DRAFT East Sussex Health and Wellbeing Board Deep Dive Sessions Briefing Note

Session #1: Scene-setting

1. Background

A key East Sussex Health and Wellbeing Board (HWB) deliverable in the joint Shared Delivery Plan (SDP) year 2 (24/25) 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”.

It has been agreed to hold a programme of 7 informal ‘deep-dive’ sessions at quarterly intervals prior to the formal HWB meetings up until February 2026, structured around the priority themes in the East Sussex JSNA. This briefing note sets out the outcomes and key messages from the first session which took place on 5 September 2024 in Battle.

2. Briefing note

2.1 Session 1: scene-setting                                                    

Voting members and non-voting members with speaking rights on the HWB were invited to the first session, which served as a scene-setting exercise and explored:

·         The long-term health outlook for East Sussex

·         How we can use our HWB’s Joint Strategic Needs Assessment (JSNA) and Shared Delivery Plan to help guide the action we can take in more immediate time frames to help with the risks and challenges. This includes the shared ambition for Integrated Community Teams (ICTs) as a critical enabler to delivering our plans in our communities and neighbourhoods.

·         The foundations we have for strategic stewardship across East Sussex and how we can build on this to go further for our population.

2.2 Understanding our long-term health outlook

The long term future outlook about health in the South East of England[1] was considered to understand where East Sussex sits, and is at the forefront of specific challenges, risks and opportunities. A summary of the key messages include:

·         Over the next 20 years, the South East population will grow by 6% (~0.5m people) and age, with the proportion of people aged 75+ increasing from 10% to 15% (~0.5m more people).

·         People are spending more of their lives in poor health as healthy life expectancy fails to keep pace with life expectancy. Coastal areas and more deprived areas with large ethnic minority populations have a particularly high burden of disease.

·         The biggest increases in demand for healthcare will be for conditions like chronic pain, diabetes, anxiety or depression and the prevalence of multiple long-term conditions will grow as the population ages.

·         Demand for services (including primary and secondary care, children’s and adults social care) will increase significantly meaning new models are needed including joint working between the NHS and local government.

·         Opportunities for the NHS to meet these challenges include:

o   Focusing on prevention to manage unsustainable pressures on treatment services and;

o   Shifting resources to primary and community care

·         Opportunities for local authorities include:

o   Mitigating the impacts of climate change and ensuring residents have clear air and water;

o   Building healthy places physically and socially, and;

o   Supporting young people and their families through early intervention.

 

2.3 System, Place and Stewardship

The significant foundations we have to build on as a HWB that will help us rise to the above challenges collectively were acknowledged:

·         Our overarching HWB Strategy and vision, aligned to the Sussex Assembly Strategy Improving Lives Together, and a supporting Shared Delivery Plan.

·         Agreement to meet informally as a HWB with three key areas of focus

o   JSNA priorities

o   Models of care that emphasis prevention, early intervention and proactive care

o   Getting the most out of Integrated Community Teams as a key shared enabler.

 

• Our live JSNA process and strong approach to evidence-driven decisions.
• Strong and trusted working relationships that have been built up over many years.

• Well established inclusive governance to support joint planning and delivery – the East Sussex Health and Care Partnership.
• An agreed Shared Outcomes Framework, based on what local people have told us is important, covering improving population health and the quality and experience of care as well as transformation of services for sustainability.

To go further, a successful high-functioning HWB in East Sussex would have the following characteristics:

·         Proactive and collaborative approach to agreeing, driving and delivering a realistic number of shared priorities at Place

·         Strategic prioritisation to tackle variations, and opportunities to provide services to achieve joint objectives and tackle inequalities, efficiently and effectively for the population

·         Deeper relational leadership andshared values and behaviours across organisational and professional boundaries

·           Mutual accountability for partnership governance arrangements, and how well this supports strengthened operational collaboration across our teams (including primary care, community health, social care, mental health, housing and VCSE services)

·         A more community based, relational and transformational approach to ultimately contribute to the refresh of the rolling HWB Strategy (due 2025 – 2027), aligned to the wider Assembly, ICB and Local Authority strategies

 

The session considered what is needed, or needs to be unblocked, to achieve the following ambitions and ingredients for success:

1.  A proactive collaborative approach

2.  Ownership of shared priorities at Place

3.  Trusted relationships and shared values

4.  Deeper operational collaboration in the borough and district geographies and communities

A summary of the themes from the discussion is set out in the table below:

A proactive collaborative approach

·      A shared language to describe the aims and intentions of working together in neighbourhoods. This should be simple and clear with a compelling narrative that sets out the case for collaboration, so that the ambitions and the contribution made to delivering them can be owned by everyone. ·      Better understanding and clarity about individual roles and responsibilities on the HWB, including feedback routes, to support clear decision-making and agreement about joint action. ·      Striking a balance between the joint action needed to deliver more urgent improvements and long-term ambitions for sustainable services, with a clear thread between the two. ·      Not being afraid to ‘not know’ the answers, and being open to having difficult conversations to help establish a constructive way forward. ·      Clear and ongoing feedback loops when we try new actions together, and be prepared to change and adapt if things aren’t working as expected. ·      Recognition of the barriers between organisations, particularly financial barriers, and work to overcome them.

 

Ownership of shared priorities at Place

·         The HWB to act as a ‘convenor’ to bring multiple parties together to work on a specific issue or problem. ·         Be clear as a HWB what the ‘core’ ICT offer is that we’re stewarding delivery of in our local communities, and how that reads across and aligns with the JSNA. ·         Use the informal sessions as the basis for engagement and feedback loops about delivering Improving Lives Together and ICTs, and ensuring representation is at the right level to deliver organisational ownership. ·         Establish a clear understanding of what needs to happen in the short, medium and long term to deliver outcomes and long-term goals, and the common thread between all three. ·         Be careful to understand cause and effect to avoid unintended consequences. ·         Share failures as well as successes, and the learning from both. ·         Build in the voice of people in our communities and the existing shared insight we have, and make sure joint action is reconciled with that. ·         Keep coming back to prevention as a core outcome in everything we do.

 

Trusted relationships and shared values

·         Make sure trust is built in at all the layers of our system, both horizontally and vertically within our governance, with robust, honest and accessible processes for escalation, built on continuous feedback loops and openness. ·         Continue to keep learning about the different roles and pressures being experienced across our system, be open about our differences and the changes we can make to support shared resilience. ·         Define our shared values and how we conduct ourselves, to build and shape strong cultural alignment across our system about how we work together, and the principles and behaviours that underpin our partnership working. ·         Agree to disagree at times, but always do the work to try and identify common ground, acknowledging this will be messy sometimes and we will need to be honest about the need to ration resources. ·         Share decision-making where appropriate, driven by shared values and understanding and clarity about what all partners are bringing to the table, and what burdens are being carried.

 

Deeper operational collaboration in the borough and district geographies and communities

·         Establish a clear line of sight from the Southeast regional population challenges, through to the East Sussex JSNA and ICT population profiles and how this informs shared priorities in communities. ·         Operational collaboration in local geographies should be driven by the ICT population profiles and what local voices and staff are telling us. ·         Communicate about the insight and link this back through openness, understanding of roles and lines of escalation. ·         Focus integrated action where it is most useful and practical and always be aware that there is very little that can be set out along neat geographical boundaries, particularly in terms of how people live and access services and support, so flexibility will be important. ·         Clarity about how the seven cross-cutting areas of delivery in the SDP relate to the ICT population profiles and ensure a simple read across to the JSNA, as well as alignment with Borough and District Council plans. ·         Give permission to act at all levels, alongside articulating what ‘good’ looks like and why.

 

2.4 Initial actions

In addition to informing the focus and tone of the future informal HWB sessions, some actions will be explored to help make a start with progressing these suggestions for our HWB:

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

 

2.5 Planning for the next session

The informal HWB deep dive sessions are built around the JSNA priority themes, following a similar format for each:

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

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

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

·           What is East Sussex doing; our current strategies, plans and services

·           What else could East Sussex be doing; collective whole system action planning to enable improvement.

This last aspect will aim to stress-test the alignment of our plans and amplify further opportunities for prevention, early intervention and integrated care. For example, our existing SDP plans and the implementation of our Integrated Community Teams model in East Sussex, and the role that they could be expected to play to support delivery of shared priorities in the future.

The following suggestion were made to get the most out of the next informal deep dive sessions:

·         Explore ways to include wider representation, in particular where this is specific to key topics e.g. from NHS providers of primary care and SCFT and SPFT, VCSE Alliance and Borough and District leads to support existing representatives, as well as nominations of deputies when people can’t attend to ensure we get the full breadth of our system participating.

·         Use the system stewardship role of the HWB and these topics as an opportunity to help us navigate and engage about the financial challenges that all our organisations are facing and the difficult decisions ahead, as well as aspects of national change as they impact on East Sussex, to support our resilience as a system.

·         Format: keep to a good balance of up-front presentation and opportunities for informed discussion.

·         Data: where possible include how East Sussex is doing compared to similar areas both within Sussex and more widely in England, and the ways other areas are tackling similar challenges to see if there is anything we can learn.

2.6 Next steps

Planning will take place for the next session on the JSNA topic of Improving Health Life Expectancy, taking the above suggestions into account. We will also return to the actions identified from the discussion about developing the HWB’s strategic stewardship role. It was agreed to share this information briefing with colleagues in organisations, partners and stakeholders to facilitate wider understanding of how our HWB stewardship role is developing.

 

For more information please contact:

Vicky Smith

Programme Director, East Sussex Health and Care Transformation

East Sussex County Council and NHS Sussex

Contact: vicky.smith@eastsussex.gov.uk