Appendix 2
East Sussex Health and Wellbeing Board (HWB) Shared Delivery Plan programme highlights
September – December 2023
1) Introduction
Our East Sussex Oversight Boards for children and young people, mental health, community and population health outcomes improvement are each responsible for overseeing and delivering the East Sussex Health and Wellbeing Board Strategy priorities that are set out in our Sussex Shared Delivery Plan (SDP). A brief summary of the progress highlights across all four East Sussex HWB priority programmes is set out below.
Children and young people
In keeping with the East Sussex SDP objectives for 2023/24, the aim of the East Sussex Children and Young People Health Oversight Board (CYPHOB) is to continue to develop and implement the children and young people priority programmes and projects, and to ensure that agreed service improvements, including pathway and service redesign are effectively implemented through collaborative working between commissioners and providers of health, mental health and care services. The following progress has taken place over the autumn period:
· A focus on progress with Family Hub developments and the Perinatal Equity and Equality Plan has been considered to promote the best start for life and best outcomes for babies and young children and their families.
· The development of pan-Sussex weight management and childhood obesity plans was considered to understand and inform the service offer for children and young people.
· The development of a comprehensive health dashboard for children and young people continues to be progressed by the CYPHOB to complement work sponsored through the pan-Sussex Children’s Board. This work will consider the CORE20Plus5[1] groups previously endorsed by the CYPHOB and the pan- Sussex Children’s Board.
· Joint work is being taken forward to develop a specific health strategy for looked after children, care leavers and unaccompanied asylum-seeking children.
Mental health
In addition to the pan-Sussex SDP mental health improvement priorities and in keeping with the East Sussex HWB SDP objectives for 2023/24, the East Sussex Mental Health Oversight Board (MHOB) has agreed a set of project plans aimed at taking forward its four priorities of dementia, homelessness, improving access and data and intelligence. The MHOB has also agreed to progress high level ambitions related to the development of older people’s mental health services in East Sussex. The ambitions relate to improving available data, improving awareness and access to services, developing integrated pathways and delivering bespoke older people’s offers. The following progress has taken place over the summer period:
· Emotional Wellbeing Services (EWS) are now operational in six PCNs in East Sussex, and it is expected that EWS services will go live in the Havens PCN in the first week of January. Place-based workshops took place in September aimed at exploring increased integration between primary and secondary mental health service offers to widen access. Outcomes are being brought together locally to enable a road map to be drafted.
· The Plan has been refreshed for the Place-based approach to delivering improvements across the next 18 – 24 months for Housing and Supported Accommodation. The plan re-confirms the commitment to the local priorities for improving integration between mental health and housing services, developing a potential ‘Discharge to Assess’ style step down accommodation model subject to available finances and increasing the overall supply of supported accommodation placements in the county. An additional priority of improving quality across the offer has also been included.
· A multi-agency working group has been established to look at enhancing the local Dementia pathway with an ambition of improving focus on prevention, reducing crises and becoming less reliant on inpatient care in conjunction with a stronger community offer. Work is underway to co-produced a set of shared priorities and a plan.
Community and integrated community teams
The broader strategic programme for Integrated Community Teams (ICTs) is led through the existing Community Oversight Board (COB), which reports to the East Sussex Health and Social Care Executive Delivery Group and wider Partnership Board. After the early work to agree the ICT footprints across Sussex including the five for East Sussex based on borough and district boundaries, strategic engagement has continued to take place to raise awareness about the opportunities that ICTs bring. The COB underwent a refresh exercise to ensure its terms of reference reflected the leadership role in implementing ICTs in East Sussex. This included updating its membership across health, social care, borough and district councils and the East Sussex VCSE Alliance to reflect the full breadth of ICT functions related to the delivery of integrated care and improved population health.
The COB was relaunched in October and the focus has been on supporting the development of the five East Sussex ICT data profiles, agreeing the scope and phasing of our Place-focussed implementation of ICTs across their key expected functions and aligning resources to support delivery. This is taking place alongside co-designing the emerging Sussex-wide framework and principles for developing ICTs, and the shared approach to communications and engagement that will support this. The following progress has been made:
· The data packs bringing together our initial understanding of population health and service needs for each ICT footprint have been developed, with accompanying packs of qualitative data themed around existing community insights. These will be available to support the initial phase of ICT establishment in January – March 2024, starting with Hastings as our community ‘frontrunner’. 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 and in line with Health and Wellbeing Board expectations, including:
o Establishing a framework to support joint planning and delivery across ICT footprints driven by local data and insight
o Revisiting our target operating model for community health and social care to widen its scope and align it with our five ICT footprints
o Exploring joint duty and triage and identifying where an integrated approach across Social Care, Community Health, Mental Health, Primary Care and VCSE teams will add the most value
o Refreshing our approach to care coordination and 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
· Our extensive learning from previous integrated care developments and current pilot projects and engagement has been reviewed to inform this. This includes the Universal Healthcare proposition in Hastings, and pilot-work to use data to identify and target local community-based support at frail older people in Lewes. Our broader programme approaches to supporting local community networks, social isolation and loneliness and asset-based community development will also be instrumental to ICT development.
· A focussed senior leadership planning meeting has taken place between NHS Sussex, ESCC (Adult Social Care, Children’s Services and Public Health), Hastings Borough Council, East Sussex Healthcare NHS Trust, Hastings Primary Care Network, Hastings Voluntary Action and Hastings Community Network to agree the next steps for developing our ICT ‘blue print’ in Hastings as our community frontrunner, building on local activity and engagement there, including Universal Healthcare. This has identified some specific opportunities and challenges in the Hastings context that the local ICT could helpfully focus on to add value as part of initial development activity. The next steps will be to identify service and team leads to begin the process of setting up the ICT in January through an initial development session that will explore these further.
Health Outcomes Improvement (HOI)
A new programme to align work and activity aimed at health outcomes improvement is being established as part of progressing Shared Delivery Plan milestones in East Sussex, aligned with existing activity and team resources both locally and across Sussex. Our key focus is a small number of health conditions where there are significant opportunities to promote better health at the earliest stages and intervening early, to prevent or delay situations getting worse through improvements to care pathways that help with current levels of need. The conditions are cardiovascular disease, chronic respiratory disease, mental health and frailty/healthy ageing. These all significantly drive inequalities in life expectancy and healthy life expectancy in our population and data, evidence and good practice shows they can be impacted through modifying risk factors in our population. The following progress has been made:
· The Improving Health Outcomes in East Sussex planning workshop took place on 3rd November. It was attended by 73 people from local NHS, ESCC, District / Borough councils and VCSE teams and services. The workshop focused on service mapping and action planning for the four conditions as well as identifying common themes across all four conditions to shape integrated responses and pathways. Participants collectively considered:
o What is currently being delivered and what is working well
o What are the key challenges and collaborative opportunities
o What would make the biggest difference most quickly
· Work is now underway to review, capture and theme the outputs from each of the groups to inform a set of priority actions and next steps for each area to support pathway improvements and longer-term change. This will be completed and finalised for review by the Health Outcomes Oversight Board on 19th December.
The Oversight Board has also considered the East Sussex Healthy Weight Plan 2021-2026 reflecting on key achievements, challenges and opportunities. Actions were agreed to strengthen partners’ strategic and operational understanding to embed physical activity into policies and processes, community engagement/co-production and working with local food outlets to improve access to healthier food.
[1] The NHS Children and young people ‘Core20Plus5’ framework was published November 2022 (the Core20Plus5 for Adults was published in November 2021). The framework is an approach to support the reduction of health inequalities in children and young people at both national and system level. It defines target population cohorts and identifies:
· ‘5’ focus clinical areas requiring accelerated improvement; Asthma; Diabetes; Epilepsy; Oral Health, and; Mental Health.
· The ‘Core20’ most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD).
· ‘Plus’ ICS-chosen population groups experiencing poorer-than-average health access, experience and/or outcomes, who may not be captured within the Core 20% alone, and would benefit from a tailored healthcare approach or accelerated focus. In East Sussex these are: looked after children and care leavers; children and young people with a learning disability or autism or life limiting illness; young carers, and; asylum seekers and migrants who have been staying in cohort hotels and in our communities living with families.