Partnership Board

The information provided in the question included information of a personal nature and this was not appropriate to be addressed in a public forum. However, the broader issues have been shared with our place-based primary care team, as they have responsibility for quality assurance visits and monitoring of GP practices. These meetings are also held with other providers, such as hospital trusts and community care providers.  Whilst there is no requirement within the GP contract, please be assured these overarching concerns are being discussed in our practice visits with the Modality Group Practice to ensure they are taking forward lessons learned.

We have to acknowledge that many local authorities across the country are facing unprecedented financial pressures, this is a structural issue that needs system reform which has been long supported by many across the health and social care system. In addition, we are now facing a significant financial challenge on budgets for NHS partners.

Reductions in council teams have been fully appraised and mitigations will be put in place, if the proposals do go ahead. A strategic review of Sports and Leisure services will be undertaken, which will include further consultation with communities and interested parties before any recommendations are presented and/or adopted with a full equality impact assessment as part of that.

In direct response to the partnership board’s thoughts on the proposed budgets and its impact on the VCSE, we acknowledge and welcome the VCSE’s initial response and the work the sector has done to issue an alternative proposal.

As a partnership, we provided a response to the council’s budget proposal and stated our concern about the impact of the proposed withdrawal of the VCSE infrastructure contract alongside the proposed changes to the stronger communities team. 

We reflected that the withdrawal of the VCSE infrastructure support and the proposed changes to stronger communities will impact on our work with communities - both in terms of wellbeing and citizen voice and activation. However, we have secured the ICB at place’s contribution and will now look to carry out a co-design process involving VCSE partners alongside our priority directors to develop a delivery model that continues to ensure the active and finically supported involvement of our VCSE.

We have acknowledged that meeting our financial challenges will result in unintended and unwanted consequences across our partnership. In particular we recognise the fragility of our VCSE partners due to difficult decisions being taken across our partnership. 

We remain steadfast in our commitment to involving the VCSE as equal partners as our place-based partnership values and recognises the contribution made by the VCSE sector that can help us deliver our vision of keeping people ‘happy, healthy at home’. We are widely recognised for our often ground-breaking work as a true partnership that values and recognises the contributions of the VCSE as well as other sectors.

We also know that VCSE organisations deliver much-needed support to our communities in their localities in spaces that communities know and trust. In addition, we understand the valuable contribution the VCSE makes in raising aspirations, improving health and wider outcomes and connecting citizens with our partnership. 

We had the ambition to be the first place-based partnership to set up a community investment standard that was designed to ensure that we ring-fenced money from our collective budget for the VCSE. Our current financial position does not allow us to do this now however we will continue to challenge ourselves on making decisions fairly and not going for the easiest option.

Our partnership board, partnership leadership executive and other key committees benefit from the insights of our VCSE system lead who advocates and provides constructive challenge on behalf of the sector.

We have examples of how the VCSE is helping to reduce pressure on stretched health and care services. From our wellbeing hubs, to the MAST service in hospitals facilitating effective, safe and quicker discharges through to our community-based mental health support options and our community partnerships.

We want to assure citizens and colleagues that we are sighted on the considerable risk facing our VCSE, including the future viability of some organisations and that we are doing all we can to mitigate these.

Since 1^st April 2023 dental services in West Yorkshire have been commissioned by NHS West Yorkshire Integrated Care Board (ICB) and in North Yorkshire have been commissioned by Humber Coworking across the Yorkshire and Humber region.  As such, we are aware of the service in question in the Settle area and appreciate the queries and concerns raised through Healthwatch and others.

As noted above, NHS Humber and North Yorkshire ICB are the commissioner of community dental services in the Settle area. As such, the consideration of this matter and subsequent decisions are taken by NHS Humber and North Yorkshire ICB together with the provider (Harrogate District NHS Foundation Trust). The decision making process includes the provider forming a business case, including engagement with patients and discussing alternate arrangements, which is considered by the commissioners and responsible director within the respective ICB – Humber and North Yorkshire ICB for this matter. This responsibility is based on historic arrangements and the agreement at the point of delegation between NHS England and respective ICBs. This is not subject to change. We appreciate the geographic complexities around this alongside other healthcare commissioning arrangements.

However, ensuring that people living in our region have access to dental services is a top priority, and we are committed to doing this in a way that addresses the barriers and inequalities faced by different population groups. Whilst decisions rest with the responsible commissioner, we are working closely with our partner ICBs within the Yorkshire and Humber region to deliver our shared priorities for dental services, and are committed to working transparently and in partnership with clinicians and communities.

Thank you for your question.  Any possible devolved funding consideration would be made on a West Yorkshire footprint and led by the West Yorkshire Combined Authority.  As such you may wish to direct your query to the West Yorkshire Combined Authority via Mayoral.Enquiries@westyorks-ca.gov.uk  

Thank you for taking the time to engage with the Health and Care Partnership, through the engagement process related to the services formerly provided at Shipley Hospital, and subsequently in asking the Partnership Board to acknowledge your views in relation to the same.

Throughout our formal involvement work the Health and Care Partnership has recognised that Shipley Hospital has been a much-loved local building, that over the last 100 years has been a maternity home and a community hospital. We recognise that, like all local facilities, people would have wanted to keep and redevelop the building. However, the investigation of options showed that it was not feasible to retain the building and bring it up to the standards needed now and in the future. That is why the option of keeping Shipley Hospital open was not included as part of an open and transparent involvement process, as it would not be viable. We did ask people to suggest alternative sites, and our NHS Property Services colleagues did review the suggestions received. Unfortunately, none of those suggested could offer a suitable alternative. 

While the building itself cannot be replaced we have been working hard to ensure outpatient physiotherapy services can be provided from a range of locations close to where the hospital is sited including Shipley Health Centre. However, the community therapy services require an adequate gym space and other specialist rehabilitation equipment which has to be provided within a purpose-built environment that also ensures we can offer patient confidentiality. 

We are working hard to ensure that at least 50% of the proceeds from the sale of the Shipley Hospital site are reinvested locally, with the ambition of supporting the Shipley Health and Wellbeing Campus as a viable and preferred option. Working closely with the constituency MP and the local community, we will keep people in Shipley (and beyond) updated on progress and are looking to develop a community involvement approach, working closely with the MP’s office and other stakeholders.

Currently women presenting with menopausal systems in Bradford District and Craven are supported in primary care. Referrals to Airedale Foundation Trust and Bradford Teaching Hospitals Foundation Trust can be made whenever additional advice and support is needed. 

We are aware that there is a specialist menopause service in Leeds, and we are learning from their experience. Our clinicians have confirmed that the Leeds service is no longer open to patients from Bradford District and Craven as they are not accepting external referrals. 

We are exploring options for how we can provide specialist menopause services for women in Bradford District and Craven. This includes how we can offer access outside of normal working hours for working patients seeking additional expertise and advice.                              

We are keen to establish community-based services and we are exploring potential funding routes to do this.

We have recently created:

• a menopause network which focuses on education and shared learning for GPs and those working in primary care to support patients who present to them. 
•  a series of learning events to provide training in menopause care for primary care staff, with the intention of increasing knowledge, understanding and capacity.                                                                            

We are committed to ensuring our Partnership Board is open and transparent to the communities of Bradford District and Craven, and that the work of the Partnership is informed by a good understanding of the needs of local people.

In order to connect with communities the Partnership Board moves around six localities in Bradford District and Craven and meet in community settings in these localities in order to be in venues that are close and accessible to people. We hold a week of ‘listen in’ involvement and engagement events with community groups and settings in the locality before each meeting where we listen to what really matters to the local people and the findings of which are presented to the Partnership Board for discussion in the meeting. We invite questions from the public before each meeting which are referenced by the Board in the meeting and answered in full following the meeting. The meetings are held in public with members of the public from any locality in Bradford District and Craven welcome to attend. This approach is working well with good engagement with the public to date. 

We have previously explored options to livestream our Partnership Board meetings and due to the high cost of this (approx. £3k per meeting) and the likely number of people who would watch the meeting, the Board agreed not to pursue live streaming or holding hybrid meetings. Instead the Board agreed to focus our attention on other ways to connect with communities. We were also mindful that livestreaming/hybrid meetings would depend on the strength and reliability of the internet connection of the community venues that we visit. 

We have recently enquired with our colleagues in the other places across the West Yorkshire Integrated Care System (ICS) on their approach to livestreaming or holding hybrid meetings and our approach aligns with the other ICB place committees. Their reasons are similar to ours (cost, resource required and technology capabilities).

We are exploring options to audio record future meetings and to place any such recordings on our Partnership website Bradford District and Craven Health and Care Partnership - Bradford District and Craven Health and Care Partnership (bdcpartnership.co.uk) where members of the public could listen back at a time that suits them. Our consideration of this option will take into account the technology available in the community venues where we hold the meetings and an analysis of the costs and benefits of the approach. 

Thanks for your question, which was raised at the board meeting in February and has since been considered by our strategic equalities lead who has prepared this response:

We want to develop services that are as accessible as possible to our diverse communities. To do this we ensure that when we are reviewing services, proposing changes to existing services or setting up a new service we carry out an equality and quality impact assessment. This assessment includes all the protected characteristics legally defined in the Equality Act 2010. In addition, we recognise that there are further considerations we need to take into account when thinking of our local communities. 

Our impact assessments also consider communities of interests (people sharing similar characteristics or affected by similar challenges), or any other issues that could lead to inequalities. In this way factors such as rurality, travel and transport, digital inclusion or low income can be taken into account.

We work with people and community based organisations through Community Partnerships to understand the strengths and needs of communities, and to act together to improve the way we respond to them. This is supported by a dedicated Reducing Inequalities Alliance that guides our work. It is through these routes that we will focus on the specific needs of rural communities.

In response to your query about patients being seen face-to-face by their GPs. We wanted to reassure you that GP practice colleagues – this includes a range of healthcare professionals with specialist expertise – have continued to and do continue to see people face-to-face. To keep people safe our GP practices implemented national guidance in response to the Covid pandemic which asked for all initial appointments to be carried out virtually, such as through video call or over the telephone. Using their skills and experience, healthcare professionals are then asked to offer a face-to-face appointment where they feel this is clinically needed. The move to this model was always planned to take place, the pandemic meant we had to implement this sooner than intended. As a result we can confirm that this approach is one that will remain in place in line with national guidance.

This approach of being able to offer more flexible appointment types has resulted in more people being seen by their GP practices than ever before. Bradford District and Craven GP practices General Practices are delivering approximately 25,466 more appointments per month in comparison with pre-pandemic appointment rates based on 415,985 appointments delivered in October 2022 in comparison with 390, 519 in October 2019 (NHS Digital Appointments in General Practice Monthly Data).

We want to reassure people that GP practices are working hard in the face of significant demand to offer all types of appointments. An example of this shows that the number of face to face appointments is steadily increasing having risen from 65% to 70% of appointments from July 2022 to October 2022. We also recognise that some people need to be seen quickly, of all appointments being offered, 45% were same day appointments.

There are also a significant number of appointments being delivered outside of core hours including enhanced access appointments (6:30pm to 8:00pm weekdays, 9am to 5pm Saturday) alongside specialist support through paediatric hub appointments or GP streaming appointments. These appointments are not included in the core general practice appointment data. These again offer the flexibility of telephone or video appointments as well as face-to-face.

We recognise for many people the convenience and flexibility of telephone or online appointments is something that works well for them as they can fit these around busy work or home lives. However, we know for a smaller number of people these options can be difficult to access and may not offer the same level of convenience. We will continue to work with our GP practices to ensure we can be as flexible as possible when offering appointments, while ensuring we keep everyone safe when attending any of our GP practices – our patients, our colleagues and our visitors.

It's really important that we help people find out more about the support available from a range of healthcare professionals working at our GP practices. This can include nurses, pharmacists and a range of other clinical colleagues. To do this we are asking people to understand why they may be asked to see someone other than a GP, this is because this is the most appropriate person to help you with your health needs and ensure you get to see the right person as quickly as possible.

We’d like to recognise the work that our colleagues in our GP practices do every day, during a time where we are experiencing the highest ever demand for health and care services. We want to thank all those who continue to treat our colleagues and our patients with dignity and respect. Please continue to be kind to our colleagues and other patients.

We can confirm that responsibility for planning and funding (commissioning) dentistry services including community dentistry will be transferred from NHS England to integrated care boards from April 2023. For our communities, this will be done centrally through NHS West Yorkshire Integrated Care Board. This responsibility will not be further delegated to local place-based partnerships such as the Bradford District and Craven Health and Care Partnership. However we will ensure we can influence decisions made on how services are commissioned, provided and delivered at a local level. This will include using feedback from our communities and our colleagues.  

The current plans and proposals for the community dentistry service are being led by NHS England who are overseeing the process working closely with the provider of the service before a business case is submitted to NHS England, that could change their terms and conditions of their contract - this is covered by the Personal Dental Services contract. 

The service that the Trust (Harrogate District NHS Foundation Trust) is proposing to close, isn’t a general access - high street - dental practice, it’s a Community Dental Service, which is a referral service, for patients who cannot be seen in a high street dental chair. 

The service is provided one day a week from Settle Health Centre. However it is recognised that this is limited as they are not able to provide aerosol generating procedures.  Where a patient does need such a procedure they receive this from Skipton. At present the provider has confirmed that they have six active patients receiving treatment from the Settle site. 

The Bradford District and Craven Health and Care Partnership will work closely with NHS England to ensure people are aware of any proposed changes and opportunities to be take part in any public involvement exercise, should one be set up.