Report to:                  Leader and Lead Member for Strategic Management and Economic Development

Date of meeting:       29 November 2022

By:                              Director of Adult Social Care and Health

Title:                           Draft Sussex Integrated Care Strategy

Purpose:                    To enable consideration of the key elements of the draft joint Sussex Integrated Care Strategy as they relate to East Sussex, and the suggested emerging shared priorities to be taken forward on a partnership basis through the statutory Sussex Health and Care Assembly.

RECOMMENDATIONS: On behalf of the County Council as one of the four statutory members of the Assembly, the Leader and Lead Member for Strategic Management and Economic Development is recommended to:

1.         Agree the terms of reference for the Sussex Health and Care Assembly (Appendix 2 of this report), setting out the Council’s statutory role in this body;

2.         Agree the emerging Sussex-wide strategic priorities in the current draft joint Sussex Health and Care Strategy, as summarised in paragraphs 2.8 – 2.9 in this report, and;

3.         Agree the feedback to strengthen the draft Strategy from the perspective of East Sussex Place and population, as summarised in paragraphs 2.14 – 2.18 in this report, and any other feedback as appropriate, prior to it being presented to the Health and Wellbeing Board and Assembly for endorsement and approval respectively in December 2022.

1. Background

1.1 Cabinet considered a report on 19April 2022 setting out the implications for the County Council’s lead role and commitment to integrating care and improving population health in East Sussex, as a result of the then Health and Care Bill (now Health and Care Act 2022).  The report detailed the new arrangements for the Council’s partnership work with the local NHS, including the requirement to participate in two new statutory bodies that make up the Sussex Integrated Care System (ICS): the proposed new Sussex NHS Integrated Care Board (ICB) and the wider Sussex Health and Care Assembly partnership. In summary Cabinet agreed the following:

• The Chair of the Health and Wellbeing Board to attend and represent the County Council on the (then shadow) Sussex Health and Care Assembly;
• The three upper tier Councils in Sussex being represented on the (then shadow) NHS Sussex Integrated Care Board (ICB) by a Director of Adult Services, a Director of Children’s Services and a Director of Public Health drawn from across the Councils;
• The Sussex Health and Care Assembly being established as a statutory joint committee between the future NHS Sussex ICB, East Sussex County Council (ESCC) West Sussex County Council (WSCC) and Brighton & Hove City Council (BHCC), to formally act as the Sussex Integrated Care Partnership with responsibility for agreeing the strategic direction which meets the broader health, public health and social care needs of the population in the Sussex ICS footprint;
• The Council’s ongoing commitment to integrated working with the local NHS was also further confirmed. 
  
  

1.2 The Health and Care Act 2022 made no changes to the role of Health and Wellbeing Boards, as statutory committees hosted by upper tier authorities responsible for assessing local health and care needs and agreeing a health and wellbeing strategy for their place. The importance of Place has also been recognised by our Sussex ICS to ensure a strong focus on local population health and care needs, integrated care and reducing health inequalities.

1.3 There are three ‘Places’ in the Sussex ICS based on the upper tier Local Authorities and statutory Health and Wellbeing Board (HWB) boundaries in Sussex – Brighton and Hove, East Sussex and West Sussex.  The East Sussex HWB brings together representation from the County Council, borough and district councils, local NHS organisations, Healthwatch and voluntary, community, social enterprise organisations, and other key public services, to assess needs and agree strategies, focussed on improving health, care and the overall social and economic wellbeing of their populations.   The informal East Sussex Health and Care Partnership enables joint working across organisations at Place to deliver the health and wellbeing strategy, and associated plans and activities.

1.4 In light of this Cabinet also agreed the set of principles that have been developed by Sussex ICS partners as the framework for how the NHS Sussex ICB will work with and in East Sussex, as one of three ‘Places’ in the Sussex ICS.  This is in keeping with the flexibility built into the Health and Care Act for ICSs to develop arrangements suited to their local circumstances, to support close working across the NHS and Local Government, based on the principle of subsidiarity and the primacy of Place.

1.5 Central to these principles is the agreement that Place is key to strategic leadership and implementation within the Sussex ICS, as well as local commissioning and delivery for population services.  The principles are set out at Appendix 1 for reference.

1.6 This report provides an update on the progress made with establishing the new joint committee (the Sussex Health and Care Assembly) and brings the current draft joint Integrated Care Strategy for consideration.  A summary of the feedback from the People Scrutiny: Health and Social Care Integration Programme (HASCIP) Reference Group meeting on 22 November will also be provided, to inform the Leader and Lead Member for Strategic Management and Economic Development’s decisions.

2. Supporting information

Sussex Health and Care Assembly

2.1 Work has taken place by the County Council with NHS Sussex, WSCC and B&HCC to jointly establish the Sussex Health and Care Assembly as a formal partnership forum in accordance with the constitutions of each body. 

2.2 The purpose of the Assembly is to support and promote greater integration and collaboration across health and social care at a strategic, Sussex-wide level.  It will build upon the local Health and Wellbeing Strategies and co-ordinate the strategic direction for meeting the broader health, public health and social care needs of the population of Sussex to develop an Integrated Care Strategy for Sussex.

2.3 The Assembly will undertake any other activities agreed by NHS Sussex and the three Local Authorities to help address the wider determinants of health and wellbeing and greater health equality at a strategic level. This will build upon and be informed by work at ‘place’ level in Brighton & Hove, East Sussex and West Sussex, including through the local Joint Strategic Needs Assessments., Health and Wellbeing Boards and other place-based partnerships.

2.4 In addition to the four statutory members, members of the Assembly have been appointed to represent universities, voluntary and community organisations, Healthwatch, further education, housing and local enterprise across Sussex.

2.5 The full terms of reference proposed to be approved by the Leader and Lead member for Strategic Management and Economic Development (LM SMED) are included in Appendix 2.

ICS Integrated Care Strategies

2.6       The Sussex Health and Care Assembly’s role will be to formally agree the strategic direction for the 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 considering Sussex-wide matters and producing an integrated care strategy for Sussex, building on local Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies in each of the three ‘places’ in Sussex (East Sussex, West Sussex and Brighton & Hove), and identifying a small number of key priorities to focus on collectively at a Sussex level.

2.7       The Department of Health and Social Care published guidance on 29^th July 2022 on the preparation of integrated care strategies for the agreement by ICS Integrated Care Partnerships (the Sussex Health and Care Assembly) by December 2022.  Some key points include:

• It is a joint NHS ICB and Local Authority responsibility to produce the strategy. The wide variation in how ICSs are structured in England and their differing maturities is acknowledged and there is flexibility for ICSs to translate the strategy into the local context, and in how developmental or ambitious it needs to be;
• An emphasis is placed on the principle of subsidiarity and place within the strategy which aligns well with Sussex ICS arrangements;
• Future Care Quality Commission (CQC) reviews will assess how the integrated care strategy is used to inform the commissioning and provision of quality and safe services across all partners, within the integrated care system, and that this is a credible strategy for the population;

· There is a requirement to give due consideration to the NHS mandate within the strategy, and one of the detailed plans it will inform is the new ‘5-Year joint forward plan’, which is to be published before the next financial year (2023/24). This is a joint delivery plan shared by NHS Sussex ICB and NHS Trusts and Foundation Trusts within the ICS which will be produced January – March 2023.  The joint 5-year forward plan will be updated annually;

· The strategy is high level and relatively ‘steady state’, and for example could be updated when there are substantial changes in understanding population needs, for example through the JSNAs.

Draft Sussex Integrated Care Strategy

2.8       The draft Sussex Integrated Care Strategy (draft Strategy) is intended as a public-facing accessible strategic statement.  Covering the period 2022 – 2027, it sets out the emerging areas that are being focussed on for developing the five-year strategy, which aims to improve the lives of everyone living in Sussex now and in the future and will address the needs of all our communities.  Covering all ages across the whole life course it will:

• Help local people start their lives well;
• Help local people to live their lives well;
• Help local people to age well;
• Help local people get the treatment, care and support they need when they do become ill.

2.9       Following early Assembly and partner discussions, the draft Strategy sets out the rationale for supporting a key shared Sussex-wide ambition to deliver this aim.  This ambition is focussed on a new community-based approach, which will work with and within different communities to better understand local population needs and respond in the best possible way. This will enable a greater focus on keeping people healthy, supporting all aspects of people’s lives and the specific needs of children and young people. The draft Strategy also sets out how a shared focus on the following critical areas will further enable this ambition to be delivered:

• Doing more to grow and support our workforce;
• Improving the use of digital technology and information, and;
• Building on the partnership working that has developed across health and care, including the Place-based Health and Care Partnerships that report into the three Health and Wellbeing Boards.

2.10 More detail can be found in the draft Sussex Integrated Care Strategy (Appendix 3).  The draft Strategy has been shaped by the themes and insight from recent public engagement.  Further plans are in place for further testing the draft Strategy with the public and staff from across the system during November 2022, in order to meet the expected timescales of a finalised Strategy by December 2022.

2.11 In response to earlier feedback from the County Council regarding the critical importance of good mental and physical health in early years in order to increase prevention of ill health in later life, a strong focus has been included on supporting children and young people’s health and wellbeing across the way the Assembly works together.    

Addressing East Sussex population health needs

2.12 The draft Strategy is informed by the Joint Strategic Needs Assessments (JSNAs) and the shared priorities in the East Sussex HWB Strategy ‘Healthy Lives, Healthy People’ (2022 - 2027), and the supporting information and evidence that was used to refresh the HWB Strategy, including national strategies, plans and good practice guidelines.

2.13 The shared focus on the key ambitions and life course described in the draft Strategy complements and aligns with the agreed vision, ambition and strategic outcomes for the East Sussex population set out in ‘Healthy Lives, Healthy People’. This includes the shared ambition to ensure measurable outcomes - based on what local people have said is important - to deliver improved quality and experience of care and sustainable services focussed on prevention and early intervention, and improved population health and wellbeing across the key life stages so that children have a good start in life, and people are able to live well, age well and experience a good end of life.

2.14 There is alignment with the Council’s existing commitment to develop more integrated care driven by the specific needs and challenges faced by the population. This aims to strengthen the integrated community-based health and social care model for children and adults of all ages, and build on the progress made to date across a range of integrated services, such as Health and Social Care Connect and Joint Community Reablement in Adult Social Care and Integrated Health Assessments across Health Visiting and Children’s Services.

2.15 In line with this, a next step for our East Sussex Health and Care Partnership will be to design and agree the model for working together in our communities across primary care, community healthcare, social care, mental health, and the full range of voluntary and community sector and accommodation-related support, driven by a deeper shared understanding of local needs. To support broader population health improvement this will link with the wider services that impact on social and economic wellbeing including leisure, housing and the environment.

2.16 This will help further inform how partners deploy collective resources more effectively to achieve the wider local vision and ambition for integrated care, through delivering the following shared objectives locally in communities:

· Greater levels of prevention, early intervention and anticipatory care to improve health outcomes for individuals and populations, and reduce health inequalities;

· Greater levels of joined up and personalised care to improve the experience and quality of care and reduce inequalities, building on the strengths people have and the assets they have in their lives and locally, and;

· Introducing new ways to remove the barriers that prevent staff and volunteers working in different teams from working together on the ground.

2.17     To support this the partners will review and refresh the existing Place governance and programme arrangements to ensure it enables the East Sussex Health and Care Partnership to coordinate leadership and delivery of the new approach, across all partners including the County Council, NHS Sussex, East Sussex Healthcare NHS Trust, Sussex Community NHS Foundation Trust and Sussex Partnership NHS Foundation Trust, and wider system partners including Primary Care Networks, the East Sussex Voluntary, Community and Social Enterprise (VCSE) Alliance, Healthwatch and Borough and District Councils.  

2.18     In order to inform the strategy delivery plan in 2023/24, cement a clear focus on leadership and implementation at Place level and avoid duplication, it would be helpful to signal this alignment more strongly in the draft Strategy, through the addition of high level summary content that describes the work that has already been taken forward by partners in East Sussex and the planned next steps as described above.

Next steps

2.19 The draft Strategy will be presented to the East Sussex Health and Wellbeing Board for endorsement on 13 December 2022, and will be considered for approval at the Sussex Health and Care Assembly meeting on 14 December 2022.  In order to support the Health and Wellbeing Board endorsement the draft Strategy ambitions will be shared at a meeting of the East Sussex Health and Social Care System Partnership Board meeting on 22 November, to enable consideration of the alignment with the existing Place partnership plans focussed on the East Sussex population. 

2.20     Partners on the Sussex Health and Care Assembly are expected to oversee the development and impact of the final agreed Strategy. It will be the responsibility of the NHS Sussex ICB to coordinate developing the shared five-year delivery plan for 2023/24, which will need to be finalised by March 2023.

2.21     National Guidance is also awaited on the implementation of key elements of the recent White Paper on health and social care integration ‘Joining up care for people, places and populations’ (February 2022).  In the context of the new statutory ICSs, this included measures to further enable the NHS and Local Government to plan, commission and deploy resources jointly at ‘Place’, to offer co-ordinated, joined up and seamless services that support people to live healthy, independent and dignified lives, and also improve outcomes for the population as a whole. National measures to be initiated during 2023/24 include:

· A lead officer for delivery agreed by, and accountable to, both the Local Authority and the NHS ICB (in the Sussex ICS this will mean a lead officer each for East Sussex, West Sussex and Brighton & Hove);

· A new national shared outcomes framework, with space for local Place priorities, and a resourced plan to support delivery;

· A proposed model for formally pooling resources, making decisions and planning jointly, and a review of the current legal framework for s75 Agreements to support increased financial flexibility;

· A series of proposed actions for workforce and carers including joint roles, career progression and workforce planning;

· Continuation of plans for digital maturity to support seamless data flow across all care settings (including social care providers), person-centred and proactive care at place level, and reporting outcomes.  

3.         Conclusion and reasons for recommendations

3.1       The current draft Sussex Health and Care Assembly terms of reference and draft Strategy are based on the principles of population and Place first (as set out in Appendix 1), providing a helpful framework that aligns with and adds value to the existing Health and Wellbeing Board Strategy, and associated plans and activities. This recognises the Council’s lead role and contribution and that, within the Sussex ICS, Place is key to strategic leadership and implementation of transformation, as well as local commissioning and delivery for population services.

3.2       In keeping with this, the draft Strategy sets out a high level strategic statement of common purpose across Sussex, and the critical areas of focus for the Sussex Health and Care Assembly. This will support the Health and Care Partnerships to lead and coordinate work in the three Places aimed at delivering improved health, reduced health inequalities and integrated care for their populations.

3.3       There are no changes to the Council’s statutory role and responsibilities for services and budgets.  The Council will remain responsible for setting the Authority’s priorities and budgets through the Reconciling Policy Performance and Resources (RPPR) process.  The approach outlined in the draft Strategy will add value through helping partner organisations focus on the things that can only be achieved well by working together.

3.4       In order to ensure a clear focus on the role of the Health and Wellbeing Board, and the leadership and coordination of the shared Strategy ambitions at Place level in the forthcoming strategy delivery plan, it is suggested that some further summary content is included in the final Strategy.  This would briefly describe the work that has already been taken forward by partners in East Sussex on integrated community health and social care driven by our specific population needs, and signal the planned next steps.  This would enable the ICS to avoid any potential duplication of effort, so that the Council’s participation in delivering the Strategy can achieve:

• Added value in supporting the Council’s continuing commitment and ambition to deliver the best possible outcomes for local residents:- and; 
• The best use of collective public funding in East Sussex, through integrated working with the NHS.

3.5       Consequently, the Leader and Lead Member for Strategic Management and Economic Development is recommended to

• Agree the terms of reference for the Sussex Health and Care Assembly (Appendix 2 of this report), setting out the Council’s statutory role in this body;
• Agree the emerging Sussex-wide strategic priorities in the current draft joint Sussex Health and Care Strategy, as summarised in paragraphs 2.8 – 2.9 in this report; and
• Agree the feedback to strengthen the draft Strategy from the perspective of East Sussex Place and population, as summarised in paragraphs 2.14 – 2.18 in this report, and any other feedback as appropriate, prior to it being presented to the Health and Wellbeing Board and Assembly for endorsement and approval respectively in December 2022.

MARK STAINTON
Director of Adult Social Care and Health

Contact Officer: Vicky Smith, Programme Director - East Sussex Health and Social Care Transformation
Email: Vicky.smith@eastsussex.gov.uk

LOCAL MEMBERS

All Members

Appendices

Appendix 1      Agreed principles for ‘Place’ within the Sussex ICS

Appendix 2      Sussex Health and Care Assembly Terms of Reference

Appendix 3      Draft Sussex Integrated Care Strategy