Report to: East Sussex Health and Wellbeing Board
Date: 7 March 2023
By: Executive Managing Director, East Sussex, NHS Sussex and Director of Adult Social Care, East Sussex County Council
Title: Integration programme and Shared Delivery Plan development update
Purpose of Report: To
provide
an update on the key recent local developments in our health and
care integration programme arising, from our planning to support
the Sussex Integrated Care Strategy joint delivery
plan
Recommendations: East Sussex Health and Wellbeing Board (HWB) is recommended to:
1. Note the progress with planning to support our implementation of the shared ambition and priorities set out in the Sussex Integrated Care Strategy and joint East Sussex Health and Wellbeing Board Strategy;
2. Endorse the direction of travel and the recommended planning milestones for 2023/24, which will also form the basis of the East Sussex Place contribution to the Sussex Shared Delivery Plan (SDP), and;
3. Agree to explore holding a meeting of the HWB in June 2023 in order to come to a view on whether the SDP takes account of HWB Strategy priorities, and enable the requirements of the HWB and timescales set by NHS England as outlined in paragraphs 2.4 – 2.7 to be met.
1 Background
1.1 Since the December 2022 meeting of the Health and Wellbeing Board our context over the winter period has been one of extreme pressure across the country for NHS and care services. Locally our staff have been working hard to quickly use the extra national £500m Social Care Discharge Fund to best effect, helping patients be discharged from hospital and into onward care as fast as possible. The national funding has been used in the following ways:
· Increased Discharge to Assess (D2A) bed capacity across general beds
· Increased provision of specialist beds
· Supporting packages of care
· Increased D2A homecare capacity
· Provision of equipment to support discharge in Emergency Departments
· Recruitment and retention incentives for the independent care sector
· Enhancing a range of measures to support safe and effective discharge
1.2 Although issues continue to need to be managed on a day-to-day basis, this has had a positive effect on reducing the numbers of people waiting for the right support to be in place for discharge, and reducing the length of time people are in hospital.
1.3 As a Sussex Integrated Care System (ICS) we have now also started to develop the joint delivery plan for the Sussex Integrated Care Strategy, which was agreed by the Sussex Health and Care Assembly in December 2022 following endorsement by the HWB at its meeting on 13 December. The Sussex Strategy builds on our East Sussex Health and Wellbeing Strategy (2022 – 2027), and sets out our ambition for a healthier future for everyone in Sussex over the next five years. It includes the following priorities:
· Building integrated community teams and local partnerships
· Growing and supporting our Sussex health and care workforce
· Improving the use of digital technology and information
1.4 To support this a 5-year joint forward plan (known in Sussex as the Shared Delivery Plan or SDP) is being brought together in the January – June time frame. This report considers the progress with developing the plan for our shared strategic objectives for health and care integration, as set out in our East Sussex HWB Strategy and the new Sussex Integrated Care Strategy, and brings our initial Place plans for 2023/24 which will also contribute to the Sussex SDP for review.
2 Supporting information
Sussex Integrated Care Strategy and Joint Forward Plan
2.1 The Sussex Integrated Care Strategy is built on the three population Joint Strategic Needs Assessments (JSNAs) and HWB Strategies in Sussex. It is also underpinned by the principle of subsidiarity and the primacy of the three Places - East Sussex, West Sussex and Brighton and Hove - in leading and supporting delivery within our Sussex ICS.
2.2 The Sussex Strategy and the East Sussex HWB Strategy specifically align around a shared priority to support greater levels of joined up working in our communities, and a shared framework of community focussed planning and delivery that links activity in Primary Care Network (PCN) services and development with all partners working to improve outcomes in our neighbourhoods and communities. This includes the NHS (primary, acute, community and mental health), Adult Social Care, Public Health, Children’s Services, the local voluntary and community sector and wider local government services in the County, Borough and District Councils.
2.3 The next phase will be to develop a joint delivery plan. The national Guidance for developing a five year ‘Joint Forward Plan’ (JFP) was published in December and can be found here. This sets out the key requirements and areas of flexibility for Integrated Care Boards (ICBs) and their partner Trusts to bring together a first JFP before the start of the 2023/24 financial year. A brief summary of the key points from the national Guidance is included in Appendix 1.
2.4 To support this, a 5-year joint plan, known in Sussex as the Shared Delivery Plan (SDP), is being brought together in two phases. An initial draft Plan will be submitted by the Sussex NHS Integrated Care Board (ICB) to NHS England (NHSE) by 31 March which will focus on year 1 (2023/24). A full finalised Plan will then be submitted to NHSE by 30 June covering high level milestones for years 2-5 (2024/25 – 2027/28). An overview bringing together the Sussex Integrated Care Strategy and proposed Shared Delivery Plan development framework produced by NHS Sussex is contained in Appendix 2. This includes alignment with wider NHS operational priorities for urgent and emergency care, planned care, primary care and hospital discharge.
2.5 In line with this our East Sussex Health and Care Partnership shared priorities for delivery in 2023/24 have been refreshed and further developed, along with our supporting partnership and programme governance, to support effective leadership and delivery at Place (East Sussex) as we move into 2023/24.
Role of the Health and Wellbeing Board (HWB) in the SDP
2.6 The national Joint Forward Plan Guidance outlines a key statutory role in the SDP development process for HWBs to be consulted for their opinion on whether the draft SDP takes proper account of HWB Strategies. Details about the opinion of HWBs and how the SDP has responded should be included in the final draft plan that will be submitted in June.
2.7 In light of this specific role and the timescales outlined in paragraph 2.4, it is suggested that a meeting of the HWB is convened in June to enable due consideration to be given to the final draft Sussex SDP and its content, as it relates to delivering the priorities we have agreed for the population of East Sussex, prior to its submission to the NHSE at the end of June.
Integrated health, care and wellbeing in communities
2.8 In summary, the overall ambition of the Sussex Integrated Care Strategy is to support people to live healthier longer lives, particularly those who are most disadvantaged, and to develop a new way of working with our different communities that better understands local people’s needs and responds to them in the best possible way. It will have a greater focus on keeping people healthy, supporting all aspects of people’s lives and the specific needs of children and young people. This ‘joined-up community approach’ will involve three aspects:
• Involvement of local people: Local people, and carers, will be more involved in, and get more support for, their own health, wellbeing and their care, and how local services work for them;
• Joined-up working: Teams of professionals and experts will work closer together across different organisations within local communities to tailor support, care and treatment to what local people need;
• Partnership with communities: Health and care will work with communities to shape support and care around what works best for them, building on what already works well and creating new solutions where that is needed.
2.9 This ambition will be achieved through a critical focus on the following:
• Doing more to grow and support our workforce;
• Improving the use of digital technology and information;
• Maximising the benefit of partnerships. As well as the new Sussex Assembly and within the NHS, this will mean supporting more leadership at “place” i.e. strengthening how our organisations can work together formally at place across our populations in Brighton and Hove, East Sussex and West Sussex through the Place-based Health and Care Partnerships, whose role is to come together to shape and transform health and care and make most of our collective resources, building on the work currently underway.
Place leadership and delivery
2.10 A brief summary of the journey to date and planned next steps in East Sussex was included in the final Strategy, and is attached to this report at Appendix 3 for ease of reference. Early system leadership discussions have made a start with exploring what our high level delivery plans could look like to deliver increased integrated working at a community/neighbourhood level. This has covered the following elements:
· Further strengthening our focus on improving health outcomes and inequalities, and how we measure improvements both to health overall and the resulting need for services in four priority areas that our initial analysis suggests are among the leading causes of early death, ill health, and less years of life lived in good health overall in our population; Cardiovascular disease (CVD); respiratory disease; mental health (all ages) and; frailty/ageing well.
The evidence suggests that these conditions are also amenable to change through the contribution of the full range of services across the NHS and social care, voluntary and community sector enterprises (VCSE) and wider county, district and borough council services, from primary prevention and early intervention, through to clinical and complex care needs. A summary of the preliminary analysis supporting this shared strategic focus on specific health outcomes is attached in Appendix 4.
· Developing our model for the way our teams can work together in communities and neighbourhoods, and removing the barriers between our organisations to enable them to do this. Initially this will be through building on our original community services target operating model, and the existing related project and pilot activity in Hastings to test and develop our approach to ensure primary care, mental health and services that impact on the wider determinants of health are a part of the model. This will be followed by further phases of activity to roll the model out across the county.
2.11 The draft high level milestone plan to support co-designing and delivering these shared programmes in 2023/24 is set out in Appendix 5, and this will form the basis of our East Sussex Place partnership contribution to year 1 of the Sussex Strategy SDP. A next step will be to develop our expected milestones for delivery in years 2 – 5, and the further evolution of our place based partnership to support this, for review by the Health and Wellbeing Board.
2.12 We have also considered how we can further evolve the role and function of our East Sussex Health and Care Partnership to better support leadership and delivery of our objectives in 2023/24. This has focussed on how we can use our experience and embedded infrastructure to model:
· The different tiers of planning and delivery at ICS, Place and community/neighbourhood;
· Streamlining and strengthening the strategic links between our Place integration programmes and Oversight Boards, and updating our system partnership and programme governance to reflect this, including how this links to Sussex-wide programme delivery, and;
· Agreeing where our SDP Place delivery priorities should report in our partnership and programme governance.
2.13 With accountability through to the HWB, this is intended to enable a clear focus to be retained at Place on our key priority integration programmes across health improvement and reducing health inequalities, and integrated care in children and young people, mental health, and community services. This will support delivery of ICS-led improvements for NHS urgent and emergency care, planned care, primary care and hospital discharge, in line with NHS Long Term Plan and operational priorities. The finalised governance will be brought to a future meeting of the HWB.
3 Conclusion and reasons for recommendations
3.1 This report provides a brief update on progress with the key developments that will shape the form and focus of our East Sussex health and care integration programme over the next five years, including our local next steps for our Place development to support leadership and delivery of shared priorities. This is aimed at collectively delivering a strengthened integrated offer in our communities and neighbourhoods, working across the different needs in our population. It signals a new phase of local partnership development to support how we are organised to do this across key integration programmes, governance and resources.
3.2 Within all of these arrangements sovereign organisations are still accountable for their statutory responsibilities, services and budgets. Our overall commitment to working in partnership across the NHS and local government at Place level remains central to our priorities, to achieve the best use of our collective resources for our population - in line with our HWB Strategy, Sussex Integrated Care Strategy, NHS Long Term Plan and County Council Plan objectives.
3.3 The ambition for an integrated health and care offer in partnership with our local communities has long been a part of this, as it is the best way to deliver improved health, social care and wellbeing outcomes for our population. There is now support and alignment across the Sussex ICS for this with a focus on delivery, and this provides an opportunity to renew how we share leadership on this agenda through our Place level partnership. In light of this members of the HWB are recommended to:
· Note the progress with planning to support our implementation of the shared ambition and priorities set out in the Sussex Integrated Care Strategy and joint East Sussex Health and Wellbeing Board Strategy;
· Endorse the direction of travel and recommended planning milestones for 2023/24, which will also form the basis of the East Sussex Place contribution to the Sussex Shared Delivery Plan (SDP), and;
· Agree to explore holding a meeting of the HWB in June 2023 in order to come to a view on whether the SDP takes account of HWB Strategy priorities, and enable the requirements of the HWB and timescales set by NHS England as outlined in paragraphs 2.4 – 2.7 to be met.
JESSICA BRITTON
Executive Managing Director, East Sussex, NHS Sussex
MARK STAINTON
Director of Adult Social Care, East Sussex County Council
Contact Officer
Vicky Smith, Programme Director East Sussex Health and Care Transformation
Email: vicky.smith@eastsussex.gov.uk Tel: 07827 841063
Appendix 1: National Joint Forward Plan Guidance key points summary
Appendix 2: Developing our ambition for a healthier future in Sussex
Appendix 3: Summary: East Sussex integrated care in communities
Appendix 4: Summary of analysis of health improvement opportunities
Appendix 5: Draft East Sussex Place high level milestone plan for 2023/24