Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Integrated Care Board (NHS Sussex,) the Local Safeguarding Boards for Children and Adults and Healthwatch.
|
Title: Shared Delivery Plan
|
|
|
|
Date of Meeting: 5 March 2024
|
|
|
|
Report of: Executive Director, Health & Adult Social Care; Managing Director, NHS Sussex (Brighton & Hove)
|
|
|
|
Contact: Chas Walker
|
|
Tel: 01273 |
|
Email: |
|
|
|
Wards Affected: All
|
|
|
|
FOR GENERAL RELEASE
|
||
|
Executive Summary This paper provides the Health & Wellbeing Board with a 12-month progress report on the delivery of our Place-based Shared Delivery Plan objectives that support both the Sussex Integrated Care Strategy and the Brighton & Hove Health & Wellbeing Strategy. The objectives support our five population health priorities of multiple compound needs, mental health, children & young people, cancer and long-term conditions. The report also covers our health inequalities work linked to the national Core20Plus5 programme and our local work to develop the Sussex Integrated Care strategy long term objective for Integrated Community Teams |
||
|
|
||
1. Decisions, recommendations and any options
1.1 The Health & Wellbeing Board are asked to consider the report for the purpose of information and assurance on progress on delivering our Place-based health and care strategy objectives.
2. Relevant information.
2.1 The Integrated Care System is a partnership that brings together NHS organisations, local authorities and community sector partners to take collective responsibility for planning services, improving heath and reducing health inequalities across a geographical area. Brighton & Hove is part of the Sussex Integrated Care System. Integrated Care Systems were established through the 2022 Health & Care Act and replaced previous Clinical Commissioning Groups. Each Integrated Care System is legally required to have an Integrated Care Partnership and that partnership is required to set an Integrated Care Strategy. Our Integrated Care Partnership is led by the Sussex Health & Care Assembly who in March 23 agreed the Sussex Integrated Care Strategy Improving Lives Together. The Shared Delivery Plan sets out how the Integrated Care Strategy will be delivered over the next five years. Brighton & Hove is one of three Place- based partnerships, along with East & West Sussex, that make up the Integrated Care System in Sussex. The Brighton & Hove Health & Wellbeing Board provides the formal governance of our Place based health & care system and is responsible for setting the city’s health & wellbeing strategy. Along with the equivalent strategies in East & West Sussex these form part of the overall Integrated Care Strategy.
2.2 Our Shared Delivery Plan supports our five priority areas set out in our health & wellbeing strategy- Children & Young People, Mental Health, Multiple Long-Term Conditions, Cancer and Multiple Compound Needs. In March 2023 the Health & Wellbeing Board agreed a set of actions for 2023-24 that would support us to deliver on these five priority areas. Set out below is a summary of progress over the past 12 months on our agreed Shared Delivery Plan objectives. Appended to this report is a more detailed table showing RAG ratings and commentary against each objective.
2.3 The Shared Delivery Plan has been well supported by all system partners over the year. But it is important to acknowledge that the external environment, with the increasing pressures felt by all system partners through escalating levels of presenting need across the system and significant financial challenges are likely to impact the scale and pace of the programmes.
2.4 Integrated Community Teams Frontrunner (people with Multiple Compound Needs Transformation Programme) People with Multiple Compound Needs describes people who experience three out of five of the following conditions- homelessness, mental health, substance dependency, criminal justice history, experience of domestic violence. People who have prolonged period of experiencing multiple & compounding needs on average have a 34-year life expectancy difference to the average person. Our transformation programme aims to improve life expectancy for these people and is built on the recommendations from the 2020 MCN Joint Strategic Needs Assessment
2.5 The detail and progress on the Shared Delivery Plan objectives are set out in the appended table. The current RAG rating for the three objective areas are all green noting timescales have been extended in line with the extended delivery period of our multidisciplinary team pilot service.
2.6 The multiple compound need transformation programme is centred around a multidisciplinary pilot service. The team provide an intensive care coordination service to 50-60 of the most vulnerable and marginalised adults in our city. The service went live at the start of 2023, early outcomes and feedback from system partners is very encouraging. At the start of February an external evaluation partner started working with the team and over the next nine months they will evaluate the impact, outcomes and wider cost benefit analysis of the pilot service. Their evaluation report will be considered by the new Multiple Compound Needs Integration & Oversight Board along with proposals for better and further integration of services to support transformation of services for people with multiple compound needs. The programme is being co-produced with lived experience through the work of Common Ambition Group.
2.7 Mental Health- Our Shared Delivery Plan objectives are based on the recommendations from our recently published mental health JSNA Mental health and wellbeing in Brighton & Hove JSNA report and summary (brighton-hove.gov.uk). Overall, 1 in 4 adults in the city identify with having common mental health problems such as anxiety and depression compared to 1 in 5 nationally. Rates of people with severe mental illness such as schizophrenia or bi-polar disorder are a third higher than in England. The city has the highest suicide rate in the Southeast with rates over a third higher than nationally. The city’s suicide prevention action plan and the Sussex suicide prevention strategy went to the city’s Health & Wellbeing Board in November 2023. The action plan was agreed and the strategy was noted. BH suicide prevention strategy
2.9 The mental health Shared Delivery Plan Objectives is being driven through the Sussex community mental health transformation programme. The principles of the programme support equal participation and decision making by all stakeholders. A multi-agency delivery group provides the overarching mechanism to ensure co-production which includes people with lived experience. The development of integrated emotional wellbeing teams is the foundation for transformation of mental health in the city. These multi-agency teams staffed by NHS clinicians and voluntary sector support workers are now established in 4 of the 6 Primary Care Networks in the city. They provide an opportunity for general practice to have quicker access for their patients to the most appropriate support whether that be a clinical intervention or support with broader aspects of someone’s life such as employment which may be having an impact on their mental health. There is significant learning from this programme, and important alignment, that will help inform the development of the Integrated Care Teams.
2.10 Health Inequalities- our Shared Delivery Plan objectives support the national NHS England Core20PLUS5 (adults) Our Place based response to the initiative enables a targeted approach to reducing health inequality across the 5 clinical priorities: hypertension, chronic respiratory disease, serious mental illness, cancer (early diagnosis) and maternity (continuity of care) and the Plus 5 Group-carers: children & young people, globally displaced communities and LGBTQ+. Public Health and NHS partners work closely with the Voluntary Community Sector to identify and put in place targeted hyper local responses aimed at tackling health inequalities across the city including 20% of our most deprived areas, and our identified Plus Groups. This includes working with “community connectors” who can influence their community, help engage local people with health services. They offer unique insight into the barriers people living in their communities’ face, connectors are ideally placed to advise local NHS services on how these can be overcome and what makes a good service. The HIV opt out testing project in Royal Sussex County Hospital A&E is at the halfway point of its 3-year programme. Since its launch in April 2022 over 40,000 people have been tested for HIV. On March 6th, 2023, the pathway was expanded to include Hepatitis C, over 16,000 people have received a test. The next planned phase of expansion is to include Hepatitis B testing from Jan 2024.
2.11 The detail and progress on the Shared Delivery Plan objectives are set out in the appended table. The current RAG rating for the two objective areas is green. The non-recurrent funding for voluntary sector health inequalities schemes came to an end in March 24. The evaluation and learning from these schemes will inform the development of the new Integrated Community Teams and the focus these new teams will have on health inequalities. Appended to this report is an interim evaluation report for our Community Health Inequality Partnership Programme.
2.12 Children & Young People: Our Shared Delivery Plan objectives focus on the young people’s emotional wellbeing, as a city rates of self-harm in those aged 10 to 24 are almost 50% higher than in the rest of England and are increasing. Our work to improve children & young people’s emotional wellbeing is being driven through the Sussex Foundations-for-our-Future mental health & emotional wellbeing strategy. The strategy has four key areas- prevention, early help & access to support, specialist & timely support to meet high & complex needs and support for life transitions. At Place the strategy is supported through a local action plan which delivers on our Shared Delivery Plan Objectives. Our local emotional wellbeing offer is delivered through the children & young people element of the city’s All Ages Wellbeing service, a partnership between the NHS, voluntary sector and the Councils schools wellbeing services. These services work closely with Primary Care and the NHS Community Adolescent Mental Health Service. Our local action plan is supporting further integration and development of the single point of access and associated pathways into and through our local emotional wellbeing and mental health services.
.
2.14 Cancer: for cancer screening coverage and early diagnosis of cancer at stages 1 & 2 we are below the national average for the city. Our Shared Delivery Plan objective is focused on improving screening and early diagnosis of cancer with a strong focus on specific health inequality population groups. Over the past 12 months there has been a focus on improving early diagnosis for cervical, ovarian, colon, renal and liver cancers. Our Act on Cancer Together partnership has focused on ensuring information on cancer, signs and symptoms, is accessible across our communities and supports the uptake of cancer screening. We have also run a targeted lung check programme aimed at specific communities including our homeless community.
2.15 The detail and progress on the Shared Delivery Plan objectives are set out in the appended table. The current RAG rating for this objective area is green.
2.16 Long term conditions: our focus over the past 12 months has been on Cardiovascular (heart disease) and Hypertension (high blood pressure) with a specific focus on health inequalities for those that experience these conditions. Example is the work across our Community Health Inequalities Partnership where we targeted 16 GP practices, across our 20% most deprived communities, and ran a number of public health engagement events called 'Know Your Numbers' events to raise public awareness of hypertension, as well as a project supporting the B&H practices with the lowest proportions of their hypertensive patients treated to target in 23/24. This service delivery will contribute to achievement of the NHS England Target of 77% of people with hypertension treated to target.
2.17 The detail and progress on the Shared Delivery Plan objectives are set out in the appended table. The current RAG rating for this objective area is amber as we haven’t progressed the developing a Brighton & Hove Cardiovascular Disease Reduction action plan. This action will be carried forward to 2024/25
2.18 Integrated Community Teams: is one of the three long-term improvement priorities of the Sussex Integrated Care Strategy. Over the next five years we will be integrating health, social care, and health-related services across local communities in a way that best meets the needs of the local population, improves quality, and reduces inequalities. Over the past 12 months we have continued to develop and deliver our community frontrunner programme for people with multiple compound needs. We have defined our neighbourhood footprint for integrated community teams across the city (East, West, Central, North). We have developed data packs for each neighbourhood area and we have started to collect local insight through engaging with our health forums and local health & care professionals. Over the next 12 months we will work with colleagues across Sussex to define the core offer for integrated community teams. This will also include agreeing our core and local footprint offer for each of our neighbourhood areas. Through our Community Oversight Board we will establish our integrated community teams local implementation plan.
3. Important considerations and implications
Legal:
3.1 Integrated Care Systems were established through the 2022 Health & Care Act and replaced previous Clinical Commissioning Groups. Each Integrated Care System is legally required to have an Integrated Care Partnership and that partnership is required to set an Integrated Care Strategy. The Health & Wellbeing Board are asked to consider the report for the purpose of information and assurance on progress on delivering health and care strategy objectives in the city against the priorities described.
Lawyer consulted: Natasha Watson Date: 26 February 2024
Finance:
3.2 The Sussex Integrated Care Strategy and Shared Delivery Plan provides the integrated care system with a flexible framework which builds on existing system and place strategies and plans, including Joint Health and Wellbeing Board Strategies. The Shared Delivery plan outlines the measures to be taken to deliver the Strategy’s system and place priorities for the short and long-term.
3.3 This informs budget development and the Medium-Term Financial strategy of the partner organisations, including the council. This requires a joined-up process for budget setting in relation to all local public services where appropriate, and will ensure that there is an open, transparent and integrated approach to planning and provision of services. Any changes in service delivery for the council will be subject to recommissioning processes and will need to be delivered within the available budget.
Finance Officer consulted: Sophie Warburton Date: 16/02/2024
Equalities:
3.4 As detailed in section 2.10 Our Shared Delivery Plan objectives support the NHS Core20PLUS5 national health inequalities programme. At the meeting there will also be a short presentation on our Community Health Inequalities Programme that has be one of key delivery approaches to meeting the aims of Core20PLUS5.
Sustainability:
3.5 There are no sustainability implications with this report
3.6 Health, social care, children’s services and public health:
Covered in the main body if the report
Supporting documents and information
Appendix1: Brighton & Hove Community Health Inequalities Partnership interim evaluation report
Appendix 2: Brighton & Hove Shared Delivery Plan Objectives performance table