A message from the leaders of Nottingham and Nottinghamshire ICS

The ICS system chief executives have put a message together for all staff across the health and care system

We are writing in acknowledgement of the extraordinary pressures that you are facing within your service at the moment. We are seeing significant demand across all areas, compounded by staff absence and the long-standing nature of the COVID-19 pandemic.

We wanted to take this opportunity to thank you again for your professionalism and service to our communities.

We are seeing substantial pressure in all areas of our health and care system – including community services, general practice, hospitals, emergency departments / urgent care, social care, 111, voluntary sector, ambulance and transport services. We ask you to be mindful of colleagues from other parts of our NHS and social care system, who are also working in challenging times.

Please look after yourselves and others and please be kind to each other.

Thank you again

Louise Bainbridge	Chief Executive Nottingham CityCare Partnership
John Brewin	Chief Executive Nottinghamshire Healthcare NHS Foundation Trust
Melanie Brooks	Corporate Director Adult Social Care and Health Nottinghamshire County Council
Rupert Egginton	Deputy Chief Executive Nottingham University Hospitals NHS Trust
Richard Henderson	Chief Executive East Midlands Ambulance Service NHS Trust
Richard Mitchell	Chief Executive Sherwood Forest Foundation Trust
Amanda Sullivan	Accountable Officer Nottingham and Nottinghamshire CCG Interim Executive Lead, Nottingham and Nottinghamshire ICS
Catherine Underwood	Corporate Director for People Nottingham City Council

Bassetlaw district to join the Nottingham and Nottinghamshire ICS

Nottingham and Nottinghamshire Integrated Care System (ICS) has welcomed the decision for the district of Bassetlaw to align with its own health and care system.

This decision is part of the Health and Care Bill proposals to change some Local Authority boundaries to provide greater alignment with ICSs – the Ministerial statement can be read here.

It means no change for patients who will continue to be seen and treated by their local GP practice and they will also carry on receiving other health and care services in the same way.

The key difference will be the development of stronger connections between Nottinghamshire County Council and the NHS in the planning of health and care services to improve the health and wellbeing of Bassetlaw people.

Amanda Sullivan, Interim Executive Lead for the ICS said: “We welcome the decision to include the area of Bassetlaw within the Nottingham and Nottinghamshire Integrated Care System.

“We will work in partnership with all health and care organisations in Bassetlaw to ensure a smooth transition into this new way of working. The inclusion of Bassetlaw into our system will allow us to build on the established high quality services that have been delivered in Bassetlaw into the future and also work more seamlessly with colleagues at Nottinghamshire County Council.

“As we move forward we will encompass Bassetlaw as a distinct Place within our ICS system. As part of this, it is important we respect the needs and expectations of the community just as we do for our communities within the rest of Nottingham and Nottinghamshire.”

Nottingham and Nottinghamshire ICS Mass Vaccination Team shortlisted for national award

The Nottingham and Nottinghamshire Integrated Care System (ICS) Mass Vaccination Team has been shortlisted for ‘The University of Bradford award for cross-sector working’ in the Healthcare People Management Association (HPMA) Excellence in People Awards.

The awards recognise and celebrate the work of Human Resources, Occupational Development and workforce professionals across the UK. Showcasing the profession as the cornerstone of the supportive and empowering cultures we need as we move from the management of the pandemic to the recovery of our people and our services.

The vaccination programme in Nottingham and Nottinghamshire was a complete system response, involving the acute providers, community teams, commissioners, local authorities, volunteers and general practice – all pulling together in the same direction to protect residents from Covid-19. Given the pace and scale of the required roll-out, individual organisations needed to take the lead on different elements of the programme and work seamlessly together in delivery.

Key amongst those partnership activities was the recruitment and deployment of frontline staff to the vaccination centres.

Sherwood Forest Hospitals volunteered to be the lead employer for the COVID-19 vaccination programme and collaborated with partners across the Nottingham and Nottinghamshire ICS to recruit, train and then successfully deploy a skilled workforce of registered and non-registered professionals to administer the COVID-19 vaccine across 10 different locations. The team has recruited more than 5,000 colleagues to administer a COVID-19 vaccine and is the largest scale programme across the Midlands region.

Working collaboratively across the whole ICS, the Mass Vaccination Team have played a key role in the success of the programme and have been vital in the most important public health interventions of all time, protecting Nottingham and Nottinghamshire colleagues, partners and community.

Commenting on the nomination, Chief Executive for Sherwood Forest Hospitals, Richard Mitchell said: “The vaccination effort across Nottingham and Nottinghamshire has been a real team effort across the whole NHS and I am so proud that we have been shortlisted for this award, which recognises the achievement across the whole system. This project has been life changing for everyone who has worked on it and also for those people who can be protected by the vaccine.”

Dr John Brewin, Chief Executive, Nottinghamshire Healthcare added: “I am so proud that our organisation has been part of this fantastic piece of work, which has demonstrated how well we work across the system and what we can achieve together. This has been a hugely important project that has helped to protect both our workforce and our community.”

Chief Executive of Nottingham University Hospitals NHS Trust, Tracy Taylor, said: “Our region’s Mass Vaccination Team has been a shining example of staff and public volunteers coming together in an organisationally agnostic way with a common goal of keeping our communities safe. We are all incredibly grateful to everyone involved for their tireless work and dedication.”

Accountable Office for NHS Nottingham and Nottinghamshire CCG, Amanda Sullivan, added: “The key to delivering great health and care services to our population is for NHS organisation and Local Authorities to work together, irrespective of organisational boundaries. The vaccination programme in Nottingham and Nottinghamshire is a great example of this with different organisations taking the lead on different areas of the work – be it estates, pharmacy, communications, operations or inequalities. The work that Sherwood Forest Hospitals NHS Foundation Trust has led for in terms of securing the frontline workforce for the vaccination programme is one great example of this – well done to them for this nomination and I wish them best of luck.”

A fresh approach to local partnerships

When the national and local priorities aligned with the launch the Primary Care Networks, more co-ordinated local care was supported with significant new investment. The timing was right to create an innovative approach. The Enhanced Healthcare in Care Homes team is not yet a year old, but has already had an impact on some of the difficulties the system faces providing high-quality pro-active primary care in care homes.

Working together with all the other agencies shown in this list of partners (pictured left) the proactive, highly skilled, multi professional team delivers improved healthcare in care homes by maximising mature, integrated services through an MDT approach. They are equipped with the time and skills required to establish close relationships with care homes, residents and families to create personalised care plans.

Did you know?
The principles and many aspects of the Nottingham West EHCH team are now being developed with the Mid Notts ICP in Newark with similar aspirations of success.Outcomes so far
The infographic, pictured left, highlights some of the outputs recorded so far.

Improved quality of patient care: the team provide pro-active case management from a dedicated and specialist team and have a MDT lead for each patient who oversees their care plan.
Care homes support: we provide training and a support network so staff are up-skilled and less likely to admit residents to hospitals unnecessarily. For any that are struggling with any aspect, we support them to work with CQC and CCG quality team to ensure the safety of residents.
Optimised GP input: Complex case management, care planning, difficult medication optimisations all became possible within the time that GPs can commit to, because care is co-ordinated by someone else: the Clinical Care Home Lead is the primary contact for all the other case workers and the care-coordinators are on hand to link in all the other services, support and facilities available.

Patient case study

Joint working between five teams means a patient avoids hospital admission, and the carer is supported.

Agencies involved: Care Home, Social Worker, Community Psychiatric Nurse (CPN), Continuing Care and EHCH team.

An elderly patient with Dementia was due to return home at start of a bank holiday weekend after spending two weeks of respite at a care home in Nottingham West.

Their carer was struggling with patient’s progressive dementia, verbal, physical aggression and was having difficulty accessing day centres during the pandemic. The patient had named Social Worker and Community Psychiatric Nurse (CPN).

The EHCH team had reviewed the patient and they were concerned about their discharge. The extended weekend left little time for allied agencies to put in place a care package. It was highly likely the patient would be admitted to hospital.

The CPN and Social Worker agreed and the team successfully applied to NHS Continuing Care to fund an extended stay in the same care home with 1:1 support. Work continues to determine whether the patient and his carer wish for a longer-term placement.

GP and Clinical Director perspective

“Patients are truly cared for in most appropriate place towards their end of life, avoiding inappropriate admissions. Advance care planning reduces falls risk, medication reviews result in more effective use of medicines and de-prescribing.”

Dr Paul Scullard, Nottm West Clinical Director

Kathy’s Blog – system standards, structures and sunshine!

I’m writing this with the sun streaming through the window of my office and so as summer looks to be arriving it seemed like a good moment to update you all on how the establishment of our new system is going.

Since I last blogged in late April, an awful lot has happened as we move quickly onwards with our plans as a system. I’m delighted with how much progress we are making, and also how much we are doing collaboratively, within the NHS and also between the NHS and Local Authority colleagues. We are agreeing on many things but also disagreeing, constructively, on some topics – this all suggests that we will be highly successful together in the future.

And it’s how we work together, how we agree things and how we behave when we disagree that I want to turn to first. I mentioned last time we were working on a ‘Leadership Compact’ – this has now been renamed as our ‘Leadership Agreement’ and is in the process of being confirmed by all partners across the ICS. This Agreement sets out the core behaviours that we all agree to adopt as we go about our work as a system. I think this is a healthy and positive foundation stone of our system – once the Agreement is confirmed at our next public ICS Board then we will share it with you all and I would ask that you use it to check if your discussions and activities are living up to the standards we would all aspire to.

One of the recent interactions where we used the Agreement to review our discussions at the end of meeting was our ICS Board Development Session at the start of June. At the Development Session we discussed how we might want to shape the Health and Care Partnership (the wider forum for partners) which will be the ‘guiding mind’ of our system from April 2022. I was pleased to see a high level of agreement from all organisations, including on the centrality of citizen insights and experience to our planning process. Here, the strength of combining our existing rich NHS data sets with the Councils’ Joint Strategic Needs Assessments and also Health and Wellbeing Plans will mean that we will be able to be truly citizen-centric in our planning and delivery.

At the Development Session we also discussed how the Provider Collaboratives at scale and Place Collaboratives will operate as part of the overall family of different ways of working together in our system. I’m grateful to Tracy Taylor and Dr Hugh Porter for presenting emerging thinking in those areas. Our place partnerships have been working together for some time now – they have developed some priorities for their populations, as well as working together to establish some really vibrant place-based approaches that will be aligned across the whole system. NHS provider trusts will also increasingly collaborate to improve care and make best use of resources. Discussions about how trusts will work together and with other partners will continue to progress in the coming weeks. All of this thinking will need to be checked for alignment against NHSE/I’s ‘ICS Design Framework’ which has just been published but I am confident that our early thinking is on the right lines to deliver the outcomes our citizens expect from us.

And talking of outcomes, I am delighted that alongside the important (but ultimately slightly theoretical) work on structures and ways of working we are still pressing ahead on three key areas of working together with direct impact on citizens and patients. These three “signature projects” are: Community Care; Children and Young People; and Integration of Person Centred Commissioning. The focus of this work will be delivering better outcomes for our population across NHS and Local Authority services – if you aren’t involved and want to find out more please do shout up.

The final thing I wanted to mention was how thankful I am for all the time that everyone has given me to have discussions of our ambitions and plans for the future – I’ve really enjoyed hearing from Non-Executive Directors as well as Elected Members and Executives from across our organisations; the focus on democratic accountability that our Councillors bring to all our interactions has been really clear, and; I’m really impressed by how hard GPs are working, still focussed on delivering face-to-face care for their patients even with the challenges of preventing infections in smaller, more cramped surgeries. I am committed to continuing these conversations, especially as we firm up plans for the Health and Care Partnership and our wider approach to citizen involvement and engagement.

As always, please do share this update with others if they have not received it and please do get in touch directly on kathymclean@nhs.net if you want to discuss something with me or have a question or an idea. I hope that you are able to get a (probably UK-based) holiday at some point over the coming couple of months. I have enjoyed some stunning weather on the hills in the Lake District in recent weeks which reminded me of the wonderful locations we have in our country that perhaps we should take the chance to appreciate a bit more.

I’ll leave you with some thoughts from that other great lover of the Lakes, Alfred Wainwright: “An objective is an ambition, and life without ambition is … well, aimless wandering”. I think we have some excellent ambitions in our system and soon we will have the structures and plans in place to keep us going and avoid any aimless wandering – I hope you will continue to join me in that progress.

Best wishes,

Kathy

A bit of background about me if you’re interested: I’ve worked in the NHS for nearly 40 years including as a senior registrar and consultant specialising in geriatrics and stroke medicine, Medical Director of Derby Hospitals NHS Foundation Trust and then as Medical Director at East Midlands Strategic Health Authority. I was then Medical Director of NHS Trust Development Authority and subsequently Executive Medical Director and Chief operating Officer of NHS Improvement. Since leaving NHSI I’ve been Chair of University Hospitals of Derby and Burton NHS Foundation Trust and a Non-Executive Director at Barts Health NHS Trust. I live in Derbyshire with my wife and have two grown-up children. When I’m not working I like to spend time on my allotment and walking in the hills and along our coasts where I can also enjoy birdwatching. I’m looking forward to doing more of this in the coming weeks as society slowly opens back up and I’m sure that you are similarly ready to take advantage of our newly returned freedoms.

Independent Living Service working in partnership across Broxtowe

Broxtowe Borough Council’s Independent Living Service offers comfortable and affordable housing, along with a lifeline which provides 24 hour a day access to an emergency response centre. The support includes regular activities delivered by Activities Coordinators and Personalised Independent Living Plans supported by Independent Living Coordinators.

The service works in partnership with other services such as Mental Health Services for Older People, Community Health Services, Primary Integrated Community Services (PICS), Social Care‘s Ageing Well service and Practice Nursing to support local people to continue to live as independently as possible.

Some examples are :

Regularly working with the PICs team. Independent Living Coordinators referring into the PICs team and attending appointments and multi-agency meetings with them.

Closely working with the Ageing Well Social Care team. They work with the allocated Social Worker to complete joint visits, updates or multi agency meetings. The Occupational Therapists within the Ageing Well and Community Health Teams also provide support through recommendations to provide extra grab rails or other lower level adaptations, as well as advice which is invaluable and makes a hugely positive difference to the resident.

Some of the team’s recent resident examples include:

Mrs W

Mrs W was struggling to live independently and had some hoarding in her property. She was initially refusing assistance from anyone, but her Independent Living Coordinator was concerned that Mrs W was struggling to maintain her property and was unsteady on her feet.

Mr W said she did not want to see her GP but did accept the Independent Living Coordinator making a referral to the PICs team and social care. The PICs nurse carried out a joint visit with the Independent Living Coordinator and was concerned about Mrs W’s health and contacted the GP and the social worker allocated to Mrs W.

This intervention found that Mrs W was not taking her medication properly and had some health issues which would benefit from respite care, which she agreed to move into that day.

Whilst in respite care, Mrs W agreed to a move to an Independent Living property located within a scheme where she would have a 24 hour emergency pendant system and regular contact from an Independent Living Coordinator (who does a three monthly review of her Independent Living Plan).

She has now left respite and moved into her new property, her social worker has set up regular daily care support and the PICS team provided a support visit on her return home. The Fire Service has also done a Home Safety check.

Mrs H

Mrs H lives in an Independent Living property within a corridor scheme. The Independent Living Coordinator was concerned that Mrs H often smelled of urine or faeces and that her property smelled strongly of urine.

Mrs H did not present as understanding the Independent Living Coordinator’s actions about cleaning the property, so they spoke with Mrs H’s GP, made a social care referral and referral to Metropolitan Connect. She was subsequently allocated a social worker and, following a referral from the GP, has support from a Clinical Care Coordinator.

Mrs H was allocated daily care and assistance with cleaning the property, including changing her mattress, bedding and carpet, and she continues to be supported by her social worker with regular partnership meetings within the scheme and ongoing daily care.

South Notts ICP commits to co-production to support development of services

We are working towards developing our plans built on the foundations of co-production with our communities. Maria Ballantyne, Group Manager – Living Well South team, Nottinghamshire County Council, is supporting the partnership with this and explains what this actually means…

Co-Production is about us working together to shape and improve health and social care services by involving the people and their carers who need and use them. In practice, it means that we want to work with people who use the service so they can tell us about what works well, what doesn’t and, how can we make sure that we are all talking about it to make positive changes.

When co-production works best, people who use services and carers are valued by organisations as equal partners and have an influence over decisions made.

Why is it important?

Co-production of health and social care services is important because it enables the people who have ‘lived experience’ of receiving them to participate in the planning and decision making about their local health and social care service offer. Involving people who have lived experience leads to service improvement and more inclusive planning for the future.

Co-Production is based on the following 4 commitments:

Equality: Everyone’s views and experience are valued, and all the people involved are equals- whether they are health and social care professionals, people or carers with lived experience.
Diversity: Health and social care services should make sure that the group of people involved reflects the diversity of the local population.
Access: Co-production meetings and discussions must be accessible for all to take part. There shouldn’t be anything that makes it difficult for any group of people to take part in co-production.
Reciprocity: The people involved in co-production should get something for taking part, for example this could be support for someone with care and support needs so to enable their carer to take part, or the chance to meet new people and feel part of a co-production community. (Social Care Institute for Excellence 2015).

Example of Co-Production in practice:

Birmingham City Council’s Adult services Department has developed new ways of working to support co-production work including:

two “quality boards” made up of people who use services, these boards co-produce the minimum standards for adult care services in the city.
ensuring that people who use services have the “lived experience” and can get involved as early as possible in projects, at all stages of service development (Social Care Institute for Excellence 2015).

The County Council is supporting South Notts ICP to develop their co-production plans and the partnership is committed to co-producing plans for local services in the future. We look to updating you on our progress.

For further information about Co- Production please see: Co-production: Working together to make things better | Nottinghamshire County Council

‘Think Local, Act Personal’ https://www.thinklocalactpersonal.org.uk/

The South Notts ICP are working towards building on the work already in place and, we look to updating you regarding our progress.

Victor the vaccine bus rolls into South Notts…

The Covid vaccination programme continues at pace across the county and Victor the vaccine bus came to our patch earlier this month, visiting Hucknall on Monday 3 May and then Beeston on Wednesday 5 May.

The bus was available for first vaccinations for eligible local people and it was an easy way for people to access a vaccine closer to home.

Talking about the bus visit to Hucknall, CCG PCN Manager Nikki Biddlestone said: “The success of the vaccination bus was a result of the community coming together, and was a fantastic example of partnership working between the NHS and the local council.

“In Hucknall, I worked very closely with Tracey Bird, Health and Wellbeing Officer at Ashfield District Council, to plan the visit. Tracey is a fantastic asset to Ashfield DC and the local population she works closely with. Her understanding of the area and community needs has been invaluable to placing the bus where they are most accessible to local people.

“It’s been great piece of work for us to join together for the benefit of people in Hucknall and has enabled our partnership working to develop even more. We continue to work collaboratively for the benefit of the Ashfield population and look forward to seeing the benefits to individuals and their families.”

Tracey, who also worked on the bus on the day, said: “The vaccination bus was really well received within the Hucknall community. I was a little worried because it was a very wet Bank Holiday Monday, but the Hucknall residents never fail me with their commitment to their community.

“Many people found the bus really convenient due to a lack of personal transport and other circumstances that have delayed them accessing the vaccine. One person told me: ‘I have changed my mind so many times about having the vaccine but coming to the bus drop-in session today has made me feel more at ease. My partner was also able to support me today because they aren’t at work’. Other people thanked everyone involved and were very pleased that the bus had visited Hucknall.”

The bus is next visiting Beeston, parking up at Devonshire car park (NG9 1 BS) on Wednesday 3 June, from 10am, drop in only and will only be around until vaccines run out. First vaccinations and available to all currently eligible.

Making networking happen at Nottingham West PCN’s Broxtowe Together event

Nottingham West Primary Care Network (PCN) would like to invite people living and working in the area to their Broxtowe Together event on Friday 11 June. The event will be an exciting opportunity to continue to further develop our relationships and connections with the wider community across Broxtowe.

The event is open to all local people in Broxtowe and will be led by Dr Tim Heywood, Clinical Director, Nottingham West Primary Care Network (PCN). Tim will be joined by Ruth Hyde, Chief Executive, Broxtowe Borough Council and Julie Bryant, Patient Representative who will facilitate the event.

Sign up here.

During the event there will be ‘breakout rooms’ to allow discussions in smaller groups to enable everyone to have the opportunity to contribute. The event which runs from 2 pm will take place using Zoom. You will receive a notification detailing the link to follow and additional information a week before the event.