Report to: East Sussex Health and Wellbeing Board
Date of meeting: 27 June 2023
By: Executive Managing Director, East Sussex, NHS Sussex and Director of Adult Social Care and Health, East Sussex County Council
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 priorities for the population of East Sussex in the East Sussex Health and Wellbeing Board Strategy and Sussex Integrated Care Strategy.
RECOMMENDATIONS:
East Sussex Health and Wellbeing Board is recommended to:
1) Endorse 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 the collaborative arrangements in East Sussex to support delivery (in paragraphs 2.11 – 2.16 of the report) and;
2) Endorse the draft SDP as set out in Appendix 1 and agree that the Health and Wellbeing Board submits a statement of support, prior to the SDP being submitted to NHS England (NHSE) and the NHS Sussex Integrated Care Board (ICB)
1.1 The Sussex Integrated Care Strategy Improving Lives Together builds on our East Sussex Health and Wellbeing Strategy Healthy Lives, Healthy People (2022 – 2027), and sets out our ambition for a healthier future for everyone in Sussex over the next five years. Within the Strategy, the Assembly identified the following key strategic priorities:
· Maximising the potential of partnerships and a new joined-up community approach, through strengthening Place-based partnerships and the development of Integrated Community Teams
· Growing and supporting our Sussex health and care workforce
· Improving the use of digital technology and information
1.2 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.
1.3 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 Integrated Care Boards (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.
1.4 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 Integrated Care Board (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 covering the additional high-level milestones for years 2-5 (2024/25 – 2027/28), and presented to the NHS Sussex Integrated Care Board (ICB) on 5 July for approval.
1.5 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). 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.
1.6 This approach was strongly endorsed, together with the need for more local flexibility from the NHS at a local level, by the Hewitt Review. On 14 June 2023 the Government published a combined response to both the Hewitt Review recommendations (published on 4 April 2023) and the House of Commons Health and Social Care Committee’s Seventh report - Integrated care systems: autonomy and accountability as a result of their inquiry on ICSs (published on 30 March 2023) due to their overlapping themes. A fuller digest of the response will be completed, and some summary headlines are:
1.7 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. To support this, at the last meeting of the HWB on 7 March 2023, it was agreed to arrange an extra meeting of the HWB in June. 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.
1.8 In light of this specific role and the timescales outlined in paragraph 1.4, 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 brings together NHS partners with East Sussex County Council (ESCC), and Borough and District Council, Healthwatch and VCSE representation, and will be responsible for delivering the East Sussex HWB Strategy elements in the SDP, accountable to the HWB. This will enable due consideration to be given to the final draft Sussex SDP and its content, as it relates to delivering our shared priorities for the population of East Sussex, prior to submission to NHSE and NHS Sussex ICB.
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 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 SDP 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 and Hove. This aligns with Sussex wide delivery priorities in Delivery Area 1 agreed through the Sussex Strategy, in particular the development of Integrated Community Teams.
2.4 Delivery Areas 2 and 3 are 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 and other partners within these Delivery Areas, where we would be seeking to maximise the benefit of partnership working with the NHS for the heath, care and wellbeing 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 as part of specific improvement actions or as distinct pieces of work. In summary these are as follows:
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 HWB Strategy (2022 – 27). This helped inform the Sussex Improving Lives Together Strategy that was endorsed and approved by the 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 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 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 roadmap for years 2-5 (2024/25 – 2027/28) across our priorities in the 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 cover existing ongoing work and the alignment of local work to support delivery of Sussex-wide programmes, for example the hospital discharge frontrunner programme. In addition, as discussed at the HWB meeting on 7 March, some new priorities and milestones for delivery have been shaped by our East Sussex Health and Care Partnership. These are 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 pathway improvement action plans for CVD, respiratory disease, mental health and frailty/healthy ageing, 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 ‘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 learning activity in Hastings, for example the Universal Healthcare proposition. The in-year milestones will enable us to test and develop our approach to ensure primary care, mental health 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 roadmap set out in the SDP.
2.10 The high level milestones in Delivery Area 4 of the draft SDP that the East Sussex Health and Care Partnership will be responsible for leading have been further developed and shaped, together with an in-year timeline for 2023/24. A progress report across all the East Sussex delivery priorities for 2023/24 will be brought to the July meeting of the HWB.
Governance arrangements to support delivery
2.11 The proposed delivery arrangements across all four Delivery Areas are set out in the SDP, including proposals to manage eleven workstreams at a Sussex level. Each of the long-term, immediate, and continuous improvement priorities set out in Delivery Areas 1, 2 and 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 HWBs and existing Health and Care Partnerships bring together NHS partners, local authorities and the VCSE sector to further develop our integrated approaches to planning, delivering and transforming services, and to improve population health through delivery of Health and Wellbeing Strategies and associated plans.
2.14 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.
2.15 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, the East Sussex Voluntary, Community and Social Enterprise (VCSE) Alliance, Healthwatch and our Borough and District Councils.
2.16 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 2. 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 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 our 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.
· Each programme Oversight Board providing a continuing focus on facilitating the local planning, commissioning, delivery and service transformation required to deliver improved health outcomes, integrated services and care 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 and developing Sussex-wide arrangements, to ensure this meets the needs of our population and fits with local provider arrangements. OPEX and the Executive Delivery 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
2.17 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.
2.18 In addition to the extensive engagement already drawn upon in the development of the Sussex Strategy, an 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 SDP. The membership of that group includes Healthwatch in Sussex, the voluntary, community and social enterprise sector, and Community Ambassadors alongside others.
Views of the East Sussex Health and Care Partnership Board
2.19 Members of the East Sussex Health and Care Partnership Board considered the full draft SDP at their meeting on 2 June, and how well it aligns with and supports delivery of our ambitions, priorities and plans for our population of East Sussex as set out in our East Sussex HWB Strategy. Members of the Partnership Board also considered the proposed refresh of our partnership and programme governance, to ensure it will support effective collaboration at Place level to enable delivery of the SDP.
2.20 The members of the Partnership Board endorsed the content of the SDP as it relates to East Sussex. It was also felt that the Place governance refresh will enable an ongoing focus on local needs and priorities building on our existing partnership working, balanced with a Sussex-wide approach that will further support the momentum and pace necessary for delivery. The full set of draft key messages and feedback from the meeting is contained in Appendix 3.
Next steps
2.21 The SDP will be considered for endorsement by ESCC, West Sussex County Council and Brighton & Hove City Council in their capacity as joint statutory partners in the Sussex Health and Care Assembly and Integrated Care Strategy and partner members on the NHS Sussex ICB. Consideration of how well the SDP supports ESCC priorities, and commitment and ambition to deliver the best possible outcomes for residents through integrated care, will take place at the Leader and Lead Member for Strategic Management and Economic Development meeting on 20 June.
2.22 Following consideration on 27 June 2023 by the HWB, the final draft SDP will be submitted to NHS England by 30 June 2023, and the NHS Sussex ICB on the 5 July. 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.
2.23 A communications and engagement plan is being finalised across system partners to support the publication of the SDP. This will involve the development of public-accessible versions of the plan to meet the needs of different audiences.
3. Conclusion and reasons for recommendations
3.1 The Sussex Improving Lives Together Strategy sets out a strategic statement of common purpose across Sussex, and the critical areas of focus of the Sussex Health and Care Assembly. As such it provides an overarching framework that will help the Health and Care Partnerships to work together in the three Places with the flexibility to improve health, reduce health inequalities and integrate care to suit the needs of their populations.
3.2 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 Strategy and HWB Strategies.
3.3 Alignment of Senior Responsible Officers, including NHS Sussex Chief Officers, 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 it aims to present a clear improvement journey in the short, medium, and longer term.
3.4 Within this there are no changes to organisations’ statutory roles 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.
3.5 Overall, the SDP supports delivery of shared priorities, and our shared commitment and ambition to deliver the best possible outcomes for our population, as well as achieving the best use of collective public funding in East Sussex, through integrated working across the County Council and 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 and added momentum necessary to support effective collaboration at Place level, so an ongoing detailed focus on local needs and priorities can be maintained to build on our existing progress.
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
Appendices
Appendix 1 Draft Sussex Shared Delivery Plan
Appendix 2 East Sussex Health and Care Partnership and Programme Governance
Appendix 3 Draft key messages from the East Sussex Health and Care Partnership Board meeting