The NHS Black Country Joint Forward Plan has been developed by working with partners and our local population. It sets out our challenges, health needs, strategic vision, and strategic priorities for the five year period of 2023 to 2028.

This update represents year two of the plan and describes achievements since the full Joint Forward Plan was published in July 2023, and learning from our continued engagement with the public and partners over the last year.

Our vision is to improve the health outcomes for local people, making the Black Country a healthier place with healthier people and healthier futures.

Welcome to the NHS Black Country Joint Forward Plan

Axcell Mark_sq.jpgThis Joint Forward Plan describes how NHS organisations within the Black Country will support the delivery of the priorities our public and partners have described as essential in meeting the needs of our population.

We created this plan following conversations with local people and partners. Our approach to working with people and communities sets out the 11 principles for how our people and communities expect to be involved in shaping priorities, developing plans, and continually improving services to address the health and care challenges that we face locally. This plan has been informed by an internal and external involvement programme. Building on this, we are committed to a future where we start with our people and communities by default, broadcast less and listen more, and act and continually feedback to ensure that Black Country people are empowered and involved at every stage of the planning process.

Through the conversations that we have had we heard that local people want:

  • improved access
  • better preventative services
  • community focus
  • more personalised care.

There was also feedback to support more investment in services to tackle loneliness, isolation and mental wellbeing. Generally, it was clear that the rising cost of living, will increasingly impact upon our communities and upon health and care services in the short and long term. A big theme in conversations about the cost of living was the ‘voluntary care squeeze’ which was the worry expressed by some working age people caring for older/younger dependents due to the cost of care.

We know that our health is determined by much more than our access to health services. How healthy we are and how long we live in good health is dependent upon other factors such as our health behaviours and lifestyles, the places and communities we live in, and the way in which we use health services.

Taking into account the national action, the views of local people and the advice on areas that will make the most difference to local people’s health, we set our five strategic priority areas in our five-year plan as follows:

  • Priority 1 - Improving access and quality of services
  • Priority 2 - Care closer to home
  • Priority 3 - Preventing ill health and tackling health inequalities
  • Priority 4 - Giving people the best start in life
  • Priority 5 - Best place to work

2023-2024 as our first full year as an Integrated Care System (ICS) has evidenced the collective strength of the Black Country system partners working collaboratively to deliver more timely and efficient services. However, we need to build on the good progress made to date and ensure we change the way we work to meet the financial and other challenges we face. This includes our new Operating Model with greater devolution and responsibility to our four Places (Dudley, Sandwell, Walsall and Wolverhampton) and provider collaboratives, the leadership model to support this and how our support
functions are aligned to the different ways of working. As a result, the update to the Joint Forward Plan includes a new priority for the system to reflect the challenges we face.

The new priority is:

  • Priority 6 - Fit for the future

These priorities and the contents of this plan have been shaped to respond to the local health needs and represents our commitment to addressing the challenges which local people and communities face. The challenges culminate in some stark statistics, such as Black Country people generally not living as long as people in other parts of England. The years of life spent in good health (what we call healthy life expectancy, HLE) is also less than other parts of England. This is something which we are focused on addressing now to benefit people in the years ahead.

We recognise that health can’t do this alone, wider determinants are the most important driver of health. They include income, employment, education, skills and training, housing, access to services, the environment and crime. In this plan you will read about how we are working in partnership, in each of our Places, to address wider determinants of health. Across the NHS locally, our collaborative
approach has helped us to perform well against NHS targets and priorities, including referral to treatment times in elective care, and access to urgent and emergency care. However, there is no question that this is a challenging time for health and care services.

We are clear that if we are to achieve the outcomes we want in these areas, we will need to work together differently, as we shift our focus from treatment to prevention, create healthier places which support people to make healthier choices and support those who work for us to provide the highest quality care.

Within the five-year period of our plan, there will be some significant developments in our bid to make the Black Country healthier. These include a shared care record, ensuring that direct care is improved through access to the right information, and the Midland Metropolitan University Hospital, which will open its doors to new state-of-the-art facilities in 2024. There will also be improved access to diagnostics and elective care through community diagnostic centres and increased theatre capacity, resulting in the reduction in waiting lists.

The following principles will underpin our approach to delivering our plan:

  • Collaboration – we will work across organisational boundaries and in partnership with other ICS partners, including our people and communities, in the best interest of delivering improved outcomes for the population we serve.
  • Integration – Integrated Care System partners will work together to take collective responsibility for the planning and delivery of joined up health and care services.
  • Productivity – we will ensure we improve productivity by making the best use of our collective resources by transforming the way we deliver services across the Black Country.
  • Tackling Inequalities – we will ensure that we continue to focus on delivering exceptional healthcare for all through equitable access, excellent experience, and delivering optimal outcomes.

The publication of the refresh of the plan for year two (2024-2025), is just the continuation of our journey. We will continue to hold conversations with local partners, people and communities to inform future iterations as the plan, which will include a significant ‘Mid-Term Review’ of the plan for the start of the 2025/2026 financial year. We will use this year to review and refresh our system strategies – both the Integrated Care Partnership Strategy and this Joint Forward Plan – and incorporate any changes to our strategic and operational priorities based on those conversations. We look forward to  continuing to engage with you over the coming 12 months - continuing the progress already made in working together in delivering the priorities in this plan and to make a real difference to the health of the Black Country.

I want to thank everyone who contributed.

Since the publication of the Joint Forward Plan in July 2023 we have made progress in a number of key strategic priority areas.

We have seen the development of our Integrated Care Partnership with a formal Board established, meeting in public and bringing together partners to meet the health and wellbeing needs of our  population. The Partnership has confirmed that its priorities remain children and young people, mental health, social care and workforce for 2024-2025. These priorities continue to align with our six strategic priorities.

To help support delivery of our partnership priorities, the ICB Academy has worked with all partners to develop a Population Outcomes Framework. The framework sets out ‘four pillars’ of population outcomes; wellbeing, prevention, management and intervention. The supporting digital tool enables transformation initiatives to be mapped to the four pillars, and will be used to inform, measure and take action to improve the health and wellbeing of our population.

A further significant development during the last year resulted in the ICB taking on delegated responsibility for pharmacy, dental and optometry services from 1 April 2023. This enabled us to take a more integrated and joined up approach to planning and designing care around our population’s health needs. From 1 April 2024 we will also be taking on delegated responsibility for 59 acute specialised services which will enable us to maximise opportunities to improve our patients’ experience and outcomes across primary, community, and acute services.

Further developments have been detailed later in the document, examples include:

  • Commenced our journey to develop a five-year programme to transform primary care
  • Continued to evolve our Operating Model including the development of Provider Collaboratives and Place Based Partnerships
  • Refreshed our transformation programmes and undertook a review of achievements to date, examples of these are captured within the strategic delivery plan document. Please note these provide a sense of our core strategic achievements, rather than a complete list.

Unfortunately, the financial challenges we face have increased since last year. To date we have been a system which has delivered our financial plans, achieving a system breakeven position, however our system now faces a number of local and national pressures which are driving excess costs. The Black Country system is responsible for meeting the health needs of 1.26 million people. Our local population has a number of specific characteristics, including being the second most deprived ICS population nationally; highly diverse populations; and a significant younger population. These characteristics translate to a range of specific healthcare challenges including higher levels of obesity levels compared to the national average; some of the highest infant mortality rates in the country; lower than average healthy life expectancy and significant health inequalities which have widened since the pandemic. These healthcare challenges mean our NHS services are used more significantly, meaning more resources are required to provide the appropriate care to our populations, which puts pressure on our finances.

As a result of this, we have developed a system Financial Recovery Plan which sets out our planned financial trajectory and options on how this will be delivered. Over the next year we will develop the detailed actions that will reduce our costs and achieve our financial plan.

To recognise this, we are including a new priority in our Joint Forward Plan – Fit for the future. This will include the implementation of the system Financial Recovery Plan; adoption of new ways
of working across the Black Country in line with the Operating Model; strengthen our enablers to support service improvement, such as digital and estates; and organisational development
adopting the leadership behaviours required to transform the way we work. It will also include the sustainability/Greener NHS agenda.

This refresh of the plan describes the actions the NHS will undertake to implement the six strategic priorities. Updates to the plan have been made where new health and wellbeing strategies have
been published in 2023/2024. The plan reflects updates to the prioritisation of initiatives in each of our Places and programme boards, and provides a summary of some of our key achievements
that support the delivery of our Joint Forward Plan and Integrated Care Partnership priorities. It also includes outputs from new conversations with the public in line with our Involving People and
Communities work.

Our successes

Our plan sets out how we will measure our success, key headline achievements since publication in July 2023 are set out below:

Case studies

A number of case studies are set out below, showcasing our more strategic developments and achievements over the last year:

Virtual wards allow patients to get the care they need, at home safely and in familiar surroundings, helping speed up their recovery while freeing up hospital beds.

The ICS was the first in England to introduce virtual wards for children. After a successful pilot scheme in Dudley, where the first paediatric virtual ward opened on 1 March 2022 at Dudley Group NHS Foundation Trust, a total of 593 children have been treated since then. Following this success, paediatric virtual wards have now been introduced in Walsall, Wolverhampton and Sandwell, with more than 1,150 children supported to date.

How does the paediatric virtual ward work? Parents and carers are given access to state-of-the art remote monitoring technology, so their child can receive specialised care at home tailored to their unique needs. To do this the virtual ward uses Docobo’s remote monitoring solution, DOC@HOME®, to monitor children who have been discharged from hospital but require a level of specialist care and monitoring to maintain their safety at home.

The children’s ward team works closely with the family to train them to use the equipment, answer their questions and ensure they are fully comfortable before their children are discharged. The family then takes part in virtual “ward rounds” with clinicians and have direct telephone access to specialist clinical staff in case of any queries.

Tyler was a patient admitted to Russells Hall Hospital in Dudley last year with a severe infection. When his condition improved, the family was offered the chance to take a virtual ward kit home. Mr Lewis, parent of Tyler said: “Tyler just wanted to be at home with his family as we all do. The virtual ward was completely new to us, and we took full advantage of it. It’s a brilliant piece of kit because you can bring it home and they can monitor your child at home. They can see every result from home, which is beneficial to us and the hospital. It saves them resources with beds, it saves us the time having to sort out arrangements at home, sort out businesses and work commitments, travelling back and forward, or wasting services that other people can benefit from in a more serious condition.”

MMUH is a brand-new, state-of-the-art acute hospital that will serve over half a million people living in Sandwell and West Birmingham.

When it opens later this year, MMUH will bring together all acute and emergency care services that are currently provided across City and Sandwell Hospital into one place. MMUH will provide a hub for emergency care, with the build also boosting regeneration in the local area.

The hospital will serve patients who are acutely unwell and need a hospital stay, or whose care is an emergency. All acute clinical teams will combine to operate as one and staff will work with new technology in modern purpose-built facilities, helping to improve patient care and experience.

The new state-of-the-art facility will be the first new hospital to open in the West Midlands since 2010, with a host of facilities including:

  • a purpose-built ED with imaging and diagnostic services
  • a dedicated children’s ED and assessment unit
  • adult and children’s wards with 50% of beds being within single ensuite rooms
  • operating theatres for both emergency, major planned surgery and maternity
  • a midwife led birth unit next to a delivery suite, two maternity wards and an antenatal clinic
  • a neonatal unit
  • same day emergency care for adults
  • sickle cell and thalassaemia centre.

Visit the Sandwell and West Birmingham NHS Trust website for more information.

Walsall Together were crowned winners of the Place Based Partnership and Integrated Care Award at the HSJ Partnership Awards in November 2023, for its work to improve outcomes for the citizens of Walsall. The ceremony recognised the partnership for the significant integrated work that has been achieved from hospital avoidance, discharge pathways (NHSE national pilot site), enhanced care homes support, workforce recruitment and retention, and community resilience.

The entry was described by the panel of judges as “An excellent example of partnership and effective leadership and structure with the implementation of some unique projects. This is a shining example of what other systems should be aiming for.”

Michelle McManus, Director of Transformation and Place Development for Walsall Together, said, “The partnership has gone from strength to strength since it was formally established in 2019 and this is down to the sheer passion and drive of all our partners and our wider colleagues in the voluntary and community sector. The strong relationships and can do attitude have meant we have been able to work together to make a real difference to the citizens of Walsall putting their voices at the heart of what we do and helping them to stay well and out of hospital, reduce inequalities and improving access to services for our most disadvantaged communities.”

For more information about Walsall Together visit their website.

An integrated care pathway has been introduced to provide safe, compassionate care for older people living with frailty in care homes across the Black Country.

The pathway aims to support all social care staff to improve early recognition and avoid deterioration of frailty to aid pre-empting end-of-life discussions and planning, also aiding carers and families to identify and respond to the health decline of individuals in a care home setting. We achieve this by using tools such as Stop and Watch, the NEWS2 scoring system and assessing residents clinical and soft signs of deterioration, including undertaking basic clinical observations skills ensuring responsive, timely escalation to the most appropriate service and timely access to holistic health care services.

The purpose of the pathway is to ensure the best evidence assessments and care planning prevents inappropriate admissions to hospital and ensures residents are on the right pathway, at the right time, and are cared for in the right place based on their wishes and condition, promoting choice and control at end of life.

Since September 2022, training has been delivered to more than 178 care providers and more than 3320 staff working within social care, caring for our most vulnerable. This has been extended to include the training of FREED champions within this sector building resilience and sustainability through increasing staff knowledge, confidence, competency and capability on the FREED pathway. An electronic resource pack was also developed which included tools, versions of assessments and support documents for care services including electronic version to either have printable access to these resources or to be uploaded to the electronic devices. 

In recognition of their commitment to improving safety, culture and experience in patient care, the FREED team were shortlisted for the Deteriorating Patients and Rapid Response Initiative of the Year at the HSJ Patient Safety Awards 2023 and were highly commended in the HSJ Partnership Awards 2023.

Walsall Healthcare NHS Trust has a new Urgent and Emergency Care Centre which brings much improved facilities and space for patient care.

The multi-million-pound urgent and emergency care centre significantly improves emergency care facilities and capacity – providing almost 5,000 square metres of additional clinical space.

The two-storey development – the most substantial investment Walsall Healthcare has seen - includes:

  • an urgent treatment centre
  • emergency department including resus and rapid assessment and treatment area, and children’s Emergency Department (ED)
  • co-located paediatric assessment unit
  • acute medical unit
  • provision for frailty and community integrated assessment services.

The new £40m building also includes reconfiguration of the current ED footprint, to incorporate improved ambulatory emergency care and imaging services.

What is an NHS Joint Forward Plan

The plan is a joint document developed together with NHS organisations in the Black Country (the Black Country Integrated Care Board and our provider NHS Trusts).  

The development of this plan has been an opportunity for us to work with local people, our health and care partners and staff to develop a plan that is locally owned, delivers the national ambitions and recognises our collective strength in working together to resolve our common challenges. It describes our ambition to improve quality and outcomes for people who use our services.

In addition, the plan: 

  • describes how we intend to use our NHS budget to make sure that local services are of the highest quality and that they meet local need 
  • sets out how we will address the challenges which we face today and those that we recognise are affecting the future health of local people
  • explains how we will support a workforce that is fit for the future and create a system of health and care organisations that are seen as employers of choice 
  • describes how we will support local people with the knowledge and skills to have more choice and control over their own health and care 
  • describes how we will change the way organisations work together moving forwards.  

The Black Country is home to 1.2 million diverse people within four distinct places: Dudley, Sandwell, Walsall and Wolverhampton. 

As NHS Black Country Integrated Care Board, we are responsible for ensuring that local people have access to the best possible NHS services. Our NHS is made up of a number of partners including the Integrated Care Board (ICB) acting as the strategic commissioner, four Acute and Community Trusts (hospitals), one Mental Health, Learning Disabilities and Autism Trust, one Ambulance Trust, one Integrated Care Trust, four local authorities, a large number of GP practices, community pharmacies, community optometry sites and general dental practices.  

Map of the Black Country showing Dudley, Sandwell, Walsall and Wolverhampton 2We are all part of the Black Country Integrated Care System (ICS) which brings health and care partners together with a number of other partners including community and voluntary sector organisations, housing, fire, police, large employers and education to improve the health and wellbeing of Black Country people.  

We also have thriving Voluntary, Community, Faith & Social Enterprise (VCFSE) partners in the Black Country. This is a vast and diverse sector, comprising of nearly 4,000 member organisations across our four place-based Community and Voluntary Services (CVS). 

Our health challenges 

We know that our health is determined by much more than our access to health services. How healthy we are and how long we live in good health is dependent upon other factors such as our health behaviours and lifestyles, the places and communities we live in and the way in which we use health services.

Within the Black Country: 

  • Life Expectancy in the Black Country is significantly lower than for England in all four places.  
  • The gap in life expectancy between the Black Country and England is 2.2 years for males and 1.6 years for females 
  • Healthy life expectancy is also lower than for England in all four places (significantly in Walsall and Wolverhampton for males and females and in Sandwell for females).  
  • The gap between life expectancy and healthy life expectancy is larger for females in the Black Country than for England; it is similar for males. 
  • Both child (43% locally vs 35% in England) and adult (69% locally vs 64% in England) obesity rates are higher than England. 
  • We have some of the highest infant mortality rates in the country, whilst smoking rates in pregnancy remain high and breast-feeding rates are low. 
  • We have higher recorded prevalence of diabetes, chronic kidney disease, chronic heart disease. 
  • We have a high number of premature deaths from cardiovascular disease (CVD) and respiratory disease, under 75 mortality rates for CVD is 99 per 100,000 and under 75 mortality rates from respiratory disease is 38 per 100,000. 
  • Dementia Diagnosis rates are below national expectation of 66.7%, Black Country is 63%. 

We recognise that one of the major drivers of poor health outcomes is socio-economic factors, which can't be addressed by health partners alone.

Other challenges 

Whilst our Joint Forward Plan sets out our ambition over the next five years, it is important to recognise the challenging landscape within which we will deliver our plan.  

  • Restoration and recovery from COVID-19 - Whilst significant progress has been made to reduce waiting list backlogs, we need to ensure that we continue to recover services and address existing health inequalities in access.
  • Urgent and emergency care pressures – Whilst we are one of the better performing systems for delivery of the four-hour accident and emergency target, urgent and emergency care remains our most pressured area. The demand for services at peak times, particularly in the colder months, is exceeding the capacity which we have. 
  • Out of hospital care demand – Whilst we have improved access to out of hospital services, the demand for out of hospital services including primary, mental, community services and social care is continuing to increase as a result of a growing ageing population and chronic disease.
  • Workforce – Our workforce is a key asset to help us deliver our five year plan. We know that we have significant challenges including an ageing workforce, recruitment, and retention challenges and that looking after the health and wellbeing of staff is a key priority.
  • Finance and efficiency – Our system is facing significant financial challenges which only be addressed by partners working together to deliver increased productivity, transforming and redesigning services to drive improved outcomes and make better use of resources.

Writing our plan

In addition to seeking the views of local people, when writing our plan, we have considered the following:

Integrated Care Systems (ICSs) are partnerships that bring together NHS organisations, local authorities, and others to take responsibility together for planning services, improving health, and reducing inequalities across geographical areas. There are four core purposes of an ICS: 

  • improving health outcomes 
  • tackling inequalities 
  • enhancing productivity and value for money 
  • supporting social and economic development. 

In writing our plan we have taken into consideration the following:

NHS priorities 

Each year, and periodically over longer periods, a set of ‘NHS Objectives’ to be achieved by NHS organisations within the NHS are published. Guidance documents that our plan takes account of:

  • NHS Long Term Plan (2019-2029) 
  • NHS Joint Forward Plan priorities (2023-2028) 
  • NHS Operational Planning Priorities (2024/25) [not yet published]. 

Our local Integrated Care Partnership strategy 

An Integrated Care Partnership (ICP) is a forum jointly convened by local authorities and the NHS, comprised of a broad alliance of organisations and other representatives as equal partners concerned with improving the health, public health, and social care services provided to their population. The Black Country ICP has established that we should focus on the areas described below. This plan describes how the NHS will play its part, jointly with partners, in making improvements to the following areas: 

  • mental health 
  • social care 
  • workforce 
  • children and young people. 

Core20 Plus 5 

The Core 20 Plus 5 work is designed to support ICSs to drive specific actions to reduce health inequalities. Core20 is the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). Half the population of the Black Country lives in these Core20 areas. Although there is variation in the proportion of people living in Core20 areas across our four places, all four are higher than the national average.  

The ‘PLUS’ are the population groups experiencing poorer than average health access or outcomes, and who may not be captured within the Core20 alone so may benefit from a tailored approach.

PLUS groups include ethnic minority communities, inclusion health groups, people with a learning disability and autistic people, people with multi-morbidities, and other protected characteristic groups.  

Along with defining target population cohorts, it also identifies five focus clinical areas requiring accelerated improvement. These are:

  • Adults:
    • maternity 
    • severe mental illness (SMI) 
    • chronic respiratory disease 
    • early cancer diagnosis 
    • hypertension. 
  • Children:
    • asthma 
    • diabetes 
    • epilepsy 
    • oral health 
    • mental health. 

Our approach to involving people and communities

In 2022 we worked with local people and partners to co-produce our approach to working with people and communities. The approach supports our commitment to meaningfully involving people and communities in the decisions we make, as well as outlining how we will meet our statutory duties.

The Black Country is committed to 11 coproduced principles for how our people and communities expect to be involved, these principles fit neatly into the six core themes below:

  • be accountable to our people and communities
  • one size does not fit all
  • start with people and communities
  • trusted voices are key
  • invest in people and communities
  • nurture relationships across the ICS.

We have developed mechanisms for involvement which crosscut neighbourhood, Place and Black Country, and are designed to be participatory, inclusive, representative, and culturally competent.

The Black Country Approach can be found on our ICB website.

Ensuring that people and communities have been involved in the development of the plan is important to us, not only to discharge our statutory duties, but to ensure that the plan is reflective of the needs and wants of our communities. The development of the original five-year plan and this year’s refresh has been undertaken in stages.

The 2023-2028 Black Country Joint Forward Plan was informed by three stages of involvement activity to establish the overarching areas that local people wanted us to focus on. In summary local people told us they would like a focus on:

  • improved access - to appointments and emergency/urgent care, to resources and reasonable adjustments, to digital devices/ data/skills
  • better preventative services
  • community focus – clinical and non-clinical
  • more personalised care options and choices.

There was also feedback to support more investment in services to tackle loneliness, isolation and mental ill health. A big theme in conversations about the cost of living was the ‘voluntary care squeeze’ which was the worry expressed by some working age people caring for older/younger dependants due to cost of care. These areas informed our priorities for the five-year plan which was published in July 2023.

Throughout the last 12 months we have continued our conversations with people and communities (Stage 4) to support the delivery of the plan. A full insight report from Stages 1, 2 and 3 can be found on the ICB website.

Each year we will refresh our five-year plan. This year is our first refresh and we have taken the opportunity to check in with stakeholders and communities on the priority areas and to update on the progress made in the first year.

The invitation to share feedback on the refreshed plan was shared widely across our networks including key partners such as Healthwatch and local Health and Wellbeing Boards. Invitations to share feedback were shared publicly along with emails to the Black Country ICB’s ‘Get Involved’ database, and Black Country Voices panel.

People contributed via an online survey, through community conversations, people panels, direct emails, or staff briefings.

Several themes emerged from the feedback received across all of our involvement activities. The following came through strongly, they resonate with previous insights and they have further influenced our refreshed plan:

  • Improving access and reducing waiting time – particularly primary care, Urgent and Emergency Care and mental health services.
  • Focusing on prevention and personalised care
  • Strengthening collaborative and participative approaches to addressing social determinants and the drivers of poor health and inequalities and recognising the importance of investing in Voluntary, Community and Social Enterprise (VCSE) sector partners as key enablers to the above. 

We invited feedback from people on the priorities set out in the refreshed plan, including the addition of a sixth priority – Fit for the future.

  • 84% of survey respondents supported the five key strategic priorities.
  • 77% of survey respondents supported the addition of the sixth priority.

We’ve clustered feedback on what matters to people under the priority areas below:

  • Priority 1 Improving access and quality of services - Access to mental health support, improved access to services and patient experience, better joined up care and reduced variation in access.
  • Priority 2 Care closer to home - More community-based provision and travel resources for patients, increase workforce specialising in prevention and people with complex co-morbidities and support for carers and the importance of personalised care.
  • Priority 3 Preventing ill health and tackling health inequalities – The need for a shared vision for preventative measures between system partners, stronger focus on the wider determinants of health and targeted funding and investment in community support/activities. 
  • Priority 4 Giving people the best start in life – More support for families to reduce infant deaths and emergency admissions, connect and educate young people, tackle inequalities.
  • Priority 5 Best place to work – Staff training and development, improving staff wellbeing and morale. 
  • Priority 6 Fit for the future – Increase collaboration, reduce duplication, pool resources, listen and involve staff and patients, bolder action, stronger focus on prevention agenda.

Participants also told us what good looks like for them in terms of how we should measure success and progress against our desired outcomes. It was also recommended that we provide a clearer explanation in the plan of the frameworks and methods which underpin how we measure outcomes.

A full insight report from the involvement activities that informed the 2024 refresh can be found on the ICB website and has been shared with NHS workstream leads to support them in compiling delivery plans.

Whilst our approach to refreshing the plan was light touch, the NHS in the Black Country will be undertaking a mid-year full review of the plan later in 2024. To inform the re-write of the full plan, we will create more opportunities for people to participate in meaningful conversations that put a lens on outcomes measures, and which ensures the very best representation of those who all too often go unheard.

We know that conversations can create health. Instead of broadcasting and trying to ‘fix’ people and communities, by listening more, we can better understand what’s important and what really matters.  In our first year as an ICB, we made good progress in bringing to life the principles of our approach which we captured in a short video.

We know from the development of our approach to involving people and communities that starting with people by default, meeting them on their terms, and recognising that one size doesn’t fit all are
key to a future where we work together to improve health and happiness.

Take a look on our website at some of our involvement activities to see how we’re listening, acting and feeding back what people and communities have shared with us. Highlights of our ongoing involvement work, and the participative dialogue spaces we’re convening, which is shaping the delivery of this five-year plan, include: 

Our approach is helping the ICB and ICS partners to nurture stronger relationships, increase connectivity with the people they serve, rebuild trust and provide under- represented communities with a meaningful way to inform lasting change.

By taking a more collaborative and joined up approach to involvement, transformation workstreams are benefiting from, and beginning to respond to, what we are hearing through our mechanisms for involvement. Highlights include:

Our commitment to increasing collaboration and nurturing stronger relationships has seen us play a lead role in the development of a range of resources and opportunities for further sharing and learning with a focus on participative practices and asset-based development approaches. Examples include: 

The ICB commissioned a project, led by a partnership of eight voluntary, community and social enterprise (VCSE) sector organisations from across the Black Country, representatives from the ICB involvement team, ICS colleagues and the University of Wolverhampton in order to better understand the barriers to attending breast screening appointments for Black and African Caribbean women, and to co-design solution focused initiatives.

Underpinned by the remarkable insights, stories and experiences of local women, which were only accessible through the trusted relationships nurtured by the eight VCSE organisations involved, three products were co-created to tackle common misconceptions and barriers to attending screening appointments; an infographic dispelling myths around cancer screening, a video of a mother and daughter talking about the importance of screening and a video from local TV sports presenter, Denise Lewis with a ‘call’ to attend screening appointments. The project has had recognition locally, regionally, and nationally for the approach taken in working with local people and communities in this way. You can hear from some of those involved in the project about what drew them to the project, and the difference the process made in a video.

There are ambitions to continue the project to create a culturally competent training package to equip the system with the knowledge of the cultural and religious beliefs that may be preventing someone from attending the screening, but also on the presentation of black women with symptoms. The group has also been awarded a 'Research Engagement Network Development' grant to continue their vital research into barriers to breast cancer screening for black women by training and remunerating people with lived experience as ‘community reporters’ who in turn, gather and curate real-life stories of others with lived experience to continue our learning and response to increasing screening uptake.

Joint Forward Plan strategic priorities

Taking into account all of the above we have identified six strategic priority areas for the NHS:

  • Priority 1 - Improving access and quality of services

The core function of the NHS is to provide quality healthcare to the population in a timely manner. We know that across the country, and within the Black Country, there is more that we can do to ensure that where required the public have access to an appropriate intervention, and for that intervention to be of the highest quality possible. Our ambition is to improve accessibility and the quality of such care across all parts of our system.

  • Priority 2 - Care closer to home

The NHS has seen more people than ever before in recent years, across all parts of the NHS. Beds within our hospitals are almost always full and our GP practices have never been so busy. Our ambition is to ensure that our hospital beds are available for those people that need them, and that we have appropriate service provision in the community to care for people where appropriate.

  • Priority 3 - Preventing ill health and tackling health inequalities

As we know, prevention is better than cure. We intend to work with partners to invest in preventative services, where we can, to reduce the pressure on the NHS. Also, we are committed to ensuring that the health inequalities we face within the Black Country are reduced effectively.

  • Priority 4 - Giving people the best start in life

In order to ensure that children and young people in our communities have the best start in life, we will refocus our efforts, with partners, on delivering improved access and services for this population.

  • Priority 5 - Best place to work

It is vitally important that we have a vibrant, effective workforce across all parts of the Black Country system if we are to achieve our priorities. Currently, there are approximately 60,000 colleagues working across health and social care in the Black Country and we know that for us to thrive, we need to look after our workforce and become a place where people want to work. 

  • Priority 6 - Fit for the future

This new priority recognises that the Black Country health system needs to change the way that it works to embrace the opportunities and meet the challenges it faces. This includes the need to be more productive and cost-effective to meet our financial challenges. We also need to recognise the power of our people and communities and support our Places and providers to work better together. We need to reduce the carbon footprint of the NHS and be more sustainable. All of this will require strong, sustainable leadership and enabling functions.

Our Strategic Programme Boards all have a role to play in achieving these priorities, further details on their work programmes are set out later in the supporting delivery plan document. Delivery of
these priorities will enable us to play our part in achieving the core purposes of our ICS and the triple aim which requires us to consider the effect of our decisions on the health and wellbeing of people, quality of services and efficient use of resources.

NHS Joint Forward Plan Priorities image.jpgView the NHS Black Country Joint Forward Plan Priorities

In implementing our plan, we will work to the following principles: 

  • Collaboration – we will work across organisational boundaries and in partnership with other system partners including our people and communities in the best interest of delivering improved outcomes for the population we serve.  
  • Integration – ICS partners will work together to take collective responsibility for planning and delivering joined up health and care services. 
  • Productivity – we will ensure we improve productivity by making the best use of our collective resources by transforming the way we deliver services across the Black Country. 
  • Tackling inequalities – we will ensure that we continue to focus on delivering exceptional healthcare for all through equitable access, excellent experience, and optimal outcomes. 

We will use resources effectively and find more cost-effective ways of delivering the high-quality care that local people deserve.  

We will encourage research and innovation to bring new ideas into the way that we work. We will support new digital technologies and improve the coordination of care through safe data sharing. We will also invest in growing the skills and capabilities of local people to use new digital technology so that they can have more options for accessing care when they need it.  

We will also recognise our social, economic, and environmental role as one of the biggest employers and investors in the local economy. Where possible we will strive to reduce our impact on the planet through Greener NHS choices and we will aim to increase our impact locally through investment in local supply chains, employment of local people and working with partners to support healthier local people, places, and futures.  

We will continuously improve quality and develop a strategy which will focus on supporting an ageing, ethnically diverse population and will aim to ensure services continue to be delivered in the right way, at the right time, in the right place and with the right outcome.

Working together to enable change 

Local health and care organisations will work together at three different levels to support the delivery of our key areas of work.

We have defined how our system will work differently to deliver this plan. This is called our Operating Model and has the following components:

Integrated Care Board

Strategy, policy and guidance, oversight and assurance of providers, resource allocation and approval of major service change.

ICB Committees

ICB oversight and assurance, including statutory duties and Strategic Commissioning Committee as a decision-making body for the overseeing the strategic programme boards.

Strategic Programme Boards

Bring commissioners and providers together to develop strategy, outcomes and priorities in portfolio areas within the devolved budget. The programme boards will also oversee performance metrics and produce recovery plans for areas behind trajectory. They will identify areas for transformation, service change and service development and form business cases to define the opportunity.

Integrated/Joint Committees

Joint committees have been established to undertake joint planning between the ICB, local authorities, and where appropriate, NHS England and respective collaboratives/partnerships both at system and place level. They will act as the vehicle to hold resource and decisions devolved or delegated by the ICB (and partners) and take joint responsibility for implementation of plans.

Provider Collaboratives

Partnerships that bring together our provider trusts to work together at scale to plan and deliver services. They are Black Country wide collaboratives, with local place support structures, that provide and/or coordinate services with the aim of improving quality, productivity, sustainability, and effectiveness of services. There are different types of collaboratives in our system as described later.

Place Based Partnerships

Partnerships that bring together NHS, local government, public health and other local organisations to help ensure more effective use of combined resources within a local area (Place) and to tackle the wider determinants/factors that influence health and drive inequalities. They will both plan and deliver services defined as in-scope, predominantly out of hospital services, focussing on demand management, relationship management with local authorities and partners and targeting local inequalities.

The operating model for the Black Country will evolve over time. As collaboratives and place-based partnerships mature, this will result in the ICB devolving a range of responsibilities to collaboratives and place based partnerships, which could include:

Commissioning and contracting of services

Place based partnerships and collaboratives will be given responsibility for commissioning and contracting health and care services for the local population. This could include setting priorities, identifying the needs of the population, and working with local providers to ensure that services are delivered in a coordinated and efficient way, including setting priorities. 

Resource allocation

Place based partnerships and collaboratives will be given greater control over the allocation of resources, such as funding and staff, to health and care services in their area. This could enable them to make decisions that are more tailored to the needs of their local population and ensure that resources are used efficiently.  

Integration of services

Place based partnerships and collaboratives may be given greater responsibility for integrating different health and care services in their area, such as primary care, mental health services, and social care. This could involve developing new models of care and ensuring that services are joined up and patient centred.  

Prevention and public health

Place based partnerships and collaboratives may be given greater responsibility for promoting prevention and public health initiatives in their area. This could include working with local authorities, community groups, and other stakeholders to promote healthy lifestyles and prevent ill-health. 

In the Black Country, we have three provider collaboratives. Provider collaboratives are partnership arrangements involving at least two NHS trusts or GP practices working at scale across multiple places, with a shared purpose and effective decision-making arrangements, to:

  • Reduce unwarranted variation and inequality in health outcomes, access to services and experience .
  • Improve resilience by, for example, providing mutual aid.
  • Ensure that specialisation and consolidation occur where this will provide better outcomes and value. 

Black Country Provider Collaborative (acute and community) 

Hospital care - two hands with cannula.jpegIn the Black Country, there is agreement between our acute and community providers to work together to deliver effective, accessible, and sustainable acute care services. The agreement is between Sandwell and West Birmingham NHS Trust, The Dudley Group NHS Foundation Trust, The Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust. 

The Collaborative has agreed a number of priorities for the short-term, including: 

  • Identification of new service models, including centres of excellence and services applicable for a Black Country networked service solution, with those services transitioning to a new service model.
  • Clinical improvement programmes, to improve health outcomes and performance standards where appropriate. 
  • Corporate improvement programmes, to improve resilience, efficiency and effectiveness where required. 

Mental Health, Learning Disability and Autism Lead Provider 

Person with depression representing mental health services.jpegIn the Black Country, we have a lead provider for mental health, learning disabilities and autism services, Black Country Healthcare NHS Foundation Trust. The Trust takes responsibility for the whole pathway of care, which means the Trust has the flexibility to decide the best services and support for local people (working collaboratively with a range of partners to achieve the aims of this plan). Find out more on Black Country Healthcare NHS Foundation Trust website.  

A number of strategic priorities have been identified for the lead provider, including: 

  • Exploiting our collective strength across the Black Country, achieving a level of scale and pace of transformation that would not be accessible, or sustainable, at our individual place based levels, whilst also addressing variation where it is agreed to be unwarranted.
  • Through more integrated community models across primary and secondary care, we are dissolving the boundaries and gaps between services to being greater integration between mental and physical health.
  • To make optimal use of our Black Country bed stock, which is flexible, therapeutic, promotes dignity and privacy. 

Primary care collaborative 

Female entering primary care service.jpegBy primary care we mean, pharmacy, dental, opticians and general practice. The Black Country Primary Care Collaborative (BCPCC) was established in early 2022 and is continuing to establish its role and purpose within the system. To ensure that the BCPCC can represent the views of all primary care providers and remain connected, four local primary care collaboratives (Dudley, Wolverhampton, Walsall and Sandwell) have been established. 

The Local Primary Care Collaboratives (LPCCs) are the fundamental building blocks of BCPCC, each of them with three nominated representatives with a seat at the BCPCC. The LPCCs core membership is comprised of the PCN Clinical Directors. In this way, there are two-way lines of communication, engagement, representation and accountability that flow between individual providers, neighbourhoods (PCN), Place (LPCC) and System (BCPCC).

Place based partnerships

There are four local place based partnerships in the Black Country covering populations which mirror the boundaries of local councils in Dudley, Sandwell, Walsall and Wolverhampton. 

Whilst working at a Black Country level can bring the benefits of working at scale to tackling some of the bigger challenges in health and care, smaller place based partnerships are better able to understand the needs of local people and design/deliver changes in services to meet these needs.

In the Black Country, Place is the level at which most of the work to join up budgets, planning and pathways for health and social care services will happen.

Each organisation, or partner, within a provider collaborative is also a member of a place based partnership. This is to embed the benefit we achieve as a system of our providers, working both at scale and within their communities. The priorities of each of our four Places are described here:

The difference our plan will make in five years

Measuring our success

It is important to have the ability to measure whether the plan we have developed is beingimplemented effectively and to  understand whether it is achieving the impact it intended.

To support this, we have identified key metrics and indicators aligned to each strategic priority that will be regularly reported within the system. Such indicators are likely to change dependent on priorities or issues that may arise during the year. We also recognise that we want to improve our metrics associated with National Oversight Framework.

In view of operational planning guidance publication being delayed, a further review of the key metrics will need to be undertaken as part of our mid-year full review of the plan, however we have set out a number of new metrics for measuring Priority 6.

  • eliminate long waits for elective care
  • continue to reduce the number of cancer patients waiting for treatment
  • increase the number of adults and older adults accessing talking therapies treatment
  • improve accident and emergency waiting times
  • make it easier for people to contact a GP practice, including by supporting general practice to ensure that everyone who needs an appointment with their GP practice gets one within two weeks and those who contact their practice urgently are assessed the same or next day according to clinical need.

  • consistently meet or exceed the two-hour urgent community response (UCR) standard
  • continue on the trajectory to deliver more appointments in general practice
  • establish a baseline of the numbers of children and young people and adult patients on Community Services waiting lists and develop and agree a plan for reduction of lists
  • increase the utilisation of virtual wards
  • recover dental activity, improving units of dental activity towards pre-pandemic levels.

  • ensuring annual health checks for those living with severe mental illness
  • increase percentage of patients with hypertension treated to NICE guidance
  • increase the percentage of patients aged between 25 and 84 years with a cardiovascular disease risk score greater than 20 percent on lipid lowering therapies
  • a clear focus on Chronic Obstructive Pulmonary Disease driving up uptake of COVID, flu and pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.

  • measles, mumps and rubella for two doses (five years old) to reach the optimal standard nationally
  • reduce the number of stillbirths per 1,000 total births.

  • improve retention and staff attendance through a systematic focus on all elements of the NHS People Promise
  • continue to recruit 26,000 Additional Roles Reimbursement Scheme roles
  • reduce percentage of staff who have left the NHS during a 12 month period
  • reduce sickness absence rates for NHS staff in England
  • increase the mean score NHS Staff Survey, Staff engagement theme.

  • adherence to Financial Recovery Plan
  • relevant metrics from Greener NHS Plan in place, aligned to delivering a net zero NHS
  • achieve well led Care Quality Commission assessment in each of our organisations.

Feedback on our plan

Each of our four Places has a Health and Wellbeing Board (HWB), these are statutory forums where political, clinical, professional and community leaders from across the care and health system come together to improve the health and wellbeing of the local population and reduce health inequalities.

Each of our HWBs has commented on the plan, their feedback is summarised below:

Strategic and Enabling Workstreams Delivery Plans

The following sections describe how, within the Black Country, we will improve the services we provide over the next four years. It is described by the type of service and includes the vision, priority actions and the improvements in health outcomes we expect to achieve.

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