Report to:                  East Sussex Health and Wellbeing Board (HWB)

Date:                           26 September 2024

By:                              Director of Joint Commissioning and Integrated Community Teams Development (East Sussex), NHS Sussex and Director of Adult Social Care and Health, East Sussex County Council

Title:                           Integration programme update

Purpose of Report:   To provide an overview of current progress on the East Sussex priorities in the Sussex Shared Delivery Plan (SDP), and the outcomes of the first informal HWB deep dive session.

Recommendations:

East Sussex Health and Wellbeing Board is recommended to:

1.    Note the early in-year progress highlights against the Health and Wellbeing Board Shared Delivery Plan (SDP) objectives for East Sussex in 2024/25 set out in Appendix 1.

2.    Note the steps that have been taken to enact the previously agreed proposals for a new way of working, to further strengthen the HWB’s existing statutory role as the key strategic stewardship group for the health and care system in East Sussex, and;

 

3.    Agree the summary briefing note (Appendix 2) of the first informal HWB deep-dive session, and the suggested initial follow up actions (as set out in the table in paragraph 2.9 of this report), for sharing more widely with organisations and partners.

 

1       Background

1.1       The 5-year Sussex Integrated Care Strategy Improving Lives Together was approved by the Sussex Health and Care Assembly in December 2022, and set out our ambition for a healthier future for everyone in Sussex over the next 5 years. A core principle for this joint work is that the primary building blocks are the three “Places” (East Sussex, West Sussex and Brighton and Hove. Place is key to strategic leadership, local commissioning and delivery within the Sussex Integrated Care System (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.

1.2       In keeping with this, the East Sussex Health and Wellbeing Board (HWB) endorsed the Strategy as building on our East Sussex Health and Wellbeing Strategy Healthy Lives, Healthy People (2022 – 2027), and our understanding of our population in East Sussex through our Joint Strategic Needs Assessment(JSNA).

1.3       A single 5-year Shared Delivery Plan (SDP) was subsequently agreed by all partners in June 2023. This covers the delivery plan for the Improving Lives Together strategy and each of the three Health and Wellbeing Board strategies in Sussex, alongside the local NHS response to the annual national NHS priorities and operational planning guidance. It covers areas for immediate, continuous and long-term improvement, as well as shared priorities specific to each of the three Health and Wellbeing Boards in Sussex and their populations.

1.4       An annual update of the SDP took place earlier this year which covered refreshed and new deliverables in 2024/25. This was endorsed at the HWB meeting on 16 July 2024, and the meeting of the East Sussex County Council (ESCC) Leader and Lead Member for Strategic Management and Economic Development on 19 July 2024. This report provides an update on the progress made with the in-year delivery of the eight East Sussex HWB deliverables in the SDP.  It provides an overview across all eight, and a focus on the specific work that has taken place on our shared objective to strengthen the HWB’s role as the strategic stewardship body for our health and care system in East Sussex.

2.            Supporting information

East Sussex HWB SDP year 2 deliverables

2.1          As reported at the last meeting, our SDP deliverables in 2024/25 reflect a continuation of previously stated plans, with some further refinements and additions to reflect the status and expectations for year 2, and any other changes after the progress made in year 1 (2023/24). In summary the East Sussex deliverables can be broken down as follows:

·      Health outcomes improvement – our collaboration on prevention and early intervention focussing on the conditions that are significantly impacting on healthy life expectancy in our population, which are amenable to prevention action across the whole life course; cardiovascular disease (CVD); chronic respiratory disease (CRD); healthy ageing and frailty; and mental health.

·      Children and young people – enhancing support to families to enable the best start in life, including an integrated pre- and post- natal offer and implementation of the early intervention partnership strategy.

·      Mental Health – enabling integrated community-based care and a wider range of earlier mental health support for adults of all ages and people with dementia through implementing Neighbourhood Mental Health Teams (NMHTs), and improved access and outcomes for supported accommodation.

·      Community - implementing Integrated Community Teams (ICTs) to deliver integrated, proactive care for vulnerable and frail older people with complex needs, and improving health and wellbeing through a strength-based approach with communities and deeper collaboration on prevention.

·      Housing – developing a partnership housing vision and strategy, including a strong focus on health, housing and care, to complement the existing borough and district housing authority strategies.

2.2          Each of the above are local joint change programmes led by an East Sussex oversight or partnership board. There are a further two East Sussex HWB SDP deliverables that are led and reported through pan-Sussex governance for planned care and hospital discharge improvement, for implementation in the East Sussex context:

·         We will implement the (previously agreed) improvements to cardiology and ophthalmology through reconfigured acute hospital services. 

·         We will further develop and implement efficient hospital discharge processes, supported by digital automation, with a long-term funding plan for discharge capacity. We will embed efficiency and process learning from transformation programmes into ‘business as usual’.

2.3          Programme boards have set in year milestones to deliver the local SDP deliverables. Key performance indicators are also being finalised to help understand the contribution and impacts in the context of our HWB Strategy’s overall aims of improving population health and the quality and experience of care, and transforming services for sustainability.  Work is also in train to link up with reporting of the wider SDP to the NHS Sussex Integrated Care Board (ICB) so that we can do this through a single process.

2.4          The full set of East Sussex HWB SDP deliverables and a high-level summary of early progress is contained in Appendix 1. Progress is on track against plans across the majority of our objectives, with the exception of hospital discharge where we are seeing an increase in the number of patients who no longer meet the Criteria to Reside (NCTR) in an acute hospital bed, and the complexity of onward care needs. Collaborative plans are seeking to address this, including modelling to inform the capacity requirements for the system going forward, and the best use of discharge funding. 

HWB system stewardship role

2.5       A final key East Sussex HWB deliverable in the joint Shared Delivery Plan (SDP) year 2 refresh is 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”.

2.6          This has progressed in keeping with the proposals that were agreed at the meeting of the HWB on 16 July 2024. A programme of 7 informal ‘deep-dive’ sessions has now been planned, at quarterly intervals prior to the formal HWB meetings up until February 2026. These are structured around the JSNA priority themes, according to the timetable set out below.

 

Date

Informal HWB deep dive session topic

1

5 September

2024

Scene-setting session

2

14 November

2024

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

3

6 February

2025

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

4

19 June

2025

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

5

4 September

2025

 

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

·      Annual review - East Sussex HWB Shared Outcomes Framework measures

6

13 November

2025

Mental Health and Wellbeing - focusing on prevention and early support

7

12 February

2026

 

HWB strategy refresh approach - reviewing outputs and progress from the previous five sessions, and agreeing the broad structure to refresh the Strategy

2.7          The first session took place on 5 September 2024 in Battle. This served as a scene-setting exercise which explored the long-term health outlook for East Sussex, and how the HWB’s Joint Strategic Needs Assessment (JSNA) helps us to understand what can be done in the more immediate time frame to help with the risks and challenges to population health. The session also underlined the role of our SDP plans in the immediate timeframe, and our shared ambition for Integrated Community Teams (ICTs), in helping us respond to this long-term outlook through enabling deeper operational collaboration in our communities and neighbourhoods.

2.8          The HWB explored what strategic stewardship means in our current context, including the backdrop of increasing financial challenges, and what would be needed (or need to be unblocked) to go further with our key ambitions of:

·                              A proactive collaborative approach

·                              Ownership of shared priorities at Place

·                              Trusted relationships and shared values

·                              Deeper operational collaboration in the borough and district geographies

2.9          A draft summary briefing capturing the outcomes and next steps from the session is included in Appendix 2. Some initial actions have been identified to help make progress and these are set out in the table below. Suggestions were also made to further shape and get the most out of the next informal sessions.

Action to strengthen strategic stewardship

Supports

·      Work with our communications leads to craft a simple, compelling, shared narrative for collaboration in our current context, including our financial challenges. Use this to explain and promote the strategic stewardship role of the HWB with our organisations, partners and stakeholders.

·      A proactive collaborative approach

·      Trusted relationships and shared values

·       Ownership of shared priorities at Place

·      Explore the creation of a shared values statement that underpins our collaboration, to help us navigate challenging conversations and decision-making as a HWB in the future.

·       Trusted relationships and shared values

 

·      Use our existing shared health and care partnership governance to help create effective open and honest feedback and escalation routes, starting with the East Sussex Health and Care Partnership Executive Board.

·      A proactive collaborative approach

·       Ownership of shared priorities at Place

·      Trusted relationships and shared values

·      Continue to raise awareness about the ambition for ICTs more widely across our organisations.

·       Ownership of shared priorities at Place

·       Deeper operational collaboration in the borough and district geographies and communities

·      Develop a regular short briefing note from these deep dive meetings to help HWB members share key messages within organisations, partners and stakeholders.

·       A proactive collaborative approach

·       Ownership of shared priorities at Place

3.            Conclusion and reasons for recommendations

3.1          As set out in Appendix 1, joint work has taken place to make early progress in line with plans to help deliver the HWB SDP objectives that were agreed for year 2 at the July HWB meeting. This is part of the wider work that is taking place across Sussex to deliver the SDP.

3.2          The HWB has also taken initial steps with its commitment to strengthen the strategic stewardship of our system and increase our mutual accountability and shared resilience across our Place, particularly in light of our challenging financial context. This will be critical to helping our organisations respond collaboratively and sustainably to the health needs faced by our population in the coming months and years, building on the strengths we have in East Sussex.

3.3          A key next step will be to ensure all partners across the NHS, Councils and VCSE partners are able to engage effectively in this refreshed stewardship approach, to ensure that we can use the collective resources we have available to get the best outcomes for our population. This will include making sure our delivery plans, including those in the SDP, align and connect to get the maximum potential benefits for our organisations and population over the short and long term.

ASHLEY SCARFF

Director of Joint Commissioning and Integrated Community Teams Development (East Sussex), NHS Sussex

 

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: East Sussex HWB SDP year 2 deliverables: progress update September 2024

Appendix 2: HWB deep dive session 1 - summary briefing note