Report to:

East Sussex Health and Wellbeing Board

 

Date of meeting:

 

13 December 2022

By:

Executive Managing Director, East Sussex, NHS Sussex and Director of Adult Social Care

 

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 shared priorities to be taken forward on a partnership basis through the statutory Sussex Health and Care Assembly.

 

RECOMMENDATIONS

The Board is recommended to endorse the draft joint Sussex Integrated Care Strategy, specifically the elements that relate to East Sussex and its alignment with priorities set out in the East Sussex Health and Wellbeing Strategy ‘Healthy Lives, Healthy People 2022 – 2027’.

 

1.            Background

1.1          At the last meeting of the Health and Wellbeing Board (HWB), alongside information about our local health and social care integration activity, the HWB received an update about the new statutory committee set up by NHS Sussex, East Sussex County Council (ESCC), West Sussex County Council (WSCC) and Brighton & Hove City Council (BHCC) – known as the Sussex Health and Care Assembly - and plans to develop the Sussex Integrated Care Strategy by December 2022. In summary this covered:

1.2          In light of this it is important that the HWB considers the draft Sussex Integrated Care Strategy, and is able to endorse it as aligning with and supporting delivery of the shared integration priorities identified to support the needs of the population of East Sussex. These are set out in our refreshed East Sussex HWB Strategy ‘Healthy Lives, Healthy People’ (2022 – 2027), which was agreed by the HWB in July 2022.  

1.3          This report brings the draft Sussex Integrated Care Strategy (draft Strategy) for consideration. It replaces the programme update that we would normally bring to the HWB, as this work will further shape the context for our existing integration work, and specifically how the Health and Wellbeing Board and the Sussex Health and Care Assembly can work together in the future to improve health, reduce health inequalities and integrate care for our population.

1.4          Once the draft Strategy has been approved by the Assembly the delivery planning stage will start, which will inform the next phase of our planning for 2023/24 to progress the shared priorities within East Sussex. A further report will be brought to the March meeting of the HWB on locally focussed implementation and delivery.

 

2.           Supporting information

Health and Wellbeing Boards and Place

2.1          Previous reports to the HWB have set out our new context for partnership working across the NHS, Local Government and wider partners to support improved health and integrated care for local populations. This includes the two new statutory bodies that make up the Sussex Integrated Care System (ICS): the new Sussex NHS Integrated Care Board (ICB) and the wider Sussex Health and Care Assembly ‘integrated care partnership’.

 

2.2       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 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.  

 

2.3          The importance of ‘Place’, defined by upper tier authority and HWB boundaries, 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. This is in keeping with national Guidance and the flexibility built into the Health and Care Act for ICSs to develop arrangements suited to their local circumstances, that can support close working across the NHS and Local Government based on the principle of subsidiarity and the primacy of Place.

 

2.4          To support this a set of principles were agreed 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. Central to these principles is the agreement that Place is key to strategic leadership and implementation within the Sussex ICS, as well as the local commissioning and delivery of population services. Our existing informal East Sussex Health and Care Partnership enables joint working across organisations at Place to deliver the Health and Wellbeing Board Strategy, and associated plans and activities.

 

2.5          A summary of the new statutory arrangements and the supporting principles underpinning how we will work together is provided in Appendix 1, for reference.

 

Draft Sussex Integrated Care Strategy

2.6       The report to the HWB in September set out the new statutory responsibility for NHS Integrated Care Boards (NHS Sussex) and the upper tier Local Authorities in their area to work together to produce an integrated care strategy by December 2022. This included supporting co-production of the Strategy involving organisations across the Sussex Integrated care System (ICS), and engagement with our citizens and workforce to inform the strategy.

 

2.7       The draft Sussex Integrated Care Strategy (draft Strategy) is intended as a public-facing and accessible strategic statement of common purpose. 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.

 

2.8       Following 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.

 

2.9          The summary of the shared ambition is set out in Appendix 2, and the full draft Sussex Integrated Care Strategy is included in Appendix 3. The draft Strategy has been shaped by the themes and insight gained from public engagement exercises over the last two years. The strategy summary has also been shared widely during November with the opportunity for the public and staff from across the system to provide feedback, in order to meet the expected timescales of a finalised Strategy by December 2022. This has included an online survey and engagement sessions with the Chair of the Assembly, and engagement on a face-to-face basis in towns and cities is continuing across Sussex. Analysis of the findings and themes will also be used to support the delivery plan.

 

2.10       Additional plans are being taken forward to scope a deliberative engagement exercise with frontline staff, which will continue in the coming months to support the delivery planning process. An assessment of potential equalities and health inequalities impacts is also being undertaken of the draft Strategy and is due to be available in December.

 

Addressing East Sussex population health needs

2.11       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.

 

2.12       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.

 

2.13       There is alignment with the HWB Board’s existing shared priority to develop more integrated care delivery in communities driven by the specific needs and challenges faced by the population, and enhance this to take in the wider range of services and support that impacts on health, care and wellbeing in our communities.

 

Local feedback

2.14       In response to early feedback from the County Council and our System Partnership Board 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.

 

2.15       An earlier draft of the Strategy and the ambitions were shared at a meeting of the East Sussex Health and Care System Partnership Board on 22 November, to enable consideration of the alignment with the existing Place partnership plans focussed on the East Sussex population. In summary the Board members welcomed the broad reach of the Strategy, and emphasised the importance of avoiding too narrow a focus on direct health and care services to better enable action on prevention and the wider determinants of health and wellbeing.

 

2.16       ESCC gave consideration to an earlier draft of the Strategy at the meeting of the Leader and Lead Member for Strategic Management and Economic Development on 29 November. While supportive of the overall ambition and strong alignment with the HWB Strategy and local priorities, feedback was provided to strengthen the draft to enable Council agreement as a statutory partner at the Sussex Health and Care Assembly on 14 December. This has resulted in the current draft which has been strengthened in the following ways:

 

·         The addition of a summary setting out how each Place has made a start with integrated care models and improving health in their communities and their plans to take this forward, in light of the key factors driving needs for services;

·         A clear reflection of population, place and the ongoing role of HWBs and the three place-based health and care partnerships in leading implementation and delivery of the ambition;

·         Acknowledgement of the strengths of our system and partnership work to date, and what this has been achieving for our population and communities, alongside the need to keep making progress with our shared priorities;

·         Clarity about organisational sovereignty and accountability within our context of partnership work as a health and care system.

 

Place implementation

2.17       The summary in the draft Strategy about East Sussex describes the strong progress that has been made through putting in place a range of integrated community-based health and social care services for children and adults of all ages, 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.

 

2.18       It sets out how our East Sussex Health and Care Partnership intends to build on this by co-designing and agreeing a 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 and recently jointly agreed development of community and family networks and hubs.

 

2.19       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.

 

Next steps

2.20     The draft Strategy will be considered for approval at the Sussex Health and Care Assembly meeting on 14 December 2022. Partners on the Sussex Health and Care Assembly are expected to oversee the development and impact of the final agreed Strategy, through the development of a shared five-year delivery plan to be updated annually, which will need to be finalised by March 2023 for 2023/24.

2.21     As part of this partners in East Sussex will review and refresh the existing Place governance and programme arrangements to ensure they enable 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.

2.22     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). As previously reported to the HWB, 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

3.1       The draft Strategy is based on the principles of population and Place first (as set out in Appendix 1) and provides a helpful framework that aligns with and adds value to our existing Health and Wellbeing Board Strategy, and associated plans and activities. This recognises the HWB’s role and contribution and that, within the Sussex ICS, Place is key to strategic leadership and coordination of plans for integration and the way organisations work together to deliver them in the three Places through local transformation, commissioning and delivery of population services.

 

3.2       In keeping with this, the draft Strategy sets out a helpful 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       The summary in the Appendix to the Strategy helps locate the key drivers of population health and care needs in East Sussex within the Strategy, the work we have been taking forward to address this and planned next steps which will help inform the strategy delivery plan in 2023/24. This cements a clear focus on leadership and implementation at Place level and avoids duplication. It also supports the principle of subsidiarity within our ICS and adds value through bringing a shared emphasis on a small number of key ambitions at a Sussex level.

 

3.4       There are no changes to each organisations’ statutory role and responsibilities for services and budgets. The approach outlined in the draft Strategy will further help partner organisations focus on the things that can only be achieved well by working together, and the stated outcomes in our East Sussex Health and Wellbeing Board Strategy to:

 

·         Improve Population Health and Wellbeing;

·         Improve the quality and experience of care, and;

·         Transform services for sustainability.

3.5       Consequently, members of the HWB are recommended to endorse the draft joint Sussex Integrated Care Strategy, specifically the elements that relate to East Sussex and its alignment with priorities set out in the East Sussex Health and Wellbeing Strategy ‘Healthy Lives, Healthy People 2022 – 2027’.

 

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 Summary of new statutory arrangements and the supporting principles underpinning how we will work together

Appendix 2 Developing our shared ambition – Strategy summary

Appendix 3 Draft Sussex Integrated Care strategy