Better Lives, Stronger Communities Our strategy 2016 to 2021 Introduction

This strategy describes our ambitions for care in Our ambitions our area. It describes what our challenges are 1 In five years, services based in the community 3 In five years, services based in the community and the changes we will make to solve them over will work as one team for each local area, will be commissioned by local clinical leadership the next five years and beyond. based around local communities, rather than teams in the most appropriate way for their This document is different to strategies that we have around individual organisations. local populations and based on local need. published in the past. This is because we cannot 2 In five years, hospital services that could be 4 In five years, working with people in west continue to work in the same way that we have better provided in the community will be , we will have established a culture of done before. We know that people are currently not delivered as part of the local teams. Our shared responsibility for improved personal getting the best possible deal from health and care investment into acute (hospital) services will health and wellbeing. services. There is also a lot of waste in the way we decrease and investment into 5 Over the next five years, with our partners and work now and we could work differently to get more the community will increase. from our resources. for our population we will continue to work towards reducing health inequalities. We have some big changes to make to increase the quality and ensure the sustainability of our services. But we also want to support a different culture in our communities and for our local people. The NHS has traditionally not done as well as it could to support people to take responsibility for their own health and wellbeing, typically taking the view that: ‘I know what’s good for you.’ We want to change this and make sure that the NHS of the future works with people to put them in charge of their health and care so that they are supported appropriately to make changes that make a difference and the best decisions for them: ‘I know what’s best for me.’ We believe that by shifting responsibility for health, care and lifestyle to people they will not only be healthier, they will be happier, as they will be informed and in control of their lifestyles and futures.

Illustration from public event, held in March 2016 2 Leeds North 1 Leeds West

Leeds South and East

2 3

6

4 5 9 10 8 Council wards and Rawdon 7 11 Calverley and Farsley Bramley and Stanningley 12 13 Hyde Park and Woodhouse 14 Farnley and Wortley Morley North Who we represent... Morley South Ardsley and Robin Hood

3 Our population Population change Ethnicity By 2020, overall this population is set to 37,000+ increase by 2%... people now live in an area of west Leeds ranking in the 10% most deprived of the country. Overall our area has a less diverse population than the Leeds average, This has increased from 7% to 11%. though wards such as Armley, Calverley and Farsley, Headingley, Hyde Park and Woodhouse 0-19 and Weetwood are more ethnically diverse. years 81,000 people White Mixed/multiple ethnicity Asian/Asian British ...with the population Black/African/ Caribbean/Black British of over 65s set to Other ethnicity increase by 5% 372,000 20-64 people registered with years Education, Skills a Leeds West GP 240,000 people and Training including approx 50,000 students There is a wide range of educational attainment in the schools in west Leeds:

On average...

65+ As the number and years proportion of older 51,000 people people increases, Our area is home to a so does need and large proportion of Leeds’ 51%of children in Leeds achieve five A* - C GCSEs 65k student population service use. including Maths and English. In our area this 4 ranges from 22% to 75%. Avoidable deaths (PYLL*) There is a Common causes of ill-health Health and lifestyle strong link * Potential years of life lost per 100,000 people between years Rates of hypertension and COPD (name given due to avoidable causes of life lost and to a range of respiratory conditions) vary deprivation in west Leeds. However, average rates are Life Expectancy Rates of PYLL in west Leeds are in line with the average citywide rates. similar to the citywide average and On average, women in west Leeds live 3.4 years show a similar reduction: 20 19% Citywide average more than men. The overall difference between the Leeds average 6000 West Leeds average most affluent and most deprived areas is 6 years. 15

10 Most affluent 5000 6% 2009 -11 2010-12 2011-13 2012-14 5 3.6% 0.8% 0 PYLL rates, 2012-2014 Lowest Highest Lowest Highest 10000 83.2 Hypertension COPD 83.2 years PYLL rates 79.8 years 8000 are around 60% years higher in our most 6000 deprived areas. People with more than 4000 However, overall one long-term condition 76.8years rates and the gap 2000 have reduced.

0 Most deprived West Leeds Citywide 25% most deprived average Over 1/4 of adults in west Leeds have Mortality Lifestyle indicators 1 or more long term Cancer, Cardiovascular Disease and Respiratory conditions Disease (RD) are the leading causes of premature and 1 in 5 are obese avoidable mortality. This is lower than the city average Cases of these are almost double for men: Children Female rates 200 Male rates 1 in 5 people smoke

150 This is lower than the 16% city average West Leeds 100 average for childhood 50 Admissions to hospital due to asthma alcohol are 4% lower in our area 0 (under 16s) Cancer CVD RD than the city average 5 Local services and providers

Commissioning is planning and buying health Services commissioned services that local people and communities need by

Contracting both NHS and non-NHS organisations to provide the services local Children’s Adult people and communities need social care social care

Which health services for children and adults do we commission?

Safeguarding Residential Planned Urgent care: (children and care (children Continuing secondary care: A&E, GP out adults) and adults) care outpatients, of hours and surgery etc ambulance

Maternity Some Public health Community and infertility and healthy equipment newborn services lifestyles services

Community health services: Learning Mental health Some health District nurses, Environmental disability services protection health visitors health services etc

We also co-commission primary care (GP) services with NHS

Illustration from public event, held in March 2016 6 Our challenges

Health inequalities We know that there are significant health inequalities in our area. The life expectancy gap between our most affluent and most deprived areas is 6 years. Those living in our most deprived areas are much more likely to develop cancer and cardiovascular diseases and suffer from mental illness. Our challenge locally is to close these gaps.

Quality of care Peoples’ health and wellbeing needs are changing and so the way health and care services are delivered needs to change to meet them. People are living for longer and with more long-term conditions, meaning people need a wider range of care from different sources over a longer period of time. The traditional divide between primary care, community services and hospitals needs to be removed so that people can more easily access services that care for all their needs. We also need to focus on prevention and early intervention.

Financial Our system-wide challenge is that our health services are not affordable in their current form in the longer term. We need to work together with our residents and patients, our local health and social care providers and commissioning colleagues. This will help us transform local services so that we can maintain and improve the quality of services, changing them to meet the developing needs of our population.

Illustration from public event, held in March 2016 7 What do local people say? ‘What matters to me most is that services are efficient and I can easily The engagement we have carried out with local People had differing views and expectations of a people over the past few years has confirmed new place-based model - some very positive, some get access to the service that people value their NHS services highly very negative. In direct contrast to the strategic me and my family needs.’ and generally have a very positive experience. direction of travel in Leeds, people requested that The things that matter most to people about resources be allocated so that the model treats services are efficient and convenient access to all people fairly, regardless of where they live. high quality local and specialist services and There were concerns about whether the levels of being treated with dignity and respect. resource and skills would be sufficient to bring Frustrations arise when access is difficult, when about the new model and people wanted to people feel as though they have been forgotten or make sure their valued hospital services would not ‘It’s important that I can information or referrals get lost, and when services be de-stabilised as a result of a greater focus on are confusing and information has to be given community-based care. get to see my GP easily. more than once. People are also worried about Support for the new model depended on the I can’t always wait a week future sustainability of the NHS and in particular appropriate use of reliable technology, together greatly value the hospital and the specialist services for a new prescription.’ with continued sensitivity and responsiveness to available there. patients accessing services. Of particular interest are the results of a public Many welcomed a role for individuals in taking event we held in March 2016 to explore the preventative measures to look after their own concept of place-based systems and self-care health and to self-manage for minor ailments, as in some detail with local people. Place-based long as these were freely chosen. Peer support, systems of care are where NHS organisations and community groups, information and the use of other services work together across / outside their selected technologies could help. traditional organisational boundaries to address the ‘I’d like to see more care challenges and improve local population’s health Self-management for more ‘medical’ issues or for specifically for older and care. The event was attended by 71 west more vulnerable people was not popular and could Leeds residents. cause problems for the healthcare system at a later people, like my mum, who date if ill patients ‘slipped through the net’. has a lot of health issues.’

8 Our vision Our values

Our values are at the heart of the decisions we make. They guide us when we develop our plans for health services, what we think we need to do first, any ‘Working together locally changes we may need to make and how we tackle to achieve the best the challenges we face. They are: health and care in all • Respect and dignity our communities.’ • Commitment to quality of care • Compassion • Improving lives We co-produced our vision with local people and staff during 2012. It still • Working together resonates and encapsulates for patients what we want to do. • Everyone counts

9 Strategic priorities Working with our partners

We recognise that we are part of Sustainability and an interdependent health and care Transformation Plan (STP) system, so it is crucial that we do The West Yorkshire STP is under development by partner organisations in the regional not work in isolation but work in health and care system. It will show how partnership with our health and services will evolve and become sustainable social care colleagues in Leeds and over the next five years - ultimately delivering the NHS Five Year Forward View vision West Yorkshire to transform care. Our of better health, better patient care and strategic priorities will focus around improved NHS efficiency. STPs are under the delivery of the following existing development in all areas of the country. strategies that have been developed The West Yorkshire STP will be underpinned by us and by partners. by plans the health and care system has developed for Leeds. The priority areas in the Leeds STP are: Leeds Health and Wellbeing Strategy 2016 to 2021 • Prevention and proactive care Our Health and Wellbeing Strategy is about • Rapid response in times of crisis how we put in place the best conditions in • Efficient and effective secondary care Leeds for people to live fulfilling lives - a healthy city with high quality services. Everyone in Leeds has a stake in creating a city which does the very best for its people. This strategy is our blueprint for how we will achieve that. It is led by the partners on the Leeds Health and Wellbeing Board and it belongs to everyone. The vision is that Leeds will be a healthy and Illustration from public event, held in March 2016 caring city for all ages, where people who are the poorest improve their health the fastest.

10 Here is real life example of how PEP can help Building Blocks: Case studies people where traditional health services may not be able to: 1. Year of Care (care planning) ‘I know what is going on now which is a relief. I ‘I went to see my GP because I had reached Year of Care is a new way of managing long- know what I need to do and what will happen rock-bottom really - I was struggling to cope term conditions (such as diabetes) based on the if I don’t. I do feel more in charge both during for lots of different reasons. Career, single- patient and their clinician working in partnership the consultation and in managing my condition.’ parent - just a lot of things had happened over to plan their care. Year of Care puts people with (Diabetes patient) the previous couple of years, and I’d reached long-term conditions firmly in the driving seat of ‘It’s better now. There is more chance to see the point really where I didn’t feel like I could their care. In Leeds, Year of Care is a key priority things and judge for yourself. My family can go on without any support of some kind. for the three CCGs and we have been working look at the information - it’s helpful for them to I knew that medication wasn’t the answer. together with GP practices to train and support understand. Things are better... It is a lot better I also felt that I had so many issues that a staff to adopt the Year of Care approach and so for me to understand these things.’ counsellor wouldn’t have been very useful far over 2000 patients in Leeds have started to (Diabetes patient) either, so what PEP enabled me to do was to receive their care in this way. separate all the different things going wrong Year of Care involves making sure that patients 2. Patient Empowerment Project in my life and deal with them step by step. (PEP) - social prescribing are well informed about their condition and But it was more than that - they directed me that they have access to test results prior to a Sometimes people need additional support to help towards things that I didn’t know existed, they review meeting with their clinician. This allows them improve their health and wellbeing, alongside gave me ideas, they helped me - I had tunnel consultations to focus on what is important to the services offered by the NHS. We know that vision and they just widened that for me. They the patient and to develop plans together that accessing services, such as debt management or gave me choices and they’ve helped me to suit the needs of the individual. local activities that allow greater social interaction, rebuild my life - they haven’t done it for me, ‘So often they might come with a plan before can help a person deal with issues that could have they’ve helped me. They‘ve provided me with they see us because they’ve had a chance an impact on their health and wellbeing. tools to help me do that.’ PEP user. to think about and reflect on it, they’ve had In 2014 we launched our innovative Patient When PEP met this client she had left her a chance to really do some reading about it Empowerment Project (PEP). PEP is provided by previous job due to ill health. PEP supported her and then come up with a plan themselves.’ a local voluntary sector organisation and helps through her benefits claim and then to become (Leeds GP) patients by giving them the opportunity to make part of a Community Health Educator course ‘It’s to give patients some empowerment as contact with services that are not normally linked where she did sessions with the health trainers. well so that they can actually have time to to those found at their GP practice. This means Subsequently has been doing sessional work as a think about their results…it gives them more GPs from 37 practices in our area can quickly refer Community Health Educator carrying out a range opportunity to express other things that are people on to other community groups that could of activities such as health promotion and cook perhaps more important to them.’ offer them the support they need. So far around and eat sessions. (Leeds GP Practice Manager) 1000 people in west Leeds have received support from PEP. 11 Future model of care

HEALTHIER LIVES COST YOU AND YOUR NHS LESS MONEY

12 The Leeds West Way

Our work programmes Community Wellbeing place-based care In the future there will be a wider range of Place-based systems of care are where NHS services available in the community closer to As a CCG we recognise ourselves as just one organisations and other services work together peoples’ homes, including some services that component of our local health system. Although across / outside their traditional organisational people currently go to hospital for such as outpatient appointments. There will also be there are many valuable things we can do locally boundaries to address the challenges and improve local population’s health and care a greater choice of non-traditional services to improve care we acknowledge that we cannot in a geographical community (typically of available, which people will be able to access HEALTHIER LIVES truly transform care in isolation. We are therefore around 35,000-50,000 population). Our to help increase their sense of wellbeing. fully committed to working in conjunction with our programme to develop place-based systems is Development of new system incentives COST YOU called Community Wellbeing. Our Community partners across the system and using our resources Wellbeing Programme will improve local care Currently the way that money works in health to work together on system wide priorities. by bringing together all community-based and social care does not make change easy. AND YOUR NHS services to provide proactive, joined up care as We will actively explore how we can make Our local work programmes below are the things ‘one team’, working towards shared outcome bold decisions and use mechanisms that LESS MONEY we are focussing on in west Leeds which will goals. Care will focus on proactive care in the currently hinder change to enable change. contribute to our ambitions, as well as the common community which allows people to achieve This might mean contracting or paying for their goals and live will a sense of wellbeing. services in a very different way and taking aims and objectives we hold as a health system. Rather than by disease or organisation, care some risks with providers. It could include use should be organised around the place in of market levers to deliver new care models. which people live. Teams should be structured Provider development Our commitment: around geographical areas and work as part of We will support the development of new and When delivering our work programmes our key principles that local community tailoring the care to local existing providers to make sure they are ready are to improve quality, reduce health inequalities and needs and strengthening local assets, including to respond to the changes that lie ahead if to involve people. volunteering and unpaid carers. we are to transform and sustain services. We are also committed to investing in relationships to Increasing the range of services Education, training and development will be improve health outcomes. available in the community systematised throughout the layers of the We want to improve the relationships between the Some of our resources will be safely heath and care system as a key mechanism different components of our health and care system. We rebalanced from hospital where appropriate, for delivering improvement as will facilitation want to increase staff and patient / user satisfaction and increasing the number of services that are of useful data which can be used by providers facilitate all providers of care to come together to deliver available closer to home. Investment will follow of care to improve quality and reduce high quality services for the population of west Leeds. where services are provided in the community. variation.

13 One of the key developments we are supporting is the West Leeds Primary Care Network which has been created by all our 37 GP practices. GP practices who serve the same local communities are working together more closely so that they can better meet the needs of their whole community.

Supporting a new strengths based culture within our communities We will work with local communities to promote the idea of personal responsibility and make sure that people are supported to do as much as they can for themselves. We will approach this, for example, through embedding clinical approaches such as health coaching where people are supported to set goals individual to their needs. We will also strengthen local community and voluntary sector provision and alternatives to statutory services, for example through extending social prescribing. We will explore ways to promote a significant culture change through extensive community engagement, education and marketing campaigns. We will work with local people and, over time, give people greater responsibility for making the very best use of our scarce resources. We are also committed to improving the health and wellbeing of all our highly valued staff who are fundamental to delivering all of our health and care services.

Illustration from public event, held in March 2016

14 Get involved Join our patient assurance group (PAG) Our PAG acts as a ‘critical friend’ assuring us that we have the right mechanisms in place to involve patients and the wider public in our decision making. The group meets monthly to look at our commissioning plans and proposals. They offer their advice and comments to say whether we have made sufficient plans to involve and engage patients and the public. We are always keen to recruit new members to our PAG, if you feel this is something you would like to be a part of get in touch with us directly on 0113 84 35470 or [email protected]

Join your GP practice’s patient participation group If you’re interested in having a say in the way your local health services are delivered, you could get involved with your GP practice’s patient participation group. Members are usually a group of volunteer patients, the practice manager and one or more of the GPs from the practice, who meet on a regular basis to discuss the services on offer, and how improvements can be made for the benefit of patients and the practice. To find out more, get in touch with the practice manager at your GP surgery. All GP practice’s have a patient participation group, some may call them their patient reference group.

There’s lots of other opportunities for you to get involved in the work we do, find out more by visiting www.leedswestccg.nhs.uk/get-involved

Illustration from public event, held in March 2016 15 Next steps...

We are your local NHS and we want to hear + Write to us at: from you so that we can make sure that we can NHS Leeds West Clinical help plan and fund the best possible services. Commissioning Group If you have an idea, suggestion or would like to Suite 2-4, WIRA House feedback your experience of using local NHS or West Park, Ring Road NHS-funded services do get in touch with us. Leeds LS16 6EB

) Call us: 0113 8435 470

* Email us: [email protected] 8 Visit us online: www.leedswestccg.nhs.uk L Tweet us: @NHSLeedsWest F Find us on Facebook: /NHSLeedsWestCCG X See our latest videos: /NHSLeedsWestCCG