Rob Webster, chief executive of South West Yorkshire Partnerships NHS Foundation Trust speaks to Healthcare Leader deputy editor Angela Sharda about the progress he has made in his STP in the past 12 months.
The West Yorkshire and Harrogate (WY&H) sustainability and transformation plan (STP) covers six acute trusts, 11 CCGs, a population of 2.6 million patients and has a collective budget of £5bn.
The plan looks at prevention, better co-ordinated services, preventing unnecessary hospital admissions and supporting people to stay well. It aims to address the health and wellbeing gap with a focus on supporting people to live longer, healthier lives, and ensuring a good and equitable service for all, no matter where people live.
Led by Rob Webster, it is built on existing local plans for people in Bradford, Calderdale, Harrogate, Kirklees, Leeds and Wakefield, which have emerged from the work of local health and wellbeing boards.
WY&H has identified nine priorities:
• Primary and community services
• Mental health
• Urgent and emergency care
• Specialised services
• Hospitals working together
• Standardisation of commissioning policies
Q What progress have you made in your STP in the past 12 months?
A • We have successfully bid for resources for cancer, diabetes and mental health with £31m of additional resources.
• We have successfully applied to change the way specialist care for child and adolescent mental health and eating disorder services are delivered.
• We have seen new services develop on issues such as perinatal mental health for expectant and new mothers.
• We have shown that we can work together to improve urgent care, with the Accident and Emergency Acceleration Zone showing a 10% improvement on people seen within four hours in A&E departments from January to March 2017.
• We have been selected by NHS England for innovative programmes, such as developing new support arrangements for unpaid carers.
We have also made changes to the way we work, with simpler arrangements, for example:
• A new WY&H joint committee of 11 CCGs that meets in public every other month.
• As a critical and integral part of the WY&H partnership, the six hospital trusts have come together as the West Yorkshire Association of Acute Trusts to form a committee in common.
• We have built capacity into our programmes through the alignment of staff from NHS England and CCGs rather than appointing new people.
• We are working better with local government and are jointly appointing a WY&H head of health partnerships with West Yorkshire Combined Authority.
Q How close are you to hitting your cancer survival rates by 2021?
A Although our survival rates are improving,WY&H still falls behind England’s average survival rate of one year (our 69.7% comparedwith the average rate of 70.2%).
The WY&H Cancer Alliance is working with partners across the six local areas of the STP to deliver a single cancer plan. The Alliance’s plan (2017 to 2019) states an ambition to increase its one-year survival rates across WY&H from 69.7% to 75% by 2021.
Latest available figures across Yorkshire and the Humber (Public Health England, Yorkshire Cancer Research, NHS England, 2013) show between 100% and 53% one-year survival rates for breast cancer patients; 98% and 57% for prostate cancer patients, and 97% and 49% for colorectal cancer patients, with rates varying dependent upon the stage at, and route of, diagnosis.
Please note these are figures for across Yorkshire and the Humber and are not comparisons across CCGs.
Significant improvements in both one-and five-year survival rates for the four main cancer sites – lung, colorectal, prostate and breast – are largely underpinned by the impact of early diagnoses.
Q What are the financial and operational pressures you still face?
A The funding available to WY&H health and social care services is set to increase to £5.8bn by 2020-21, representing an overall increase of £0.4bn from 2016-17.
Based on forecast levels of population changes, pay and non-pay inflation, advances in medical technology and rising patient expectations, demands on our resources are growing faster than those available; as a result our services are under increasing financial pressure.
We are refreshing our financial strategy for the WY&H STP. This will continue to be based on being more efficient within organisations, changing the way we deliver care and targeting the additional income expected to support change.
We will also need to address operational pressures, which include some elective waiting times, urgent care targets, staffing, capacity in general practice, social care and links with care homes.
Q What approach has been working in your STP?
A We are developing a much greater focuson preventing ill-health and reducinghealth inequality. In the past six months ourpartnership has made major strides in thisarea through:
• The structures we have established to support joint working.
• The support we have given to our priority programmes, so that we can deliver change at pace.
• Our commitment to engaging with local communities and tackling inequalities.
• Our commitment to developing a joint-owned financial strategy rather than competing organisational plans.
• Our conversations with people and communities who both provide and use services across our area.
Q What techniques have you used to reach different groups and what brings the public on board?
A We want to keep everything as local as possible.
This is possible because our STP is built up from local plans that have been in development since 2012 when the Health and Care Act required local government to have a health and wellbeing board and local health and wellbeing strategies.
That is why we mapped out all engagement and consultation activity in WY&H and published the findings alongside the STP.
This information has informed the development of our draft plans so far and will help identify where further engagement is needed.
At a WY&H level, we continue to have patient groups as equal partners. Our joint committee has an independent lay chair and two public lay members.
Healthwatch is a key partner at all levels, with its organisations supporting engagement with local people across a number of the WY&H key areas in the past 18 months.
We have also established a CCG lay member assurance group, which meets every three months. We are looking to develop this further with hospital non-executive directors.
Q What were your key priorities at the start of 2017 for your STP, and are they still the same?
A Our priorities are consistent with ourdraft plan submitted last November, withparticular emphasis on:
• Managing through the winter.
• Focusing on cancer, maternity, GPs and primary care, mental health and urgent care.
• Refreshing the financial strategy and bidding for capital funds from the budget.
• Building clinical networks.
• Engaging the public with genuine involvement in the STP.
• Building the governance so we have more autonomy from central government.
• An infrastructure to support innovation.
Q What key challenges are you facing? And how are you trying to resolve them?
A We are working in a system that is designed to be a quasi-market with independent regulators, in which every provider is on a path to becoming a foundation trust. That is not the way we are moving – collaboration is key to the future. In addition, local government has been dealt a very difficult hand from central government and we are trying to work through the consequences.
Q How are you finding tackling the overweight population with a BMI of 25 or more?
A Diabetes prevention is a priority for us with a coordinated programme that offers weight management and physical activity interventions. This includes targeted support for people with a raised BMI.
Work is taking place in our six local places to help promote environments that support healthy eating workplaces, including local authorities reviewing the density of fast food outlets close to schools through to increased physical activity.
Q What lessons have you learned along the way and what advice would you pass on to other STPs?
A • It is possible to improve care in today’s climate and there are examples of this everywhere.
• Don’t underestimate the challenges of working together. The behaviours, relationships and the shared goals must all be strong enough to bind the organisations together.
• This is the first-ever ground-up reorganisation of the NHS, where there is real space for innovation and working methods. Push the boundaries of this where it makes a difference to the people who need support.
• We have to be credible. That means an honest assessment of where we are today, the progress we have made and what opportunities we have for the future.
• We won’t reach the ambitions of our STP without collective and clinical leadership and the full engagement of our communities.
• The NHS is and will always be a political issue – embrace this and don’t fight it.
Q What success have you made in tackling the 455,000 binge drinkers?
A Approaches are being strengthened across WY&H on evidence-based interventions, such as advising local authorities on the potential health impacts of granting alcohol licences, delivering alcohol awareness training to employees and working with the NHS to improve hospital-based initiatives.