Suffolk and North East Essex ICB People and Communities Strategy

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Overview

This document sets out a three-year strategy for the Integrated Care Board (ICB) that describes how we will work with people and communities to identify better and more sustainable approaches to providing healthcare and improve health and wellbeing outcomes.

The approach towards Public and Community Involvement has been developed in collaboration with the people and communities of Suffolk and north east Essex and our partners in Healthwatch and the voluntary, community and social enterprise (VCSE) sectors through place-based conversations. Listening to and understanding what motivates people to be involved in improving health and care services, as well as what they expect to see as a result of their involvement, has enabled us to develop a clear and concise vision for the future.

At the time of writing the strategy, a commitment has been made to people, communities and wider partners that we will review our progress in achieving this vision, along with the effectiveness of the strategy, on an annual basis. This review will happen in collaboration, and the aims of the strategy, along with the vision, may be amended to reflect the conversations.

Our vision

The health and care experience of the people of Suffolk and north east Essex will be improved as a result of our working effectively together, both with people and communities as well as organisations and groups.

Our mission statement

We will collaborate with people in everything we do –

• To understand people and communities’ experiences
• To plan a health and care system that achieves better outcomes for people
• To commission and procure services for the people of Suffolk and north east Essex
• To assess the quality and safety of health care in Suffolk and north east Essex

We will achieve this by working in partnership with our colleagues in Healthwatch, local NHS organisations such as the acute hospitals, primary care and mental health services, local authorities, the voluntary and community sectors and place-based Alliances.

This document explains how we arrived at this vision and how we will achieve it. It explains how people and communities expect us to work with them and with our partners. Our success will be measured on the effectiveness of our relationships with people who live in Suffolk and north east Essex and the completion of the objectives set out at the end of this document.

This strategy is based on the conversation and planning discussions we have held with local people and communities about how they would like to work with us in the future, their priorities and ideas. And on the conversations, we have held with partners across the Integrated Care System about how we will work together to support these aims.

It has also considered a number of other documents:

• A guide to involvement and equalities, which sets out our legal duties and statutory obligations
• The Suffolk and North East Essex ICS Quality strategy (final draft to be agreed)
• The three delivery plans for the place-based Alliances
• Strategic work programme annual charters
• NHS providers’ involvement and experience strategies
• The strategies and polices from wider partners of the ICB

The people and communities of Suffolk and North East Essex (SNEE)

The population served by NHS Suffolk and North East ICB includes Ipswich and east Suffolk, west Suffolk and north east Essex, it does not include Waveney. The population of NHS SNEE ICB is 1,022,000 and is projected to grow by 10% by 2036 (SNEE ICS, 2019).

• 8,900 people in West Suffolk Alliance have cancer
• 2,100 more 75+year olds living alone in Babergh by 2030
• 1,900 more people with dementia in North East Essex in 20 years
• 340 more older people living in care in Mid Suffolk by 2030
• 2,300 more people aged 85+ in Suffolk coastal by 2030
• 16,000 adults have a common mental health issue in Ipswich
• Almost 1 in 3 people in Tendring are 65 or over
• The number of older people living in care homes will increase by 40% (in the next 10 years)
• 11,500 children have some mental health disorder – 9.0% of 5016 year olds compared to 9.2% in England
• The number of people aged 85+is set to increase by 39% (in the next 10 years- compared with 33% for England)
• The rate of people with liver disease dying prematurely per year varies widely- from 7.7 per 100,000 in Mid Suffolk to 26 per 100,000 in Tendring
• North East Essex has a suicide rate – 14.2 deaths per 100,000 compared to 9.6 per 100,000 in England
• 11% of adults are obese – higher than average for England and the data suggests that this percentage is increasing
• 10% of GP registered patients have a recorded diagnosis of depression- this is higher proportion compared to England and trends indicate an increase
• In Suffolk and Essex, 32% of children aged 10-11 are overweight or obese- this is lower that the rate for England but increasing
• 42,700odeler people aged 75+ live alone – and this is increasing
• Only 20% of children in Essex and 18% of children in Suffolk ages 5-16 are active (for 60 minutes or more every day)
• 9,100 older people have been diagnosed with dementia and this is likely to almost double in the next 20 years
• 3.3% of the population of Suffolk and North East Essex have cancer- compared with 2.7% of England
• Nearly 54,200 adults have diabetes – data suggests that this rate is increasing , in line with the national trend

Understanding our people and communities

The NHS Suffolk and North East Essex ICB’s vision is to have in place a viable value-based people-focused system of care which is best in class, promoting inclusivity and inspiring and embracing diversity. The ICB is committed to equality of opportunity, elimination of discrimination and the promotion of good relations between all people, regardless of age, disability, ethnic or national origin, sex, gender assignment, gender identity, religion or belief, sexual orientation, pregnancy or maternity, marital or civil partnership status.

We have a legal duty to make sure our policies, services and functions do what they are intended to do in a way that does not discriminate and promotes equality and inclusion. Public Health England defines health inequalities as unfair and avoidable differences in health between different groups in a society. Health inequalities are caused by a complex mix of environmental and social factors which lead to variation in the conditions in which we are born, grow, work and live. These conditions affect the way people look after their own health and use services throughout their life. Proactive steps will be taken to engage communities who are carrying the greatest burden of ill-health and who are least likely to be well-served by existing health services.

We have carried out an Equalities and Health Inequalities Impact Assessment (EHIIA) of our approach to better understand the potential impact of our work on groups with protected characteristics, or those at increased risked of experiencing health inequalities. The completion of this assessment provided evidence that our approach was compliant with our statutory duties, identified mitigating actions and identified additional considerations to be taken into account in the application of this strategy. The EHIIA will be reviewed regularly and mitigating actions audited.

In developing the strategy, we took part in the ICS wide 100-day equity challenge. Alongside partners from across the ICS we attempted to address health inequalities, health equity and justice with engagement and coproduction. Building on the outcome-based approachalready embedded in our ICS we considered the broader concepts of;

Awareness – of our own privilege and biases, of the disadvantages others experience, and the complex intersectionality of living with multiple disadvantages in relation to working with people and communities.

Assessment – of the impact on health inequalities on how we work with people and communities, so that we can take steps to achieve equity and justice for everyone.

Allyship – together with co-production, to make sure that we understand the issues and work together to find the right solutions with people and communities.

Accountability – meeting our legal and moral duties towards all our communities.

The outcome of this work has influenced our approach to working in partnership with particular communities, how we develop long lasting trusted relationships and listen to people’s experience.

How will we work in the future?

Adopting the Core20plus5 approach we will work alongside the place-based Alliance partnerships to identify local communities experiencing significant health inequalities or worse outcomes and those who would benefit most from a tailored approach. For example, the fishing community working out of our large ports, migrant agricultural workers working in our rural communities and transgender people.

We will work with our strategic programmes to support specific clinical areas to ensure we have an inclusive and equitable approach to working with people and communities. A good example of this is our work with people who have severe mental illness (SMI). We have implemented a joined-up approach; a collaboration of the CCG, Norfolk and Suffolk Foundation Trust, primary care and Voluntary, community and Social Enterprises working with people who have a SMI to improve health and wellbeing outcomes for them. This group of patients experience serious health inequalities and traditionally we have failed to engage them in health services. However, as a result of our partnership work, Suffolk achieved the highest vaccination rate in adults with a serve mental illness in the east. This piece of work shows how a proactive, person-centred approach has significantly improved the health and wellbeing of this group of patients.

Integrated Care Board requirements for engagement and co-production

The Integrated Care Board (ICB) has clear functions and responsibilities for engagement and coproduction.

The soon to be published Statutory Guidance for Integrated Care Boards, NHS Trusts, NHS Foundation Trusts and NHS England on working with people and communities, replaces the 2017 statutory guidance for commissioners, the 2008 guidance for trusts and the 2021 Implementation Guidance for ICSs to create one statutory duty for NHS partners. These statutory duties will be delivered in partnership, with people and communities, organisations, and groups.

Listening to and working with people leads to improved health outcomes.

Experience tells us that outcomes are better when communities, partners, providers and commissioners work together to shape the delivery of our health and care.

Understanding how people experience health and care support is a fundamental part of learning how to improve quality and patient safety. Engagement and coproduction will underpin and guide all activity of the ICB, working at neighbourhood, Place and System level to lead change.

We have identified the different types of collaboration and coproduction that will take place at the different levels of activity within Suffolk and north east Essex.

Communities

• Build on what already exists within communities using asset based community development approach.
• Always engage at the earliest opportunity.
• Work with communities for better and sustainable solutions.
• Provide feedback to show involvement is valued and led to change.
• Develop and maintain good communication channels with communities.
• Ensure conversations are quality-led.

Place-based Partnerships(Alliances)

• Fully engage those affected by decisions.
• Build on existing approaches to involve people on decisionmaking.
• Support Primary Care Networks and neighbourhood teams to work with people and communities to strengthen health promotion and treatment.

Integrated Care Board (ICB)

• Involve people and communities in the planning of services and proposals and decisions having an impact on services.
• Demonstrate how legal duties have been met at different levels.
• Develop integrated health plans with people and communities.
• Create strategy on how the ICB will work with people and communities.

The guiding principles that underpin our work

The ambition for the new guidance is that it will support health and care systems to work effectively with their communities and ensure that people are involved in decisions about health and care services, quality assurance and delivery.

The guidance sets out 10 principles upon which our work with people and communities should be built. They provide ways of working, culture and best practice. Using these 10 principles we collaborated with people and communities in Suffolk and north east Essex to identify what they would mean to us locally;

1. Ensure people and communities have an active role in decision-making and governance
   • Community engagement will be focused at a local level; working in neighbourhoods with existing groups, networks and forums.
   • Engagement work will move from the centre, to the groups in our communities and talk to them where they are. We will not expect people to come to us. Engage with people who are affected by the decisions that the Alliances and others make, building on existing approaches to involve people in decision making.
2. Involve people and communities at every stage and feed back to them about how it has influenced activities and decisions
   • There will be clear reporting and feedback mechanisms between the Neighbourhoods and the Integrated Care Board (ICB)
   • Feedback will be part of the process not an afterthought – we will talk often and openly with people. Feedback will help demonstrate the value of involvement and impact people have made.
3. Understand your community’s needs, experiences, ideas and aspirations for health and care, using engagement to find out if change is working
   • Communities will tell the ICB the things that they think it needs to know and understand and the ICB will listen.
   • This will not be about us asking lots of questions, it will be more about us listening; this is a subtle change of language, but a huge shift in culture. We will listen to people around their experience of care. If we don’t listen to people about their experience of and perceptions of what quality is, we miss opportunities for improvement.
4. Build relationships based on trust, especially with marginalised groups and those affected by inequalities
   • We will assure that all engagement is representative of the population, strive for involvement activities to reflect the diversity of age, ethnicity, gender and race of the population.
   • Be creative – use different routes and approaches.
   • We will take time to build trust, demonstrating the credibility of involvement. We will use impact assessments to support our quality governance and ensure equity, assessing the impact of quality to inform and enable appropriate decision-making regarding service changes. This will be essential to ensuring coproduction and collaboration is equitable and inclusive.
5. Work with Healthwatch and the voluntary, community and social enterprise sector as key partners
   • We will work in partnership to maximise opportunities and improve outcomes for people and communities
   • We will develop strong relationships and connections to existing networks, rather than creating something different.
   • We will understand the assets that exist in our communities and work with these to develop our work.
6. Provide clear and accessible public information
   • Ensure that Alliances and ICB are communicating with neighbourhoods in a range of ways appropriate to the communities within them.
   • Barriers will be different in each neighbourhood (central/urban/rural), we will take the time to understand the barriers and work with communities to remove them.
   • Make sure the public know they can be involved and what they can be involved in.
7. Use community-centred approaches that empower people and communities, making connections to what works already
   • People living in our communities have the knowledge and skills and ideas to develop the solutions to meet the needs of their health and care and wellbeing.
   • Offer alternatives to meetings and encourage people to get involved in different ways.
8. Use co-production, insight and engagement methods so that people and communities can actively participate in health and care services
   • Coproduction, insight and engagement will make sure that we are putting services in the right places at the right times, that they’re being delivered in a way that makes sense for people.
   • We will be clear about the role, time commitment, method of participation on offer to people and what their role will be.
   • Manage expectations and articulate limits to what we can/can’t do – transparency of expectations.
   • Ensure all conversations are quality-led – use insight to make change across the system
9. Tackle system priorities and service reconfiguration in partnership with people and communities
   • Ensure experience of quality filters up through the ICB governance structure to understand what it feels likes for the people at local neighbourhood level.
   • Communities will be telling the ICB the things that they think it needs to know and understand.
   • We are able to tailor services that will be able to meet the needs and preferences of the particular communities.
   • Assure that processes are in place to ensure citizen involvement in all commissioning and procurement activity.
10. Learn from what works and build on the assets of all partners – networks, relationships, and activity in local places
    • Do not badge things as a health issue – encourage people who don’t identify as a patient to get involved. Health is more than just NHS services.
    • Make use of what already exists – banks of resources and local intelligence.
    • Build a network of intelligence that we’re sharing and working together on.

The ICB and Alliance partnerships will develop so that all partners, including ICB staff, NHS provider organisations, local authorities, Healthwatch and the VCSE sector, come together to develop a better understanding of how patients and users experience ‘integrated care’ and whole pathways. Moving from only understanding how people experience the care and support of single services or providers, to partners listening together to learn how they can provide better joined-up care acting as a system. The success of our services should be judged by the principles identified by the people of Suffolk and north east Essex.

Governance and joint working

Governance at all levels

The governance structure for involvement and coproduction with people and communities ensures that insight and collaboration with people and communities happens at all levels across Suffolk and north east Essex. The Patient Involvement and Experience Team are part of the Nursing and Quality Division because patient experience is one of the three pillars of quality, along with safety and clinical effectiveness. The Nursing and Quality Division are required to provide assurance that all services are safe, effective and provide good patient experience. The work of the People and Communities strategy is therefore required to report through Quality governance processes at both system and Alliance Level.

We have worked with local people to design and develop the most effective governance route for citizens to come together, reflect on insight and experience, contribute to decision making and raise important issues.

Citizens have identified that building on existing work in localities and neighbourhoods and working in partnership at neighbourhood level is the most effective and appropriate approach. This work will be brought together at Place level to form part of the Alliance delivery plans and local Quality groups. Finally, all place-based and system programme work will be heard in the ICB subcommittee to provide assurance and oversight is delivered to the ICB. We will be working closely with Alliance committees, the Board and strategic partnerships to embed the people and communities’ narrative so that it is seen as an essential part of the infrastructure.

Decision making and joint working

There is an expectation that organisations across the integrated care system (ICS) come together in an integrated care partnership to plan and deliver services collaboratively. The new partnership structures provide an opportunity to improve the health of communities and individuals, with NHS organisations working closely with local authorities, VCS organisations and communities themselves.

A committee of the Integrated Care Board will be established bringing together partners from across the wider system to jointly lead work with people and communities. These partners include People, Healthwatch, the Voluntary and Community Sector, Acute Trusts, Foundation Trusts, Local Government, Public Health and Social Care. The committee will;

• Identify collective priorities and common themes and identify opportunities for system responses.
• Identify areas of concern and issues being raised across different parts of the system (organisation, neighbourhood, Alliance) and bring these to the attention of the Board.
• Respond to system prioritises identified at the Board with insight and voices of experience, drawing on the range of expertise and experience of the committee partnership.
• Look ahead at potential issues or areas of work and work together with people and communities to influence strategy and decision making. Understand collective feedback loops and system communications about engagement, making sure opportunities are transparent and open and outcomes shared widely.

As the wider integrated care partnership develops so too will our wider system approach to people and communities. We will continue to review our approach and how we work in partnership with people and communities.

The role of the ICB Patient and Public Involvement Team in the delivery of this strategy

The team will lead on the organisation’s collaboration with citizens to ensure the ICB works together with the people they serve to make unified decisions with the ultimate goal of maximising the chances of success, through informed commissioning, in achieving the best health outcomes for our populations. We will work with the wider NHS partners in the ICB, align this strategy with their strategies and work alongside one another.

The team is responsible for:

• Establishing a collaborative environment and working in partnership.
• Setting out the parameters and maximising the opportunities for working with citizens to understand their experience.
• Supporting the commissioning teams to execute the objectives of collaboration.
• Closing the project following meaningful change, support the evaluation, identify and share the learning.

This strategy outlines why collaboration and involving people is important, the principles which underpin the work and the way we will work.

What can people expect to be involved in?

The ICB is responsible for lots of different aspects of health care meaning that participation, collaboration and understanding patient experience will be happening across a range of service areas. By working to understand patient experience and gain their insight it will help us plan and improve health and care across Suffolk and north east Essex.

Local people will be engaged and consulted in decision making and in the quality cycle of planning, control, and improvement.

There will be a clear range of ways and opportunities through which people are able to share their experience, have their voice heard and be able to have influence, in particular those communities who are often excluded or heard from less often.

Our approach will seek to strengthen and broaden engagement in all activity in the ICB:

• Quality planning, control, and improvement – The public can expect to be part of quality activity learning from the patient experience, insight and narrative to identify quality improvement opportunities which are developed with local people.
• Service development and design – The public can expect to support the design and development of new services or pathways, either at Alliance or system wide level, learning from experts by experience to work with providers and partners.
• Commissioning, procurement and performance – The public can expect to be part of the commissioning cycle, working alongside commissioners and partners.
• Statutory compliance – The public can be assured that the ICB will meet all its statutory and regulatory obligations for reporting its patient and public Involvement and experience activity.

These measures will be used to understand the level of success this strategy has had in our approach to involvement and collaboration with our populations.

How will we involve people?

Getting involvement and collaboration with the public right relies on developing strong relationships with local communities and individuals, building trust and respect.

We are committed to a set of guiding principles which will underpin all our involvement and collaboration activity:

• Collaboration – working together and creating partnerships to understand patient experience throughout all parts of the organisation
• Respect – building trusted relationships between citizens, organisations and communities based on inclusivity, mutual understanding and accessibility so that everyone feels they belong in the conversation
• Listening – taking every opportunity to hear the patient experience, paying attention and being curious about what local people say and acting on what we are told
• Equality – we will ensure that a diverse range of voices are heard and that people who are seldom heard are able to take part in every opportunity
• Transparent – we will be open and honest about our activity, be clear about parameters and decision making
• Meaningful – activity will be relevant and purposeful
• Influential – all activity will seek to have impact and lead to positive change, quality improvement or better decision making

What methods will we use?

We recognise that just as members of our communities are diverse, so too will be the ways in which they want to collaborate and engage with us. The team will work with citizens and communities, in partnership to find the best way to collaborate.

We will coproduce activities with communities and citizens in ways that work for them, taking an asset-based approach to community involvement. This means investing in bespoke solutions, supporting a range of opportunities, and enabling people to work with us in different ways. Often this will mean taking a narrative based approach to understanding experience, utilising storytelling, creative expression, or content analysis.

We already know that meetings, forums and face to face collaboration is not right for everyone. Many people want to collaborate with us at times and circumstances which suit them. Consequently, we are developing an online engagement platform to support engagement and collaboration with communities. Each Alliance will have its own platform, reflecting its own priorities and programmes of work. The platform will enable forum discussions, quick polls, sharing news and information, surveys and idea development.

Where possible these pages will be codesigned with local people to maximise accessibility and engagement. We will also use this online tool for engagement across the ICS. However, we also know that other people would prefer attending an event or meeting to discuss things in person with us, and so these will continue to be an option for people. Alternatively, completing a survey or questionnaire suits other people. Therefore, we will continue to gather experience through methods such as this.

Who else will we work with?

Community Support Groups, Volunteer Groups and Charities – We know that working with partners across Suffolk and north east Essex helps improve outcomes for people. There are lots of patient representative and influencing organisations that amplify the voice of local people and work directly with communities to ensure their voice is heard. We will work alongside these organisations and groups so that our work is accessible, inclusive and representative of the population in Suffolk and north east Essex.

Regulator Organisations – NHSE, CQC and others. We will look to our regulatory organisations to ensure health services provide people with safe, effective, compassionate, high-quality care and to encourage those services to improve. Providing independent assurance to the public of the quality of care in their area will clarify if we have involved and collaborated with our populations and if we have really listened to what they have said.

Healthwatch – As local health and social care champion, Healthwatch Suffolk and Healthwatch Essex record public feedback and work with local services, and the people who pay for them, to make sure the public voice voice is heard where it matters. They are independent and have the influence to make sure NHS leaders and other decision makers list to local feedback and improve standards of care. Both Healthwatch organisations use the insight people tell them to better understand the challenges facing the NHS and other care providers and make sure experience insight is used to improve care for everyone –locally and nationally.

The ICB Communications Team – The involvement and experience team are responsible for involving and collaborating with people in identifying what people’s expectations and experiences are; developing the story. The communications team are responsible for communicating the organisation’s message with external audiences; telling the story. We will work with the communications team to promote opportunities, share messages, and report feedback.

Delivering the Strategy

Year 1 – Develop an organisational culture of involvement and collaboration

• Detailed thematic work plans in place
• Establish a menu or range of opportunities to broaden depth and spread to support meaningful collaboration, relationships and partnerships with people
• Develop robust training, support and development plan for members of the public and staff about involvement and working together
• Ensure members of the public are part of quality assurance and improvement, including safety programmes , incident reviews, PALs, complaints and quality impact assessments, including EQIA
• Develop an annual reporting programme on all patient involvement
• Support, develop and facilitate patient leadership
• Develop fast, real time, meaningful feedback loops and lines of communication
• Broaden the diversity and increase the number of members of the public we work with across the organisation.

Year 2 – Develop sustainable organisational systems and processes

• Embed place based collaboration in line with the Alliance Board delivery programmes
• Establish a baseline patient experience narrative for strategic programmes
• Support a system approach to patient experience and involvement in the ICB programmes
• Detailed work plans for each area of activity developed inline with system partners

Year 3 – Take stock and refresh

• Evaluating the culture
• Determine success against planned outcomes
• Identify next steps

What we will be engaging on over the next three Years

There are several programmes of work that together make up the ICB strategy. Some programmes are commissioned across SNEE as these are seen to be strategic services that would not benefit from multiple contracts.

There are also a number of programmes of work that are commissioned at an Alliance level to ensure these reflect the true health and care needs of the local populations.

Strategic Programmes and Quality Improvement

There are several big strategic transformation and quality programmes across SNEE. Each of these strategic transformation programmes will have a focused engagement plan to work in partnership with people in the community. These programmes include Primary Care, Cancer Care, Integrated Care, Maternity Services, Mental Health, Learning Disabilities, Urgent Care, Elective Care, Children and Young People services and End of life Care.

Alliance Programmes and Quality Improvement

The Integrated Care System is formed of three Alliances – North East Essex, Ipswich and East Suffolk and West Suffolk. Each Alliance has its own local Delivery Plan. These Plans are system based and not focussed on health commissioning in isolation, rather they draw together the wider determinants of health. The focus for the Engagement Team is to involve and collaborate with the people within the Alliances. Each Alliance will have its own Engagement and Involvement plan which will form part of the overall strategic delivery plan.