Evolution of our Sussex Health & Care Assembly

… to enable and accelerate Improving Lives Together

Introduction

1. The Sussex Health & Care Assembly is the statutory joint committee of Brighton & Hove City Council, East Sussex County Council, West Sussex County Council and the NHS Sussex Integrated Care Board set up to meet the Health & Care Act 2022 requirement for each health and care system to establish an Integrated Care Partnership.

2. The Assembly has met a total of 5 times since September 2022 and achieved the ambition of approving an integrated care strategy, called Improving Lives Together, in December 2022.

3. A commitment was made by the Chair of the Assembly to review the effectiveness and governance arrangements of the Assembly at the end of the first year, which led to the Assembly Members holding a workshop session to discuss this on 11 October 2023.

4. This proposed approach has been developed by NHS Sussex and the three councils drawing on the feedback from the workshop session and their knowledge of other partnerships locally. It covers how the role, membership and arrangements for the Assembly could evolve from 1 April 2024.

5. The statutory partners agreed the principles of this evolution before consulting the other Assembly Members in their respective sectors (ie NHS Sussex, Healthwatch, Universities VCSE and Specialist Members) during January 2024. A virtual meeting of the Assembly was then held on 25 January 2024, where this proposal was presented and supported by all members present. The statutory partners will now take the proposals through their own governance procedures aiming for implementation as soon after 1 April 2024 as possible.

Workshop Feedback

6. There was considerable support for retaining a wide range of members from different sectors involved in the Assembly to reinforce that our system involves more than the NHS and social care partners. It was also recognised that the Assembly has strengthened partnership working across our system and had a fundamental role in approving Improving Lives Together.

7. There was an acknowledgement that the Assembly could be perceived as an NHS committee rather than a system committee, or an even broader public sector committee, because it is currently chaired by the NHS Sussex Chair, has a large number of NHS members and most agenda items are led by NHS leaders (albeit with the support of other Assembly members).

8. There was strong support for selecting a key theme at each Assembly meeting as part of a forward plan to drive and enable the implementation of Improving Lives Together. Assembly members and subject matter experts could then be invited to present on that theme and other Assembly members could then highlight the value their sector could add to that theme.

9. There was also strong support for the Assembly to demonstrate how it is listening to patient and resident voices, especially those that are seldom heard, and to consider what impact any new initiatives will have on patient or resident lives and population health.

10. There was an ambition to ensure that the Assembly has a clear ongoing role which is greater than the sum of its component parts and does not duplicate the responsibilities of its statutory partners or other governance arrangements. It was suggested that the Assembly could have a role in assessing the effectiveness of our partnership working in Sussex.

11. There was a strong consensus that an Independent Chair should be appointed to chair the Assembly, provided that they are well supported and resourced to do the job effectively.

12. It was questioned if the Assembly really needs three members from every sector and it was suggested that there would be a benefit in adding a Director of Public Health, Director of Adult Social Services and a Director of Children’s Services to the membership of the Assembly, together with senior representatives from the Police, Fire & Rescue Service and South Downs National Park.

13. There was also a suggestion that the three local authority Health & Wellbeing Boards could adopt a more consistent approach to complement the work of the Assembly.

Further Reflections

In considering the feedback from the Assembly Meeting, the four statutory partners have also considered:

14. The importance of the Assembly and the three place-based Health and Wellbeing Boards being considered together as the partnership system across Sussex and the importance of their roles complementing each other and avoiding duplication.

15. That the Health and Wellbeing Boards do operate differently, reflecting the different characteristics and ways of working of their places. It is also noted that they operate under the same legislative framework.

16. The suggestions on local government membership have been considered and are reflected in the proposal below, but given the statutory presence of the Directors of Adult Social Services, Director of Children’s Services and Directors of Public Health on the Health and Wellbeing Boards, it is not felt necessary to include them as permanent members of the Assembly. It should also be noted that Council officers and elected Members do not sit as equal members on bodies reflecting the democratic legitimacy of Councillors. Officers can attend in a professional advisory role to the Assembly and/or their Health and Wellbeing Board Chairs as needed.

17. The existence of very active partnerships in each of the three places and the need to ensure NHS participation in those is appropriate. The remits include:

· strategic co-ordination (including East Sussex Strategic Partnership and City Management Board)

· economic development, skills and workforce (eg Team East Sussex, Brighton and Hove Economic Partnership and an emerging Growth partnership in West Sussex replacing the Coast to Capital LEP)

· at Sussex level includes the Local Skills Improvement Partnership and emerging Local Visitor Economy Partnership.

18. A comparative analysis was also considered on the membership of the integrated care partnerships in the other five integrated care systems with 3 upper tier and/or combined local authorities in England:

ICP MEMBERSHIP *ICP Chair or Co-Chair	CURRENT SUSSEX ASSEMBLY	BRISTOL N SOMERSET & S GLOS ICP	CAMBS & PETER- BOROUGH ICP	DEVON ICP	LEICESTER, LEICS & RUTLAND ICP	MID & SOUTH ESSEX ICP
Independent Chair	-	-	-	-	-	-
HWB Chairs	3	3*	1*	3*	3*	3
Other Councillors	-	-	4	-	-	-
ICB Chair	1*	1	1*	1*	1*	1*
ICB CEO	1	1	1	1	1	1
ICB Other	6	-	3	3	2	6
NHS Providers	-	3	5	2	2	5
General Practice	1	-	2	1	-	1
Care Providers	-	1	-	-	-	1
Local Authority CEO/DASS/DPH/DCS	-	3	4	3	7	9
Place Leaders	-	4	-	5	-	8
Healthwatch	3	-	-	1	2	3
VCSE	3	13	1	3	-	1
Housing	1	-	-	1	-	-
Education	4	-	-	-	-	3
Commerce	1	-	-	-	-	-
Sport & Leisure	-	-	-	-	-	-
Police	-	-	2	-	-	1
Fire & Rescue	-	-	-	-	-	-
Lower Tier LAs	-	-	2	-	-	7
Health Innovation	-	-	1	-	-	-
NHSE Locality Director	-	-	-	-	-	1
TOTAL	24	29	27	24	18	51

Proposal

19. The purpose of the Assembly in its existing Terms of Reference is confirmed as:

‘To support and promote greater integration and collaboration across health and social care at a strategic, Sussex-wide level. It will build upon the local Health and Wellbeing Strategies and co-ordinate the strategic direction for meeting the broader health, public health and social care needs of the population of Sussex to settle an Integrated Care Strategy for Sussex. It will undertake any other activities agreed by NHS Sussex and the three Local Authorities to help address the wider determinants of health and wellbeing and greater health equality at a strategic level. Its work will build upon and be informed by work at place level in Brighton & Hove, East Sussex and West Sussex, including through the local Joint Strategic Needs Assessments.’

20. An Independent Chair and secretariat will be appointed by the four statutory partners (ie Brighton & Hove City Council, East Sussex County Council, West Sussex County Council and NHS Sussex). The Chair should be a resident in or have a close association with Sussex and must not be currently employed by or have any affiliation with any of the members of the Assembly to demonstrate their neutrality and transparency. A competitive process will be used to, recruit and select, with unanimous support, an Independent Chair. The Independent Chair will be employed by one of the four statutory partners in just this specific role. Any disciplinary and dismissal processes in respect of the Independent Chair will be undertaken in line with the employing partner’s policies and procedures but can be triggered by any one of the Assembly Members from the four statutory partners.

21. Organisation and administration for the Assembly will be overseen by the Independent Chair but is a shared responsibility between the four statutory partners, who also need to agree the funding and timing. Support will be provided by one of the four statutory partners on a full cost recovery basis and managed through a Service Level Agreement. NHS Sussex will continue to publish the agendas, papers and recordings of Assembly meetings on the Sussex Health & Care website.

22. The four statutory partners will make equal contributions towards the cost of the Assembly.

23. Each statutory partner will also provide a venue and refreshments free of charge for one of the Assembly Meetings each year in rotation.

24. The Independent Chair will be responsible for agreeing the Assembly dates and venues with the four statutory partners for the year in advance. The Independent Chair will then need to agree the agendas, papers and presentations with the four statutory partners at least two months before each Assembly meeting. All the papers will be circulated to members at least one week, and ideally 10 days, in advance of the meeting and draft minutes / actions circulated to members no more than one week after the meeting, through their own secretariat. The Assembly meetings will be recorded professionally so that a video of each meeting can be published on the Sussex Health & Care website within 24 hours of the meeting being held.

25. The Assembly membership will be reduced from 24 to 18 Members as follows:

Sector

Proposed Assembly Membership

Comment

Independent Chair

New Chair

Statutory Partners

Chair of Brighton & Hove Health & Wellbeing Board

Chair of East Sussex Health & Wellbeing Board

Chair of West Sussex Health & Wellbeing Board

Chair of NHS Sussex Integrated Care Board

Existing Member

Education

Further Education

Higher Education

Existing Member

Reduce from 3 to 1 Members

Employment

Sussex Chamber of Commerce

Existing Member

Built Environment

Housing

Existing Member

Physical Activity

Sport and Leisure Provider

New Member

Healthcare

Chief Delivery Officer of NHS Sussex

General Practitioner Member

Existing Member

VCSE

Brighton & Hove

East Sussex

West Sussex

Existing Member

Voice of the Public

Healthwatch Brighton & Hove

Healthwatch East Sussex

Healthwatch West Sussex

Existing Member

26. This means that the new invitees would be an Independent Chair and a Leisure Provider, whilst the following existing members of the Assembly will be asked to stand down as Members of the Assembly after the next formal meeting:

· Chief Executive Officer, Chief Medical Officer, Chief Nursing Officer and 3 x Executive Managing Directors of NHS Sussex

· 2 x University Members (although the 3 University Vice-Chancellors will rotate their one membership place so that one of them is present at all meetings).

27. Each statutory partner will retain the option to invite an executive officer to support or advise them during each Assembly Meeting. As an example, the Chair of NHS Sussex will invite the Chief Executive Officer of NHS Sussex to attend the Assembly, but their role will be to support the Chair of NHS Sussex and not represent, make decisions or be held to account on behalf of NHS Sussex or the Sussex Health & Care System during any of the Assembly discussions.

28. The four statutory partners recognise that the Police and Fire & Rescue services have a vital role to play in system working and are not currently represented on every Health & Wellbeing Board in Sussex or the Assembly. The preferred approach is for the Police and Fire & Rescue services to become members of each Health & Wellbeing Board in Sussex, but if that is not possible, then consideration will be given to inviting appropriate representatives of these services to join the Assembly.

29. Subject matter experts, research specialists, people with lived experience of each stage of the life course and representatives from seldom-heard communities can also be invited to attend and participate in specific agenda items at Assembly Meetings, with the agreement of the Independent Chair and the four statutory partners.

30. The number of Assembly Meetings held in Public will remain at three times per year and the frequency will be kept under review to ensure that the Assembly meets often enough to achieve its purpose.

31. The Terms of Reference of the Sussex Health & Care Assembly will be updated and endorsed through the governance processes of each statutory partner before being presented to the next Assembly Meeting held in Public on 10 April 2024.

Alignment of Related Activities

32. The Chair of NHS Sussex will take one of the NHS Member roles on each of the three Health & Wellbeing Boards across Sussex to strengthen the alignment of the priorities between NHS Sussex, the Sussex Health & Care Assembly and the three Health & Wellbeing Boards across Sussex. Due to the nature of the NHS Sussex Chair’s role and potential conflict of interest, the postholder cannot hold a Health & Wellbeing Board office, such as Chair or Vice-Chair.

33. The Chief Executive Officer of NHS Sussex will attend or ensure appropriate senior NHS Sussex attendance at each of the Health Overview & Scrutiny Committees (HOSC) in East Sussex and Brighton & Hove, and the Health & Adult Social Care Scrutiny Committee (HASC) in West Sussex.

34. The three Directors of Public Health will collaborate to strengthen the alignment of Joint Strategic Needs Assessments in each local authority across Sussex whilst recognising each are required to be Place focussed and reflect the needs of their specific local populations.

35. The three Health & Wellbeing Board Chairs will collaborate to strengthen the alignment of Health & Wellbeing Strategies and Plans in each local authority across Sussex whilst recognising each are required to be Place focussed and reflect the needs of their specific local populations.

Cllr Glazier, Cllr Lanzer, Cllr De Oliveira and Stephen Lightfoot, 26 January 2024