These are all initiatives that have been completed across the whole of the Lancashire and South Cumbria area and managed across the partnership system
Mental health (including children and young people)!
Mental health has been a pressing concern during the COVID-19 pandemic, with increases in stress, isolation, low mood and anxiety as a result of the virus and lockdown restrictions. A new interactive map of local mental health services was produced on the ICS website, allowing residents to search for specific types of support.
With lockdown restrictions being tough for children and young people, local health and care organisations reached out to reassure parents, carers and young people that they could still get the help they needed. Helplines, a self-referral process and online resources were flagged and highlighted on the Healthy Young Minds website, which talks about common issues such as anxiety and low moods. The website has been further developed during 2020/21 with children and young people, their families, and professionals to make it as easy as possible for them to access advice, help and support quickly, whenever they need it. The ICS attended virtual focus groups, local participation groups and ran an online survey to gather feedback, and some ‘digital champions’ have been engaged to provide continuous feedback.
Children and adolescent mental health services (CAMHS) have remained open, with face-to-face contacts where needed, but also making increased use of technology to work with children and young people. Primary mental health workers have continued to support professionals to identify and meet needs, working across agencies.
Children and young people have been particularly impacted by the lockdown restrictions and younger ones may even be struggling to understand the reasons why. The Lancashire and South Cumbria Integrated Care System (ICS) launched a Mental Health Family Hour podcast to support families during lockdown, and regularly signposted children and their parents to useful resources and services. Kooth also provided free access to online support and counselling for young people aged 10-18.
In May 2020, CCGs across Lancashire and South Cumbria commissioned Togetherall (previously Big White Wall), a clinically safe and anonymous online community offering peer-to-peer support, personal assessments and self-help courses. The resource was actively promoted to young people aged 16+, amid heightened concerns about high levels of loneliness and anxiety during the festive season of 2020/21.
Recognising the impact of the COVID-19 pandemic and lockdowns on people’s mental health, the Lancashire and South Cumbria ICS frequently campaigned on suicide prevention. Efforts included:
- Supporting people who are isolated whilst shielding and/or self-isolating, and targeting people worried about their job security or finances.
- The ‘Let’s keep talking’ campaign – encouraging local organisations, businesses and community groups to access resources that promote people to open up about their mental health.
- Publishing an online directory of suicide prevention and bereavement services across Lancashire and South Cumbria.
- Launching the Orange Button Community Scheme on World Suicide Prevention Day (10 September 2020). Local people who have undergone extensive suicide prevention training wear an orange button to signal to others that while they cannot counsel people, they can provide comprehensive signposting to relevant services.
In March 2021, the suicide prevention programme won the Health Services Journal Connecting Services and Information Award for using data to target high-risk groups and locations. The approach was described as “underpinned by clear principles, where suicide prevention is now seen as everyone’s business, has connected their services, communities and combined efforts in a meaningful way.” The real time surveillance system was also shortlisted for a Health Service Journal System Leadership Initiative of the Year Award for working with local partner organisations and communities to make suicide prevention ‘everyone’s businesses.
COVID-19 accelerated the take up of digital technology solutions within primary care. The ICS Digital team responded at pace to support the implementation of the Digital First approach across GP practices in Lancashire and South Cumbria. By late May, almost all GP practices across Lancashire and South Cumbria were actively providing video consultations, thanks to the relevant licences and extra training for staff.
In response to the pandemic, the Lancashire and South Cumbria Data Hub was developed to support virtual wards, the LAMP testing programme, and to create an outbreak mapping tool for COVID-19 data. Through a combined COVID-19 / Population Health Management system for West Lancashire, information relating to vulnerable citizens (held by health and care teams and West Lancashire Borough Council) can now be used by multi-disciplinary teams.
Lancashire and South Cumbria partners offered iPads to care homes in the region to improve access to remote consultations and healthcare services, and to help residents maintain contact with loved ones. The devices went to homes that were at least partially NHS or local authority-funded, with priority given to those that lacked good digital infrastructure. NHSX funded the project, which was coordinated by the ICS Digital team and Regulated Care sub cell.
A locally developed digital communications tool known as ‘Advice and Guidance’, has been rolled out to all acute providers in Lancashire and South Cumbria. This gives GPs rapid access to advice from specialists in secondary care and has been used over 15,000 times between April 2020 and January 2021. Early feedback suggests a potential reduction in the number of patient journeys, and in waiting times for certain appointments. More than 97 per cent of GPs say the system is easy to use and rated the information they obtained as either ‘useful’ or ‘really useful’.
Clinical and digital experts across the Lancashire and South Cumbria ICS have collaborated on developing the Clinical Systems Roadmap, as part of the plan for an area-wide Electronic Patient Record (EPR). Lancashire Teaching Hospitals NHS Foundation Trust was the first to go live with a new maternity specialist system in March 2021, and learnings will be shared as each hospital trust prepares for their launch.
As part of an essential upgrade to avoid cyber-security risks, GP practices across Lancashire and South Cumbria are being upgraded to Office365. New functionality includes video calls with patients and colleagues via Microsoft Teams, and full integration with the national NHSmail email service.
The Integrated Response and Falls Lifting Service has had high levels of activity. A non-emergency visiting response is provided to people who have fallen in their own homes, relieving pressure on the ambulance service. Since launching in October 2019, 23,655 visits have been undertaken (as of February 2021). A new process to increase referrals from North West Ambulance Service is proving successful in an ongoing trial.
Across the country, the NHS saw a reduction in the number of people reporting stroke symptoms during the COVID-19 pandemic. It was understood that people were reluctant to waste the NHS’ time and concerned about the risk of catching COVID-19 when visiting hospitals. As stroke is the third largest cause of death in England, the Lancashire and South Cumbria Integrated Care System (ICS) made efforts to dispel these myths, and supported the new ‘Act FAST’ campaign that advises people of how to recognise the main signs of stroke and to dial 999. Raising awareness and encouraging people to make healthier lifestyle choices to reduce their risk of the condition has continued throughout the year.
In September 2020, the Lancashire and South Cumbria Integrated Stroke and Neuro rehabilitation Delivery Network (ISNDN) was established to design and deliver optimal stroke pathways and ensure that more people receive high-quality specialist care. The network has already launched the Lancashire and South Cumbria Healthy Hearts website and agreed the design of the optimal network configuration for delivering stroke services across the region.
A newly-formed group with lived experience of stroke, the Lancashire and South Cumbria Stroke Patient and Carer Assurance Group, provides the patient and carer voice, reporting into the ISNDN Programme Board and holding it to account. It has already been involved in developing a carers’ pack, and in stroke awareness campaigns.
More than 100,000 people aged 17+ in Lancashire and South Cumbria have Type 2 diabetes, and it is estimated that more than 75,000 people are at a high risk of developing the condition. It is essential to diagnose Type 2 diabetes as early as possible, and to identify people at risk of the condition, so they can be supported to make healthier lifestyle choices to reduce their risk. In Lancashire and South Cumbria, people identified as being at risk are offered tailored support through the local Healthier You NHS Diabetes Prevention Programme. Normally the programme involves a series of face-to-face group sessions, but virtual meetings were established during the pandemic.
On the Fylde Coast there are approximately 20,800 people with diabetes. In the last year 112 Blackpool patients started the ‘Healthier You’ national diabetes prevention programme. You can read one of the patient’s stories here: https://www.stopdiabetes.co.uk/case-studies/pumped-and-ready-challenge-retired-tyre-fitter-rae-confidently-reduces-his-risk
Local people with Type 2 diabetes can access support to manage their condition through the Your Diabetes, Your Way service. Again, all face-to-face learning sessions were temporarily suspended during the pandemic, but a lot of digital support and online resources were available. As people with diabetes are amongst those more vulnerable to COVID-19, local health and care organisations worked together to provide practical and emotional support, especially during the winter months.
Blackpool Teaching Hospitals NHS Foundation Trust, East Lancashire Teaching Hospitals NHS Trust, Lancashire Teaching Hospitals NHS Foundation Trust and University Hospitals Morecambe Bay NHS Foundation Trust, are working together to design a single pathology service which is high quality, clinically effective and cost effective. A hub and spokeframework has been chosen, with the Pathology Hub processing all non-urgent tests, but essential service laboratories remaining on each hospital site to turnaround tests needed for emergency and urgent care.
A robust and transparent process was put in place for choosing a location for a Pathology Hub, with Leyland (near Centurion Way) endorsed as the preferred clinical option. A purpose-built environment will bring together highly qualified clinical and scientific staff to drive adoption of new technology, maximise future investment and increase the ability to continue providing a high-quality service. The Outline Business Case is being developed and will require endorsement from all four Trust Boards prior to submission to NHSEI. Staff, partners, and stakeholders will continue to be informed and involved as this project develops.
The Lancashire and South Cumbria Cancer Alliance is one of 19 across England, established to bring together decision makers and those who deliver such services to transform services and improve outcomes. The Cancer Alliance took a system leadership role across the ICS in response to the pandemic. Clinical and operational oversight groups were rapidly set up to implement all appropriate guidance, develop bespoke reporting tools, and ensure consistency across all localities. A surgical prioritisation group was developed to maintain oversight of the cancer waiting list and ensure equity of access.
A successful capital bid secured over £6m of investment to endoscopy services, which has allowed rapid expansion of services to support recovery of waiting lists. Whilst current backlogs remain significantly higher than before the pandemic, the proactive work of the Alliance means that plans for restoration include specific, measurable and achievable targets for 2021/22.
In response to the national trend of falling cancer referrals during the COVID-19 pandemic, the Cancer Alliance encouraged local people not to ignore the various cancer symptoms. Media releases, social media toolkits and videos all carried the message that it was safe to attend for tests if recommended after an initial virtual consultation. Campaigns were aligned with various national awareness dates, and a number of targeted messages signposted to support people who were shielding whilst undergoing cancer treatment.
Lancashire and South Cumbria ICS partners are working together across Better Births Lancashire and South Cumbria to make sure all women, their babies and their families experience safe, kind, compassionate and personalised care, and to make sure they can access support that is centred on their needs and circumstances. During the pandemic, pregnant women were reminded that NHS maternity services were still open, but with some changes such as more virtual appointments where appropriate, and whether partners could attend appointments and scans. A maternity COVID communications campaign delivered safety messages in six languages to vulnerable ethnic minority groups.
During 2020/21, the Lancashire and South Cumbria Maternity and New Born Alliance (MNBA) made successful funding bids to develop perinatal pelvic health services as an early implementer, and also for three local trusts to be fast followers in implementing maternal mental health services. The MNBA addressed inequalities in maternity care with two projects. A study led by colleagues from the University of Central Lancashire looked at the experiences of local maternity care of women from ethnic minority backgrounds, while the other project developed a cultural safety toolkit to support staff to better understand cultural barriers to the delivery of care.
In May 2020, a new Mum and Baby app was launched to improve women’s experiences of maternity care and ensure that the information they receive is consistent, no matter where they choose to give birth across Lancashire and South Cumbria. An extended-hours breastfeeding helpline was also launched for women across the region. In December 2020, Chorley Birth Centre opened to support ‘continuity of carer’ models for maternity care.
The implications of COVID-19 have been the main priority for children’s services this year. Parental anxiety during the pandemic caused a significant reduction in the number of children and young people accessing health services. Media campaigns emphasised that services were still available and should be used as usual. Clinicians mobilised quickly to adapt to virtual consultations, and some local paediatricians were involved in the production of a webinar about Attend Anywhere – which was broadcast nationally.
Despite the pandemic, some transformation work continued with the agreement of a system-wide cerebral palsy integrated pathway, and further work to develop pathways for children with autism spectrum disorder. Clinicians across the system have continued to be involved in discussions about developing the New Hospital Programme and the impact this will have on services for children and young people. Once the ICS Children and Young People Health Board is developed, groups in each of the ICP areas will work with the board to ensure implementation of the national transformation programme and oversee quality.
Lancashire and South Cumbria was chosen by NHS England as one of 13 personalised care demonstrator sites for 2019/20. The ICS is learning from what is working well and creating partnerships within the local health and care system, local populations, and neighbourhoods to ensure people have choice and control over the way their care is planned and delivered.
The Personalised Care Hub provides the local health and care workforce with education and support to continuously improve how they deliver person-centred and personalised care. As face-to-face training has been suspended during the pandemic, resources were made available online for colleagues to support people’s health and wellbeing, maximise self-management and reduce unnecessary demand on services.
The Let’s Get Personal Group produced several videos telling the stories of how personalised care has improved patients’ lives. Many of these were shared during Co-production Week (6-12 July 2020) to demonstrate how listening and respecting the contribution that a patient can make ensures that the care provided helps that person live the life they want to. The Supported Self-Management and Psychological Resilience Collaborative used social media to promote self-care to colleagues and service users and hosted a live tweet chat during Self Care Week (16-22 November 2020).
CCGs in Lancashire and South Cumbria are part of SEED – a collaborative Health Alliance made up of health, business, academia and the voluntary, community, faith and social enterprise sector which exists to tackle social, economic and environmental determinants of health. SEED has established a Research and Innovation Partnership which has recently submitted an asthma medtech bid. A report produced for the ICS details the positives and negatives of health and social care during the pandemic. This involved many workshops, speaking to staff from CCGs, hospital trusts, councils, care homes, hospices, patient groups, voluntary organisations and charities.
SEED is heavily involved in future workforce proposals and are demonstrating to local MPs that there are existing groups in the North West that can help. SEED has also helped signpost medical students to opportunities to participate in the COVID-19 vaccination programme. SEED will be part of a Patient and Public Involvement Collaborative which will seek to include the region’s population in future decision-making and advancing health and care.
The Lancashire and South Cumbria ICS has four priorities around workforce: compassionate leadership and systems development, opportunities for all, a positive employment experience, and building a sustainable workforce. It is developing the Lancashire and South Cumbria People Plan, in response to the NHS People Plan (July 2020), which will build on the existing ICS workforce strategy to develop one plan for delivering workforce ambitions.
The ICS’ Strategic Apprenticeship Group works to develop the apprenticeship pipeline, aiming to create clear career pathways that will aid the recruitment and retention of staff, while also upskilling local communities. The group’s ‘Grow our Own’ strategy highlights apprenticeship vacancies, but also aims to inspire people at every stage of their career journey. Its work to date has included mapping the nursing apprenticeship pathways for social care, and analysing system data to forecast and map gaps in the future workforce. The five trusts in Lancashire and South Cumbria work collaboratively to maximise the apprenticeship levy.
The ICS was able to recruit people who had been made redundant to help with the COVID-19 vaccination programme, and their contribution made a significant impact to our work in our large vaccination centres. In the period November 2020 to January 2021, 121 job offers were made to people who had taken part in an online intensive programme.
Several Integrated Voluntary Services projects are in development, including pilots in Fleetwood and Blackpool for a volunteering scheme to give carers and young carers the experience they need to enter careers in regulated care homes. Work has also been underway on a system-wide digital volunteer passport to provide proof of identity for volunteers, with the potential to show DBS checks and mandatory training compliance.
Organisations are working in partnership to improve diagnostic services for people across Lancashire and South Cumbria. The diagnostic imaging programme aims to provide robust and sustainable integrated diagnostics services for local people, improving quality and efficiency and reducing unwarranted variation in standards of care. Following a significant impact from COVID-19, the focus of the programme shifted from planned transformation work to supporting the recovery and restoration of elective work. The programme has also succeeded in securing capital to procure three additional CT scanners for the region, one of which will be on the Fylde Coast, which will go live in April/May 2021 and will increase CT diagnostic capacity for Lancashire and South Cumbria.
Learning Disabilities and autism
During the pandemic, the pace of work stepped up to ensure people with learning disabilities and autism received accessible, timely and relevant information and were still able to access the health services they needed. Teams adapted quickly to remote working to ensure all commissioning work and tasks continued without pause. Remote working also enabled care, education and treatment reviews and assurance visits to continue for all inpatients and facilitated increased attendance and more involvement at case discussions by specialists such as consultant psychiatrists and paediatricians.
Targeted work was also undertaken with people on the Learning Disability register, encouraging and supporting them to accept the COVID-19 vaccine. In all cases where a person with learning disability has sadly died, a Learning Disabilities Mortality Review has taken place.
Using population health management to reduce health inequalities
More people are experiencing long-term health problems as they get older, but some of this could be avoided, or the ill-effects slowed down, if we took positive action to prevent it. Population health management uses existing data to look at the best way to help people live longer, providing personalised care tailored to their needs.
During the pandemic, the focus has been on vulnerable groups such as the homeless and individuals living in deprived communities. Primary care and the voluntary sector have provided wrap-around support to reduce their susceptibility to infection, and supported people in virtual wards to manage their risk factors from home. Going forward, data will be used to identify people with multiple long-term conditions and understand how they can be supported to prevent complications and live independently.
The Fylde Coast CCGs have been an integral partner in the development of ICS plans on reduce health inequalities across Lancashire and South Cumbria.
The Fylde Coast includes some of the most deprived communities in the country where health inequalities are high. As part of our pandemic approach to tackle health inequalities and prevent COVID-19 in those vulnerable communities the CCG has worked with local authority partners to engage with the voluntary, community, faith and social enterprise (VCFS) sector to co-produce with residents bespoke messages, videos and advice and guidance which is tailored to the needs of local communities.
In order to protect the most vulnerable from COVID-19 the CCG worked with local authority partners (Blackpool, Fylde and Wyre) to develop information sharing pathways between primary care and local authorities to identify individuals, their needs, and coordinate a response. For example, sharing details of people who could not be contacted by the local authority with primary care to see if they were in hospital or shielding with a family member. This then informed the local authority follow up response.
The most vulnerable includes the homeless people living on the Fylde Coast. Supporting those people required a significant response that included weekly meetings across agencies, reserved accommodation for self-isolation and using remote monitoring so that changes in symptoms could be quickly escalated to our homeless health team.
Working with local housing teams in Blackpool, Fylde and Wyre, public health, GP practices, the Blackpool Lived Experience and local commissioned services and charities that support people who are homeless the CCG was able to support the homeless to get the flu vaccine. This included setting up drop-in clinics and having a qualified vaccinator on our local homeless health bus.
We continue to work with local practices to ensure that people are able to register even where they have no fixed abode.
Partnership working and developing has been significant during 20/21 to increase local understanding of how-to best support people in health inclusion groups. This has been particularly evident through the multiagency approach to supporting people to get the COVID-19 vaccination. This has been key to ensuring that we have accurately identified people, but also so that we work sensitively, recognising the societal stigma towards people within health inclusion groups. This has included the delivery of specialist clinics for sex workers, which includes sexual health screening and advice alongside delivery of the COVID-19 vaccination, as well as working with site managers on traveller sites to determine who is on site, and whether they are eligible for, or want, the vaccine. These links have been maintained and will put us in a good position for further supporting people in health inclusion groups.
Blackpool has very high levels of poor mental health with 19 per cent of the population reporting moderate or extreme anxiety or depression. To help with this the CCG implemented four trainee associate psychological practitioners (TAPPs) in four primary care networks. This is part of an ICS pilot to introduce an entry level qualification for psychology services, where we have worked with the Strategic Clinical Network, Health Education England, NHS England, University of Central Lancashire, and the ICS Personalised Care Team, to develop and implement the TAPPs.