Background and context
Integrated care system (ICS): West Yorkshire ICS
Number of places in the ICS: Five
Key partners in the Leeds place:
- Leeds and York Partnership NHS Trust providing mental health and learning disability services to the city’s population and specialist services on a regional basis
- Leeds Community Healthcare NHS Trust providing adult and children’s community health services to the city
- Leeds Teaching Hospitals NHS Trust which provides acute and specialist services across five sites to patients from Leeds, Yorkshire and Humber and beyond
- Leeds City Council, which is a large unitary authority
- Leeds office of the West Yorkshire ICB (commissioning functions previously held by Leeds CCG)
- Primary care services, including Leeds GP Confederation, a membership organisation for the approximately 90 GP practices in the city
- Social care providers
- A range of voluntary and community sector organisations
Key features of the Leeds population:
- around 800,000 people, with a growing population
- Leeds has a diverse population, including an unusually large student body thanks to several universities being based in Leeds
- wide health inequalities, including a life expectancy gap of around 14 years for women and 12 years for men
- Leeds is a growing economic centre, with around 125,000 businesses in the city, although the population also sees some challenges around economic inactivity and deprivation
Role of the trusts at place
In Leeds, trusts are taking a collaborative approach to developing place arrangements and are playing leadership roles in different ways alongside local government, the voluntary sector and wider partners. This includes supporting strategic planning processes; increasing operational collaboration to design new service delivery models across traditional organisational boundaries, including with a range of local government services; modelling a culture of joint working; and shifting towards a conceptualisation of a shared ‘Leeds pound’ (without requiring structural changes to funding flows).
All three trusts have important roles as anchor organisations, contributing to the wider determinants of health through their roles as employers and purchasers of goods and services. As part of this work, Leeds Teaching Hospitals NHS Trust is investing in a redevelopment programme for a new wing of Leeds General Infirmary and plans to create an innovation village to bring in investment and jobs. This is all part of the bigger agenda to make Leeds a prosperous and healthy place to live.
Partners in Leeds have been working together to improve health and care services for a number of years. Leeds Health and Wellbeing Board (HWB) provides a focus for articulating health and care ambitions for the population through its health and wellbeing strategy, which aims to make Leeds a healthy and caring city, with a particular emphasis on improving the health of people living with deprivation.
A partnership executive group, formed in 2015, brings together executive leaders of the trusts and wider partners including VCSE and primary care to lead on the implementation of agreed priorities. It reports to the HWB on a quarterly basis on progress, including on operational and financial performance. Several leaders of statutory organisations also sit on the HWB – thereby spanning the strategic and operational leadership forums.
As the West Yorkshire ICS has matured, with the ambition for places to lead many key functions by default, partners in Leeds have been exploring how to build on and strengthen their existing arrangements to mobilise shared resources more effectively and deliver against core objectives. This has led to the creation of a formal place-based partnership, known as the Leeds health and care partnership.
The partnership will be underpinned by an operating agreement and a formal joint committee, which will outline the relationship between the partnership arrangement and its constituent organisations and enable the delegation of a budget from the West Yorkshire ICB.
The partnership’s work programme is shaped by a shared strategic plan (the Healthy Leeds plan), formally led by Leeds CCG, which sets out several programmes of work. The strategic plan includes a set of indicators which will be tracked to assess whether the partnership’s collaborative work is generating impact. The indicators fall into three key categories:
- health outcome measures eg infant mortality rate and healthy life expectancy
- system activity measures eg reduce the rate of growth in A&E attendances
- quality experience measures eg patients’ experience of inpatient hospital services and experience of primary care services.
To date, partners in Leeds have intentionally sought to embed a fairly lean leadership model, drawing on leaders from across participating organisations, rather than creating new roles. Key executives are part of the partnership executive group, chaired by the council chief executive, which has evolved over time to reflect how the agenda has become more ambitious. This group considers estates strategies, public and patient engagement plans, and solutions to collective challenges.
Looking to the future, place-based governance arrangements will evolve and there will be a Leeds place committee of the ICB, including an independent chair and non-executives. This will be separate to the HWB but still hold close relationships. The current CCG Accountable Officer will take on the place-based lead role for Leeds, employed by West Yorkshire ICB. The exact details of how the place lead role will function will develop with time. Responsibility for service delivery will continue to sit with trust boards. The work of place-based planning infrastructure will be supported by a Leeds office of the West Yorkshire ICB, hosting staff formerly employed by Leeds CCG.
Approach to managing collective resources
Like other parts of the country, Leeds has pooled budgets through the Better Care Fund. Since 2019, it has worked through an integrated commissioning executive, drawing on capacity from both Leeds CCG and Leeds City Council (including some joint roles). Pooled spending has been largely focused on mental health care and learning disability support, intermediate care and at-home reablement support to promote timely discharge from hospital settings.
Additionally, organisations in Leeds have for some time been flexible in how funding is allocated, to enable the best use of public resources locally while also meeting national expectations and statutory requirements.
The details of system financial management from July 2022 are subject to ongoing development, but the West Yorkshire ICB plans to support financial delegation to places through establishing committees of the ICB. Place committees will lead on: agreeing plans to meet local needs; allocating resources to meet priorities; contracting for the delivery of services; and overseeing progress against the plan and ensuring local people’s views are embedded in ways of working. These functions will be discharged through a sub-committee structure, likely covering quality and finance.
Benefits and learning
One of the key achievements of partnership working in Leeds has been the establishment of the Leeds Health and Care Academy, which is comprised of the trusts, Leeds City Council, Leeds CCG, Leeds universities and the VCSE sector. The academy is a key partner in responding to the city’s workforce challenges, working on behalf of the entire Leeds health and care sector to design and deliver collaborative learning and development programmes for all staff. Since its formation, the academy has improved the recruitment and retention of health and care staff across the city. It has also used partnership working to provide employment opportunities for those in the most disadvantaged communities to ensure Leeds has a diverse, skilled workforce both now and for the future.