Agenda item

To receive a report on Mid Yorkshire Teaching NHS Trust’s strategy to the NHS 10 year plan.

Contact: Nicola Sylvester, Principal Governance and Democratic Engagement Officer.  Tel: 01484 221000.

The Committee received a presentation from the Chief Executive of Mid Yorkshire Teaching NHS Trust outlining the national context of the NHS 10?Year Plan and its implications for the Trust. The presentation highlighted the significant shift towards preventative, community?based, digitally enabled and patient?centred care. The panel noted the three strategic shifts underpinning the plan: hospital to community, analogue to digital, and sickness to prevention, with a strong emphasis on tackling health inequalities.

The Committee was informed about the Trust’s strategic direction under Delivering MY Future 2023–28, including its strategy deployment approach and alignment with the Improving Together programme.  It was noted that the approach aimed to empower teams through clearly defined breakthrough objectives, supported by strategic initiatives, divisional drivers and Trust?wide projects.  Progress was being monitored through structured governance arrangements, with a focus on continuous improvement, quality, safety and access.

The presentation outlined the development of Neighbourhood Health and Integrated Neighbourhood Teams (INTs) within Kirklees, aligned to national neighbourhood health guidance.  The panel noted the focus on key population cohorts including frailty, mental health, and children and young people, and the phased rollout of INTs across borough neighbourhoods. The aim was to improve care coordination, reduce hospital admissions, and support care closer to home through integrated, multidisciplinary working.

The Committee also considered Mid Yorkshire Teaching NHS Trust’s role as an anchor organisation within Kirklees and the wider Calderdale, Kirklees and Wakefield system.  The Trust described its responsibility to contribute to social value, economic wellbeing and community resilience, including through partnership working, employment, volunteering, and the MY Community Promise.  The panel noted the Trust’s involvement in the Place Provider Partnership model and its contribution to system?wide transformation and population health management.

The presentation also provided updates on quality and safety, including the Trust’s position on temporary escalation spaces, learning from reported incidents, and ongoing clinical safety reviews. The panel noted service activity and performance at Dewsbury and District Hospital, including access, reconfiguration impacts, maternity services and volunteering. The Committee was advised of several major reviews and improvement programmes underway, including the implementation of a new electronic patient record, service reconfiguration reviews, and support for provider collaborative arrangements.

Members were advised that the Trust was reflecting on whether its current five?year strategy required reframing in light of national operating model changes and Integrated Care Board reforms.  While the strategic framework remained valid, the Trust indicated that it was considering how best to adapt its focus to ensure alignment with emerging place?based partnership arrangements and Integrated Health Organisation principles, and confirmed that engagement with partners and stakeholders would form part of this work.

Further detail was provided on neighbourhood health delivery in Kirklees, including foundational work already underway despite Kirklees not being a national pilot site. The Committee noted that partnership working across primary care, community health services and wider system partners was progressing.  It was reported that early pilot neighbourhood sites had gone live, with others operating in shadow form or under development, supported by the use of shared data and evidence?based targeting of interventions.

The Committee was also briefed on the Trust’s wider role as an anchor organisation, including its economic, social and employment impact across North Kirklees and Wakefield. The Trust highlighted its use of local procurement, employment, training, volunteering and estate assets to support community wellbeing and reduce inequalities and noted a renewed focus on partnership working through its Community Promise and engagement with the voluntary and community sector.

Finally, the Committee was updated on quality and safety issues following Members’ recent site visit.  Assurances were provided regarding the Trust’s approach to managing periods of acute operational pressure, including the controlled and risk?assessed use of temporary escalation spaces when unavoidable.  It was confirmed that such arrangements were not regarded as acceptable practice, were subject to external scrutiny, and were accompanied by learning, transparency and patient communication. The Trust also outlined ongoing clinical service reviews aimed at ensuring services across sites remained safe, sustainable and fit for future population needs.

Questions and comments were invited from Members of the Health and Social Care Scrutiny Panel, and the following was raised:

·       The panel asked for clarification on the role of Dewsbury District Hospital as a Type 1 Emergency Department and what cases would be treated there versus transferred elsewhere.  It was explained that Dewsbury operated as a Type 1 Emergency Department, treating and stabilising patients locally where appropriate, with more complex emergency care (such as stroke, thrombolysis and emergency surgery) transferred to Pinderfields, following established clinical protocols and ambulance triage arrangements.

·       The panel raised concerns about corridor care and whether additional capacity, beds or wards were planned to address this issue and it was confirmed that the focus was not solely on increasing bed numbers, but on improving patient flow, assessment, same?day emergency care and discharge processes, with a clinical services review underway to assess asset use and system?wide flow, including joint working with local authority social care.

·       The panel queried how health inequalities and reduced life expectancy in parts of North Kirklees were being addressed through place?based and population health approaches.  It was confirmed that reducing inequalities was a core priority, with population health data being used to differentiate care, supported by public health input, preventive approaches, and early intervention models embedded within place provider partnerships.

·       The panel asked how Integrated Neighbourhood Teams differed from Primary Care Networks and how community services fitted within these models.  it was explained that PCNs primarily focused on primary care delivery and contractual mechanisms, while Integrated Neighbourhood Teams brought together a wider range of services, such as community nursing, palliative care, VCSE support and care coordination, around defined neighbourhoods and population needs.

·       The panel sought assurance about the future of the Brontë Birth Centre, including utilisation thresholds and potential closure risks.  It was stated that the review of the Birth Centre was not driven by financial thresholds or minimum activity levels, but by good practice, quality and access considerations, with a commitment to an open model, growing utilisation, and promotion of the service as a hub for maternity care.

·       The panel asked what the main risks, challenges and threats were in delivering the NHS 10?Year Plan locally.  It was acknowledged that the scale of change required effective public engagement, workforce adaptation, and investment in digital and estates, with some elements requiring significant transformation effort and others achievable through service redesign and repurposing of existing resources.

·       The panel queried whether community pharmacy and other key partners had the capacity to take on expanded roles described in the national plan.  It was acknowledged that capacity and variation existed and that commissioning, workforce and contractual arrangements would need to evolve to ensure pharmacy and wider multidisciplinary teams were supported to deliver these expectations sustainably.

·       The panel raised concerns about higher rates of premature cardiovascular disease among South Asian men and asked about targeted prevention, screening and monitoring, with the Panel being advised that health inequalities were recognised as a priority.  Primary care played a key role in early identification, and that further work was required to map existing services, data by ethnicity and outcomes, with a commitment to take this issue away and report back with more detailed local information.

·       The panel asked about same?day GP access and how this aligned with residents’ lived experience.  It was clarified that GP access was not within the Trust’s direct control, and that this issue sat with ICB commissioning and primary care delivery, although the challenges were acknowledged.

·       The panel asked how genomics and personalised medicine would impact local services and patient access.  The Panel heard that genomics formed part of a longer?term national ambition, with early examples already in place in areas such as cancer care, while broader application locally was expected to evolve over time as part of more personalised approaches to treatment.

·       The panel sought clarity on what was meant in practical terms by clinical service reviews, redistribution and standardisation of services across Kirklees.  It was explained that the clinical services review would revisit the 2017 reconfiguration, assess impacts on communities, and use engagement with residents, clinicians and partners to inform future models, with place?based working offering opportunities for more joined?up, flexible and locally responsive service delivery.

·       The panel requested that Scrutiny be involved at an early stage in future clinical service reconfiguration and place?based service redesign.  It was acknowledged that early scrutiny involvement would be valuable, and the Trust expressed openness to further engagement, discussion and site visits as the review progressed.

RESOLVED –

1)    That representatives from MYTT be thanked for their presentation and attendance at the meeting.

2)    That Scrutiny be involved at an early stage in the Trust’s forthcoming clinical services reconfiguration review, including engagement on proposals affecting service distribution and access across Kirklees.

3)    That further written clarification be provided on targeted action being taken to address premature cardiovascular disease and related inequalities, particularly among South Asian men, including data, interventions and anticipated timescales.