As we look forward to a more positive year ahead, it's important that we take a brief moment to learn valuable lessons from the last 12 months. This 2020 SYB Annual Review highlights just how much we've collectively achieved - and how far we've come - in one of the most challenging and frenetic periods of the NHS' long history.
This month-by-month analysis provides a snapshot of just some of the incredible examples of partnership working, service developments and innovations that have occurred throughout 2020.
2021 offers hope and an opportunity to build on all we are doing to improve health outcomes and reduce health inequalities for our population. The national COVID-19 vaccination programme is now up and running and our learning from the rapid innovations implemented during the pandemic helping us to move forward with key transformation programmes.
I'd like to acknowledge all that has been achieved by everyone across SYB in such an extraordinary year and wish you all the best for 2021.
Sir Andrew Cash
Chief Executive | South Yorkshire and Bassetlaw Integrated Care System
Following the General Election at the end of December 2019, the new-look majority government moved forward with plans to enshrine the NHS’ Long term Plan (LTP) in law, thereby acting as a catalyst for Integrated Care Systems – like ours in SYB - to put even greater focus on improving population health and reducing health inequalities, tackling unequal access and outcomes, providing value for money through collaboration and supporting broader economic and social development.
Closer to home, SYB ICS continued with its second phase of the 569 Million Reasons campaign which aimed to ensure over the counter medicines for minor ailments are purchased by the public rather than via the NHS which would save around £569 million pounds annually on non-essential prescriptions.
Engagement wise, we opened a system-wide survey asking stoma patients for their views about the quality of service they had received.
It was at this point, the World Health Organisation first started to hear of an as yet unknown Coronavirus which would later be identified and referred to as COVID-19.
SYBs overall performance as a system remained as one of the best ICS' in the country including outperforming ‘first wave’ and northern counterparts as well.
We supported an important new cardiac research project with national (the British Heart Foundation) and regional partners including Sheffield Teaching Hospitals NHS Foundation Trust (STH) and Sheffield Hallam University (SHU). The ICS-funded research, with a collaboration workshop event (25 February), enabled the recruitment of 300 patients who had been in hospital following a cardiac event or diagnosis. This project aimed to boost patient uptake of valuable cardiac rehabilitation programmes as part of the NHS LTP.
Our work with independent national champions for people using health and social care services was widely recognised in the National Healthwatch Annual Report (2018-19) with the engagement work of Healthwatch organisations in SYB featured as an exemplary case study (p14 in the report).
Meanwhile, we launched a new children and young people’s mental health support service; ‘With me in Mind’ forms part of a nationally funded pilot scheme leading to the creation of new Mental Health Support Teams (MHSTs) in selected schools across Rotherham and Doncaster.
The NHS Operational Planning and Contracting Guidance 2020/21, published on 30 January, set out the new expectations for ICS’ around planning, operational requirements, people and financial settlements as part of NHS’s LTP commitments for 2020/21.
At the beginning of March, the ICS launched its Five Year Plan (2019 2024). It set out the ambition to significantly improve the health of our 1.5 million population through developing a population health system, strengthening our foundations, building a sustainable health and care system and broadening and strengthening our partnerships.
The days following will be forever known as a momentous point in time in which SYB followed the rest of the country into the first national lockdown during ‘wave 1’ of the COVID-19 pandemic.
All across SYB, partner organisations and the ICS Programme Management Office (PMO) were able to ensure the rapid reconfiguration of essential services and safeguarding measures were put in place to protect patients where care was paused or rescheduled.
Among a range of practical measures taken, an extended license for an enhanced support service for bereavement through Listening Ear (Amparro) was one of them.
On the theme of health inequalities, Doncaster Metropolitan Borough Council held the ‘Complex Lives’ workshop bringing together ICS partners to focus on strengthening the relationship between people that are homeless/rough sleeping, support agencies and affiliated SYB health services.
The SYB ICS Shadow Board also its saw first cohort graduate with 14 senior colleagues.
During the initial response to the pandemic, SYBs critical care response continued to perform well thanks in part to the setting-up of a Critical Care Operational Delivery Networks (ODN).
SYB had a significantly better critical care survival rate than the national average and put us in a stronger position to increase critical care capacity by over 300% above the baseline to meet these new extraordinary demands. In doing so, it meant that SYB did not need to transfer a single patient out of the region. This was attributable to a flexible workforce management programme which saw high numbers of staff moving into critical care roles through selective redeployment (and retraining) where appropriate.
As part of our commitment to ensure the timely cascade of important information relating to COVID-19, the ICS facilitated frequent meetings between SYBs health and care leaders to manage the unfolding pandemic.
Key discussion points from the newly formed Strategic Health Co-ordination Group (SHCG) – bringing together the Incident Management Team and the ICS to remove barriers and find solutions – talked through a range of critical priorities such as procuring and distributing Personal Protective Equipment (PPE) and rapidly setting up staff testing alongside other contingency planning considerations.
As part of recovery, restoration and transformation, to get services re-started where safe to do so, Sir Simon Stevens (NHS England and Improvement Chief Executive) and Amanda Pritchard’s (NHS England and Improvement Chief Operating Officer) letter to the NHS (29th April) summarised the next steps for Phase Two, setting-out the current position and proposing new ways that systems could continue to deliver urgent care relating to cancer, stroke and cardiac issues.
In terms of our wider partnership approach across SYB, we supported Sheffield City Region in a joint call-to-arms for local manufacturing firms to recalibrate their manufacturing products to support the local demands for PPE - resulting in around 50 businesses coming forward to support the cause.
We also helped to facilitate the hosting of 600 healthcare students from Sheffield Hallam University (SHU) across the system to support the regional effort.
Later in the month, we were able to coordinate the rapid scaling-up of the Doncaster Sheffield Airport (DSA) and its reconfiguration as a drive-through testing facility.
As we started to see the first signs that COVID-19 was slowing down nationally, the system continued with contingency planning related to 'Our Plan to Rebuild: The UK Government’s COVID-19 Recovery Strategy’ document.
This led to the launch of the second viral testing hub at Meadowhall as part of the national Pillar Two testing capacity - including asymptomatic staff - supporting the NHS Test and Trace programme.
Meanwhile, the Health Executive Group (HEG) and COVID-19 specific Strategic Health Co-ordination Group (SHEG) converged into a weekly ICS Health and Care Management Team (HCMT) meeting to align these two strategic priorities.
In support of the national NHS ‘Help Us, Help You’ campaign, partners released an animation video to inform local people about which health services were running and why it was important to continue using them. This was boosted with the extension of Independent Sector contracts within SYB being renegotiated nationally and supporting our system to start working through the backlog of postponed care and treatments. SYB pledged to ensure that those patients who needed priority treatments and diagnostics would continue to have access - regardless of where they lived. In doing so, this additional capacity directly contributed to the NHS' capacity during these testing times.
Based on draft year end results the system exceeded its financial plan for the year bringing in £19m of cash support that would not otherwise have been available had the system not been in balance. This was a very credible performance for the SYB System which has now exceeded its financial plan in each of the last three years.
As the COVID-19 situation continued to calm, we reached a positive milestone with zero ‘new admissions’ on some days in acute trusts for the very first time since the outbreak.
This slowing down enabled for the system to scale-up and support Local Authorities across SYBs five places with Local Outbreak Management Plans.
The reduction in COVID-19 cases also allowed the ICS to reset the temporary arrangement of consolidating all children's surgery at Sheffield Children's Hospital NHS Foundation Trust (SCH) whereit was appropriate to do so. As Trusts in SYB confirmed in June that they were in a position to stop using the pathway, evaluation outcomes recorded 130 children transferred (up to 7th June) receiving excellent patient and staff feedback.
We also continued to strengthen ties with the voluntary, community and social enterprise (VCSE) sector with the introduction of the ‘passporting scheme’ when many of their funding streams, (shops and conference hire facilities) were heavily impacted by the pandemic.
Early diagnosis and cancer treatment remained a priority for the ICS and the Cancer Alliance (CA) with the launch of a new toolkit that built on the ‘Help Us, Help You’ national campaign.
The long-awaited confirmation of South Yorkshire’s devolution deal via the Sheffield City Region (SCR) was a significant step forward for the region's long-term economic prospects.
We reinforced our commitment to listening to communities across SYB by launching two online membership schemes, ‘Let’s Talk Cancer’ and ‘Let’s Talk Health and Care’ with these forums creating opportunities for people across the region to have their say on the future of health and social care.
We were also very proud of results published by NHS England and Improvement’s National Cancer Patient Experience Survey; SYB scored 2% above the national average in the areas of patients thinking they were seen ‘as soon as necessary’ (86%) and the length of time ‘waiting for tests to be done being about right’ (90%).
Work progressed well with the creation of a Flu Board to oversee the delivery of a much-enhanced flu vaccine roll-out to reach greater numbers of the population, as our five places published and updated their existing Local Outbreak Management Plans - and established Local Outbreak Boards - under the leadership of Local Authorities.
Public Health England (PHE) also paid tribute to SYBs approach during the pandemic at this point; through ‘intelligence-led testing’ and ‘agile decision making’ these swift actions enabled a reduction in new cases. PHE commended the work of our Public Heath Directors - Greg Fell (Sheffield), Julia Burrows (Barnsley), Rupert Suckling (Doncaster), Teresa Roche (Rotherham) and their teams, along with the South Yorkshire Local Resilience Forum.
The ICS also took part in a national piece of work which identified five key areas as being integral to the NHS’ recovery; endoscopy, outpatients, diagnostics (CT / MRI scans), theatres and cancer.
July was also the month of the NHS’ 72nd birthday in an especially pertinent year of highlighting the importance of our national health system – and partners that support its continued delivery.
As SYB returned to a single patient site (within acute trusts) to manage new cases of COVID-19, the release of NHS E/I’s Phase Three letter outlined the key priorities for SYB ensuring system leaders had a clear mandate for the coming months ahead in terms of service reconfigurations and restoration.
The ICS was awarded £5m from the Regional Capital panel as part of a bid for COVID-19 diagnostic money, directly benefit patients across SYB as further services moved closer with restoration plans.
On a related note, a highly useful scenario pandemic and winter preparedness workshop was facilitated by the ICS enabling system leaders to discuss winter resilience, testing, flu outbreaks and contingencies for forecasted limitations to deliver routine care.
In our COVID-19 contingency plans, we were also able to ensure the smooth transit of 1600 pallets worth of PPE to a new Yorkshire-based warehouse facility for our supplementary stockholding - saving over £5000 per week in storage and retrieval fees.
To support SYBs ongoing workforce enhancement plans, university training places were increased by 12 percent for nursing and midwifery students with the ICS supporting the coordination of additional 100 placements within Trusts across the patch.
August also saw the launch of a new mental health programme in Sheffield across 21 GP practices in four Primary Care Networks (PCNs) supported by the ICS and Sheffield-based providers including NHS Sheffield Clinical Commissioning Group, Primary Care Sheffield, Sheffield Health and Social Care Trust (SHSC), Sheffield Mind and voluntary sector partners.
To coincide with the release of the NHS People Plan, the ICS supported the continued investment in Equality, Diversion and Inclusion, staff wellbeing and retaining talent in the SYB system.
SYB received £50k pilot-funding for the NHS Low Calorie Diet Programme, an important new development involving 10 localities across the UK to implement a new diabetes scheme.
After a few months of relatively low cases of COVID-19, health and care leaders once again convened more regularly to discuss the steadily rising number of new infections identified predominantly among 15-34 year old age groups.
The release of the North East and Yorkshire (NEY) Regional COVID-19 Interim Review included insights from SYB's health and care leaders, taking a functional look at the initial emergency response to COVID-19, setting out learning outcomes and areas for further consideration. The Review highlighted a number of thematic areas that health and care leaders attributed as good practice: Business Continuity, Command, Control and Coordination, the role of the Integrated Care System (ICS) in incident response, Partnership Working & Coordination.
On the theme of a networked approach, SYB’s Primary Care (PC) Steering Board devised a new strategy to support PC alignment within the system. The strategy outlined key principles learned from Wave One of COVID-19 to support patients and reduce newly exacerbated health inequalities arising from the pandemic.
Early plans also started taking shape to develop the COVID-19 vaccination sites across the SYB footprint.
By this point, COVID-19 had started to accelerate more rapidly coinciding with the Government’s new tier system; Sheffield was added to the Government Watch List under ‘Areas of enhanced support and concern’ and Rotherham was listed as an ‘Area of Concern’ due to the continued spike in new cases.
The SYB Wave 2 Plan, born out of the Phase 3 Recovery Plan, received national praise by Keith Willett, Director for Acute Care at NHS E/I, who stated that the SYB plan was both impressive and assured.
As SYB celebrated Allied Health Professionals (AHP) Day on 14 October, appreciating our flexible and valued workforce - who continued to work relentlessly during the height of the pandemic - was foremost in our thoughts.
To this end, partners fully backed the NHS England and NHS Improvement’s (NHSE/I) Workforce Race Equality Standard (WRES) requirements to support employees from black and minority ethnic (BME) backgrounds into equity of access for both career opportunities and treatment in the workplace.
There was also a number of SYB recipients recognised in The Queen’s Birthday Honours Lists 2020 ranging from NHS leaders and frontline staff, to volunteers from within community.
As the Government implemented the second national lockdown, pressures across the system were being felt across the board; GPs, acute trusts, community services, mental health services and social care providers were all particularly hard-hit but were able to cope well.
In fact, the Prime Ministers’ address listed a number of hospital trusts in SYB among the 30 most pressurised hospitals in the UK as efforts to provide COVID-19 (and non-Covid) care intensified.
However, there was light at the end of the tunnel, with the announcement of the Pfizer/BioNTech COVID-19 vaccine approval. This gave the green light for concrete plans to be made to begin vaccinations aimed at the highest priority groups within SYB. This extensive and complex work was overseen by a newly formed SYB COVID-19 Vaccine Steering Group.
With the vaccine around the corner, those who have long term complications from COVID-19 were being supported through a new funding award of £250,000. As part of SYBs plans to support the scale-up of appropriate treatment and rehabilitation services for Long Covid, an engagement study was launched to collate views of people still feeling persistent ill-effects from the virus.
As part of national plans to reduce pressures on A&E services, the updated NHS 111 scheme was given the go ahead in SYB after extensive collaboration with national and regional partners which will be rolled-out in the coming few weeks.
The CCG annual assessment ratings by NHSE/I were also released with SYBs partner organisations performing very well.
'Integrating care: Next steps to building strong and effective integrated care systems across England' was released by NHS E/I setting out a clear roadmap for ICSs from April 2021. With an excellent track record and experience of exemplary partnership working, we are collectively – as a system - in a very strong position to move forward with these proposals.
SYB was at the forefront of the COVID-19 vaccination programme with Sheffield Teaching Hospitals NHS Foundation Trust (STH) among the first 50 hub sites in the UK to administer the Pfizer/BioNTech vaccine. As we emerged from the second national lockdown, SYB resumed its Tier Three status – and there appeared to be positive signs of new infections slowing.
Although hospital bed occupancy rates continued to remain high, our Trusts continued to cope well and thanks to SYBs extensive flu programme we had been able to stem flu-related illnesses massively – whilst exceeding our target of 75% among immunisations for vulnerable patient groups.
The Rotherham NHS Foundation Trust (TRFT) was also named as one of 34 early adopter trusts for Lateral Flow Testing (LFD) which reinforced SYBs position as one of the key regions for COVID-19 testing.
Meanwhile, the publication of the co-produced report with Yorkshire and the Humber Academic Health Science Network on Rapid Insights report about the transformations that took place during the first wave of COVID-19 was released. It aligned closely with the ICS’ own research into patient and public experiences during the pandemic (March 2020 - onwards).
The Local Maternity System was also able to work across its partnerships to create the COVID-19 Safety Strategy, providing helpful guidance to support our most vulnerable patient groups during and after pregnancy.
On the subject of equity of access, the SYB EDI Action Plan was created with the welcome formation of a new Steering Group to take the agenda forward.
Following a One Year Review (2019 - 2020), we have also produced a Final Report for the latest developments across SYBs autism pathway having committed to improve agency collaboration, awareness and support for families in our Five Year Plan.
We were also delighted to hear that Working Win – a South Yorkshire support service helping people with mild/moderate mental health conditions or physical health conditions to stay in work – was commissioned for a further three months until 31st March 2021 at a time when employment support is needed most.
The Phase Four letter (23 December) provides further clarity for SYBs health and care leaders to deliver upon the operational priorities with a keen focus on responding to COVID-19 demands; this includes the rapid roll-out of the COVID-19 vaccination programme given the approval of the Oxford-AstraZeneca vaccine (30 December). We will continue to maximise capacity to treat non-COVID-19 patients across all settings, face the winter pressures head-on and continue to support the health and wellbeing of SYBs workforce during these challenging early months of 2021. In addition, we will work together on the new financial framework and build on the development of effective partnership working at place and system level as set out in the Integrating Care document.
Looking ahead, there are better times on the horizon and we can all look forward, with optimism, to more prosperous 2021.