Report to: East Sussex Health and Wellbeing Board
Date: 10 December 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 second informal deep dive session.
Recommendations:
East Sussex Health and Wellbeing Board is recommended to:
1. Note the progress highlights against the Health and Wellbeing Board (HWB) Shared Delivery Plan (SDP) objectives for East Sussex in 2024/25, as set out in Appendix 1, and the positive whole system collaborative action taking place to improve hospital discharge;
2. Note the outcomes from the second informal HWB deep dive session as set out in the summary briefing note contained in Appendix 2, and;
3. Agree the key messages and suggested actions in the briefing note, for sharing more widely with organisations and partners
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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, setting out our ambition for a healthier future for everyone in Sussex over the next 5 years. It builds 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).
1.2 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 (HWB) 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 HWBs in Sussex and their populations.
1.3 A core principle for this joint work is that the primary building blocks are the three “Places” within the Sussex Integrated Care System (ICS) - East Sussex, West Sussex and Brighton and Hove. Place is key to strategic leadership, local commissioning and delivery within the Sussex 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. To support this the HWB has agreed to hold a programme of informal ‘deep dive’ sessions aimed at strengthening the HWB’s role as the strategic stewardship body for our health and care system in East Sussex within the Sussex ICS, through developing a deeper shared understanding of our population’s health and care needs.
1.4 This report provides an update on the current progress being made with the in-year delivery of the eight East Sussex HWB deliverables for 2024/25 in the SDP, which were previously agreed by the HWB on 16 July 24. In addition, the report also brings the outcomes of the second HWB informal ‘deep dive’ session which was focussed on the topic of improving healthy life expectancy in East Sussex.
2. Supporting information
East Sussex HWB SDP year 2 deliverables
2.1 In summary the East Sussex HWB deliverables are framed around the following areas of core joint health, social care, public health and housing planning and delivery:
· Health outcomes improvement and specific partnership action on the diseases and conditions that significantly impact on our population where risks can be modified
· Previously agreed improvements to cardiology and ophthalmology through reconfigured acute hospital services
· Strengthening the role and vision of the East Sussex Health and Wellbeing Board
· Children and young people
· Mental Health
· Community including implementing Integrated Community Teams
· Previously agreed actions to implement improvements to hospital discharge processes
· Housing, health and care
2.2 The full set of East Sussex HWB SDP deliverables for 2024/25 (year 2) and a high-level summary of progress is contained in Appendix 1. In summary, through the shared leadership of the individual programmes of work to support delivery, good progress is being made across the majority of our SDP objectives in 2024/25 by the full range of partners in East Sussex, including the local NHS, social care, public health, Voluntary, Community and Social Enterprises (VCSE) organisations and borough and district councils.
2.3 In the case of hospital discharge, as reported at the September HWB meeting, health and care systems around the country are seeing larger numbers of patients presenting in our acute hospitals whose discharges are being impacted by increasingly complex onward care needs. This is particularly challenging in Sussex and in East Sussex specifically where we have proportionately high numbers of people aged over 85 in our population, who often have more than one long term condition alongside other complexities due to ageing and being frail.
2.4 In light of this, whole system improvement action has taken place on hospital discharge, involving parts of the NHS, Adult Social Care, Borough and District Councils and the VCSE. Examples of this work are included in Appendix 1 and as a result, we are starting to see significant improvements in Mental Health delayed discharges across Sussex, and more recently an improvement in discharges from acute hospitals in East Sussex, where people are classed as having No Criteria to Reside (NTCR) in an acute bed but have onward care needs.
2.5 This area of delivery remains challenging, and there will now be a need to sustain the improving performance trajectory as we head into winter, through our work to model and jointly agree system discharge capacity requirements for ‘step down’ and intermediate care. In keeping with this, the ICB and East Sussex County Council (ESCC) are jointly investing funds to create additional ‘Discharge to Recover and Assess’ (D2RA) bedded capacity to maintain and improve hospital discharge flow throughout the winter period.
HWB informal deep dive session
2.6 In keeping with the proposals agreed at the meeting of the HWB on 16 July 24, a programme of 7 informal ‘deep-dive’ sessions has been put in place, with each session focussing on a specific theme in our East Sussex Joint Strategic Needs Assessment (JSNA).
2.7 The second informal session took place on 14 November 2024 in Lewes covering the topic of improving healthy life expectancy and our work to extend the years of life people spend in good health, by enabling healthy behaviours and reducing the risk and impact of chronic disease and ill-health. The draft briefing note and key messages from the session is included in Appendix 2 of this report for discussion and formal agreement by the HWB. The note includes a set of suggested actions to help our East Sussex Health and Care Partnership further enhance its focus on delivering measurable improvements to healthy life expectancy in our population, building on the plans and activity already in train.
2.8 The next session is planned for 6 February 2025 and will focus on the building blocks of health - a decent home, education and employment, alongside good social connections and community. We will also return to the agreed key actions that came out of the first deep dive session in September 2024 to develop the shared narrative, values and principles that underpin the HWB’s collective vision and strengthen its strategic stewardship of our system. This includes the HWB’s ambition to support deeper operational collaboration in our local geographies and the sustainability of our integrated health, care and wellbeing offer to our population and communities in our challenging financial context. Work is currently being progressed by our East Sussex Health and Care Partnership and the outcomes will be brought to a future meeting of the HWB.
3. Conclusion and reasons for recommendations
3.1 As set out in Appendix 1, progress continues to be made in line with plans to help deliver the HWB SDP priorities that have been agreed for 2024/25. This is contributing to the broader joint work that is taking place across Sussex to deliver improvements as set out in our SDP.
3.2 Whole system collaboration has taken place to help mitigate the challenges being experienced by our system in relation to the rising numbers of patients with complex onward care needs who are delayed in our hospitals, that was reported to the HWB in September. This is having a positive impact, and the collective focus now needs to turn to maintaining and sustaining improvement trajectories through winter when we would naturally see an increase in pressure and beyond.
3.3 The informal HWB session on 14 November 2024 identified areas where we can enhance our partnership focus on improving the healthy life expectancy of our population, building on current joint plans and work. This will also inform our approach in 2025/26 and will be taken forward through the planning process for our SDP by the appropriate lead partnerships.
3.4 As agreed at the HWB on 26 September, steps have also been taken with organisation leads on behalf of our East Sussex Health and Care Partnership to start to develop a shared narrative and values statement to underpin our collective vision and system stewardship at Place. The outputs of this will be brought to a future meeting of the HWB in the New Year.
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 November 2024
Appendix 2: HWB deep dive session 2 - summary briefing note