How we will work together to achieve improved health for all

Building from neighbourhoods

Our NHS West Yorkshire Fuller Board was formed in December 2022 building on existing arrangements but also based on the recommendations from the Fuller Report.

The main purpose of the Board is to support delivery of our integrated care board strategic priorities and objectives for primary care and community health services – in a way consistent with the scheme of delegation, principle of subsidiarity and alignment with the ‘three tests’ for partnership working (for example working together where it makes sense at a West Yorkshire level). Moving forward the Board’s remit will be guided by the refreshed West Yorkshire Five  Year Strategy, the Joint Forward Plan and implementation of recommendations in the national Fuller Stocktake Report.

At the first meeting, discussions reflected on the outputs from a roundtable in November on the themes arising from the Fuller Stocktake Report. This covered potential priorities for the first 12 months and beyond, and developments that could support achieving the vision in the Fuller Report. This was viewed alongside a map of the building blocks to support transformation to take place, such as the West Yorkshire operating model, governance arrangements and a draft terms of reference, potential workstreams and sub-groups.

Our strategy begins with people, families and in the local communities or neighbourhoods in which they live. The ability of neighbourhood teams, working together in an increasingly integrated way across the breadth of health and care services to meet the needs of our communities, underpins our ambitions to improve outcomes and tackle inequalities.

We know that in recent years, we have seen increasing pressure across primary care, community health services, social care and within the voluntary community sector. This has largely been due to a combination of increased demand for care resulting from factors including an ageing population with greater morbidity, changes in people’s needs following the pandemic, and increased pressures on the primary care and community workforce.

Since our original strategy was published in 2020, and often in the face of the pressures created by the COVID pandemic, we have continued to see local teams and services within our neighbourhoods work more closely together – for example through primary care networks and other related models of community and locality working. This is better for our populations in terms of helping provide a more joined-up experience, more personalised to people’s needs and that helps people stay healthier and well at home and close to home. More integrated working also creates further opportunities and rewarding roles for our staff. We know this is an on-going journey and one that we will need to keep in focus together across the Partnership over the next five years.

For example, as we take on responsibility for pharmacy, optometry and dental services over the coming year, there is also an opportunity for us to integrate these services further into our neighbourhood model of working. Our voluntary community social enterprise partners are already an integral part of the way we work in our neighbourhoods, and there is valuable learning as to how other partners can integrate their work and their teams. This will then ensure that we have a diverse team representing not just traditional health and care but also wider determinants of health, to wrap around individuals and families providing the support they need.

Mental Health Learning Disabilities and Autism (MHLDA) Collaborative

Our MHLDA Collaborative consists of our four mental health/learning disability trusts across West Yorkshire. It is designed to help drive forward the system changes that need to be made, remove barriers to integration and ultimately ensure that our resident population receive the best care and support that can be offered within finite resources.

Through the Collaborative, providers will share and learn from their experiences, including what has not gone well, offer peer support and challenge. Boundaries between services, organisations and across the provider/commissioner landscape will begin to blur, focusing on becoming “one workforce” with a collective ambition.

We know that the pandemic has had a significant impact on mental health and this is now compounded by the cost of living crisis. As a collaborative, much work has been undertaken over recent years to transform services and this will continue through the delivery of this strategy.

Community Health Services Provider Collaborative

Our collaborative of community services providers, which formed in 2021, has come together to work collectively on shared issues of common interest to the sector, such as enabling more healthcare to happen close to home, and where joint approaches or shared learning, such as in workforce development and service redesign, can add collective value.

The collaborative has an important contribution in delivering the strategy by working together and with other partners, ensuring that community services have a clear and engaged stake in the direction and decisions.

Hospice Collaborative

In West Yorkshire we have an ambition that people will die well and have a good death. Our Hospice Collaborative is built from a powerful trust base and has strong relationships through which it delivers a manifesto for palliative and end of life care.

Through our strategy we plan to provide the very best palliative and end of life care for the people of West Yorkshire, which will be personalised, holistic, accessible, a good life to the end and a good death. We will provide effective and personalised support for carers, families and friends and ensure access and inclusion of diverse communities across West Yorkshire.

Working with the Palliative and End of Life Care (PEoLC) networks from each of our places, and a range of health, social care and VCSE representatives and people with lived experience of PEoLC, as an ICB we are committed to developing a vision of PEoLC to enable people to die in a place of their choice, with people that matter to them and what their end of life wishes in place.

Collaborating with improving population health, children and young people, harnessing the power of populations, colleagues leading inequalities research and Healthwatch, a key focus is to speak with our communities experiencing inequalities across West Yorkshire so we can learn how to improve palliative care support, reduce inequities and enable personalised outcomes at the end of life, as well as providing diverse person centred bereavement and community support.

We want to make sure that hospices are working in a seamless way with the NHS and palliative end of life care system, to meet the needs of patients, reduce unnecessary hospital admissions and enable patients to be discharged home or to the setting of their choice. We are working with our hospices to raise awareness of the range of support available and how this can be provided within our local communities, and through virtual support.

Working with NHS England, Care Quality Commission and OFSTED

NHSE has a key leadership role in relation to the health challenges we face as a country. The focus and emphasis it has placed on important topics such as elective recovery, urgent care, primary care access, cancer services and mental health absolutely reflects the priorities of people who live in West Yorkshire, and it is critical that NHSE continues to amplify the importance of these issues. We will work with NHSE to ensure that they are able to define what needs to improve and as a partnership we can focus on how we deliver this according to our local need and relationships.

We work closely with the NHSE team and have built a relationship over many years which is based on openness, trust and mutual accountability. This enables our Partnership to balance the tension between national and local requirements and need. We continue to work to support national programmes of work around improvement and innovation, building on our own approach of clinical leadership and coproduction.

We also work closely with the Care Quality Commission and recognise the importance of their role in system oversight. It is important that this is co-produced with systems so that enablers such as shared clinical risk, joint roles across organisations, multi-disciplinary and multi-agency teams working across the NHS and social care are recognised. Through the life of this strategy we will seek to undertake broader collaborative working across regulators such as the CQC and Ofsted in relation to children’s services, acknowledging system working and the broader impact of regulatory decisions across services.

Working with wider partners

We need to work effectively with partners outside of health and social care to make the most impact on health and wellbeing, as so much of good health is related to wider determinants of health such as employment, technology, policing, the economy and climate change.

We have a long history of successful working in relation to wider determinants of health, for example through our work on health and housing. In some parts of West Yorkshire, we have successfully introduced housing advisors into hospital settings so that we can begin to address people’s housing needs as soon as they are admitted into hospital, therefore supporting the discharge process. We are also undertaking an assessment of the housing needs of people with learning disabilities, autism and severe mental Illness to drive change in future planning decisions and ways of caring for people outside of hospital settings.

As a Partnership we are committed to working with both the West Yorkshire Combined Authority and the West Yorkshire Mayor on work which will in turn improve the health and wellbeing of our population. We know that employment, housing and transport all have an impact on health and wellbeing and are all factors of concern in the cost-of-living crisis. We know that this is an issue for both our workforce and our population.

It’s important to also note that with the creation of the North Yorkshire and York Combined Authority over the coming year, there is likely to also be a new elected mayor who will work for the people of Craven. It will be important to link with the new mayor to plan together.

In delivering this strategy we aim to work more closely with our partners to tackle this, placing more focus on the action we can take. The West Yorkshire Mayoral Pledges align well to this strategy and provide us with a good opportunity to focus our work around supporting broader social and economic development, working on the factors that are important to our communities and our workforce. As a partnership we have opportunities to work more closely with these wider stakeholders.

There are a significant number of large employers in a broad range of sectors across West Yorkshire. Taking a proactive approach to working with employers on health promotion and prevention will be mutually beneficial and more accessible for the population. Working with education and early years providers to support children to have the best chances in live and outlook for their future is an important element of our wider working.