Report to: East Sussex Health and Wellbeing Board
Date of meeting: 28 September 2023
By: Executive Managing Director, East Sussex, NHS Sussex and
Director of Adult Social Care and Health, East Sussex County Council
Title: East Sussex Shared Delivery Plan (SDP) programme update
Purpose: To receive a progress report on the Sussex Integrated Care System (ICS) joint Shared Delivery Plan (SDP), as it relates to delivering the agreed Health and Wellbeing Board priorities for the population of East Sussex.
RECOMMENDATIONS:
East Sussex Health and Wellbeing Board (HWB) is recommended to:
1) Note the content of the progress report and the proposed footprints to support the development of Integrated Community Teams (ICT) in East Sussex, as described in paragraphs 2.9 – 2.12 of this report and set out in Appendix 4, and endorse their use to enable proof of concept activities to be progressed, and;
2) Note that proposals are being explored for a strengthened East Sussex ‘Health, Care and Wellbeing Partnership’ to reflect the broader role and involvement of Borough and District Councils, and this will be brought to a future meeting of the HWB.
1.1 At the last meeting of the HWB on 27 June 2023 the draft Sussex Integrated Care Strategy Shared Delivery Plan (SDP), was considered and endorsed by the HWB as reflecting our agreed HWB Strategy priorities. HWB comments and feedback from the perspective of the needs and shared priorities for the population of East Sussex were incorporated in the subsequent letter of support to the NHS Sussex Integrated Care Board (ICB), which was required as part of the statutory sign-off process (attached in Appendix 1 for information). In particular, it was noted that Delivery Area 4 in the SDP set out eight key milestones in 2023/24 related to our East Sussex HWB priority programmes and projects covering:
· Children and young people
· Mental health
· Community (and integrated community teams)
· Health outcomes improvement
1.2 The Sussex SDP was approved by the NHS Sussex ICB in July 2023 and the final plan has now been published: Our plan for our population - Sussex Health and Care (ics.nhs.uk). This report provides an update across the HWB elements of the joint SDP, which the East Sussex Health and Care Partnership leads on behalf of the HWB to deliver our agreed priorities for the population of East Sussex.
1.3 It includes the early progress being made with scoping new programme milestones and the detailed activity that will support delivery through joint approaches across Sussex and East Sussex, and progress with our ongoing collaborative programmes for children and young people and mental health. This includes sharing the latest developments on the Sussex Health and Care Assembly’s priority to maximise the potential of partnerships and a new joined-up community approach through the development of Integrated Community Teams, and strengthening our Place-based partnership to strategically support this across our collective resources as we move forward.
2 Supporting information
East Sussex SDP programme progress
2.1 For ease of reference, Appendix 2 contains the eight milestones specific to the East Sussex HWB in the SDP, mapped to the lead oversight board in our East Sussex Health and Care Partnership governance. Some of these eight milestones also directly support delivery in East Sussex of pan-Sussex objectives in the SDP for long term, immediate and continuous improvements, which are being managed through eleven new pan-Sussex SDP delivery boards that have been set up over the summer. This is also captured in Appendix 2 where there is a direct relationship.
2.2 The detailed milestones and projects for children and young people and mental health reflect ongoing delivery programmes refreshed and updated for 2023/24. As the working arrangements and governance across Place and Sussex continues to emerge in relation to new programmes, our original articulation of the high-level in-year activity needed to develop and deliver the milestones for integrated community teams and health outcomes improvement is now being reviewed and re-profiled. This will enable us to take into account the outputs of the joint planning processes that are starting to support the pan-Sussex delivery boards, and ensure alignment across the resources and capacity required to deliver our objectives as an Integrated Care System.
2.3 A brief summary of the highlights across all four East Sussex HWB SDP priority programmes for children and young people; mental health, community (including integrated community teams), and; health outcomes improvement is included in Appendix 3 for information.
Integrated Community Teams
2.4 To support the long-term vision set out in the Sussex Assembly Improving Lives Together Strategy, the SDP outlines the Sussex-wide ambition for “joining-up (‘integrating’) health, social care, and health-related services across local communities in a way that best meets the needs of the local population, improves quality of services and reduces inequalities”.
2.5 This will be achieved through the development of ‘Integrated Community Teams’ (ICTs), that are made up of professionals working together across different organisations with local communities, individuals, and their carers. It will involve integrated working across primary care, community, mental health, local authority partners (including social care, housing and wellbeing services), voluntary, community and social enterprise organisations and other local partners.
2.6 This is a long-term strategic objective within our five-year SDP, with year one milestones for ICTs including having a clear model informed by Joint Strategic Needs Assessments (JSNA), Health and Wellbeing Board Strategies, population data and insights from local people and communities. It is in keeping with the ‘The next steps for integrating primary care: Fuller Stocktake report’, which NHS England and NHS Improvement commissioned and published in May 2022. This sets out a snapshot of the state of play in general practice, and some recommended next steps that could be taken to better integrate the different strands within primary care and also harness the opportunities that Integrated Care Systems (ICS) bring across the wider partnership of service delivery.
2.7 The following East Sussex HWB milestones in the SDP were also shaped to support delivery of this shared objective, building on progress we have already made on integrated care:
|
What we will do (2023/24) |
What we will achieve |
When |
|
Building on the Universal Healthcare initiative and other local programmes, we will have a joined-up approach to planning and delivering health, care, and wellbeing in Hastings, with clear evidence of integrated approaches to improving outcomes for local communities. |
A planning and delivery approach agreed by Place leadership board. |
March 2024 |
|
Service models will be developed and approved for scaling up across the county and an implementation timetable with key milestones agreed. |
Service models will be approved by Place leadership board. |
March 2024 |
2.8 In keeping with the approach across Sussex, our East Sussex Health and Care Partnership has agreed that this significant change programme will be led through our existing East Sussex Community Oversight Board (COB), chaired by the Director of Adult Social Care and Health who will also be the programme Senior Responsible Owner (SRO). The COB has refreshed terms of reference and membership to reflect responsibility for delivering this significant programme of work, and the key relationship with the pan-Sussex SDP ICT Delivery Board. This includes agreeing with Borough and District Councils representation of all five Councils on the COB.
Proposed ICT footprints
2.9 As a first step, early progress has been made to establish the proposed footprints model for Integrated Community Teams (ICT) in East Sussex through initial exploration at our COB meetings in April and June. Footprints that have been used previously to organise integrated approaches to engagement and the deployment of collective resources were revisited and updated, to arrive at a consolidated ‘working’ model to use in 2023/24, that would best support an integrated offer of health, care and wellbeing in communities.
2.10 This is based around five footprints for ICTs reflecting borough and district boundaries, with our twelve PCNs currently operationally grouped within three community health and care teams, and working across our borough and district-based community networks. This model, alongside seven similar footprints in West Sussex and four in Brighton and Hove, was agreed by the pan-Sussex ICT Delivery Board in July 2023.
2.11 This provides a starting place to help us to test the different functional elements of ICTs - population health and wellbeing improvements, reducing health inequalities, and delivering integrated care for those who need it - as part of our proof of concept activity in 2023/24. The proposed ICT footprint maps for East Sussex are included in Appendix 4.
2.12 Planning work has now started to develop profiles of population health, service demand and other insight data for each ICT footprint by December 2023. Through recognising and building on existing relationships, teams and community focussed partnership activity, we can start to link together the full range of services and programmes in East Sussex that will underpin ICT development aligned to these agreed footprints.
Next steps
2.13 Our current focus is on agreeing the scope and phasing of our Place-focussed implementation of ICTs across key functions. This is taking place within the emerging Sussex-wide framework and principles for developing ICTs and the shared approach to communications and engagement that will support this. The next steps will be to finalise the first phase programme plan to make a start with key functional areas of ICTs that make sense in our East Sussex context, including:
· Revisiting our target operating model for community health and social care and aligning it with the five ICT footprints;
· Exploring joint duty and triage and identifying where an integrated approach across Adult Social Care, Community Health, Mental Health and Primary Care will add most value;
· Refreshing our approach to multi-disciplinary team working across primary care, community health and social care, mental health and housing and voluntary, community and social enterprise sector teams (VCSE) teams, and;
· Establishing a framework to support joint planning and management across ICT footprints.
2.14 Learning from current pilot projects and engagement will be actively used to inform developments, such as the Universal Healthcare proposition in Hastings as our ‘community frontrunner’, and work to use data to identify and target specific support at frail older people in Lewes. Our broader programme approaches to community networks, social isolation and loneliness and asset-based community development will also be instrumental in guiding development.
Strengthening the East Sussex Place Partnership Governance
2.15 Discussions have recently taken place with Chief Executives of our Borough and District Councils about shaping our current ‘East Sussex Health and Care Partnership’ into an ‘East Sussex Health, Care and Wellbeing Partnership’. This will be of particular importance as we move into implementing our integrated community teams model and strengthening our focus on prevention as part of improving health outcomes for our population.
2.16 Proposed action includes reviewing participation and membership of key groups within our partnership governance to strengthen the full contribution of Borough and District Council resources to health and wellbeing, through services such as economic development, planning, housing, leisure, wellbeing and environmental services for local communities.
2.17 A next step will be to share the terms of reference for the various place governance partnerships and identify where it will be helpful to ensure all five Borough and District Councils are represented, or whether this could be done collectively to support capacity. Appropriate reporting of key strategic partnership and shared priority programmes will also be explored, for example housing. Finalised proposals will be brought to the next meeting of the HWB for consideration.
3. Conclusion and reasons for recommendations
3.1 Joint work in East Sussex has continued to take place to progress delivery of our objectives across our HWB Strategy SDP priorities for children and young people, mental health, community and improving population health outcomes. Involvement in the new SDP Delivery Boards at a pan-Sussex level has also helped align the detailed planning and the resources needed to deliver improvements.
3.2 Within this, the shared Sussex ICS ambition for integrated community teams presents a significant opportunity to build on the progress we have already made with integrated care - including joint community reablement teams, Health and Social Care Connect and initial approaches to locally focussed planning and delivery across our collective resources – to embed an approach to planning and managing our resources in a way that is nuanced to the needs, strengths, assets and challenges of people and their local communities.
3.3 Joint work across Sussex and Place has started to define a shared approach to delivering this long term ambition, and developing a deeper shared understanding of local community need, driven by data and insight. This is aimed at enhancing the roles our organisations already play in local communities and neighbourhoods through a collaborative ‘team of teams’ model working within our existing resources. The proposed footprints for integrated community teams have been agreed, so that we can start to test what needs to change to support this different way of working and secure the benefits for our population. The HWB is asked to endorse these footprints.
3.4 Deeper engagement with our Borough and District Council partners throughout our Place partnership governance will further strengthen our ability to collaborate to deliver improved population health and reduced health inequalities, and an integrated offer of health, care and wellbeing in our communities, in keeping with the role of Place in our Integrated Care System. In line with this a full proposal will be brought to the next meeting of the HWB for consideration.
JESSICA BRITTON
Executive Managing Director, East Sussex, NHS Sussex
MARK STAINTON
Director of Adult Social Care and Health, 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 HWB letter of support
Appendix 2 Draft East Sussex HWB SDP milestones mapped to East Sussex Health and Care Partnership governance and Sussex SDP delivery boards
Appendix 3 Summary of East Sussex HWB SDP programme highlights
Appendix 4 Proposed ICT footprints for East Sussex