DRAFT Notes of the WY&H Partnership Board Meeting Held On

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DRAFT Notes of the WY&H Partnership Board Meeting held on Tuesday 3 September 2019

Members and Deputies Present (By place and then alphabetical by first name)

* = Organisation also part of the Kirklees Place ** = Organisation also part of both the Kirklees and Calderdale Places

Bradford, Airedale and Craven  Andrew Gold, Airedale NHS Foundation Trust  Dr Andy Withers, NHS Bradford Districts CCG and Chair of the WY&H Clinical Forum  Brendan Brown, Airedale NHS Foundation Trust  Brent Kilmurray, Bradford District Care NHS Foundation Trust  Helen Hirst , NHS Airedale, Wharfedale and Craven CCG, NHS Bradford City CCG & NHS Bradford Districts CCG  James Drury, Bradford Metropolitan District Council (Deputy for Kersten England)  Dr James Thomas, NHS Airedale, Wharfedale and Craven CCG  John Holden, Bradford Teaching Hospitals NHS Foundation Trust  Michael Smith, Bradford District Care NHS Foundation Trust  Dr Sohail Abbas, NHS Bradford City CCG  Cllr Susan Hinchcliffe, Bradford Metropolitan District Council

Calderdale  Neil Smurthwaite, NHS Calderdale CCG (Deputy for Matt Walsh)  Owen Williams, Calderdale and Huddersfield NHS Foundation Trust*  Philip Lewer, Calderdale and Huddersfield NHS Foundation Trust*  Robin Tuddenham, Calderdale Council  Dr Steven Cleasby, NHS Calderdale CCG  Cllr Tim Swift ,Calderdale Council (Chair)

Harrogate  Alistair Ingram, NHS Harrogate & Rural District CCG  Angela Schofield, Harrogate and District NHS Foundation Trust (Vice Chair)  Steve Russell, Harrogate and District NHS Foundation Trust

Kirklees  Carol McKenna Chief Officer NHS North Kirklees CCG and NHS Greater Huddersfield CCG  Richard Parry, Kirklees Council (Deputy for Jacqui Gedman)  Cllr Shabir Pandor, Kirklees Council  Dr Steve Ollerton, NHS Greater Huddersfield CCG  Cllr Viv Kendrick , Kirklees Council  Diane McKerracher, Locala Community Partnerships

Leeds  Chris Schofield, The Leeds Teaching Hospitals NHS Trust (Deputy for Linda Pollard)  Dr Jason Broch, NHS Leeds CCG (Deputy for Gordon Sinclair)  Julian Hartley, The Leeds Teaching Hospitals NHS Trust  Cllr Rebecca Charlwood, Leeds City Council  Dr Sara Munro, Leeds and York Partnership NHS Foundation Trust  Thea Stein, Leeds Community Healthcare NHS Trust  Tim Ryley, NHS Leeds CCG  Tony Cooke, Leeds City Council (Deputy for Tom Riordan)

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Wakefield  Dr Adam Sheppard, NHS Wakefield CCG  Anna Hartley, NHS Wakefield CCG (Deputy for Jo Webster)  Charlotte Dyson, South West Yorkshire Partnership NHS Foundation Trust (Deputy for Angela Monaghan)  Cllr Faith Heptinstall, Wakefield Council  Keith Ramsey , The Mid Yorkshire Hospitals NHS Foundation Trust*  Martin Barkley, The Mid Yorkshire Hospitals NHS Foundation Trust *  Merran McRae, Wakefield Council  Rob Webster, South West Yorkshire Partnership NHS Foundation Trust**

Other Partnership Board members (alphabetical by first name)

 Andy Clow, Co-opted Member  Emma Stafford, Co-opted Member  Fiona Hibbits NHS England and NHS Improvement (North East and Yorkshire) (Deputy for Anthony Kealy)  Helen Hunter, West Yorkshire & Harrogate Healthwatch organisations representative  Kate Holliday, Health Education England (Yorkshire and the Humber) (Deputy for Mike Curtis)  Dr Mike Gent, Public Health England (Yorkshire and the Humber)  Jackie Dolman, Co-opted Member  Rod Barnes, Yorkshire Ambulance Service NHS Trust  Stephen Featherstone, Co-opted Member  Dr Soo Nevison, Chief Executive Officer, Community Action Bradford & District (representing WY&H Voluntary and Community Sector organisations)  Tony Jamieson, Yorkshire and Humber Academic Health Science Network (Deputy for Richard Stubbs)

Additional attendees (alphabetical by first name)

 Donna White, BTM (Item 15/19)  Ian Holmes, Director, WY&H Health and Care Partnership  Jonathan Webb Lead Director of Finance, WY&H Health and Care Partnership  Keir Shillaker, Programme Director for WY&H Mental Health, Learning Disabilities and Autism Programme (Item 14/19)  Lauren Phillips, Head of Programmes, WY&H Health and Care Partnership (Secretariat)  Omar Sardar, BTM (Item 15/19)  Sue Crowe, BTM (Item 15/19)  Sue Rumbold, Interim Programme Director for WY&H Children, Young People and Families Programme (Item 14/19)  Tom Walsh, BTM (Item 15/19)

Apologies (alphabetical by first name)

 Amanda Bloor, NHS Harrogate & Rural District CCG  Angela Monaghan, South West Yorkshire Partnership NHS Foundation Trust  Anthony Kealy, NHS England and NHS Improvement (North East and Yorkshire)  Cllr Bob Metcalfe, Calderdale Council  Colin Martin, Tees, Esk and Wear Valleys Foundation NHS Trust  Dr David Kelly, NHS North Kirklees CCG  Dr Gordon Sinclair, NHS Leeds CCG  Jacqui Gedman, Kirklees Council  Jo Webster, NHS Wakefield CCG  Cllr Judith Blake, Leeds City Council  Kathryn Lavery, Yorkshire Ambulance Service NHS Trust

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 Karen Jackson, Locala Community Partnerships  Kersten England, Bradford Metropolitan District Council  Linda Pollard CBE DL Hon.LLD, The Leeds Teaching Hospitals NHS Trust  Dr Matt Walsh, NHS Calderdale CCG  Dr Maxwell McLean, Bradford Teaching Hospitals NHS Foundation Trust  Cllr Michael Harrison, North Yorkshire County Council  Cllr Mike Chambers MBE, Harrogate Borough Council  Mike Curtis, Health Education England (Yorkshire and the Humber)  Mrs Miriam Harte, Tees, Esk and Wear Valleys Foundation NHS Trust  Neil Franklin OBE, Leeds Community Healthcare NHS Trust  Paul Shevlin, Chief Executive, Craven District Council  Cllr Peter Box CBE, Wakefield Council  Dr Peter Davies, Regional Ambassador for WY&H, Royal College of General Practitioners  Richard Flinton, North Yorkshire County Council  Cllr Richard Foster, Craven District Council  Richard Stubbs, Y&H Academic Health Science Network  Cllr Sarah Ferriby, Bradford Metropolitan District Council  Professor Sue Proctor, Leeds and York Partnership NHS Foundation Trust  Tom Riordan, Leeds City Council  Wallace Sampson, Harrogate Borough Council

Item Agenda Item

10/19 Welcome

The Chair welcomed members, deputies and attendees to the second meeting of the West Yorkshire and Harrogate (WY&H) Health and Care Partnership Board.

The Chair explained that a Council Chamber had been selected as the venue of the meeting both to afford the best opportunity for members of the public to attend and observe the meeting and to emphasise the partnership nature of the Board, bringing together local government and health partners across WY&H. He thanked Wakefield City Council for the use of its Council Chamber, in particular Councillor Charles Keith, Lord Mayor of Wakefield.

Members noted the commitment of the Partnership Board to make the papers and discussions as accessible as possible, avoiding the use of jargon where possible.

The Chair explained that the meeting was being webcast as part of the Partnerships’ commitment to transparency and accountability.

The Chair reminded members of the Partnership’s shared mission to join up our services and investment to meet the current and future needs of the people of WY&H.

The Chair reminded members that at the last meeting (4 June 2019), one of the recommendations from Healthwatch on public engagement was to invite people with lived experience to share their perspectives with members at future meetings of the Partnership Board. As such, colleagues from BTM would be joining todays’ meeting to share their experiences.

The Chair explained that the meeting was quorate, with over 75% of partner organisations being represented, and each of the six places.

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Item Agenda Item

The Chair invited Rob Webster to give an update on national and WY&H developments since the last Partnership Board meeting.

Rob reflected that whilst we live in uncertain times, some things remain certain. For example, the existence of health inequalities; the variations in care; and that collectively we manage our resources better when we do it together. He commented that Health and Care Partnerships, such as the one in West Yorkshire and Harrogate can play a significant role in addressing some of these issues, for example today’s meeting would include discussions on workforce issues that affect the delivery of health and care; and our plans for a different future over the next five years. He added that we know from the work we have done to date, by working together in partnership we can make the biggest difference locally. When we do it in the right way, people locally feel engaged, partners feel that they can have the right conversations and the national organisations are more likely to invest in us.

11/19 Questions and public deputations

The Chair advised that as part of the Partnership Board’s commitment to transparency and accountability, there would be an opportunity for members of the public to ask questions and make deputations/statements at each of the Partnership Board meetings.

The Chair advised that the Partnership Board had agreed to adopt the approach recommended by Healthwatch, which has now been set out on our website. As a result of this we offer different ways of asking questions:

 In writing (either in advance or on the day); and  Verbally (in person at the meeting or by asking one of the team to ask a question on your behalf)

The Chair explained that wherever possible, the Board would provide a concise verbal answer to questions in the meeting. If this is not possible, further information with be provided verbally or in writing after the meeting.

The Chair advised that all questions and answers would be posted on the WY&H Partnership website (see Annex A).

12/19 Declarations of Interest

The Chair explained that the Partnership Board takes conflicts of interest seriously and that declarations of interest would be a standing item on all agendas.

He highlighted that, as set out in the Partnership Board’s Terms of Reference, members and those in attendance must abide by all policies of the organisation that they represent in relation to interests. Members noted that the WY&H Partnership Team had prepared a

composite register, bringing together, into one place, the declarations that members and attendees have submitted to their own organisation and that this had been published on the Partnership’s website.

The Chair invited members and those in attendance to declare any interests relevant to the agenda – none were raised.

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Item Agenda Item

13/19 Minutes from the last meeting – 4 June 2019

The Chair asked members of the Partnership Board to consider and agree the draft minutes of the last meeting on 4 June 2019. The draft minutes were agreed.

Ian Holmes provided an update on the actions agreed at the meeting on 4 June 2019 as follows:

Action 05/19-1: The Partnership Board Terms of Reference had been updated to reflect the amendments requested at the last meeting and would be considered at Item 14/19a on today’s agenda.

Action 06/19-1: An opportunity to reflect on, and review how the implemented recommendations from Healthwatch have worked would be scheduled for the meeting on 3 March 2020.

Action: 06/19-2: The WY&H Partnership’s approach to broader engagement would be considered at the Partnership Board Meeting on 3 December 2019

Action: 07/19-1: Since the last meeting, a WY&H programme on children, young people and families had been established with Merran McRae (Wakefield Council) taking on the role of Senior Responsible Officer. A WY&H programme on improving population health had also been established with Robin Tuddenham (Calderdale Council) and Dr James Thomas (NHS Airedale, Wharfedale and Craven CCG) taking on the roles of joint Senior Responsible Officers.

Action: 07/19-2: A first draft of the WY&H Five Year Strategy would be considered at Item 16/19 on today’s agenda.

Action: 08/19-1: The outcome of the actions relating to a revised proposition for the allocation of the 2019/20 Flexible Transformation Funding would be considered at Item 14/19b on today’s agenda.

14/19 Matters arising from the last meeting

a) Partnership Board Terms of Reference

Ian Holmes reminded members at that the last meeting (4 June 2019), members had requested amendments to the Partnership Board’s Terms of Reference in relation to the membership of the Board and the role of the Co-opted members. He advised that the amended Terms of Reference were attached at Annex A for approval by the Partnership Board and included the following amendments:

 provision for the Partnership Board to include three representatives from the Voluntary and Community Sector (VCS) as members (para 4.1);  clarification of the role of the four independent Co-opted members (paras 4.2, 4.5); and  additions to Annex 1 - list of members.

Dr Soo Nevison clarified that the role on the Partnership Board of the proposed three Voluntary and Community Sector (VCS) members would be to represent the principles that belong to the Voluntary and Community Sector, rather than represent their specific “place”. Should the three Partnership Board VCS representatives want to feed into

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Item Agenda Item discussions in relation to their “place”, this would be done through local Health and Wellbeing Boards.

The Partnership Board agreed the amended ToRs (at Annex A).

b) Integrated Care Systems Flexible Transformation Funding 2019/20

The Chair reminded members that at the last meeting (4 June 2019), the Partnership Board considered proposals for the deposition of the £8.75m of flexible transformation funding that would be available for 2019-20. He invited Jonathan Webb to introduce the paper which confirms to the Partnership Board the actions taken following the last meeting and the final dispositions of the funds.

Jonathan reminded members that at the 4 June 2019 meeting, the Partnership Board had agreed that:

 a limited sum of funding should be allocated to support the newly established children, young people and families programme recognising the state of readiness around transformational investment proposals within this programme;  a revised proposition should be shared with Partnership Board members to enable further discussion during June 2019, (including discussion with Health and Wellbeing Boards);  based on those discussions, a revised proposition should be considered at the WY&H System Leadership Executive Group Meeting on 2 July 2019;  a recommendation should be made by the WY&H System Leadership Executive Group to the Chair and Vice-Chair of the Partnership Board for decision; and  that the decision should be reported to the WY&H Partnership Board Meeting on 3 September 2019.

Jonathan added that a number of principles had been proposed to support the more detailed utilisation within each programme receiving funding (Para 7).

The Partnership Board:

 noted the decision-making process followed on the deployment of the 2019/20 flexible transformation funding since the last Partnership Board meeting on 4 June 2019 and the final disposition of £8.75m to key programme priorities;  noted the updates provided by programmes on the further process to deploy funding on individual schemes or programme support; and  requested that the Partnership Board receive information on the outcomes delivered as a result of the 2019/20 £8.75m flexible transformation funding in due course.

ACTION The Partnership Board to receive information on the outcomes delivered as a result of the 14/19-1 2019/20 £8.75m of flexible transformation funding in due course.

15/19 WY&H Health Champions with lived experience

The Chair welcomed Sue Crowe, Tom Walsh, Donna White and Omar Sardar from BTM to the meeting. Members noted that BTM is an organisation who has been commissioned by the WY&H Health and Care Partnership to provide expertise on how to better involve

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Item Agenda Item people with learning disabilities, develop the role of Learning Disability Health Champions and help to ensure that the services we provide are as accessible as possible.

Tom and Donna highlighted the importance of developing Learning Disability Health Champions and how they can make a positive difference to everyone who has a learning disability.

Based on their lived experiences, Tom and Donna highlighted the importance of:

 involving people with learning disabilities as early as possible in new pieces of work;  identifying other people with lived experiences who are not currently involved to ensure they too have a voice;  the availability of easy-read information;  the design of health and social care building and settings so that they are accessible to all people that use services;  clear communication (plain-English) and eye-contact from health and care staff;  access to training for health and social care staff so that staff have the knowledge and confidence to communicate with people who heave learning disabilities; and  making reasonable adjustments, for example: by providing written (and where possible, easy-read) information for the person to take home; by allowing the person to record the appointment to listen to again after the appointment; slightly longer appointments so that the giving of important information is not rushed.

Tom and Donna advised that making reasonable adjustments can enable people with learning disabilities to attend health and care appointments alone (should they wish to) and therefore keep their medical history private.

The following comments were raised during the discussion:

 in respect of health inequalities, a learning disability is not a health condition, however the life expectancy of someone with a learning disability is 10-20 years shorter than someone who doesn’t have a learning disability;  reasonable adjustments are a statutory duty under the Equality Act 2010 which applies to all health and social care providers;  if we get services right for people with learning disabilities (including the provision of reasonable adjustments), we get services right for everyone; and  we should encourage all WY&H programmes to access the services and capacity the Partnership has commissioned from BTM.

Members noted some examples of other work underway in WY&H to improve access and services for people with learning disabilities:

 “Project Search” a work training programme for young people with a learning disability and/or autism, aged 18-24 who would like a job currently running in partnership between Kirklees Council and The Mid Yorkshire Hospitals NHS Trust; and  “Get Me Better Champions” – a group of people with a learning disability who work in different roles to help improve care and communication for anybody with a learning disability accessing services provided by Leeds Teaching Hospitals Trust.

The Chair and members thanked Donna and Tom for sharing their experiences.

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Item Agenda Item

16/19 Developing our Five Year Strategy

The Chair invited Ian Holmes and Rob Webster to introduce the item.

Rob and Ian reminded members that at the last meeting (4 June 2019) the Partnership Board had discussed the approach being taken to develop the Partnership’s Five Year Strategy, which had begun in early Spring 2019.

Ian explained that the purpose of the item today was to share the first draft of the document (Annex B), and set out the process for further developing and agreeing it, whilst ensuring we have sufficient and appropriate engagement.

Ian highlighted the following intentions:

 to discuss and engage further on the document with individual Health and Wellbeing Boards during Autumn 2019;  to strengthen the programme content to quantify and specify ambitions over the five- year period and reflect the findings from the WY&H Healthwatch Engagement Report published at the end of June 2019 (Annex C);  to use case studies to illustrate how our priorities are being taken forward at ‘place’ level; and  to publish a summary version, an easy read document, an animation, a British sign language version alongside the main document, all of which will be available online (Annex D provides draft design options for the suite of documents).

The Partnership Board was invited to:

 provide any comments on the draft at this stage, recognising the work still to be done;  note the areas where the plan needs to be strengthened and the processes to do this; and  note the timelines for completing the plan.

Members welcomed the approach that had been taken to develop the document.

The following suggestions / comments were made during the discussion:

 strengthen the sense of distinctiveness of WY&H including our values, what is important to us and what makes us unique;  good to see a focus on prevention in the document (for example in the case studies), but should strengthen the emphasis on non-clinical prevention activities;  include more information on local authority services such as supporting people to find employment, adult social care and wider community services provided;  strengthen the ambitions to reduce health inequalities, particularly in relation to healthy life expectancy;  place a stronger emphasis on the social determinants of good health, including employment, housing, and the climate emergency;  strengthen references to social care, and the importance of social care in developing integrated community models for adults and children;  a stronger theme in the document on the importance of compassion and kindness in the care that is provided to people (as per the findings of the Healthwatch Engagement

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Item Agenda Item Report at Annex C);  acknowledgement of the pressures currently faced by local authorities and reference to the uncertainly of some local authority funding;  acknowledgement of the current instability of the domiciliary, nursing and residential care market and what action the Partnership may want to take to address this;  go further to capture our ambitions in relation to “improving population health”, including a focus on health inequalities, wider determinants of health and prevention at scale;  better describe “integrated care / delivery” rather than “silos” of work;  include a focus on patient safety throughout;  encouraging to see in the cancer section that there is not just a focus on meeting national performance targets, but an approach that is based on listening to the experience of our patients (for example through our WY&H Cancer Alliance Improvement Collaborative);  strengthen the connections between the feedback from public involvement / engagement and the actions we are taking;  set out some of the ambitions as minimum standards, reflecting that where possible we want to improve beyond these;  it would be important to support the ambitions in the Five Year Strategy with a strong commissioning plan; and  improve the flow and navigation of the document – including web navigation.

Rob and Ian thanked members for their comments and suggestions. Following discussion, members agreed that it would be helpful for the Partnership to articulate a list of wicked issues / shared ambitions in the next iteration of the document.

A further draft of the Five Year Strategy to be considered at the Partnership Board ACTION meeting on 3 December 2019 to include an articulation of the Partnership’s wicked issues 16/19-1 / shared ambitions. 17/19 WY&H Workforce Strategy

The Chair invited Brendan Brown, Co-Chair of the WY&H Local Workforce Action Board (LWAB) to introduce the paper which described the LWAB’s programme of work achievements to date, and its future priorities in order to respond effectively to the recently published Interim NHS People Plan.

Brendan highlighted that that health and care workforce in WY&H is crucial to delivering the Partnership’s ambition of improving the health and care of people across the system. If we are to truly transform our workforce and make WY&H the best place to live and work, then we need to be even more ambitious and exemplify system wide working with all our partners collectively tackling the issues we face.

He advised members that our Partnership has recently been selected to be involved in the development of the National Full NHS People Plan, which will be published ahead of the Government’s Spending Review later in 2019. Members noted that the Partnership’s involvement is via field testing a workforce development tool which is sponsored by the National People Board. This will be an enabler of work for transformation so we deliver

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Item Agenda Item better quality of care to people and fully support those who work for the NHS. It will also provide us with the insight to further develop our Five Year Strategy and enhance our workforce approach across our six local places whilst considering our position against workforce best practice.

Brendan acknowledged that the paper had been written from a health perspective, in response to the Interim NHS People Plan – however there is a commitment across the Partnership to work together as a health and social care system to tackle our workforce challenges.

In respect of the Interim NHS People Plan, Julian Hartley highlighted the following:

 in terms of context, the £20.5bn extra funding a year by 2023 (announced in 2018) does not include a settlement for Health Education England, Public Health England or capital spending in the NHS (which is the subject of the forthcoming spending review) – so the immediate challenge for the Interim NHS People Plan is one of resources;  the Interim NHS People Plan is based on an underpinning philosophy that: only by engaging our people and having an enlightened and improvement-led approach will we liberate the talent, the initiative, the enthusiasm and the drive to address some our most challenging issues;  one of the key themes in the plan is “Making the NHS the best place to work” however feedback from NHS staff (through the annual staff survey) still sees significant deficits and variations – for example reports of poor experiences in the workplace are particularly high for BAME staff;  the importance of the proposed actions outlined in the Interim NHS People Plan, such as a review of the NHS’ regulatory and oversight frameworks to ensure there is a greater focus on leadership, culture, improvement and people management;  some of the actions being taken across WY&H to tackle issues described in the Interim NHS People Plan, for example tackling the nursing shortage by increasing placement capacity whilst not compromising on quality, the work of the West Yorkshire Excellence Centre, and the work with partners across WY&H to maximise the use and impact of the apprenticeship levy; and  the intention in WY&H to continue to work collaboratively and to be clear what needs to be done locally, regionally and nationally, with more activities undertaken by the WY&H Partnership.

In relation to the “Improving Leadership” theme, the Owen Williams highlighted:

 the importance of inclusion, alongside equality and diversity;  some examples of the health inequalities that exist for people from BAME communities; and  that of the 696 local government and NHS provider organisations, there are only 13 BAME Chief Executives (approx.2%), compared to the 14% of the working age population being from a BAME community.

Owen described some examples of the work already underway within WY&H to ensure that talented BAME leaders emerge and help drive forward the health and care system including the work of the BAME Networks, and the success of schemes such as the “Stepping Up” programme for aspiring BAME leaders and various mentoring programmes.

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Item Agenda Item The WY&H Partnership was asked to note the work to date, and provide a steer on the next steps, and to identify any gaps and priorities for further work.

The following comments were raised during the discussion:

 we have workforce challenges in WY&H, but we are an ambitious system with a huge amount of things that we can harness and align to this work and we should be brave in our actions;  though the Interim NHS People Plan is focused on the NHS, the issues and challenges are equally applicable to local government;  as a sector, Social Care has the largest turnover of staff – approx. 32% per annum;  we should share learning across WY&H, for example Calderdale’s recently launched “Future Focus Framework” to develop the next generation of registered managers (care provision);  we should be creative and flexible when thinking about how to maximise the use of Apprenticeship Levy across WY&H;  we should continue to explore opportunities for a common brand and campaign for health and care recruitment across WY&H;  as leaders we have a duty to promote health and care careers, not only describe them in the deficit model; and  we should be explore existing talent pipelines such as current volunteers / unpaid carers who may want to consider a career in health and social care.

Members noted that the WY&H LWAB is currently realigning its priorities to the Interim NHS People Plan and that a list of priorities for 2019 is set out at Annex A. The next steps are to formally agree these actions through the LWAB and quantify them with Key Performance Indicators (KPIs) where possible, to support the development of a “WY&H specific People Plan”.

18/19 AOB and Close

The Chair thanked all members and attendees for their participation, and the WY&H Partnership Team for their co-ordination and preparation of the meeting papers and logistics.

There was no further business.

Date of next 3 December 2019, 2pm – 5pm, Bradford meeting:

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WY&H Health and Care Partnership Board – Action Log

Action Log Agenda Item Action By Who Deadline Status No OPEN ACTIONS The Partnership Board to receive information on the 14/19-1 Matters arising from WY&H outcomes delivered as a result of the 2019/20 £8.75m of Sept 2020 IN PROGRESS (3 Sept 2019) the last meeting Partnership Team flexible transformation funding in due course. A further draft of the Five Year Strategy to be considered IN PROGRESS 16/19-1 Developing our Five at the Partnership Board meeting on 3 December 2019 to WY&H 3 Dec 2019 (Due to be considered as (3 Sept 2019) Year Strategy include an articulation of the Partnership’s wicked issues / Partnership Team Item 25/19 on 3 Dec big shared ambitions. 2019)

06/19-1 Proposition on Public An opportunity to reflect on, and review how the WY&H 3 March Questions and implemented recommendations have worked to be IN PROGRESS (4 June 2019) Partnership Team 2020 Statements scheduled for the meeting on 3 March 2020. IN PROGRESS 06/19-2 Proposition on Public The WY&H Partnership’s approach to broader WY&H Questions and engagement to be considered at a future meeting of the 3 Dec 2019 (Due to be considered as (4 June 2019) Partnership Team Item 24/19 on 3 Dec Statements Partnership Board. 2019) Actions closed at or since the last meeting CLOSED 05/19-1 Partnership Board’s Terms of Reference to be updated to reflect the WY&H 3 Sept 2019 (Considered as Item (4 June 2019) Terms of Reference amendments requested by the Partnership Board. Partnership Team 14/19a on 3 Sept 2019) CLOSED 07/19-1 Developing our Five WY&H programmes to be established on children, young WY&H ASAP (Programmes (4 June 2019) Year Strategy people and families and improving population health. Partnership Team established and SROs appointed)

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Action Log Agenda Item Action By Who Deadline Status No A first draft of the WY&H Five Year Strategy to be CLOSED 07/19-2 Developing our Five WY&H considered by the Partnership Board at its meeting on 3 3 Sept 2019 (Considered as Item (4 June 2019) Year Strategy Partnership Team September 2019 16/19 on 3 Sept 2019) Integrated Care Agreed actions in respect of a revised proposition for CLOSED 08/19-1 System (ICS) allocation of funding to be carried out, with the outcome WY&H 3 Sept 2019 (Considered as Item (4 June 2019) Transformation to be reported to the next WY&H Partnership Board Partnership Team 14/19b on 3 Sept 2019) Funding 2019/20 Meeting on 3 September 2019

Item 22/19 Annex A

WY&H Health and Care Partnership Board meeting - 3 September 2019 Response to questions from members of the public

Question 1

In 2013, I attended many ‘Meeting the Challenge’ evenings where we, the public, were assured by NKCCG and MYH NHS Trust our views would be taken into consideration when decisions were being made. Many comments came from the public but none of any importance were listened to. The only concession gained was a shuttle but service connecting Pinderfields and Pontefract. Is this just another exercise to make it seem the public have been consulted?

Question 1: Response

Thank you for your question to the Partnership Board.

The Partnership cannot comment on consultation events in individual places or on consultation which took place before it came into existence in 2016. The Partnership is committed to hearing and acting on the voice of the public – today’s question and answer session at the Partnership Board is just a small part of this. You can find out here https://www.wyhpartnership.co.uk/engagement-and-consultation how you can get involved in the work of the Partnership.

Question 2

Over the past couple of years, my wife and I have had reason to access a number of different Health Professionals both within and outside the WY&H STP.

The evidence of our experiences has highlighted a worryingly poor level (sometimes lack of) of communication and incomplete patient data.

My wife’s increasingly updated Patient information has clearly not consistently been shared between GP practice, Mid-Yorkshire Hospital departments, private providers of NHS medical offers (e.g. Methley Spire) - all within the WY&H STP as well as between Health Professionals in a different ‘footprint - (9 Sheffield, Northern General).

1) Does the WY&H STP recognise this as an issue? If so, what is the current extent of the issue across the STP? 2) Are All GPs, Hospitals and Clinics and other Health Professionals in WY&H STP required to use one approved software programme in which to input NHS patient data? If not, has an audit been undertaken to identify the continuing costs in time, money and damage to Health outcomes due to delays as well as inaccuracies when Health Professionals initially have to rely upon a patient’s memory or notes on recent procedures that haven’t appeared on their system? 3) Are there any NHS, Country-wide IT Protocols to enable Health Professionals in different STPs to access and share patient data?

Item 22/19 Annex A 4) Finally, why does the STP highlight in your 5 year Strategic plan the positive activities of ‘Partnership’, ‘relationships’, ‘conversations’, ‘listening’ and ‘collaboration’ between the 6 local areas whilst not prioritising or signposting any tangible strategies and cost to facilitate these aspirations both within as well as between the STP and others?

Question 2: Response

Thank you for your questions to the Partnership Board.

 The Partnership recognises that the current systems, processes and technology to ensure timely and predictable sharing of non-urgent clinical information are inconsistent between all organisations that provide health care.  All organisations utilise the NHS’s “Summary Care Record” which is intended to ensure everyone that provides health care has key clinical information about patients.  The national strategy is to create shared care records inside and in between STPs that will ultimately cover the country. Our Partnership is one of the first to create a shared record as part of the Yorkshire & Humber Care Record Exemplar. The programme is working towards ensuring robust clinical information is available when needed. More information is available here: https://yhcr.org/  There is a suite of IT protocols for sharing information however further protocols are needed and are being developed as part of the Exemplar programme.  The digital strategy for the Partnership will be reviewed in October and specifically outlines a priority objective to share clinical data.

Question 3

Can the local authority provide specific assurance that the level of 0-19 budget will not be impacted by the current local financial challenges?

Question 3: Response (Note: As this question does not refer to the work of the WY&H Partnership, but specifically relates to one partner, we agreed with the member of the public who raised it to refer the question to the Wakefield Health and Wellbeing Board. For information, the response from Wakefield is provided below):

As Director of Public Health for Wakefield and the lead commissioner for this service I can confirm that the level of the 0-19 budget will not be reduced, and has been confirmed at the current level until the end in March 2021. Ongoing commitment beyond April 2021 is dependent on the outcome of the 2020-2021 spending review.

Anna Hartley, Director of Public Health, Wakefield Council on behalf of Wakefield Health and Wellbeing Board.

Item 22/19 Annex A Question 4

Speaking as a patient, a member of ‘Keep Our NHS Public’ which campaigns for a modern health service but firmly based on Bevan’s founding principles, and someone who has worked in the NHS for over 40 years. I would like to ask questions about why important elements are missing from the draft five year strategy.

There is an acknowledgement of the chronic underfunding of the NHS but not for the fact that £20m rom Mrs May, should it ever materialise, is wholly inadequate for making up the existing deficit.

The fact that the increased funding on offer will generally be absorbed in restoring financial balance is in fact acknowledged, while at the same time it is implied that it will be possible to deliver the many uncosted and ambitions service developments set out in the long term plan.

Impressive targets are set for smoking reduction at the same time as the public health budget for smoking cessation services has been cut, and while poor oral health is rightly identified as a serious problem, there is no commitment to water fluoridation, the single most effective intervention for preventing dental caries.

The underfunding of social care is identified as a problem causing huge strain on the NHS, but while the financial problems of the care home sector are referenced, the instability that comes from a model encouraging hedge funds and private equity investors to extract massive profits is not mentioned.

CCG mergers go against the localism promised with the H&SCA and distances decision makers further from communities without even the legally required consultation process having been followed.

No mention is made of the massive costs associated with marketization and competition in health care, whereas an opportunity could be taken to highlight the huge waste of resources associated with this failed experiment – coupled with a call for the restoration of the NHS as a public service.

Austerity as a political choice is widely identified as a cause of ill health and premature death as well as stalling life expectancy and yet is not mentioned.

Finally, a small point – under ‘A New Health and Care Partnership’ (p109) – could I suggest the mantra – “be the change you want to see” – is abandoned. According to an article in the New York Times, it can be found on bumper stickers, but cannot be attributed to Gandhi himself as it is in the strategy document. Perhaps take another strap line from the report as a mantra – “the Partnership Board belongs to its citizens”.

Question 4: Response

Thank you for your constructive and helpful comments and questions about the Partnership’s draft five year plan, which we will take into account in developing the document. You highlight a number of perceived gaps, which are addressed below:

 Financial challenges - You rightly highlight that the Partnership’s draft five year strategy explicitly recognises that demand for services is growing faster than the resources that

Item 22/19 Annex A are available to us. Financial sustainability is one of the key gaps which Partners are seeking to tackle. Whilst we will continue to make the case to government for increased funding, we have to live within our means. We recognise that working together and not competing for funding is the only way that we can tackle these financial challenges and deliver our priorities.

 Prevention - Preventing ill health and tackling inequalities is at the heart of our draft strategy and we are prioritising a wide range of measures designed to improve health and wellbeing.

 Competition and privatisation – in its response to the Department of Health in April 2019, the Partnership welcomed potential legislative changes designed to enable greater collaboration and integration and place less emphasis on competition. You can read the Partnership’s full response to the proposed legislative changes here: https://www.wyhpartnership.co.uk/application/files/6015/5661/2678/WYH_response_t o_Implementing_the_NHS_Long_Term_Plan__proposals_for_possible_changes_to_legisl ation_25_April_2019.pdf

 Austerity and ill health - whilst we may not have employed the term ‘austerity’, we explicitly recognise in our strategy the impact of the under-funding of services such as social care. We also highlight the impact of deprivation on health and wellbeing and have set how we will work together on key issues like employment, housing and community support.

 Accountability – you reference CCGs mergers as going against localism and highlight the need for the Partnership Board to belong to its citizens. Our Partnership is built on the principle that our local places are best placed to make decisions about their local area – including, for example, the configuration of CCGs. Where the CCGs have agreed to work at WY&H level, we are committed to ensuring that decision making is clear and accountable through our Joint Committee of CCGs. https://www.wyhpartnership.co.uk/meetings/west-yorkshire-harrogate-joint- committee-ccgs

 The Partnership is clear that the Board belongs to and is accountable to its citizens. We have introduced a range of measures to enable citizens to be involved in the decisions that it takes, including the question and answer session at the start of each meeting. More widely, the Partnership is committed to hearing and acting on the voice of the public. You can find out here https://www.wyhpartnership.co.uk/engagement-and- consultation how you can get involved in the work of the Partnership.

Item 22/19 Annex A Question 5

Partnership Board Terms of Reference

1. Para 1.5 says that over time the Integrated Care System leadership is going to enact the NHS quangos’ regulatory and oversight functions. What leadership? Presumably this means the Board? Since 3.1 says ‘The Partnership Board will provide the formal leadership for the Partnership.’

2. How can you square the limitations on the Board’s decision making powers, with enacting the NHS quangos’ regulatory and oversight functions? These limitations are identified in 3.1, which says the Board “will make joint decisions on a range of matters which do not impact on the statutory responsibilities of individual organisations and have not been delegated formally to a collaborative forum.” But the NHS quango’s regulatory and oversight functions DO impact on the statutory responsibilities of individual organisations. Where is the consent of these statutory organisations to bringing such matters to Board decision making? Surely this would require these statutory organisations to formally delegate these matters to the non-statutory Board?

3. Similarly, (3.1.v) says that this non statutory non organisation Board with no formal delegated powers from the statutory organisations in the ICS is to oversee financial resources of NHS partners within a shared financial framework for health across the constituent CCGs and NHS provider organisations; and maximise the system-wide efficiencies necessary to manage within this share of the NHS budget. This is also referred to in the 5 year strategy, in term of taking collective responsibility for a single control total for the Integrated Care System, in exchange for anticipated extra funding from NHS England. By what statutory powers is the Board to do this?

Question 5: Response

Thank you for your questions to the Partnership Board.

 The Partnership Board Terms of Reference set out an aspiration for the Partnership and the Board, over time, to take on more local responsibility for regulatory and oversight functions. Should this in the future have an impact on the statutory responsibilities of individual organisations, we will put forward proposals for any changes to the role of the Board which may need to be considered.

 The Partnership Board has no statutory powers and relies on a shared commitment to collaborative working. In relation to finance, Partners recognise that working together and not competing for funding is the best way to tackle the financial challenges that face us. We do this by working together within a shared financial framework and maximising system-wide efficiencies. The Partnership Board is supported in this by a Finance Forum which is comprised of the finance leaders of all our partner organisations. The Forum enables knowledge and intelligence to be shared and aims to build agreement around a shared direction of travel.

Item 22/19 Annex A Question 6

Relationship between Board Terms of Reference and Five Year Strategy

4. Similarly, .1.vii. in the Board Terms of Reference commits the non-statutory non organisation Board to making sure that the member NHS, social care and public health organisations operate the Optum system of population health management in primary and community health services. This para does not mention Optum but it seems clear that this is what is meant by population health management in primary and community health services. a) By what legal powers is the Board to do this? b) What is the relationship between:  Terms of Ref 3.1.vii,  The statement in the Executive Summary of the Developing our 5 year strategy document that the 4th June ICS Board meeting decided to expand the existing prevention programme into a new improving population health programme, and  The NHS England/Optum 20 week population health management programme that ran from Jan-May 2019, which Optum delivered to the Leeds PHM development programme, made up of officials from Leeds Clinical Commissioning Group and Leeds Council Adult Social Care and Public Health directorates.

5. In that 20 weeks, the February 2019 PHM Newsletter shows that Optum basically supplanted the statutory CCG and Council commissioners by providing “practical support” for redesigning care for the frail elderly, and providing actuaries and population health analytics to the business intelligence team. Optum’s “practical support” produced business intelligence outcomes that I don’t really understand but that is to do with the business model for the redesigned frail elderly care model. My question is: in terms of the work of the Leeds Developing PHM Business Intelligence Team, made up of System Business Intelligence and Finance Leads, what exactly is meant by the outcomes that resulted from Optum’s “practical support”? i.e.:  Localised population health insight report – where is this and can we see it?  Case for change for identified opportunities – ditto  Balanced outcomes framework – ditto  System model – ditto

Question 6: Response

 The Partnership Board has no legal powers in relation to population health management (PHM). Its objective is to promote partnership working in each place to ensure a better focus on the needs of individuals and provide more care in primary and community settings. The places that make up our Partnership can seek support in doing this, but the Partnership has no powers to, or any intention of, promoting the approaches of any specific companies or other organisations.

 It is not correct that Optum ‘supplanted’ the role of CCG and Council commissioners. Commissioners agreed to work with NHSE as part of a national PHM development programme. Optum were commissioned by NHS England to work with them to deliver the programme. The programme provided support and resources to develop

Item 22/19 Annex A our use of population health management to deliver more personalised care for people.

 Localised population health insight report The outcomes produced from the support include detailed data packs for localities covered by Local Care Partnerships (LCPs). Public health intelligence profiles are used to provide context for the PHM analysis. These are available here: https://observatory.leeds.gov.uk/health-and-wellbeing/ph-documents/. A specific example for Beeston is available here https://observatory.leeds.gov.uk/wp-content/uploads/2018/11/Beeston-LCP- footprint-health-profile.pdf )

 Case for change In terms of the case for change, the analysis provided by Optum and supplemented with local data on Frailty deficits has supported LCPs to select sub-segments of the Frail cohort.

 Balanced outcomes framework In April 2018 a set of outcomes were developed for people identified as living with frailty. These are attached. These were co-designed by local health and care professionals working with local people to find out what matters most to them.

 System model The PHM development programme delivered an actuarial model and the training to use it. This model allowed us to look at the system wide projected increase in estimated costs by population cohort as opposed to by point of service delivery. Further training was provided to improve the actuarial model. This included an introduction to the Delphi method, an iterative process by which expert views are gathered from across the system as to the potential effectiveness of interventions on demand for services. The aim is to reach consensus on changes to service delivery and the impact those changes could have on future service use. Please note the actuarial analysis was undertaken for the whole Leeds population not at LCP level.

More information about the PHM work in Leeds is available from: [email protected]

Question 7

Of course all this depends on having the technology for a population health management tool, so in June, Yorks and Humber Local Health and Care Record buys £4m kit from Deloitte, Google and Synanetics, through a five-year contract for Deloitte UK, Google, Cloud and Synanetics to “work in partnership across the region”.

My questions are:  What exactly does this “partnership” work entail?  Which organisations are part of this “partnership” just the 3 companies, or the 3 companies and the NHS organisations and local authorities across Yorkshire and Humber?

Item 22/19 Annex A  The news report says that “the data collected and used will remain within the NHS, in compliance with data protection regulations”. So is it correct that these 3 companies will be collecting confidential patient data?  Which organisations will “use” it?  And which organisations will define how this data is used? Statutory NHS and Local Authority commissioners? Or the companies themselves, providing “practical support” i.e. doing the work, as Optum did in the 20 week population health management programme.

Question 7: Response

What exactly does this “partnership” work entail? In order to provide improved population health management capability across the region we have contracted three external companies that are experts in providing technical/digital resource. The contract is held by Humber Teaching NHS Foundation Trust on behalf of the Health & Social Care organisations in the Yorkshire & Humber region.

Which organisations are part of this “partnership” just the 3 companies, or the 3 companies and the NHS organisations and local authorities across Yorkshire and Humber?

Yorkshire & Humber Care Record is made up of: · Humber, Coast and Vale Health Partnership · South Yorkshire and Bassetlaw Integrated Care System · West Yorkshire and Harrogate Health and Care Partnership · 74 NHS and local authority organisations across the region · 725 individual GP practices

The team working on the Yorkshire & Humber Care Record contracted the three companies (consortium of expertise from Deloitte UK, Google Cloud and Synanetics) following a robust procurement exercise using the Health Systems Support (HSS) Framework, which was created by NHS England to guarantee the procurement was robust, extremely thorough and diligent.

The HSS Framework makes certain that suppliers have passed rigorous selection criteria to confirm their products are of a high quality, their prices fair and their financial position stable. The Yorkshire & Humber Care Record team manage the contract with the three suppliers on behalf of the organisations listed above.

The news report says that “the data collected and used will remain within the NHS, in compliance with data protection regulations”. So is it correct that these 3 companies will be collecting confidential patient data?

No. Deloittes and Synanetics provide the technical capability to share information safely and securely from organisations and this will be stored in the cloud – which is provided by Google Cloud UK. They do not have the ability or right to see the data because this is protected and encrypted. The data collected and used will remain in the hands of the NHS. All data will be encrypted, stored securely in the UK and will not be used for any other purposes beyond population health management

Which organisations will “use” it?

The anonymised data that is collected will be available to the three health partnerships (of which West Yorkshire & Harrogate is one) and the individual NHS and local authorities that

Item 22/19 Annex A work for the populations they serve with the Yorkshire & Humber region and will help to deliver the NHS Long Term Plan. Again, this is under strict data protection rules.

And which organisations will define how this data is used? Statutory NHS and Local Authority commissioners? Or the companies themselves, providing “practical support” i.e. doing the work, as Optum did in the 20 week population health management programme.

Population health management will help to provide improved intelligence on the populations they serve within the region and it is hoped that will allow better planning and improved services that help people in our area. It is up to the organisations and the health partnerships to agree how they may alter or change services because of gaps identified due to being able to see better information on what is required in our changing populations. The three organisations do not offer “practical support” on the information available. However, Deloittes is in the process of setting up a “Population Health Management Academy” which will train and improve the skills of NHS/local authority staff in working and understanding data. Please note, that this is in the early stages of development and has not been launched yet, further news will be made available on www.YHCR.org website when available.

. Question 8

The Five Year Strategy, pages 28-29 says that the ICS Board will:

 Support places with organisational and leadership development to support PHM. Including working with partners to promote Chief Information Officer representation on each NHS organisation’s board.  Share learning from exemplar sites within the Partnership to allow others to learn from their experiences. For example the approach Leeds has taken to using a PHM approach to improve outcomes for those living with frailty. (This is a reference to Optum’s work on redesigning frail elderly care in Leeds.)

My questions are: a) Does ‘places’ mean local authorities? And are Chief Information Officers Local Authority employees? b) How will this support and shared learning be carried out? c) Which organisations will deliver it? d) Will it be down to Leeds Developing Population Health Management Programme? e) Will Optum provide any of this support and shared learning? f) Does the adoption of the Optum model of Population Health Management by WY&H ICS involve the purchase of Optum PHM tools such as data analytics etc.? g) Which organisations will “support” Primary Care Networks to develop population health management?

Question 8: Responses a. Place Place refers to the 6 geographies that make up the West Yorkshire and Harrogate Partnership (Bradford, Calderdale, Harrogate, Kirklees, Leeds and Wakefield). When we refer to “place” in reference to PHM we consider all health and care organisations that

Item 22/19 Annex A commission and provide services for the populations for each of the 6 geographies. This is wider than local authorities and also includes (but is not limited to), NHS Clinical Commissioning Groups, NHS Hospital Trusts, Mental Health Trusts, Community Trusts, Primary Care Networks and Voluntary and Community Sector Organisations. Chief Information Officers are generally employed by NHS Trusts. b. Support and learning To date we have shared learning between each of the six places at the West Yorkshire and Harrogate PHM Network and members of that network have also been invited to the national PHM Community of Practice events which take place quarterly. In addition to this we have learning workshops planned for Autumn/Winter 2019/20. Each place, through their nominated PHM contact, has been offered support through the form of workshops aimed at increasing PHM capability for Primary Care Networks (or equivalent). c. Which organisations will deliver it? One workshop per place will focus on accelerated learning for one PCN (supported by the AHSN and Imperial Health Partners) and one will focus on a broader introduction to PHM for all PCNs, with practical support for getting started (supported by the National Association of Primary Care). d. Will it be down to Leeds Developing Population Health Management Programme? We have shared learning from Leeds and will continue to do so; an event on 17th September will be another opportunity to learn from the PHM Development in Leeds. But this only forms part of the learning and development offer. We will continue to also seek learning from other areas. e. Will Optum provide any of this support and shared learning? Optum will be supporting a PHM event in Leeds on 17th September on improving outcomes for people living with frailty in Leeds. This is part of sharing learning from the PHM development programme. There will also be national case studies and materials published from the PHM Development Programme run by Optum. This will include the work in Leeds but also three other sites which were part of the development programme. We will share these through the West Yorkshire and Harrogate PHM Network. f. Does the adoption of the Optum model of Population Health Management by WY&H ICS involve the purchase of Optum PHM tools such as data analytics etc.? As a partnership we are supporting the development and implementation of PHM, however we are not supporting one single approach to PHM. Optum are one organisation who can provide PHM support but there are other providers which local places may decide to use to support implementation or places may decide to develop and utilise their own expertise. The use of Optum to facilitate an accelerated PHM development programme in Leeds has been funded through a national support offer from NHS England. g. Which organisations will “support” Primary Care Networks to develop population health management? Please see responses to b. and c. above.