Place-based leadership and partnership is key to tackling health inequalities.
The power of place is felt in your street, neighbourhood, town and – especially in Yorkshire – your county.
The impact of place is felt in the long shadow it can cast over your whole life, as seen in every report from every one of our directors of public health.
We have used this power to build place-based leadership, where political, managerial, clinical and community leaders can build effective relationships to make a change to the status quo. People die too soon and suffer more disability in too many of our places, and we want to change that.
When the idea of sustainability and transformation partnerships (STPs) was first mooted, we realised two things: that the issues affecting people’s lives went well beyond health; and that we had plans to address the issues they faced in every health and wellbeing board in all of our six places – Bradford District and Craven, Calderdale, Harrogate, Kirklees, Leeds, and Wakefield.
What has emerged in West Yorkshire and Harrogate Health and Care Partnership (WY&H HCP), built on over four years of working together, is a model that tackles problems faced by real people in our communities by seeing the six local places as the building blocks for action.
All saw quickly that they could own their own plans and amplify their impact by working together on a broader geography.
We have rules that define how we only work together at a West Yorkshire and Harrogate system level where it makes sense to do so – where there are economies of scale, good practice can be shared, and difficult issues can be solved with collective action.
By working collaboratively with the people who live and work locally, we are able to build a picture of the system from a local perspective, taking a place-based approach that seeks to highlight the strengths, capacity and knowledge of all those involved.
We also believe that WY&H HCP belongs to all of its partners. It is theirs to do their bidding, and wherever you work – whatever your role – you are part of the system and the solution.
Supported by our politically led and inclusive partnership board (pictured), and a memorandum of understanding adopted by every partner, our focus is to strengthen joint working to improve health and care for the 2.7 million people living across the area.
A key enabler for place-based working is having a clear framework and set of agreed guiding principles for the scope of work and decision-making at each level of the wider system.
Working alongside communities, the partnership board brings together the NHS, councils, care providers, health and wellbeing board chairs, Healthwatch, social enterprises, and community and voluntary organisations to give people the best start in life, with support to stay healthy and live longer.
Each is an equal partner – there are no bosses, but there is challenge and mutual support, and accountability. This approach is augmented by provider collaboratives, with real power and authority for collective decision-making.
For those who think this must mean a talking shop where cosy consensus is the order of the day, or a world where providers hold sway, then we would point to potentially contentious decisions being made in the interests of people – not organisations.
This has led to genuine changes in hyper-acute stroke units (the critical care people receive in the first 72 hours), vascular services, assessment and treatment units for people with complex learning disabilities, and specialised child and adolescent mental health services.
“An important part of the board’s work is improving the lives of the poorest the fastest”
It has also led to an adoption of good practice that saves lives and prevents illness, such as WY&H Healthy Hearts and our work on cardiovascular disease.
And when difficult issues arise, we tackle them together.
An important part of the partnership board’s work is tackling health inequalities while improving the lives of the poorest the fastest.
COVID-19, with its disproportionate impact on those with the greatest challenges, including black, Asian and minority ethnic communities and colleagues, gives added urgency to this work, and our recent commission on this topic focuses on real action.
The action covers everything from housing and jobs to improved planning, representative leadership and improvements in mental health services – because that is what people need and everyone who can help is around the table.
Without our partnership, our handling of the pandemic would have been much poorer. Issues such as personal protective equipment supply, testing, shielding and mutual aid have been so much easier with our good rules and good relationships.
Our Economic Recovery Plan is founded partly on the anchor role of health and care – and our third-sector partners have avoided disaster through partners working to ensure they have the resources to operate in local streets, neighbourhoods and places.
Any new legislation around integrated care systems needs to recognise that this combination of system, place and sector (provider) collaboration is a winner. It really is a way to truly harness the power of communities.