Report to: Leader and Lead Member for Strategic Management and Economic Development
Date of meeting: 20 June 2023
By: Director of Adult Social Care and Health
Title: Draft Sussex Integrated Care Strategy Shared Delivery Plan (SDP)
Purpose: To enable consideration of the draft joint Sussex Integrated Care System (ICS) Shared Delivery Plan (SDP) as it relates to delivering the agreed ESCC and NHS priorities for the population of East Sussex in the Sussex Integrated Care Strategy.
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 East Sussex milestone plans that will enable delivery of East Sussex population and Place priorities, as set out in Delivery Area 4 of the SDP and Appendix 2 of this report; and
2) Provide any further feedback to strengthen the draft SDP and the collaborative arrangements in East Sussex to support delivery (in paragraphs 2.11 – 2.15) prior to it being presented to the Health and Wellbeing Board on 27 June and NHS Sussex Integrated Care Board (ICB) on 5 July for endorsement and approval respectively.
1.1 The County Council is a statutory joint partner in the Sussex Health and Care Assembly alongside NHS Sussex ICB, West Sussex County Council and Brighton & Hove City Council. The Council is also represented as a partner on the Sussex NHS ICB which is responsible for planning and commissioning healthcare services for the population of Sussex.
1.2 Within this report there are no changes to the Council’s statutory role and responsibilities for services and budgets. The Council remains responsible for setting the Authority’s priorities and budgets through the Reconciling Policy Performance and Resources (RPPR) process. The approach outlined in the Strategy and Shared Delivery Plan will add value through helping partner organisations focus on the things that can only be achieved well by working together.
1.3 This report provides an update on the progress made with producing the Integrated Care Strategy SDP, and the role of the East Sussex Health and Care Partnership which will be responsible for delivering the East Sussex HWB Strategy elements in the SDP. A summary of the feedback from the People Scrutiny Committee: Health and Social Care Integration Programme (HASCIP) Reference Group meeting on 1 June 2023 will also be provided, to inform the Leader and Lead Member for Strategic Management and Economic Development’s decisions.
1.4 A core principle for this joint work is that the primary building blocks are the three “Places” (East Sussex, West Sussex and Brighton and Hove). East Sussex is where the County Council’s statutory responsibilities, budgets and democratic accountability sit for the residents in our area. At the inception of the Sussex ICS there was local agreement that “Place” is key to strategic leadership, local commissioning and delivery within the ICS, in order to get the best value out of the full range of collective resources available to meet needs and improve the health, care and wellbeing of populations. This approach has been strongly endorsed, together with the need for more local flexibility from NHS at a local level) by the Hewitt Review.
1.5 The Sussex Integrated Care Strategy Improving Lives Together was approved by the Sussex Health and Care Assembly on 14 December 2022 following agreement by the East Sussex County Council (ESCC) Leader and Lead Member for Strategic Management and Economic Development (LM SMED) on 29 November 2022, and endorsement by the East Sussex Health and Wellbeing Board (HWB) at its meeting on 13 December 2022. The Strategy builds on our East Sussex Health and Wellbeing Strategy Health Lives, Healthy People (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:
· A new joined-up community approach, through the development of Integrated Community Teams
· Growing and supporting our Sussex health and care workforce
· Improving the use of digital technology and information
1.6 The approach 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, as well as living well and ageing well as adults and having a good end of life.
1.7 To support the subsequent delivery planning process, the national guidance for developing a five year ‘Joint Forward Plan’ (JFP) was published by NHS England (NHSE) in December 2022, setting out the key requirements and areas of flexibility for NHS ICBs, their partner Trusts and system partners to bring together a first draft JFP before the start of the 2023/24 financial year. NHSE also published the NHS Operational Planning Guidance for 2023/24 at the same time covering NHS operational priorities including primary care, urgent and emergency care, planned care and hospital discharge, to ensure links could be made between the two planning processes by ICBs.
1.8 To meet the national timescales, a 5-year joint plan, known in Sussex as the Shared Delivery Plan (SDP), has been brought together in two phases. A first draft Plan was endorsed by the Sussex NHS ICB on 29 March 2023 for further development, which covered initial milestones for year 1 (2023/24). A full finalised Plan will be submitted to NHSE by 30 June 2023 covering the additional high-level milestones for years 2-5 (2024/25 – 2027/28).
1.9 The national Joint Forward Plan Guidance also 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 SDP that will be submitted in June. In light of this specific role and the timescales outlined in paragraph 1.4, a special meeting of the HWB is taking place on 27 June 2023. This will enable due consideration to be given to the final draft Sussex SDP and its content, as it relates to delivering our shared Council and NHS priorities for the population of East Sussex.
2 Supporting information
Sussex Shared Delivery Plan (SDP)
2.1 A core programme team within NHS Sussex has managed and coordinated the process of drawing the broader SDP together. At ICS level the Senior Responsible Officer for this work is the NHS Sussex Chief Transformation, Innovation and Digital Officer (CTIDO). The SDP has been written as a single plan that incorporates the NHS Operating Plan requirements for 2023/24 and the delivery plan for the five-year Sussex Improving Lives Together Strategy.
2.2 The full draft Sussex Shared Delivery Plan is attached at Appendix 1. It brings together into one place the strategic, operational and partnership work that will take place across our system to improve health and care in Sussex over both the short and long term. It also reflects and responds to national policy and guidance. In summary it set out actions across four main delivery areas:
2.3 Across all delivery areas the SDP aims to set out a comprehensive response to the Sussex Integrated Care Strategy based on the needs of the population of Sussex, which is built on the three local Joint Strategic Needs Assessments (JSNAs) and HWB Strategies. Delivery Area 4 contains the primary shared delivery milestones that are unique to East Sussex, based on the shared understanding of the needs and priorities for our population, alongside those for West Sussex and Brighton & Hove. This aligns with Sussex wide delivery priorities in Delivery Area 1 agreed through the Sussex Improving Lives Together Strategy, in particular the development of Integrated Community Teams.
2.4 Delivery Areas 2 and 3 are broadly focussed on areas that are operational priorities for immediate and continuous improvement for the NHS. There will also be key interfaces with ESCC Adult Social Care, Public Health and Children’s Services within these Delivery Areas, where we would be seeking to maximise the benefit of partnership working with the NHS for the heath and care of our population in line with our wider HWB Strategy priorities.
2.5 To support the delivery of the ambition and the four delivery areas, there are other areas that will require continued focus, either within the actions of specific improvement priorities or as distinct pieces of work. These are summarised in the strategy under the following headings:
East Sussex shared delivery priorities
2.6 Our shared strategic priorities and objectives for health and care integration are set out in our East Sussex Health and Wellbeing Board (HWB) Strategy (2022 – 27). This helped inform the new Sussex Integrated Care Strategy Improving Lives Together that was endorsed and approved agreed by the East Sussex HWB and Sussex Health and Care Assembly respectively in December 2022.
2.7 The direction of travel for year 1 (2023/24) East Sussex delivery priorities and milestones was endorsed by the East Sussex HWB on 7 March 2023 as the basis of the East Sussex Place contribution to the initial draft Sussex Shared Delivery Plan (SDP). This was submitted by the ICB to NHS England (NHSE) at the end of March for their early review, and the milestones were subsequently further developed.
2.8 Milestone planning for years 2 – 5 has subsequently taken place to finalise the East Sussex contribution to the full SDP. This included further updates to our year 1 milestones and the high-level milestones for years 2-5 (2024/25 – 2027/28) across our priorities in the East Sussex HWB Strategy in the following areas:
· Population health and reducing health inequalities;
· Children and young people;
· Mental health, and;
· Community
2.9 The draft East Sussex delivery priorities and high-level milestones in Delivery Area 4 covers existing ongoing work and alignment of local work to support delivery of Sussex-wide programmes, for example the hospital discharge frontrunner programme. In addition, some new priorities for delivery that have been shaped by our East Sussex Health and Care Partnership designed to increase the pace of our partnership activity in the following areas:
· Accelerating health outcomes improvement, specifically focussed on Cardiovascular Disease (CVD), Respiratory Disease, mental health (all ages) and frailty/healthy ageing. This will be achieved in 2023/24 through co-designing and delivering whole system and pathway improvement action plans, in line with the high-level timeline and milestones set out in the SDP.
· Our model for delivering integrated health, care and wellbeing in communities and progressing the integrated community team model ‘proof of concept’ exercise in Hastings. Initially this will be through building on our original integrated community health and care services target operating model (TOM) and existing related project and pilot activity in Hastings, for example the Universal Healthcare Proposition. The milestones will enable us to test and develop our approach to ensure primary care, mental health, housing and other services that impact on the wider determinants of health are a part of the model. Planning for further phases of activity will then take place to roll the model out across the county, in line with the high-level timeline and milestones set out in the SDP.
2.10 Both of these developments encompass the full range of wider services in the County, Borough and District Councils and Voluntary, Community and Social Enterprise (VCSE) sector that impact on health and wellbeing, as well as their role in providing care and support to individuals alongside clinical care. The full set of high-level milestones for years 1 – 5 that the East Sussex Health and Care Partnership will be responsible for leading are set out in Appendix 2, to provide further detail and current progress with the developing delivery arrangements for the two new programmes of work.
Governance arrangements to support delivery
2.11 The proposed delivery arrangements are set out in the SDP, including proposals to manage eleven workstreams at a Sussex level across Delivery Areas 1, 2 and 3. Each of the Long-term Improvement Priorities (Delivery Area 1), Immediate Improvement Priorities (Delivery Area 2) and Continuous Improvement Areas (Delivery Area 3) will be led by a Delivery Board, chaired by a system Chief Executive Officer, and they will have a workstream that will be resourced from across system partners. The work of these Boards and workstreams will be overseen by a System Oversight Board Chaired by the Chief Executive Officer of NHS Sussex. The Boards will address the needs of the whole population of Sussex. To ensure that there is a clear focus on the needs of children and young people, the ICS Children and Young People Board will contribute to and advise the work of each of the Delivery Boards to ensure that those needs are well addressed.
2.12 At Place level within the ICS, the three Health and Wellbeing Boards and existing Health and Care Partnerships bring together NHS partners, local authorities including Borough and District Councils, and the Voluntary, Community and Social Enterprise (VCSE) sector to further develop our integrated approaches to planning, delivering and transforming services, and improving population health, through delivery of Health and Wellbeing Board Strategies and associated plans.
2.13 The Health and Wellbeing Strategies and Place-based Partnership priorities specific to each Place (Delivery Area 4) will be delivered through agreed programmes of work, overseen and managed at Place level through the three Health and Care Partnerships. Shared governance and senior responsible officer arrangements drawn from our organisations are in place to monitor delivery, with mutual accountability to Health and Wellbeing Boards for delivering joint Local Authority and NHS plans. These Place arrangements will also support coordination and alignment of local implementation across all four Delivery Areas in the Shared Delivery Plan, where this is needed.
2.14 In line with this the East Sussex Health and Care Partnership will coordinate leadership of Delivery Area 4 across all partners in East Sussex, including the County Council, NHS Sussex, East Sussex Healthcare NHS Trust, Sussex Community NHS Foundation Trust and Sussex Partnership NHS Foundation Trust, and our wider system partners including Primary Care Networks, Borough and District Councils, the East Sussex VCSE Alliance, and Healthwatch.
2.15 To support this we have reviewed and refreshed our existing Place-based East Sussex Health and Care Partnership and programme governance structure to ensure it is fit for purpose and can best enable the collective leadership required at Place level to deliver our Shared Delivery Plan milestones. The refreshed streamlined governance structure and detail is contained in Appendix 3. In summary this includes:
· A shared focus on collective strategy and impacts for our population through the East Sussex Health and Care Partnership Board and accountability to the HWB.
· A clear focus on leading implementation and delivery at Place level within our ICS through the East Sussex Health and Social Care Executive Delivery Group. This includes ensuring robust connections with the new Sussex-wide Delivery Boards where appropriate.
· Proposals to bring together the existing Planned Care Oversight Board and Population Health, Prevention and Health Inequalities Steering Group into a single new Health Outcomes Improvement Oversight Board, with responsibility for the new programme of work to deliver service and pathway improvements across CVD, respiratory, mental health and frailty/healthy ageing.
· Ensuring each programme Oversight Board provides the opportunity to facilitate the local planning, commissioning, delivery and service transformation required to deliver improved health outcomes, integrated services for children and young people and mental health, and integrated community teams for health, care and wellbeing. This includes ensuring strong connections and alignment with Sussex-wide Delivery Boards and programmes where appropriate.
· Ensuring a local implementation focus on Sussex-wide programmes for urgent and emergency care through the existing Local A&E and Urgent Care Delivery Board and developing Sussex-wide arrangements, to ensure this meets the needs of our population and fits with local provider arrangements. The Executive Delivery Group and operational executive (OPEX) group will enable appropriate alignment of Sussex-wide delivery on the ground.
· Instigating a new ‘Population Health and Care Intelligence Steering Group’ to enable our Oversight Boards, programmes and systems locally to be guided by the right intelligence, insight and evidence about our population, and learning about what works.
Patient and public engagement
2.16 National guidance made clear that in the development of the SDP, existing patient, public and workforce insight and feedback should be drawn upon to inform development of the plan. As part of the development of the Sussex Improving Lives Together Strategy the engagement approach successfully delivered direct feedback from 18,000 people, face to face and virtual workshops with 420 people, 500 interviews and direct feedback through partners, 1440 survey responses on our ambition priorities, 800 individual conversations in public engagement events and online communication that reached more than 200,000 people.
2.17 In addition to the extensive engagement already drawn upon in the development of the Integrated Care Strategy, an ICS Engagement Planning Oversight Group has been established to ensure that insight from people and communities is appropriately and satisfactorily represented in the plan. The Group will also ensure that there is an ongoing commitment to, and arrangements for, engagement with people and communities across the broader SDP. The membership of that group includes Healthwatch in Sussex, the voluntary, community and social enterprise sector, and Community Ambassadors alongside others.
Next steps
2.18 The draft SDP will be presented to the East Sussex Health and Wellbeing Board on 27 June 2023 to enable consideration and endorsement of the SDP based on its alignment with our existing Place plans. Prior to this it was presented to the People Scrutiny Committee: Health and Social Care Integration Programme (HASCIP) Reference Group on 1 June 2023, and the East Sussex Health and Social Care Partnership Board meeting on 2 June 2023.
2.19 Following internal NHS endorsement and passage through the governance processes of Local Authorities, and HWB consideration, the final draft SDP will be submitted to NHS England by 30 June 2023 and the NHS Sussex ICB on the 5 July 2023. The SDP will then be formally launched to coincide with the NHS 75th Anniversary celebrations and communications campaign. The new Sussex-wide Delivery Board arrangements will also be established in the same timeframe.
2.20 A communications and engagement plan is being finalised across system partners to support the publication of the SDP. This will involve the development of accessible versions of the plan to meet the needs of different audiences.
Conclusion and reasons for recommendations
3.1 The draft Sussex Integrated Care Strategy sets out a strategic statement of common purpose across Sussex, and the critical areas of focus of the Sussex Health and Care Assembly. Good progress has been made with developing the Sussex Shared Delivery Plan with proactive engagement and support from system partners, to set out the arrangements for making this a reality over the next five-year timeframe. Part of this has involved managing the complexity of developing a cohesive single plan at a Sussex level, with significant progress made in developing a clear way forward which incorporates the NHS Operational Planning requirements and the delivery response to the Sussex Integrated Care Strategy, Improving Lives Together.
3.2 Alignment of Senior Responsible Officers, including both NHS Sussex Chief Officers and system Chief Executive Officers, Directors of Adult Social Care and Health, Public Health and Children’s Services, has ensured collective commitment to the delivery framework. In totality the SDP aims to present a clear improvement journey in the short, medium, and longer term.
3.3 Place is where the County Council’s statutory responsibilities, budgets and democratic accountability sits for the residents in our area. At the inception of the Sussex ICS there was local agreement that Place is key to strategic leadership, local commissioning and delivery within the ICS, in order to get the best value out of the full range of collective resources available to meet needs and improve the health, care and wellbeing of populations.
3.4 The SDP supports delivery of relevant Council priorities, and the Council’s commitment and ambition to deliver the best possible outcomes for local residents, as well as achieving the best use of collective public funding in East Sussex, through integrated working with the NHS. It provides an overarching delivery framework that will help the Health and Care Partnerships to work together in East Sussex, West Sussex and Brighton & Hove, with the flexibility necessary to support effective collaboration at Place level, so an ongoing detailed focus on local needs and priorities can be maintained building on existing progress.
3.5 As indicated above, there are no changes to the Council’s statutory role and responsibilities for services and budgets. The SDP contains high level milestones and a roadmap covering the next 5 years. Were any detailed plans to be developed where the proposed changes to services would have significant impact on the East Sussex population, these would be subject to the normal process of engagement and formal consultation, including assessments of equality and health inequalities impacts and scrutiny by the Health Oversight and Scrutiny Committee, as appropriate and necessary to support accountability and decision-making by the relevant organisations.
MARK STAINTON
Director of Adult Social Care and Health
Contact
Officer: Vicky Smith, Programme Director East Sussex Health and
Care Transformation
Email: Vicky.smith@eastsussex.gov.uk
LOCAL MEMBERS
All Members
Appendices
Appendix 1 Draft Sussex Shared Delivery Plan
Appendix 2 Draft East Sussex SDP priorities and milestones detail
Appendix 3 East Sussex Health and Care Partnership and Programme Governance