Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.
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Title: Sussex Health & Care Plan – the local response to the NHS Long term Plan
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Date of Meeting: 5th November 2019
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Report of: Lola Banjoko, Executive Managing Director, Brighton & Hove Clinical Commissioning Group, Rob Persey, Executive Director of Health & Social Care, Brighton & Hove City Council
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Contact: Ashley Scarff, Director of Partnerships and Commissioning Integration, Brighton & Hove Clinical Commissioning Group |
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Email: ashley.scarff@nhs.net
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Wards Affected: ALL
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FOR GENERAL RELEASE
By reason of the special circumstances, and in accordance with section 100B(4)(b) of the 1972 Act, the Chair of the meeting has been consulted and is of the opinion that this item should be considered at the meeting as a matter of urgency because of the timescale for submitting the Sussex Health & Care Partnership’s response to the NHS Long Term Plan.
Note: The special circumstances for non-compliance with Council Procedure Rule 3, Access to Information Procedure Rule 5 and Section 100B(4) of the Local Government Act 1972 (as amended), (items not considered unless the agenda is open to inspection at least five days in advance of the meeting) were that the NHS Long Term Plan requires a formal response by 15th November 2019 and this requirement was not known before the last Health and Wellbeing Board meeting in September 2019. A Special Meeting has therefore been called and timed in order to have time for the discussion and comments from the Board to be taken into account.
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Executive Summary
The NHS Long Term Plan (LTP) has been published. Each area of the NHS has to produce a response to this plan explaining what they need to do and what they wish to achieve in response to the needs of their local community while achieving the key objectives as described in the NHS Long Term Plan.
The Sussex Health & Care Partnership (made up of the CCGs and health bodies that cover East and West Sussex and Brighton & Hove) has formed a Partnership: the Sussex Health & Care Partnership (SHCP). Local Authorities will be collaborating with the Partnership. The SHCP have to produce a 5 year strategic plan for NHS England outlying what they wish to achieve. This report and presentation outline the further developed Plan which will be submitted to NHS England on 15th November. The full Plan and the three area Placed Based Plans can be found in Appendix 1.
The Sussex Health and Care Plan will help to improve lives, extend lives and save lives.
The plan represents our response to the local health and care needs of our populations and the national ambitions and expectations set out of the NHS Long Term Plan.
The Brighton & Hove elements within this build on existing plans in Brighton & Hove: • Builds on the Joint Health and Wellbeing Strategy as set out by the Health and Wellbeing Board • Responds to local needs as identified in the Joint Strategic Needs Assessment carried out by the Health and Wellbeing Board • Shows how locally Brighton & Hove will deliver the local aspects of the NHS Long Term Plan • The plan responds to the needs of the local population as picked up in extensive public engagement involving over 4,000 conversations with local Brighton & Hove residents over the last two years • Developed with the involvement of partners, clinicians, health and care professionals, staff, and previous consultation with the public
The plan includes commitments to change how our health and care organisations work together, transform patient pathways, address our financial deficit, address our workforce gap and deliver the significant number of initiatives included within the Long Term Plan.
The key ambitions of the plan are:
The plan is a continuation of the work that has already taken place over the last few years to improve and join-up health and care services. It has been built on the local transformation plans that were already in place and uses the clinical evidence from the Population Health Check developed by local doctors, clinicians and professionals.
The plan represents the collective response across our health and care partners to the challenges we all face around the rising demand on services, finances and workforce shortages.
To meet the ambitions of the plan, we need to strengthen existing relationships between primary, acute, community and mental health services, and reinforce relationships with Local Authorities, including district and borough councils, and the voluntary and community sector.
The plan has been developed with the involvement and input of partners, clinicians, specialists, health and care professionals, staff, and previous consultation with our public. It is a collective effort across our partners and is currently being formally agreed through all statutory organisations, before it is finally submitted on 15 November.
The core purpose of the plan is to bring real benefits to the lives of our populations:
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Glossary of Terms BAME – Black and Minority Ethnic BHCC – Brighton & Hove City Council CCG – Clinical Commissioning Group NHS – National Health service NHS E – National Health Service England NHS I – National Health Service Improvement NHS LTP – National Health Service Long Term Plan SHCP = Sussex Health & Care Partnership
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1. Decisions, recommendations and any options
1.1 That the Board agrees to the following:-
1.1.1 To note the further developed SHCP 5 year strategic plan as set out at Appendix 1;
1.1.2 That a progress update report will be provided to the January Health & Wellbeing Board. This report will update the Board on the:
· Submission and outcome
· The development of the operational delivery plan
· Financial implications for Sussex and the Brighton & Hove Place Based Plan
· Any targets that have been set and monitoring arrangements.
2. Relevant information
2.1 The NHS Long Term Plan has been published. A copy can be downloaded here https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
2.2 Areas have to submit a local response to the NHS LTP, a strategic plan outlining how they are going to meet the aspiration of the NHS Long Term Plan and to meet the health needs of the population at both a Sussex level as well as a Place / local authority area level.
2.3 The supporting presentation will take the Board through the work achieved to date and outline the process after submission of the Plan on 15th November 2019.
Progress since the draft Plan was presented to the Board September 2019
2.4 Further work has been done to the Plan. There are key features which reflect local areas needs including:
· An overarching introduction of the Sussex wide provision and aspirations
· Local Place Based Plans for each area within Sussex to reflect each areas specific needs.
Place Based Plans are drawn from local engagement and consultation;
2.5 Each of the Place Based Plans underpinning the overarching Sussex wide plan reflect the individual CCGs within their area. The Sussex Health and Care Partnership covers three distinct areas that are each coterminous with the Local Authority areas concerned. This will make planning joint local support for our populations significantly easier.
2.6 Brighton & Hove city council have been very active in developing the Place based response. The response to the LTP sits alongside our local Joint Health and Wellbeing Strategy, reflecting the prevention agenda necessary to support the health of our population over a life course, and address our local population health and care needs as identified in the Joint Strategic Needs Assessments. Summary assessments of our population and the wider determinants of health for the people of Brighton & Hove that underpin the local plan are set out in section 2 and are drawn directly from the joint Health & Wellbeing Strategy.
2.7 Our Place Based Plan draws on extensive consultation over the last 3 years using the Big Health & Care Conversation as well as utilising other engagement e.g. the development of the Health & Wellbeing Strategy and the refresh of the Transformation Plan for children and young people’s mental health.
2.8 Consultation and engagement does not finish now as this is a continuous process. In Brighton & Hove we will continue to build on the public and patient engagement to develop and inform commissioning and delivery of the plan in particular hard to reach groups. The CCG and BHCC have also commissioned 10 Voluntary and Community Sector (VCS) organisations under the Third Sector Investment Programme, to engage with local people in specific groups such as BAME, carers, young men and people with disabilities on health and social care.
2.9 Each of the Place Based Plans has been tailored to meet the needs of the local population. The Brighton & Hove Place Based Plan relates directly to the joint Health & Wellbeing Strategy and for consistency uses the ‘4 Wells’: Starting Well, Living Well, Ageing Well, Dying Well to frame the implementation of the plan. Using the same framework will support the alignment of our local health and wellbeing plans with the local implementation for the NHS Long Term Plan. This alignment will ensure that our planning, implementation and reporting are all more joined up.
Following 15th November submission
2.10 We will be submitting the SHCP LTP response to NHS England to meet the deadline of 15th November 2019. Following submission all plans will be scrutinised by NHSE to ensure they meet local people’s needs as well as achieve the key objectives of the NHS Long Term Plan.
2.11 The NHS organisations within the SHCP have had had 3 year funding levels agreed, although this is not the case for local government. Having a Plan will not impact on the overall health finances of the Sussex Health & Care Partnership, an agreed plan will enable and allow the focus of spend to change as required to best meet local needs e.g. mental health spend in Brighton & Hove.
2.12 We will be open and transparent in how progress is reported on implementing the Brighton & Hove Place Based Plan and the SCHP Plan overall. Working with the 4 Wells framework will make it easier to see how the Plan together with the Health & Wellbeing Strategy of the city are concurrently being achieved. Any annual reporting process will come to this Board given the impact on achieving the city’s Health & Wellbeing Strategy.
2.13 Following submission and scrutiny the SHCP could be asked by NHSE to review areas of the Plan if NHSE require further assurance that those areas of the plan will achieve the NHS Long Term Plan objectives and /or our targets. Any such areas identified will be reviewed and addressed locally ahead of a final plan publication on 2nd December. If any amendments have to be made and there is an impact on the Place Based Plan this will be reported to the Board.
Risks and liabilities
2.14 An important aspect of the Sussex wide plan and our approach is demonstrating the validity and value of the 3 identified local Places within Sussex, mapped to the 3 local authority areas. The NHS LTP is modelled with single ‘places’ for each health and care partnership or ICS, our partnership believes strongly that such a singular approach does not best serve the populations of Sussex.
2.15 We have not asked the Board to fully approve the Plan as we are aware that there is significant content that is health led and Sussex wide. However there are key areas such as the preventative provision and alignment with public health, social prescribing, post hospitalisation care and alignment with social care, and children’s services, that without our key Local Authority Partners the Plan cannot deliver to Brighton & Hove residents.
Refreshing the Plan
2.16 Like all strategic documents we are anticipating change. The Queens speech highlighted that there will be legislation introduced to further support the NHS. We are also awaiting the Adult Social Care White Paper. We do not know what the impact on our Plan will be. We are committed to engaging the Board and local residents as and when refreshing the Plan is needed.
3. Important considerations and implications
3.1 Legal:
From the CCG
There is a regulatory requirement set out in the NHS LTP that all systems will develop into Integrated Care Systems (ICSs) by April 2021 – the Sussex Health and Care Partnership’s strategic delivery plan, and the related technical submissions, will be a key driver of this.
There is a regulatory requirement from NHS England (NHSE) and NHS Improvement (NHSI) that systems develop plans for local delivery of the LTP, which includes providing a local response to each of the national commitments in the LTP.
From the Council
Sustainability and Transformation Partnerships/Integrated Care Systems are required to respond to the NHS Long Term Plan by mid November 2019. The requirement is that the responses are developed with full local engagement of stakeholders and therefore it is appropriate for the response to be considered and commented on by the Health and Wellbeing Board.
The NHS Long Term Plan includes a number of areas where changes to legislation are proposed to make it easier for Integrated Care Systems to work together effectively. The Plan does not refer to Health and Wellbeing Boards in relation to its proposals. There are also proposals to review statutory responsibilities in relation to Public Health services, commissioning responsibility for which currently rests with local authorities.
The Health and Wellbeing Board will need to keep the local response to the LTP under review and monitor progress in order to ensure that the implementation and delivery aligns with the agreed Health and Wellbeing Strategy and Joint Strategic Needs Assessment approved by the Health and Wellbeing Board.
Lawyer consulted: Elizabeth Culbert Date: 291019
3.2 Finance:
Financial Comments from the CCG
High level financial implications of establishing the Sussex Health and Care Partnership’s strategic delivery plan, and of delivering our response to the LTP are set out in the report. Detailed financial planning at organisation and local system level will be worked up as part of the implementation and delivery process.
From the Council Finance Officer
This report provides an update on the NHS Long Term Plan. At this stage, this is a high level plan which, when accepted by NHS England, will then be developed into a delivery plan. Any changes in service delivery for the council will be subject to the recommissioning processes and will need to be delivered within the budget envelope available.
Finance Officer consulted: Sophie Warburton Date: 28/10/2019
3.3 Equalities
From the CCG
Consideration of equality issues has been integral to the Plan development process. The LTP response devotes a section to requirements for ensuring stronger action on health inequalities. Where required, Equality Impact Assessments will be undertaken in relation to specific service modifications as part of the detailed implementation processes.
From the Equalities lead of the Council
Consideration of all equality issues has been integral to the Plan development process. The LTP response devotes a section to requirements for ensuring stronger action on health inequalities. Where required, Equality Impact Assessments will be undertaken in relation to specific service modifications as part of the detailed implementation processes.
Brighton & Hove City Council supports the equalities approach outlined above by the CCG - with health inequalities being considered as an integral part of the wider Plan, in addition to a commitment to undertaking Equality impact Assessments to support the plan’s practical implementation and delivery.
Supporting documents and information
Appendix1: Sussex Health & Care Plan with the three Area Based Plans
1) Brighton & Hove
2) East Sussex County
3) West Sussex
Full colour versions can be seen here:
https://www.seshealthandcare.org.uk/about-us/sussex-health-and-care-plan/