A core feature of the West Yorkshire Mental Health, Learning Disability and Autism (WY MHLDA) Collaborative is its in-depth work on public health and health inequalities. Demonstrating this commitment, all workstreams within the collaborative have health inequalities integrated within their objectives. There is also a specific workstream dedicated to wider determinants and inequalities. This workstream has three aims:
- To enhance support of health promoting activities – including improving the physical health of people with mental health conditions, learning disabilities and/or neurodiversity.
- To increase collaboration across the wider West Yorkshire system – focused on building and strengthening relationships to raise the profile of the work of the MHLDA programme and ensure MHLDA populations are advocated for.
- To support the implementation of the Patient and Carer Race Equality Framework (PCREF) across the four trusts to maintain a focus on improving the access, experience and outcomes of mental health, learning disability and neurodiverse populations.
Fundamental to this work has been the recruitment of a consultant in public health with a clinical background who joined the senior leadership team of the collaborative. The role of the consultant in public health is to:
- Provide specific public health expertise to the collaborative with a particular focus on reducing health inequalities.
- Provide leadership around data and intelligence across the providers and standardise how the trusts record and define data.
- Use the data and information they have access to in a more intelligent way do drive population health management work as a provider collaborative.
- Promote parity of esteem between mental health and physical health and join up the other good work being done on public health across the system.
- Train and educate the next generation of the public health workforce.
The decision to recruit a consultant in public health is relatively new for the collaborative, and unique among provider collaboratives. The West Yorkshire Integrated Care Board (ICB) had some experience of the benefit and value of public health expertise, having employed a consultant in public health to lead their population health programme.
The provider collaborative programme director and leaders of the MHLDA trusts in West Yorkshire saw the value of a public health approach. They had already started working with their partners at place and had seen the importance of the consultant in public health role.
As well as the public health expertise, bringing in a role that is more familiar and common to local authorities was seen as a real benefit. This has particularly been the case in 'translating' and reflecting the views of both the local authorities (Place) and the trusts and collaborative.
How is the focus on health inequalities making a difference?
There is a drive in the collaborative towards early intervention and prevention and they are building that lens into all the services that the collaborative is delivering. This can be a challenge for secondary care services as they are used to being at the crisis end of things, but the WY MHLDA Collaborative think that there is a lot that can be done if providers get involved at an earlier stage, particularly around physical health prevention.
The consultant in public health also sees their role in joining up and sharing examples of the work already being done by each trust to reduce health inequalities. Opportunities and examples of how this approach is already making a difference and having an impact in West Yorkshire include:
Optimising data
- The consultant in public health also leads the WY MHLDA Collaborative workstream on data and intelligence. This workstream supports collaboration between the business intelligence units of each trust, place and the system to ensure that the approach to MHLDA care is data and intelligence driven, as well as eventually developing the capacity to analyse real-time system data to improve care.
Building relationships
- People across the providers are keen to work with each other in new and different ways. For example, the business intelligence teams at each provider now regularly go to support each other's work, in a way that didn't happen previously.
- Stronger relationships with other public health professionals and practitioners who work in the ICB improving population health team, and greater opportunities to share learning with an invaluable regional network of consultants in public health, including a subgroup of people who work in mental health trusts across Yorkshire.
- Developing a relationship with the medical director of West Yorkshire Association of Acute Trusts (WYAAT) to increase opportunities to develop parity of esteem between mental and physical health. For example, ensuring preventative offers, such as smoking cessation services, are available to mental health patients.
- There's a developing relationship with the regional police force – particularly through the Right care, Right person programme.
Supporting new projects
A significant aspect of the role of the consultant in public health is dedicated to the training and education of the next generation of the public health workforce in West Yorkshire. The consultant takes on public health registrars on placements and can take on medical students for public health electives.
The consultant in public health also supervises system-wide senior leader fellow projects that focus on parity of esteem across mental and physical health including a project to make reasonable adjustments for adults with autism and/or neurodiversity in acute settings.
They are also supporting a project in emergency departments to better support patients who don't have a serious mental health condition but have repeat attendances. The project will work with emergency department teams to better identify the right support for this cohort of people, supporting the 'Right Care, Right Person' model.
Key challenges
An ongoing challenge is access to the right data to fully understand what's going on and map the complex layers of health inequalities across the local population. There are some places where they can access the data they need, but as the collaborative is not the same statutory entity as the ICB it can be very hard to get hold of the data they hold due to information governance constraints. The consultant in public health also works closely and effectively with the business intelligence units in each trust in the provider collaborative and they share information well. However, as the collaborative is not a statutory entity it can be very hard to get hold of the data they need due to information governance constraints. It is also hard to access anonymised patient level data from the ICB and link this with primary care and trust data.
Another challenge is that the workforce across the providers is so stretched. There's a core group of people at each trust who are very engaged, but their multiple roles make it difficult to have the time and space they need to dedicate to the collaborative's work. However, the consultant in public health believes that despite this, there's still a major opportunity for someone in their role to drive forward the collaborative's innovative new ways of working. There's a core group of people at each trust who are very engaged in the innovative change work of the provider collaborative, but they need the time and space to carry out the change within their organisations and because they take on multiple roles, often don't have the time to free them up to be able to do this.
However, the consultant in public health believes that despite this, there's a real freedom for someone in their role who's sitting in the provider collaborative, as they are able to prioritise what they think is important.