The health and care system in England is about to enter a period of change, with integrated care systems (ICS) now being seen as the unit of planning and delivery. This is the culmination of five years’ work between councils, the NHS, voluntary, community and social enterprise (VCSE) and communities. The legislation planned for 2021 will help us move to the next stage in ICS development. In doing so, we need to recognise that the pandemic has reintroduced an old problem for the NHS – very long waiting times.
As a mature ICS we support 2.7 million people, 500,000 of whom live in areas ranked in the most deprived 10% of England and 20% of people are from minority ethnic communities. We take an approach built on collaboration in places, between sectors or across a whole system, depending on the issue at hand. This uses the strengths of all partners and communities. Those involved work for the greater good – pandemic or not – to address historical inequalities and improve outcomes.
This approach has led to positive system-wide change in hyper acute stroke units, vascular services, assessment and treatment units for people with complex learning disabilities; specialised child and adolescent mental health services, adult eating disorder care and the Healthy Hearts Project which has identified thousands of people at risk and aims to prevent 1,200 heart attacks and strokes in the next 10 years.
New technology is improving cancer diagnostic pathways and our work on perinatal mental health is setting out how we can further improve maternity care. The hard work of designing projects, such as the West Yorkshire and Harrogate Pathology Network, Scan4Safety and Yorkshire Imaging Collaborative across acute trusts enable better care and value for money, as well as the sharing of expertise and resources.
Crucially, we had supported all of this with a new approach to finances built on aligned incentives and the collective management of risks. We worked hard to achieve a shared financial control total and to fairly allocate COVID-19 resources.
We are in no doubt that the pandemic has proven our mettle. Issues of maintaining PPE supply, coordinating testing, helping over 100,000 people shielding, rolling out the vaccine programme with support of volunteers, has been achieved by the collective. For example the West Yorkshire Vaccination Programme established a health inequalities subgroup, and equality impact assessments carried out locally resulted in the vaccination of an additional 50,000 unpaid carers.
Collective strength helps deliver on health inequalities, with examples seen in our primary care networks (PCNs) developing an overarching health inequalities framework and hospital trusts working towards equitable reset and recovery. For them, waiting should be prioritised taking into account deprivation and ethnicity alongside clinical need.
The pandemic has also had a devastating impact on people who live in care homes. The vaccination programme rightly recognised this and placed residents and care home staff in the very highest categories of priority to receive a vaccination. We have seen social care working hand in glove with NHS colleagues to support people in communities. Our partnership recognises that social care covers all ages and is crucial for people with a learning disability.
System support for the VCSE has seen over £5m additional funding (on top of grants given locally) invested in their vital work – targeted at people who are disproportionately affected by COVID-19 and the indirect social impact of issues like isolation. Declaring a climate emergency, we are training our workforce in sustainable healthcare and awarding grants for green social prescribing and active travel in an attempt to get people out and about safely. With the onset of long-COVID we have also seen GPs come together to restart respiratory care using innovative approaches, not used before.
A five-year plan agreed in February 2020 set out our ambitions. It is clear that the multi morbidity and inequality we faced has not gone away. There is no doubt that health inequalities have been exacerbated by COVID-19, reflected in the impact of people from minority ethnic communities and those in areas of higher deprivation. Alongside the health and care system, jobs, housing and the environment are key.
Tackling these issues must now sit alongside addressing waiting times in our hospitals which are back with a vengeance. I have been around long enough to be part of the great work done to address long waiting times in the NHS. The techniques used then – working harder and longer and delivering more and more care – will not work in 2021. We can only succeed if we use strong partnerships of acute providers like our West Yorkshire Association of Acute Trust, the ICS Clinical Forum and the insight of councils and collaboratives in local places to address the root causes and change care delivery.
This is both a new way of working and being. As we stand at a new dawn for health and care, the measures set out in the Government’s White Paper, reflects our reality in West Yorkshire and Harrogate. The proposals support our delivery of care to communities, in a way that is locally led, less legally bureaucratic, more accountable and more joined up. We need time and tools to get on with the jobs at hand. Tackling waiting times is just one.
Rob Webster CBE is CEO lead for West Yorkshire and Harrogate Health and Care Partnership (an integrated care system). He is also the CEO for South West Yorkshire Partnership NHS Foundation Trust
