Rob Webster on deliverables offered by integrated care systems during this covid-19 crisis and the phenomenal progress in safety through joint care

Integrated Care Systems have a fundamental role to play in tackling the coronavirus pandemic. In a context where command and control arrangements for the NHS are delivered through the National Incident Management Centre/Regions and parallel arrangements go through the Ministry of Housing, Communities and Local Government to councils and local resilience fora, our Partnerships are central to delivering meaningful, visible change.

West Yorkshire and Harrogate Health and Care Partnership is made up of councils, the NHS, Healthwatch, independent and third sector organisations and our communities. It covers 2.6 million people with collective spend of over £5.5bn. After four years of working together, the strength of our relationships, our infrastructure and our governance is being applied to be the biggest challenge the country has faced for generations.

Evidence from other countries suggests that a whole system approach is essential and we have focused on four tasks:

1. Delivering an exponential increase in critical care capacity;

2. Ensuring our share of the 30,000 patients discharged from our acute hospitals are held safely in their communities;

3. Supporting our share of the 1.4 million people who are shielded, as well as other vulnerable people, through an integrated offer that meets their mental, physical and social needs;

4. Business continuity and service delivery during the pandemic period.

The response from everyone has been astonishing. In a matter of days we have seen fundamental changes in the way care is delivered. Most of this does not make the news, because most of it is unseen. It happens in our dispersed communities and often behind the closed doors of isolated people.

After chairing the WY&H System Leadership Executive meeting yesterday, I wanted to give an indication of what has been delivered.

Our West Yorkshire Association of Acute Hospitals has exponentially increased their critical care capacity to record levels, reconfiguring whole hospitals as a result. They have done so whilst safely discharging thousands of patients to our community services, social care, general practices and volunteers across WY&H ICS, with bed occupancy falling to as low as 51 per cent rather than 98 per cent in the winter.

This has only been possible because of the support of the 56 primary care networks, working with councils and others to deliver integrated offers, such as the “hot” and “cold” site covid-19 hubs in communities like Wakefield.

This has come as our councils across WY&H ICS lead support to 45,000 people who are shielding themselves and need food, company and basic essentials. Never has the power of the third sector partners and community services been felt by more people. This support is often delivered by key workers enjoying childcare delivered in almost every school, transformed into keyworker childcare provision.

Necessary developments 

Personal Protective Equipment has been close to our hearts every day. We continue to improve supply in a dynamic context. We have mobilised through the West Yorkshire Resilience Forum a new hub in Huddersfield to distribute PPE more evenly, to ensure we get better flow to care homes, GPs, pharmacies and small organisations in the coming days. Our Trusts are also working together to manage supply collectively. We have coordinated mutual aid between partners in the meantime.

Staff testing is ramping up and we have developed drive-thru testing hubs in each of our six places, operational now. These will deliver the staff tests that will ensure we get people back to work safely and quickly across all partners in the WY&H ICS.

The big media interest has been in the new NHS Nightingale Hospital for Yorkshire and the Humber, based in Harrogate with support from WY&H ICS, South Yorkshire & Bassetlaw ICS and Humber Coast & Vale ICS and the brilliant Ministry of Defence partners.

This is a necessary development that has been delivered by people working at phenomenal speed. It has engaged every organisation and been supported by the partnership on matters like psychological support and mental health liaison. I hope we do not need it for covid-19 surge, but am glad it is there.

This has all been delivered with 10 per cent fewer staff across WY&H ICS, because we have enabled greater digital delivery and operated new clinical models. Our staff have delivered this in the face of emotional stress, capacity issues and legitimate fears of this novel virus. They have been magnificent.

Our distributed model of leadership, where people act on behalf of the collective, with permission and a mandate to do so is bearing fruit. It is a testimony to the strength, breadth and depth of the leadership in all sectors.

I have been a strong proponent of ICSs and of collaboration for many years. I am also a strong proponent of public service. I know that many are not and you don’t have to go far to read commentaries that suggest the NHS is inflexible or that councils are unresponsive. Nothing could be further from the truth. The evidence is all around us if you care to look.

In case you think this column is devoid of criticism, then it is worth stating that when faced with problems and issues we have chosen to address them rather than look first to point the finger or apportion blame.

There will be enough time for that later. For now we should say thank you to everyone involved in the biggest transformation of care seen in my lifetime. As we do so, we prepare for the “new normal” after the pandemic, for when our lives and our services are forever changed.