Hidden in plain sight: Rob Webster on his STP

Source: NHE Jan/Feb 18

The strategy to join up mental, physical and social care has been bearing fruit beyond just the sustainability and transformation of the health service, says Rob Webster, chief executive of South West Yorkshire Partnership NHS FT, and leader of the West Yorkshire & Harrogate (WY&H) Health and Care Partnership.

The National Health Service turns 70 on 5 July 2018. It operates in a society that is barely recognisable from the one that spawned it in 1948. The founding principles of the NHS are a constant that guide us now and into the future. The NHS meets the needs of everyone; is free at the point of delivery; and is based on clinical need, not the ability to pay.

The NHS Constitution expanded these to include additional principles. In particular:

  • The NHS aspires to put the patient at the heart of everything it does;
  • The NHS works across organisational boundaries and in partnership with other organisations in the interests of patients, local communities and the wider population.

At a time when there is widespread reporting that the health service cannot deliver the NHS constitutional standards, part of the answer to our problems is within embracing these additional principles. Our modern health and care system needs to meet the physical, mental and social needs of people. In doing so, it should recognise the skills and assets that people themselves bring and organise around the lives of people.

Most NHS bed days in our hospitals are for older people. The majority of health and care spend is for people with enduring issues and long-term conditions. We can’t cure growing old, or long-term conditions like asthma or type 1 diabetes, or being a child with special educational needs. Taking a purely medical approach to social, mental and societal issues is at best suboptimal and at worst a major contributor to stress and pressure in the health and care system. It’s time to value the social, physical and mental health interventions in our communities alongside the amazing work done in our medical institutions.

People as assets

This takes a mindset shift and requires us all to embrace the principles in the NHS Constitution around partnership and truly meeting people’s needs. This shift is one where we stop organising on the premise that people are visitors to our institutions who bend to our will, and start seeing we’re one of many guests in people’s lives. Doing so quickly gets us to see people as assets and engage with our partners in the charity and third sectors, as well as within the NHS and local authorities, to harness the knowledge and expertise of all the people involved in someone’s care.

This is important for three reasons: it allows us access to shared capacity that can be moulded into a team; it improves efficiency and effectiveness (sceptics can reference ‘Realising the Value’ for evidence); and it reduces the “burden of treatment” that people feel in a disjointed system that requires them to navigate and organise multiple systems and services. I also believe it is the key to a sustainable health and care system.

Building sustainability

As the lead CEO for the WY&H Health and Care Partnership (formerly the STP), I am proud of the fact that this approach and this work is at the heart of our plans. We are building sustainable services across a population of 2.6 million people, where the 260,000 unpaid carers are as valuable to us as the 115,000 NHS staff. Services that are built from 50 neighbourhoods averaging 50,000 people, where integrated services from the NHS, local government, charities and families are a reality, and where more is done by and with people and less to and for them. These 50 neighbourhoods are where the vast majority of work is delivered by charities, GPs, local pharmacies, care agencies and community teams. And they are where people live and work.

The 50 neighbourhoods come together in seven nascent provider organisations delivering care and support in six distinct places where local authorities and CCGs are working together to spend their resources together. A single association of acute hospitals supports all of this, alongside a single collaborative of mental health providers. All of this is wrapped up in a partnership that is seeking greater autonomy to preserve this approach and give local control over resources, staffing and the buildings we need to deliver better and changed models of care.

Bradford Town Hall c. kelvinjayc. kelvinjay

The way we do things around here

Of course, we are not delivering this model everywhere yet and there is much work to do. But we’re already seeing results from vanguards, integration pioneers and other experiments that give us significant hope for the future. Our care home vanguards in Airedale and Wakefield, for example, are delivering stunning results for individuals and improvements for the system. Work in Leeds on becoming a ‘child-friendly city’ adopts a restorative practice approach and family group conferencing that is changing the number of kids going into the care system. The Carers Charter in Kirklees is changing the way carers are seen in building a team around the person. Social prescribing and recovery-based approaches exist in every borough, from downtown Bradford (pictured) and the stray in Harrogate to the wilds of rural Airedale, Wharfedale and Craven. Calderdale’s approaches to sustainability, food and the environment are inspirational and improve mental health and community cohesion. 

The WY&H Partnership wants to take all of this learning and make it part of “the way we do things around here.” If we are successful, our world-class institutions can flourish and do what they do brilliantly: operate both at the limits of science and at a time when meeting basic human needs is paramount. 

Providers are also playing a part. My own trust is delivering on this through our linked charities, Creative Minds and the faith-based Spirit in Mind. They’re partnered with over 100 charities that deliver sport, art and leisure activities across South and West Yorkshire. They are augmented by our recovery colleges where you can take part in educational, motivational or even just fun courses and get better along the way.

This means that a man with mental health problems stigmatised by his local community can now belong to something like the Good Mood Football League. He can play with fellow service users and staff and enjoy football just like everyone else, engaging in meaningful and joyful activities with informal peer support. Examples like this break down stigma and improve outcomes; they also provide the best chance we have of winning European silverware when the EASI Cup comes to Barnsley in the summer!

People who come to our recovery colleges are more likely to gain employment and reduce input from community mental health teams, while seeing up to 75% reported improvements in control. Such services are available across all our geography, whether you’re in forensic mental health services detained in the criminal justice system, a child with learning disabilities in Featherstone, or an ex-miner in Grimethorpe.

At the heart of this is understanding that hidden in plain sight are the resources we need to help tackle the “crisis” in health and social care. We just need to open our eyes, work together, and focus on what matters to people. As one of our service users – who’s now an employee – always says: “Creative Minds not only saved my life, it gave me a life.” Her story is a very human one of recovery, employment, and artistic success – but also an economic one of reduced treatment costs, no reliance on the benefits system, and significant cost savings.

We’re putting this work at the centre of our strategy for the future to join up mental, physical and social care. So whether you believe this is the right thing to do in your heart or you need the proof for your head, I think there is evidence that can show this is the answer for you, for me and for all of us.




Laura Brown   03/02/2018 at 08:26

Will this provide a mental health assessment facility in an emergency setting to prevent patients spending hours in an inappropriate a and e department or police cell. Will it provide more therapists to enable people to be discharged sooner with support in the community. Will it prevent admission by providing early intervention for an ageing population with several co morbidities. Will it acknowledge the increase in people suffering respiratory conditions and other conditions that are ageing and need care in the community. ( More pulmonary rehabilitation, support in primary care quicker access to a GP. Support to directly access respiratory services avoiding a and e waits and community support on discharge. Commissioning a pathway appropriate for the population that also includes anxiety and mental health support to prevent patients mistaking mental health issues for physical symptoms ?

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