Suffolk Health and Wellbeing Board Agenda

Suffolk Health and Wellbeing Board A committee of Suffolk County Council Quorum: 11

Date: Thursday, 12 May 2016

Venue: Elisabeth Room Endeavour House 8 Russell Road Ipswich, Suffolk IP1 2BX

Time: 9:30 am – 11:00 am

People attending the meeting will have an opportunity to use Twitter. Anyone wishing to join the conversation is invited to do so using the hashtag ‘#healthysuffolk’. A summary of the tweets posted will be on display in the meeting room. For further information on any of the agenda items, please contact Linda Pattle, Democratic Services Officer, Suffolk County Council, on 01473 260771.

Item Agenda Page no. reference

1. Confirmation of Appointment of Chairman

Following the resignation of Councillor Alan Murray, to confirm the appointment of the Chairman of the Health and Wellbeing Board for the remainder of the 2015/16 municipal year.

2. Election of Vice-Chairman

To elect a Vice-Chairman for the period up to the end of the 2016/17 municipal year.

3. Public Participation Session

The Board is keen to hear the views of those with experience of, or involvement in, the delivery of health and social care, and welcomes attendance at Board meetings.

A member of the public who is resident, or is on the Register of Electors for Suffolk, may speak for up to five minutes on a matter relating to the following agenda.

A speaker will need to give written notice of their wish to speak at the meeting using the contact details under ‘Public Participation in Meetings’ by no later than 12 noon on Friday 6 May 2016.

4. Apologies for Absence and Substitutions

To note and record any apologies for absence or substitutions received.

5. Declarations of Interest and Dispensations

To receive any declarations of interests, and the nature of that interest, in respect of any matter to be considered at this meeting.

6. Minutes of the Previous Meeting Pages 7 - 16

To approve as a correct record, the minutes of the meeting held on 10 March 2016.

7. Health in All Policies Pages 17 - 30

To consider the feedback from the Health in All Policies review in the context of the Health and Wellbeing Board and consider a response.

8. Way Forward Pages 31 - 62

To receive an update in relation to the emerging Sustainability Transformation Plans and to consider an approach to developing and delivering the outcomes and the cross cutting themes within the refreshed Joint Health and Wellbeing Strategy.

Appendix A contains two “embedded” documents. These are not included in the hard copy circulation of the papers but are available electronically on the County Council’s website. Some hard copies of the documents will be available at the meeting.

9. Family 2020 Strategy Pages 63 - 96

To consider the Family 2020 strategy, which will deliver Outcome One of the Joint Health and Wellbeing Strategy, “Giving every child in Suffolk the best start in life”.

10. Reports from Partnership Groups

Standing item to consider any specific recommendations or actions for the Board and updates from the System Leaders Partnerships (SLPs):

1. Health Scrutiny Committee 14 April 2016 2. Great Yarmouth and Waveney Joint Health Scrutiny Committee 15 April 2016 3. West Suffolk System Forum 4. Integrated Care Network Forum – Ipswich and East Suffolk Pages 97 - 98 5. Great Yarmouth and Waveney System Leaders Partnership 6. Safe and Strong Communities Group Pages 99 -100 7. Local Health Resilience Partnership

11. Information Bulletin Pages 101 - 112 To receive reports, for information only, on:

1. Update from Great Yarmouth and Waveney 2. Update from integration programmes – Ipswich and East Page 101 and West Suffolk Page 103 3. Suffolk Workforce Forum 4. Suffolk Better Care Fund Plan 2016/17 Page 104 5. Local Digital Roadmap – Approval to Submit Page 105 6. Update on the Poverty Strategy Page 106 7. Creative Heritage in Mind; mental health Page 108 8. Suffolk’s Year of Walking Page 109 9. The District Council contribution to public health: a time of Page 109 challenge and opportunity, a report by The King’s Fund Page 110 10. Easy Read version of the Joint Health and Wellbeing Strategy Refresh document Page 112 12. Urgent Business

To consider any other item of business which, in the opinion of the Chairman, should be considered by reason of special circumstances (to be specified in the minutes), as a matter of urgency.

13. Dates and Topics for Future Meetings

To note the following dates and topics for future meetings of the Board. (All dates are subject to confirmation at the Annual Meeting of the County Council on 26 May 2016.)

Date, Time and Venue Key Themes to be considered Thursday, 21 July 2016  Reports from Scrutiny Committees and Key Messages 09:30 – 11:30am from other partnership groups, including: Endeavour House,  Great Yarmouth and Waveney System Leaders Ipswich Partnership  Integrated Care Network Forum (Ipswich and East Suffolk)  West Suffolk System Forum  Strong and Safe Communities Group for Suffolk  Local Health Resilience Partnership Update  System Transformation Programmes, including Better Care Fund (BCF) update  Sustainability and Transformation Plans update(s)  Volunteering Strategy Action Plan  Report and presentation on ‘Strengthening Commissioning for Physical Activity and Sport in Suffolk: Mental Health and Wellbeing’ (to be confirmed) Information Bulletin Progress reports on the implementation of the integration of Suffolk`s health and care review (may be incorporated into BCF update) Healthwatch Suffolk Annual Report (to be confirmed) Progress update on Adult and Community Services Systems Transformation Programme Update on Transformation Challenge Award Thursday, 8 September  Reports from Scrutiny Committees and Key Messages 2016 from other partnership groups, including: 09:30 – 11:30am  Great Yarmouth and Waveney System Leaders Riverside, Lowestoft Partnership  Integrated Care Network Forum (Ipswich and East Suffolk)  West Suffolk System Forum  Strong and Safe Communities Group for Suffolk  Local Health Resilience Partnership Update  Data and long term results from Beat the Street  Quarterly Outcome Monitoring Reports  Quality systems/Commissioning  Suffolk’s Information and Intelligence Assets  Hidden Harm/Domestic Abuse (to be confirmed) Information Bulletin Progress reports on the implementation of the integration of Suffolk`s health and care review Annual Update on Health Protection Assurance

Thursday, 17 November  Reports from Scrutiny Committees and Key Messages 2016 from other partnership groups, including: 09:30 – 11:30am  Great Yarmouth and Waveney System Leaders Endeavour House Partnership Ipswich  Integrated Care Network Forum (Ipswich and East Suffolk)  West Suffolk System Forum  Strong and Safe Communities Group for Suffolk  Local Health Resilience Partnership Update  Poverty Strategy  Annual Report of the Director of Public Health  Annual Report of the Local Safeguarding Children Board  Annual Report of the Suffolk Safeguarding Adults Board  Annual Report of the Health and Wellbeing Board Information Bulletin Progress reports on the implementation of the integration of Suffolk’s health and care review

Access to Meetings

Suffolk County Council is committed to open government. The proceedings of this meeting are open to the public, apart from any confidential or exempt items which may have to be considered in the absence of the press and public. For more information about this meeting, including access arrangements and facilities for people with disabilities, please contact Democratic Services on: Telephone: 01473 260771; Email: [email protected]; or by writing to: Democratic Services, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk IP1 2BX. Public Participation in Meetings Members of the Public who wish to speak at the Suffolk Health & Wellbeing Board meeting should read the following guidance: www.suffolk.gov.uk/council-and-democracy/the-council-and-its-committees/apply-to-take- part-in-a-public-meeting and complete the online form: www.suffolk.gov.uk/apply-to-speak Filming, Recording or Taking Photographs at Meetings Further information about the Council’s procedure with regard to the filming, recording or taking of photographs at meetings can be found at: http://www.suffolk.gov.uk/assets/suffolk.gov.uk/Your%20Council/Decision%20Making/201 4-06-09%20Filming%20at%20Meetings%20Protocol.docx

Evacuating the building in an emergency: Information for Visitors If you hear the alarm:

1. Leave the building immediately via a Fire Exit and make your way to the Assembly point (Ipswich Town Football Ground). 2. Follow the signs directing you to Fire Exits at each end of the floor. 3. Do not enter the Atrium (Ground Floor area and walkways). If you are in the Atrium at the time of the Alarm, follow the signs to the nearest Fire Exit. 4. Use the stairs, not the lifts. 5. Do not re-enter the building until told it is safe to do so.

Deborah Cadman OBE Chief Executive

Unconfirmed Suffolk Health and Wellbeing Board A committee of Suffolk County Council Minutes of the meeting of the Suffolk Health and Wellbeing Board held on 10 March 2016 at 9:30 am in the Conference Room, Riverside, Lowestoft Present: Suffolk County Council (SCC): Councillor Alan Murray (Chairman) Councillor Tony Goldson, Cabinet Member for Health Councillor Beccy Hopfensperger, Cabinet Member for Adult Care Councillor Gordon Jones, Cabinet Member for Children’s Services Tessa Lindfield, Director of Public Health Sue Cook, Director for Children and Young People’s Services NHS Great Yarmouth and Waveney Dr John Stammers, CCG Chairman Clinical Commissioning Group (CCG) NHS Great Yarmouth and Waveney Andy Evans, Chief Executive Clinical Commissioning Group (CCG) NHS West Suffolk Clinical Dr Christopher Browning, CCG Chairman Commissioning Groups (CCG) NHS Ipswich and East Suffolk Clinical Dr Mark Shenton, CCG Chairman Commissioning Group (CCG) Suffolk Coastal District Council and Councillor Steve Gallant Waveney District Council Babergh and Mid Suffolk District Councillor Nick Ridley Councils Forest Heath District and Councillor Robin Millar St Edmundsbury Borough Councils Healthwatch Suffolk Andy Yacoub Police and Crime Commissioner Tim Passmore Chief Constable Gareth Wilson Suffolk’s Voluntary and Community Nicola Bradford Sector Congress

The Chairman welcomed representatives of ‘providers’, guests and observers as follows: Barbara Buckley, Medical Director, Ipswich Hospital Trust Sue Watkinson, Director of Operations, James Paget Hospital Trust Mark Hardingham, Chief Fire Officer John Lewis, Assistant Director, Adult and Community Services

The Chairman congratulated the Director and the officers of Children and Young People’s Services, together with all partner organisations, on the fact that Suffolk’s 7

Children’s Services had achieved an overall effectiveness rating of “Good” as a result of a recent Ofsted inspection. (Further details were included in the Information Bulletin at Agenda Item 12.) He also congratulated members and partner organisations on the following achievements:  The Sole Bay Health Centre, Southwold, had achieved an overall “Outstanding” rating from the Care Quality Commission.  West Suffolk CCG had won a national award for collaboration at the NHS Leadership Awards for their multi-agency work to support care home residents and their families.  Councillor Robin Millar, who represented Forest Heath District and St Edmundsbury Borough Council on the Board, had recently been elected to the County Council. Members noted with regret that Anna McCreadie, Director of Adult and Community Services, was not present due to sickness. This would have been her last meeting as a Board member, as she had resigned her post. The Chairman paid tribute to the important role she had played in shaping partnership work in Suffolk, and the meeting recorded its thanks to her for her very significant contribution to the work of the Board. 53. Public Participation Session There were no applications to speak in the Public Participation Session. 54. Apologies for Absence and Substitutions Apologies for absence were received from: Charlie Adan, Deborah Cadman; Julian Herbert; Councillor Neil MacDonald, Anna McCreadie; Tony Rollo (substituted by Andy Jacoub); and Carole Theobald. 55. Declarations of Interest and Dispensations There were no declarations of interest or dispensations. 56. Minutes of the Previous Meeting The minutes of the meeting held on 28 January 2016 were confirmed as a correct record and signed by the Chairman, subject to an amendment to Minute No. 45 (b), sixth bullet point, so that the first sentence should read: “At the invitation of the Chairman, Councillor Terry Clements spoke about the need to understand the pathways service users might follow, and to enlist the support of the voluntary sector in providing better signposting to help people understand the way in which an active life style could promote mental health.” 57. Lowestoft Out of Hospital Team a) Andy Evans introduced Debbie Coe, Team Manager, and Jason Peek, Area Allocations Co-ordinator, who gave a presentation about the work of the Lowestoft Out of Hospital Team. b) In the ensuing discussion, the following were among the points noted:  Members praised the work of the Out of Hospital Team and supported the aims of the initiative, which were: to provide rapid response crisis intervention; to keep people at home; to provide access to beds with care; and to facilitate early discharge from hospital. 8

 A member expressed the view that statistics for admissions to the James Paget Hospital in Gorleston and the Patrick Stead Hospital in Halesworth suggested the closure of community hospitals was premature. However, other members pointed out that: the Great Yarmouth and Waveney CCG was only two-thirds of the way through its system change, and therefore it was too early to judge the full effects; and the changes were being made in the context of an increase in the ageing population.  The Board noted that the new ways of working introduced by the Out of Hospital Team were not primarily driven by the need to save money. Nevertheless, a rigorous Treasury model of how to estimate savings in this area supported the approach.  It was intended to extend the principles of the Lowestoft Out of Hospital Team work to other areas of Great Yarmouth and Waveney. Learning from the initial work included: there was a need to introduce more social care and more mental health care into the services offered; and that arrangements would need to be varied across the area according to the size and nature of the communities concerned.  There could be further opportunities to involve the charitable sector and the Suffolk Fire Service in assisting the Out of Hospital Team.

58. Joint Health and Wellbeing Strategy (JHWS) – priorities for action a) Tessa Lindfield introduced a report at Agenda Item 6, proposing a mechanism for the Board to focus on the delivery of a small number of priorities in 2016/17, yet still be confident that the system was delivering the JHWS outcomes as part of core business. She explained that since the report had been circulated to the Board there had been further developments with regard to the Sustainability and Transformation Plans (STPs) being produced by the NHS (referred to in the report at Agenda Item 9), therefore there was a need to amend the recommendations set out in the report. b) Sara Blake, Head of Localities and Partnerships, Public Health, gave a presentation to enable the Board to: agree action planning and reporting arrangements for the refreshed JHWS; and respond to initial feedback from a recent “Health in All Policies (HiAP)” peer review (referred to in the Information Bulletin at Agenda Item 12). c) In the ensuing discussion, the following were among the points noted:  The HiAP review had recommended fewer priorities and indicators, and greater emphasis on the wider determinants of health, such as housing, employment and education. It had also recommended that the Board should focus more of its attention on the cross- cutting themes of health and care integration, addressing inequalities, embedding the prevention of ill health and developing stronger, resilient communities.  The CCGs were now required to produce STPs. These would in effect be action plans for the cross-cutting themes. For Ipswich and 9

East and West Suffolk, the vision of the STP was the same as that of the JHWS, and the Suffolk Health and Wellbeing Board would oversee its delivery. The Waveney area would be included in a Norfolk and Waveney STP, and it was acknowledged that there would need to be strong links with the STP for Ipswich and East and West Suffolk.  It was suggested that for each of the four JHWS Outcomes there should be a sub-partnership group, which should be responsible for ensuring that action was being taken to achieve the Outcome. The sub-partnership group should bring key issues to the Board only when strategic intervention was required, for example if problems needed to be unblocked.  The view was expressed that the sustainability of the NHS in Suffolk was dependent on the JHWS because of the importance of prevention in reducing demand for services. Members recognised that they would need to address the difficult question of how to bring about changes to behaviours which in themselves were non- clinical and yet had a profound effect on the health of the public.  There was general support for a small number of priorities explained in plain English, so that they could be communicated clearly to the residents of Suffolk.  The Voluntary Sector Congress fully supported the suggestion that the Board should focus more of its attention on the wider determinants of health, particularly prevention. The Congress did not consider that at present the public sector in Suffolk was making best use of available voluntary sector resources. This view was echoed by other members of the Board. Decision: The Board agreed: i) That it supported in principle the alignment of the Sustainability and Transformation Plans and the Joint Health and Wellbeing Strategy. ii) That the Board’s main roles should be to enable better partnership working across the public system in Suffolk and to unblock problems at a strategic level. iii) That the role of overseeing the delivery of the Joint Health and Wellbeing Strategy Outcomes should be devolved to the Board’s sub- partnership groups. The Board would maintain a ‘light touch’ oversight of these groups. iv) That the Board should focus on a limited number of issues which would particularly benefit from Board leadership and oversight. These should be capable of being explained simply. v) That officers should continue to develop the approach outlined above and bring to the Board at its meeting on 12 May 2016:  Further details about the Sustainability and Transformation Plans for Suffolk and how they would be aligned with the Joint Health and Wellbeing Strategy.

 Firm proposals for a limited number of actions which the Board should focus on in the future, explained in simple terms and supported by concise evidence.  Proposals as to how the Board would maintain oversight of Joint Health and Wellbeing Strategy delivery in a light touch manner. vi) That subsequently the Board should review its membership and that of the Programme Office.

Reason for Decision: The alignment of the STPs and the JHWS was seen as offering great potential to create a plan which could be owned by the whole of the public sector system in Suffolk, and against which partner organisations could hold each other to account. Members considered that allowing the Board’s sub-partnership groups to oversee the detailed delivery of the wider JHWS outcomes would allow the Board to concentrate on its strategic role whilst giving it confidence that the wider JHWS outcomes would be delivered as part of the core business of partners. Members recognised that focussing on a limited number of priorities at any one time would be in accordance with the recommendations of the recent Health in All Policies peer review, and would enable the Board to communicate a clear and relatively simple message to the residents of Suffolk. It was acknowledged that refining the role of the Board and focussing on a small number of priorities could mean that the current membership of the Board and the Programme Office became inappropriate. Therefore it was agreed to review this issue at a later date. Alternative options: None considered. Declarations of interest: None declared. Dispensations: None noted.

59. The Time is Now: A prevention strategy for Suffolk to reduce demand in the health and care sector by improving health : 2016 - 2021 a) Tessa Lindfield introduced a report at Agenda Item 7, setting out a strategy and action plan aiming to decrease demand in the health and care sector in the short and medium term by improving healthy life expectancy. b) Amanda Jones, Assistant Director of Public Health presented the strategy and action plan. She explained that they had been developed by a multi-agency group using the evidence base contained in the 2015 Annual Report of the Director of Public Health and built on in a recent Health and Wellbeing Board workshop session. The strategy did not include mental health or child health, nor those interventions that would take more than five to ten years to impact on health.

c) Copies of a final version of the Strategy and Action Plan were available at the meeting, and it was intended that in due course an “easy read” version would be made available online. d) In discussion of this item, the following were among the points raised by members:  Amendments to the strategy and action plan were suggested as follows:  the early detection of cancer should be included in Priority 1;  the detection and management of Chronic Obstructive Pulmonary Diseases (COPD) should be included in the action plan;  there should be greater emphasis on the importance of strengthening the role played by families in preventing ill heath, promoting wellbeing and increasing community resilience.  Most of the interventions outlined in the report had a positive return on investment, but as demand and demographic pressures were rising, might not lead to any monetary saving. Some entailed no extra cost and would be implemented at an early stage. In other cases, whilst the system as a whole would benefit from a proposed action, there would be a cost to one of the partners. Members expressed concerns about how the necessary resources were to be found.  Members acknowledged that there was an inherent difficulty in attempting to transform the system when there was no new money available in the public sector. However, some potential existing sources of funding were suggested, such as the Transformation Challenge Award, the STP transformation fund, and methods of introducing outside capital.  The Voluntary Sector Congress was aware of examples of interventions already underway which matched the priorities outlined in the report but which were no longer being funded. They considered there was a risk that resources could be lost which would be expensive to reinstate. Decision: The Board: i) Subject to the amendments set out in (ii) below, agreed the strategy (to be named “The Time is Now”) as set out in Appendix A to the report at Agenda Item 7, with the following three priorities:

Priority 1: Improve early detection and treatment of hypertensions, atrial fibrillation, chronic obstructive pulmonary disease, diabetes and “frailty” Priority 2: Improve direct and indirect support to those who wish to change their lifestyle Priority 3: Create Community and Personal Capacity and enhance Community and Personal Resilience. ii) Agreed that the following amendments should be made to the strategy and action plan set out in Appendix A to Agenda Item 7: a. improving the early detection of cancer should be included in Priority 1; b. the detection and management of Chronic Obstructive Pulmonary Diseases (COPD) should be part of the year 1 and 2 action plan; c. there should be greater emphasis on the importance of strengthening the role played by families in preventing ill heath, promoting wellbeing and increasing community resilience. iii) Agreed the 2016-2018 action plan as set out in Appendix A to Agenda Item 7 with the amendments set out in (ii) above. iv) Agreed to provide leadership for delivery across the system. v) Agreed that the “cross-cutting” leads for prevention (Board members and officers) would coordinate overall delivery and report progress to the Board. vi) Agreed that there would be Board level support to the officer leads who would coordinate multi-agency delivery of the three priority areas in the action plan. The officer leadership was agreed as follows: Priority 1: Jep Ronoh, Consultant in Public Health, Public Health Suffolk Priority 2: Lynda Bradford, Head of Health Improvement (adult), Public Health Suffolk Priority 3: Davina Howes, Head of Families and Communities, Forest Heath District and St Edmundsbury Borough Councils The specific Board level support to the officer leads would be agreed at a later date. vii) That officers would report back to the Board on any strategic problems encountered in implementing the plans.

Reason for Decision: The Board considered that the actions agreed would commit the system to working towards delivery of the prevention strategy and the embedding of evidence based approaches to decrease demand in the health and care sector by improving health. Members were broadly content with the strategy and actions, but they wished to see greater emphasis on the early

detection of cancer, the detection and management of COPD and support for the family because of their significant impact on health and wellbeing. Members recognised that there was still a considerable amount of work to be done to develop a financial modelling plan for the implementation of the prevention strategy. Lead agencies would need to be responsible for co- ordinating financial plans. Alternative options: None considered. Declarations of interest: None declared. Dispensations: None noted.

60. Update on aspiring to a tobacco-free Suffolk Councillor Tony Goldson, Chairman of the Tobacco Control Alliance, introduced a report at Agenda Item 8, providing an update on progress made since the Board had endorsed the Aspiration to a Tobacco Free Suffolk on 26 March 2015. Mary Orhewere, Consultant in Public Health, presented the report and answered members’ questions. Decision: The Board agreed: i) To note the progress made towards a tobacco free Suffolk and endorse the actions planned. ii) To support particular focus on reducing pregnant smokers. Reason for Decision:

The Board recognised that significant progress had been made in many areas. For example, the Tobacco Control Alliance had been re- established, there had been a successful prosecution of a pub landlord who had allowed smoking in designated smoke-free places, and progress had been made in protecting people from second hand smoke.

However, members were aware that across Suffolk an average of one in ten pregnant women was a smoker. They acknowledged that this statistic reflected the national picture, but agreed that a concerted effort was required to reduce the proportion of pregnant smokers. Alternative options: None considered. Declarations of interest: None declared. Dispensations: None noted.

61. Suffolk System Transformation Programmes a) At Agenda Item 9 the Board considered a report providing an overview of the activity currently underway to deliver integrated health and care in Suffolk. Andy Evans spoke briefly about the Sustainability and Transformation Plans which had already been discussed in some detail in relation to Agenda Item 6 (see Minute No. 58 above). b) Jo Cowley, Programme Manager, Health and Social Care Integration, gave a presentation about the Better Care Fund. 14

c) The following were among the points noted with regard to this item:  The 2015/16 Better Care Fund Plan had included an element of payment for performance, but the required performance had not been achieved. Officers were asked to research whether any area in the country had been successful in obtaining payment for performance, and if so, how they had achieved this.  The 2016/17 Better Care Fund Plan was due to be submitted to the Government by 25 April 2016, and at its meeting on 28 January the Board had agreed to delegate authority for its final approval. (Minute No. 47 refers.) The draft submission would be circulated to all Board members for comment. Decision: In relation to the Report at Agenda Item 9, the Board: i) Noted the development of the Better Care Fund 2016/17 and engagement with key partners. ii) Noted the quarter 3 return for the Better Care Fund 2015/16. iii) Noted an update from the Suffolk Workforce Forum. iv) Agreed that the Board’s Terms of Reference should be amended to include the following: “To have responsibility for the oversight and agreement of the Better Care Fund Plan in Suffolk.” Reason for Decision: Members recognised that the Health and Wellbeing Board played an important part in the leadership of integrated care in Suffolk. The Board had responsibility for agreeing and overseeing the Better Care Fund for Suffolk, but this was not reflected in its current Terms of Reference. Alternative options: None considered. Declarations of interest: None declared. Dispensations: None noted.

62. Personal Health Budgets – Local Offer a) Jan Thomas, Chief Contracts Officer, Ipswich & East and West Suffolk CCGs, presented a report at Agenda Item 10, setting out the approach being adopted by those CCGs in order to develop the local offer for Personal Health Budgets in and beyond continuing healthcare. b) Andy Evans presented a paper which was circulated at the meeting, setting out the way in which the Great Yarmouth and Waveney CCG proposed to roll out Personal Health Budgets to a population wider than NHS Continuing Healthcare patients. c) In the ensuing discussion, the following were among the points noted:  The Board welcomed the proposals outlined, but members were aware that some of the patients involved would have very complex needs, and there would be many practical difficulties to overcome.

 Members were pleased to learn that in developing their proposals, the CCGs were committed to co-creating the local offer with service users. The CCGs confirmed that they were keen to learn from the experience of others. The Board noted that Adult and Community Services already had experience of offering personal budgets, and Healthwatch could provide access to learning from other authorities. Members agreed that it was important to take the opportunity to align the new arrangements with personal budgets for children, such as those with Special Educational Needs. Decision: The Board agreed: i) To support the approaches set out in the paper at Agenda Item 10 and in the paper tabled by the Great Yarmouth and Waveney Clinical Commissioning Group. ii) To align the clinical commissioning groups’ work plans with the Joint Health and Wellbeing Strategy 2016 – 2020. Reason for Decision: The Board was satisfied with the way in which the Suffolk clinical commissioning groups proposed to develop mechanisms for giving Suffolk residents more direct control over the care they received from the NHS through the option of having a Personal Health Budget or an Integrated Personal Budget. Alternative options: None considered. Declarations of interest: None declared. Dispensations: None noted. 63. Reports from Scrutiny Committees and other Partnership Groups

The Board received an update on the Safe and Strong Communities Group at Agenda Item 11d. 64. Information Bulletin The Board received an Information Bulletin at Agenda Item 12. 65. Urgent Business There was no urgent business. 66. Dates and Topics for Future Meetings The Board noted: a) the dates, venues and topics for future meetings as set out on the agenda sheet; and b) that the next Board meeting would take place on Thursday, 12 May 2016 at Endeavour House, Ipswich.

The meeting closed at 12:52 pm. 16

Agenda Item 7

Suffolk Health and Wellbeing Board A committee of Suffolk County Council

Report Title: Health in All Policies

Meeting Date: 12 May 2016

Chairman: To be confirmed

Board Member Lead(s): Tessa Lindfield, Director of Public Health Sara Blake, Head of Localities and Partnerships Author: Email: [email protected]

What is the role of the Health and Wellbeing Board in relation to this paper? 1. To consider the feedback from the Health in All Policies (HIAP) review in the context of the Health and Wellbeing Board (HWB) and consider a response. Key questions for discussion: 2. The key questions for discussion are: a) Does the feedback from the Health in All Policies review resonate with your experience of the Board? b) What are the positives that the Board should build from? c) What are the areas of improvements for the Board and what action needs to be taken to make the suggested improvements? What actions or decisions is the Board being asked to take? 3. The Board is asked to note the feedback and consider this as part of the informal partnership meeting which will be considering the form and function of the Board going forward.

Brief summary of report 4. The World Health Organisation and Public Health England are keen to see the Health in All Policies programme embedded across the UK. The programme is designed to build capacity to promote, implement and evaluate health and wellbeing, encourage engagement and collaboration across the sectors and facilitate the exchange of experiences and lessons learnt. 5. Suffolk County Council agreed to be part of a pilot programme working with the Local Government Association (LGA) to develop its approach. The aim of the paper is to highlight the feedback from the Health in All Policies Review and for the Board to give consideration to those elements which relate to the role of the Board in particular.

Main body of report Background 6. Earlier in the year Suffolk County Council agreed to take part in a pilot LGA peer review programme looking at how well the local authority has been able to embed health in its policies, decision making and delivery of its services. 7. As a two tier local authority area the role of boroughs and districts and indeed the wider partnership of the Health and Wellbeing Board was seen as a critical part of the system and so the peer review was extended to include other public and voluntary and community sector organisations. Approach

8. The peer review programme focussed on four key lines of enquiry: a) Does the Council and Health and Wellbeing Board have a clear vision and ambition for health and wellbeing? b) How well does the Council enable others to improve health? c) Is the Council making a sustainable impact on health outcomes? d) Is the Council using its resources to best effect to improve health? 9. In the Position Statement which was prepared locally in advance of the peer review, Suffolk County Council also requested that the team examine and challenge us to help stretch our thinking and ambition in the context of devolution and system wide change and specifically welcomed ideas on how we could measure the impact of the HWB more effectively. 10. In total the two day programme included 24 sessions and involved contributions from 116 people from across the Suffolk system. Initial feedback

10. Initial feedback provided by the team and the conclusion of day two included the following headline messages: a) Lots of goodwill, real enthusiasm and aspiration for Suffolk and its people – you live here, you work here you ARE Suffolk. b) The Council and its partners need to be clear about what needs to be achieved for Suffolk (place and people) and build greater trust amongst key players in order to be ready for devolution, opportunities and challenges. c) To embed HWB business across the system, traction with key organisations is needed through: i) negotiation and influencing (informal); ii) priorities becoming the day job; iii) mechanism for holding named individuals to account; iv) praise and acknowledge for achievements. d) To measure health and wellbeing impact it would be helpful to have fewer and more focused indicators recognised across the system and a greater use of personal stories to bring impact to life.

Formal feedback

11. Attached at appendix A is the formal feedback letter from the Peer Review Team. Peer Review Recommendations

12. The Peer Review made two sets of recommendations. The first are specific to Suffolk County Council and the second relate to the HWB. Recommendations for Suffolk County Council 13. The peer review team recommended that in order to further embed health in all policies within Suffolk County Council, the council should: a) Use the business planning process to ensure all parts of the Council are explicit about their contribution to health and wellbeing b) Improve accountability for health improvement by including specific objectives as part of senior staff contracts and appraisal c) Improve still further its use of resources towards the health agenda by: i) making more explicit use of Locality Grants to support the health agenda; ii) engaging councillors more in the health and wellbeing agenda so they are better supported to fulfil their community leadership role – using refreshed ward profiles to stimulate local priorities and action; iii) improving the accountability arrangement for money devolved to Districts and Boroughs to improve health. Recommendations for the Health and Wellbeing Board 14. The second set of recommendations are aimed at the partnership working of the HWB. They recommend the following for consideration: a) build greater trust amongst key players to deliver the required outcomes; b) use jointly shared targets and other mechanisms to ensure that Health and Wellbeing Board business has traction across the system to deliver required outcomes; c) develop a shared SMART dashboard of key indicators for prevention, ideally with targets. Actions/decisions recommended 15. That the Board consider how it responds to the three recommendations within the HIAP feedback. Why this action/decision is recommended 16. To ensure effective delilvery of the refreshed HWB Strategy for Suffolk, making best use of resources of the Suffolk system. Who will be affected by this action/decision? 17. HWB stakeholders and Suffolk residents.

Sources of further information

No other documents have been relied on to a material extent in preparing this report.

Agenda Item 7 Appendix A

Cllr Colin Noble, Leader of the Council Deborah Cadman OBE, Chief Executive Suffolk County Council Endeavour House 8 Russell Road Ipswich IP1 2BX

February 2016

Dear Colin and Deborah,

Suffolk County Council Health in All Policies (HiAP) Peer Support 22 & 23 February 2016

On behalf of the peer team, I would like to say what a pleasure and privilege it was to be invited into Suffolk County Council to deliver Health in All Policies peer support and to thank you for participating in the pilot programme and contributing to its evaluation. The offer is based on the principles of sector led improvement and delivered by elected member and officer peers.

The peers who delivered the peer support were:

 Nick Hodgson, LGA Associate  Cllr Philip Corthorne, Cabinet Member Adult Social Care, Health and Housing, London Borough of Hillingdon  Deb Watson, LGA Associate  Paula Boyce, Director of Community Services, South Norfolk Council  Kay Burkett – Programme Manager, Local Government Association  John Tench - Advisor, Local Government Association

Background and Introduction to the HiAP peer support offer

The Health in All Policies peer support has been developed by the Local Government Association, the Association of Directors in Public Health and Public Health England to help councils work out how they can accelerate the good progress made to date on addressing the wider determinants of health and the extent to which they are maximising the impact of all policies and services in keeping people healthy and tackling health inequalities. Getting the best return on investment from ever tighter local authority budgets will become increasingly important in the coming years. Adopting healthy policies, investing in effective prevention programmes, strengthening early intervention and building on community assets will be critical for councils and their partners.

The focus of the peer support is primarily on the role of the council and as part of that, considers how the council is acting as a leader for public health in the wider system. The headline questions used during the visit were:

1. Does the Council have a clear vision and ambition for health and wellbeing? 2. How well does the Council enable others to improve health?

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3. Is the Council making a sustainable impact on health outcomes? 4. Is the Council using its resources to best effect to improve health?

In addition to these headline questions, you also asked us to consider the following issues during the peer support visit:

1. How can the Council further embed HWB business across the Suffolk system? How can we get greater buy-in and the drive that the HWB needs? 2. How can the Council and partners realise the potential opportunities for health that devolution could bring? 3. How best could the HWB measure its performance and impact?

Whilst these issues were not considered separately, the peer team were keen to offer some thoughts on them. Comments relating to these issues are included below as appropriate within our feedback on the four headline questions.

Prior to the two-day on-site visit, background reading was undertaken by the peer team including key documents, an online questionnaire and self-assessment in the form of a Position Statement. The Council drew up a timetable of on-site activity with interviews and workshops.

The peer team were made to feel welcome and were impressed with the level of engagement from within the Council and from partners that resulted in 1½ days: 24 sessions and discussions with 116 people including elected members, staff and partners. Our thanks are extended to all participants and to those in the Public Health Team who co-ordinated the process with efficiency and helpfulness.

Headline messages

The peer team experienced a very high level of goodwill among everyone involved in the peer support visit along with a real enthusiasm and aspiration for Suffolk and its people. The majority of people we met live in Suffolk and there was a palpable sense of people’s personal investment in all that the council has to offer - this is a real strength in achieving your ambitions for the health and wellbeing of the population.

There is clear understanding in Suffolk that improving population health is never a quick fix and that the health and wellbeing of the population will require more airtime as part of wider place- based strategic discussions such as those for devolution arrangements. In light of this, we acknowledge the ambition, tenacity and bravery shown by strategic leaders within Suffolk County Council in going for the prevention agenda as a priority within Suffolk and on a wider footprint.

The recent refresh of the Health and Wellbeing Strategy and particularly the recently developed Prevention Strategy help to establish a clearer understanding about what needs to be done but there is still a sense among staff and partners that there are too many priorities. The Council and partners need to be clearer about the actions required in the short, medium and long-term for population health and prevention outcomes to be realised. Continuing to build trust amongst key players will be important in order to focus everyone’s energy and capacity and in order to be ready for the opportunities and challenges arising from devolution.

22 Agenda Item 7 Appendix A

To go to the next stage, further embedding the health of the public across the council and wider system and gaining more traction with key organisations, the following will be required:

 The Joint Health and Wellbeing Strategy will need to be seen by all partners as the overarching strategy for the wellbeing of the population so that all other plans and activities with an impact on health are developed in light of the strategy  The creation of more informal opportunities for negotiation and influencing, as well as using formal mechanisms to understand, discuss and agree the prevention investment that is required  Health and wellbeing priorities must become part of the day job for all relevant external partners and across all departments of the Council  Develop a mechanism for holding named individuals to account for their delivery of health related objectives and an active culture of praise and acknowledgment of individual and team achievements to celebrate the good work that is taking place  Greater use of the personal stories you have started to articulate in order to be clear about the impact and benefits of individual and joint efforts in relation to prevention and for shared learning about what works

We hope the suggestions in this letter will be helpful in addressing these.

Does the Council have a clear vision and ambition for health and wellbeing?

There is an obvious drive and passion for improving the health of the population in Suffolk and this was clearly evident in our discussions with senior leaders across the Council and other partners. There is also a clear determination to incorporate the health and wellbeing agenda alongside economic growth and other key local priorities for joined-up delivery as a key part of the devolution deal currently being negotiated for Suffolk and neighbouring areas.

There is a strong history of health needs analysis and assessment in Suffolk and this has resulted in a comprehensive compendium of web-based health needs data as well as published documents such as the State of Suffolk Report and Director of Public Health Annual reports. The technical work on the Joint Strategic Needs Assessment (JSNA) and good interpretation of Suffolk’s data is a clear strength and this has underpinned the development of the Suffolk Health and Wellbeing Strategy, alongside a programme of local engagement.

The Health and Wellbeing Strategy was recognised and cited by most of the people we spoke to and the strategy was seen by many as capturing the Council’s own vision and ambition as well as the ambition of other wider Health and Wellbeing Board partners. Some, but not all of the Health and Wellbeing Strategy’s objectives and themes are noted as being reflected in Suffolk County Council’s own corporate priorities. This is important because some Council middle managers view the Council’s published corporate priorities as being the main drivers of their plans and actions i.e. more so than the Health and Wellbeing Strategy itself. Therefore, you may want to reflect on this in terms of increasing the buy-in to this agenda within the Council. You may also want to consider having a systematic means of considering health- related opportunities and impacts as part of the Council’s general decision-making processes, beyond health impact assessments.

The four broad cross-cutting themes of the refreshed Health and Wellbeing Strategy were widely recognised although some people did not understand the rationale for the recent change to Outcome Two and worried that, as a result of the strategy re-fresh, the main elements of the previous Outcome Two (access to a healthy environment and helping the majority of working age adults to maintain or improve their health) might now be seen as less strategically

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important. In terms of mental health, it was good to hear that Outcome Four is a live and visible issue among Council staff who reported a focus on staff mental wellbeing. A positive example of this was that the agendas for one-to-one supervision meetings routinely include consideration of stress, work/life balance and working conditions.

The recently developed ‘Prevention Strategy for Suffolk’ is a clear and well-structured plan for embedding prevention initiatives and actions that will have an impact on health and care demand in the next 5 to 10 years. This was seen as a real strength because there is a clear rationale for it based on the population’s health needs through to the three priorities of (a) early detection and treatment of modifiable underlying causes of ill health, (b) improving support to those who wish to change their lifestyle and (c) creating community capacity. Based on the evidence presented in the 2015 Director of Public Health’s Annual report, the Prevention Strategy includes priorities for action across a range of organisations and settings. If this is used to really focus and manage activity in Suffolk, it can be expected to increase clarity about priorities for short to medium term impact as well as increasing traction and delivery across the system. This is undoubtedly a helpful development in a context that was reported as having too many priorities across the system and in which it was suggested that the themes of the refreshed Health and Wellbeing Strategy are now so broad that almost anything might be argued to be a priority.

On the back of the Prevention Strategy, there is an opportunity to increase traction on the health agenda across the Council and the wider system. An obvious example would be to develop a small number of core SMART tangible outcomes or targets which articulate what progress is required in this aspect of the health and wellbeing strategy and over what timeframe. This can then be used to hold relevant parts of the Council and partners to account for their delivery of the plan. This approach might also usefully be used to clarify and focus the action plans to be developed for other aspects of the Health and Wellbeing Strategy more generally, avoiding unwieldy monitoring and reporting mechanisms which use up a great deal of capacity without necessarily shedding light on impact. The original Health and Wellbeing Strategy included over 50 key measures (indicators) requiring improvement but without baselines or targets being set over the 10-year life of the strategy and importantly without any apparent differentiation between them in terms of their relative importance for Suffolk. The peer team recognised that annual reporting against the indicators in the Public Health Outcomes Framework and the Adult Social Care Outcomes Framework and the NHS Outcomes Framework all provide an overview of general progress compared to other places, but it is the things that are really important to Suffolk which need to be differentiated, driven and counted carefully over time. The Council and its partners are already using personal stories to bring impact to life and a greater use of these will help to ensure that the meaning and purpose of the health and wellbeing agenda is understood at a human level.

It will be important to ensure that health needs data continues to act as a ‘rudder’ to steer the whole system strategically towards understanding and responding to local needs. Whilst average health outcomes in Suffolk tend to be similar or better than the England average, more localised analysis highlights particular health inequalities in Suffolk’s more deprived communities and trend analysis highlights the ageing population. In light of austerity, it will become increasingly important for Suffolk to take a whole system approach to tackling the considerable growth in demand for care that can be expected in the near future. This will require more tenacity and collaboration amongst all the local authorities in Suffolk and health partners to bring more prominence to the Prevention Strategy and other preventative aspects of the Health and Wellbeing Strategy and to ensure these feature strongly in the development of other plans including the Sustainability and Transformation Plans currently being developed.

24 Agenda Item 7 Appendix A

How well does the Council enable others to improve health?

In order to enable others to improve health, any local authority needs to work collaboratively, engaging and empowering others to work on solutions that are appropriate to the communities it serves. In terms of collaboration, Suffolk was described to us as being on a journey of improving partnership relationships, partly driven by current devolution discussions but also by the necessity caused by austerity and financial pressures. We heard that previous organisational silos in Suffolk have changed in recent years and partnership relationships have become more open and engaged, supported by the maturing partnership approach modelled by current key leaders. We also heard that whilst formal partnerships are improving, there is relatively little focus on actively building informal relationships of trust and confidence between people despite the fact that many staff in Suffolk County Council and partner organisations often live and work in Suffolk over many years. In these circumstances and in the current climate, it may be possible to build on the current journey of improvement and to develop a sense of a single team for Suffolk.

Suffolk County Council is clearly well-placed to lead the development of both formal and informal mechanisms for senior leaders to share information and perspectives about the financial and service pressures they face. In sharing ideas and emerging plans, it will also be important to share briefings about the potential implications of plans. One example is the briefing of MPs so that they are fully aware of the prevention agenda, understand why prevention activities in some cases need to be prioritised over more acute activities and understand that prevention and early intervention can change the ‘shape’ of care services needed in future (e.g. less acute care but more community based care, less high cost residential care but more people living more independently for longer, with smaller packages of care at home, etc). It is important for key influencers such as MPs to understand the rationale for prevention as well as the implications of preventative activity in order to ensure that their public messaging actively supports this type of strategic change.

In terms of mechanisms for actively developing relationships, it was suggested to us that one opportunity might be harnessing the potential of the Suffolk Congress to strengthen the network of informal relationships. There is also an opportunity to rationalise formal partnership structures in Suffolk which are currently seen as somewhat complicated with potential for duplication, confusion and insufficient connectedness. One person referred to “lots of disparate parties, both internal and external” to the Council. Several people also referred to the difficulty of understanding the language and cultures of other partners in formal partnership contexts and the unintended barriers created by professional and technical language.

Whilst purposeful working relationships seem to be common at middle management level and often span many years in Suffolk, there is clearly an opportunity to strengthen the network of informal relationships at this level that might promote even greater engagement and trust among partners as well as a shared understanding of the challenges facing the population, potential solutions and a greater sense of the finite total resource available across the public sector in Suffolk.

As noted in the section above, there is a real enthusiasm for health to be part of Suffolk’s devolution arrangements, signalling the growing level of trust between people at an overarching strategic level. Equally, we heard about examples of strengthening partnership work at a very local operational level where Locality Teams are co-locating and working more coherently

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together in ‘Connect’ integration pilot sites in areas of particular health need. The importance of creating community capacity and resilience is a theme within the HWS and specific actions have been developed as part of the Prevention Strategy which is an obvious strength.

We were also pleased to hear about a number of local initiatives and interventions which are harnessing the skills and enthusiasms of local people, e.g. Care Farms, Men’s Sheds, as well as large-scale cross-county movements such as the Most Active County initiative which is embracing the many local residents taking part. The roll out of the training for Making Every Contact Count (MECC) to the staff of partner organisations as well as Council staff was also seen as a strength and a systematic means of enabling a large group of people to support healthy change. Other mechanisms could also be considered for cascading the energy and passion about health throughout the Council and on into communities e.g. including setting relevant objectives relating to health as part of staff appraisals and/or using staff awards or other methods for staff recognition for innovative practice relating to health and wellbeing.

In terms of other systematic methods of enabling others to improve health, we saw little evidence of a culture of annual business planning at departmental or team level within the Council although this approach was evident in some parts of the organisation where it was cited as having been inherited from previous organisational or managerial eras. There is therefore an opportunity to develop a new corporate approach to business planning and service planning across the council and to systematically embed considerations relating to health as an integral part of this. Community development considerations could be part of this and might also facilitate getting more of the voice of the community into service planning. Similarly, it might be possible to strengthen the positive health impacts of procurement and contracting by systematically requiring all staff leading procurements to actively consider health and wellbeing as part of the procurement and/or contracting process.

Is the council making a sustainable impact on health outcomes?

There is clearly a strong commitment to prevention and early intervention and this commitment resonates through many key people within the Council and partners. We also heard the positive news that the Council has devolved 2-year budgets for health improvement to District and Borough Councils and that these have been weighted in favour of deprivation. This is clearly an enabler of action to improve health at a more local level, although we were not able to ascertain what specific outcomes are expected as a result of these budgets. There is an opportunity to be clearer with partners about their use of these resources and the outcomes they can contribute to.

Many people we met told us about important local initiatives, successful programmes and individual case studies of good practice – there are clearly a lot of good things happening in Suffolk - but very few people were able to say what was really going well in terms of overall impact at the level of population health. Many of the Health and Wellbeing Board’s reported key achievements are about strategies, toolkits or charters being launched, key staff being recruited or grants being awarded. Any and all of these things will hopefully lead to improvements in healthy life expectancy, to a reduction in inequalities and to more people in Suffolk living healthier, happier lives in line with the Health and Wellbeing Board’s vision and aims, but it is simply too soon to say. These are still very early days in terms of the Health and Wellbeing Board and its strategy.

26 Agenda Item 7 Appendix A

Improving the health of the population will undoubtedly require a relentless focus on the causes of poor health and health inequalities as well as long term sustainable changes in the lives of individuals, communities and organisations, working through the organised efforts of society. We saw some good individual examples starting to emerge where the Council and/or partners are investing in longer term initiatives such as the development of the Local Area Co-ordination network, which is already building community capacity to identify, support and contribute to the health and wellbeing of isolated elderly. We also heard some compelling personal stories in case studies used to illustrate the human impact of community level work.

However, in order to strongly align activity on the front line, it is important to be clear about what needs to be done and more explicit about what needs to be achieved across all aspects of the strategy. Public health progress is currently tracked using a wide range of indicators, particularly PHOF indicators but the impact on many health-related interventions will not be evident for 10, 20 or even 30 years and high level population indicators are notoriously slow to change over time. As described above, there is an opportunity following the HWS re-fresh and on the back of the Prevention Strategy, to develop a small number of core SMART tangible outcomes or targets which articulate what is required and which could be used to drive and track progress across the system on the things that are most important to Suffolk.

In continuing to implement the refreshed HWS, it will be important to continue to actively target particular health interventions towards areas of real health need and, in line with the ‘equity’ principle agreed as part of the original strategy and ensure that provision of services is proportional to need. In relation to public health campaigns and messages, we saw examples of many good public health campaigns using a variety of methods e.g. poster, local radio etc and we heard that partners do endeavour to develop and implement campaigns together. However, we also heard that there is an opportunity to develop a more consistent approach to public communications in order to have maximum impact for the community and enable better use of resources. We also commend the council on the idea of appointing HWB Champions but it will be necessary to ensure that they are adequately supported to enable them to fulfil the role in a meaningful way beyond just being a Champion at HWB meetings.

Is the Council using its resources to best effect to improve health?

In general, the peer team found that the Council is making a good use of its resources towards improving health. The Council and the whole health and wellbeing system in Suffolk benefits from good public health analysis and needs assessment to guide the use of resources, including good coverage of issues in the JSNA, the State of Suffolk report and the DPH annual report.

In Suffolk, the ring-fenced public health grant has largely been protected and despite financial pressures, its use continues to be weighted towards deprivation for relevant interventions along with other resources such as the Transformation Challenge Award used for the ‘Connect’ projects for health and care integration. Some flexible use of the Public Health Grant has enabled positive innovations in other Departments of the Council such as Children’s Services and Adult Social Care, although it is important to guard against the notion that the Public Health Grant should be used to ‘buy’ engagement in health-related work by other Council departments or that action to improve health can only be achieved across the Council if funding from the Public Health Grant is provided.

The Council could become more of a ‘public health authority’ by making sure that appropriate health considerations and actions are built in to the plans for all it delivers including, for

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example, through its locality budgets, which could be required to have an explicit health dimension appropriate to the people in each locality. A strong example of health considerations being embedded in relevant County-wide plans is Suffolk’s Nature Strategy which includes a number of actions about using the natural environment to improve health. In addition, we were impressed by the Working Well for Suffolk initiative and by the Council leading the way in terms of promoting staff health and wellbeing, including developing a toolkit for wider use. We also heard about some good examples of mainstreaming preventative activity using existing assets and resources to best effect e.g. the Fire Fighter Fit gyms in fire stations.

Councillors are a huge source of local knowledge and local connections in communities and this resource could be used better by more active engagement of councillors in health and wellbeing agendas. It is still early days since the local leadership of public health was transferred to local authorities but Councillors who better understand these new public health responsibilities are better equipped to fulfil their role as community leaders for health. We heard that there are plans to refresh local ward health profiles and this, together with active support, could certainly be used to ignite interest in health issues as well as action at a very local level.

As resources become more and more scarce, it will become ever more important that the County Council’s leadership role is further developed, along with others, to ensure the best use of capacity and capability in the whole of the system. There may be more opportunities to integrate teams and budgets within the Council and with partners and there is certainly an appetite among Council staff for more cross-directorate planning and delivery of services and signposting relating to health.

The Council may want to consider developing a mechanism for sharing ideas and evidence about what works across different parts of the Council and with partners. You may also want to consider the use of priority based budgeting to try to ensure that more of the Council’s resources are used explicitly in line with the priorities of the Council rather than being based on historical budgets adjusted down in light of savings plans. Lastly, it may be possible to influence the proportion of the Council’s own expenditure that remains in Suffolk through considering the addition of appropriate local criteria in any relevant contracting and procurement processes.

Recommendations

It is recommended that in order to further embed health in all policies Suffolk County Council:

1. Uses the business planning process to ensure all parts of the Council are explicit about their contribution to health and wellbeing

2. Improves accountability for health improvement by including specific objectives as part of senior staff contracts and appraisal

3. Improves still further its use of resources towards the health agenda by:

 Making more explicit use of Locality Grants to support the health agenda  Engaging councillors more in the health and wellbeing agenda so they are better supported to fulfil their community leadership role – using refreshed ward profiles to stimulate local priorities and action  Improving the accountability arrangement for money devolved to Districts & Boroughs to improve health

Across the wider health and wellbeing system the following is also recommended, Suffolk County Council and its partners:

28 Agenda Item 7 Appendix A

 Develop a clearer shared view about exactly what needs to be achieved for Suffolk and build greater trust amongst key players to deliver the required outcomes  Use jointly shared targets and other mechanisms to ensure that Health and Wellbeing Board business has traction across the system to deliver required outcomes  Develop a shared SMART dashboard of key indicators for prevention, ideally with targets

Next steps

Suffolk County Council’s political leadership and senior management will undoubtedly wish to reflect on these findings and suggestions before determining how to take things forward. In the meantime we are keen to continue the relationship we have formed with you and colleagues through the peer support to date. For example, you may benefit by increasing member awareness of the role they play in delivering on your ambitions for tackling health inequalities and embedding health across the council. We can offer a facilitated workshop with your elected members to explore this as part of the follow-up offer of this pilot process.

Rachel Litherland, Principal Adviser (East of England) is the main contact between your authority and the Local Government Association. Rachel can be contacted at [email protected] (or telephone 07795076834) and can provide access to our resources and any further support. - In the meantime, all of us connected with the peer support would like to wish Suffolk County Council every success going forward. Once again, many thanks for inviting the peer support and to everyone involved for their participation.

Yours sincerely,

Kay Burkett Programme Manager Care & Health Improvement Programme Local Government Association

Tel: 07909 534126 [email protected]

29 Agenda Item 7 Appendix A

30 Agenda Item 8

Suffolk Health and Wellbeing Board A committee of Suffolk County Council

Report Title: Way Forward

Meeting Date: 12 May 2016

Chairman: To be confirmed Tessa Lindfield, Director of Public Health Board Member Lead(s): Deborah Cadman, Chief Executive, Suffolk County Council Sara Blake, Head of Localities and Partnerships Author: Email: [email protected]

What is the role of the Health and Wellbeing Board in relation to this paper? 1. At its meeting in March 2016 the Health and Wellbeing Board (HWB) agreed to an approach which would: a) Co-ordinate the delivery of the cross cutting themes contained in the refreshed HWB Strategy through the Sustainability Transformation Plans (STPs) which are being developed by the three clinical commissioning groups (CCGs) in Suffolk. These cross cutting themes being: Prevention; Reduce Inequalities; Health and Social Care Integration; and Strong Resilient Communities. b) Identify a forum for each of the four outcomes which would have responsibility for co-ordinating and driving delivery, ensuring that a credible plan or strategy is in place. c) Invite each of the four outcome leads to put forward one or two priorities which would form the forward plan of the Board, focussing on those issues which require the strategic leadership of the Board. 2. This paper updates on progress for putting this into practice. Key questions for discussion: 3. The key questions for discussion are: a) Does the content of the emerging STPs give the HWB confidence that the cross cutting themes will be delivered effectively? b) Are there credible strategies or plans in place to deliver the four outcomes in the HWB Strategy? c) Is there a robust partnership or forum which can take responsibility for delivering each of the four outcomes and the cross cutting themes? d) What is the role of the HWB, the Programme Office (PO) and the family of partnerships which underpin delivery of the HWB Strategy?

e) How will the Board know if the System is making an impact on the outcomes and cross cutting themes? What actions or decisions is the Board being asked to take? 4. That the Board agree to: a) Support the emerging STPs in Suffolk and confirm commitment to use the STPs to deliver the cross cutting themes within the HWB Strategy and contribute to the delivery of the outcomes. b) Delegate responsibility for delivering the four outcomes and the cross cutting themes to the three forums identified: Children’s Trust; Joint Commissioning Group; and Health, Care and Safety Group. c) That the leads for the cross cutting themes are invited to attend the Health, Care and Safety Group. d) That responsibility for the delivery of outcome 3 moves from the current Steering Group to the Health, Care and Safety Group. e) That the Joint Commissioners Group look to develop its focus around physical disability during 2016/17 to ensure this element of the outcome has a plan in place. f) Request that the PO scopes current participation and makes specific recommendations to the Board to ensure that relevant officers and stakeholders are represented on the three delivery forums. g) Reduce the number of PO meetings and focus on information sharing. h) Agree the items proposed for inclusion in the HWB forward programme as proposed by the delivery forums.

Brief summary of report 5. This report provides an update in relation to the emerging Sustainability Transformation Plans and outlines the approach to developing and delivering both the outcomes and the cross cutting themes within the refreshed HWB Strategy. This report also provides some contextual information for the informal session which follows the Board meeting which will be considering form, function and principles of the Board itself. Main body of report Sustainability Transformation Plans Background 6. The NHS shared planning guidance 16/17 – 20/21 outlines a new approach to help ensure that health and care services are planned by place and the needs of our populations rather than being focused primarily around individual institutions. 7. As in previous years, NHS organisations are required to produce individual operational plans for 2016/17. In addition, every health and care system is required to work together to produce a multi-year Sustainability and Transformation Plan (STP), showing how the Five Year Forward View will be delivered and how local services will be transformed to become sustainable over the next five years. 32

8. Whilst being a national requirement which will form the basis of application for resource, it is the intention in Suffolk to develop the STPs to be useful for the health and care system and to accelerate our plans to develop Integrated Care Systems across the county. Footprints 9. To do this, local health and care systems are required to come together in STP ‘footprints’. The health and care organisations within these geographic footprints will work together to narrow the gaps in the quality of care, their population’s health and wellbeing, and in NHS finances. Suffolk cuts across two footprints. Ipswich and East CCG and West CCG form part of the Suffolk and North Essex footprint and Waveney forms part of a footprint with Norfolk. 10. Although the STPs will set out the vision and plans for the overall footprint area it has been agreed that each STP will reflect their respective place based plans eg covering the Waveney, Ipswich and East and West areas. Scope 11. STPs will be place-based, multi-year plans built around the needs of local populations. They are intended to help ensure that the investment secured in the Spending Review does not just prop up individual institutions for another year, but is used to drive a genuine and sustainable transformation in patient experience and health and care outcomes over the longer-term. In Suffolk, we know that we cannot meet the challenges we face through continued incremental change and no single partner or locality can deliver the scale of transformation proposed on its own. Our transformation must be comprehensive covering all aspects of health and care for our local population. 12. As part of this, local leaders will be required to set out clear plans to pursue the ‘triple aim’ set out in the NHS Five Year Forward View – improved health and wellbeing, transformed quality of care delivery, and sustainable finances. 13. STPs are not intended to be an end in themselves, but a means to build and strengthen local relationships, enabling a shared understanding of where we are now, our ambition for 2020 and the concrete steps needed to achieve this ambition. The STPs therefore will be an important element of the delivery of the HWB Strategy for Suffolk focussing on the core principles contained within the Strategy, particularly focussing on the delivery of the cross cutting themes of: Prevention; Strong Resilient Communities; Reduce Inequalities; and Integration. Funding 14. There will be tangible benefits for areas with good STPs. The Spending Review settlement included a national commitment to invest £2.139bn in a Sustainability and Transformation Fund in 2016/17. Of this total, £1.8bn of funding has been allocated to the sustainability element of the fund to bring the NHS provider trust sector back to financial balance. The STPs will become the single application and approval process for being accepted onto programmes with transformational funding for 2017/18 onwards. Timescales 15. Each footprint is required to submit their STP by 30 June 2016. A short submission was required on 15 April which set out the “early thinking” for each of the footprint areas. The draft submission for the STP covering Suffolk and North Essex is attached as Appendix A. 33

16. The slide pack attached as Appendix B outlines the approach being developed for Suffolk as part of the footprint which covers Ipswich and East and West CCGs with North Essex. Delivery of the Outcomes 17. Attached at Appendix C is a diagram summarising the key forums which will be responsible for delivering the outcomes and cross cutting themes within the refreshed HWB Strategy on behalf of the Board. Each outcome lead has been asked to work with their relevant forum to identify a small number of key strategic priorities which they believe should be the focus of the Board through 2016/17. Should the Board agree these priorities will inform the Board’s forward plan. Outcome One 18. Outcome One, Every Child has the Best Start in Life is a key focus of the Family 2020 Strategy and the effective delivery of this strategy would see the achievement of the priorities for this outcome. The delivery of the Family 2020 Strategy is overseen by the Children’s Trust Board. 19. The Children’s Trust Board has put forward the following for inclusion of the HWB Forward Plan: • Emotional wellbeing - Develop a single point of access and assessment for emotional wellbeing • Community services - Integration of community services, including speech, language and communication services between NHS and Suffolk County Council (SCC) 20. Alternative areas which could be considered for inclusion are • Transition - Independence and adulthood supported by all professionals using signs of safety, education, health and care plans and health passports • Healthy Living - Work with schools and further education to promote positive health, develop resilience and reduce risky behaviour such as smoking and alcohol abuse Outcome Two 21. Outcome Two has two elements, improving independent life for people with both physical and learning disabilities. Greater focus to date has been on learning disabilities and the HWB has endorsed the Learning Disability Strategy in 2015. 22. The Joint Commissioning Group (JCG) is the forum which will co-ordinate activity of the Learning Disability Strategy and it has engagement from SCC (Children and Young People’s Services and Adult and Community Services), the three CCGs, Health and Police, with other stakeholders invited as appropriate to the topic. 23. The priorities below need to be agreed by the Learning Disability Partnership Board which is yet to meet to consider the request from the Board. However, representatives from the Learning Disability Partnership Board who site on the JCG have agreed to put forward the following:

1.) Access to good quality housing/accommodation for people with a learning disability. (This will include greater choice and availability.) a) Supported housing, general needs and not excluding residential and respite b) More specialised housing/accommodation for people with complex needs and behaviours that may challenge services 2.) Improving health for people with a learning disability – focussing on access to primary care and universal services 24. Within these areas of focus, priority will be given to workforce development to ensure that the experience of accommodation based services and health services is positive and includes reasonable adjustments. 25. Currently there is no strategy in place for physical disabilities but it is proposed that this is scoped during 2016/17. Outcome Three 26. The lead for Outcome Three Older people have a good quality of life, has historically brought together a steering group, a partnership network of organisations both public and voluntary including representatives of the Suffolk Older People’s Council to co-produce the action plan. The Steering Group has identified a range of partnership activity which contributes to this outcome. Going forward, it is proposed that the Health, Care and Safety Commissioners Group should oversee the delivery of this outcome. Should this be agreed, the steering group have concluded that they would not continue to meet but would welcome the principle of co-production continuing in the delivery of strategies which impact on older people. This is consistent with the proposal for co- production to be a key principle for the activity associated with the HWB. 27. They have put forward the following priorities for the HWB forward plan: 1. A good environment in which to live - promote and develop a range of high quality housing options to support people retaining their independence. through the outcome of the Suffolk Strategic Housing Partnership review of supported housing options 2. Healthy Living - Improve the detection of frailty and prevent further deterioration in frail people 3. Improve outcomes and quality of life for people with dementia and their family carers - Creating supportive community environments through the implementation of the joint dementia pathway including the development of Dementia Friendly Communities Outcome Four 28. Outcome Four, People in Suffolk have the opportunity to improve their mental health and wellbeing has a Strategy in place to deliver on this outcome which has been endorsed by the HWB and subsequently an action plan has been developed. The Joint Commissioning Group (JCG) also has a role in co- ordinating the delivery of this action plan.

29. The JCG has put forward the following for the HWB forward plan: 1. Reduction of mental illness and self-harm; zero tolerance of suicide The development and implementation of a suicide action plan following on from the publication of the Suicide Prevention Strategy in Summer 2016 forms part of this priority and is an underlying theme in the Crisis Concordat. This is likely to be the proposed topic of the HWB conference which will be held in October of this year. Due to the number of partners that would need to be involved in the development and implementation of a Suicide Prevention action plan, this could be considered as a pertinent area for HWB support. 2. Population and workforce development Training and development of both the wide range of staff across the Health, Social and voluntary sectors and the general population are elements which thread through all three priorities in the Joint Mental Health Strategy. This will require resourcing and the cooperation of a large number of organisations and for the public within the current tight financial constraints. The need to raise awareness and upskill a wide variety of staff, carers, volunteers and the general public in pertinent areas of Mental Health is vital to help the system function better. Programme Office 30. In light of the decision to use the STPs and the Health, Care and Safety Group to deliver the cross cutting themes, a meeting was held with members of the Programme Office to consider how these two forums could work effectively together and whether there was potential to amalgamate the two forums into one. 31. Two key issues emerged with this proposal. The first was the engagement of the district and boroughs and the voluntary and community sector (VCS) who attend the PO but are not currently regular attendees of the three delivery forums. The PO therefore acts as a single forum by which information is shared. The second was that the PO has a role in agenda planning. 32. Whilst the conclusion was that there are other ways in which the agenda planning can take place there still seemed, for the time being, a place for the PO for information sharing. Over time fuller engagement in the three delivery forums may mitigate the need for the PO, it was proposed that we retain this forum but hold the meetings less frequently and explore opportunities for virtual networks. Why this action/decision is recommended 33. To enable effective and efficient delivery of the ambitions in the Health and Wellbeing Strategy for Suffolk. Who will be affected by this action/decision? 34. Suffolk residents.

Note: Appendix A contains embedded documents. If you need assistance in accessing them please contact Suffolk County Council Democratic Services (email [email protected], telephone: 01473 265119).

Sources of further information  Refreshed Health and Wellbeing Strategy for Suffolk: http://committeeminutes.suffolkcc.gov.uk/LoadDocument.aspx?rID=09002711 81ac53bf  STP Guidance: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/

Agenda Item 8 Appendix A

Annex: Template for the 15 April checkpoint

Please use the following slides for your submission, and remove the earlier slides to keep the pack concise (max 10 slides).

39 1 Agenda Item 8 Appendix A

Please fill in key information details below Name of footprint and no: Suffolk and North East Essex Region: Midlands and East Nominated lead of the footprint including organisation/function: Nick Hulme (Chief Executive, Ipswich Hospital NHS Trust) Contact details (email and phone): [email protected] 01473 702087 Organisations within footprints:

Suffolk: Ipswich and East Suffolk CCG, West Suffolk CCG, West Suffolk NHS Foundation Trust, Ipswich Hospital NHS Trust, Norfolk and Suffolk Foundation Trust, Suffolk County Council, Ipswich Borough Council, St. Edmundsbury Borough Council, Mid-Suffolk District Council, Babergh District Council, Suffolk Coastal District Council, Suffolk GP Federation CIC, East of England Ambulance Trust, Healthwatch Suffolk, Voluntary and Community Services.

North East Essex North East Essex CCG, Colchester Hospital University NHS Foundation Trust, Anglian Community Enterprise CIC, North Essex Partnership NHS Foundation Trust, GP Primary Choice, Essex County Council, Tendring District Council, Colchester Borough Council, East of England Ambulance Trust, Healthwatch Essex, Community Voluntary Services.

Our locality STP plans can be found here:

40 2 Agenda Item 8 Appendix A Section 1: Leadership, governance & engagement

Please discuss progress you have made (and any challenges) in the following areas:

Collaborative leadership and decision-making – STP footprint area

• The Suffolk and North East Essex STP footprint is led by Nick Hulme, Chief Executive of The Ipswich Hospital NHS Trust. • The Suffolk element of the footprint comprises the Ipswich and East and West areas of Suffolk. The Waveney area is included in the Norfolk footprint. References to Suffolk throughout this document apply to the Ipswich and East and West Suffolk area and population. • The Suffolk and North East Essex systems have appointed STP leads who are bringing together their place-based plans and are collaboratively developing an overarching footprint STP. • Both systems are building on work which is already well underway in their respective areas. We are keen to create an ambitious blueprint for our footprint area which will deliver a sustainable health and care system which focuses on the needs of the footprint population. Our systems will each continue to progress their respective place-based plans and where applicable will identify opportunities for closer working across county boundaries where this will benefit our populations. • The diagram opposite sets out our governance arrangements for the STP. • The Joint STP Steering Group is made up of system leaders from health commissioning organisations, major providers, local authorities and Healthwatch. • A Local Action Workforce Group will also be established across the footprint to support workforce development and transformation. • The first meeting of the Joint STP Steering Group took place on 14/4/2016. • The Suffolk and North East Essex locality STP governance structures are well established, with the Acute Hospital Transformation Programme in the early stages of development. • The Health and Wellbeing Boards will drive delivery of the STP in order to deliver the respective Health and Wellbeing strategies. • The Suffolk health and care system continues to work as part of a wider footprint for devolution across Suffolk, Norfolk, Cambridgeshire and Peterborough. The East Anglia Devolution Agreement states that the system “will work together … to support each of the counties through their Sustainability and Transformation Planning process to set out plans for moving progressively towards integration of health and social care, bringing together local health and social care resources to improve outcomes for residents and reduce pressure on Accident and Emergency and avoidable hospital admissions.” • The county of Essex is currently not on the devolution pathway but recognises that there is a need to work across local authority boundaries.

41 Agenda Item 8 Appendix A Section 1: Leadership, governance & engagement

Please discuss progress you have made (and any challenges) in the following areas:

Our ongoing work to engage partners and the public over a number of years has given us a clear mandate upon which to develop and shape our strategy for the STP. Across both parts of our footprint, we have been regularly engaging with local communities, who have been consistently telling us that they want high quality health and care services delivered locally and that they want us to bring services closer together. The key themes of our engagement to date are set out below:

Self Care Access to information and Prevention Integration GP Services are highly Taking personal services through Clear information about how Services should be more valued and need to link responsibility for health and signposting and simple to stay healthy and stay in joined up, especially around closely with other services wellbeing language control discharge from hospital

As a footprint, we are committed to working closely with a wide range of local government, community and voluntary sector partners to ensure that we harness close links with our community in order to involve them in shaping the future of their communites and the health and care economy. This approach will continue through the development and implementation of the STP. It will enable us to reach broader sections of our local population, across a far wider range of topics which impact upon their health and wellbeing than can be reached by traditional NHS organisations alone. Representatives from Healthwatch are also key members of our Joint STP Steering Group.

The picture opposite shows Engagement in Suffolk Engagement in North East Essex the wide range of engagement activity that has taken place During 2014, we launched the Big Care Debate which gave people an opportunity to over recent years which has say how they would like health and social care to develop across North East Essex, been supported by all system which has informed our transformation of out of hospital care. At the start of partners and also includes the February 2016, the CCG and its community partners launched a second Big Care wider determinants of health Debate aimed at finding out local peoples’ views on instances of waste or and wellbeing such as housing duplication within local health and social care services. The engagement activities and education. System also sought peoples’ experiences of services and how they thought communities partners are working together could further support people to maintain a happy and healthy lifestyle within their to develop a number of events own neighbourhood. The Big Care Debate 2 will conclude at the end of April 2016 to be held in May to engage and the key themes emerging from it will continue to shape the development of the with the health and care STP. community, including the third sector, to further develop our plans and agree how we can work together in their delivery.

Engaging clinicians and staff We have established a number of joint clinical transformation groups to encourage the health and care system to work collaboratively to design fit for purpose clinical pathways and models of care for the future. The membership of these groups includes clinicians and staff from primary, community, acute, mental health and social care as appropriate. This approach has resulted in the design of a number of innovative models of care and clinical pathways. We will be continuing to use this approach to develop new service models for all our services, aligned to the Transformation Programmes that will be outlined in our STP. 42 4 Agenda Item 8 Appendix A Section 2a: Improving the health of people in your area

Transformation Programme 1 – A step change in prevention and early intervention and building strong, resilient communities

50% increase in the Deprivation Significant variation in Levels of mental ill Lifestyle choices number of people over 1 in 3 residents of Tendring health and wellbeing health often not remain poor - levels of Educational 65 by 2034 – more LTCs and Ipswich, 1 in 10 a 13 year difference in life recognised smoking, alcohol use, attainment in NEE is Significant numbers of residents of Colchester and expectancy in Tendring , are higher than the poor diet, obesity are worse than expected people with undiagnosed 1 in 9 residents of Suffolk a 9 year difference in national average in NEE too high, while levels of risk factors (BP, AF) given current relative live in the 20% most Colchester and a 6 year and similar to the physical activity are too leading to cardiovascular levels of wealth deprived areas in England difference in Suffolk average in Suffolk low disease

These factors are leading to an acceleration in the number of people living with high and complex needs, placing further pressure on the health and care system. There is an opportunity to improve the health and wellbeing of our populations and reduce demand for services

Prevention Mobilise power Multi agency Initiatives and of local approach Enablers communities

43 5 DRAFT SUBMISSION Section 2b: Improving care and quality of services Agenda Item 8 Appendix A

Please see slides 6 & 7 for potential areas of focus for improving care and quality

Across both Suffolk and North East Essex, we know that we cannot meet the challenges we face through continued incremental change and that no single partner or locality can deliver the scale of transformation proposed on its own. By 2021 we want a health and care system which supports people to take responsibility for their own health and wellbeing and which focuses on prevention and early intervention. In order to achieve this, our transformation must be comprehensive covering all aspects of health and care for our local population. We must improve the quality of our services through reshaping care delivery so that care is delivered predominantly in the home or community, with hospital services focussing on those in acute need. This will be delivered by working closely with our key partners, including local government, the voluntary sector, housing, education, leisure and transport on four key transformational programmes which are:

Vision Vision 1) A step change in prevention and the building of stronger, resilient communities 2) Transforming locality based care and support through health and care integration 3) Ensuring that our acute system, mental health, community, social and primary care providers and commissioners are sustainable in terms of finance and workforce and continue to provide high quality care 4) Enabling better health and care through the development of effective, innovative models of care and ways of working.

Performance, Quality, and Safety Opportunities to Our Priority Performance System wide quality issues Provider specific issues Population Groups address unwarranted • A&E: 4 hour – 95% • Delay in ambulance • Acute – CHUFT CQC rating variation 80% (NEE), 95% (West), response times overall inadequate In line with our local 95.5% (I&E) • Safe and timely flow of • Mental Health – NEPT CQC Key spend and challenges, as a • RTT incomplete – 92%: patients across system rating overall requires system we have outcomes opportunity 88.7% (NEE), 94.6% • Delayed transfers of care improvement areas we have prioritised the following (West), 96.4% (I&E) • Care home capacity, NSFT - expected to come populations: identified through right • 62 day cancer - 85% safety and quality out of special measures care include: • The frail elderly 72% (NEE), 82.2% (West), standards after July inspection • Children & young • Gastro-Intestinal 84.6% (East) • GP Capacity and • Primary Care – 4 (NEE) • Respiratory people • Delayed transfers of care capability practices with CQC rating • People with Mental • Cancer Consistently above • Mental health bed overall inadequate, special • MSK Health care needs national targets capacity / safe and timely measures, others requiring • People with • Genito Urinary discharge of service users improvement. • Neurological Improvement Priorities learning disabilities • Trauma and injuries • Rising and high risk population Thematic review of SIs includes incidents associated with perinatal mental health; diagnostic incidents; • Endocrine suboptimal care of deteriorating patients; treatment delays; intrauterine deaths; unexpected deaths; • Ophthalmology Always focussing on admissions to ITU; never events; apparent/actual/suspected self-inflicted harm; Place apparent/actual/suspected homicide; medications management

Ipswich and East Suffolk and West Suffolk Integrated Care Systems North East Essex Integrated Accountable Care System (Out of Hospital Care) incorporating Primary Care at Scale

of Care Acute Transformation and Reconfiguration Newmodels

New commissioning, Leadership commercial and Workforce and OD IT Estates contracting models Enablers Enablers 44 6 Agenda Item 8 Appendix A Section 2b: Improving care and quality of services

Please see slides 6 & 7 for potential areas of focus for improving care and quality

As a footprint, we recognise that we cannot meet the challenges we face through continued incremental change. No single partner or locality can deliver the scale of transformation required on its own. Our transformation must be comprehensive covering all aspects of health and care for our local population. We believe we can improve and reshape care delivery and quality across health and care through four interlinked programmes as summarised in the diagram below. Further details of the transformational plan in each area can be found in our locality submissions included in Slide 2.

Programme Area What we are doing / plan to do

A step change in • Upgrading prevention and self-care and building safer, stronger, resilient communities to radically change the way people view and use public prevention and the services. This involves working closely with local government and voluntary community services and organisations to mobilise the power of building of stronger, more local communities in order to prevent ill health, promote healthier lifestyle choices and self help. This will need to be co-designed with our resilient communities citizens and our local communities.

• “Connect” rolled out in two areas of Suffolk - one urban, one rural.

• Bringing together the physical and mental health and care workforce including GPs, social workers and district nurses, into Integrated

Neighbourhood Teams working together to risk stratify, assess, plan and target coordinated services so that people’s health and care needs

are proactively met and which should also lead to a moderation in activity growth.

• Developing and delivering sustainable primary and community care at scale.

Transforming locality • Create simpler, coordinated access arrangements for urgent, emergency and planned health and care services, operating 24/7 where required

based care and support to do so.

through health and care • Develop 24/7 integrated health and care reactive responses to enable people to stay at home and to leave hospital at the earliest opportunity

integration with rehabilitation, recovery and end of life support as appropriate, reducing delayed transfers of care, emergency admissions and hospital

lengths of stay.

• Building on the successful foundations of the outcomes based Care Closer to Home Programme in NEE - which has already integrated

traditional community services with a number of elective pathways and some elements of social care in order to deliver more seamless care

whilst delivering efficiency savings. We will build on this by shifting further elective pathways into out of hospital settings where it is clinically

safe and appropriate to do so, and further Integration of both health and social care around local GP clusters using an MDT approach – an

example of which we have already piloted in the CO15 area in close joint working with the Essex County Council.

• Management of demand and activity by focussing on prevention, supportive communities and locality based care with more people cared for close to home, seeking efficiencies through joint working, creating a flexible workforce and addressing the wider determinants of health and wellbeing. Ensuring that where people do need interventions, they receive the right care, in the right place, at the right time in order to reduce overall demand. • Reducing variation in the outcomes, quality and safety of care – as highlighted through the Atlas of Variation, Carter Review and Right Care benchmarking. This includes tackling significant variation in Primary Care. • Our emerging Acute Hospital Transformation Programme will focus on opportunities for collaboration across providers and with the rest of the System sustainability health and care system.

• Transformation of Primary Care so that it is responsive, fit for the future and sustainable by operating at greater scale – for example by developing federations / super-partnerships / a hub and spoke approach. This will help us to take pressure off urgent care services and ensure that Primary Care is more integrated with community provision as part of NEE’s Out of Hospital model and Suffolk locality working plans. • Joint clinical transformation groups will drive outcomes focused transformation with integrated CIP, QIPP and CQUIN delivery through joint teams focusing on productivity, pathways and clinical innovation. • A strategic market review across Suffolk of the care home and domiciliary care market in order to identify the extent of the problem and to formulate a plan to address it.

45 7 Agenda Item 8 Appendix A Section 2b: Improving care and quality of services

Please see slides 6 & 7 for potential areas of focus for improving care and quality

Programme Area What we are doing / plan to do

• New models of care

• Suffolk - Integrated Care Systems developing in both East and West Suffolk, with an organisational focus replaced by a place-based population focus. Changing the way health and care is commissioned by adopting a more collaborative approach with providers, integrated commissioning across health and care, outcomes based contracting and payment.

Alignment of performance and financial incentives, plus potential for capitated budgets and risk share arrangements.

• NEE - Build on the successful foundations of CC2H to accelerate the development of an Integrated Accountable Care System for Out of Hospital Care. We have the support of our local system partners to expand the scope and remit of the Accountable Care System at pace, to include the broader determinants of our population’s health and wellbeing - such as planning, housing, education, families, community assets and leisure and transport - and develop a system wide approach which incentivises the shift from treatment to prevention and early intervention.

• Effective leadership and partnership working – We recognise that strong, visible and effective system leadership will play a

vital role in achieving sustainability. We will need to work in partnership across all parts of the health and care system.

• New commissioning, commercial and contracting models - for example through alignment of financial incentives across the Enablers system to promote the delivery of outcomes rather than activity, support the shift from treatment to prevention and early intervention and reduce demand for health and care services. This includes the development of new contract models of Primary Care.

• IT – Using the local digital roadmap to deliver interoperability, paper-free at the point of use and shared care records in order to

promote integrated and seamless care across traditional organisational boundaries. Innovative shared information and intelligence solutions for patients and health and care teams to enable self care, joined up care with people only having to tell their story once and extended access / seven day working.

• Workforce and OD – Developing a collaborative, system wide workforce and OD plan in conjunction with HEE and local partner organisations. This will include mapping current workforce by skill mix and grade and understanding the impact of demographics, our Transformation Programmes and new models of care in order to inform future workforce planning. We recognise that Primary Care in particular represents a major workforce challenge.

• Estates - We understand that Estates will be a key enabler of transformation going forward and have established a multi agency working group across all partner organisations in order to baseline the current estate and map out requirements for transformation and rationalisation. Our practices are also bidding for funding to transform our Primary Care estate via the Primary Care Transformation Fund in line with our Estates and Primary Care strategies.

46 8 Agenda Item 8 Appendix A Section 2c: Improving productivity and closing the local financial gap

Please discuss your emerging thinking in the following areas.

Ipswich The sustainability challenge West Total Across the footprint, the health and care system is costing 2015/16 latest estimates £m NEE and East Suffolk footprint approaching £100m more than funds coming in. With a growing Suffolk and ageing population, combined with rising expectations and cost CCG (8.1) 0.1 (1.2) (9.2) inflation, this gap will continue to increase if we do nothing. All organisations are facing financial problems which can lead to a Acute providers (39.5) (10.0) (22.1) (71.6) focus on organisational rather than whole population solutions. Main MH providers (3.5) * * (3.5)

The table opposite is intended to give an indication of the scale of Main community providers 0.0 0.0 0.0 0.0 the financial challenge that the footprint faces. We are working EEAST ** with partners to develop a consistent view of our baseline financial Social care and PH ** position and to project this into the future. (51.1) (9.9) (23.3) (84.3) Delivering system sustainability We recognise that the current financial situation across the CCG allocations 430.5 279.1 433.4 1,143.0 footprint is not sustainable and we will need to deliver against the key priorities and transformational initiatives set out in section 2 in * Norfolk and Suffolk Foundation Trust total deficit £8.9m across Norfolk and Suffolk order to achieve financial balance over the next five years and beyond. ** Other areas being worked through to ensure consistency We need to address increasing demand which is driving levels of activity which are not sustainable in our current system. Many people are treated in hospital when their needs could be better met elsewhere, care is not joined up between teams and not always of a consistent quality. We have issues recruiting staff in some key areas and we spend millions of pounds on treating people with illnesses which could be prevented if we could address mental health wellbeing, high blood pressure, smoking, drinking, loneliness, unhealthy eating and physical inactivity.

Our emerging Acute Hospital Transformation Programme (See section 1) will focus on opportunities for collaboration across providers working in a wider geographic footprint. Continuing to improve the productivity and efficiency of our acute services will require us to look at reconfiguring our acute hospitals. There are a number of different models of horizontal collaboration and we are in the initial stages of identifying those model options that will best suit our health system. In reconfiguring our acute hospitals we are looking for opportunities to continue to improve the quality of service delivery both today and in the future, maintain performance against core standards, reduce the cost of acute delivery to the system, improve efficiency through delivery of Carter Review recommendations and address future workforce challenges.

47 9 Agenda Item 8 Appendix A Section 2c: Improving productivity and closing the local financial gap Please discuss your emerging thinking in the following areas. Our current thinking and plans The Suffolk Integrated Care Systems which have been in development over the last year will be central to the delivery of health and care and will enable the changes required to achieve financial and workforce sustainability whilst maintaining or improving the service provided for the local population. Decisions around resourcing need to be based on the needs of our population and not organisations. A new approach to resource allocation and risk sharing will be an important enabler for delivery of a sustainable health and care system. It is envisaged that some form of capitated payment, covering as much of primary, secondary, community, mental health and social care as possible will be developed. As a first step, the acute trusts and the CCGs are developing a new approach to contracting which provides assurance, aligns incentives and clinical outcomes and which alongside work across the wider system, will aim to create a sustainable care delivery system for Suffolk within 5 years.

The NEE system believes that the biggest savings will be delivered by reducing the demand for acute services. The Care Closer to Home model has already delivered efficiency savings in the region of £1.7m, and we have also put contractual incentives in place to share any of the savings associated with a reduction in the level of non elective admissions in the over 65s. Our plans to shift further activity out of hospital, develop new models of community urgent care through a ‘hub’ model, and increase our focus on prevention and early intervention as we continue to develop the Accountable Care System will lead to further savings against these opportunities. Our plans to transform Primary Care and extend access to GP appointments will also play a fundamental role in reducing demand for urgent and emergency care services and delivering system sustainability.

Analysis by Right Care highlights that the NEE system is a significant outlier for non-elective care, with an estimated savings opportunity of over £9m if we can reduce this level of variation. Whilst the level of savings associated with elective care are less significant, improvements in this area point to a savings opportunity of over £3.5m. In addition, the Carter Review estimates £21m of savings opportunities at CHUFT alone.

The mental health provider, NEPFT, is also currently in the process of merging with SEPT, which will deliver further operational efficiencies.

Further work required to better understand the financial gap and to model the impacts of our emerging plans on sustainability System Finance leads across the STP footprint (representing all major providers, commissioners, local authority and Public Health), are working together to compile an agreed consistent view of the 5 year “do nothing” financial gap and to model the impacts of our STP on demand, activity and finances across health and care. Partners have agreed the following principles: • Consistent assumptions • Transparency • A focus on system expenditure rather than pricing and the system deficit rather than allocation across organisations. The following target outputs have been agreed: • 5 year system-wide financial sustainability plan • A shared understanding of the system-wide (do nothing) financial gap • To identify cost / deficit drivers to inform system transformation (to close the financial gap) • To identify variations in activity / costs through benchmarking within the system (eg across providers) and externally • A mechanism for evaluating the system-wide impacts of our proposed Transformation Programmes • Public Health have made some estimates of the impact of the prevention strategy which will be utilised • All underpinned by robust population and activity analysis and projections

48 10 Agenda Item 8 Appendix A Section 3: Your emerging priorities Please discuss your emerging thinking on what the key priorities are to take forward in your STP, and why:

We are developing four interlinked transformation programmes to address the challenges set out in the five year forward view and our own local challenges: 1. A step change in prevention and the building of stronger, resilient communities 2. Transforming locality based care and support through health and care integration 3. Ensuring that our acute system, mental health, community, social and primary care providers and commissioners are sustainable in terms of finances and workforce and continue to provide high quality care 4. Enabling better health and care through the development of effective, innovative models of care and ways of working

Our emerging priorities are:

• Ensuring that we have strong and effective system leadership and partnership working in place in order to enable a collective view of our priorities and challenges outside of traditional organisational boundaries and to drive the required programme of whole system transformation. We are at the start of this journey, and recognise that we need to develop at pace in order to build the required level of trust and momentum to make this a reality. This will require decisions to be made which put the needs of people and the system above existing organisations. • Managing demand for care through investment in prevention, self care and behaviour change in order to reduce the overall demand for services, whilst also ensuring that people who do need interventions receive the right care, in the right place, at the right time. This may mean we have to stop commissioning some services, as we have already started to do across our footprint. • Mobilising the power of local communities in order to prevent ill health, promote healthier lifestyle choices and self help, and foster increased resilience at both a personal and community level – leading to a change in behaviour and a reduced reliance on public services. This will require us to work closely with partners across the wider system and actively involve communities in local decision making. • The accelerated development of an integrated Accountable Care System for Out of Hospital Care in NEE and Integrated Care Systems in Suffolk to ensure that services are delivered by a multi-skilled workforce, in the appropriate care setting, with hospital services focussing on those in acute need. This will involve making tough decisions such as shifting care into different settings and pooling budgets across organisational boundaries to ensure that we make the most effective use of resources across the system as a whole. Commissioners will also need to be bold in order to re-focus the system from treatment to preventing and early intervention by giving the accountable care system the freedom and incentives to do so. • Ensuring parity of esteem between physical and mental health and closing the health gap between people with mental health problems and the population as a whole. • The development of a more sustainable model of Primary Care operating at greater scale. • Acute hospital reconfiguration to further develop the work on the clinical and financial sustainability of acute provision in the STP footprint will include some clinical reconfiguration of pathways and workforce across the providers. This will inevitably result in a collaboration between Colchester and Ipswich Hospitals • Attracting, developing, and retaining a workforce which meets our future needs through the Local Action Workforce Group, exploring a more strategic approach to recruitment and retention of staff which could include recruitment of urgent care staff as a system with rotation, joint posts and increased training opportunities. • Ensuring the sustainability of the care homes and home care market. • Maximising the new powers and leverage of the Suffolk devolution deal to deliver the STP.

49 11 Agenda Item 8 Appendix A Section 4: Support you would like

Please discuss your emerging thinking in the following areas: • Areas where you would like regional or national support as you develop your plans. • Reconfiguring and merging Trusts – both Acute and MH – will require support around choice and competition, workforce, managing communications, and external support to increase the pace of change. This will include transformational support for the development of new service models and pathways which improve quality and patient safety whilst also delivering the required level of efficiency savings. • Support with health economics and modelling health needs assessments (including mental health). • Support with system-wide financial modelling focussed on place-based rather than organisation spend. • Evidence base for transformation in other areas e.g. examples of activity shifts across care settings which have resulted in lower overall costs . • Potential partnering with an academic partner to evaluate the changes for population health. • Different models of Primary Care – including advice and support around the implementation of new contacting options, legal form, and structure etc. • Support for the delivery of Integration – especially practical support around areas such as pooled budgets, capitation and risk sharing arrangements and how this has been developed elsewhere. • Development of an evaluation framework to ensure that we monitor the effectiveness of our plans and their implementation and take action when our aims and objectives are not being met. • Support with public conversations on difficult issues eg streamlining of acute and other services, decommissioning and supported self care.

• National barriers or actions you think need to be taken in support of your STP. • Support to explore a system based approach to finance and performance management. • Adequate prioritisation for STP planning and delivery alongside short term performance – systems given the space to plan and deliver transformational change. • The facilitation of information sharing across the health and care system. • In North East Essex, our plans for mobilising the power of local communities would benefit significantly from a devolution approach. We are unsure how county council boundaries across the Suffolk / NEE; and Mid / South Essex STP footprints will support and enable this. There is therefore a clear need to break down the barriers between different parts of the public sector and acknowledge the need for cross boundary working.

• Areas where you would like to access expertise or best practice from other footprints. • We would like access best practice in activity and financial modelling across whole systems. • Learning from the success regimes, both Essex and wider, about accelerating the pace of change, especially with regard to acute hospital reconfiguration.

• Any other key risks that may affect your ability to develop and/or implement a good STP. • A top down focus on fixing issues in one part of the system which distracts from whole system transformation and which could stifle collaborative design opportunities. • Procurement and competition rules which could delay implementation of new models of care. • Stretched resources to plan, secure system wide agreement and deliver STP with large scale system-wide transformation alongside ongoing delivery of operational performance requirements and the ability to sustain the energy and commitment of the workforce. • Lack of alignment at a national level between STP and Devolution planning. 50 12 Agenda Item 8 Appendix A Annex 1

Annex: Template for the 15 April checkpoint

Please use the following slides for your submission, and remove the earlier slides to keep the pack concise (max 10 slides).

1 Agenda Item 8 Appendix A Annex 1

Please fill in key information details below Name of footprint and no: Suffolk and North East Essex (NEE Submission) Region: Midlands and East Nominated lead of the footprint including organisation/function: Nick Hulme (Chief Executive, Ipswich Hospital NHS Trust) Contact details (email and phone): [email protected] 01473 702087 Organisations within footprints:

North East Essex CCG: Colchester Hospital University NHS Foundation Trust, Anglian Community Enterprise CIC, North Essex Partnership NHS Foundation Trust, GP Primary Choice, Essex County Council, Tendring District Council, Colchester Borough Council, Healthwatch Essex, Community Voluntary Services

DRAFT SUBMISSION 2 Agenda Item 8 Appendix A Annex 1 Section 1: Leadership, governance & engagement

Please discuss progress you have made (and any challenges) in the following areas: Across North East Essex we have established an ‘STP Board’ to provide the required level of leadership and partnership working across the local care economy - the first time that a forum of leaders from the local care economy has come together to develop a placed based plan which will shape the local system and deliver the level of transform required to achieve a sustainable future for local care services.

The STP Board, Chaired by Sam Hepplewhite (NEE CCG AO) includes representation at a Chief Officer level from the CCG; all local NHS provider organisations; Essex County Council (commissioning and operations); second tier local authorities (Colchester Borough and Tendring District Councils); local community voluntary services organisation; and Health Watch. It is proposed that this group will transition over time into a shadow Integrated Accountable Care System Board, which oversees the design and implementation of our Accountable Care System for Out of Hospital Care across North East Essex. Our STP Board will feed into the Essex Health and Wellbeing Board, who will provide strategic oversight of our local plans in parallel to those covered by the footprint of the Essex Success Regime and West Essex. We will also engage at a local level with, our LWAB, Tendring District Council’s own Health and Wellbeing Board.

The role of the NEE STP Board, and how this fits into the wider leadership and governance arrangements across the combined STP footprint is set out in the diagram below:

We also have developed strong partnership arrangements with local government commissioners through our joint Strategic Commissioning Committee, which has a remit to develop vision and strategy for local commissioners across North East Essex - leading and implementing an integrated health and care system that empowers patients, and provides more coordinated, proactive and responsive care. This group will ensure that the priorities of local communities are clearly understood and reflected within the STP, and that all placed based initiatives commissioned across North East Essex as a whole are aligned with, and contribute towards, the programme of work set out in the STP.

DRAFT SUBMISSION 3 Agenda Item 8 Appendix A Annex 1 Section 1: Leadership, governance & engagement

Please discuss progress you have made (and any challenges) in the following areas: We are committed to working closely with a wide range of local government, community, and voluntary sector partners across North East Essex to ensure that we harness close links with our community in order to involve them in shaping the future of their community and the local care economy. This approach has, and will continue through the development and implementation of the STP, to enable us to reach boarder sections of our local population across a far wider range of topics which impact upon their health and wellbeing than can be reached by traditional NHS organisations alone – including areas such as planning, housing, the environment, education, sport and leisure facilities, and community resilience. Essex Health watch are also a key member of our North East Essex STP Board.

During 2014, the CCG, working with its community partners, launched its Big Care Debate which gave people an opportunity to say how they would like health and social care to develop across north east Essex. The feedback we have received from these events shows our local communities want high quality health and social care services delivered in their locality, closer to home. The main themes of the Big Care Debate are summarised below, which have helped to shape our thinking to date:

GP Services are highly Access to information and Prevention Self Care Integration valued and the first point of services, through People also wanted clear Taking personal Services should be more contact for care. They need signposting and simple information about how to responsibility for their own joined up, especially around to link closely with other language was viewed as stay healthy and stay in health and wellbeing discharge form hospital services important. control

At the start of February 2016, the CCG and its community partners launched a second Big Care Debate aimed at finding out local peoples’ views on instances of waste or duplication within local health and social care services. The engagement activities also sought peoples’ experiences of services and how they thought communities could further support people to maintain a happy and healthy lifestyle within their own neighbourhood. The Big Care Debate 2 will conclude at the end of April 2016, and the key themes emerging form it

will continue to shape the development of the STP

As a system we have also engaged widely with staff across both Primary, Community, and Social care in preparation for the transformation of Out of Hospital care. This has included the alignment of social care staff with GP practices, moving community staff into neighbourhood teams in order to delver care around practices, and engagement with GPs around the need to transform Primary Care and deliver at greater scale. Further work needs to be done in order to engage with staff in a hospital setting around how acute services can be provided in a more joined up way, in settings closer to the patients / citizens home’s.

DRAFT SUBMISSION 4 Agenda Item 8 Appendix A Annex 1 Section 2a: Improving the health of people in your area

Please see slide 6 for potential areas of focus for improving health and wellbeing

Significant variation in Lifestyle choices High deprivation: 30% of Levels of mental ill 50% increase in the Educational health and wellbeing: remain poor - high Tendring district’s wards health - often not number of people attainment is worse are in the most deprived 13 year difference in levels of smoking, recognised - are over 65 by 2034 – than expected given 20% nationally. Pockets life expectancy in alcohol use, poor diet, higher than the more long term current levels of of deprivation also exist Tendring and 9 in obesity and low levels in Colchester national average conditions wealth Colchester of physical activity

There is a significant opportunity to improve the health, wellbeing, and educational attainment of our population - making areas of Tendring and Colchester more desirable places to live and ensuring that people are able to develop their full potential - and in turn reducing pressure on the care system

Prevention Mobilise power Multi agency Initiatives and of local approach Enablers communities

DRAFT SUBMISSION 5 Agenda Item 8 Appendix A Annex 1 Section 2b: Improving care and quality of services Please see slides 6 & 7 for potential areas of focus for improving care and quality

“By 2021 we want a local health and care system which supports people to take responsibility for their own health and wellbeing and which focuses on prevention and early intervention. Care will be delivered by a multi-skilled workforce working in neighbourhood teams and delivered predominantly in the home or community, with hospital services used only where they add value. Technology will play an important role helping people to monitor their own health and to stay independent for as long as possible. In achieving this vision, the health and care system will work

Vision Vision closely with other key partners, such as voluntary sector, housing, education, leisure and transport as a matter of course; and all services will be

designed in conjunction with service users”

Our Priority Performance, Quality, and Safety Opportunities to

Population Groups address unwarranted

Performance System wide quality issues Provider specific issues variation In line with our local • Delay in ambulance • Acute – CQC rating

challenges, as a • RTT incomplete: response times overall inadequate Key spend and system we have we 88.7% (92%) • Safe and timely flow of • Mental Health – CQC outcomes opportunity have prioritised the patients across system rating overall requires areas we have following populations: • 62 day cancer: • Care home capacity, improvement: identified through right 80.4% (85%) safety and quality • Primary Care – 4 care include:

• The frail elderly standards practices with CQC rating • Children & young • A&E: 80% (95%) • GP Capacity overall inadequate, • Gastro-Intestinal

people • Mental health bed special measures, others • Respiratory

• People with Mental capacity / safe and timely requiring improvement: • Cancer

Health care needs discharge of service users • MSK • People with • Genito Urinary

Improvement Priorities Improvement Priorities learning disabilities Thematic review of SIs includes incidents associated with perinatal mental health; diagnostic

incidents; suboptimal care of deteriorating patients; treatment delays; intrauterine deaths; unexpected deaths; admissions to ITU; never events; apparent/actual/suspected self-inflicted harm; apparent/actual/suspected homicide; medications management

Integrated Accountable Care System (Out of Hospital Care), incorporative of Primary Care at Scale Acute Transformation and Reconfiguration of Care Newmodels

Commercial Leadership contracting Workforce IT Estates methods Enablers Enablers

DRAFT SUBMISSION 6 Agenda Item 8 Appendix A Annex 1 Section 2b: Improving care and quality of services Please see slides 6 & 7 for potential areas of focus for improving care and quality

New Models of Care

We view the development of a new model of Out of Hospital Care as the key driver in delivering our vision, and addressing many of the priorities, performance and quality issues, and opportunities set out above. issues set out above. We have already made significant progress along this journey. In line with the Multi-Speciality Community Provider model set out in the Five Year Forward View, our outcomes based Care Closer to Home programme has already integrated traditional community services with a number of elective pathways and some elements of social care in order to deliver more seamless

care and improved outcomes, whilst delivering efficiency savings and incentivising reduced demand for non elective care.

As a priority, we plan to build on these successful foundations to accelerate the development of an Integrated Accountable Care System for Out of Hospital Care - shifting care into out of hospital settings where it is clinically safe and appropriate to do so, aligning incentives to further reduce non- elective admissions, and integrating both health and social care around local GP clusters using an MDT approach – an example of which we have already piloted in the CO15 area in close joint working with the Essex County Council.

We have the support of our local system partners to expand the scope and remit of the Accountable Care System over a longer period of time, to include the broader determinants of our population’s health and wellbeing - such as planning, housing, education, families, community assets, and leisure and transport - and

develop a system wide approach which incentivises the shift from treatment to prevention and early intervention.

Alongside the development of our ACS, will need to transform Primary Care to ensure that it can operate at greater scale, and reconfigure acute provision to ensure that services that need to delivered in an acute setting can be done so safely and sustainably.

DRAFT SUBMISSION 7 Agenda Item 8 Appendix A Annex 1 Section 2b: Improving care and quality of services

Please see slides 6 & 7 for potential areas of focus for improving care and quality

Transformation of Primary Care

Transforming primary care provision and reducing variation in general practice is one of our main priorities as we appreciate that high quality primary care services are essential to our out of hospital vision and the wellbeing of our patients. We are working with our GP Federation and an external provider, who has experience working with practices in Manchester, to practically achieve a reduced number of practices, resulting in a more sustainable financial and clinical model across NEE. We aim to have an integrated model across health and social care delivered from hubs serving between 30,000 and 50,000 patients across 7 days a week which are closely aligned to our care closer to home service.

Reconfiguring Acute provision to secure a right sized, sustainable Hospital

Another major driver in achieving high quality care and system sustainability is the reconfiguration of acute services within our local hospital, Colchester Hospital University Trust.. This will enable us to improve the productivity of local acute provision, address concerns over the delivery of core performance standards, and achieve improved levels of quality and safety. This transformation will be delivered through increased collaboration between acute and specialist care providers across the wider STP footprint, and is specifically addressed within the Acute Transformation work stream of the STP.

Key Enablers

The key enablers of our plans to transform care include:

• Effective Leadership and partnership working – We recognise that effective system leadership will play a vital role in achieving sustainability. No single partner can deliver the scale of transformation proposed on its own, and delivering our vision will therefore require true partnership working across health, local government, the voluntary sector, housing, education, leisure and transport.

• Commercial, finance and contracting methods – alignment of financial incentives across the system to promote the delivery outcomes rather than activity, support the shift from treatment to prevention and early intervention, and reduce demand for care services – especially in an acute setting. This includes the potential to build on the new contracting approach already established under Care Closer to Home and move towards a fully for capitated budget model and risk share arrangements with our Accountable Care System partners. Work is already underway with ECC to define and pool budgets associated with older people and carers.

• IT – Using the local digital roadmap to deliver shared care records in order to promote integrated and seamless care across traditional organisational boundaries, and enable extended access and seven day working. The role that new technology can play in promoting self care is of vital importance and needs to be developed as priority.

• Workforce and OD – We recognise that Primary Care represents a major workforce challenge – and through our role as lead for Primary Care Workforce we have commissioned the Essex Primary Inter professional Care for Workforce Development (EPIC WD) as a hub for the training and development of future Primary Care workforce, which are able to deliver future requirements in line with the Five Year Forward View. We have an active role in the Essex Workforce partnership and therefore fully appreciate the challenges that the whole system is facing especially around urgent , acute and mental health care. Our AO is also the CCG representative on the HEE EoE board which enables us to access best practice examples across the EoE. We are also progressing plans for collaborative workforce development across the system as a whole

• Estates - We understand that Estates will be a key enabler of transformation going forward, and have established a multi agency working group across all partner organisations in order to baseline the current estate and map out requirements for transformation. DRAFT SUBMISSION 8 Agenda Item 8 Appendix A Annex 1 Section 2c: Improving productivity and closing the local financial gap

Please discuss your emerging thinking in the following areas. The sustainability challenge

• The CCG’s total 2015/16 expenditure for North East Essex was £438.6m in 2015/16, against our allocation of £430.5m

• The total 2015/16 position for the system is currently an in-year deficit of approximately £51m. Of this: • £8.1m CCG draw down • £39.5m sits in the CHUFT • £3.5m sits with NEPFT • ACE, our Care Closer to Home provider, currently operates without a financial deficit (it will re-invest any surplus)

Delivering system sustainability

We recognise that the current financial situation across North East Essex is not sustainable, and we will need to deliver against the key priorities and transformational initiatives set out in section 2 in order to achieve financial balance over the next five years and beyond.

Analysis by right care highlights that we are a significant outlier for non-elective care, with an estimated savings opportunity of over £9 million if we can reduce this level of variation. Whilst the level of savings associated with elective care are less significant, improvements in this area point to a savings opportunity of over £3.5m.

Our system believes that the biggest savings will be delivered by reducing the demand for acute services. Our Care Closer to Home model has already delivered efficiency savings in the region of £1.7m, and we have also put contractual incentives in place to share any of the savings associated with a reduction in the level of non elective admissions in the over 65s. Our plans to shift further activity out of hospital, develop new models of community urgent care through a ‘hub’ model, and increase our focus on prevention and early intervention as we continue to develop the ACS will lead to further savings against these opportunities. Our plans to transform Primary Care and extend access to GP appointments will also play a fundamental role in reducing demand for urgent and emergency care services and delivering system sustainability.

DRAFT SUBMISSION 9 Agenda Item 8 Appendix A Annex 1 Section 2c: Improving productivity and closing the local financial gap

Please discuss your emerging thinking in the following areas. The efficiency and productivity of our Acute provision will also have a significant impact on delivering sustainability. The Carter review estimates that £21m worth of efficiency savings can be made in CHUFT alone. The acute transformation work across IHT and CHUFT will also deliver operational efficiencies and enable a recued range of services to be delivered in an acute setting on a sustainable basis across a wider geographical footprint. Our mental health provider, NEPFT, is also currently in the process of merging with SEPT, which will deliver further operational efficiencies.

Further work required to better understand the financial gap

System Finance leads across the STP footprint (representing all major providers, commissioners, local authority and Public Health), are working together to compile an agreed consistent view of the 5 year “do nothing” financial gap and to model the impacts of our STP on demand, activity and finances across health and care. The Finance leads have identified the following requirements for financial modelling and will agree how this will be resourced w/c 11/4:

• 5 year system-wide financial sustainability plan • A shared understanding of the system-wide (do nothing) financial gap • To identify cost / deficit drivers to inform system transformation (to close the financial gap) • To identify variations in activity / costs through benchmarking within the system (eg across providers) and externally • A mechanism for evaluating the system-wide impacts of our proposed Transformation Programme • Public Health have made some estimates of the impact of the prevention strategy which will be utilised • All underpinned by robust population and activity analysis and projections

DRAFT SUBMISSION 10 Agenda Item 8 Appendix A Annex 1 Section 3: Your emerging priorities

Please discuss your emerging thinking on what the key priorities are to take forward in your STP, and why:

Our main areas of focus in delivering the priorities set out in the Five Year forward View and addressing local challenges include:

• Ensuring that we have strong and effective system leadership and partnership working in place across North East Essex in order to enable a collective view of our priorities and challenges outside of traditional organisational boundaries and drive the required programme of whole systems transformation. We are only at the very start of this journey, and recognise that it will take time to develop the required level of trust to make this a reality. This will require decision to be made which put the needs of people and the system above exiting organisations. (Addressing the Sustainability, Quality, and Health and Wellbeing gap)

• Managing demand for care – through prevention, supported self care, and behavior change, whilst also through ensuring that people who do need interventions receive the right care, in the right place, at the right time in order to reduce the overall demand for services. (Addressing the Sustainability and Quality gaps)

• Mobilising the power of local communities in order to prevent ill health, promote healthier lifestyle choices and self help, and foster increased resilience at both a personal and community level – leading to a change in behavior and a reduced reliance on public services. This will require us to work closely with partners across the wider system and actively involve communities in local decision making (Addressing the Health and Wellbeing gap)

• The accelerated development of an integrated Accountable Care System for Out of Hospital Care, which ensures that services are delivered by a multi- skilled workforce, predominantly in the home or community, with hospital services used only where they add value. This will involve making tough decisions such as shifting care into different settings and pooling budgets across organisational boundaries to ensure that we make the most effective use of resources across the system as a whole. Commissioners will also need to be bold in order to re-focus the system from treatment to preventing and early intervention by giving the accountable care system the freedom and incentives to do so. (Addressing the Sustainability and Quality gaps)

• The development of a more sustainable model of Primary Care operating at greater at scale – including decisions regarding the form, structure, and contracting route for General Practice. (Addressing the Sustainability and Quality gaps)

• Acute reconfiguration- to further develop the work on the clinical and financial sustainability of acute provision in the STP footprint will include some clinical reconfiguration of pathways and workforce across the providers. This will inevitably result in a collaboration between Colchester and Ipswich Hospitals. (Addressing the Sustainability and Quality gaps)

• Attracting, developing, and retain a workforce which meets our future needs – exploring a more strategic approach to recruitment and retention of staff which could include recruitment of urgent care staff as a system with rotation, joint posts and increased training opportunities. (Addressing the Sustainability and Quality gaps)

DRAFT SUBMISSION 11 Agenda Item 8 Appendix A Annex 1 Section 4: Support you would like

Please discuss your emerging thinking in the following areas: We would like regional or national support in the following areas to help us develop our plan:

• Reconfiguring and merging Trusts – both Acute and MH – will require support around choice and competition, workforce, managing communications, and external support to increase the pace of change

• Different models of Primary Care – including advice and support around the implementation of new contacting options, legal form, and structure etc.

• Support for the delivery of Integration – especially practical support around areas such as pooled budgets and capitation, and how this has been developed elsewhere

National barriers or actions we think need to be taken in support of your STP include:

• Our plans for mobilising the power of local communities would benefit significantly from a devolution approach. We appreciate devolution is already in train across Suffolk, but we are unsure how county council boundaries across the Suffolk / NEE; and Mid / South Essex STP footprints will support and enable this. There is therefore a clear need to break down the barriers between different parts of the public sector, at acknowledge the need for cross boundary working.

We would like to access to expertise or best practice from other footprints around the following:

• Learning from the success regimes, both Essex and wider, about accelerating the pace of change, especially with regard to Acute reconfiguration

DRAFT SUBMISSION 12 Agenda Item 8 Appendix A Annex 2

Annex: Template for the 15 April checkpoint

Please use the following slides for your submission, and remove the earlier slides to keep the pack concise (max 10 slides).

1 Agenda Item 8 Appendix A Annex 2 Key information

2 DRAFT Agenda Item 8 Appendix A Annex 2 Section 1: Leadership, governance & engagement

Collaborative leadership and decision-making – STP footprint area • The Suffolk and North East Essex STP footprint is led by Nick Hulme, Chief Executive of The Ipswich Hospital NHS Trust. • The Suffolk element of the footprint comprises the Ipswich and East and West areas of Suffolk. The Waveney area is included in the Norfolk footprint. References to Suffolk throughout this document apply to the Ipswich and East and West Suffolk area and population. • The Suffolk and North East Essex systems have appointed STP leads who are bringing together their place-based plans and are collaboratively developing an overarching footprint STP. • Both systems are building on work which is already well underway in their respective areas. We are keen to create an ambitious blueprint for our footprint area which will deliver a sustainable health and care system which focuses on the needs of the footprint population. Our systems will each continue to progress their respective place-based plans and where applicable will identify opportunities for closer working across county boundaries where this will benefit our populations. • The diagram opposite sets out our governance arrangements for the STP. • The Joint STP Steering Group is made up of system leaders from health commissioning organisations, major providers, local authorities and Healthwatch. • The first meeting of the Joint Steering Group is will take place on 14/4/2016. • The Suffolk and North East Essex Locality STP governance structure is well established with the Acute Hospital Transformation Programme in the early stages of development. • The Suffolk Health and Wellbeing Board will drive delivery of the STP in order to deliver its Health and Wellbeing Strategy.

3 DRAFT Agenda Item 8 Appendix A Annex 2 Section 1: Leadership, governance & engagement

Collaborative leadership and decision-making – Suffolk • In Suffolk, system leadership in terms of agreeing the plan and implementation of the plan will sit with the two shadow Integrated Care System (ICS) Boards whose members comprise leaders from health and social care organisations. • The West Suffolk and Ipswich and East Suffolk health and care systems have agreed to work together towards two ICSs, one for West Suffolk and one for Ipswich and the East. The ICS shadow Boards have been meeting on a monthly basis since mid 2015. The ICSs will be central to delivery of the health and care model and will be enablers for the changes required to achieve financial and workforce sustainability whilst maintaining or improving the service provided for the local population. A number of workstreams have been set up to provide focus on specific priority areas which will be key to the success of the STP.

Local government involvement • The health and care system has well established partnership working arrangements across health commissioners and providers, Suffolk County Council, districts and boroughs and local community voluntary services organisations. This includes working together to develop integrated Better Care Fund spending plans. • The Suffolk health and care system continues to work as part of a wider footprint for devolution across Suffolk, Norfolk, Cambridgeshire and Peterborough. The East Anglia Devolution Agreement states that the system “will work together … to support each of the counties through their Sustainability and Transformation Planning process to set out plans for moving progressively towards integration of health and social care, bringing together local health and social care resources to improve outcomes for residents and reduce pressure on Accident and Emergency and avoidable hospital admissions.”

4 DRAFT Agenda Item 8 Appendix A Annex 2 Section 1: Leadership, governance & engagement

An inclusive process • Our work in Suffolk to engage partners and the public on several strategies over many years has given us the map to develop our strategy for the STP. As a system, we have been regularly engaging since 2010 and our population has been asking us to bring services closer together. • The picture opposite shows the wide range of engagement activity that has taken place over recent years which has been supported by all system partners and also includes the wider determinants of health and wellbeing such as housing and education. • System partners are working together to develop a number of events to be held in May to engage with the health and care community including the third sector to further develop our plans and agree how we can work together in their delivery.

Engaging clinicians and NHS staff • We have established a number of joint clinical transformation groups to encourage the health and care system to work collaboratively to design fit for purpose clinical pathways and models of care for the future. The membership of these groups includes clinicians and staff from primary, community, acute, mental health and social care as appropriate. • This approach has resulted in the design of a number of innovative models of care and clinical pathways. • We will be continuing to use this approach to develop new service models for all our services, aligned to the Transformation Programmes that will be outlined in our STP.

5 DRAFT Agenda Item 8 Appendix A Annex 2 Section 2a: Improving the health of people in your area

It is tempting to think that prevention is not relevant in a healthy place like Suffolk but preventable disease is needlessly causing early death and disability. • Residents generally have a long and increasing life expectancy, which is higher than the England average • But recent evidence suggests that healthy life expectancy in Suffolk (the proportion of life which is lived in good health) may be declining and the gap between life expectancy and healthy life expectancy, where people have poor health and use more health and care resources, is increasing. • And life expectancy in Suffolk’s more deprived communities is 6.4 years lower than the Suffolk average for men, and 4.2 years lower than the Suffolk average for women; and this pattern may be worsening over time Our Prevention Strategy “Is Prevention better than the Cure” describes how we can reduce demand in the health and care sector by improving health. It identifies actions that we can do now that have the potential to drive down demand including the following three priorities: • Reduce avoidable admissions by improving the early detection and treatment of high blood pressure, atrial fibrillation, chronic obstructive pulmonary disease, diabetes and frailty • Improve the direct and indirect support offered to those who wish to change their lifestyle – tackling smoking, alcohol and inactivity • Create community and personal capacity and enhance community and personal resilience An action plan has been drafted with measures and proposed leads across health and care organisations which prioritises actions according to the evidence base and return on investment and which will form an important part of the first of our four Transformation Programmes which are set out in section 2b. Transformation. Programme 1. A step change in prevention and the building of stronger, resilient communities By upgrading prevention and self-care and building safer, stronger, resilient communities we are proposing to radically change the way people view and use public services, creating a new relationship between people and public services. This will be done through five key developments: • Enable people to take responsibility and manage their own health and wellbeing by giving them the knowledge skills and confidence that they need (patient activation) including through the use of technology, integrated personal health budgets and choice. • Develop a range of networks utilising the collective assets of the private, voluntary and community sector and embedded in our localities to support people. • Significantly increase earlier intervention to prevent mental and physical ill health and identify the ‘missing thousands’ • Support children and young people to have the best possible start in life through implementing our Families 2020 Strategy • Working across Suffolk to ensure that Suffolk has an adequate supply of suitably located, well designed, supported accommodation for those in need

6 DRAFT Agenda Item 8 Appendix A Annex 2 Section 2b: Improving care and quality of services

Our vision is that “people in Suffolk live healthier happier lives” We know that we cannot meet the challenges we face through continued incremental change and no single partner or locality can deliver the scale of transformation proposed on its own. Our transformation must be comprehensive covering all aspects of health and care for our local population. We believe we can improve and reshape care delivery and quality across health and care through four interlinked programmes of transformation which are described on the next slide: 1. A step change in health prevention and the building of stronger, resilient communities (described in section 2a) 2. Transforming locality based care and support through health and care integration 3. Ensuring that our hospitals, mental health, community, social and primary care providers and commissioners are sustainable financially and continue to provide high quality care 4. Enabling better health and care through the development of effective, innovative models of care and ways of working

Currently the system generally has high quality and good performance relative to others, however, we continue to look for improvement and will be focussing our programmes on help us to reduce unwarranted variation in outcomes, quality and safety which are highlighted in our analysis of the 2015 Rightcare Atlas of Variation shown below:

7 DRAFT Agenda Item 8 Appendix A Annex 2 Section 2b: Improving care and quality of services

Our Transformation Programmes (see section 2a for programme 1 )

2. Transforming locality based 3. System Sustainability 4. Enablers care and support through • Management of demand and activity by focussing on New models of care prevention, supportive communities and locality based care • Integrated Care Systems developing in both health and care integration with more people cared for close to home East and West Suffolk • Reducing variation in the outcomes, quality and safety of • Organisational focus replaced by a place-based • “Connect” piloted in two areas, one care, key areas of which for Suffolk are highlighted through population focus the Atlas of Variation, Carter Review and other • Changing the way health and care is urban, one rural benchmarking commissioned by adopting a more collaborative • Bringing together the physical and • Our emerging Acute Hospital Transformation Programme approach with providers, integrated commissioning across health and care, mental health and care workforce - will focus on opportunities for collaboration across providers outcomes based contracting and payment and with the rest of the health and care system. GPs, social workers and district • Alignment of performance and financial nurses, into Integrated • Joint clinical transformation groups will drive outcomes incentives Neighbourhood Teams working focused transformation with integrated CIP, QIPP and • Potential for capitated budgets and risk share CQUIN delivery through joint teams focusing on arrangements together to risk stratify, assess, plan productivity, pathways and clinical innovation. IT and target coordinated services so • Primary care • Local Digital Roadmap that people’s health and care needs - facilitate practices working together by engaging with – delivering full interoperability by 2020 and are proactively met which should localities and sub-localities as well as via the Suffolk GP paper-free at the point of use Federation - innovative shared information and intelligence also lead a moderation in activity - invest in training and education to enable continuous solutions for patients and health and care growth improvements in the quality of general practice and to teams to enable self care and joined up care • Developing and delivering support the recruitment, retention and development of the Workforce and OD sustainable primary and community whole workforce as well as growth of new clinical roles • OD plan including establishing a culture based - facilitate GPs and Secondary Care Clinicians to on integrity and trust care at scale collaborate and drive system-wide transformation • System-wide workforce plan • Create simpler, coordinated access - Working with HEE to compile current • System working to support Norfolk and Suffolk Foundation workforce by skill mix, care setting and arrangements for urgent, Trust to support their CQC improvement programme. organisation emergency and planned health and • Local authorities are facing continuing financial pressures - Apply impact of projected changes in demand care services operating 24/7 due to a combination of funding cuts, demand growth and and demographics - Specification of new roles to meet the need of • Develop 24/7 integrated health and additional cost pressures. Our system based approach an integrated system focuses on prevention, effective rehabilitation and = Projected workforce requirement care reactive responses to enable reablement, seeking efficiencies through joint working, people to stay at home and to leave • Strategy and plans for implementation creating a flexible workforce and addressing the wider - Developing capacity and capability across the hospital at the earliest opportunity determinants of health and wellbeing. system with rehabilitation, recovery and end • The sustainability of the care home and domiciliary care - Retaining, Recruitment and Retention of life support as appropriate, market is recognised as a major risk for the health and care • System leadership development plans system. The CCGs and Suffolk County Council are carrying • Give staff the tools to lead integration and reducing delayed transfers of care, out a strategic market review in order to identify the extent service transformation emergency admissions and hospital of the problem and to formulate a plan to address it. Estates lengths of stay. • Rationalisation across the public sector • Bringing teams together

8 DRAFT Agenda Item 8 Appendix A Annex 2 Section 2c: Improving productivity and closing the local financial gap

• In Suffolk the health and care system is costing [£m tbc] more than funds coming in. With a growing and ageing population, combined with rising expectations and cost inflation, this gap will continue to increase if we do nothing. All organisations are facing financial problems which can lead to a focus on organisational rather than whole population solutions. • We need to address increasing demand which is driving levels of activity which are not sustainable in our current system. Many people are treated in hospital when their needs could be better met elsewhere; care is not joined up between teams and not always of a consistent quality. We have issues recruiting staff in some key areas and we spend millions of pounds on treating people with illnesses which could be prevented if we could address mental health wellbeing, high blood pressure, smoking, drinking, loneliness, unhealthy eating and physical inactivity. • Our 4 Transformation Programmes (described in sections 2a and 2b) are focussing on these challenges. • Our ICSs (see section 1) will be central to the delivery of health and care in Suffolk and will enable the changes required to achieve financial and workforce sustainability whilst maintaining or improving the service provided for the local population. Decisions around resourcing need to be based on the needs of our population and not organisations. A new approach to resource allocation and risk sharing will be an important enabler for delivery of a sustainable health and care system. It is envisaged that some form of capitated payment, covering as much of primary, secondary, community, mental health and social care as possible will be developed. As a first step, the acute trusts and the CCGs are developing a new approach to contracting which provides assurance, aligns incentives and clinical outcomes, and which alongside work across the wider system, will aim to create a sustainable care delivery system for Suffolk within 5 years. • System finance leads (representing all major providers, commissioners, local authority and Public Health), are working together to compile an agreed consistent view of the 5 year “do nothing” financial gap and to model the impacts of our STP on demand, activity and finances across health and care. The finance leads have identified the following requirements for financial modelling: • 5 year system-wide financial sustainability plan • A shared understanding of the system-wide (do nothing) financial gap • To identify cost / deficit drivers to inform system transformation (to close the financial gap) • To identify variations in activity / costs through benchmarking within the system (eg across providers) and externally • A mechanism for evaluating the system-wide impacts of our proposed Transformation Programmes • Our Prevention Strategy includes estimated reductions in activity and return on investment • All underpinned by robust population and activity analysis and projections • Our emerging Acute Hospital Transformation Programme (See section 1) will focus on opportunities for collaboration across providers. Continuing to improve the productivity and efficiency of our acute services will require us to look at reconfiguring our acute hospitals. There are a number of different models of horizontal collaboration and we are in the initial stages of identifying those model options that will best suit our health system. In reconfiguring our acute hospitals we are looking for opportunities to continue to improve the quality of service delivery both today and in the future, maintain performance against core standards, reduce the cost of acute delivery to the system, improve efficiency through delivery of Carter Review recommendations and address future workforce challenges.

9 DRAFT Agenda Item 8 Appendix A Annex 2 Section 3: Your emerging priorities

• Describe your main areas of focus, to address (a) the priorities set out for the NHS in the Five Year Forward View, the mandate and the shared planning guidance, and (b) your own particular local challenges as set out in section 2

Our vision is that “people in Suffolk live healthier happier lives” We know that we cannot meet the challenges we face through continued incremental change and no single partner or locality can deliver the scale of transformation proposed on its own. Our transformation must be comprehensive covering all aspects of health and care for our local population. We believe we can improve and reshape care delivery and quality across health and care through four interlinked programmes of transformation: 1. A step change in prevention and the building of stronger, resilient communities 2. Transforming locality based care and support through health and care integration 3. Ensuring that our hospitals, mental health, community, social and primary care providers and commissioners are sustainable financially and continue to provide high quality care 4. Enabling better health and care through the development of effective, innovative models of care and ways of working

And that we achieve the following health and care outcomes  People manage their own health and social care with the right support when needed  Communities are easy and supportive places to live with a health or care need  The health and care system is coordinated and effective  Higher cost interventions are replaced where possible with lower cost interventions

10 DRAFT Agenda Item 8 Appendix A Annex 2 Section 3: Your emerging priorities

• Any big decisions you will need to make as a system to drive transformation

The following is an emerging list of strategic challenges which the system faces and which will require decisions to be made as part of the STP process

• Acute hospital transformation including the future of Colchester Hospital University NHS Foundation Trust and the impact on West Suffolk NHS Foundation Trust and Ipswich Hospital NHS Trust • The future of Community Services, 111 and Out of hours provision in Suffolk – current 1+1 contract with West Suffolk NHS Foundation Trust, Ipswich Hospital NHS Trust and Norfolk Community Health and Care NHS Trust terminates in October 2017 • How to ensure the sustainability and enable transformation of primary care • How can we ensure parity of esteem between physical and mental health and close the health gap between people with mental health problems and the population as a whole • Investment in our prevention strategy where benefits will be realised in the short term and longer term - essential to deliver longer term sustainability • How to ensure the sustainability of the care homes and home care market • Introduction of capitated budgets, pooling of budgets across existing organisations and risk share arrangements • How can we maximise the new powers and leverage our devolution deal to deliver the STP?

11 DRAFT Agenda Item 8 Appendix A Annex 2 Section 4: Support you would like

• Areas where you would like regional or national support as you develop your plans. • Examples of best practice • Evidence base for transformation in other areas eg examples of activity shifts across care settings which have resulted in lower overall costs • Support with health economics • Modelling health needs assessments (with a focus on mental health) • Risk sharing arrangements • National barriers or actions you think need to be taken in support of your STP. • Support to explore a system based approach to finance and performance management • Adequate prioritisation for STP planning and delivery alongside short term performance – systems given the space to plan and deliver transformational change • The facilitation of information sharing across the health and care system • Areas where you could share good practice or where you would like to access expertise or best practice from other footprints. • We can share examples of clinical transformation • We would like access best practice in activity and financial modelling across whole systems • Any other key risks that may affect your ability to develop and/or implement a good STP. • A top down focus on fixing issues in one part of the system which distracts from whole system transformation and which could stifle collaborative design opportunities • Procurement and competition rules which could delay implementation of new models of care • Stretched resources to plan and deliver STP with large scale system wide transformation alongside ongoing delivery of operational performance requirements and the ability to sustain the energy and commitment of the workforce • Lack of alignment at a national level between STP and Devolution planning

12 DRAFT Agenda Item 8 Appendix B

Sustainability and Transformation Plan Update

Karen Tew 18/4/2016

51 Local Governance Locality STP STP Footprint Overarching STP Governance Arrangements and Sign Off Governance Governance

Suffolk Suffolk Shadow ICS WSHFT WSHFT Board Ipswich Eastand Ipswich Suffolk Health and Wellbeing Board Board Local WorkforceLocal Action Board - - Suffolk Federation,GP LMC WSCCG WSCCG GB Suffolk County Council Suffolk CountyCouncil

Primary care NSFT Board IHT Board West Suffolk ICS Shadow Board Shadow IESCCG IESCCG

Essex Health and Wellbeing Board Local Action Workforce Group (Future Shadow ACS Board) North North East Essex STP Board Local WorkforceLocal Action Board Joint STP Steering Group ECC / CBC / TDC ECC/ / TDC CBC NEE CCG Board NEE CCGBoard 52 NEPFT NEPFT Board CHUFT Board Board CHUFT ACE Board

Acute Transformation Agenda (Format TBC) CHUFT Board Board CHUFT WSH Board IHT Board IHT Item 8 Appendix

B Agenda Item 8 Appendix B Vision and Transformation Programmes

“Our vision is that people in Suffolk live healthier, happier lives” (adopting the Health and Wellbeing Strategy vision)

It is accepted that Suffolk cannot meet the challenges it faces and deliver this vision over the next five years through continued incremental change. In addition, no single partner or locality can deliver the scale of transformation proposed on its own. Our transformation must be comprehensive through covering all aspects of health and care to our local population.

We believe that our vision will be achieved through four interlinked programmes of transformation: 1. A step change in prevention and the building of safer, stronger, resilient communities 2. Transforming locality based care and support through health, care and other services integration 3. Ensuring that our hospitals, mental health, community, social and primary care providers and commissioners are sustainable financially and continue to provide high quality care

Our fourth programme underpins the delivery of the other three programmes: 4. Enabling better health and care through the development of innovative new models of care and ways of working 53

The link to devolution and wider public sectorAgenda Item 8 Appendix B transformation

Better health and care outcomes

1. Step change in 2. Transforming Improved prevention and locality based care building stronger and support educational resilient through health and Increased attainment communities care integration People in Suffolk live productivity healthier happier lives 4. Enabling better health and care 3. Creating a through the sustainable health development of and care system innovative for our population organisational forms and ways of working

Sustainable public Wealth and sector - £ and economic growth workforce

54 Agenda Item 8 Appendix B The relationship between devolution and public services

55 Agenda Item 8 Appendix B 1. A step change in prevention and the building of safer, stronger, resilient communities

By upgrading prevention and self-care and building safer, stronger, resilient communities we are proposing to radically change the way people view and use public services, creating a new relationship between people and public services. This will be done through four key developments: 1. Enable people to take responsibility and manage their own health and wellbeing including through the use of technology. 2. Develop a range of networks utilising the collective assets of the private, voluntary and community sector and embedded in our localities to support people. 3. Significantly increase earlier intervention to prevent mental and physical ill health and identify the ‘missing thousands’ 4. Support children and young people to have the best possible start in life through implementing our Families 2020 Strategy 5. Working across Suffolk to ensure that Suffolk has an adequate supply of suitably located, well designed, supported accommodation for those in need.

The above will be delivered through: Prevention Strategy (and linked strategies), Families 2020 Strategy, Health and Housing Charter, Supporting Lives, Connecting Communities Programme, plans to deliver the cross cutting theme of the Strong, Resilient Communities strand of the HWB Strategy and any plans which emerge from the Safer and Stronger Communities Group, Families and Communities Strategy (West Suffolk), Enabling Communities Strategy (East Suffolk), Poverty Strategy for Suffolk, Volunteering Strategy for Suffolk, Carers Strategy, Marginalised Vulnerable Adults work and elements of LD and MH Strategies related to prevention and dementia diagnosis and care market development Produced at: Pan-Suffolk level with local implementation across two ICS areas Programme Outcomes: TBC 56 Agenda Item 8 Appendix B 2. Transforming locality based care and support through health, care and other service integration Aim is to integrate health, care and other services within each locality across Suffolk so as to enable people to stay well at home through four key developments: 1. Bring together the physical and mental health and care workforce, such as GPs, social workers and district nurses, in to integrated neighbourhood teams working together to risk stratify, assess, plan and target coordinated services so that people’s health and care needs are proactively met 2. Developing and delivering sustainable primary and community care at scale 3. Create coordinated access arrangements for urgent, emergency and planned health and care services operating 24/7 4. Develop 24/7 integrated health and care reactive responses to enable people to stay at home and to leave hospital at the earliest opportunity with rehabilitation, recovery and end of life support as appropriate

The above will be delivered through: Health and Care Review, Connect Programme, Primary Care Strategy(ies), Local Policing Review, Community Services transformation (related to 1+1 contracts), EOL Framework, Rehab and Recovery/Discharge to Assess, Supporting Lives, Connecting Communities and Planned Care Demand Management.

Produced at: Pan-Suffolk level with local implementation across two ICS areas Programme Outcomes: TBC

57 2. Transforming locality based care and supportAgenda Item 8 Appendix B through health and care integration

Health and Care Review Outcomes People manage their own health and social care with the right support when needed Communities are easy and supportive places to live with a health or care need The health and care system is coordinated and effective Higher cost interventions are replaced where possible with lower cost interventions 58 3. Ensuring that our hospitals, mental health, community,Agenda Item 8 Appendix B social and primary care providers and commissioners are sustainable financially and continue to provide high quality care Aim is to ensure that our population is served by sustainable health and care system: 1. Management of demand and activity 2. Reducing variation in outcomes quality and safety 3. Emerging acute hospital transformation programme focussing on opportunities for collaboration across providers and the health and care system as a whole 4. Joint clinical transformation groups driving outcomes focussed transformation 5. Sustainable primary care including opportunities for practices to work together 6. Sustainable care home and domiciliary care market

The above will be delivered through: Specialist Commissioned Services, all Acutes (including NSFT) Carter Review, Planned Care Demand Management Programmes, Seven Day Working, Cancer Taskforce Report, Maternity Taskforce Report, acute sustainability programmes, Primary Care strategy, Strategic market review of care homes and domiciliary care market.

Programme Outcomes: TBC 59 4. Enabling better health and care throughAgenda the Item 8 Appendix B development of new models of care, innovative organisational forms and ways of working Aim is to radically change the way in which health and care services are both commissioned and provided through five key developments:

1. Develop two integrated care systems (West Suffolk and Ipswich and East Suffolk) as vehicles for the transformational change needed 2. Radically change the way in which health and care is designed, by adopting a more collaborative approach between commissioners and providers. This will include integrated commissioning arrangements across health and care and developing innovative capitated, outcomes-based models 3. Develop and deliver innovative shared information and intelligence solutions to support improvement in health and care as set out in the Digital Roadmap 4. Create a One Public Estate across Suffolk utilising public sector property assets as a single resource and key enabler for change 5. Develop an efficient, integrated and flexible workforce which is focussed on the holistic needs of the individual rather than organisations 6. Use public engagement, co-production and activation to underpin system transformation 7. Develop, test and implement new ideas to address the health needs of the local population through drawing on the collective expertise of all partners from health and social care providers, academia and industry collaborators

Programme Outcomes: TBC

60 Agenda Item 8 Appendix C Health and Wellbeing Board

HWB Programme Office

Waveney Ipswich and East and West Suffolk

Joint System Health, Care and Commissioners Leadership Children’s Trust Safety Group • Outcome 2 Group Partnerships • Outcome 3 • Outcome 2 • Cross Cutting Themes • Outcome 4

Task and Finish/Project/Thematic Groups

61 Agenda Item 8 Appendix C

Agenda Item 9

Suffolk Health and Wellbeing Board A committee of Suffolk County Council

Report Title: Family 2020 Strategy

Meeting Date: 12 May 2016

Chairman: To be confirmed Councillor Gordon Jones, Cabinet Member for Children, Board Member Lead(s): Education and Skills Sue Cook. Director for Children and Adults Richard Selwyn, Assistant Director Commissioning Email: [email protected] Author: Tina Hines, Head of Commissioninng & Partnerships Email: [email protected]

What is the role of the Health and Wellbeing Board in relation to this paper? 1. The Joint Health and Wellbeing Strategy sets the long term strategic framework for improving health and wellbeing in Suffolk through its four outcomes. Outcome one is Giving every child in Suffolk the best start in life. The strategy that sits behind this outcome is Family 2020. A copy of the draft strategy is attached at Appendix A. Key question for discussion: 2. The key question for discussion is: How would the Health and Wellbeing Board like to be involved in the engagement phase of Family 2020, and support delivery? What actions or decisions is the Board being asked to take? 3. Support engagement and delivery of Family 2020. 4. To receive a final version of Family 2020 in the Autumn.

Brief summary of report 5. This report introduces the Family 2020 strategy, which will deliver outcome one of the Health and Wellbeing Strategy, “Giving every child in Suffolk the best start in life”. Main body of report Background

6. The Health and Wellbeing Board agreed at their meeting on 10 March 2016:

a) That the Board’s main roles should be to enable better partnership working across the public system in Suffolk and to unblock problems at a strategic level. b) That the role of overseeing the delivery of the Joint Health and Wellbeing Strategy Outcomes should be devolved to the Board’s sub-partnership groups. The Board would maintain a ‘light touch’ oversight of these groups c) Family 2020 has been drafted as a system-wide Strategy that is owned and agreed by the Children’s Trust Board and delivers outcome one of the Joint Health and Wellbeing Strategy. Key points 7. Family 2020 has been developed with partners, and is part of the NHS Sustainability and Transformation Plans. 8. Family 2020 is our five year transformation plan for children’s services. It sets out the principles, actions and enablers that will deliver efficiency and better outcomes for families in Suffolk. 9. For Family 2020 to be successful it must have shared ownership from all partners in the Suffolk system working with families. 10. Although Familty 2020 is a finished draft, it is not a completed document and will be subject to further engagement until September 2016 to shape the final version. 11. An engagement strategy will be agreed by the Children’s Trust Board in May. The engagement will cover all partners, and will be co-produced with Communicate Suffolk. 12. The outcomes of the Strategy have been co-produced with families. Why this action/decision is recommended 13. To agree a system-wide family strategy which transforms family services to meet future challenges, and enables effective delivery of outcome one of the Joint Health and Wellbeing Strategy. Alternative options (if appropriate) 14. None. Who will be affected by this action/decision? 15. Suffolk residents and Health and Wellbeing Board partners

Sources of further information No other documents have been relied on to a material extent in preparing this report.

Agenda Item 9 Appendix A

Family 2020

DRAFT for professionals and partners, March 2016. Our partner strategy to improve the outcomes of all children, young people and families in Suffolk. 65 Please email your thoughts and ideas to [email protected] Agenda Item 9 Appendix A

Giving every child the best start in life Outcome One, Suffolk Health and Wellbeing Board

66 Agenda Item 9 Appendix A Vision

All children and families in Suffolk have the right to: Challenges Be safe However, local partners are facing large cuts to funding which threaten our ability to deliver outcomes for families. The best education And at the same time pressure is growing on local services. By 2020 we anticipate significant population growth where Physical and emotional health houses will be built in Ipswich, Forest Heath, Lowestoft and along the A14. And there will be increasing need as national Successful preparation for and local services reduce. adulthood and employment Family 2020 This strategy is for professionals and partners. It is our Too many children and families do not have these sustainability and transformation plan and sets the principles, opportunities and we are committed to changing that. We actions and enablers that will deliver efficiency and better must be brave and change the way we work to deliver this. outcomes for families in Suffolk.

67 1 Agenda Item 9 Appendix A What does the future look like?

Joint delivery Service design There are signs from devolution, NHS five year plan and local Families and friends will be supported by guidance to help practice that the Suffolk public sector will be increasingly each other earlier, with assistance from universal professionals. integrated: multi-agency locality teams, delivery from the same We will be better at predicting future need and targeting buildings and IT, integrated points of access and assessment, our resources to reduce demand. Services will be designed in frontline staff with multi-agency knowledge, one Suffolk partnership to deliver sustainable outcomes with more early commissioning team, and joint budgets and governance. Local help to reduce demand to high cost services. Our services will joint delivery will be bespoke and varied across the Connect teams, be co-designed with families. while county level services will become simpler and streamlined. Suffolk families and communities Online services Families will be better informed to support their own needs. Face-to-face delivery will always be important but services will Services will be co-produced using Signs of Safety, and families also be online in a blended model. Many services will have a take control of their own lives. Communities will support digital front-door as the first point of contact with portals and themselves and each other more, being more responsive guidance tailored to young people, parents and carers, and and socially integrated, improving health and wellbeing and professionals. reducing social isolation.

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This31 section describes31 the principles for how £ we will design services and other support 13 in Suffolk. The four design principles are to guide professionals, service managers and Principles commissioners to get the best possible outcomes for children, young people and families.

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Agenda Item 9 Appendix A P A E Four design principles PRINCIPLES ACTIONS ENABLERS

1 Quality – we want to get our interventions right first time, 4 Early help – we will predictively target Suffolk resources commission based on clinical evidence and Suffolk JSNA, to families that will need help in the future, and we will monitor rigorously for impact on sustainable outcomes, co- reduce demand to expensive statutory services by drawing produce services, and stop doing things that do not work on community, universal and digital resources: 2 Efficiency – we will increase productivity, be more rigorous • Community – Signs of Safety practice will encourage in applying commercial thinking to commissioning and community support in all interventions, we will promote markets, co-design services, performance manage against volunteering to increase community resilience, and help outcomes, and develop early help that is more cost families to help themselves effective across the system • Universal – we will support universal staff in GPs, children’s centres, early years settings, schools, post- 3 Integration – we will integrate services around our users 16 education, pharmacies, the voluntary sector and where this makes sense for them, joining up processes, businesses to give more early help at the point of access, adopting the same thresholds, removing duplication before referring to specialists between partners, and co-producing with families and the community. And we will connect transformation • Digital – we will significantly increase the digital help programmes across Suffolk. that is accessed online, including guidance for young people, parents and carers and professionals, and new digital service delivery 71 5 24 13 13 24 12B

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• Be consistently designed to prioritise better outcomes Signs of Safety is the way services interact12A rather than more activity 28 28 with8 families – developing10 relationships and 12E Get interventions right the first time as much as possible, 28 co-producing the 10outcomes we want together • 27 8 which means stopping if it’s not working with families 12C Use clinical evidence, our own data and the Joint Strategic • 29 29 If we define the outcomes10 we want and always Needs Assessment to design services (and test and 28 28 measure8 performance10 against outcomes, we will prototype where there is limited evidence) increase our impact and incentives to work12E together Use Signs of Safety practice to deliver every intervention in • 30 30 co-production with families

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How 24 Why 13 13 24 12B We also need to drive the efficiency of how we improve All partners’ services are delivered within a fixed families’ lives. That means our focus on outcomes24 but also 24 envelope9 of resources – if we improve the efficiency 12D improving the return on investment and considering the best of each service and the system. then we can help 24 24 9 delivery models for services. more vulnerable families 12D

27 27 9 10 • Co-designing services with children and young people to To encourage innovation and design more efficient 12A drive innovation and early help 27 27 services9 we will work10 more closely with families and • Improving the productivity of services through better frontline staff in both commissioning and12A co-design 28 10 IT, integration and shared property, processes27 and 8 12C management information 28 10 27 8 • Being clear about the cashable return on investment so we have 12C the greatest and most sustainable impact on families’28 outcomes 28 8 10 12E Open to a range of delivery models including generating 8 • 28 28 10 revenue 12E Commercial thinking so all professionals consider the • 29 29 financial impact of decisions and are responsible for using 10 29 29 the most cost effective interventions 10 73 7 30 30

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24 13 13 24 12E12B 24 24 9 How Why 12D We are committed to integrating services so they make sense Services that are integrated will be more efficient

29 29 to families, and make the most of reducing resource in Suffolk. and10 able to respond better to the complex needs of 2724 2724 99 10 vulnerable families 12D Where it makes sense for families and services we will • 24 24 13 13 12A 12B deliver through Connect localities in multi-agency teams Services such as children’s centres are delivered 30 30 27 27 9 – linked closely to local schools, education 28and early years where1010 they make sense in the community, especially 27 8 settings and aligned to Adult health and care structures in rural areas 12C12A 24 24 9 Family service with 0-25 age range for complex needs 12D • 30 30 If a child needs help then parents or carers can and including services for vulnerable parents.28 Integrating 10 2728 28 88 also10 receive integrated support for parenting, 12C community health services, mental health and Suffolk 12E 27 27 9 domestic abuse, drug and alcohol abuse, and their County Council children and young people services, but 10 mental health excluding Emergency services.31 31 12A 28 28 8 10 £ Re-think public estate and29 community buildings29 across Greater efficiency at a County level to make best • 10 13 12E 28 10 Suffolk, and integrate children’s27 centres with partners’ 8 use of Suffolk resource estate 12C

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28 28 8 10 74 12E 8 30 3030 30

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31 31 £ P A E 13 PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS

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Agenda Item 9 Appendix A P A E Suffolk Model PRINCIPLES ACTIONS ENABLERS

As a child or young person in Suffolk the support I need is mostly from my family, friends and community. There is online guidance to help me or my parent or carer to give the best support.

And I can access universal services from the GP surgery and my children’s centre, early years setting, school or post-16 establishment. When I or my family need more support there is a Connect multi-agency team in my area and specialist services in the County such as respite support. When I’m receiving specialist or crisis support my school or GP continues to help me so I can more easily step down to universal and locality support.

If I need help in a crisis I will be supported by emergency health and care services. At all points my education setting and GP continue to support me along with community and family resources to get the outcomes I need. 75 9

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24 13 13 24 12B Agenda Item 9 Appendix A P A E Scope of integration PRINCIPLES ACTIONS ENABLERS 24 24 9 12D

24 13 13 How24 Why 12B The following27 services will27 be redesigned9 and integrated by10 It is everyone’s business to support the 40,000 2020, following the four design principles: children12A and young people with diagnosed or less 24 24 139 13 24 severe12D12B mental health needs – we cannot rely on • Community services including speech and language 28 10 specialist services to meet demand therapy,27 specialist communication aids,8 audiology, 12C incontinence,27 occupational27 therapy, physiotherapy,9 10 Children have a better experience of community 24 24 139 13 24 12B community paediatrics, health visiting and school nursing services12D such as speech and language therapy – 12A • Transforming28 care for28 children with learning8 disabilities10 or teams are integrated and can support more families 12E autism, integrated education health and care including10 2428 13 13 2724 27 89 10 Improving12B children’s outcomes through effective special24 educational needs,24 children with9 disabilities, and early12D12C years settings community equipment 12A 29 29 • Emotional wellbeing, crisis and in-patient services 10 28 28 8 10 24 2824 9 10 Adult27 mental health,27 domestic violence,9 substance misuse10 Improving placement choice and bringing young • 27 8 12D 12E and parenting support people12C in care or in an education placement back 12A • Aspects of Children in30 Care services including30 health outcomes into Suffolk 27 27 9 Single point of access and assessment8 for family services10 • 2928 2928 10 Reducing inequality alongside27 the MASH 8 10 12C12A12E 30 30 76 10 28 10 30 30 2728 28 8 10 29 29 10 12C 12E 31 31 £ 30 30 28 28 8 10 13 30 30 29 29 10 12E

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3130 3130 30 £ P A E 13 30 30 PRINCIPLES 31 ACTIONS 31 ENABLERS £ 13 P 31 A 31 E £ PRINCIPLES ACTIONS ENABLERS 13 P A E PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS 24 13 13 24 12B

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28 Agenda10 Item 9 Appendix A 27 8 12C P A E 4 Early help 28 28 8 10 PRINCIPLES ACTIONS ENABLERS 12E

29 29 How Why 10 It is our collective responsibility to ensure there is early help for Reducing the number of children and families 24 30 30 13 13 vulnerable families, reducing the spend on late24 interventions whose needs escalate and lead to suffering12B – early and improving outcomes. help or prevention of need

30 30 • There is hidden need in Suffolk’s most vulnerable families For every child we support there are 24 24 9 that leads to poor outcomes and drives the costs of many others that potentially need12D help, statutory services 31 31 such as mental£ health where we support • When we redesign a service it will be based on our four only13 1 in 8 design principles including an increase in the27 volume of 27 9 10

early help support 12A • But early help will have to be much more cost-effective, drawing on digital delivery, teachers and other universal 28 10 27 If 8we measure children’s outcomes then we will be professionals, volunteers, family and community24 support 13 13 12C 24 able to tell which early interventions12B work best, and Intelligence and IT strategies will show the impact of our • P A E where to put our resource early help work and drive improvements PRINCIPLES28 ACTIONS 28 ENABLERS 8 10

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30 30 Agenda Item 9 Appendix A P A E 30 Early30 help PRINCIPLES ACTIONS ENABLERS

The Intelligence Hub shows For Early Help to really work we have to support our real impact on families’ more vulnerable families and reduce inequality. 31 31 TARGET outcomes. And who needs So interventions to improve outcomes will have help in the future. £ to be much more cost-effective. 13

Predictive In the nursery A single All staff use If a young person Multi-agency modelling they have a list point of Signs of Safety is worried about teams are shows that of children we access and to co-produce their emotional based in a child could want to help assessment shared health they first Connect be at risk in 3 early. Building alongside outcomes with speak with their localities and years, so the relationships the MASH children, parents friends or parents work together family might with parents for all and carers. For and go online to – sharing be supported and carers and referrals every family self-help. Then information by a good breaking down controlling with complex get support from and resources. neighbour. traditional demand needs there is teachers, the 24/7 boundaries. and risk. one plan and chat service and one lead worker. professionals. P A E PRINCIPLES ACTIONS ENABLERS 78 12 24 13 13 24 12B

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29 29 10 Agenda Item 9 Appendix A

30 30

This section describes the actions we will take 31 31 to get the best outcomes for families in Suffolk,£ and how we will measure impact. Whilst13 actions are presented under separate outcomes many are connected. There is a fifth set of actions to Actions deliver enabling projects with partners such as community resilience.

P A E PRINCIPLES ACTIONS ENABLERS

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Agenda Item 9 Appendix A P A E Be safe PRINCIPLES ACTIONS ENABLERS

Priorities Children Suffolk Family Social Community 1 in care 2 Focus 3 care 4 Safety

Actions 1. Integrate services 1. Build on Suffolk Family 1. Develop a single point of Deliver the Police Children and supporting health Focus to expand family access for children’s services Young People strategy with outcomes for children in mentoring using volunteers alongside the Multi-Agency partners to improve safety at care including redesigned to provide targeted early Safeguarding Hub home, in public and online mental health support help 2. Draw together the ‘voice including: 2. Increase the sufficiency of 2. Integrate parenting support of the child’ and data 1. Work with the Youth placements and edge of services including mental around child exploitation Offending Service to care services for children health, domestic abuse, and children missing from support young people in care alcohol and drug abuse home, school & care to 2. Reduce the risk of children and parenting skills protect more children at going missing risk of suffering harm, 3. Implement the poverty 3. Tackle domestic abuse strategy to enable every abuse and neglect child to have the best start 3. Develop a multi-agency 4. Mental health concordat in life neglect strategy that more 5. Best use of stop and search sustainably addresses the principles underlying causes including 6. eSafety – raising awareness parental mental health, to prevent crime and domestic violence and reduce harm substance misuse

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Agenda Item 9 Appendix A P A E The best education PRINCIPLES ACTIONS ENABLERS

Effective and Strong school Excellence in Developing aspirations Clear timely school to school leadership and with families, strategy and Priorities 1 2 3 4 communities and 5 improvement support governance businesses communication 1. Further embed the system 1. Establish the School to 1. Embed a new workforce 1. Build aspirations among 1. Develop a clear strategy Actions for monitoring achievement School Support Partnership, strategy: young people and their and plan for Raising the Bar in all schools, to identify to give education leaders a) Develop ‘Teach Suffolk’ families 2015-17 schools at risk of declining access to high quality brand to attract high quality 2. Extend the opportunities 2. Improve the effectiveness and intervene more rapidly school to school support teachers into Suffolk; where necessary for family learning in the of communications 2. Develop with school b) Build schools’ capacity community and consultation with 2. Strengthen target setting to recruit and manage new leaders a cohesive strategy 3. Further increase education providers to ensure that targets set to support leadership, talent pipelines; by schools, especially for involvement of businesses 3. Review and strengthen teaching and learning c) Invest in developing school disadvantaged children, leaders at all levels, from to support young people the Raising the Bar are aspirational and link to 3. Foster innovation in newly qualified teachers to 4. Work in partnership with the communications strategy County targets teaching and learning, by headteachers voluntary and community with internal and wider investing in and sharing stakeholders 3. Increase access for 2. Provide effective support to sector to strengthen their role education leaders to good practice enable governors in schools in supporting educational 4. Build the national profile of high quality support and 4. Promote excellence in and committees in early attainment, including Suffolk education challenge from County teaching STEM (Science, through the Raising the Bar Council services years providers to challenge 5. Promote local and national Technology, Engineering performance and attainment Community Fund awards to celebrate the 4. Further develop the role and Maths) subjects to 5. Encourage all parents to excellence of education in of County Council officers support our economic be actively involved in their Suffolk to monitor, support and growth sectors children’s education challenge schools 81 15 24 13 13 24 12B

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Agenda Item 9 Appendix A P A E Physical and emotional healthPRINCIPLES ACTIONS ENABLERS

Priorities Emotional Community Transforming Healthy 1 wellbeing 2 services 3 Care and SEND 4 living

Actions 1. Single point of access and 1. Integration of speech, 1. Integrated community 1. Deliver weight assessment for emotional language and services for learning management and wellbeing communication services disabilities or autism physical activity strategies, 2. 24/7 chat service between NHS and SCC, 2. Integrated community significantly increasing and new schools choice services for learning the number of families 3. Digital help and training – market for SALT supported portals for professionals, disabilities and autism parents and carers, and 2. Redesign community 3. Connect through Tech to 2. Work with schools and young people services including OT, improve access to internet further education to physiotherapy, continence, promote positive health, 4. Eating disorder service for children with SEN or community paediatrics, disabilities developing resilience and improvements health visiting and school reducing risky behaviour 5. Acute services delivered in nursing with Connect such as smoking and Connect localities based on localities alcohol abuse IAPT model 3. Implement the national maternity review

82 16

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Agenda Item 9 Appendix A Successful preparation for adulthood and employmentP A E PRINCIPLES ACTIONS ENABLERS

Work Aiming high Learning Skills for Priorities 1 Transition 2 inspiration 3 16-18 4 and work 5 growth

1. Independence and 1. Raising the Bar - Careers 1. Post-16 opportunities to 1. Supporting adult learning, 1. Developing skills in our Actions adulthood supported by all Enterprise Company meet the needs of every in-work progression and growth sectors professionals using signs education / employer young person full employment 2. Supporting Suffolk of safety, education, health brokerage 2. Growing Apprenticeships as 2. Building a new youth offer, businesses to invest in and care plans and health 2. Icanbea – showcasing our a prestigious career path MyGo and Youth Pledge growing the skills of their passports economy to young people 3. Supporting school leavers to 3. Joining up welfare to work workforce 2. Flexibility in the age of 3. The Suffolk Skills Show make successful transitions locally 3. Helping businesses attract transition between children and supporting events and develop young talent and adult services up to 4. High quality impartial careers bringingyoung people and guidance for all 25 years for young people employers together with complex needs 4. Inspiring young people to study and build careers in scienceand technology

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Agenda Item 9 Appendix A P A E Enablers PRINCIPLES ACTIONS ENABLERS

Intelligence, Priorities Community insight and Commissioning Workforce 1 resilience 2 digital 3 and design 4 Actions 1. Increase community 1. Develop IT infrastructure, 1. Establish a Suffolk wide 1. Giving staff the tools to do resilience to reduce service data sharing and three Design team including the job demand portals for young people, commissioners and 2. Joint workforce planning 2. Establish a volunteering parents and carers, and providers and organisational resource to support the professionals 2. Establish engagement development needs of vulnerable 2. Long-term plan for model including human 3. Develop Connect locality residents integrated systems across centred design teams across Suffolk with 3. Establish community health and care 3. New single point of access links to local partners, development teams across 3. Measure universal outcomes and assessment building voluntary sector and Suffolk of most children in Suffolk from emotional wellbeing communities 4. Making Every Contact using school surveys model 4. Ensure quality and supply Count to identify 4. Model demand to services 4. Alignment of strategic asset of critical roles for Suffolk vulnerable families without to support the single point plans across NHS, Police Family services community support of access and local government 5. Fully embed Signs of Safety 5. Predictive modelling of need 5. Maximise impact on One practice in all internal and in partnership with Essex Public Estate on Family external services University Services 6. One family, one lead worker and one plan 84 18 24 13 13 24 12B

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Agenda Item 9 Appendix A P A E Measuring impact PRINCIPLES ACTIONS ENABLERS

The following outcome measures really matter to children, and families. The best education All Suffolk partners will measure success through these outcomes. • Vulnerable children accessing funded childcare Be safe • Children are ready for school (healthy with social and • Children on a child protection plan for a second or learning skills) subsequent time • Key Stage 2 children achieve national standard • Children in care who are in stable placements • Key Stage 4 children achieve national threshold • Entrants to the youth justice system • Children in poverty achieving the same or higher at Key • Incidents of anti-social behaviour by families with children Stage 4 as peers • Families where there is a report of domestic abuse • Children in care achieving same or higher at Key Stage 4 as • Young people feel safe outside and know how to get help peers • Young people who are a victim of crime • Children with special educational needs achieving same or • Evictions for families with children higher at Key Stage 4 as peers • Bullying of children and young people • Young carers achieving same or higher at Key Stage 4 as peers • Care leavers are confident and able to look after their own • Availability of places in education and early years health and wellbeing Permanent school exclusions each year Children, young people and parents / carers who feel that • • Attendance at education settings they co-produced the support they received • 85 19 24 13 13 24 12B

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Agenda Item 9 Appendix A P A E Measuring impact PRINCIPLES ACTIONS ENABLERS

Physical and emotional health Successful preparation for adulthood • Healthy birth and employment • Mothers breast-feeding at 6 to 8 weeks • Good job prospects, advice about careers and preparation • Children in care with good health for young people • Young people with good mental health • Care leavers and young adults with disabilities who are in • Professionals know about mental health employment, education or training • Children obese in reception and year 6 • 16 to 18 year olds who are in employment, education or • Young people smoking or taking drugs training • Children and young people in A&E seen within 4 hours • Care leavers who are in suitable accommodation • Young people admitted to hospital due to alcohol • Children in care and children and young people with consumption Education, Health and Care plans who have a co-produced, • Admissions to hospital for children and young people with planned transition to adulthood long-term conditions • Young people who are learning to manage long-term • Young people who know how to get help with mental health conditions health, physical health and safety • Families who have friends, extended family or community • Children and young people reporting that they are happy groups they can ask for help

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31 31 This section describes what else£ needs to be in place with partners to13 deliver the actions and get the best outcomes. For example, enablers will help us to increase community resilience, Enablers make better use of IT and data, and improve our workforce and commissioning of services.

P A E PRINCIPLES ACTIONS ENABLERS

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Agenda Item 9 Appendix A P A E Community resilience PRINCIPLES ACTIONS ENABLERS

How Why Children and families will be helped to help themselves and each Vulnerable families are supported by local 24 24 13 13 other, in strong and inclusive communities. This strand of the TCA volunteers before their needs escalate, 12B programme is to encourage community resilience and volunteering, extending the Good Neighbour scheme and link into services to improve outcomes and reduce demand. Everyone is more resilient because of their 2424 1324 9 13 24 connections and knowing24 where13 to get help 13 12B • Integrated community teams of development staff from Districts, 24 12B12D Police and Suffolk County Council to increase community resilience Volunteering – promoting formal and informal volunteering, Young people want to make a contribution • 27 27 9 10 24 24 9 including creating a new volunteer resource to give early help to 2424 1324 9 13 24 to their community but they don’t know 12B12D 12D12A vulnerable families how to volunteer • Programme to encourage community resilience so that residents: 10 27 Making27 best use of928 local assets and business: 27 810 make connections to each other, know where to go for help, are 27 27 9 10 24 230024 taxi drivers, 91300 hair dressers, 530 12C emotionally resilient, and more likely to help each other 12D12A pubs, 430 early years settings, 400 faith 12A • Making Every Contact Count includes a new theme of Connect. groups,28 137 pharmacies,28 130 coffee8 shops, Ensuring vulnerable families have a community that helps them to be 28 10 10 27 288 10 27 2727 9 10 120 dentists, 80 GP surgeries, 25 8leisure 12E more resilient. For example: Friends and family, community of interest, 12C centres and 7 job centres 12C faith or work, local community resources, or online connections 12A

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31 31 £ 13 P A E PRINCIPLES ACTIONS ENABLERS P AP EA E PRINCIPLES ACTIONS ENABLERS PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS 24 13 13 24 12B

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Agenda Item 9 Appendix A P A E PRINCIPLES ACTIONS ENABLERS Know Connections where to get help

Emotional Culture Resilience

There are lots of things we can do to help build community resilience. For example encouraging connections between residents, knowing where to get help in the community and online, building emotional resilience of individuals, and shifting the culture so people are more likely to help each other. 89 23 24 13 13 24 12B

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Agenda Item 9 Appendix A P A E Intelligence, insight & digitalPRINCIPLES ACTIONS ENABLERS

How Care Over time IT and other back-office functions will integrate First/ across partners including case management and shared data. Eclipse SystmOne MOSAIC • An effective IT infrastructure will underpin improvements & Universal in productivity, experience for users and our intelligence Needs to target early help. Assessment • Giving staff the tools to do the job including Data connectivity and mobile working EMS/ Store • Improving case management systems Capital • Rationalising infrastructure and integrating with partners One • Digital services – all transactions online, digital approaches to reduce demand such as ChatHealth CRM & and Skype, Connect through Tech assistive technology SCC web strategy, and one family, one lead, worker one plan Portals • Integrated intelligence in Suffolk County Council: case MS management, universal needs assessment and website Power BI with predictive modelling of future needs & Share 90 Point 24 24 13 13 24 12B

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Agenda Item 9 Appendix A

24 13 13 24 P A E 12B Outcomes PRINCIPLES ACTIONS ENABLERS

2424 1324 9 13 24 24 13 13 12B How Why 24 12D12B We need good shared intelligence about all families in Suffolk, One family, one plan, one lead worker – to give a

27 27 9 10 so we can tailor our services, target those most in need and 24 better24 experience 9for children and parents / carers, 24 24 9 12D understand the effectiveness of our services. and to join up services 12A12D • Quantitative measurement of the outcomes achieved from Feedback from children, young people, parents and 10 27 289 27 27 810 every Signs of Safety intervention by analysing the end carers27 shows the experience27 of services9 and impact 10 12C statements – for all internal and external services – informing our commissioning decisions 12A 12A Easy digital service for young people and parents to feed • Data will measure the difference we are making 28 28 8 back their experience of services and outcomes 28 10 10 27 to families lives, and288 how to improve our 10 27 8 12E Central collation of user feedback attributed to specific 12C • commissioning 12C interventions and providers And we want to improve our overall understanding of • 28 28 8 2928 2928 810 children’s outcomes through universal needs assessment: 1010 12E • Measuring individual needs of Suffolk children annually so 12E we can offer help more effectively 30 30 Evaluating the impact of our interventions and service design29 29 • 29 29 10 10 91 25 30 30 30 30 30 30

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24 24 9 12D Agenda Item 9 Appendix A 27 27 P A9 E 10 24 13 13 Predicting need 24 PRINCIPLES ACTIONS ENABLERS 12B 12A

24 13 13 24 12B 28 10 27 8 12C How 24 Why 24 9 12D Government and businesses are improving their use of Understanding the health and wellbeing of 24 24 9 12D big data and artificial intelligence to understand demand all28 children in Suffolk28 so we can measure8 the impact10

12E and predictors of risk. We can tap into these established 27 of27 early help and other9 services, and10 understand technologies: how well we are doing 27 27 9 10 12A Developing new algorithms to identify which families will Predicting which vulnerable families need help • 29 29 12A 10 28 10 need more support in the future, in a joint project with 27 rather than waiting8 until their needs escalate. 12C Essex CC and Essex University Making28 services cheaper and improving10 outcomes 27 8 Using pseudonimised data and data agreements to legally at the same time. 12C • 30 30 share data with partners so that our predictions become 8 28 Modelling28 demand will show the impact10 of more accurate and we can spot risks to families 12E 28 interventions28 and 8optimise our resources10 across Modelling demand into all children’s services including the • 30Suffolk 30 12E MASH, and the costs associated with changing demand

29 29 • Supporting the business case for early help and setting 10 targets to reduce referrals 29 29 10 31 31 £ 30 30 13

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P A E PRINCIPLESP ACTIONSA ENABLERSE PRINCIPLES ACTIONS ENABLERS 24 13 13 24 12B

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24 24 9 12A 12D Agenda Item 9 Appendix A 28 10 27 8 12C 27 27 9 P A10 E Digital help PRINCIPLES ACTIONS ENABLERS 12A

28 28 8 10

28 10 12E How 27 Why 8 12C Young people want to engage with services online and to have Increase in early help and reduced demand,

29 29 information so they can help their friends. because peers, parents, carers and universal 10 28 professionals28 know8 how to support10 children, young The Source offers guidance, forums and apps to help • people and families better 12E all Suffolk young people, e.g. with mental health and relationship issues Chat, Skype, forums30 and apps will30 give more

29 29 • A second portal will be developed for parents and carers immediate interaction between families10 and staff at offering guidance and InfoLink showing all services and the moment of need, alongside face to face services 30 30 community resources in Suffolk • A third portal will support professionals alongside the 30 30 MASH helpline to give guidance and confidence to help their children 31 31 • ChatHealth and other text or chat services to connect 30 30 £ professionals and young people 13

31 31 £ 93 13 27

P A E PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS 24 13 13 24 12B

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28 10 27 8 12C 27 27 9 10 27 27 9 10 24 24 9 12A12D Agenda Item 9 Appendix A 12A 28 28 8 10

28 P A10 E 12E 27 27 8289 10 Workforce 27 PRINCIPLES ACTIONS810 ENABLERS 12C 12C 12A

29 29 10 28 28 8 10 How Why 2828 28 810 10 27 8 12E The quality and passion of the Suffolk workforce is our biggest Making Suffolk public sector an attractive place 12C 12E asset. Support and development to the workforce will help us to work, to assure the30 supply of highly30 skilled to sustainably improve outcomes, as well as contributing to 2928 staff2928 for key roles such8 as nursing, social10 care, 29 29 10 growth in the economy. Increasingly professionals’ careers will 10 home care, teaching 12E move across traditional service boundaries, developing a more 30 30 rounded expertise and integrated service for families. Better local skills will support financial growth in 30 30 Suffolk and the health30 and social 30benefits that come Joint workforce planning and organisational development 29 29 • 10 across health, local authorities, police and education, and with a more affluent population encouraging career paths between sectors 31 31 30 Connect30 localities across Suffolk to integrate £ Develop Connect locality teams with a wide range of 30 30 • services30 and draw30 on local community 13 public sector services resources • Identify critical roles across public services and secure the volume and quality of staff required 31 To31 move away from current delivery models and 30 3130 31 • Work with schools, further education and MYGO centres cultures we will need to be brave £ £ to raise the profile of public sector careers, including a new 13 cohort of integrated roles and skills 13 Encourage businesses to release staff to volunteer for two • 31 31 days a year 94 £ 28 P A E 13 PRINCIPLES ACTIONS ENABLERS

P AP EA E PRINCIPLES ACTIONS ENABLERS PRINCIPLES ACTIONS ENABLERS P A E PRINCIPLES ACTIONS ENABLERS 24 13 13 24 12B

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28 28 8 29 29 10 10 12E Agenda Item 9 Appendix A

30 30 29 29 P A10 E Commissioning and designPRINCIPLES ACTIONS ENABLERS

30 30 30 30 How Why Our joint commissioning will be more focused on outcomes Being clear about outcomes will improve efficiency and strategic, and we need to design the whole Suffolk system30 and31 30 innovation 31 in partnership with providers: £ 13 • Integrated and co-located commissioning and design function Using the total resource in Suffolk to get the across the NHS and Suffolk Country Council including aligned31 outcomes31 for families in the most efficient, effective resources where services are being integrated and sustainable way £ • Children, young people, families and professionals involved 13 in service design and co-production of outcomes, using human-centred design principles. Inputs Outcomes Commissioning based on statute, clinical evidence, Suffolk Finance • • Commissioning is Community and JSNA and our four design principles Capital • the most efficient, place outcomes • Improved service specifications to focus on outcomes and • WorkforceP A E Markets effective and Children and productivity. Performance manage providers against the PRINCIPLES• ACTIONS ENABLERS sustainable route family outcomes impact they are having on families’ lives and outcomes. • Families and experience • Clear joint principles and process for commissioning P • ACommunity E PRINCIPLES 95 ACTIONS ENABLERS 29 Agenda Item 9 Appendix A

Family 2020

Agenda Item 10d

Suffolk Health and Wellbeing Board A committee of Suffolk County Council

Integrated Care Network System Forum – Ipswich and East Suffolk

Integrated Care Network (ICN) System Resilience Group Meeting 12 April 2016 Update 1. Dr John Hague, Governing Body and Lead Mental Health GP, presented the Mental Health 5 Year Forward View briefing covering the national document and Mental Health Taskforce Strategy for information advising there is wider Government support for Parity of Esteem and this is a central drive to give Mental Health issues time and attention. 2. Clare Banyard, Associate Director Ipswich and East Suffolk Clinical Commissioning Group (IESCCG) presented slides to the ICN on the Reactive and Proactive Models of Care advising next steps for information and discussion. 3. The Reactive Care Model is split into three sub-groups with Task and Finish Groups developed to take the work forward:  Sub-group 1: Community Reactive Response led by Andy Willis Operations Manager Ipswich Hospital Trust (IHT);  Sub-group 2: Front Door Services led by Carolyn Tester Head of Transformation IHT; and  Sub-group 3 - Collaborative Working between Health and Social Care led by Nicola Roper Area Manager Suffolk County Council (SCC).

Proactive Care Model 4. Sandie Robinson, Associate Director West Suffolk Clinical Commissioning Group (WSCCG) is leading the Proactive Care Model on behalf of both IESCCG and WSCGG with active involvement from IESCCG. 5. The model although pan-Suffolk, will focus on working with the Integrated Care System both in Ipswich and East and also West Suffolk intending to implement 8 Integrated Neighbourhood Teams (INTs) from a health and care perspective initially. 6. Clare Banyard confirmed for the ICN there is general support for simplification and that although there are a lot of good services available there are a number of cross overs and duplications which are confusing for professionals, patients and Carers alike.

Next Steps: Reactive 7. The next steps are: a) Continued discussions and focus on community and acute based reactive care response within the three identified sub-groups and overarching Community Response Task and Finish Group. b) Further development of the pan-Suffolk level Task and Finish Group focused on developing a single point of access and integrated 111, Care Coordination Centre and GP Out of Hours Service. c) Initial draft of model to be developed by end April 2016 for first discussion at Reactive Care Task and Finish Group on 4 May 2016. Proactive 8. The next steps are: a) Pan-Suffolk Proactive Care Task and Finish Group being formed to support the development of the clinical model, service specification and business case. Stakeholders currently being agreed with WSCCG. b) Pan-Suffolk ‘lock-in’ on 06/04/16 to review draft specification. c) Initial draft of model to be developed by end April 2016 for first discussion at Proactive Care Task and Finish Group.

9. Jon Reynolds Deputy Chief Contracts Officer presented the Escalation Review and Forward View to discuss bottle necks and potential solutions. 10. Three key issues affecting flow are: 1. Delayed Transfer of Care (DToC); 2. 111 performance; and 3. Continuing Health Care (CHC) placement packages of care. 11. Karen Tew ICO Programme Manager presented an update of the Sustainability and Transformation Plan (STP) for information and discussion advising: a) Joint Steering Group is being set up; b) Early draft setting out “early thinking” submitted to NHSE 15 April 2016; c) Combined Suffolk and North East Essex plan being pulled together; and d) Final Sustainability and Transformation Plan submission 30 June 2016.

Agenda Item 10f

Suffolk Health and Wellbeing Board A committee of Suffolk County Council Safe and Strong Communities Group (SSCG) 1. A meeting of the SSCG too place on 21 April 2016 at the offices of Mid Suffolk District Council. The following agencies were represented at the meeting: Suffolk County Council (SCC); West Suffolk councils; Babergh Mid Suffolk councils; Ipswich Borough Council; Suffolk Police; Suffolk Coastal Community Safety Partnership (CSP); the Local Safeguarding Children Board (LSCB); the office of the Police and Crime Commissioner (PCC); East Suffolk Councils; and the Youth Offending Service (YOS). Hilary Collyer, Norfolk/Suffolk National offender management –contracts manager, was present as a guest. Apologies were received from: Public Health, Clinical Commissioning Group (CCG), Waveney CSP. Norfolk and Suffolk Contract Management Service - Hilary Collyer 2. A presentation was given by Hilary in respect of the current service and a who’s who. Hilary is keen to engage local key stakeholders and understand the local landscape and commissioning opportunities in Suffolk. 3. All welcomed Hilary’s presentation and agreed it would be useful for Hilary to return to the SSCG periodically, to ‘check in’ with what is happening and also to ask the SSCG to provide an unblocking role should that be required. Governance 4. It was noted that ‘safety’ is not covered in the ‘Healthcare and Safety’ group and it was suggested that the SSCG become that safety group. 5. A wider discussion took place around being mindful of the original Terms of Reference (TOR) which included to unblock and clarify governance arrangements for those groups that do not have a natural home. (It was not necessarily for the SSCG to become the home, although this is possible if nowhere else is found to be suitable.) SSCG should be the place for coming together to speak about safety issues. There are many groups/boards in the arena and many opportunities for duplication. It was suggested that the chairs of these groups should come together to help to frame where they all fit in or overlap via a workshop type session. A lead should be decided for each priority area about who will be the governance and take this work forward. Partners should then feel assured that this is happening, it has an ‘owner’ and the work is being progressed (with support from other partners as required). 6. All agreed that members needed to take stock of current SSCG and revisit the TOR. CSPs- their statutory status and roles – Mike Grimwood 7. Since the demise of the Safer Suffolk Partnership Board and grant funding, some CSPs have struggled to set priorities and move forward without the

Strategic assessments which were produced on the CSPs behalf by SCC. It was agreed by SCC that this will be part of the remit for the new team, however it will be for the CSPs to request the information which they require. CSPs should also note that the Police strategic assessment and the PCC plan are still there and can be used as a reference point for CSPs. 8. Following discussions with CSP chairs, SSCG chair and PCC office the Suffolk Police and Crime Panel have recently produced a report as to how the three organisations link together. 9. The group thanked the Panel and noted the content and recommendations in the report. Workstreams Domestic Abuse – scoping lead Sara Blake 10. SB – deep dive on track to report in May following three Suffolk Domestic Abuse partnership workshops and 1:1 meetings by SCC staff with those in the system. There will be a series of recommendations and a draft report will come to the SSCG in mid May, which will cover • Commissioning • Coordination and communications • Education and prevention • Data and Information Youth violence and Gangs –scoping lead Jen Meade 11. JM reported that there was no further update at present although the exploited children’s group have made two suggestions as to how to take work forward • County lines • Rapid assessment exercises 12. There will be an update at the next meeting. Sexual Exploitation – scoping lead Ali Spalding 13. Taxi work – moving forward, developing a training package for taxi drivers which will be quality assured by the LCSB and then shared with Local Authorities to roll out as part of new /renewal of licences. 14. SB attended a meeting where decriminalisation of the provider of sexual services and criminalisation of the purchaser was discussed. Dave Cutler will be taking this to the Adult Safeguarding Board to try and understand the scope of the problem in Suffolk. Cyber Crime – Sara Blake 15. For the time being, the E safety working group is sitting with the LCSB, although there is other work being done through a variety of groups. This overlap and potential duplication should be on the agenda for the chairs of Boards meeting which is to be set up. 16. The next meeting will take place at 9:30am on 13 July 2016 in the Conference Room East, at West Suffolk House, Bury St Edmunds.

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Agenda Item 11

Suffolk Health and Wellbeing Board, 12 May 2016 A committee of Suffolk County Council

Information Bulletin

The Information Bulletin is a document that is made available to the public with the published agenda papers. It can include update information requested by the Committee as well as information that a service considers should be made known to the Committee. This Information Bulletin covers the following items: 1. Update from Great Yarmouth and Waveney 2. Update from integration programmes – Ipswich and East and West Suffolk 3. Suffolk Workforce Forum 4. Suffolk Better Care Fund Plan 2016/17 5. Local Digital Roadmap – Approval to Submit 6. Update on the Poverty Strategy 7. Creative Heritage in Mind; mental health 8. Suffolk’s Year of Walking 10. The District Council contribution to public health: a time of challenge and opportunity, a report by The King’s Fund 11. “Easy read” version of the refreshed Joint Health and Wellbeing Strategy

1. Update from Great Yarmouth and Waveney

Cancer care revolution 1.1 Newly diagnosed cancer patients in the Waveney Valley are receiving better support and easier access to GP services thanks to a new initiative designed to revolutionise care on the east coast. 1.2 A group of 12 practice nurses have taken part in a new course, called “an introduction to cancer”, which has been designed to support and improve cancer care in general practice. 1.3 As part of the course, the nurses were tasked with developing a project in their practices, with many focussing on improving cancer care reviews, which are offered to patients by their GP practice within six months of their diagnosis. Thanks to the nurses’ input, a template has been drawn up to standardise the reviews, while they have also been expanded to give patients the chance to talk about practical issues such as exercise, pain management, counselling and local support groups. 1.4 The group also looked at improving access to primary care for people affected by cancer, which included flagging patients with GP receptions so that they would be prioritised when they called for an appointment or advice. In addition, they also focused on cancer survivorship and the support which

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would be needed in the future as the number of people living with cancer doubles to four million over the next 20 years. 1.5 The pilot has been driven by NHS Great Yarmouth and Waveney Clinical Commissioning Group (CCG), the East of England Strategic Clinical Network for Cancer, Macmillan Cancer Support and the Norfolk and Suffolk Palliative Care Academy. Following its success, it is hoped the course will now be rolled out nationally. For further information, please contact: Maggie Tween, Head of Cancer, Palliative Care & End of Life Care; Email: [email protected], Telephone: 01502 719897 New primary care provider 1.6 NHS Great Yarmouth and Waveney Clinical Commissioning Group (CCG) has announced a new provider of primary care medical services for two GP practices in Kirkley, Lowestoft, following a procurement exercise. 1.7 East Coast Community Healthcare Community Interest Company (ECCH) will take over the Kirkley Mill and Westwood GP practices from 1 April this year under a 12 month ‘caretaker arrangement’ after the current contract holder, Malling Health, served notice on both contracts late last year. 1.8 A full and open procurement process has taken place, with ECCH announced as the new provider during the week beginning 25 April 2016. Patients should note that the other practice based at Kirkley Mill and run by the Victoria Road Surgery is not affected by this announcement. 1.9 Patients registered at either practice do not need to take any action. Services will continue at both practices as normal. For further information, please contact: Tracey Bullard, Primary Care Development Manager, Email: [email protected] Withdrawal of gluten-free foods on prescription 1.10 Gluten-free foods on prescription have been withdrawn across Great Yarmouth and Waveney and the savings re-invested in other local health services. 1.11 NHS Great Yarmouth and Waveney Clinical Commissioning Group (CCG) made the decision to stop prescribing gluten-free foods to people with coeliac disease due to the wide availability of cheaper products in supermarkets. 1.12 The change, which has been fully supported by GPs through both the CCG’s clinical executive committee and the prescribing leads forum, was introduced on 1 April and came after several other local CCGs also withdrew funding for gluten-free foods. 1.13 In June 2014, the CCG restricted the number of gluten-free foods available on prescription to only bread and flour, and this new decision was to stop prescribing all gluten-free products. The decision was taken because products provided on prescription are priced at a premium, with gluten-free flour, for example, costing the NHS £9.95 compared with £1.70 in the supermarket, and bread priced at £3.80 compared with £1.70. For further information, please contact: GYW Patient Advice & Liaison Service, Email: [email protected], Telephone: 01502 719567.

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Connect 2.1 The Connect roll out plan has been developed and approved, with plans to ensure that Integrated Neighbourhood Teams are set up during this financial year. A timetable for roll out has been set out and the resources to support the roll out have been identified. The core principles and the elements of integrated working developed in Sudbury and East Ipswich will be adhered to in the wider roll out, although locality difference will be acknowledged, with local strengths built on. 2.2 Governance and project planning is in development to ensure that a planned approach is developed to meet the objects of the programme, within clearly articulated and agreed timeframes. 2.3 The Connect roll out is part of the wider health and care integration programme in Ipswich and East and West Suffolk, which is developing both a reactive and proactive care model with the aims of keeping people living healthily independent at home, and supporting them to get home after a health crisis or stay in hospital. 2.4 In a recent piece of work with Adult and Community Services staff in Sudbury this is what they said about working in the new health centre

For further information please contact: Rachel Bottomley, Commissioner Health and Social Care Integration Programme Manager; Email: [email protected]

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3. Suffolk Workforce Forum

3.1 A meeting of the Suffolk Workforce Forum (SWF) was held on 19 April 2016 and the following points represent the “highlights”: LEP Sector Skills Plan 3.2 The New Anglia Local Enterprise Partnership (LEP) works with businesses and public sector partners, to help grow jobs in Norfolk and Suffolk. Their aim is to transform the economy through the development and delivery of ambitious programmes, which will ensure that companies have the funding, support, skills, and infrastructure needed, to grow jobs and flourish. The SWF received an overview of the LEP sector skills action plan. The top three priorities as chosen by the project group are:- • Entry and Retention in the Health and Social Care Sector • Recruitment and retention of registered nurses in nursing homes • Leadership and succession planning for registered managers and owners 3.3 A project officer post has been part-funded by the Better Care Fund and the Norfolk and Suffolk county councils to drive strategy forwards. The post will be hosted by Suffolk Brokerage and Norfolk Independent Care. Transformation Challenge Award 3.4 The SWF received an update report on the Transformation Challenge Award (TCA) work activities which are progressing as planned. The Connect East Ipswich Think Big workshop took place on 20 April 2016 and was well attended by practitioners from health, social and community sectors. Connect is expected to be rolled out at a fast pace across the rest of Suffolk so further workshops need to be planned and funded. Sudbury intend to re-scope their second think big workshop to include members from new Connect areas. Steve Griffee, Transformational Lead Suffolk (workforce planning), is going to do a feasibility study to determine whether existing allocated funding is sufficient, for workshops in the new Connect areas. Connect lunch and learn sessions have been going well with attendance numbers varying from 8 to 37 people. Sustainability and Transformation Plan 3.5 Meetings held with Health Education East (HEE) Workforce Team and workforce data has been identified. HEE to deliver in early May. This will cover Suffolk and also North East Essex. However it was noted that this does not mirror “Devolution” which is being planned as Norfolk, Suffolk and Cambridgeshire. This will need to be resolved as work progresses. 3.6 A potential issue is the capacity to provide support services to accelerate roll out of ten new Connect sites across Suffolk and this is being assessed by the transformational lead. Integrated Workforce “I” Statements (IWIS) 3.7 The Transformational lead gave a demonstration of the new IWIS tool which can be used to support each organisation to identify Strengths, Weaknesses, Opportunities and Threats (SWOTs) and areas to work on. The tool was

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requested by the Integrated Care System group and developed by Steve Griffee and Fiona Denny (Suffolk County Council). An offer was made to run a pilot of this tool and Lee Taylor (Transformation Lead – Integrated Care, West Suffolk CCG) asked if this could be used at West Suffolk Clinical Commissioning Group. This was agreed and a date is to be arranged. Self-care and prevention update 3.8 The Transformational Lead presented the updates on prevention and self- care. He demonstrated the new NHS OneYou tool which is now available to all employees and the general public. Plans need to be put in place for roll out and Steve Griffee is in discussions with Public Health. For further information please contact: Steve Griffee, Transformational Lead Suffolk (workforce planning); Email: [email protected], Telephone: 07944 212642.

4.1 The draft Better Care Fund (BCF) Plan 2016/17 was circulated to Health and Wellbeing Board (HWB) members on 8 April 2016. Comments received back have been incorporated into the Plan and it was signed off on behalf of the HWB on 3 May 2016 by the Corporate Director for Children and Adults, the Chief Executive of the Great Yarmouth and Waveney CCG, the Chief Officer of the Ipswich and East and West Suffolk CCG and the chairman designate of the HWB. The Plan was submitted to the regional and national BCF support teams, who will make an assessment as to whether our plan is credible and deliverable. This will lead to an assurance rating which should be communicated back to us later in May. 4.2 The Better Care Fund Plan describes how we will deliver integrated care in Suffolk in 2016/17. It is the only Plan that gives a Suffolk-wide overview of activity, rather than a Clinical Commissioning Group/Sustainability and Transformation Plan level view. We also need to have an approved plan to unlock the £51m of existing funding that makes up the BCF Pooled Fund. For further information please contact: Jo Cowley, Business Development Specialist; Email: [email protected], Telephone: 01473 265202.

5.1 In early 2014 we formed the Suffolk Informatics Partnership (SIP) Board, and progress updates are regularly received by the Health and Wellbeing Board. 5.2 As a supporting document to the NHS 5 Year Forward View, the National Information Board published Personalised Health and Care 2020 in late 2014; this has further informed the Digital Strategy in Suffolk being planned and implemented through the SIP. 5.3 In mid-2015 NHS England outlined the requirement for each ‘local area’ to have a ‘Local Digital Roadmap’ (LDR) which would need to be signed off by the Health and Wellbeing Board prior to the submission date of 30 June 2016; 105

the LDR would underpin the local Sustainability and Transformation Plan (STP). 5.4 Initial requirements were to submit a footprint – the current Suffolk Footprint encompasses all agencies / services in our geography, with the exception of those covered by Great Yarmouth and Waveney CCG (which is part of the Norfolk footprint); it is accepted that over time LDR Footprints may change. 5.5 Guidance as to how to develop the LDR is not specific, but due to the maturity of the SIP, and the existing governance in place, Suffolk has found themselves well placed to develop a mature and innovative first LDR (it is recognised that the LDR will have an annual iterative update). The SIP has therefore aligned its existing function to the needs of the LDR, and been working on a multi-agency approach that encompasses the following: a) How to deliver the nationally defined ‘Universal Priorities’ (UPs) in 2016- 18 b) What the ‘ambition’ is for these and other digital priorities (the ‘Suffolk Priorities’), and how they align to the STP and the UPs c) What the gap in capability and resources is (and how to approach that) between:  Where we are now  The Universal Priorities  The Suffolk Priorities  Personalised Health and Care 2020 5.6 The development of the LDR is therefore well underway, but there are very tight timescales to its completion and sign off. 5.7 As such the Health and Wellbeing Board will be asked to receive this document by email no later than 13 June, and within a week feedback comments and / or approval, so that this may be factored into the final submission. It is also proposed the HWB Chairman be authorised to give final approval of the submission on 29 June 2016. For further information, please contact: Kate Walker, Suffolk LDR Lead, Head of ICT & Informatics, IES & WS CCG, Email: [email protected], Telephone: 01473 770046.

6.1 The Poverty strategy was launched on 29 March 2016 and it was accompanied by a slide pack. The strategy and accompanying presentation are here. 6.2 The Steering Group would like the members of the Health and Wellbeing Board to discuss the poverty strategy in their own organisations, using the slide pack to identify existing work that contributes to either mitigating the effects of poverty or helping to prevent poverty.

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6.3 The Steering Group is asking for feedback from partners so that evidence of what works and the outcomes it achieves can be reported back to the Health and Wellbeing Board. 6.4 At its April meeting the Steering Group heard from Phil Aves, Change Manager, Lowestoft Rising, about what works in embedding a strategic plan. His input was invaluable in identifying the following points which will be required if we are to be successful in embedding poverty in all our business as usual:  Focus on a few outcomes in order to gain traction and deliver outcomes Action - The steering group will consider at its May meeting.  Recruit a Poverty Lead to be a ‘change maker’ and give them the high level support needed in the same way as Phil Aves’ post. Action – The Steering Group is working on this with a proposal to base a post with the Localities and Partnership Teams funded through the Transformation Challenge Award. The Steering Group is keen to ensure there is sufficient capacity to work county-wide so a full time post would be needed. Action – The Poverty Lead to meet with Suffolk Leaders to talk about some of the key issues identified by the steering group as needing attention. For example, when commissioning services for the people of Suffolk the need for providers to understand the local community to ensure we deliver services that meet the needs of our Suffolk residents.  Hold some events to raise awareness of the poverty strategy and its ‘asks’ Action – This approach will require some funding. Can the Health and Wellbeing Board assist in identifying a source of funding? Action - The Steering Group propose we include an item at the Health and Wellbeing Board conference in October to make the links between mental health and poverty. For further information please contact: Alison Manning, Strategic Lead Early Years and Childcare, Children and Young People’s Services, and Sarah Nivison, Finance and Performance Manager, Adult and Community Services; Email: [email protected] and [email protected], Telephone: 01473 264727 and 01473 265198. Back to top

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7. Creative Heritage in Mind; mental health

7.1 The Health and Wellbeing Board is asked to note the work of ‘Creative Heritage in Mind’ - a collaboration between the Norfolk and Suffolk NHS Foundation Trust (NSFT) and the cultural sector in Suffolk - that is supporting the Board’s priority of ensuring ‘people in Suffolk have the opportunity to improve their mental health and wellbeing’.

Aims and Background 7.2 Four professional museum services in Bury St Edmunds, Ipswich, Stowmarket and Sudbury co-created a project with an experienced artist and senior NHS Foundation Trust staff to provide a series of 7-week courses over 12 months that aimed to • Support small groups of people in their community who are managing mental ill health by developing their confidence and resilience through creative activity that connected them to their local heritage and museum • Develop the confidence and expertise of museums to support work in this area • Develop informed links between the NHS and cultural sector 7.3 Evaluation was agreed and has its ongoing governance through the NSFT with the support of a user group that is now helping to shape the programme. Sharing the learning and outcomes of the programme through booklets and events is built into the programme. 2016 World Mental Health Day in October will be its culmination. 7.4 Funding is made up of £39,000 from the Heritage Lottery Fund and a grant of £5,000 from Suffolk County Council with support in kind provided by museums and the NSFT until October 2016. Programme and Outcomes So Far 7.5 47 people have benefited from the courses so far and of those, 37 attended every session which was a major achievement for some attendees. 7.6 Many attendees have developed sufficient confidence to make independent visits to ‘their’ museums and most did their own course work and research at home. 7.7 Evaluation feedback has been very positive – direct testimony from people involved in the courses is perhaps most eloquent. Diana writes "From a personal point of view …. I have ... gained confidence, learned new skills and now look at museums in a totally different way and this has contributed enormously to the point where I am quite stable. I am not so naive as to think that I am 'there' but I believe that I have reached a point where I can contain any issues I may have in the future. To put it simply, the skills I have gained over the last year can be transferred to every day issues." 7.8 After attending a Taster session for the project, two Peer Support Workers from the Integrated Delivery Team in Bury South reported they ‘came away full of inspired energy after the event … at the museum. We will spread the

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word throughout the Trust of the exciting, meaningful, co-operative work being achieved and the opportunities Creative Heritage in Mind offer.’

For further information please contact: Lyn Gash, Museum Development Manager, Suffolk County Council; Email: [email protected], Telephone: 01473 265241.

8.1 This information item is brought to the Health and Wellbeing Board as a follow-up to the Active for Life Suffolk Walking Strategy 2015-2020 which was approved by the Board last year. 8.2 The walking strategy was launched in June 2015. It sets out a vision to increase the number of people walking in Suffolk, firmly establishing it as a normal form of transport for everyone. The strategy aims for walking to be seen as beneficial, easy, inclusive, accessible, pleasant and safe, and for walking to become the ‘default’ choice for journeys of 20 minutes walking time or less. 8.3 Suffolk’s Year of Walking is a campaign celebrating walking in Suffolk. It provides a platform to promote walking events and activities, as well as providing inspiration and opportunities to encourage people to walk more often. It will promote walking in all its formats, from recreational walking to Nordic walking, from long distance walking to walking football and from walking to school and work to walking for health. 8.4 The key messages behind Suffolk’s Year of Walking are: a) Suffolk is a wonderful county to walk in; b) Walking is simple, inclusive, accessible, pleasant and safe; c) Walking is an efficient and effective way to get from A to B; d) Walking is easy to build in to a busy lifestyle; e) There are many benefits to walking for both the individual and the community at large. 8.5 Key features of the Year of Walking include:  A calendar of over 300 walk related events taking place across the county;  A dedicated website and social media presence;  A media partnership with Archant;  Suffolk Walking Festival 2016 and 2017  Pigs Gone Wild - Suffolk’s biggest ever mass-participation, public art event.  Beat the Street (Sudbury and Great Cornard) - a fun, free walking game for the whole community. Subject to evaluation from Beat the Street Lowestoft.

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8.6 Suffolk’s Year of Walking will be launched on Saturday 14 May 2016 and will run until May 2017. For further informationvisit www.suffolkyearofwalking.co.uk, https://twitter.com/SuffolkYOW and https://www.facebook.com/SuffolkYOW/ or contact: Adam Baker, Most Active County Project Manager; Email: [email protected], Telephone: 01473 260821.

Back to top 9. The District Council contribution to public health: a time of challenge and opportunity, a report by The King’s Fund

9.1 This information item relates to good practice elsewhere and its inclusion is at the request of the Board’s SCOLT (Suffolk Chief Officers Leadership Team) representative, Charlie Adan. This report was commissioned by the District Councils’ Network (DCN) in 2015. Its intention is to contribute to the understanding, assessment and development of the role of district councils in improving the health of their citizens and communities. It focuses on district councils’ role in promoting public health through some of their key functions and enabling roles and in their wider role supporting communities and influencing other bodies. 9.2 District councils make a major, but often under-recognised, contribution to the health of their citizens and communities. As English devolution and the move towards integrated place-based public services gathers pace they will be critical partners for the NHS and other tiers of local government seeking to develop population health systems. 9.3 The King’s Fund report is a useful document that highlights both the important current contributions of districts to the health and wellbeing of local communities and the potential for even greater district impact on health outcomes. The key messages and recommendations provide a direction of travel for establishing districts in the mainstream of health and social care policy for the future. Key messages: 9.4 The key messages are: a) District Councils influence many factors of good health through their key functions (for example housing, leisure, environmental health etc) and wider community enabling roles (such as planning, economic development, working with complex dependencies). b) Public health reform and localism create opportunities for districts’ contributions to health and wellbeing to be more integrated and embedded in future public health systems. c) To assist in this integration, districts require a more robust evidence base of return on investment from their actions on public health, in order to influence and inform health policy decisions.

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9.5 In order to achieve this integration into mainstream health policy, the report sets out three key factors for districts to focus upon: to continue to lead innovation in services and their delivery, to strengthen their enabling role in the health of their communities and to better demonstrate effectiveness and return on investment. 9.6 The King’s Fund also provide ten recommendations to help ensure that districts maximise their impact on health. Some of these relate to the District Council Network itself, whilst others focus directly on district councils and local health and care system partners. The following recommendations may be of particular interest to the Board: Recommendation 3: Clinical commissioning groups (CCGs) and county councils should include district councils when discussing alignment as one key part of the ‘out-of-hospital care’ system. District councils are a key partner in improving the relationship between the health and social care system and the community. Recommendation 4: The DCN should work with directors of public health and their representative bodies (including the Association of Directors of Public Health and the Faculty of Public Health) and the NHS to better articulate district councils’ prevention role in the Forward View (for example, through their role in providing leisure services). Recommendation 5: District councils should be more proactive in collating existing evidence on the health economics of their activities (i.e. to better understand cost effectiveness and social return on investment) Recommendation 9: District councils need to invest in health impact assessment (HIA) to move beyond innovative case studies of processes to show demonstrable improvements in health outcomes. 9.7 The full set of recommendations can be accessed in the report which is available at: http://www.kingsfund.org.uk/publications/commissioned/district- council-contribution-public-health 9.8 The King’s Fund and DCN have also produced a useful set of infographics that illustrate the key role played by district councils in keeping people healthy: http://www.kingsfund.org.uk/audio-video/district-councils-contribution-public- health These are free to use in documents and presentations within your organisations. 9.9 Drawing on key themes in the King’s Fund report as the starting point, the informal session of the next Health and Wellbeing Board meeting on 21 July 2016 will focus on the district role in health, wellbeing and prevention by showcasing some of the current and planned district level activity within Suffolk. For further information, please contact: Jonathan Seed, Corporate Manager – Policy & Strategy (Health and Wellbeing), Babergh and Mid Suffolk Councils, Email: [email protected] Back to top

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10. “Easy read” version of the refreshed Joint Health and Wellbeing Strategy

10.1. At its meeting on 28 January 2016 the Board approved the Joint Health and Wellbeing Strategy refresh 2016 - 2019 as set out in Appendix 2 to the report at Agenda Item 5. 10.2 At the same time, the Board agreed that an “easy read” version of the document should be produced. This has now been completed and is available on the Healthy Suffolk website at http://www.healthysuffolk.org.uk/assets/Health-and-Wellbeing-Board- Papers/A-Joint-Health-and-Wellbeing-Strategy-for-Suffolk-Refresh-easy-read- DRAFT-1.pdf For further information please contact Chris Pyburn, Public Health Manager, Social Marketing and Knowledge; Email: [email protected], Telephone: 01473 260094.

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