Our Approach
It set out our strategic framework for improving health and healthcare in the region, based on international and national evidence of best practice, informed by local circumstances and needs in Yorkshire and the Humber. It was not a reconfiguration plan for the region. Rather, it was intended to provide the backdrop and context for individual organisations to set their own strategy and to raise our collective ambition to improve health and health care.
This chapter sets out how we (that is the SHA and our fourteen PCTs) approached the next phase – designing a road map for the implementation of the recommendations contained in Healthy Ambitions.
This has been complex and has required a careful balance between ensuring that we make the improvements we need, with securing local ownership and engagement. It was our ambition to accelerate improvement – not to override local leadership which would be counter-productive to making the changes needed in the region. The following chapters set out the ways in which the recommendations in Healthy Ambitions will be taken forward – covering:
- All of the different pathways
- Levels of delivery – i.e. regional or local
- The key enablers needed to support delivery
- How we will ensure delivery is taking place
- How we will measure success
- Region wide governance arrangements
Principles of our approach
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We have adopted five principles to shape our approach to implementation. These are:
- Clarity of purpose: Keep the objectives of the report – improving health and health care – at the forefront of all discussions
- Collaborative production: Design implementation programmes as much as possible with the NHS, local authorities and key stakeholders
- Subsidiarity: Ensure that where details of implementation can be determined locally, they should be
- Clinical ownership and leadership: Build and sustain clinical engagement and leadership through all elements of implementation
- System alignment: Incorporate implementation into mainstream processes, and align our objectives to the goals of Healthy Ambitions.
Levels of delivery
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In line with the approach of local decision making and collaboration, the SHA agreed a framework with the NHS community in Yorkshire and the Humber to determine how recommendations should be taken forward. This is set out above. It was agreed that as much as possible should happen at a local level, led by local organisations. Local organisations whether commissioners or providers, can use Healthy Ambitions as a backdrop for prioritising their own future development or investment. Every PCT has now developed a five year strategic plan. In developing these plans the SHA asked all 14 primary care trusts to review the recommendations in Healthy Ambitions and prioritise them in light of their own local circumstances.
Where collaboration was desirable or essential because issues cross local boundaries, then it has been agreed that recommendations should be taken forward through cross-regional vehicles, ideally using existing mechanisms wherever possible. Only where it is essential that something should be done only once, would responsibility for delivery take place at a regional level.
For each pathway, we have determined which recommendations should be taken forward at each level. A brief summary is set out at the beginning of each pathway chapter.
Dissemination and feedback
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During the course of this process, we have gathered feedback from a wide range of people in Yorkshire and the Humber on both the content of Healthy Ambitions, and on proposals for delivery. A number of key messages have emerged:
- People are broadly supportive of the content of the report. There had been considerable concern expressed by GPs over an initial draft recommendation about setting up children’s GPs. However, the final report recommended improving paediatric expertise in primary care, with children’s GPs as one option.
- Some parts of local government would like more opportunities to be involved in cross-regional and regional work. There is a recognition that the initial pathway groups focused very much on the NHS elements of improved health and care, but all involved know that working with partners is key to making these improvements.
- Clinicians and others need to understand the decision-making process, particularly for decisions which cross a number of providers– we have addressed these issues in the section on governance later in this report.
We have received a number of written comments from organisations and individuals on the report, all of which have been documented and taken into account in the drafting of this publication.
We continue to listen to stakeholders and partners and will always welcome comments both on the implementation framework and the original recommendations themselves.
In addition we have undertaken to keep all stakeholders regularly informed in a systematic way and to make updates on implementation regularly available, for example through the Healthy Ambitions website, www.healthyambitions.co.uk