Report to: Leader and Lead Member for Strategic Management and Economic Development
Date of meeting: 19 July 2024
By: Director of Adult Social Care and Health
Title: Sussex Integrated Care Strategy Shared Delivery Plan (SDP) year 2 refresh
Purpose: To enable consideration and agreement of the year 2 refresh plans for the Sussex SDP.
RECOMMENDATIONS: The Leader and Lead Member for Strategic Management and Economic Development is recommended to:
1) Endorse the update for year 2 of the 5-year Shared Delivery Plan;
2) Agree the continuation of the East Sussex Health and Wellbeing Board population and Place priorities as set out in Appendix 1 of this report;
3) Provide any further feedback to strengthen the update and the collaborative arrangements to support delivery, and;
4) Delegate authority to the Director of Adult Social Care and Health to provide feedback in writing to the NHS Sussex Integrated Care Board, to support final approval.
1.1 East Sussex County Council (“the County Council”) is a statutory partner in the Sussex Health and Care Assembly (“the Assembly”) alongside the NHS Sussex Integrated Care Board (ICB), West Sussex County Council and Brighton & Hove City Council. The County Council is also represented as a partner on the ICB which is responsible for planning and commissioning healthcare services for the population of Sussex. The Health and Care Act 2022 provides for the establishment of ICBs and integrated care partnerships between ICBs and local authority partners. The Assembly is the integrated care partnership in Sussex. Taken together this establishes a Sussex integrated care system (ICS).
1.2 In keeping with national policy and guidance, at the inception of the ICS there was local agreement that “Place” is key to strategic leadership, local commissioning and delivery within the ICS, in order to get the best value out of the full range of collective resources available to meet needs and improve the health, care and wellbeing of populations. The three “Places” in the ICS are East Sussex, West Sussex and Brighton and Hove.
1.3 East Sussex is where the County Council’s statutory responsibilities, budgets and democratic accountability sit for the residents in our area and there are no changes to this. The County Council remains responsible for setting its priorities and budgets through the Reconciling Policy Performance and Resources (RPPR) process. The approach outlined in the Integrated Care Strategy and SDP adds value through helping partner organisations focus on the things that can only be achieved well by working together.
1.4 This report provides an update on the progress made with the 5-year SDP in year 1 (2023/24), and the refresh plans for year 2 of the SDP (2024/25). This will focus on content as it relates to delivering the agreed shared County Council and NHS priorities for the population of East Sussex in the Sussex Integrated Care Strategy, and the specific East Sussex Health and Wellbeing Board (HWB) and Partnership plans. It covers governance arrangements to support delivery including the work of the East Sussex Health and Care Partnership which is responsible for delivering the East Sussex focussed elements of the SDP. The People Scrutiny Committee: Health and Social Care Integration Programme (HASCIP) Reference Group considered the SDP year 2 refresh plans at a meeting on 24 June 2024, and feedback has been provided at Appendix 3 to inform the Leader and Lead Member’s decisions.
2. Supporting information
Sussex Integrated Care Strategy and Shared Delivery Plan
2.1 The 5-year Sussex Integrated Care Strategy Improving Lives Together was approved by the Assembly on 14 December 2022, following agreement by the County Council’s LM SMED on 29 November 2022, and endorsement by the East Sussex Health and Wellbeing Board (HWB) at its meeting on 13 December 2022. The Strategy builds on our East Sussex Health and Wellbeing Strategy Health Lives, Healthy People (2022 – 2027), and sets out our ambition for a healthier future for everyone in Sussex over the next 5 years.
2.2 Improving Lives Together sets out our shared ambition for a healthier future for everyone in Sussex over the next 5 years, and 3 overarching strategic priorities:
· A new joined-up community approach, through the development of Integrated Community Teams
· Growing and supporting our Sussex health and care workforce
· Improving the use of digital technology and information
2.3 In line with the NHS England Joint Forward Plan guidance, the supporting 5-year delivery plan was developed and agreed by all system partners, including the County Council’s LM SMED, in June 2023. In Sussex this is known as the Shared Delivery Plan (SDP). It is written as a single plan that incorporates the local NHS response to the annual national NHS priorities and operational planning guidance, the delivery plan for the Improving Lives Together strategy and each of the three HWB strategies in Sussex. It covers areas for immediate, continuous and long-term improvement, as well as shared priorities specific to each of the 3 HWBs and their populations in Sussex.
2.4 Joint Forward Plans (JFPs) must be refreshed each year and ICBs and their partner Trusts and NHS Foundation Trusts must involve each relevant HWB in preparing or revising their forward plans.
SDP year 2 refresh
2.5 To provide the opportunity to reflect the national NHS priorities and operational planning guidance for 2024/25 (published on 27 March 2024), NHS England) initially set 30 June 2024 as the date for ICBs to publish and share their refreshed plans. Following the announcement of the election and the immediate start of the pre-election period, NHS England subsequently confirmed that systems should publish their JFPs as soon as possible after 4 July, in line with published pre-election guidance. Once approved, an accessible version will be designed. To support this and due to the timing of respective HWB meetings in July 2024, local authorities in Sussex are ensuring the SDP is taken through their individual governance arrangements for comment and agreement as joint statutory partners in the Sussex Health and Care Assembly and Integrated Care Strategy, and partner members on the NHS Sussex ICB.
2.6 A summary progress review of year 1 of the SDP (2023/24) was produced for the Assembly meeting on 10 April 2024: Shared-Delivery-Plan-Progress. A draft paper setting out the proposed year 2 refresh plans covering the full SDP is contained in Appendix 1 and includes:
· Long-term improvement priorities
· Immediate improvement priorities
· Continuous improvement areas
· Health and Wellbeing and Place-based Partnerships strategies
2.7 The proposed updates for year 2 have been developed and signed off by each of the 11 pan-Sussex delivery boards. As well as a continuation of improvement plans from year 1, the SDP year 2 refresh contains new ‘stand-alone’ pan-Sussex workstreams for children and young people (pages 61– 65, Appendix 1) and helping the NHS support broader social and economic development (pages 103 – 104, Appendix 1).
2.8 Both the Integrated Care Strategy and the SDP are built on our understanding of population health needs in East Sussex, and the East Sussex Health and Wellbeing Strategy. The County Council participates in joint work with the NHS on both 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. Work on a pan-Sussex level includes improvements to hospital discharge arrangements and aspects of mental health, learning disability and autism services for children and adults.
East Sussex Health and Care Partnership Plan deliverables
2.9 Alongside the pan-Sussex SDP deliverables, the year 2 SDP includes the East Sussex HWB priorities in pages 86 – 94 of Appendix 1. This represents shared work specifically focussed on the population Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategy for East Sussex.
2.10 The refresh builds on the summary of progress and achievements in year 1 of the SDP which was presented to the HWB at its meeting on 5 March 2024: SDP milestones progress summary 23/24. Highlights are also included in section 6 of Appendix 1.
2.11 Most of the year 2 deliverables reflect a continuation of previously stated plans, with some further refinements or updates to reflect the status and expectations for year 2 and any changes after delivery of the SDP in year 1. This has been agreed via the programme leads and Oversight Boards in the relevant area. Delivery plans reflect our continuing shared priority programmes covering children and young people, mental health, community (and integrated community teams) and improving health outcomes.
2.12 Some specific changes to note for year 2 are as follows:
· Specialist Childhood and Adolescent Mental Health Services (CAMHS) pathway transformation is now led through the pan-Sussex CAMHS Transformation Operational Group. This includes the stock take of specialist CAMHS and exploration of options for investment (including any resource reprofiling if appropriate), and improvement of accessibility of self-help and information, advice and guidance on mental health and emotional wellbeing. Our East Sussex SDP deliverables have been updated to reflect this partnership work is now taking place on a pan-Sussex basis, which the County Council is a part of. Support to families to enable the best start in life continues to be the ongoing focus of partnership delivery at Place.
· A new East Sussex Health and Care Partnership Plan deliverable has been added to ensure a strong focus on health, care and housing as a shared priority for HWB oversight in 2024/25, in line with the East Sussex Health and Wellbeing Strategy and previous agreement by the East Sussex Health and Care Partnership in 2023/24. This has been agreed by our East Sussex Housing Partnership Board and members include Borough and District Councils, Voluntary, Community and Social Enterprise (VCSE) and County Council housing and public health leads.
Supporting governance
2.13 The overall ICS architecture in Sussex is evolving to include:
· Plans to establish a new committee in common between the ICB and NHS providers to focus on increasing productivity and efficiency, and the overall sustainability of healthcare services in Sussex focussing on NHS elements of Improving Lives Together and the SDP.
· Developing 2 new pan-Sussex NHS provider collaboratives focusing on acute and community pathways to better enable improvements to healthcare services, supported by the outcomes-based strategic commissioning role of the ICB.
2.14 In light of this, the existing pan-Sussex partnership governance of 11 delivery boards to support the SDP set up in year 1 is currently being reviewed to better align with the new arrangements described above, and support effective delivery in year 2. The amended approach to oversight and grip on delivery of the Sussex-wide SDP workstreams is expected to be streamlined as a result. There will still be oversight needed for delivery of some our shared long term shared strategic areas of improvement, as set out in Improving Lives Together, including the implementation of Integrated Community Teams.
2.16 Consideration has also been given to the role of Place within this newly evolving system architecture. The continuing pivotal role of the three Place Health and Care Partnerships within the Sussex ICS is to bring together the contribution of the Voluntary, Community and Social Enterprise (VCSE) sector, Borough and District Councils, NHS providers, the NHS Sussex ICB, County Council and others to deliver an integrated offer of health, care and wellbeing for their population.
2.17 Tailored to the JSNAs, differing population health and care needs and the system of partnership planning and delivery that exist in East Sussex, Brighton & Hove and West Sussex, it has been agreed that 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
2.18 This is framed around the specific ‘East Sussex Health and Care Partnership Plan’ in the SDP, and the priorities shared across the NHS and the County Council for our Place. We have undertaken an early review of our partnership and programme governance to ensure it is best aligning our capacity to enable monitoring and delivery of East Sussex specific plans in the SDP and reduce any potential duplication with pan-Sussex arrangements. This includes incorporating our East Sussex Housing Partnership Board into our health and care governance structure to enable monitoring of delivery.
2.19 A summary of the background and changes to our East Sussex Health and Care Partnership programme governance in 2024/25 is contained in Appendix 2. This also links to a broader review of the vision, focus and role of our East Sussex HWB as the key stewardship group for our system at Place. To support this, specific proposals have been developed to strengthen strategic oversight by our HWB of our collective Place-based work to improve health, care and wellbeing outcomes for our population.
2.20 A critical next step will be to ensure our borough and district council partners are able to engage effectively in this refreshed governance, from the perspective of mutual accountability to the HWB through the East Sussex Health and Care Partnership Board and in the key shared priority programmes, for example Housing and Integrated Community Teams development.
Consultation and engagement
2.21 As part of the development of the Sussex Integrated Care Strategy, Improving Lives Together, the engagement approach successfully delivered direct feedback from 18,000 people, face to face and virtual workshops with 420 people, 500 interviews and direct feedback through partners, 1,440 survey responses on our ambition priorities, 800 individual conversations in public engagement events and online communication that has reached more than 200,000 people.
2.22 The original SDP was informed by this feedback from patients, the public and workforce as well as existing insight and feedback available to the ICS. The SDP refresh builds upon this engagement. Recognising that this is a refresh of commitments rather than a full restatement of our strategy and intended areas of focus, a short period of engagement with bodies reflecting the patient voice is planned. Wider engagement with the public will take place when the refreshed SDP is published, led by NHS Sussex and supported by accessible material which clearly articulates our shared areas of focus in 2024/25 and what this means for our population.
2.23 There will be ongoing and strong engagement with people with lived experience and patients, clients, carers and communities tailored to the discrete SDP deliverables, including those captured in our Place-based plans. This will include impact assessments of equality and health inequalities in line with the polices of lead organisations.
Conclusion and reasons for recommendations
3.1 The year 2 refresh of the 5-year SDP reflects the continuing priorities for change that are thought will improve the system working to achieve better health and care outcomes across Sussex. This includes the areas of change related to the East Sussex system and population specifically.
3.2 Deliverables are being carried out within existing resources, and as a single shared plan the SDP will support alignment of resources and capacity to enable delivery at both a Place and System level. As such programme delivery arrangements at a pan-Sussex and Place level are being aligned with new System and Place-Partnership governance arrangements described in paragraphs 2.13 – 2.20.
3.3 The People Scrutiny Committee: Health and Social Care Integration Programme (HASCIP) Reference Group met on 24 June 2024 to consider the SDP year 2 refresh plans, and feedback has been provided in Appendix 3 to inform the Leader and Lead Member’s decisions.
3.4 The unique statutory role of the East Sussex HWB and the underpinning Place partnership governance will be critical to maintaining oversight and mutual accountability for how well we work in partnership at Place to deliver our SDP. Proposals to further strengthen the way the HWB carries out the ‘stewardship’ role for partners in our East Sussex system have also been developed for HWB consideration at its meeting on 16 July 2024.
MARK STAINTON
Director of Adult Social Care and Health
Contact
Officer: Vicky Smith, Programme Director East Sussex Health and
Care Transformation
Email: Vicky.smith@eastsussex.gov.uk
LOCAL MEMBERS
All Members
BACKROUND DOCUMENTS
None