Report to:	East Sussex Health and Wellbeing Board
Date of meeting:	1 March 2022
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 our integration programme and related areas of system collaboration

RECOMMENDATIONS

The Board is recommended to:

1) Note the continued acceleration of integrated working as a result of our system collaboration, and actions required by increased needs for services during the festive and winter period;

2) Note the key recent national and local developments that will inform and influence the way work together to improving population health, reduce health inequalities and deliver more integrated care; and

3) Endorse the recommended next steps as set out in paragraph 3.3 of the report.

1. Background

1.1 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 is delivered through our shared East Sussex Health and Care Partnership Plan and programme.  This is 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 As expected, since the Health and Wellbeing Board (HWB) last met on 14^th December our Partnership, at Place and Sussex Integrated Care System (ICS) level, has experienced high levels of sustained need for services over the festive and winter period.  This has required intensive system collaboration to support our population to access appropriate health and care, as well as mobilising vaccination booster rollout as part of the response to Omicron.   

1.3 To support this, this has resulted in some delays in taking forward our previously reported strategic plans by approximately 6 – 8 weeks.  This is in common with the national picture which also included a formal delay to launching statutory Integrated Care Systems in England to 1 July, from the previous intended start date of 1 April.

1.4 This report sets out an update of our system working in this context, and notes the key recent developments at a national and local level including the new integration White Paper.  It outlines how this will inform our plans and programmes for 2022/23, and contribute to a renewed focus on our shared commitment to strengthen delivery of integrated health and care for our population.  

2. Supporting information

System delivery

2.1       The last report to the HWB described the local system working and coordinated action that was required to meet increasing challenges and pressure being experienced across all areas of the system.  This was driven by both needs for services and workforce pressures compounded by some Covid-19 outbreaks.  This aimed to ensure that the needs of the individual are best served through the most appropriate care in the right setting at the right time, and included for example:

· Increased commissioning of Discharge to Assess (Pathway 3) Care Home beds including beds to support specific needs and Home Care capacity

· Continued support of hospital discharge arrangements and case management to improve patient experience and flow through the system

· Development of improved front-door models to ensure people access the right services for same day needs and Emergency Departments

· Focussed work to support individuals of all ages needing access to mental health services and supporting timely discharge from hospital

· Maximising access to additional national resources as this became available to support local systems

Transforming care models

2.2  Our recent focus has remained on ensuring our work to transform care models and pathways can both help us build on the developments that have been accelerated by the pandemic, and supporting restoration and recovery of our system in a sustainable way.  In summary this includes:

• Delivery of our East Sussex Health and Care Partnership Plan
• Taking forward a Best Start in Life strategy focusing on shared action with the 0 – 7 age group that will be critical to achieving good outcomes across the board for children.
• Engagement with our Primary Care Networks (PCNs) to shape how services aimed at providing greater access to a range of mental health and wellbeing support will be implemented.
• A shared approach to supporting our health and care teams to work together in our communities and neighbourhoods to support prevention and personalisation, and coordinating action on the services that impact on health more broadly, including the role of our larger organisations (Anchor Institutions) in supporting wider economic and social wellbeing for our population.
• A Trusted Assessor pilot for Crisis Response and a focus on urgent response to avoid unnecessary attendance and admission at hospital, and a strategic approach to Discharge to Assess (D2A) and Home First pathways.  

· Improving our model to support people needing to access care urgently and in an emergency at the front doors of our hospitals, with a focus on working as a system and helping people to best access the service that is most appropriate.

· Public consultations on improving cardiology and ophthalmology services in East Sussex were launched, based on evidence and examples of best practice from around the country and with feedback from people who use and work in our local services, as well as consulting local people on the opportunity for a new modern facility to support mental health inpatients as part of the national eradicating dormitories programme.

· Joint action on workforce and recruitment to support our collective workforce recruitment in East Sussex using digital and the benefits of scale for all providers including the independent care sector and voluntary, community and social enterprise sector. 

2.3 Our shared priorities for transforming care models are currently being reviewed, and programme plans will be finalised for 2022/23, together with supporting key performance indicators, to ensure grip on delivery and the expected impacts and HWB oversight.

Integration White Paper

2.4 On 9 February the government published a new White Paper on health and social care integration called Joining up care for people, places and populations.  This forms part of wider plans to reform the health and social care system and builds on the Health and Care Bill and the Social Care Reform White Paper People at the Heart of Care (December 2021), which sets out the Government’s ten-year vision for adult social care.

2.5 The White Paper sets out a vision for integrated health and care services, and focusses on the role of Place in co-ordinated, joined up and seamless services that support people to live healthy, independent and dignified lives and which also improve outcomes for the population as a whole. This complements our existing direction of travel as an Integrated Care System (ICS) in Sussex and at the local level in East Sussex.  A brief overview of the key aspects of the White Paper is contained in Appendix 1.

2.6 A next step will be to review our local plans in full in light of the detail in the White Paper.  The Government has been keen to underline the continuing flexibility available to local ICSs and Places in taking the White Paper forward in ways that are appropriate to local circumstances, and it is also inviting views in response to a series of questions to support effective implementation of the proposals by 7^th April.  Topics include outcomes, finance, accountability, workforce, and digital and data, and it suggested that we coordinate a response to this on behalf of our Health and Wellbeing Board.

2.7 The White Paper will also be used to inform an update of our high level East Sussex Health and Wellbeing Strategy which was delayed due to the pandemic.  An interim Strategic Development Framework was produced for 2021/22, and this will also be updated to support the delivery of our Strategy.

2.8 There is a commitment in the White Paper to implement a set of national shared outcome priorities and a broader framework for local outcome prioritisation from April 2023.  In light of this we will review our approach to our existing strategic shared outcomes framework, which we developed based on what matters to local people, and how we monitor it linked to our Health and Wellbeing Strategy.

Health and Care Bill implementation

2.9 Further to the update provided at the December HWB meeting, a new target date of 1 July 2022 has been set for Integrated Care Systems (ICSs) to take on a statutory footing and NHS Integrated Care Boards (ICBs) to be legally and operationally established. This replaces the previous target date of 1 April 2022. This change is to allow enough time for the Health and Care Bill to progress through the remaining Parliamentary stages. It also means health and social care systems will have additional time to prepare, and to focus on the immediate priorities of the pandemic response.

2.10 If the Health and Care Bill is agreed by Parliament, a new NHS Sussex Integrated Care Board will be established which will absorb the role and functions of the three Clinical Commissioning Groups in Sussex and be responsible for a health budget of over £2bn. It will oversee the commissioning, performance, financial management and transformation of the local NHS, as part of the Sussex Integrated Care System (ICS).   An NHS Sussex Assembly will also be established to bring together a wider array of partners to look at Sussex-wide matters.

National ICS Population Health and Place Development Programme

2.11     To support the implementation of the Health and Care Bill and the role of Place within ICSs, a national development programme has been set up by NHS England and Improvement (NHSEI) and the Local Government Association (LGA).   Our Sussex ICS has been invited to participate in the Programme, and as part of this East Sussex Health and Care Partnership has been chosen to help accelerate the development of the role and function of Place.  The national Programme is due to launch in March and is set out around four elements:

· Ambition, vision and leadership

· Governance, function and finance

· Population Health Management and integrated transformation capability

· Digital, data and analytics (to be led at a pan-ICS level)

2.12     With strong resource backing from NHSEI and the LGA and combined with the new integration White Paper, this represents a valuable opportunity to inform and shape the next steps for how our Place Partnership in East Sussex develops as part of our ICS.   Local priorities have been reviewed by senior leaders across our ICS and Place to ensure the Programme can be tailored to reflect and build on our strong progress to date.  In line with national policy objectives and our long standing local commitment to integrate care and improve the health of our population, our critical focus will be:

· Identifying our future strategic roadmap and the next steps for delivering increased integration and shared accountability for outcomes   

· Developing our practical approach to using data and insight to better understand needs, profiles and resources in our communities and neighbourhoods, and support how our teams work together to deliver preventative, proactive and coordinated care and reduce health inequalities.

3. Conclusion and reasons for recommendations

3.1       Our context of high need for services and pressure across our system has continued over the winter months, and this has required our integrated working to accelerate and be strongly focussed on operational delivery to protect our population. 

3.2       At the same time the new integration White Paper and implementation support for the Health and Care Bill, in the form of the ICS Population Health and Place Development Programme, offers us new opportunities to plan how our close working in recent months can be sustained over the long term to deliver improved health, reduced health inequalities and a joined up offer of care for our population. 

3.3       As a result, and to ensure we fully utilise the new opportunities available to us in the White Paper, the following next steps are recommended and a further update will be brought to the July HWB meeting:

• Finalise the reset of our programmes to transform care models and the monitoring arrangements that support this in 2022/23
• Coordinate a local response to the Government’s questions in the integration White Paper Joining up care for people, places and populations
• Review the detail in the White Paper and using this to inform local plans and an update of our East Sussex Health and Wellbeing Strategy, including our approach to monitoring delivery of our shared outcomes
• Participate in the ICS Population Health and Place Development Programme to support this, and help shape our future roadmap for further developing the way we collaborate at Place to join up care, improve health and reduce health inequalities.

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

Appendix 1 Brief Overview of the Integration White Paper