Agenda item - Introduction to Neighbourhood Health Agenda for Change

Report of the Corporate Director, Health & Care, and of NHS Sussex (copy attached).

40.1    This item was presented by Steve Hook, Tanya Brown-Griffith, Kate Pilcher and Dr Colin Hicks. Ms Brown-Griffith outlined the national drive to improve neighbourhood health, supporting the most vulnerable, shifting activity from acute to community settings, reducing delays in treatment and saving money. NHS Sussex has been an early adopter of the neighbourhood health framework.

Mr Hook told the Board that there are 3 city Integrated Community Team (ICT) delivery groups, plus a citywide ICT which focuses on supporting people who are homeless or with multiple complex needs. The Voluntary & Community sector (VCS) is heavily involved in the leadership of ICTs – e.g. through the Hangleton & Knoll Project in the west ICT and the Trust for Developing Communities in the east. The approach is data driven, using resources such as the Health Counts survey. A bigger statutory role for Health & Wellbeing Boards in neighbourhood health is anticipated. There is also a Neighbourhood Health Alliance coordinated by Sussex Community NHS Foundation Trust (SCFT).

Ms Pilcher explained that the Neighbourhood Health Alliance includes SCFT, Sussex Partnership NHS Foundation Trust (SPFT) and the Primary Care Collaborative. The Alliance is developing memorandums of understanding with the city council, VCS and the hospice sector. The Alliance will focus on preventative and proactive care for high need populations, using population data to develop targeted priorities for each ICT, reducing emergency admissions by at least 10%, and increasing vaccination and screening take up by at least 10%. The Alliance is working with the city council to develop an offer around children and young people.

Dr Hicks told the Board that there is a priority to break mental and physical health silos. To this end, Neighbourhood Mental Health Teams are aligned with ICTs and mental health is represented in every Sussex ICT leadership group. There is a major focus on developing better community support, which will reduce the number of people presenting to A&E with mental health needs. Other areas of focus include improving sharing of electronic patient records and addressing the severe mental illness mortality gap.

40.2    Ian Smith stressed that improving neighbourhood health is fundamental to the future of the NHS. The current trajectory of the NHS is unsustainable, and pathways must be redesigned to shift activity away from acute settings, population health must be improved, and the stress on major system points such as A&E and ambulance callouts must be better managed. This is very challenging and will only be achieved by focusing on priority pathways and by identifying and supporting the highest risk patients. Prevention is key, but it will be important to develop better ways to measure the effectiveness of preventative measures.

40.3    Tom Lambert noted that the VCS is happy with how involved they have been in the planning of neighbourhood health improvement. However, there has been little additional resource for the sector, and this limits what can be achieved. Mr Lambert also asked about what services are planned for people in work. Ms Brown-Griffith responded that the most vulnerable people have been prioritised in the roll-out of neighbourhood health, but services will, in time, Include everyone who needs support.

40.4    Professor Robin Banerjee noted that neighbourhood health is an important initiative. It is vital that this is aligned with complementary initiatives such as the Civic University Agreement for Sussex. Health is a key focus of the civic agreement and NHS Sussex is a key partner. Professor Banerjee asked how place-based partnerships connect to Sussex and national structures. Ms Brown-Griffith responded that we are still in the relatively early stages of planning. However, the Susex model is fully aligned with the national model and there is a focus on better aligning incentives via a reformed Better Care Fund. Steve Hook added that, whilst local planning should be aligned with regional and national models wherever applicable,  it is important to recognise that Brighton & Hove has particular challenges that are different to those in the rest of Sussex, and may sometimes require different, appropriately resourced, solutions.

40.5    Professor Banerjee asked about setting targets for young people outcomes. Kate Pilcher responded that there is a commitment to look at this: some ICT areas will definitely want to focus in improving outcomes for young people. Professor Banerjee noted that the universities could help with this as they hold rich data on the varying needs of young people across the city.

40.6    Ian Smith told the committee that he is a supported of the Civic University agreement. He also noted that Surrey and Sussex have taken different approaches to neighbourhood health. There will be a challenge to better align the counties and also to align neighbourhood health with the boundaries of the unitary local authorities soon to be formed.

40.7    The Chair asked about the alignment of Brighton & Hove ICTs with local Primary Care Networks (PCN). Mr Hook replied that there are 6 PCNs in the city, 2 in each ICT footprint. Adult social care assessment teams and neighbourhood mental health teams are also aligned with the ICT footprint.

40.8    Alan Boyd noted that these are big changes which need to be effectively communicated to patients, but it is not clear that this is happening consistently. This is a particular challenge given the high degree of transience in the local population. A more standardised approach to engagement is needed, one that develops best practice models by learning from the experience of each ICT.

40.9    RESOLVED – that the report be noted.