To tackle the increasing need for health and care services and reduce our environmental impact, the focus of this plan will be on preventing ill health and proactively supporting people to stay well at home with new models of care in the community. We will work to ensure that services are arranged in a way that allows people to receive care from the most appropriate healthcare providers in the right setting and that everyone knows how they can access care, for example our campaign ‘Together We Can’ is one of our communication approaches.
Taking a life cycle approach, we recognise the importance of addressing inequalities experienced by children and young people by adopting a family-centred approach. By working together and implementing our plans, we aim to address the rising need for health and care services and improve the overall well-being of everyone in West Yorkshire. We also take a trauma informed approach.
Our efforts will involve targeting prevention resources in neighborhood’s, hospitals, and specialist centre’s related to these clinical areas. We will work collaboratively with the voluntary, community, and social enterprise (VCSE) sector to ensure that help and support are accessible to communities.
We continue to focus our attention on seeing everything through an inequalities lens. For example, in terms of healthy life expectancy, musculoskeletal and long-term mental health conditions are two of the main contributors to this. In the short term, we will prioritise inclusive elective recovery to support people who are experiencing long waiting times for elective procedures and to reduce the number of people added to waiting lists. We will develop initiatives tailored to local needs and addressing these priority areas, working closely with all care providers in all our local places and collaboratives.
We have built on the national women’s health strategy to develop approaches to joining up care for women’s health across our places and will be learning from other ICBs nationally.
National targets and expectations
We are required as a Partnership to deliver the expectations of Government set out in the mandate for the NHS and in guidance and legislation.
These expectations include targets on tackling waiting times for elective care, community services, improved ambulance and accident and emergency (A&E) responses, access to a GP, improved mental health services and substantial improvements for people with learning disabilities. These overlap with the findings of our work with Healthwatch and local involvement activity on what local people want from us. These are essential parts of our plan.
Our 10 big ambitions
Our 10 big ambitions summarise the work we will do and they are central to our efforts in increasing the number of healthy years people live in West Yorkshire. We still have specific focus areas, such as improving early diagnosis rates for cancer, reduce the gap in life expectancy by 10% for people with mental health illness, learning disabilities, and/ or autism and other groups – as well as preventing death by suicide.
Additionally, we are committed to keep people well, closer to where they live with the need to support the left shift towards care outside of hospitals and prevention.
People’s ability to lead healthy and fulfilling lives is significantly influenced by factors such as their social, cultural, and demographic backgrounds. Therefore, it is crucial that our services and initiatives continue to acknowledge and address these factors, whilst also tackling inequalities and injustice within our workforce.
We continue to make strides in recruitment through work such as Project Hope, our Health Inequalities Academy and The Fellowship. We have implemented coaching and mentoring programmes, and initiated various initiatives to address health inequalities in our population, including our anti-racism movement.
Furthermore, we continue to work with colleagues in planned care and partners across the system, place, and sectors to understand the needs of our population regarding weight management and living with obesity. Our aim is to improve health outcomes for current and future generations.
Financial challenge, efficiency, and effectiveness
Alongside this, we know that 2024/25 will be a challenging year financially and the medium term will be no less challenging. We have submitted a balanced financial plan for 2024, which is predicated on needing to deliver significant levels of efficiency. This is in addition to all places carrying a high level of unmitigated risk, for example where cost growth may end up being higher than levels assumed in plans. As previously outlined, our local authorities and other partners also face significant levels of financial pressure and this is impacting considerably on our VCSE partners who are key to the delivery of services to our communities.
Our strategy and plan include a focus on efficiency, effectiveness, and value for money. We will create a longer-term financial model that looks at the choices and opportunities for us to deliver quality safe care over the next five years. These choices will often require difficult judgements. We are focusing our work in places this year on a small number of transformation priorities which will have a large impact on our financial sustainability (insert when agreed).
Assurance and oversight
Our approach to assurance and oversight is geared towards performance improvement rather than traditional performance management and is data-driven, evidence-based and rigorous, including real time data to track continuous improvement. Our focus is on improvement, supporting the spread and adoption of innovation and best practice between partners and is central to supporting delivery of our JFP.
Our improvement approach is staff, service user and patient driven, requiring skill to facilitate change and improvement at all levels in the system. It is consistent with the subsidiarity principles that we have agreed:
- Individual organisations will seek to manage their own performance and resources;
- Where this is not possible, commissioners and providers will work together in their place to manage their collective performance and resources;
- Where this is not possible, all partners will work together as a whole ICS to manage our collective performance and resources.
A number of partner organisations have their own improvement capacity and expertise. This is being harnessed and leveraged for the benefit of the overall partnership, together with the improvement expertise provided by national bodies and programmes. Peer review is a core component of the improvement methodology we use and this provides valuable insight for all peer participants and support the identification and adoption of good practice across the system. The system oversight and assurance group (SOAG) prioritises the deployment of improvement support across the partnership, with the appropriate input from places.
Within West Yorkshire Health and Care Partnership a mutual accountability framework is supported by our statutory oversight and assurance arrangements comprising:
- Regular meetings in public of the Board of the Integrated Care Board (ICB).
- Regular meetings of the Finance, Investment and Performance Committee (FIPC) of the ICB. Decisions on formal assurance actions are taken in this committee.
- Regular meetings of the Quality Committee which supports the ICB in delivering its statutory quality functions and strategic objectives in a way that secures continuous improvement in the quality of services.
- Meetings of the ICB Transformation Committee which leads system transformation, including the development and adoption of service redesign and best clinical practice on behalf of the ICB.
- Place based committees - each of the five place partnerships has an ICB committee to make decisions.
- The ICB Audit Committee, which provides oversight and assurance on the adequacy of governance, risk management and internal control processes within the ICB, including a current audit on our oversight and assurance processes.
- The ICB Remuneration and Nomination Committee, which is accountable to the Board for matters relating to remuneration, fees and other allowances.
The formal statutory mechanisms are supported by our executive arrangements, which include monthly meetings of the ICB Executive Management Team, three meetings each month of the System Leadership Team (including ICB directors, place accountable officers and sector leads). The cycle of meetings covers oversight and assurance, transformation and tactical issues. There are also Programme and Provider Collaborative Boards leading on the transformation of key areas of delivery ensuring the oversight of current performance is used to guide the effective transformation of services.
Managing strategic and operational risk
The ICB recognises that the principles of good governance must be underpinned by an effective risk management system designed to ensure the proactive identification, assessment and mitigation of risks, within the context of its risk appetite, to ensure that the ICB achieves its strategic priorities and in doing so maintains the safety of its staff, patients, and members of the public. Effective risk management processes are central to providing the ICB with assurance that all required activities are taking place to ensure the delivery of the ICB’s strategic priorities and compliance with all legislation, regulatory frameworks and risk management standards.
The ICB has an integrated risk management framework, which outlines the effective governance arrangements in place to manage all types of risks faced by the organisation. It describes:
- The ICB’s approach to managing risk and risk management processes
- The ICB’s risk management objectives, and
- The ICB’s organisational and individual accountability for risk management.
The ICB is dedicated to ensuring a positive risk management culture is in place that ensures that risk management is an integral part of everything we do. This is supported by a comprehensive system of internal controls and risk management processes aligned to the working of the ICB to assure the Board of the ICB that the organisation is doing its reasonable best to protect stakeholders against risks and is capable of delivering its strategic priorities.
An effective accountability framework for the management and reporting of risk is in place, which separates the ICB’s internal governance arrangements for risk processes and management of risk, and accountability to NHS England for the operational management of risk. Risk management is embedded into the activities of the ICB.
Managing partnership risks
The key partners for the ICB include a number of NHS providers, local authorities, independent contractors including Locala, and the voluntary sector. In addition to having robust internal scrutiny arrangements, the organisations are required to contribute to joint “risk registers” and frameworks with partner organisations. This recognises the need to manage risk across organisations and partnerships to deliver whole system change and improvement. The ICB also has a number of major projects which have their own programme level risk registers and which are captured on the ICB’s main risk register.
One of the greatest risks to delivery of the 2023/24 JFP has been the ongoing Industrial Action across a number of areas of NHS professional groups. There is a risk that future COVID waves, urgent and emergency care pressures and continued industrial action will negatively impact the delivery of all elective care, due to reduced workforce and bed capacity. This will lead to reduced elective capacity, increased backlogs, delays to patient care, and implementation of new models of working to address backlogs across WYAAT.
This risk has not only been managed through internal risk management processes, it has also been managed as a partnership risk given the interdependencies with other providers and commissioners including NHSE and Local Authorities. It is likely that this will continue to be a risk for the ICB over the coming year.
Quality and safety
The ICB Quality Committee supports the ICB in delivering its statutory quality functions in a way that secures continuous improvement in the quality of services. It reviews and monitors those risks on the Board Assurance Framework and Corporate Risk Register which relate to quality, and high-risk operational risks which could impact on care. Through collaboration the ICB oversees safety across our places and the system to ensure the ICB is kept informed of significant risks and mitigation plans and they are addressed in a timely manner to ensure safe high quality care for the people of West Yorkshire.