Report to:	East Sussex Health and Wellbeing Board
Date of meeting:	19 July 2022
By:	Executive Managing Director, East Sussex, NHS Sussex 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 system integration and related areas of collaboration

RECOMMENDATIONS

The Board is recommended to:

1) Note the contents of this update and the work that has taken place to respond to recent national and local developments, including the updated Health and Wellbeing Board (HWB) terms of reference (Appendix 1 – to follow) and Health and Wellbeing Board Strategy; and

2) Endorse the refreshed HWB Strategy ‘Health Lives, Healthy People 2022 – 2027’ (Appendix 2)

1. Background

1.1 Previous reports to the Health and Wellbeing Board have detailed the expected changes to health and care as a result of the Health and Care Act 2022, including the establishment of new Integrated Care Systems (ICS) in July 2022. The role of place-based partnership working and Health and Wellbeing Boards is pivotal in the new arrangements, further emphasised by the recent Heath and Social Care Integration White Paper Joining up care for people, populations and places published in February 2022.

1.2 At the last meeting members of the Health and Wellbeing Board agreed taking forward some key actions as a result of the opportunities set out in the White Paper and the forthcoming Sussex ICS. To help create plans that are sustainable over the long term to deliver improved health, reduced health inequalities and a joined up offer of care for our population, in summary the next steps were:

Review the detail in the White Paper to enable a response to national Government’s questions, and inform an update of our East Sussex Health and Wellbeing Strategy and how we monitor shared outcomes
Finalise the refresh of our integrated care priorities and programmes of work and monitoring to support delivery in 2022/23
Participate in the national ICS Population Health and Place Development Programme, to help shape our future roadmap for further developing the way we collaborate at Place to join up care, improve health and reduce health inequalities

1.3 A response was submitted to the Government’s questions in the White Paper, and this report provides a further update on these actions and includes the draft refresh of our East Sussex Health and Wellbeing Board Strategy for endorsement by the Board. The draft refreshed strategy aims to enable us to continue to build on our progress as the East Sussex Health and Care Partnership, and our shared objectives to improve health and integrated care for our population and place, in the context of the new ICS.

2. Supporting information

Sussex Integrated Care System

2.1 Previous reports to the Health and Wellbeing Board have detailed the expected changes to health and social care as a result of the Health and Care Act 2022. In line with this, the three NHS Clinical Commissioning Groups (CCGs) in Sussex closed on 30^th June 2022, and a new statutory NHS Integrated Care Board (ICB) known as NHS Sussex was formally established on 1^st July. NHS Sussex is responsible for agreeing the strategic priorities and resource allocation for all NHS organisations in Sussex, taking on the commissioning functions previously carried out by CCGs. It has also taken on responsibility for wider primary care services including dental, pharmacy and opticians.

2.2 NHS Sussex held its inaugural Board meeting on 6^th July, and East Sussex County Council (ESCC) is a partner member alongside West Sussex County Council and Brighton & Hove City Council. Partner organisations are still individually responsible for their own services and budgets, and in summary the following arrangements have now been agreed to support our joint working:

A wider partnership called the Sussex Health and Care Assembly will be established as a statutory joint committee between the NHS and local government to come together to formally agree the strategic direction for our system to meet the broader health, public health and social care needs of the population in the ICS footprint.
It will do this primarily through agreeing an Integrated Care Strategy for Sussex, building on local Joint Strategic Needs Assessments and Health and Wellbeing Strategies in each of the three ‘Places’ in Sussex (East Sussex, West Sussex and Brighton & Hove).
The engine of delivery and reform within the Sussex ICS will be through partnerships which bring together organisations at place level in East Sussex, West Sussex and Brighton & Hove, to deliver shared priorities and plans for improving health, integrating care and reducing health inequalities.
The Chair of the Health and Wellbeing Board has been nominated to represent East Sussex County Council at the meetings of the shadow Sussex Health and Care Assembly

· Both the NHS Sussex ICB and the Assembly will have duties to consider Health and Wellbeing Board plans.

Our integrated plans and work between the local NHS, East Sussex County Council and wider partners in district and borough councils and Voluntary, Community and Social Enterprise (VCSE) sector and others, is delivered through our shared East Sussex Health and Care Partnership and overseen by our Health and Wellbeing Board. 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.
There will be an NHS Place Executive Lead role who will ultimately be accountable to the NHS Sussex ICB Chief Executive Officer and upper tier Local Authority Chief Executive, so that the NHS can continue to be an effective partner at place level.
This new role will work with other Executive leads at place level such as the NHS Provider Chief Executives, Director of Adult Social Care, Director of Public Health and Director of Children’s Services to deliver shared outcomes that will be set nationally, with locally agreed priorities.

2.3 To support this, the Terms of Reference of the Health and Wellbeing Board have been updated (subject to agreement by County Council on 12 July) to reflect both the changes to NHS organisations and the new relationship between local Health and Wellbeing Boards and Strategies, and the role of the Sussex Health and Care Assembly. The updated Terms of Reference are attached at appendix 1 (to follow) and in summary the key changes are:

Replacing CCG representatives with representatives of NHS Sussex

· Adding references to the relationship of the Health and Wellbeing Board with the Sussex Health and Care Assembly within the new ICS, including that the Board may receive reports from, and direct issues to, the Assembly

· Adding references to the Integrated Care Strategy for Sussex, including ensuring that this builds upon the Joint Local Health and Wellbeing Strategy and Joint Strategic Needs and Assets Assessment.

East Sussex Health and Wellbeing Board Strategy refresh

2.4 The expected timeframe for preparing the integrated care strategy is December, with a supporting delivery plan developed by March 2023 to be overseen by the NHS Sussex ICB. A refresh of our rolling East Sussex Health and Wellbeing Strategy ‘Health Lives, Healthy People’ has been undertaken to support this. This focusses on where the East Sussex Health and Wellbeing Board believes a more integrated and joined up approach will help to improve outcomes, reduce health inequalities and deliver more integrated care in a more sustainable way.

2.5 ‘Healthy Lives, Healthy People’ is our overarching guiding strategy for improving health, reducing health inequalities and integrating care for the population of East Sussex. It is designed to be a short, accessible, public facing narrative about our shared strategic commitments and focus, and our work as organisations and system partners in this area. It is informed by our Joint Strategic Needs and Assets Assessment (JSNAA) and other evidence, and is delivered through a range of detailed and technical plans and strategies.

2.6 The previous iteration of the rolling strategy was extended during the first waves of the pandemic. Delivery has been supported in the last three years through our Health and Social Care Plan and integration programme that has been agreed and managed through our oversight and partnerships boards, and the Health and Wellbeing Board has received regular updates and monitoring reports. Other partnership and commissioning activity that supports healthy behaviours, health improvement and prevention also play a key role.

2.7 To support the refresh a review was undertaken to ensure that the core vision and strategic commitments still provide a strategic framework to guide our East Sussex Health and Care Partnership’s progress and intended impacts. This also aligns with expectations set out in the Health and Social Care Integration White Paper and the relationship between the NHS and Local Government at Place level within ICSs, in particular:

Joining up care across primary care, community health, adult social care, acute, mental health, public health and housing services which relate to health and social care
New national shared outcomes framework and implementation of national priorities and a broader framework for local outcome prioritisation to go live from April 2023
Leadership and accountability for delivery to the LA and NHS ICB and a formal model for pooling resources, making decisions and planning jointly for adoption by Spring 2023, working towards extending inclusion of services by 2026
Increased financial flexibility through strengthened approach to s75 Agreements

2.8 The draft refreshed HWB Strategy is attached at Appendix 2. It has been updated to reflect our current policy context and priorities for our population, including the pandemic experience in the last two years and the impacts on society as a whole, and to ensure it fully aligns with more recent shared plans and strategies. In line with this the refreshed strategy contains the following new elements:

· A brief summary description about our population characteristics, drawn from the JSNAA and State of the County.

· Links to the JSNAAs, key reports and other evidence that informs and supports the strategy

· Links and signposts to the key detailed partnership plans that support delivery

· A clear focus on the wider determinants of health and supporting work

· A clear focus on our priorities for integrated health and care services, drawn from the work of our Oversight Boards to refresh shared priorities for 2022/23

· Our East Sussex shared strategic outcomes framework to support measurement of progress previously agreed by the Health and Wellbeing Board. This was co-produced with local people based on what they have told us is important about their health and care.

· An extension of the planning cycle to 3+2 years to align with NHS long term planning processes.

2.9 A key addition to the refreshed strategy is the shared strategic outcomes framework, previously developed and agreed by our Health and Wellbeing Board. A small set of pilot measures and indicators will be finalised to test our approach, and help prepare for the introduction of the national shared outcomes framework as a result of the White Paper in Spring 2023 (guidance awaited), as well as the need to align with ICS-wide strategic outcome measures which are currently in development.

2.10 The draft refreshed strategy has been shared for comment with individual organisations and leads including district and borough councils, Healthwatch East Sussex, East Sussex VCSE Alliance, the former NHS East Sussex CCG, East Sussex Healthcare NHS Trust (ESHT), Sussex Community NHS Foundation Trust (SCFT), Sussex Partnership NHS Foundation Trust (SPFT) and ESCC. It has also been reviewed in meetings of our East Sussex Health and Social Care System Partnership Board and Executive Group and joint Population Health, Prevention and Health Inequalities Steering Group, to ensure it reflects the contribution of all our organisations and sectors across health and care delivery and the wider determinants of health. The broad range of delivery covered and signposted in the strategy encompasses partnerships that include a range of wider system partners including East Sussex Fire and Rescue Service and Sussex Police.

2.11 The strategy recognises that working with people, carers, families and communities themselves is crucial to designing services and support that works. We will continue to build on the strengths of our communities and involve people in ways that suit them, including considering the potential impacts of any decisions and exploring all opportunities to ensure equal access to services across our diverse communities. This will be supported by the ongoing role of our joint East Sussex Communications and Engagement Steering Group.

Programme delivery

2.12 In 2021/22, our Health and Wellbeing Board Strategy delivery was supported through our in-year programme for health and care integration. Work has been undertaken by our Oversight Boards to refresh shared priorities for 2022/23 across children and young people, mental health, community, urgent care and planned care, and this has been incorporated into the draft refreshed Health and Wellbeing Strategy.

2.13 Our focus continues to be delivery of our East Sussex Health and Care Partnership Plan to support restoration and recovery of our system in a sustainable way. Summary highlights of progress include:

· Recruitment of PCN based roles to enable access to mental health practitioners via primary care and agreement to develop an action plan to support better mental health in the wider population

Continued prioritisation of investment into children and young people’s mental health and wellbeing services

· Planning for future arrangements to support discharge from hospital after the government hospital discharge programme funding ends, alongside research into ‘Discharge to Assess’ models

· The report from the engagement workshops on the long term vision for community hubs in East Sussex has been finalised, and a high level action plan to set out how the recommendations will be taken forward is being co-produced

· Agreement to take forward specific work on respiratory pathways to ensure people are supported to wait well for appointments and treatment, reduce inequalities and improve integration

· Finalising proposals for improving cardiology and ophthalmology services following the public consultations, alongside continuing work to progress the development of a modern facility to support mental health inpatients as part of the national eradicating dormitories programme.

2.14 To ensure our health and wellbeing strategy objectives are progressed across all the determinants of health, our Strategic Delivery Plan focussed on improving population health and wellbeing, increasing prevention and addressing health inequalities has also been refreshed for 2022/23. Progress as a result of partnership work in the last period includes:

Help with data and guidance about CVD and Cancer to support Primary Care Networks with tackling neighbourhood health inequalities

Underage alcohol sales enforcement started during the Easter Holidays and a record-breaking £28,000 of illegal tobacco has been seized in Eastbourne to protect children and young people from becoming dependent on smoking
Funding has been secured under Healthy Weight Plan work for the Active Partnerships model and Active Hastings, and food partnerships established in all areas with action plans
Vision workshops took place to explore possible options for future approaches to community wellbeing by researching and presenting examples/models of community hubs in other areas, to feed into the recommendations in the final report
More than 5000 eligible young people attended funded Holiday Activity and Food programme provision with over 97 separate providers and partners
858 new families received a Family Focus intervention, and 1762 children were supported as a result

ICS Population health and place development programme

2.15 Our Sussex ICS has been invited to participate in this national programme to support the implementation of the Health and Care Act, and the role of Place within ICSs, 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 programme runs until October, and in line with our refreshed HWB strategy vision and focus, early work has involved:

· Exploration of how the next steps and roadmap for shared leadership, governance, function and finance can be best taken forward to support increased levels of integration and accountability for outcomes, consistent with future ICS expectations to delegate responsibility to places, and the opportunities outlined in the White Paper to support how our teams work together to deliver preventative, proactive and coordinated care and reduce health inequalities.

· Implementation of action learning sessions designed to explore a ‘population health management’ approach. The Foundry Primary Care Network in Lewes has volunteered to undertake case study work with partners to pilot the use of more integrated data and insight to understand the needs and resources of particular groups more clearly, and improve and better manage the health of local populations. This involves a broad range of our clinical and care teams across the key statutory, voluntary and independent sector services working locally, and will help shape the design of our model for locality and neighbourhood working.

3. Conclusion

3.1 Our HWB terms of reference and overarching East Sussex Health and Wellbeing Board Strategy have been refreshed to ensure they will guide our partnership work aimed at improving outcomes for the East Sussex population, as well as enabling new statutory responsibilities to be fulfilled as part of our role in the Sussex ICS.

3.2 The draft refreshed strategy is designed to maintain continuity with the existing and longstanding shared vision and commitments that have been set out previously by our Health and Wellbeing Board, so that we can continue to build on progress. In addition, it is a timely opportunity to describe clearly the role of Place, and the range of contributions from HWB partners to support delivering shared objectives at both the East Sussex and Sussex level, that all of our organisations can unite behind.

3.3 The strategy and our other work to further develop the role of place within our ICS, will enable us to develop sustainable long term plans to deliver improved health, reduced health inequalities and a joined up offer of care for our population.

JESSICA BRITTON
Executive Managing Director, East Sussex, NHS Sussex

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 Revised Terms of Reference of the HWB

Appendix 2 Draft refreshed Health and Wellbeing Board Strategy