Report to:                  East Sussex Health and Wellbeing Board

Date:                           16 July 2024

By:                              Director of Adult Social Care and Health, East Sussex County Council

Title:                           Proposals for strengthening our East Sussex Health and Wellbeing Board

Purpose of Report:   To enable consideration of the vision, focus and role of the East Sussex Health and Wellbeing Board (HWB)

Recommendations:

East Sussex Health and Wellbeing Board is recommended to:

1.    Agree the suggested future vision, role and focus of the HWB, as outlined in paragraphs 2.11 – 2.14 of the report, and;

2.    Agree the proposed new way of working, set out in paragraphs 2.15 – 2.17 and Appendix 3 of the report, to strengthen the HWB’s statutory role as the key strategic stewardship group for the health and care system in East Sussex

 


1       Background

1.1       The joint 5-year Sussex Integrated Care Strategy ‘Improving Lives Together’ was approved by the Sussex Health and Care Assembly in December 2022. The Strategy builds on the East Sussex Health and Wellbeing Strategy ‘Healthy lives, healthy people’ (2022 – 2027)’, and our compelling understanding of population health needs and assets and strong history of partnership working in East Sussex. It sets out our shared ambition for a healthier future for everyone in Sussex over the next five years, and three overarching strategic priorities of developing a new joined-up community approach through the development of Integrated Community Teams; growing and supporting our Sussex health and care workforce; and improving the use of digital technology.

 

1.2       In line with the NHS England Joint Forward Plan guidance, the supporting 5-year Sussex Shared Delivery Plan (SDP) was developed and agreed by all system partners in July 2023, and covers areas for immediate, continuous and long term improvement, as well as shared priorities specific to each of the three Health and Wellbeing Boards and their populations in Sussex. The year 2 refresh of the SDP is covered separately on the meeting agenda.

 

1.3       Both the Sussex Strategy and the SDP build on our understanding of population health needs in East Sussex set out in our population Joint Strategic Needs Assessments (JSNA) and other evidence such as the annual State of the County report. Joint work takes place between the County Council, the NHS and partners at a pan-Sussex and Place (East Sussex) level which contributes to a range of service improvement objectives for the benefit of the East Sussex population.  Our specific Place priorities are delivered through transformation programmes overseen by the East Sussex Health and Care Partnership covering, children and young people, mental health, community (including integrated community teams implementation), housing and improving health outcomes.

 

1.4       A core principle for this joint work is that the primary building blocks in Sussex are the three ‘Places’ (East Sussex, West Sussex and Brighton and Hove). East Sussex is clear that ‘Place’ is key to strategic leadership, local commissioning and delivery in order to achieve the best health, care and wellbeing outcome for our population.

1.5          Informed by feedback from recent County Council Peer and LGA reviews, atthe meeting of the HWB on 5 March 2024 it was agreed to develop proposals for strengthening the vision, focus and role of the HWB, to ensure that this can best support strategic leadership and mutual accountability for delivering our agreed shared priorities for the population of East Sussex, in the context of the wider Sussex Integrated Care System (ICS). Proposals will be informed by national guidance and good practice, and take into account recent developments in the System architecture at a Sussex-scale designed to better enable improvements to healthcare delivery for the population.

 

1.6          This report brings for consideration suggestions for strengthening the way our Health and Wellbeing Board operates to serve as the key stewardship group for strategic leadership and oversight of our health, care and wellbeing system at Place, and suggested priority areas of focus.

 

1.7          This will support County Council priorities to keep vulnerable people safe, help people help themselves and make the best use of resources. It will also contribute to a key East Sussex Health and Care Partnership Plan deliverable in the joint Shared Delivery Plan (SDP) for year 2 refresh as follows:

 

“We will strengthen the focus and role of the Health and Wellbeing Board and the East Sussex Health and Care Partnership by strategically aligning partnerships and working to support our shared priorities for delivering a joined-up offer for health, care and wellbeing, including prevention, across NHS, local government and VCSE sector services for our population.

We will develop proposals for the Health and Wellbeing Board (HWB) to phase in during 2024/25, focussed on the Joint Strategic Needs Assessments (JSNAs) and needs and assets in East Sussex”.

2       Supporting information

Integrated care systems and the role of ‘Place’

2.1         The following White Papers, reports, guidance and good practice outline expectations in relation to HWBs and the role of Place and Place-based partnerships in Integrated Care Systems in England:

 

·         Developing Place-based Partnerships: the foundation of effective integrated care systems (The King's Fund, April 2021).

·         Health and Care Act 2022, Health and wellbeing boards – guidance (Department of Health and Social Care (DHSC), November 2022)

·         Thriving Places: Guidance on the development of place-based partnerships as part of statutory integrated care systems (NHS England, September 2021)

·         White Paper, Health and social care integration: joining up care for people, places and populations  (DHSC, February 2022)

·         Next steps for integrating primary care: Fuller stocktake report (NHS England, May 2022)

·         Working in partnership with people and communities: statutory guidance (NHS England, July 2022, updated May 2023)

·         Shared outcomes toolkit for integrated care systems (DHSC, October 2023)  

·         Integrated care systems (NHS England)

 

2.2          A light-touch review[1] of the themes suggests some core design principles for the critical role of Place within Integrated Care Systems:

·         Shared outcomes based on the holistic needs of local people and communities

·         Joint vision for population health, prevention and health inequalities

·         NHS, Local Government and wider partners should agree the ICS responsibilities and functions to be carried out at place level.

·         Leadership reflective of local responsibilities and functions

·         Mutual accountability

·         Development of Integrated Neighbourhood/Community Teams

·         Appropriate resource, capability and delegated decision making to support subsidiarity

·         Digital levelling up across care settings and population health data capability

·         Enablers - workforce development, estates, integrated data and population health analytics, contractual, commissioning and funding frameworks for new care models. 

2.3       There is flexibility in how arrangements can be adopted and supported by each of the 42 ICSs in England and their constituent Places, as this is dependent on geography, population size, and local government structures as well as existing relationships and shared priorities. At the inception of our Sussex Integrated Care System (ICS), it was agreed that ‘Place’ is key to strategic leadership, commissioning and delivery to enable a clear focus on population needs. Sussex is made up of three Places – Brighton & Hove, East Sussex and West Sussex. The purpose of the NHS and Local Authorities coming together to jointly facilitate wider partnership work at Place within the ICS is two-fold:

·         To drive health and care improvement through joint commissioning of services

·         To develop and oversee the implementation of Integrated Community Teams

 

System and Place in the Sussex Integrated Care System (ICS)

2.4          The NHS Sussex ICB has recently led work to strengthen integrated working between NHS organisations. This is taking place on a pan-Sussex scale and involves developments in the System architecture aimed at improving delivery of healthcare services. Changes include:

 

 

2.5          The ongoing role of the Place-based health and care partnerships in Sussex is being considered alongside these changes. East Sussex has a longstanding and relatively mature Health and Care Partnership which is responsible for delivering shared HWB ‘Place’ priorities captured in the SDP, reporting into the HWB. The refreshed high-level list of proposed Year 2 deliverables is included in Appendix 1 of this report for ease of reference. More detail about the deliverables, the broader SDP and the supporting East Sussex Health and Care Partnership governance arrangements can be found in the separate report about this on the agenda.

Statutory role of HWBs

2.6       The Health and Social Care Act 2012 introduced HWBs, which became operational on 1 April 2013 in all 152 local authorities in England with social care and public health responsibilities. The purpose of HWBs is threefold:

·         provide a strong focus on establishing a sense of place

·         instil a mechanism for joint working and improving the wellbeing of their local population

·         set strategic direction to improve health and wellbeing

2.7          Since 2013 other legislation and statutory guidance has built on this, including for example the need to involve HWBs in receiving specific annual reports about safeguarding children and adults, and learning from the lives and deaths of people with a learning disability and autistic people.

2.8          The Health and Care Act 2022 did not change the statutory duties of HWBs as set out by the 2012 Act, but established new NHS bodies known as Integrated Care Boards (ICBs) and required the creation of Integrated Care Partnerships (ICPs) in each local system area. This empowers local health and care leaders to join up planning and provision of services, both within the NHS and with local authorities, and help deliver more person-centred and preventative care.

2.9          New Health and Wellbeing Boards guidance published as a result of the Health and Care Act 2022 underlined the roles and duties of HWBs and clarified their purpose within the new system architecture. A summary of the statutory role and functions of HWBs and how this relates to the new statutory arrangements for the ICS is included in Appendix 2 of this report.

2.10       In summary HWBs are critical to ensuring there is a ‘joining up’ of ICB work to improve healthcare for populations and the work of the Place-based Health and Care Partnership, which is rooted in Place and populations across all the services that impact on health, care and wellbeing.

Proposed future role of the East Sussex Health and Wellbeing Board

2.11       In light of the new elements of NHS System architecture on a Sussex scale (described in paragraphs 2.4 – 2.5 above), there is an opportunity to further strengthen the role of our HWB as the key strategic stewardship group for partnership working across the wider range of system partners that contribute to the health, care and wellbeing of our population. This would both complement and augment the collaborative working at a pan-Sussex level, ensuring it is tailored to local populations and Place across the collective resources available to meet needs and challenges.

 

2.12       The vision for our HWB is set out in our HWB Strategy Healthy Lives, Healthy People 2022 – 2027. The HWB is responsible for ensuring the organisations that make up the health, care and wellbeing system in East Sussex work in an integrated way together, to deliver shared strategic priorities for change set out in the Strategy. As an overarching rolling 3+2 year strategy, it covers a 5-year period with the next refresh due no later than 2027. This will also inform the refresh of the broader Sussex Integrated Care Strategy Improving Lives Together which covers the same 5-year time-frame.

 

2.13       At Place level our HWB’s role is to ensure we can be mutually accountable for working as a system in the following ways:

·         Aligning partnership plans and activity across statutory, voluntary and civic sectors and the contributions different partners make to the health, care and wellbeing of our population, and building the case for the further action we can take together to add maximum value.

·         Using the resources and assets we have collectively available in innovative ways to deliver the ambitions we share, and the best possible outcomes for our population.

2.14     In keeping with the discussion at the HWB meeting on 5 March 2024, and our commitment in the SDP, it is suggested that this will focus on holding organisations collectively to account for undertaking collaborative action in following key areas:

o   Building blocks of good health – decent home, education and employment alongside good social connections and community.

o   Importance of the Life course approach – good start in life, living well, ageing well, and a good end of life.

o   Improving Healthy Life Expectancy – extending years in good health by enabling healthy behaviours and reducing risk and impact of chronic disease and ill-health.

o   Reducing Health Inequalities – underpinning everything we do. Gaps are always changing and not always in the direction we want them to.

o   Mental Health and Wellbeing - focussing on prevention and early support.

·         Embedding prevention and early intervention and proactive, person-centred models of care as part of delivering the following HWB priorities in the SDP:

 

o   Health outcomes improvement

o   Children and young people

o   Mental health

o   Community and ICT implementation

o   Housing

·         Ensuring that our new Integrated Community Teams (ICTs) model is best enabled in East Sussex, as a key mechanism to strengthen our partnership working across a number of strategies and services, to deliver an integrated offer of health, care and wellbeing in our neighbourhoods and communities.

 

2.15     To support this it is suggested that the HWB adopts the following arrangements to carry out its role effectively and drive expectations to address the above three areas of focus:

·         Continuation of the minimum of four formal meetings a year to be held in public to carry out statutory functions and receive update reports, based on the forward plan, to include our SDP integration programme progress reports

 

·         Measuring impact: agreement of the overarching measures and indicators in our East Sussex Health and Wellbeing Strategy Shared Outcomes Framework, and an annual review process, to ensure a clear focus on population and Place in line with the recommendation at the 5 March HWB meeting and the Shared outcomes toolkit (DHSC, October 2023) good practice

 

·         Holding additional informal ‘strategy’ workshop sessions focussed on specific challenges faced by our population and system, informed by JSNA priority themes. Workshops would be data-driven and facilitated through the following format:

o   A description of the priority, what it is and why it is important

o   How is East Sussex doing; an exploration of the data and performance 

o   What should East Sussex be doing; the evidence base and what ‘good’ looks like

o   What is East Sussex doing; current strategies and services

o   What else could East Sussex be doing; collective whole system action planning to enable improvement, and where appropriate looking to align opportunities for prevention, early intervention and integrated care in the SDP and implementation of our Integrated Community Teams model in East Sussex

2.16     The informal Strategy workshop sessions would link to the existing work plans of key strategic leadership partnerships and groups, to enable the actions identified to be taken forward at the earliest opportunity. At the same time the sessions will support the refresh of the rolling HWB Strategy which will need to start from 2025, and ensure a fully up to date position that is owned across our Place in time for the refresh of the Sussex Improving Lives Together Strategy in 2027.

2.17     Appendix 3sets out a draft possible timetable showing how the combined informal and formal meetings, measurement of impacts and overall HWB Strategy refresh process would look in practice. An important step will be to ensure all partners, including our East Sussex VCSE Alliance and borough and district councils can engage effectively in these proposals, including mutual accountability to the HWB through the East Sussex Health and Care Partnership Board, and arrangements to support ICT implementation in East Sussex.

3          Conclusion and recommendations

3.1       In England, HWBs have been a key mechanism for driving joined up working at a local level since they were established in 2013. In the new landscape introduced by the Health and Care Act 2022, HWBs were, and are, expected to continue to play an important statutory role in instilling mechanisms for joint working across health and care organisations, and setting strategic direction to improve the health and wellbeing of people locally.

 

3.2       The East Sussex HWB is uniquely positioned to provide the strategic stewardship of collaboration across health, care and the wider system that impacts on the health and wellbeing of people and communities in East Sussex, to improve outcomes for our population. If accepted by the HWB these proposals will strengthen the HWB’s ability to:

 

 

3.3       There are no changes to the statutory role and function of our HWB as a result of these proposals, and they are within the existing terms of reference for the HWB.

 

MARK STAINTON

Director of Adult Social Care and Health, East Sussex County Council

 

Contact Officer

Email: Vicky.smith@eastsussex.gov.uk

Tel: 07827 841063

Appendix 1      Draft East Sussex HWB Shared Delivery Plan year 2 priorities (excerpt)

Appendix 2      Summary of HWB statutory role and functions

Appendix 3      Draft proposal timetable


[1]Pre-publication draft: Place Development toolkit (NHS England, June 2024)