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 three 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.
The NHS Black Country Joint Forward Plan: a strategic intent - Summer 2025
Here in the Black Country, we punch above our weight when it comes to public sector reform and good practice. Our four local areas (Places) – Dudley, Sandwell, Walsall and Wolverhampton – work closely together for the benefit of local people, but with each Place retaining its own unique identity.
Despite some big challenges in recent years – financial pressures, growing demand on health and care services, and the need to recover services from the major impact of the COVID-19 pandemic – the Black Country has achieved great things. We’ve improved performance in a number of areas including elective waiting lists and ambulance turnaround times, formed strong collaboratives across acute, mental health and primary care, strengthened our Place-based Partnerships, and agreed a financial recovery plan – not to mention delivering the biggest new hospital build in decades.
Our achievements could never have been delivered without partners working together, with shared goals and a joint vision for the Black Country’s future good health. Over the last few years, we have worked to deliver on our Joint Forward Plan (JFP) six key priorities:
- Improving access to and quality of services
- Community where possible, hospital where necessary
- Preventing ill health and tackling health inequalities
- Giving people the best start in life
- Making the Black Country the best place to work
- Making the system fit for the future.
In future, all local plans and strategies must consider the unique challenges of the Black Country. These include persistent deprivation and inequalities, unsustainable growth in demand (e.g. a predicted 55,000 more emergency department visits every year by 2035), and the need to maintain financial balance under strict national scrutiny.
If we don’t act, these challenges will only get worse. We can’t simply create more hospital beds to meet growing demand, and we have a pressing need to maintain our supply of skilled and compassionate staff to deliver services. Financial sustainability is critical, and deficit budgets will no longer be accepted. We’re also expecting major shifts in the forthcoming NHS Ten Year Plan and other public sector reforms, toward a focus on neighbourhood health, the prevention agenda, and more service collaboration at a regional level.
With changes afoot we have set out a new shared strategic intent ahead of our full JFP. This intent aims to get us on the front foot in tackling these challenges. In developing our objectives we’ve spent lots of time talking to patients, members of the public, and health and care sector staff, about what matters to them, as well as undertaking a detailed analysis of our data, and factoring in our known national NHS priorities.
Where we will focus our efforts
- Healthier lives: We want people to live longer and healthier lives, especially in the poorest areas.
- Better experience for patients: Care should be quicker, easier to get, and the same high quality no matter where you live.
- Happy staff: People working in health and care should feel supported, respected, and proud of their work.
- Using money wisely: The system needs to stop losing money so we can keep improving services.
- Safe, high-quality services: Everyone should feel confident that they’re getting safe and reliable care.
What matters to local people
The following themes came up in our engagement activities:
People reported difficulty accessing GP and specialist appointments, and experiencing long wait times with a lack of interim support. They call for clearer, more streamlined service pathways, with digital solutions made more accessible to those with limited skills or access.
There is strong support for collaboration with community organisations. Services must be tailored to individual needs, ensuring cultural competency, and sustainable funding for VCSE (voluntary, community, and social enterprise) services is crucial.
The emphasis is on dignified, empathetic, and non-judgmental care, with a need to amplify the voices of underrepresented communities and ensure inclusivity.
There is a need for stronger integration between health, social care, and community services, focusing on addressing wider social determinants of health too (e.g., housing, employment, community safety).
Ultimately, people want their future NHS to remain free and accessible, with kind, passionate staff delivering quality and efficient services. They would like a shift toward prevention, with greater community and VCSE involvement and more support for patients and staff.
How we will measure our success
Thanks to the input of patients, staff and stakeholders, we’ve been able to capture clear priorities for the future of health and care in the Black Country, and five key measures of success that we will use to hold ourselves accountable:
While life expectancy in the Black Country is projected to improve by up to three years on average by 2035, the time that a resident can expect to live in good health is four years less than the national average, with 11.3 per cent of our population living with two or more long term conditions.
As well as reducing quality of life for individuals, this increases demand on services. Our vision is for the NHS and social care partners to work together to improve healthy life expectancy and reduce the gap to the national mean, over time.
Ways that we will do this include equipping general practice to identify risk and intervene in the areas of greatest need, supported by neighbourhood multi-agency teams and the relevant secondary care expertise as required (taking a “community first” mindset). We will also prioritise health promotion among pre-school children for long-term benefits.
Although the Black Country system performs relatively well on some user experience measures, there is inconsistency across our services in NHS measures such as friends and family test results and national service user survey results in social care. The most challenging service areas are primary care, where access is variable, and emergency care, where access performance varies by up to 10 per cent between providers.
Our vision is for health and care services in the Black Country to deliver improved and less variable user experience. We will ensure year-on-year improvement that enables us to meet the NHS access standards and achieve upper quartile service user survey results by 2030.
Ways that we will do this include embedding continuous quality improvement across all services, using best practice pathways consistently, expanding our care navigation offer and improving elective care productivity with one-stop pathways, patient initiated follow-ups and electronic referrals.
International research evidence in healthcare is clear – if your staff are happy, healthy and well engaged, they will deliver better, safer and more efficient care. Measurable staff experience in the Black Country – for example via the NHS Staff Survey and quarterly Pulse Survey results – is variable.
Our vision is for the Black Country to be the system of choice for people who want to work in health and care professions. Our goal is to achieve upper quartile staff survey results both as a system, and as individual organisations within the system.
Ways we will do this include developing formal reward and recognition schemes for our employees, working with estates teams to improve the working environment, improving and standardising how performance reviews are delivered, and rolling out training in compassionate and inclusive leadership.
The underlying NHS deficit in the Black Country is at least £100 million. This makes it almost impossible for us to make long term investment decisions, which will ultimately impact on the quality and availability of services. It is particularly affecting our ambition to develop new, ‘community first’ models of care.
Our vision is to achieve best value across our system, with the best outcomes for every pound spent. Our goal is to deliver a financial surplus across the system, giving us the ability to continually invest in meeting predicted changes in demand and patient needs.
We will do this by implementing a system-wide financial recovery programme, which relies on three key pillars: primary and secondary prevention, productivity, and workforce cost reduction.
Despite an increase in the number of staff employed in our system since 2019, there is still a bit gulf between our best and worst rated services, and too few services are achieving the CQC rating of “Good” or “Outstanding” that our residents deserve.
Our vision is for citizens of the Black Country to have confidence that their health and care services are safe, effective and deliver a good experience. Our goal is that all services in our health and care system are rated as Good or Outstanding by the CQC.
Ways we will do this include setting clear, cross-system standards for the fundamentals of care, developing a standardised approach to self-assessment and assurance, and making better use of service user involvement and data analysis when planning care.
How we will work together
We’ve made great strides in recent years in developing a system leadership model – breaking down silos, championing and modelling joint ways of working, and involving a greater range of agencies and partners. There’s still work to do though, and we pledge to be bolder – moving away from accepted norms and looking at different kinds of leadership arrangement if this supports improvement and problem-solving.
This is particularly important in the context of recent announcements about major structural changes across the NHS, including the abolition of NHS England. At a time when there is uncertainty around the future of current ICS and ICB governance models, it is even more crucial that the JFP is accepted as the main framework to guide local health and care planning.
This means that Trusts’ annual plans must align with the JFP objectives and success measures, and the ICS operating model should be revised to oversee JFP delivery. All collaborative work programmes including the provider collaborative and primary care networks, must be aligned with the JFP’s goals. For non-NHS partners, and our Place Partnership strategies should be reviewed to ensure their objectives are consistent with those of the JFP, and ICP delivery plan will be drawn up, which will focus on bringing organisations together to address wider determinants of health at a system (Black Country) and regional (West Midlands) level.
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 few 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.
