Spring forward! Leadership Blog November 2021
In her leadership blog for November 2021 (and after recovering from Covid-19), our Chief Executive Dr Sara Munro talks about the massive changes ahead next Spring when the Government’s Health and Care Bill comes into force, and what it means for LYPFT.
Hello,
Apologies for the lack of leadership blog in October. Unfortunately I’ve been off with Covid and have only recently come out of isolation.
The experience was a painful reminder that the pandemic is still very much with us and taking its toll on our home and working lives, whilst we try and reset and recover and do all those other things that are expected of us.
We cannot escape the pressures on the NHS. Every day there seems to be another indication of how tough the situation is. Last week it was our colleagues in the ambulance services who featured in the news.
All I can say is that we are working together locally and regionally to do all we can to relieve that pressure. I know you are all working incredibly hard to deal with the demand on our services and please know it really is appreciated. There is some extra funding we can use in the short term to alleviate pressure on mental health crisis and inpatient services, and we’ll do all we can to use this and all other mechanisms available to us to get through the winter months.
Looking ahead to Spring
With a lot of focus on all the immediate pressures, you would be forgiven for forgetting that in April 2022 the Government’s Health and Care Bill will come into force. For those not familiar with it – here’s a useful explainer on the King’s Fund website.
I felt it was a good opportunity to talk about some of these new legislative changes and what they mean for us.
I know this is all very heavy, jargon-ladened stuff, but before you click away, I’ll try and live our value of keeping it simple! So, here goes . . .
First, a bit of background
The Department of Health and Social Care (DHSC) and NHS England have been developing proposals for integrated care over several years, looking at both the operational and legislative opportunities to deliver enhanced integration across the health and care system.
One of the key mechanisms for supporting integration is ‘system working’. Since 2018, integrated care systems (ICSs) have developed from pre-existing sustainability and transformation partnerships (remember them?). They currently exist as non-statutory partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.
Part of the policy proposed in the Health and Care Bill is for a statutory body to be created to drive forward the progress on integration and continue to strengthen relationships between organisations in an area. This statutory body will be known as an integrated care board (ICB), and it is intended that the area for each ICB, once established, matches the area for the existing non-statutory integrated care system.
Hope you’re keeping up!
What does that mean for us?
Currently, most of our services sit in the West Yorkshire Integrated Care System (ICS). This is a mature, well-established and constructive partnership.
We are also a member of the Humber, Coast and Vale ICS (covering York and parts of North and East Yorkshire) through our low secure forensic and inpatient children and young people’s services based in York.
Many of our regional services such as Gender ID, veterans, gambling and Deaf CAMHS span multiple ICS footprints, and therefore our relationships and reporting lines for those services are not expected to change.
The exception is services that fall under the new Provider Collaboratives (more on those later!).
Stand by for statute
As the Health and Care Bill makes its meandering progress through Parliament, we’re expecting these ICS partnerships to become “statutory”. Basically what this means is that they will take responsibility for the finance and performance of services in their area.
Clinical Commissioning Groups will cease to exist as statutory standalone organisations, with their powers and responsibilities transferred up to the ICS.
In West Yorkshire the plan is to see them reborn as Place-Based Partnerships (PBPs) made up of local NHS organisations, local authorities, public health, primary care, and the third sector.
Those with longish memories will recall Strategic Health Authorities and may say it all sounds a bit back to the future.
I believe things are different this time. For a start, the breadth of membership is much wider, with many more voices and influences at the table. And as one colleague put it recently, “the ICS is the servant of place”. Which means intelligence and priorities must flow from the ground up, as well as down from Westminster in terms of delivering the NHS Long Term Plan (remember that?).
What is important for me is that we are not sitting here waiting to be told. The legislation is highly permissive, and we can influence and shape how things are delivered on the ground given our specialist expertise, diversity and geographic reach.
Our place in the Place
As the majority of what we deliver is for the population in Leeds. That’s our Place-Based Partnership (PBP).
For the Leeds PBP we are not making any big changes because we have:
- a well-functioning Health and Wellbeing Board which sets out the ambition for health and care,
- a Partnership Executive Group chaired by the CEO of the Council and attended by all key partners, and
- a workforce strategy and infrastructure for system resilience and population health management.
Where we do need to make changes is around how we allocate resource and funding for the population of Leeds, and how we report this to the ICS board. Proposals are currently in development.
Coming back to Provider Collaboratives
You may have already heard about provider collaboratives or PCs (not to be confused with personal computers or Police Constables). They are important and at LYPFT we are literally leading the way.
As detailed in the NHS Mental Health Implementation Plan, an NHS-Led Provider Collaborative is a group of providers of specialised mental health, learning disability and autism services who have agreed to work together to improve the care pathway for their local population – taking responsibility for budgets and pathways. The Collaborative will be led by an NHS provider (like us).
A Lead Provider remains accountable to NHS England and NHS Improvement for the commissioning of high-quality, specialised services – rather than an ICS.
Sounds great, but what does it mean for us at LYPFT?
Provider organisations like us are being empowered to take control of the commissioning and provision of services, working constructively (and not in competition with) partners.
In 2020 LYPFT was named as lead provider for adult eating disorder services, known as CONNECT. Launched in 2018, this award-winning service has already made incredible progress by:
- Reducing out of area placements and length of inpatient stays
- developing a comprehensive and consistent community model and pathway across West Yorkshire, including in places where there was no community service previously, and
- reinvested financial efficiencies in the further development of the service, based on experience of local need.
And in October we were named as the lead provider for Children and Young People’s Inpatient Mental Health Services (also known as Tier 4 CAMHS) across West Yorkshire, working with our partners at Bradford District Care NHS Trust, Leeds Community Healthcare NHS Trust and South West Yorkshire Partnership NHS Foundation Trust.
Some of the finer detail is still being worked out but we look forward to working together to improve these vital and highly sought-after mental health services for children and young people.
I hope this was helpful. I’d love to hear feedback about my blogs and any of our leadership communications, as well as suggestions for future ones.
Drop me a line via our Communications Team at communications.lypft@nhs.net
Picture credit: The Blue Diamond Gallery