Robin Tuddenham, chief executive of Calderdale Council, reflects on the relationships his team has formed with local NHS colleagues and their importance in supporting place-based integrated working. He goes on to highlight the need for time to continue developing these partnerships.
I can still remember quite clearly the two meetings that started to change the nature of relationships between the council and our local NHS partners. We’d always worked quite well together, with a good amount of trust in the room, and a fair understanding of the challenges that each part of the system faced. But these two meetings were the start of really questioning one another, being more open and reflective of what we could do at pace to change the way we thought about health and wellbeing in Calderdale.
One of the things I think the NHS sometimes gets wrong when faced with large-scale change is that it will look for external consultants to give leaders the capacity to start to think and work in a different way. Place-based integration of health and social care, and the move to thinking in terms of whole population health is different however. It’s about people, trust and relationships. The NHS could reflect that creating space to have discussions with local government and partners is for sustainability and transformation partnerships/integrated care systems/integrated care providers, without questioning the critical issue. Time to build trust, to understand one another’s organisational challenges, to create space to experiment and fail - that’s where our investment needs to be.
In Calderdale, these better relationships have started to pay off. Our DTOC (delayed transfer of care) figures in Calderdale are significantly improved, because of the way we’ve started working more closely together. But, interestingly, what is in one way a definite success, hints at where we need to go next as our partnerships develop further. Because although our DTOC is good, our 30-day re-admissions are not as good as they should be - so what does that suggest? Are we working hard on one measurable but missing the bigger picture? We know that self-care and more local community support is where we want to be going, but sometimes I’d reflect that the NHS England focus is too much on how a local council can support its local hospital, to the detriment of other equally important issues.
The challenge for our system is ensuring that the actions that we take are driven by what will make our communities healthier and are not just in response to nationally set key performance indicators. If we allow DTOC to dominate our thinking, and to be the focus of our activity then we are missing the point.
Supporting older people in fact only accounts for 20 per cent of our social care spend in Calderdale. We’re working hard in our council to support families with learning disabilities, an area of growing importance for us. I’m also really concerned about the wider range of issues relating to younger people, from reductions in education funding, to the messages that I am hearing from our schools about the state of adolescent mental health.
For our local partnership to develop we need to make sure that our focus is not dominated by the sometimes unhelpful focus on national targets. We need to be given space for our local partnership to lead our development of healthy and happy communities. In Calderdale for example, we’re really proud that voluntary and community assets are able to lead on core activities like Sure Start, or our focus through these assets on helping people to stay fit and healthy though our Staying Well programme. As a council we recognise when we need to lead, and when we need to get out of the way and let the voluntary groups in our community do things better than we ever can.
We’re really excited about our Active Calderdale initiative, and our work to target the 32 per cent of our residents classed as being rarely active. The focus of our work will be to reduce this percentage, to both support and promote individual health and reduce demand on health and social care services in the future.
There is also the development of the Calderdale economy, from reinvigorated interest and regeneration in Halifax as a result of The Piece Hall to our plans to boost our creative and visitor economies. Because we recognise that nothing contributes more to health and wellbeing than the provision of good quality jobs, and good quality housing for people to live in.
So, while I’m proud of the progress we’ve made in partnership with local NHS colleagues, my ask is for NHS England not to look to evaluate the success of our complex, vibrant local partnership, by over-focussing on single issue measures. Our partnership has taken time to develop and is getting better all the time. We need time, space and latitude to continue learning how we can best work together, to the benefit of our communities.
Working on an integrated and collaborative approach to health and care feels to me to be one of the greatest and most important challenges for any local authority chief executive at present. Our system is close to breaking point, but we need to retain hope and determination that we can find solutions that work, and reflect our wider vision that Calderdale will be a resilient and kind place to live and work.
Robin Tuddenham is chief executive of Calderdale Council, a leader in West Yorkshire and Harrogate Health and Care Partnership and represents SOLACE (Society of Local Authority Chief Executives) on health and care issues. Follow him on Twitter @robintuddenham