Lancashire Place-Based Partnership - Briefing - 25 July 2024

The Lancashire Place Partnership met on the 25th of July.  The focus for the partnership was on communication and engagement, palliative and end of life care, and a “deep dive” into the progress we are making with the partnership in North Lancashire.  ​

Transforming Community Care Impact event
Louise Taylor, Director of Health and Care integration for Lancashire reported on the very successful ‘transforming community care impact event, which was held recently.  This involved 150 health and care professionals, as well as members of the public who explored ways to improve community health services in Lancashire and South Cumbria. The event was jointly organised by NHS Lancashire and South Cumbia Integrated Care Board (ICB) and NHS Impact. Participants focused on identifying and understanding why and where things needed to change and how collectively we can put effective local delivery plans into action. It was a brilliant event with a real buzz and energy.  It was fantastic to get so many dedicated health and care professionals in the same room to talk improving services for people living in Lancashire and South Cumbria. The Place Team attended the event sharing our plans for Community Care and the objectives set out in our Place Plan. Louise was particularly pleased to see members of the public with first-hand experience of using community services sharing their thoughts and opinions. Their input on the day was instrumental in shaping our discussions and we are incredibly grateful to them for giving up their time and contributing so richly.
Place Plan
Louise also reported the continued good progress in getting endorsement for our Place Plan from partners. The Place Plan which acts as the service plan for Lancashire Place was approved by Lancashire County Council's Cabinet. This provided Lancashire Place with assurance that Lancashire County Council as an organisation approve of the plan but also provided democratic oversight and scrutiny to our approach. Partners within the Integrated Care System, including the county council and the NHS, fully recognise the wide range of differing natural boundaries and communities within the Lancashire Place and that cut across Place boundaries. These natural boundaries are always fully taken account of in working with those communities and in delivering services. We recognise that some organisations will inevitably deliver services across a number of Places, and give reassurance that from a Place perspective we are working well with Blackpool Place and the South Cumbria Place in the North and with Blackburn with Darwen in the East as well as the Cheshire and Merseyside system in the West.

This includes working with NHS Providers (such as Hospital Trusts) that cover more than one Place, to co-ordinate conversations about services so we can work with them together to consider and manage any implications.

As a practical example of this, Louise spent a day in Blackpool meeting with colleagues from Blackpool Borough Council, Blackpool Place and Blackpool Teaching Hospitals to agree how stronger collaboration between and across place boundaries might serve to help address some of the intractable issues we've been facing. This is particularly important for Lancashire Place whose residents regularly travel to Acutes located in the other Places – Blackpool and the surrounding Fylde coast being a good example of this in the North of the locality. Finally, Lancashire Place hosted a workshop of Chief Executives as part of our continued work with the District Councils. In addition to discussing the Place Plan, the group reported back on workstreams, areas of collaboration & commissioning opportunities. This has been an area in which Lancashire Place has been making an impact and encouraging integrated working.
Better care fund, discharge to access summit
Lancashire County Council hosted the Discharge to Assess summit with NHS Partners from the ICB and Acutes attending.

This is a component of the Better Care Fund (BCF). Diagnostic work had been taking place to review Discharge to Assess and the way in which it is operating in Lancashire. This is part of the wider work we are doing to get people home from hospitals quickly and to avoid hospital admissions where possible. The review found that whilst most peoples’ feedback was positive there were some areas such as language, communication, standardisation, and data keeping where we could improve, and this was the focus of discussion and necessary action.
Communication and Engagement
The Lancashire Place Partnership Board received a paper proposing an approach to working in partnership on communication and engagement. 

Involving people and communities is important to us because it not only gives people agency and power to live healthier, happier lives, it also means that services can be improved and be delivered to a high standard that people are happy with. By reaching, listening to, involving and empowering our people and communities, we can make sure they are at the heart of decision making in the development and delivery of services.
The Lancashire Place Partnership is committed to the systematic engagement, coproduction and involvement of people and communities in all areas of Lancashire, and in partnership with all partners. Having been coproduced by the ICB, Healthwatch and the Voluntary, Community, Faith and Social Enterprise (VCFSE) Alliance representatives on the partnership, the paper proposed initial steps to ensure that systematic engagement, coproduction and involvement takes place in the Lancashire Place.

Our ambition is to demonstrate to our residents in Lancashire they and their communities are equal partners in the co-production of health and wellbeing services. We intend to build on the positive work that has already taken place across Lancashire amongst partners.
As well as having a communication and engagement lead, and place-based engagement coordination team, the proposal seeks to build on our place-based engagement networks, through the delivery of three discrete “set pieces” of engagement. 

These are a joint project to consider the experiences and views of those who use community equipment in Lancashire, delivery of engagement for the better care fund, and a proposed network of lived experience.  Along with the routine communication and engagement work of our partners, these “set pieces” of engagement will be the foundational work that we will undertake as a partnership.  The considerable communication and engagement work to support the partnership that is already ongoing by all partners, and these projects will be incorporated into a Lancashire Partnership Communication and Engagement Plan that will be monitored through the programme office methodology that the Partnership has approved.
Getting to Outstanding: Palliative and End of Life Care Framework and Assessment 
Members received a presentation from Drs Tony Naughton and Lindsey Dickinson who are, respectively the Lancashire and system clinical leads for palliative and end of life care.
Dr Naughton shared the ‘Getting to Outstanding’ ambitions of which there are six:

1. Each person is seen as an individual
2. Each person gets fair access to care
3. Maximising comfort and wellbeing
4. Care is coordinated
5. All staff are prepared to care
6. Each community is prepared to help

Significant progress in this area has been made in the Morecambe Bay footprint, working with South Cumbria place, which you can find out more about here.
Across Lancashire and South Cumbria, each place team, system leaders for palliative care and end of life and partners conducted a review to assess progress against the standards.  The review found a lot of good practice and progress in each of our places, including Lancashire Place.  However, it was clear that there is more to do to get us to  ‘outstanding’ in palliative and end of life care.  Key recommendations from the review are:

• Early identification of patients at End Of Life (EOL) and use of advanced care planning to be made a priority across all care settings. (March 2025)
• Data sharing and system interoperability to facilitate EPaCCs ('Electronic Palliative Care Coordination System’) across ALL settings (inc. VCFSE). (March 2026)
• Standard approach to the commissioning of Palliative End of Life Care (PEoLC) services at Place/Place+ and ICB level. (March 2025)
• Access to timely bereavement services for all ages (No date set)
• Single Point of Access for PEoLC patients, families and professionals across Place/Place+. (March 2025)
• All staff are prepared to care through a collaborative approach to an ICB wide education strategy for PEoLC. (March 2025)

As well as these key recommendations across Lancashire and South Cumbria, a particular priority for Lancashire will be to ensure that shared care records are available via the EPaCCs (Electronic Palliative Care Coordination System) in every sector, including the voluntary, community and faith and social enterprise (VCFSE) sectors in Central, East and West Lancashire.
Scott Alker, the Transformation Lead for palliative and end of life care, and dying well will be sharing a 12 month high level action plan with the ICB execs in August, which reflects the recommendations and priorities highlighted above.
Finally, Drs Naughton and Dickinson advised partnership board members that Lancashire and South Cumbria ICB along with all of our partners won the national palliative and end of life award in the “partnership-working” category.   The award is recognition for our collective approach to using the “Getting to Outstanding” framework to assess progress, identify good practice and gaps or inequalities in the care provided and make our recommendations for planning for the future.   The judges praised the partnership-working as “an outstanding exemplar of partnership working”. The resounding positives to come from the work include our effective relationship building, sharing of knowledge and information, collaborative working and the determination across all sectors and partners to ensure that collective we get our support for people when dying, in death and through bereavement, right.
‘Living Better Lives in North Lancashire’
The partnership board heard about progress against the priorities for North Lancashire from Heather Woodhouse, Integrated Place Lead (North Lancashire), and Claire Niebelski, Population Health Lead (North Lancashire). The board was also privileged to welcome Allan Oldfield, Fylde Borough Council chief executive and Mark Broadhurst, Wyre Council service director of health and wellbeing.

Instrumental as key drivers and delivery of the ongoing work on our priority areas, the Health and Wellbeing Partnerships (HWBP) and are led by Yak Patel, chief executive officer for Lancaster District Community and Voluntary Solutions as chair of Lancaster HWBP and Mark Broadhurst as chair of Fylde and Wyre HWBP.
Priorities for Lancaster
There are three big priorities for Lancaster.  These are:

• Health Inclusion Approach – this includes using the ‘Reach Model’, Health outcomes- treatment to target and the community conversations group which listens to our communities.
• Focussed wards – this includes focused work in communities (using the ward footprint) to  tackle adult respiratory problems, tackling children & paediatric respiratory conditions and the resultant frequent A&E attendance and empowering families through Community Development.
• Universal priorities – this includes a focus on adult mental health and suicide prevention, children and young people prevention & early intervention, building community resilience, and working with district councils to tackle the wider determinants of health (for example housing conditions that impact on the health of residents).

What has been achieved in Lancaster so far 
Heather reported that there is significant progress with the Primary Care Networks (PCN’s) working on preventing Cardiovascular Disease by increasing our ‘treatment to target’ and meeting or close to meeting ICB ambition through identification and treatment of  Cholesterol, Atrial Fibrillation and Hypertension  The Health inclusion approach has been applied to deliver Enhanced Health Checks. This is the right thing to do as it is a person and community-centred  approach, and health checks don’t just start with ‘health’. People lead complex lives and a ‘whole person’ or ‘whole family’ approach is critical. It takes time, patience, perseverance, and a flexible approach but this achieves better outcomes.
The Health & Wellbeing Partnership (HWBP) in Lancaster District is making a difference.  By targeting the Adult Social Care (ASC) Prevention fund/ Population Health Investment Fund at the HWBP priorities and providing additional capacity through the VCFSE, Heather and Claire reported that we are reaching our most disadvantaged communities and provide alternatives to prevent, reduce and delay demand for formal ASC services.  The Lancaster Service Directory is making a difference helping sign-post people to a range of services in the area. There is also a big shift towards more prevention-orientated work with partners across Lancaster district, including the council, the VCFSE and the Health and Wellbeing Partnership members and their networks.
Priorities for Fylde and Wyre
There are three big priorities for Fylde and Wyre. These are:

• Health Inclusion Approach -  this includes a focus on health outcomes- treatment to target, a health inclusion approach and integrated neighbourhood team (INT) developments.
• Wards ‘In Focus’ – this includes proactive care and integrated neighbourhood team (INT) Development in particular wards, as well as a focus on respiratory conditions, encouraging and tapping into community conversations, and learning from Healthier Fleetwood.
• Universal Priorities - there are 4 universal priorities supporting older adults to stay well, supporting children and young people's emotional health & Wellbeing, promoting and encouraging lifestyle support and prevention and working with district councils to tackle the wider determinants of health.

What has been achieved in Fylde and Wyre so far 
Heather and Claire reported that we are making significant progress through our PCN’s on preventing cardiovascular disease by increasing our ‘treatment to target’ and meeting or close to meeting the ICB ambition to reduce the risk of cardiovascular disease through identification and treatment of hypertension cholesterol and atrial fibrillation.  There is increased integrated through the shared use of the health inclusion approach and PCN’s are demonstrating best practice in this.  However, there is more we can do by sharing and learning from this across the whole of the Fylde & Wyre area.
We are commencing the ‘Wards in Focus’ work around proactive care, respiratory can and the community conversations, and this is the next steps to us achieving our vision of reducing health inequalities.  The Health & Wellbeing Partnership (HWBP) in Fylde & Wyre is in its infancy but is already starting to make a real difference. As with Lancashire, through targeting the ASC Prevention fund/ Population Health Investment Fund at the HWBP priorities and providing additional capacity through the VCFSE we are able to reach our most disadvantaged communities and provide alternatives to prevent, reduce and delay demand for formal ASC services.
Collectively we are beginning to make a difference to people in Fylde and Wyre and there continues to be a big shift towards more prevention-orientated work with partners across area. This is testament to the participation and involvement of the councils, the VCFSE and the Health and Wellbeing Partnership members and their networks.
There is a lot more detail in Heather and Claire’s presentation, much more than can be shared in this briefing.
You can also contact Heather at (heather.woodhouse2@nhs.net) or Claire (claire.niebieski@nhs.net) by email.
Changes to the delivery of health and care services in Blackburn with Darwen and East Lancashire
Over the past year, colleagues across the Lancashire and South Cumbria health and social care system have worked together to make some changes and improve the way we provide and deliver some services within Blackburn with Darwen and East Lancashire.  In May 2024, it was agreed there would be a formal transfer of physical and mental health services between Lancashire and South Cumbria NHS Foundation Trust (LSCft) and East Lancashire Hospitals NHS Trust (ELHT).
You can read about this in more detail below. If you have any questions about any of the changes please contact Claire Richardson, director of health and care integration for Blackburn with Darwen at NHS Lancashire and South Cumbria Integrated Care Board (ICB): claire.richardson47@nhs.net.
Transfer of physical and mental health services
Following many months of collaborative working between NHS Lancashire and South Cumbria Integrated Care Board (ICB), Lancashire and South Cumbria NHS Foundation Trust (LSCft) and East Lancashire Hospitals NHS Trust (ELHT), the following transfers were agreed by the Boards of all three organisations in May 2024:

• The transfer of NHS adult community physical health services in Blackburn with Darwen from LSCft to ELHT – including the transfer of existing colleagues
• The transfer of children and young people’s mental health services in Blackburn with Darwen and East Lancashire, known as ELCAS (East Lancashire Child and Adolescent Services), from ELHT to LSCft – including the transfer of existing colleagues.

The people delivering all these services will remain the same, meaning that patients will still receive the same excellent care, in the same place, by the same people. The only change will be the name of the provider.
Teams across all three organisations have been working incredibly hard over the past few months to ensure the smooth transition of services and staff, which went live on 1 July.
These transfers mean services can be more responsive to meet the needs of local people and more resilient. It is about providing the right care, at the right time, in the right place for patients consistently throughout East Lancashire and Blackburn with Darwen.
The new number to contact ELCAS is 01282 628800, or the service can be contacted via email: ELCAS (general) elcas.referrals@lscft.nhs.uk or Mental Health Support Team (schools)  mhstreferrals@lscft.nhs.uk.