Our ambition for a healthier future
We want to improve the lives of people living across Sussex now and in the future and we will be working differently with our communities to make this happen. We want people to thrive and be the best they can be; to be healthier and feel supported; and have the best possible services available to them when needed.
We know this is not happening often enough at the moment, particularly for those who are the most disadvantaged in our communities.
Not enough people are being supported to live healthier. Too many people are living in poor health. And too many people are waiting too long for treatment or care. This is despite our dedicated health and care staff working hard every day to give local people the best care they can.
In some areas, this has been the case for many years, but things have been made worse by the impact of the pandemic and the current pressures on people’s lives due to the cost-of-living crisis.
A lot of work has already taken place across health and care to make improvements and we have made some progress for our population. But this has still not gone far enough for some people and more needs to be done.
A lot of the issues we face can only be resolved with long-term change. We need to think and work differently to make a bigger difference to local people. And this needs an even greater and longer-term ambition to build on what we have done in the past.
Improving Lives Together represents that ambition.
We are building on the Health and Wellbeing Strategies we have in place across Brighton and Hove, East Sussex and West Sussex that focus on the priorities across our local populations.
In addition to this, we have agreed the areas that will make the biggest positive difference to people’s lives that can be best achieved by working across the whole of Sussex. These are:
· A new joined-up community approach to health and care.
· Growing and developing our workforce.
· Improving the use digital technology and information.
· Maximising the power of partnership working.
We now have a better opportunity to make our ambition a reality because of the different way we – the organisations responsible for planning, providing, supporting and influencing health and care - are working together.
We will be strengthening how our organisations work formally in partnership across our populations in Brighton and Hove, East Sussex and West Sussex - what we call working at “place”. This is where our organisations have already been working to better join-up care and take positive action, co-ordinated through three Health and Care Partnerships whose work is overseen by Health and Wellbeing Boards.
We cannot do this alone though and will be working with local people, our communities, and our staff to make it happen. We will all need to be committed to making the changes we want to make and help support each other to do so.
By
working together in this way we can improve lives now and in the
future.
Sussex Health and Care Assembly
1. Where we are now: Why we need to change
The majority of people in Sussex receive good quality support, care and treatment most of the time. Satisfaction rates are still high among those using services and a lot of work has taken place to improve health and care over the last few years that has brought real benefits.
This includes giving people better and quicker access to the right services when they need them. For example:
· We are creating more appointments at GP practices at more convenient times of the day.
· We have improved how people get urgent care by introducing Urgent Treatment Centres at hospital sites and expanding the 111 service.
· There has been an expansion of mental health services to include a single point of access service in West Sussex, to go along with that already in place in Brighton and Hove and East Sussex.
· More is being done to prevent people going to hospitals for care, such as the ‘virtual wards’ we are creating to support people are home, and the community diagnostic centres being rolled out to provide people with tests, scans and treatments closer to where they live.
· There has been greater focus and improvements on how people can manage long-term conditions and on supporting people’s wellbeing.
During the Covid pandemic, all health and care organisations and staff worked together, and with our communities, to rapidly do whatever was needed to keep local people as safe and well as possible. Many of these ways of working have been maintained and improved, and the partnership working and learning from the pandemic has continued. We successfully rolled out the biggest vaccination programme in history and to date have delivered more than 3.8m jabs to keep people protected thanks to the efforts of health and care staff, and our partners.
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People are telling us things need to change
Despite the good work to improve and maintain high quality health and care, local people are telling us they are not always getting what they need, when they need it.
We are constantly hearing feedback from individuals, communities and staff and we need to listen and respond to what they are saying. A lot of feedback is positive, but we also hear a lot about areas that need to improve. Every person has a different experience and story to tell, but there are common themes people keep telling us:
· People say we need to improve access to services
“Getting to see the right service can be slow, inaccessible and makes you reluctant to ask for help. You don’t want to bother emergency services which are already stretched and not the correct first point of call, so you just muddle through and feel unwell.”
· People are finding care disjointed and a confusing ‘system’
“Services can be disjointed and appointments often seem unnecessary. Some services could be made much more accessible by being community based.”
“My mother has a complex condition, both mental and physical. The biggest challenge has been dealing with all the different teams, being batted around, and no one really taking responsibility. You don’t want to have to repeat your situation with each person you come into contact with. You can feel like you’re going back to square one.”
“I am carer for my husband who has Alzheimer’s. I struggle to get help as the whole process from diagnosis is too confusing. You end up feeling you have been left to get on with it.”
· People need more involvement in their own care
“Someone's health belongs to them, not to the system. A person knows their body and mind best even if they can't diagnose what's wrong. They know what motivates and disincentivises them. A system built around the needs and preferences of an individual is more likely to see that person fully engage with it.”
· People need more focus on their individual needs
“I think the thing that gets missed is the individual person - what people actually need for them beyond a one size fits all. That’s where people fall through the gaps.”
· People need better access to information
“I know the information I need is out there but I either cannot find or access it. This is a problem that other family members have faced.”
· People need support for all aspects of their lives
“I think you should be working with local activity and social groups to help get people out in their local community to show that people can help them.”
· We need to better support our workforce
“Tackling the issues and supporting local people better can only be done if the workforce is sufficient and encouraged, not stressed to the point of leaving the service or becoming ill themselves.”
“I work in healthcare and don’t really feel I can progress beyond my current role. I’ve done the same thing for many years and would like to develop and learn new skills but I don’t know how best to do it.”
Understanding the reasons behind the need to change
More people living across Sussex now need more support, care and treatment more often and the services currently available cannot keep up. This is causing some people to get sicker, experience delays and is putting staff under more pressure. We need to understand what the reasons are behind this so we can tackle them and make improvements.
Across Brighton and Hove, East Sussex and West Sussex, there are unique strengths and challenges, which contribute to differences in the overall health of their populations. This informs the different approaches being taken in the three Health and Wellbeing Strategies and other local plans. There are also common themes across Sussex that we need to tackle and improve.
Different factors affecting health
Many factors influence a person’s health and wellbeing, most of which they are unable to control or improve themselves without support. Many different organisations are responsible for influencing these factors and they have not always worked in a joined-up way in the past. To make improvements, we need to consider all the factors and make sure all the organisations are working more closely together.
What influences a person’s health
· 40% socioeconomic factors, including education, employment, family support and income.
· 30% health behaviours, including smoking, diet and exercise and alcohol use.
· 20% health care, including access and quality of care.
· 10% physical environment, including housing and air quality.
We have a growing population, with the main reason being that more people are coming to live in Sussex. We also have an ageing population. This means more people are needing more care and support more often.
Brighton and Hove
· 291,000 people live in Brighton and Hove.
· The population is predicted to increase by 3% by 2032.
· There is a younger population with 83% are aged under 60, but the greatest population increase is expected in the 65 and over age group.
East Sussex
· 559,000 people live in East Sussex.
· The population is predicted to increase by 4.1% by 2032.
· Over half the increase in population is expected to be people aged 65 years and older.
West Sussex
· 867,000 people live in West Sussex.
· The population is predicted to increase by 5.3% by 2032.
· Over half the increase in population is expected to be people aged 65 years and older.
Living with long term conditions
Many people are living with long-term conditions that are affecting their day-to-day lives and need to be better supported to manage their condition. The common causes across all our populations are:
· Respiratory problems
· Mental health problems
· Lower backpain and joint problems
· Cardiovascular disease
Health inequalities
There are avoidable and unfair differences in health between different groups of people across Sussex that we need to reduce. There are many reasons for ‘health inequalities’, including employment, where someone lives, income, housing, education, their ethnicity and their personal situation.
People living in more deprived areas have worse health and outcomes and there are big differences in life expectancy across Sussex which matches deprivation. The greatest levels of deprivation in Sussex are along the coast and in South West Crawley.
Brighton and Hove
· The difference in life expectancy between the most and least deprived areas is 9.9 years for men and 7.7 years for women.
· The difference in the number of years a person can expect to live in good health (‘healthy life expectancy’) is xxx for men and xxxx for women.
East Sussex
· The difference in life expectancy between the most and least deprived areas is more than 11 years for men and almost 10 years for women.
· The difference in the number of years a person can expect to live in good health (‘healthy life expectancy’) is xxx for men and xxxx for women
West Sussex
· The difference in life expectancy between the most and least deprived areas is xxxx years for men and xxxx years for women.
· The difference in the number of years a person can expect to live in good health (‘healthy life expectancy’) is xxx for men and xxxx for women
The impact of Covid and cost-of-living
The Covid pandemic, and the lockdowns we lived through, impacted on people’s health and wellbeing in different ways. As a result, we have seen:
o More children needing support for mental health issues.
o Increasing alcohol consumption, smoking and obesity among adults.
o Physical and mental wellbeing of older people getting worse.
o Waiting times for procedures and treatment growing.
o Sicker patients coming into hospital.
o Inequalities made worse for some people, including ethnic minority communities.
o More health and care staff leaving the profession.
The current cost of living crisis is also having an impact on people’s wellbeing and more are likely to need support and care as a result in future.
Why services cannot keep up with the need
There are a number of reasons services are not always able to keep up with the growing need. These include:
· How services are arranged and organised: Services are currently run by different parts of the NHS, local authorities and other organisations and many people need support and care from more than one service at a time. Services do not always work seamlessly, which means they can sometimes feel disjointed, slow, and people have to repeat their stories many times.
· Emphasis on prevention: The majority of health and care services are focused on treating and supporting people when they become ill. This is often necessary but there is more that could be done to focus on helping to prevent people becoming ill in the first place.
· Digital technology: We have been developing new ways of using digital technology over the last few years to improve health and care services. But we are still not using it in the best possible way and not tapping into all the benefits it could bring.
· Limited money and facilities available: There is a limited amount of public funding available for health and care and this has an impact on investment in services. There is not enough money available to do everything we ideally would want to do, so we have to get the best value out of the funding we have. We are still using ageing buildings in some areas, which can make it difficult to provide high quality care and we need to think differently around how we can best use the buildings and land we have.
Our workforce challenge
When we talk about workforce, we are describing those that keep people safe and who deliver care and support, either through paid employment or volunteering. Working in health and care is incredibly rewarding and those that do want to give the best possible care, in the best possible way. They are currently not always able to do this because of the growing pressure on services and the way some services are run. There are three main issues we need to tackle:
· Retaining our staff: The increasing pressure, and the lasting impact of their efforts during the pandemic, has resulted in some staff being stressed, overworked and tired, which is resulting in more going off sick and leaving health and care professions.
· Recruitment: We are currently not able to recruit enough health and care professionals to cover vacancies in our services and it takes time to train and develop future staff. Housing is also very expensive in some parts of Sussex, which can mean some staff are not able to afford to live locally and makes it more difficult to recruit and keep a local workforce.
· Development: We are not doing enough to support staff to develop new skills which can be used in the best possible way across different teams and services.
Other areas we need to improve
Alongside our commitment to give greater support to our most disadvantaged people and communities, we have agreed three other areas that need particular focus:
Children and young people
Our early years have a big impact on the rest of our lives. More children and young people are needing help and care, and the issues they have are more complicated and severe than they were, but services are not always able to meet this growing need. We have to give more focus on our children, young people and families, to better support them in all aspects of their lives. This includes the environment they grow up, their education, and the support around them. We need to give particular focus to children in and leaving care, those who need support to keep them safe, and young people as they become adults.
Unpaid carers
Unpaid carers play an important role and on average have poorer health than people who are not carers. Over 10% of adults across Sussex say they provide unpaid care to a relative or friend. Many carers do not get the support they need and we need to do more to help them maintain their own health and that of those they are caring for.
People who feel lonely and live in social isolation
The feeling of being alone and a lack of social connections can have major impacts on someone’s health and wellbeing. This is an issue for people of all ages, but particularly for our older population, and we can make a big positive difference by giving them more support.
2. Where we want to get to: Our ambition for a healthier future
We are taking collective action to respond to what local people are telling us and to tackle and improve the issues.
Our ambition is to improve the lives of people living across Sussex by supporting them to live healthier for longer and making sure they get the best possible care and treatment when needed.
To make this a reality, we have four goals we want to achieve:
· Improve health and health outcomes for local people and communities, especially those who are most disadvantaged.
· Tackling the health inequalities we have.
· Working better and smarter, and getting the most value out of funding we have.
· Doing more to support our communities to develop socially and economically.
We will do this by organisations working closer together and differently with and within our communities to support people through each stage of their lives. We want to:
· Help local people start their lives well by:
o Improving mother and baby health and wellbeing, especially for those most in need.
o Creating healthy environments for children, young people and families to grow up in.
o Supporting parents and carers.
o Linking health and care up in a better way with education and schools.
o Supporting good mental health for all children and young people.
o Doing more to support the most vulnerable children and young people, including those in and leaving care, and those who need to be kept safe.
· Help local people to live their lives well by:
o Supporting people to look after their own health and wellbeing.
o Supporting people to live, work and play in places that promote health and wellbeing.
o Supporting people to know how they can look after themselves better when they have a health issue.
o Supporting people who have physical disabilities, learning disabilities and mental health conditions, to have good health and joined-up care and support, including access to opportunities such as accommodation, housing and employment.
o Ensuring more access to services for people who have traditionally been under-served, for example homeless people and other groups
· Help local people to age well by:
o Ensuring fewer older people feel lonely or isolated.
o Helping older people to stay healthy and live independently for longer.
o Reducing the number of older people who suffer falls.
o Helping people receive good quality care at the end of their lives and to die at a place of their choosing.
· Help local people get the treatment, care and support they need when they do become ill by:
o Tailoring care to support people in their own homes, or as close to home as possible.
o Supporting the health and wellbeing of informal carers.
o Giving them access to the most appropriate and best experts and professionals as early as possible that best suits their needs.
o Managing risk factors for long-term conditions.
o Giving greater joined-up care and support for people with long-term conditions and a number of health issues.
o Making sure people only need to use health and care services when they really need to.
· Help our staff to do the best job they can in the best possible working environment by:
o Providing more support to them and creating a more diverse, inclusive and healthier working environment.
o Encouraging and supporting more people to go into health and care professions, particularly young people and students.
o Developing our staff to give them the skills they need to work more flexibly and progress their career.
3. What we will do to get there: Making our ambition a reality
We are not starting from scratch as we look to achieve our ambition. We have our Health and Wellbeing Board Strategies and other pieces of work underway that are making improvements all the time to try to meet the immediate needs of local people.
We will now be building on this with bolder long-term action and change that aims to make a greater positive difference to local people.
This involves developing ‘Joined-up Community working’ that will better meet the specific needs of local residents.
To support this, there are three ‘success factors’ that we need to develop and improve:
· Growing and supporting our workforce
· Improving the use of digital technology and information
· Maximising the power of partnerships
So how will this work and what difference will it make?
Joined-up Community working
In future, health and care organisations will work in a more joined-up way with and within communities to better understand and respond to their specific needs. Support and services will be shaped around local people, rather than expect them to fit into the ‘system’. When we say communities, we mean both the local area people live in and also communities that we know people identify with, such as those with the same interest, beliefs, or way of life.
What will be different?
This will involve a very different way of working to how health and care organisations have often worked with communities in the past. There will be three big differences:
· Greater joined-up working: Joined-up Community Teams of professionals and experts will work together across different organisations and within local communities to tailor support, care and treatment to what local people need. This will involve linking up all the services and organisations that influence a person’s health, care and wellbeing - including primary care (GP services, pharmacy, dental and eye health services), social prescribing, community, mental health and social care services, hospitals, the full range of support provided by local voluntary and community organisations, and wider services such as public health, schools and lifelong learning institutions, leisure, housing, environment and support for business. When someone needs more specialist care and treatment, they will be better supported to get it as quickly as possible.
· Different relationship with communities: We want to change the relationship between health and care organisations, the staff providing services and those who are receiving care and treatment. We will work with, rather than ‘doing to’, people and communities to better understand their needs and circumstances, maximise the use of what already works well for them, and find solutions together to issues they face. This will involve greater engagement with local people, community leaders and those with lived experience.
· Greater involvement of individuals: Local people will be more involved in, and get more support for, their own health, wellbeing and care. People will be given more support to have the confidence to keep themselves healthy and, if they do become ill, help them manage better themselves so they can carry on living a fulfilled life. There will also be more involvement of, and support for, carers so they can stay healthy themselves and can better support the person they are caring for.
We know every community is different so there will not be a one-size fits all approach, and we will start by specifically focusing on communities who experience the poorest health and have the biggest needs.
As well as changes to how services work, this new way of working will have three differences in how we approach health and care:
· Greater focus on all aspects of a person’s life: We will be focusing more on all the factors that influence a person’s health. This will include doing more to support and contribute to local communities, such as supporting local businesses and employment, working in a more joined-up way with housing and education, the community and voluntary sector, and supporting and working with community groups and local initiatives that encourage healthy living.
· Greater focus on supporting you to stay healthy: We want to shift more of our effort, resource and expertise into helping people stay healthy and supporting them to continue to live a fulfilled life if they do have a health issue. This includes more of what we call ‘proactive care’ which focuses on prevention and not just cure. We will make sure more people get urgent, emergency and specialist care as early as possible when they need it to avoid their condition getting worse.
· Greater focus on our children and young people: We will focus more on supporting children, young people and families with every aspect of their lives to help them stay healthy and get the support, care, and access to services they need when they need it. This includes more support during the early years, working closer together with schools and further education, and providing more career opportunities.
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Our success factors
We have three success factors – workforce, digital technology and information, and partnership working - that need to be improved and developed. Without these, there will not be enough staff and the right expertise to give local people what they need, and services and organisations will not work in the best way.
Growing and supporting our workforce
We want to support our staff and volunteers to do the best job they can by growing and developing our workforce. The number of people working in health and care has grown and we need to carry on increasing staff numbers but recruiting more is not the only answer. We need to also get the best out of the staff we already have.
There are five objectives we want to achieve:
· Working as ‘one team’: We want to create a ‘one team’ approach across health and care, as well as the voluntary sector, other professionals and volunteers, so they can work together and across different areas to help local people get the support and care they need.
· A more multi-skilled workforce: We will support staff to develop new skills and expand the skills they have. This will allow them to work across different disciplines and areas and help staff to have more opportunities to progress in their careers.
· Creating an inclusive environment: We want to create a more inclusive working environment that recognises diversity and has a workforce that better represents the population they care for.
· More recruitment and career opportunities: We will encourage, and make it easier for, more young people, students, and people who have never considered a career in health and care, to work with us. We will do this by working more closely with local further education, colleges and our universities. We want to employ more local people and we will give greater opportunities for those living in the most disadvantaged areas.
· Learning culture: We want to create a culture where people feel valued and supported to develop their skills and expertise. We want to take a ‘lifelong learning’ approach where people never stop developing their skills throughout their career.
Improving the use of digital technology and information
We will build on the work that has already taken place to improve the use of digital technology. This will help staff make better decisions, work more efficiently and provide better care. It will also help local people access services more easily, to tell their story once and have more involvement and control over their own health and care.
There are five objectives we want to achieve:
· Connecting services: We want to connect information better across our different services to help them work in a more joined-up way.
· Improving technology and sharing data: We want to support organisations to improve the way they use technology and how they share data to improve the support, care and treatment they provide.
· Supporting staff: We want to help staff access the information they need, wherever they are and whenever they need it.
· Giving local people information: We want to support local people better to access and manage their own health and care information, care preferences and choice, and the way they wish to interact with those providing services.
· Supporting people to use technology: We want to do more to help people use and know how to use digital technology that will best suit them and their needs. This will help those who do not have regular access to technology or are unsure how to use it.
Maximising the power of partnerships
In addition to working at a local level across our communities, organisations responsible for influencing health and care will be working more closely together and with other organisations for the benefit of local people.
There are three objectives we want to achieve:
· More leadership at “place”: We will strengthen how our organisations can work together formally across our populations in Brighton and Hove, East Sussex and West Sussex, focussing on the distinct needs and challenges in our local areas. We call this working at “place” and it is where the local NHS, local government and a wide range of local partners come together to shape and transform health and care, and make the most of the collective resources available. We will do this by working in our three Health and Care Partnerships to increase ways for our staff and volunteers to work together to deliver joined-up care and improve health in our local communities. More information can be found in the Appendices about how each place has made a start with this, and what we plan to do next.
· Working across Sussex: Our new Health and Care Assembly will strengthen how key organisations can work together formally on the complex and challenging issues that are shared across Sussex. This is a new way of working and will mean more organisations will be able to contribute to improving health and care.
· Greater joining-up of the local NHS: The local NHS will be doing more to join-up services in future. The NHS across Sussex is made up of 1,100 different organisations and we will be supporting them to work in a more effective and seamless way to improve the care and experience of local people.
Our ambition in summary
How this will benefit local people and staff
Achieving our ambition will bring real benefits to the lives of local people. Examples of what this will look like in future are set out below and are based on the situations of real people living across Sussex.
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4. How we will get there: Achieving our ambition
Achieving our ambition will need change, with how health and care organisations, services and teams work, and how communities interact with services and are involved in their own health, care and wellbeing.
We want to achieve our ambition over the next five years and we will not be able to do everything at once, with some things taking longer than others to get up and running. We need to be focused on what we can do and when. We will also need to do it in a realistic way, using the funding, staff and facilities we have available. This is alongside all the work that we continue to do every day to improve and maintain the immediate and short-term support, care and treatment local people need.
This will be a big challenge but we need to be ambitious and bold because just doing what we have always done, or what we are doing now, is not going to make the difference we want and need. This will need a collective effort and everyone will need to play their part.
How we will achieve our ambition is something we will be discussing across organisations, staff, and our communities over the coming months. We will be developing a plan that clearly sets out what actions need to be taken and will be agreeing across organisations how they will need to work differently in the future. We will engage with local people and staff to discuss what will be different for them and how they can play a role in supporting the change.
We will also be setting out how we will measure progress and success to make sure we know whether or not our ambition has become a reality.
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