Report to: East Sussex Health and Wellbeing Board
Date of meeting: 5 March 2024
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 joint programme delivery, as it relates to 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 forthcoming changes to aspects of our partnership working within our Sussex Integrated Care System (ICS), and;
· The proposed review to ensure our HWB is empowered to undertake its leadership role across the broader range of stakeholders working together at Place, and;
· That further reports that will be brought to the July meeting of the HWB on delivery plans for 2024/25 and the outcomes of the review.
1.1 The NHS, County Council and Voluntary, Community and Social Enterprise (VCSE) sector and other partners in East Sussex and Sussex, agreed and endorsed the Sussex Integrated Care Strategy Improving Lives Together in December 2022, and subsequently finalised a Shared Delivery Plan (SDP) in June 2023. Information about both the Strategy and the SDP is brought together here: Our plan for our population.
1.2 The pan-Sussex Strategy and SDP set out our shared 5-year ambition for a healthier future for everyone in Sussex over the next five years. They are both built on the understanding of population health and care needs in East Sussex, as set out in our Joint Strategic Needs Assessment (JSNA), and other intelligence and evidence, and the overarching strategy for improving population health and integrated care as set out in our East Sussex Health and Wellbeing Strategy Healthy Lives, Healthy People (2022 – 2027).
1.3 The Sussex SDP covers areas for improvement over the immediate, continuous and long term, as well as shared priorities specific to each of the three Health and Wellbeing Boards and their populations in Sussex. In light of this, joint work takes place between the local NHS, County Council and other partners on a pan-Sussex and Place (East Sussex) level. This contributes to a range of service improvement objectives for the benefit of the East Sussex population.
1.4 This report brings an update on our integration programme focussed on three areas:
· Progress across our eight HWB objectives in 2023/24
· Progress with the key strategic shared priority of developing a joined-up approach in communities, known as ‘Integrated Community Teams’, which requires a joint approach at both a pan-Sussex and Place level within our Sussex ICS.
· The scoping of our proposals to strengthen the Health and Wellbeing Board’s (HWB) role and vision, including how the integrated offer of health, care and wellbeing for the population of East Sussex can best be delivered by our Place Health and Care Partnership as we move into 2024/25.
2 Supporting information
East Sussex SDP programme progress
2.1 Delivery Area 4 in the SDP Our plan for our population builds on our East Sussex Health and Wellbeing Strategy Healthy Lives, Healthy People (2022 – 2027), and sets out eight key milestones in 2023/24 related to our shared priority programmes and projects for our East Sussex population including:
· Children and young people
· Mental health
· Community, including a new joined-up community approach through the development of Integrated Community Teams (ICTs)
· Health outcomes improvement
· Pan-Sussex work on social and economic wellbeing
2.2 As indicated at the HWB meeting on 12 December 2023, a review of progress against the eight milestones for 2023/24 is being undertaken ahead of year-end, to inform our shared priorities and refresh of milestones for 2024/25 (year 2 of the 5-year SDP). A summary will be published as a separate supplement to this report, to ensure it contains the most up to date account of progress across 2023/24.
2.3 Alongside this we have also started the process of refreshing plans for 2024/25. Plans for 2024/25 will largely be a continuation of shared priorities for transformational change over the medium term, building on the activity and progress in 2023/24. Plans will be further tested and finalised in the next phase of strategic partnership and programme oversight board meetings in March and April. A set of appropriate measures to monitor progress and impacts will also be developed, aligned to the stage of programme delivery. The finalised East Sussex HWB SDP plans for 2024/25 will be brought to the HWB meeting on the 16 July 2024.
Developing Integrated Community Teams
2.4 As reported previously at HWB meetings, partners have agreed to develop Integrated Community Teams (ICTs) to support delivery of a range of strategic objectives within our HWB Strategy and the Sussex Integrated Care Strategy. This is captured as a long term improvement priority within the Sussex ICS Shared Delivery Plan (SDP), and there are links across a range of community-facing plans and activity.
2.5 In summary, the purpose of ICTs will be to strengthen the way we collectively deliver an integrated offer of health, care and wellbeing in our communities and neighbourhoods, and improve outcomes across different needs in our population. Within this there are no changes to the statutory roles and responsibilities that individual organisations have for services and budgets in our communities.
2.6 ICTs are, however, an important partnership development to enhance how delivery is managed, coordinated and supported collectively within our communities, across key priority programmes, governance and resources. This will be underpinned by deeper shared understanding of local communities, based on intelligence, insight and evidence about what works. As such, the HWB is well-placed to oversee the strategic implementation of ICTs across the full range of activity that will improve outcomes in communities in East Sussex.
2.7 The successful implementation of ICTs requires an integrated approach across multiple partners, which will require oversight and stewardship at both System and Place level within our Sussex ICS. The overarching approach to ICTs in Sussex is led through the pan-Sussex ICT Delivery Board, to ensure consistency across our Integrated Care System (ICS). The East Sussex Community Oversight Board (COB), chaired by the Director of Adult Social Care & Health and reporting into our East Sussex Health and Care Partnership and HWB, is responsible for leading implementation tailored to our East Sussex population and context, alongside the similar oversight groups for the populations in West Sussex and Brighton & Hove.
2.8 In addition to the agreement of the 16 ICT footprints in Sussex, 5 in East Sussex which are coterminous with borough and district boundaries and other progress previously shared with the HWB at the meetings on 28 September 2023, and 12 December 2023, in summary early the initial phase of ICT development has focussed on the following:
· Public health and business intelligence leads across the three Local Authorities and NHS Sussex have collaborated to develop intelligence profiles for each of the 16 ICT footprints. These have now been finalised and the profiles for the five East Sussex ICT footprints are published on our East Sussex Joint Strategic Needs Assessment (JSNA) website ICT Profiles | (eastsussexjsna.org.uk). They consist of an initial understanding of population health and service needs in each ICT footprint, and will serve as a tool to support local discussions about priorities and focus as the ICTs develop.
· Themed insight packs have also been developed covering a number of topics that will be of interest to ICTs and their populations, for example rurality and carers, based on existing local information and good practice.
· Designing a pilot community panel model to support ICTs. The pilot will aim to set up a panel to coincide with ICT development in Hastings, to enable an evaluation of this way of working.
· Agreeing the potential areas of focus for the ICT in Hastings as our community frontrunner, and aligning and nominating frontline service and team leads who will part of the first ICT development session on 21 March 2024.
· Designing the first session which will be aimed at exploring the functions of ICTs in more detail, and specifically shared objectives in the context of Hastings, for example how it could help with resilience, leadership and understanding the local challenges and strengths where the ICT approach can add value. In line with our plans, the session will build on learning from the Universal Healthcare programme, and other local projects as well as the outcomes of the initial Hastings leadership session held on 20 November 2023.
· An alignment exercise is also taking place currently to nominate frontline service and team leads for the four other East Sussex ICT footprints, to support similar ICT development sessions in Quarter 1 of 2024/25 using the Hastings session as the blueprint.
· Starting with Hastings, consideration is also being given to how the intelligence profiles will be actively used as part of the broader development of ICTs, alongside the methods and approach to support local community engagement.
2.9 In addition, a broader process of programme discovery and scoping has also been managed by the East Sussex Community Oversight Board, to ensure the following factors shape and inform our next steps for ICTs and progress builds appropriately on what is already in place:
· Legacy learning from our previous development of health and social care integration in East Sussex, in particular multi-disciplinary team working and person-centred care coordination across health and social care, for people with multiple long-term conditions and complex care needs.
· Similarly, our broader programmes and investment supporting local community networks, social prescribing, and asset-based community development focussed on deprived wards in East Sussex, are also recognised as being instrumental to ICT development. These have been reviewed by the Community Oversight Board to identify connections and opportunities to add value as part of our local ICT implementation.
· Programme resources have been identified and aligned, and general awareness raising about the concept of ICTs and the opportunities they bring has also taken place with relevant staff and partnership forums. Recently this has included the East Sussex Primary Care Providers Leadership Group, East Sussex Organisational Development Practitioners Network, Adult Social Care Operational Managers Forum and East Sussex Early Intervention Partnership Board for children and young people.
2.10 A key piece of current collaborative work is the draft pan-Sussex ICT ‘core offer’, which will be finalised by the end of March 2024. This will describe the overarching principles, functions, outcomes and model that will underpin the core offer that will be common to all ICTs in Sussex, and the way we will work together to deliver this in 2024/25.
2.11 Once the draft ICT core offer has been finalised in March 2024 by the Sussex ICT Delivery Board, an important next step will be agreement through individual organisational and Place-based governance processes respectively. In light of this, a further report will be brought to the July meeting of the HWB, to support oversight and endorsement of the core offer.
Strengthening our strategic collaboration across health, care and wellbeing
2.12 The work to develop ICTs and health and care integration more broadly is taking place in a changing policy landscape, as well as increasing levels of demand for services and financial pressures on all parts of our health and care system. In addition, there are changes being proposed to some of our Integrated Care System (ICS) working arrangements which are intended to help with the challenges faced collectively by our system. These include:
· A new operating model in 2024/25 to carry out NHS Sussex ICB core functions as a strategic commissioning organisation, in keeping with the request by NHS England (NHSE) that all ICBs in England make 30% savings from their Running Cost Allowance (management and back-office roles).
· Plans to establish a new committee in common between the NHS ICB and NHS providers to focus on increasing productivity and efficiency, and the overall sustainability of healthcare services in Sussex.
· Developing two pan-Sussex NHS provider collaboratives to better enable improvements to healthcare services, supported by the outcomes-based strategic commissioning role of the ICB.
2.14 As signalled at the meeting of the HWB in December, we have started to shape next steps aimed at strengthening our HWB’s unique role in overseeing our mutual accountability and collaboration, for the benefit of the East Sussex population within the Sussex ICS. This functions across the full range of NHS, social care, mental health, public health, voluntary sector, housing, and wider services across local government and other organisations that determine health. The review will need to take into account the existing statutory role of the HWB, and previous agreements about the role of Place in our Sussex Integrated Care System. Progress has been made in the following ways:
2.15 As acknowledged above, the new working arrangements for local NHS organisations are currently evolving, and it will be important to take them into account as the detail emerges. In addition, we will explore our current understanding of best practice for HWBs and Place partnerships, national guidance and expectations, as well as any helpful feedback arising from the forthcoming Local Government Association (LGA) Adult Social Care (ASC) Peer Challenge that is due to take place at the end of February 2024. The scope and approach will be further tested across our Place partnership and ICS leadership, so that detailed proposals can be developed for the HWB to consider at the next meeting in July, and phase in during 2024/25. Overall, this will encompass three key elements:
3. Conclusion and reasons for recommendations
3.1 Progress has been made to deliver our objectives across our HWB Strategy SDP priorities in 2023/24, for children and young people, mental health, community and improving population health outcomes. This is shaping the ongoing critical milestones for 2024/25 that will be a focus for our shared work to improve health and integrated care for the population of East Sussex.
3.2 Within this, the development of ICTs represents a key opportunity to further develop and transform to a more locally coordinated approach to planning and delivering in, and with, our local communities, based on their needs, strengths and collective assets. This will strengthen our ability to deliver an integrated offer of health, social care and wellbeing, that is integral to our longstanding commitment to improve outcomes for our population.
3.3 Progress has been made to articulate a shared understanding for all partners in Sussex about ICTs, and scope how ICTs can build on our existing progress with integrated care in East Sussex. This includes delivering the key milestones and tasks set out in the SDP that will pave the way to the next phase of implementation.
3.4 In our changing strategic context, a review is proposed of the vision and role of the HWB in helping support the strategic collaboration required at Place level to enable an ongoing focus on local needs and priorities, and get the best value out of the full range of collective resources we have available. This will be based on the understanding brought together in our population JSNA, and the role and contribution of all our stakeholders working in partnership across East Sussex.
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