This week’s leadership message comes from Jo Webster, Accountable Officer for Wakefield District Health and Care Partnership. Her role also includes responsibility for Adults and Health at Wakefield Council and Community Services at The Mid Yorkshire Hospitals NHS Trust.

Hello, my name is Jo.

I’m the Accountable Officer for Wakefield District Health and Care Partnership. My role also includes responsibility for Adults and Health at Wakefield Council and Community Services at The Mid Yorkshire Hospitals NHS Trust. That long list incorporates most services that are experienced by people in communities across the Wakefield District every day, and I’m in a privileged position to help join up care in their interests.

I’ve been in this unique, triple role for four months now, having taken up my post with Mid Yorkshire Hospitals on 1 April. Here’s what I’ve learned while wearing three very different hats...

I have to look at situations through multiple lenses

I’m one of the first leaders in England to have three executive roles across one local health and care system. That means three things; it means I have a bird’s eye view of what we need to do to prevent ill health, improve people’s life chances, improve care experience, and reduce variation. It means that I work alongside partners who have recognised that by bringing functions together in this way we can move further and faster with our integration ambitions - improving outcomes and experience of care for local people and making the best use of our collective workforce. It also means that I often look at situations through multiple lenses. Very early in my role across the (then) CCG and the local authority, I was faced with a legacy issue between the two organisations and I had to debate with myself as to what the right solution was. The right solution, of course, is always to consider what would be right for the individual resident concerned, rather than what is right for either organisation. It highlighted very early on that I was going to need to really understand different perspectives and develop a different approach to risk and opportunities.

In the past, organisational boundaries and accountabilities might have sometimes got in the way of doing the right thing for the person at the centre of those decisions. The changes in the Health and Care Act are allowing us, formally, to move away from those traditional structures and that’s helping us make better decisions, together. It’s about understanding the collective pressures and delivering solutions which meet all our needs and ultimately improves people’s lives. Keeping the person at the heart of all we do doesn’t take the pressures away, but the solutions become clearer, and those decisions suddenly become easier.

Team work makes the dream work

I can only do what I do because my local provider, council, housing, industry and voluntary, community and social enterprise (VCSE) colleagues have created the conditions that allow my role to work. That single vision of a connected system that supports people in their homes and communities to live healthier, happier lives is the glue that binds us together.

Finding common ground has allowed us to do great things for local people; our Mental Health Alliance brings together partners to address system issues, including supporting people who attend the emergency department in need of mental health support. The Wakefield Safe Space, delivered by voluntary sector partners, supports anyone over 16 experiencing mental health crisis and provides an alternative to A&E where appropriate. The multi-disciplinary team of social care professionals, nurses, therapists, discharge coordinators and third sector agencies in our Integrated Transfer of Care Hub are providing a holistic approach to discharge planning, streamlined processes, and safe, timely and effective transfers of care for patients. And our Shared Referral Pathway is a truly transformational programme that has resulted in a significant change in how primary and secondary care collaborate to support patients.

Now, rather than traditional structures built around specific services or functions, we operate as a collection of teams that come together around specific goals - a ‘team of teams’. Stanley McCrystal, who developed the team of teams concept, said that leaders should “delegate until it hurts, delegate until it feels uncomfortable, then delegate some more, then support and take responsibility for those taking the delegated actions”. We work on a distributive leadership model and have honorary contracts for me and other colleagues to be able to work across organisations. This approach is strengthening our mutual accountability as a system, and it’s empowering and enabling people to make decisions and take action. We’re currently working with the team from Canterbury, New Zealand, learning from their experiences in creating a world class integrated system. In our workshops they often repeat the phrase “we need the whole system to work for the whole system to work”. And that’s the crux of it for me - my role simply couldn’t work if I didn’t work with great people united by a shared vision for our district. We either all succeed, or we all fail.

It’s ok to not have all the answers

Our system, though integrating, is a collection of organisations, of cultures, and of “the way we do things around here”. To get to where we need – and want – to be, means being open to different perspectives, getting underneath the issues, challenging assumptions, continually learning and adapting, and yes, asking the ‘obvious’ questions. It’s not always comfortable, but as leaders we choose courage over comfort and this keeps us focused on tackling the root causes of problems – however difficult they may be.

The last few months have really opened my eyes to the complexity, challenges and the breadth of adult social care, community services and public health. Our community services single point of contact receives more than 10,000 calls every month. The community integrated care team completed more than 31,000 face-to-face visits last year. More than 8,000 people work in adult social care across the local authority and the independent sector in the Wakefield District, with a vacancy rate of 8.1 percent. The team receives an average of 51 new requests for support every single day. Across our district too many babies are born to mothers’ who smoke, childhood obesity is an issue in all age groups, and self-harm and deaths by suicide are high. Throw in covid recovery, stark health inequalities, an aging population and it’s clear we’ve got a lot to do.

I’m not an expert in every facet of health and social care – and that’s actually a good thing. At one point in my career it would have terrified me to not be all over the detail, or to have a gap in my knowledge. But now I recognise that its sometimes useful to take that step back to be able to think differently about resources and structures and delivery. Again, it comes back to having that trusted network of people and teams who are able to respond to the needs of our population collectively utilising our shared assets, energy and enthusiasm. So no, I don’t have all the answers, and that’s ok.

People, people, people

I apply the ‘people test’ to everything we do: is this good enough for me? Is this good enough for my family and for my friends? Is this good enough for people living in the Wakefield District?

Ultimately, I want everyone to be happy and healthy, to feel valued, and know that their time is precious - whether that’s as a patient or service user, a carer, a member of staff or a resident of the district. I don’t want people to fall through cracks, or to tell their story twice. We’re well on the way to realising this ambition, thanks to the introduction of collaborative commissioning arrangements and development of multi-agency, multi-professional teams delivering person-centred care close to home.

Our co-located integrated teams of specialist workers from different health, social care and voluntary organisations support people most at risk to stay well and out of hospital, and our electronic care record system means that everyone involved in someone’s care know what’s happened to that person from the beginning to the end of their journey. 

We’ve got a fantastic opportunity now to build on these strong foundations and make people feel like services are wrapped around them, not that they are wrapped around services. This includes putting more preventative and care services into communities with the highest levels of deprivation, such as family hubs to support parents and children, virtual wards supporting care homes to manage more complex patients without the need for hospital admission, access to community diagnostics and extended access to primary care services so that people can receive care in their own communities without the need to travel.

The real test of my role, the changes in the Health and Care Act and forthcoming social care reforms, is the positive difference we are and will continue to make to people’s lives. Because it’s people, not organisations, that are at the heart of everything we do – it’s in our DNA.

Staying true to myself has never been more important

People often ask me how I manage this triple role – surely there aren’t enough hours in the day?! Leadership, system working, transformation - none of it is easy. Alongside a clear vision for the future, a team of wonderful colleagues and a very disciplined approach to diary management, my personal values are the things that help make what I do easier. I act with integrity, I’m honest and I create the conditions for people to be the best that they can be. I’m supportive, I’m collaborative, I choose courage over comfort and I never make promises I can’t keep. These values are my anchors, I hold onto them to steady myself against the waves of challenges and opportunities, under the pressures of good decision-making and through the times when change feels like the only constant. I stay true to them - and they help me stay true to myself – and it’s never been more important.

So, four months in, and there’s so much to do and so much to learn. But I’m as excited and hopeful about my role now as when I was first appointed. Creating a new system takes time.  We have made so much progress already but our journey is far from complete. Deepening our approach to integration, engaging all our staff, our communities and people is at the heart of our next chapter.

I am so proud to work in the Wakefield District and to be part of such a dedicated, talented team that puts our communities and our staff at the heart of everything it does. Together, we will work with the people of Wakefield District to create a connected system that supports people in their homes and communities to live healthier, happier lives and that helps them to start well, live well and age well.

Have a lovely weekend.
Jo