As we approach winter, we are seeing concerted efforts across health and care to prepare effectively for winter. One of the conversations we have been having with NHS England and NHS Improvement is the role of the West Yorkshire and Harrogate partnership in managing winter pressures. In our partnership, with our focus on local places and systems, most of the work gets done through local A&E delivery boards and local partners. At a West Yorkshire and Harrogate level we need to be careful not to confuse matters or add layers of bureaucracy.
What we do know is that working together at this level can make a massive difference. Our West Yorkshire Acceleration Zone was able to demonstrate improvements in urgent and emergency care through sharing good practice, targeting areas of pressure and focused interventions in some trusts.

This will be the approach we want to take collectively this winter. I will be sitting down with colleagues from NHS England and NHS Improvement to make sure we focus on the right activities at this level, building on work agreed between the West Yorkshire Association of Acute Trusts and Joint Committee of the Clinical Commissioning Groups.

Winter is causing significant headlines, with a number of stories about interventions from the Department of Health and national regulators. This includes the segmentation of all parts of the country into layers of performance on A&E. It is reported that Chief Executive departures are linked to this and there is a return to a more performance driven culture in the NHS.

I think what is clear is that we need to do all we can to achieve national targets and make progress on priorities of mental health, primary care, urgent care and cancer. This is going to be a tough ask and will require the right culture and support. It also requires us to recognise that these are all interlinked. A&E performance is a system issue not solely an issue for hospitals. The impact of poor investment in mental health, primary or social care is felt at the front door of the hospital.

Conversely, we can develop services that are more joined up and help people be seen in the right places.

Our culture is based on engagement, mutual accountability and support, as well as the professional insight into performance and management. The CQC presented findings at the Queen’s Nursing Conference from their inspections, which show cultures of engagement deliver better quality improvement. It is not enough to have a plan or a strategy; staff must be involved in its design and delivery. That culture needs to be set from the top – in organisations and the system. As an STP leadership team, we will ensure that this is the case.

I was delighted that the first clinical leaders’ network for STPs was held in London this week. I will ask Dr Andy Withers, Chair of our Clinical Forum, to talk about this in next week’s message. Clinical leadership and a culture of stewardship are required in the coming years. Money will always be an issue – it is as much an issue for the government in the USA as it is in Zimbabwe. We need to ensure clinical leaders – and public voices – look at how we deliver the best value and highest impact with what we have got.


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