The Context for Yorkshire and the Humber
On July 5 1948, the brass band from Yorkshire Main Colliery trooped up to the doctor’s surgery in Edlington, South Yorkshire, and began to play. The doctor hung a Union flag out of the window and gave them all a drink. The NHS had arrived.
Dr Michael O’Donnell, the GP’s son, the Independent, 5 July 1988.
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This year will see the 60th anniversary of the establishment of the NHS. In Yorkshire and the Humber (Y&H), as elsewhere in the country, we are proud and privileged to work for a service which touches everyone in the region at some time in their life.
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But life today is very different from when the NHS was set up. Public expectations are changing; working and family lives have altered; people are living longer; and patterns of disease are changing. Technological innovations – both in terms of drug therapies and scientific advances – have transformed the ways in which we can deliver care or support people taking care of themselves.
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This report sets out the work we have been doing to take forward the review established by Lord Ara Darzi last year. The review was led by clinicians from across Y&H and examines how we can improve health and health care in the region. It sets out the Strategic Health Authority’s (SHA's) ambition to save lives and improve the care for our population over the next ten years.
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The report begins with a description of Y&H, and then outlines the process through which we carried out the review. It then describes some of the main reasons why we need to change; in particular, it outlines the main arguments for the need to improve our services.
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The report then outlines the work and recommendations of our eight Clinical Pathway Groups (CPGs), who were each asked to look at how we could make improvements across pathways for: staying healthy, maternity and newborn care, long-term conditions, children, planned care, acute episodes, mental health and end of life. The report concludes with chapters on delivery models and enablers.
Our geography (Y&H)
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Y&H covers an area of 15,510 square kilometres. This includes major cities, such as Bradford, Hull, Leeds, Sheffield, Wakefield and York, as well as a number of large towns and rural areas with scattered populations. It includes two of Britain's national parks (Yorkshire Dales and North York Moors) covering over 3,198 square kilometres (over 15,500 square miles). Population density in Y&H is 323 people per sq km (compared with 4,700 in London). Within the region population density varies. The highest rate is in Kingston upon Hull with 3,379 people per sq km, more than twice any other district including Sheffield, Bradford and Leeds with 1,392, 1,292 and 1,299 respectively. Population density is lowest in Ryedale with only 34 people per sq km.
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Transport links in the region are varied with some of the most remote and rural communities in the country in parts of North Yorkshire – in contrast with major conurbations such as Leeds and Sheffield. Distance to services varies accordingly, as illustrated in the map opposite (figure 2) showing how close people are to their local GP practice.
Our population
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There are currently 5,120,000 people living in Y&H. This is about a tenth of England's population.
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Our population is our starting point in thinking about the best way to organise care and services over the next ten years. And we believe it is important to understand how our population may differ both within the region, and from elsewhere in England. The solutions for dense urban areas are not necessarily appropriate for sparsely populated rural areas.
Life expectancy varies. In Hull men can expect to live for 74.7 years and women 79.0 years. This compares with Hambleton where men can expect to live for 79.3 years; women in the district of Craven can expect to live 83.4 years. This is longer than the national average of 77.3 years for men and 81.6 years for women.
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Alongside significant differences in life expectancy, there are variations in the ethnicity and age profile of the population, which means different areas have different challenges (figure 3).
Our workforce
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The NHS represents about 12% of the economy in Y&H. Over 140,000 people work for the NHS in Y&H. This includes 38,000 NHS nurses, 9,000 GPs, consultants and dentists and 2,339 paramedics and qualified ambulance staff. At just over 3,100, NHS managers account for 2.2% of the total workforce.
Our current service provision
NHS
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We have 14 Primary Care Trusts (PCTs), 15 acute trusts (figure 4), four mental health trusts, two care trusts and one ambulance service. The results of their most recent annual health check by the Healthcare Commission are shown in figure 4.
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There are over 800 GP practices, whose distribution varies greatly across the region. North Yorkshire and York PCT is best served by general practice, as illustrated in figure 5. There are over 3,000 GPs (WTE – whole time equivalents) in Y&H.
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There is a well established set of non-NHS providers across Y&H:
- There are around 30 independent providers of acute medical and surgical services as well as private healthcare services provided by 5 NHS Trusts in the region.
- There are 16 independent mental health providers.
- There are nearly 1,700 care homes as well as a wide range of home care service providers.
- Third sector providers deliver a wide range of services to NHS patients including respite care and advocacy support.
Key Partners
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The NHS also works in close partnership with key partners such as local authorities. Local authorities commission and provide a range of services (such as social care, education, leisure services), all of which have a major impact on people’s health and well being.
