAB in August.

The LWAB also welcomed colleagues from the West Yorkshire Combined Authority to learn more about their work promoting careers and to discuss closer working going forward.

West Yorkshire Association for Acute Trusts [hospitals working together] are developing a social media campaign to promote careers as operating department practitioners. The LWAB and Health Education England have recently approved all 111 of the applications received for funding to support recruitment of advanced clinical practitioners across West Yorkshire and Harrogate. The LWAB continues to work with WY&H programme and local place leads to identify investment priorities.

Urgent and Emergency Care Programme Board

The Urgent and Emergency Care Programme Board met on Monday. The Board is chaired by Dr Adam Sheppard. The Board discussed the recent communications from Pauline Philip, National Director of Urgent and Emergency Care regarding expectations to reduce long stays in hospital unless necessary. This equates to a reduction of 281 beds to support the national ambition to reduce long stay patients by 25% across the country. Further guidance is expected soon. This will further inform winter planning. Conversations will take place in our local areas around how best to implement the guidance [Bradford District and Craven; Calderdale, Harrogate, Kirklees, Wakefield].

The Board received an update on the stroke care programme, including the engagement findings and work with specialist units.

There was also a discussion around IT systems as sometimes systems don’t link up as much as we would like for clinicians and our patients. One of our key ambitions is to get our IT systems talking to each other better. We are working locally and nationally to make improvements.

Elective Care and Standardisation of Commissioning Policies

The elective care and standardisation of policies group met on Tuesday. Chaired by Matt Walsh, the senior responsible officer for the programme, and CEO for Calderdale Clinical Commissioning Group

(CCG), members include colleagues from CCGs, GPs, and colleagues from Public Health, Health Education England, and Councils. There are also two members of the public on the group.

There was an update on the work programmes, for example eye care where there is also the potential to work with the Institute for Voluntary Action Research [IVAR] and local community organisations to build cross sector working. There are a number of local and national eye care community organisations who have expressed an interest in partnership working across service delivery; and practical and emotional support for people with sight loss. The work with IVAR will give us the opportunity to look at this in more detail.

There was also a conversation around workforce development and training. This work is with Health Education England and will support the future workforce needs of the programme. Existing opportunities for example the Excellence Centre will be put to best use and there is the potential for funding also from LWAB. Developing short courses for example prescribing and injecting therapy are also being considered.

The theme of reducing variation in policies and how we benchmark this across our six local places in terms of measuring the activity and difference was also discussed. There was a good conversation around the importance of capturing the difference standardisation of policies will make to people’s lives and the value of working at scale across the area. Conversations with care providers will continue around how we capture people’s experience and wellbeing as outcomes.

Maternity programme update

The WY&H Local Maternity System [LMS] have been supporting the local Maternity Voices Partnerships to develop. A Maternity Voices Partnership (MVP) is a team of women and their families, commissioners and providers (midwives and doctors) working together to review and contribute to the development of local maternity care. We are also co-producing a personalisation plan with women and families. This is coupled with an early discussion around developing a ‘Local Offer’ website. This website will provide information on the maternity services available in the area along with links to local information that women are telling us they like and need. This should then allow women, their partners and families to be able to make informed choices on their care.

A meeting was recently held with local commissioners about the development of a local maternity service specification. Work on this will continue over the next few months. The next piece of work for the commissioners is to work with council colleagues to begin the work on community hubs. A community hub is a local centre where women can access various elements of their maternity care, such as a birth centre. They could be located in a children’s centre, or in a freestanding midwifery unit according to local need.

The WY&H Local Maternity System Team has a Programme Lead and Project Officer in place. The team continues to grow with the appointment to a senior midwife role, with the successful candidate starting working in September 2018. A second senior midwife will be recruited shortly. Vacancies for a data analyst and programme manager for prevention and maternity are currently being advertised on NHS Jobs.

The work of the task and finish groups continue with the safer maternity care group setting up a safer forum and looking in more detail at fetal movement. Two new groups are also being established to look at workforce and perinatal mental health.

What’s happening next week?

  • Sustainable Health and Care Week on 25-29 June - Look out for the blog from Rob Webster; Glen Garrod, Executive Director of Adult Care and Community Wellbeing at Lincolnshire County Council and the President of the Association of Directors of Adult Social Services and Alex Fox OBE, CEO of Shared Lives Plus and Chair of the Joint VCSE Review next week on the NHS Confed website.
  • West Yorkshire and Harrogate Partnership discussion with Professors Don Berwick and Sir Chris Ham on Wednesday.
  • Our Directors of Finance meet on Wednesday.
  • West Yorkshire and Harrogate Health and Care Partnership Public Health Co- ordination Group meets on Thursday.