Report to:	East Sussex Health and Wellbeing Board
Date of meeting:	30^th September 2021
By:	Executive Managing Director, East Sussex Clinical Commissioning Group and Director of Adult Social Care, East Sussex County Council
Title:	East Sussex Health and Social Care Programme – update report
Purpose:	To provide an update on progress with preparation for the implementation of the NHS Health and Care Bill and our Partnership Plan for 2021/22

RECOMMENDATION

The Board is recommended to:

Note the progress to date to support our continued collaboration and implementation of the NHS Health and Care Bill in East Sussex and in the context of our Sussex Integrated Care System (ICS)

Note the progress with our planning activity in 2021/22; and

Endorse our shared Health and Social Care Partnership Plan aimed at improving population health and delivering more integrated care (Appendix 1).

1. Background

1.1 Previous reports to the East Sussex Health and Wellbeing Board (HWB) have updated members on our progress with integrated working between the local NHS, East Sussex County Council and wider partners in the District and Borough Councils and Voluntary, Community and Social Enterprise (VCSE) sector. This is delivered through our shared programme aimed at improving health and delivering new models of preventative and integrated care, based on our population needs across children and adults of all ages.

1.2 In 2021/22 our context continues to be implementing the changes brought about by the NHS Health and Care Bill and further developing our place-based collaboration in East Sussex to support this. At the same time our system is managing the ongoing pandemic response and the risks and challenges around capacity, and restoration and recovery of services.

1.3 Our system in East Sussex and across Sussex is currently experiencing high levels of pressure due to the ongoing pandemic situation, and the associated impacts on the workforce across all sectors and care settings. To help mitigate this we are working to ensure a strategic approach to supporting urgent care demand and maintaining system flow to best support local people in the most appropriate care setting. Locally we are also exploring additional opportunities for how we can work together to support our collective workforce.

1.4 The Government presented ‘Build Back Better: Our Plan for Health and Social Care’ to Parliament on 7^th September focussed on tackling the electives backlog in the NHS and putting the NHS on a sustainable footing. The Plan also sets out proposals for funding Adult Social Care in England, including a cap on social care costs and how financial assistance will work for those without substantial assets. It covers wider support that the government will provide for the social care system, and how the government will improve the integration of health and social care, including the Government’s Plan to introduce a new Health and Social Care Levy. These proposals will be factored into our system plans once detail is published.

1.5 This report provides a summary of developments with supporting our continued collaboration and implementation of the Health and Care Bill, as well as progress with our planning activity focussing on our shared priorities aimed at improving population health and delivering more integrated care.

2. Supporting information

Sussex Integrated Care System

2.1 Since the last meeting of the HWB the Health and Care Bill has been presented to Parliament which will put Integrated Care Systems (ICSs) on a statutory footing in England by April 2022. The report to the last meeting summarised the detail of proposals set out in the NHS White Paper, and the expected arrangements that will help remove some of the barriers to integration within the NHS and also between the NHS and Local Government and wider partners.

2.2 The previous report described the proposals contained in the then White Paper and in summary the key points are recapped as follows:

· The new legislation will establish ICSs covering the whole of England as being legally responsible for commissioning healthcare services for their populations by April 2022.

· Our East Sussex Health and Care Partnership member organisations; East Sussex Clinical Commissioning Group (CCG), East Sussex County Council (ESCC), East Sussex Healthcare NHS Trust (ESHT), Sussex Community NHS Foundation Trust (SCFT), Sussex Partnership NHS Foundation Trust (SPFT) are each individually members of the Sussex Health and Care Partnership (SHCP) ICS, alongside and the upper tier and unitary Authorities, CCGs and NHS Provider Trusts in West Sussex and Brighton and Hove.

· In our Sussex ICS East Sussex Health and Care Partnership is one of three existing Place partnerships, that contribute to the wider health and wellbeing of our population. Longstanding relationships between partners at the local level across NHS commissioners and providers, local government and the voluntary, community and social enterprise sector and other organisations have grown organically to reflect priorities and local context. All three Places in Sussex are based on the boundaries of Local Authorities and their Health and Wellbeing Boards.

· There are no proposed changes to existing statutory responsibilities for Councils’ social care and public health services, or the role of Health and Wellbeing Boards and Health Overview and Scrutiny Committees.

2.3 To support implementation for April 2022, the following developments are currently being progressed by our Sussex ICS to implement the Bill:

· Confirmation of designate appointment to the ICS Chair position, with the ICS appointment to the designate ICS Chief Executive Officer position to follow

· Confirmation of proposed governance arrangements for the developing ICS

· The draft proposed ICS Memorandum of Understanding (MOU) arrangements for 2022/23, which will cover the ICS vision and principles and operating model, and the governance arrangements that will support oversight and assurance of the NHS system and mutual accountability between ICS partners

Place and place-based partnerships

2.4 The Sussex ICS MOU will include the critical role, responsibilities and governance of the three Places, including East Sussex. To carry out the role of Place set out in the Bill effectively, it has been agreed through leadership discussions that the focus of place-based partnerships and plans will be on the coordination and delivery of the following:

· Population health management using public health principles

· Health inequalities

· Transformation of clinical pathways and health and social care service models

· Primary care

· Priorities for social care and housing, and other services related to delivering outcomes for our community

· Operational issues and pressures

2.5 Improving population health will be central to the role of the place based partnerships with Directors of Public Health having a lead role, alongside others, in coordinating and leading partnership plans across the range of services and activity that support this. The role of Places in the Sussex ICS is aligned to the Sussex Vision 2025 Strategic Outcomes:

Tackle health inequalities and the causes of reduced healthy life expectancy
Establish collaborative partnerships to develop integrated models of care based upon the needs of the local population
Lead on the delivery of transformation to improve the quality of services and deliver financial and workforce sustainability

2.6 Our East Sussex Health and Care Partnership has contributed to developing an ICS Place Development Plan to ensure there is a consistent approach to the role and responsibilities of Place across Sussex. In East Sussex work has taken place on the following critical milestones for 2021/22, which align with our agreed local partnership development proposals and actions that were shared at the last meeting of the HWB, and are as follows:

Confirmation of the key elements of our established place-based partnership governance structure, including our existing partnership Executive Group and System Partnership Board arrangements with oversight and accountability to the East Sussex Health and Wellbeing Board for our system working
Updating and delivering our health and care partnership plan and programme jointly developed with partners, which includes delivering our Sussex-wide and local priorities (covered below)
Agreement of our placed-based principles for collaboration, which link back to our shared ICS principles
Designing a self-assessment tool based on recognised good practice about the role of place set out by the Kings Fund[1], and aimed at testing the level of our ambition for our Place against evidence and best practice. This will be used to carry out a partnership maturity self-assessment to inform a development plan and roadmap for the next phase of our integration plans and maturity at Place, including the potential to meet defined criteria for readiness to assume delegated responsibilities in following years.
Agreeing and testing a model of neighbourhood working in line with the NHS Long Term Plan and our shared ambition for planning and delivery of services jointly in local communities in East Sussex
Delivering a roadmap for integrated commissioning at place aligned to the ICS.

Health and Social Care Partnership Plan 2021/22

2.7 The planning round for 2021/22 has involved planning at both Sussex/ICS level and CCG/Place level. The NHS Operational Planning Guidance required an initial Sussex-wide plan focused on NHS recovery and LTP commitments. This was submitted to NHS England in June 2021. We have since focused on developing our in-year plans for the partnerships in the three Places within the Sussex ICS, with a broader focus on delivering a joined up offer of care and addressing the wider determinants of ill-health. The draft East Sussex Health and Care Partnership Plan Summary is included in Appendix 1.

2.8 The Partnership Plan for 2021/22 provides an update of the long term East Sussex Health and Social Care Plan which was finalised in March 2020 after engagement and consultation across our local system. This brought together our response to the NHS Long-Term Plan (LTP) commitments and our shared priorities for our East Sussex system across health, social care and wellbeing over 3-5 year time frame.

2.9 The Partnership Plan for 2021/22 is based on our latest summary update of our population needs previously shared with the HWB, and sets out our in-year delivery priorities across health, social care and wellbeing and our response to the impact of the Pandemic. Key features of the plan are:

· Local population – identification of needs and priorities

· Local priorities responding to local population needs

· Addressing health inequalities

· NHS performance challenges

· ICS priorities reflected at place

· Recovery and restoration of services

· Progressing transformation of services to improve services and ensure clinical and financial sustainability.

· Place based governance arrangements including oversight and management of place-based risk.

· Key Performance Indicators and Success Measures

2.10 The East Sussex priorities in the Plan are taken from the significant work of our five programme Oversight Boards to update our shared priorities for children and young people, mental health, community, planned care and urgent care, to enable increased levels of personalised and integrated care as well as prevention and early intervention, which has been previously reported to the HWB. Work is being progressed to agree metrics and KPIs to enable progress and impact of our transformation to be monitored, and delivery will be supported by the Oversight Boards.

2.11 The Strategic Development Framework to support a strengthened focus on improving population health and coordinating our cross-cutting work on prevention and health inequalities was shared as a work in progress at the last HWB meeting, and has now been finalised. We have now established arrangements to monitor and deliver our collective work in this area, and this is sponsored and overseen by our East Sussex Health and Social Care System Partnership Board.

2.12 The Partnership Plan should be seen as an iterative document that will be further refreshed during 2021/22. Planning and delivery will continue to be a live process supported by ongoing engagement with stakeholders in specific projects and areas of work, and plans will also need to be sensitive to any changes necessary to respond to the ongoing pandemic and other requirements that may arise during the year as applicable.

2.13 In addition, our ICS has currently set a six-month expenditure plan from April 2021 to September 2021 in line with the NHS national financial framework arrangements. These plans look to the longer-term priorities based on our population health and will need to respond to future funding arrangements, including those proposed in ‘Build Back Better’. This means that all three of the Place plans will continue to be reviewed as the financial framework for the second half year is confirmed, and will reflect any changes necessary to respond to the ongoing pandemic or national guidance.

2.14 It has been agreed that oversight of the delivery plan will be primarily through our East Sussex Health and Social Care Executive Group on behalf of the HWB and ICS, with the key deliverables aimed at the wider determinants of population health led by our Health and Social Care System Partnership Board. Updates on progress and overall reporting will be provided to the Health and Wellbeing Board. An updated governance chart is attached at Appendix 2.

2.15 Delivery of our Partnership Plan will support our shared whole population Outcomes Framework which sets out our shared aims for improvements across population health and wellbeing, the quality and experience of care and the financial sustainability of services including prevention and early intervention, and is based on what local people have told us is important about their health and care services. A next step will be to set appropriate measures and indicators for improvements, so that we can include this as part of our overall reporting framework to our Health and Wellbeing Board and other stakeholders.

3. Conclusion and reasons for recommendations

3.1 As part of wider plans to put our ICS on a statutory footing by April 2022 we are progressing plans locally to further develop our Place-based partnership, so that we can continue to build on our strong foundations to take forward increased integration of commissioning and delivery of services for the population of East Sussex This will lead to a roadmap for the next phase of our integration plans, setting out the areas where we would like to go further and faster as part of our ICS, and our further development of neighbourhood and community working in 2022/23. This will be brought to a future meeting of the HWB.

3.2 Our East Sussex Health and Care Partnership Plan 2021/22 was agreed as a live operating plan by our Executive Group on 30^th July, and endorsed by our System Partnership Board on 5^th August. Plans include a strengthened focus on our collaboration to improve population health and address health inequalities. The next steps will be to share Plans more widely as we continue to use as the basis for ongoing engagement with stakeholders in specific projects and areas of work. Plans will also be revisited over the second half of the year as the detailed expectations and underpinning financial framework becomes clear.

JESSICA BRITTON
Executive Managing Director, East Sussex Clinical Commissioning Group

MARK STAINTON

Director of Adult Social Care, East Sussex County Council

Contact Officer: Vicky Smith
Tel. No. 01273 482036

Email: Vicky.smith@eastsussex.gov.uk

Background documents

None

Appendices

Appendix 1 East Sussex health and care Partnership Summary Plan

Appendix 2 East Sussex Health and Social Care Partnership Governance

[1] Developing place-based partnerships, the foundation of effective integrated care systems (The Kings Fund, April 2021)