Joint Forward Plan Appendix 3

Appendix 3: Our Partners’ Aligned Plans

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1.1 Primary care – general practice

1.1.1 Context

Our ambition is to build vibrant, sustainable primary care at the heart of high quality, integrated health, and care provision for the people we serve. Many of our plans are ICS wide; some are Alliance- focused; and others are neighbourhood or community based. This is determined by clinical need, appropriate partnership relationships and economic viability.

The people of SNEE are generally served by high quality practices, with care delivered by experienced and qualified professionals. There is some variation in access and performance. Almost all practices, nationally and locally are facing significant and increasing pressure due to several factors:

• increasing population
• ageing population
• recruitment and retention issues
• the increase in the delivery of care outside of hospitals
• funding

What our people and communities say

We know that access to primary care remains one of the highest priorities for our people and communities, heightened since the pandemic and some of the measures introduced.

We know that most people contact Primary Care over the phone. Although in some Alliances almost half make contact via a website or app. For those making contact via the telephone, the waits can be long and difficult to navigate. Although we also know that people are willing to try more online options for making contact.

People have told us that they are being offered a range of appointment options, telephone triage or e-consult, same day appointments or appointments through enhanced or extended hours together with opportunities to see a range of healthcare professionals. Most people are offered a face-to-face appointment with someone at their practice. However, despite this variation and range of choices some people feel they experience a poor service and bad experience.

Many people praise the staff they meet as caring and kind even if they are frustrated by extended waits and access to services. Many recognise that primary care simply cannot keep up with the level of demand being placed on it.

We have strong Patient Participation Groups (PPG) working alongside Primary Care. Members of the groups are committed to supporting good quality care and better outcomes for people and working with the Practices to develop their approach. We have three PPG Networks in SNEE supporting the development and collaboration with people and communities in primary care and bridging the gap between local communities and primary care.

1.1.2 Strategy

Running through our whole plan and its delivery there are seven golden threads which collectively make a significant contribution towards our current vision and aim to address those pressures described.

The seven threads are:

• new models of care: enabling primary care collaboration, and delivering joined-up care in localities and within PCNs
• reducing workload to safe levels and optimising care
• workforce, including recruitment and retention and caring for every professional and caring for our people
• access: enhancing access to GP-led services, and promoting and supporting people in self care
• infrastructure: creating environments for future care needs, and enabling digital connectivity for our people and professionals
• investment: stimulating transformation and delivering high impact changes
• leadership, governance, and programme management: co- producing strategy and plans with clinical leadership, patients, public and partners; enabling excellence in delivery with management support

We are currently engaging with the whole primary medical care community to see whether change is needed to our strategy and support the implementation of the NHS LTP, namely: further integrating primary and community health services; reducing pressure on emergency services; supporting personalised healthcare to reduce inequalities, to provide continuity of care for our most vulnerable people; and achieve digitally enabled healthcare. This requires system working at each level of the ICS, using population health data management to locally design services that meet the needs at neighbourhood level, recognising both the urban and rural challenges.

Local delivery action plans will be co-developed at Alliance level to respond to both new and national requirements and local need to support local primary care resilience. These will articulate:

• further local demand management measures including alignment of Alliance prevention and self-care strategies
• local support for PCNs specifically including their Clinical Directors workload management measures beyond national measures
• further workforce plans (specifically but not limited to recruitment and retention issues) and working with the Training Hub to support the wider workforce with primary care and community systems
• estates and digital integration, including uptake of online services and rollout of Digital First
• integration of PCNs with wider partners: community providers, the voluntary sector and local government
• the relationship with social prescribing and wider non-medical service offers

1.2 Primary care – pharmacy, dental and optometry

1.2.1 Context

Our local population currently receive four distinct services from GPs, pharmacists, dentists, and optometrists. Each provides a valuable service however there are overlaps and gaps in advice given due to a lack of co-ordination between the professions and poor connectivity. All the professions give advice on self-care, condition management, prevention and deliver emergency care but have limited referral pathways, joint training, or targeted messages. Fully integrating the local professional network into strategic planning and with PCNs will break down silos and generate co-ordinated person-centred care.

1.2.2 Strategy

Several strategic priorities have been set out to enhance integrated care:

1. Improved connectivity: greater IT connectivity between GPs, pharmacies, dentists, and optometrists would enable information to be shared between practitioners. The scope for change here ranges from new systems to allow read/write access to summary care records, to more efficient and widespread use of NHS e-mail accounts instead of fax and telephone

2. Workforce: more efficient use could be made of the skill mix within dental, pharmacy and optometry settings. All practitioners should be enabled to work ‘to the top of their license,’ with work allocated appropriately to the most relevant professional

3. Training: targeted training would facilitate an increase in the contribution of local professional teams. Independent prescriber training for pharmacists and optometrists would support long term condition management. Other specific training – such as post- graduate education in glaucoma care – could enable the transfer of low-risk hospital patients into primary care.

4. Pathway redesign: focusing on several pathways, including:

• provision for the falls and frailty fractures pathway to receive referrals from optometrists and community pharmacists
• enhanced service pathways in the Diabetic Eye Screening Programme
• new Learning Disability Pathway for eye health checks in locations where primary care general ophthalmic services contracts cannot be awarded
• improved use of pharmacist referral to physiotherapy and to the Improving Access to Psychological Therapies Programme

5. Prevention: training and referral pathways should be developed:

• ensuring people have access to Eye Clinic Liaison Officers in Ophthalmology departments to reduce preventable sight loss
• more preventative-based dental care to decrease the need for advanced dental care
• support for all community pharmacies to secure Level 2 Healthy Living Pharmacy Level status; and
• linking local screening and prevention initiatives with contractually mandated pharmacy public health campaigns to maximise local benefit

6. Emergency care: better commissioning of rapid access community pathways so that people with acute red eye and other more minor presentations can be seen in accredited optical practices and ensuring the new Community Pharmacy Consultation Service allows pharmacists to manage minor illness with direct referrals from NHS 111 and GPs

7. Self-care: service enhancements would better realise opportunities for pharmacists, dentists, and optometrists to support people to manage their self-care. Training and pathway redesign have the potential to increase the role pharmacists play in providing an alternative to GPs for the treatment of minor illnesses (which will now be advanced through national contracting)

8. Condition management: the local professional network should have an expanded role in management of certain conditions. For optometrists, for example, this would include glaucoma and age- related macular degeneration; for dentists, periodontitis management in diabetic patients; and for pharmacists, asthma

9. Patient safety: pharmacists will have an expanded role in medicines safety and reducing harm caused, both through poor compliance to prescribed medication and by recognising risks associated with some medicines due to polypharmacy, addiction, anticholinergic burden, and acute kidney injury

10. Enhanced detection: pharmacies will have a more comprehensive role in detecting high blood pressure and Atrial Fibrillation. Service enhancements would also strengthen the role of the local professional network in the early detection of certain cancers

Other commitments for Oral Health and Eye Health and can be found in Sections 5.6.3.4 and 5.6.3.5 respectively. The next sub section focusses in more detail on pharmacy.

1.2.3 Pharmacy

Since the implementation of the Health and Social Care Act 2013, community pharmacy services have been provided through a national contractual framework. This has meant that poor integration between community pharmacy services and those of other primary care providers, has limited the benefit for our communities. Direct commissioning of primary care providers by the ICB gives us a unique opportunity to optimise the benefit of these services through better integration and pathway redesign.

By achieving this, we will also create a strong foundation for future innovative working, where clinicians operate at the top of their licence to deliver seamless and responsive care to our local population.

Strategy

Several strategic priorities have been set out to enhance integrated care. These are included in the East of England (EoE) Community Pharmacy Strategy, as agreed by pharmacy leads from each ICS:

1. Pathway redesign: community pharmacy should be considered at the outset of any primary care or community pathway redesign. There would be significant benefit in ensuring that nationally commissioned services are optimised through appropriate inclusion in local patient pathways. The recent delivery plan for recovering access to primary care progresses this. The development of innovative locally commissioned services provides significant opportunity for building additional capacity across primary care

2. Improved Connectivity and Use of Data: greater IT connectivity between GPs, pharmacies, dentists, and optometrists would enable activity to be shared between practitioners. The current picture in terms of community pharmacy digital capacity and effective use of data is complex. An understanding of the current baseline, along with national priorities being embedded into the local digital strategy, will be key to establishing next steps. Clarity around the data available and how that can be used to drive integration and improve outcomes will need to be established. Visibility and appropriate use of this data should be agreed with system partners supported by ICS digital leads

3. Workforce redesign: more efficient use should be made of the skill mix within primary care settings. All practitioners should be developed to work ‘to the top of their licence,’ with work allocated appropriately to the most relevant professional. This will foster a greater sense of job satisfaction and contribute to workforce retention. Pharmacy workforce recruitment, retention and development will need to be a clear and ongoing focus for the system, as detailed in the SNEE Pharmacy Workforce Strategy

4. Training: targeted multi-professional training would facilitate improved inter-professional relationships, joint working, and opportunities for pathway re-design. Independent prescriber training for pharmacists and utilisation of these skills would support long term condition management and the treatment of low acuity conditions, as well as expanding capacity in primary care

5. Urgent and Unplanned Care: optimising referrals from NHS111, Urgent Treatment Centres and GP practices via a community pharmacist consultation service should be a priority. This should be linked to the development of a locally commissioned patient group directions led service which would allow the supply of appropriate medication for low acuity conditions, without referral back to a GP practice. This should be further extended to fully utilise the skills of IPs in a community pharmacy setting which would improve timely access

6. Prevention: prevention is now a core part of the national service offering through community pharmacies and the outcomes from these services should be fully optimised through better integration and increased visibility of these services for patients and other system partners. All community pharmacies are now Healthy Living Pharmacies and the whole pharmacy team should be supported to maximise the value of, and capture data from these contacts. Pharmacies are well placed and have the necessary skills to support important public health initiatives such as Covid and Flu vaccinations and this could be extended to include support for additional immunisation programmes, maximising access for hard- to-reach groups

7. Condition management: there is huge scope for expanding the role of community pharmacies in supporting condition management across primary care. Key areas for focus should include hypertension management, diabetes care, COPD, and asthma. This could be achieved through both optimising existing commissioned services and local commissioning of services which fully utilise the skills of the whole community pharmacy team

8. Early detection: pharmacies have a unique opportunity to improve population health through their frequent contact with members of the community throughout all stages of life. They are often in areas of deprivation and have contact with people who may not regularly access other healthcare services. They have a significant role to play in the early detection of cardiovascular disease and cancer and locally agreed referral pathways would ensure that the additional workload created through early detection does not all impact on general practice

9. Patient safety: pharmacists have an expanded role in medicines safety and reducing harm caused to people, both through poor compliance to prescribed medication and by recognising risks associated with some medicines. Full integration of the New Medicines Service (NMS) and increased referral from secondary care and community service via the Discharge Medicines Service (DMS) should be the primary focus to reduce harm and improve outcomes through co-ordination of medicines information

10. PCNs and Place Level Integration: it should be a key focus of the system to develop a funded mechanism by which community pharmacies can engage with PCNs and integrate at place level. This should include leadership development opportunities for pharmacy staff so that we can strengthen the community pharmacy voice. This would support more rapid integration across primary and community care and encourage innovation in service delivery.

1.3 Community

1.3.1 Context

There are an extensive range of services in the community across SNEE, including:

• Community Audiology Services
• Elective Cardiology Outpatient service
• Carer Support
• Community Hospitals
• Community Nursing including specialist nursing services
• Therapies including Physiotherapy, Dietetics and Occupational Therapy
• Ophthalmology
• Community Urology and Continence
• Falls Prevention and Clinics Musculoskeletal and Pain Management
• Stroke Rehab
• Homecare and Rapid response Support
• Community Diagnostics and Clinic Assessment Service
• Community Paediatrics

Community service providers in the ICS include key local independent providers such as Allied Health Professionals Suffolk.

1.3.2 Strategy

Our community services are key to delivery of this plan to ensure better care close to home, encourage people to live independently, to live healthier lives and to give them greater choice and control over the services they receive. Planning for community services focuses on:

• responding to increasing expectation and demand
• ensuring appropriateness of referrals (‘right place, right person, right time’)
• enabling self-management and prevention of chronic conditions

Key developments include on-line self-referral and triage services, and widening partnership working to enhance prevention, improve wellbeing and reach all parts of the community.

Within North East Essex, a new ‘Integrated Community Service’ contract has been commissioned with a Collaborative of Alliance Partners working together to deliver more joined up community services for our population. These partners range from statutory and independent providers to charitable and voluntary sector organisations. Aligned to our ambition to support prevention of ill health and a focus on the wellbeing of our population, our Collaborative aims to maximise use of existing community assets by working at Alliance and Neighbourhood level together to support a cohesive person-centred approach.

In Ipswich and East and West Suffolk, an independent review of our Integrated Community Services contract has been commissioned to identify the opportunities for delivering the full ambitions of the White Paper Health and Care Integration: Joining up care for people, places, and populations. This will explore opportunities around how we also invest in personal and community wellbeing including prevention supported by intelligence and PHM approaches. We expect the outcomes of this by summer 2023.

1.4 Integrated community and acute health providers

1.4.1 Context

SNEE has two integrated community and acute healthcare Foundation Trusts, providing a range of services within people’s homes, in community hospitals and three acute hospitals in Bury St Edmunds, Colchester and Ipswich.

Strategic planning by WSFT and ESNEFT sets out to address several challenges: the needs of an ageing population; increases in emergency activity; more people with dementia and diabetes; predicted future demands associated with ‘lifestyle diseases’ (obesity, alcoholism, and smoking); and the use of resources.

The Boards of both Trusts share a vision to work together:

As integrated Acute and Community Trusts and anchor organisations, we are uniquely positioned to improve the health and care of our communities. Working together and learning from each other we will offer the highest quality and access to care for the people of SNEE. We will work collaboratively to reduce variation in the services available to our communities and to improve the wider determinants of health.

1.4.2 Strategy

East Suffolk and North Essex NHS Foundation Trust 2019- 2024 Strategy

The ESNEFT 2019-2024 Strategy sets out an ambition to offer the best care and experience. This is supported by five strategic objectives to guide planning and investment.

Keep people in control of their health, by:

• enabling people to manage their own health and wellbeing
• enabling people to have control of their information and appointments
• maximising health promotion and prevention of ill health
• understanding and addressing the causes of health inequality

Lead the integration of care, providing services co-ordinated around individuals’ needs, through:

• integrated neighbourhood teams
• mentally healthy services
• shared information across the ICS
• one clinical community with system pathways
• urgent care integration
• a home-first approach to post-treatment care

Develop our centres of excellence, by:

• supporting care close to home
• ensuring good access to services
• delivering the best clinical quality and latest treatments
• enhancing emergency care
• meeting and exceeding standards for elective care

Supporting and developing our staff:

• valuing and embracing diversity in our workforce
• diversifying skill mix and developing new roles in our teams
• engaging and developing all our staff

Drive technology enabled care by:

• embracing transformational medical technology
• increasing the integration of information and connectivity across the ICS

West Suffolk NHS Foundation Trust Strategy

WSFT launched its new 5-year strategy in 2022. The strategy was developed with staff and other stakeholders and recognises the importance of learning lessons to develop the culture and deliver the vision of providing the best quality and safest care for the community. Key areas of focus are identified within each of the Trust’s three ambitions:

First for patients

• we will strive to provide a seamless experience for all our patients, with effective communication from beginning to end
• we will treat everyone with dignity and respect, and as quickly as possible
• we will continue to focus on preventing infections and keeping the good things that have come out of the pandemic, like the ‘Keeping in Touch’ service
• we will join up more care with our neighbouring organisations, following the West Suffolk Alliance strategy
• we will provide more care in people’s own homes and in their local areas
• we will give everyone the tools and support they need to put patient quality and safety first
• we will undertake research and innovation to bring about new ideas and innovations to improve patient care

First for staff

• We will embed a culture where everyone feels valued and listened to; where the interests of our people and staff are not at odds with one another; and where kindness, effective communication, and compassion towards one another are standard behaviours
• We will deliver our first People Plan informed amongst other things by the findings of our ongoing ‘What Matters to You’ staff engagement programme
• We will keep using large-scale conversations with staff as an ongoing approach to hear how leadership in the organisation is working and how it could be better
• We will communicate and co-produce better within the Trust, with patients and families, and with the organisations we work with

First for the future

• We will maintain all our buildings, facilities, and equipment to the best possible standard and make sure everyone has a comfortable environment to be cared for and work in
• We will finalise planning permission and detailed designs to progress the replacement of West Suffolk Hospital under the national New Hospital Programme and develop other local services, for example at Newmarket Community Hospital
• We will make optimum use of digital and medical technologies we already have available and work to transform our services to meet the increasing demand for health and social care
• We will always have a non-digital offer for those that cannot or do not want to use digital solutions
• We will sensitively, securely, and responsibly use data and information we have at our fingertips to understand quality and outcomes and tailor our care to people’s needs.
• We will address the disparities in access to healthcare and health outcomes, including the PHM approach to elective recovery
• We will embed a sustainability ethos throughout our organisation through delivering our Green Plan (as detailed in Section 7.9 of the JFP)

1.5 Mental health and learning disability

1.5.1 Context

Improving mental health is a central focus in our plan. Mental health services across SNEE are being developed and delivered through collaboration between the ICB with Foundation Trusts, local government, police constabularies and a range of VCSE organisations.

NSFT is the statutory provider of mental health services in Suffolk and as well as across Norfolk serving over 1.6 million people. Services are delivered by over 4700 staff across more than 50 locations.

EPUT provides community health, mental health, learning disability and social care services to over 3.2 million people across the East of England in Bedfordshire, Luton, Essex, Southend, Thurrock, and Suffolk. Services are delivered by more than 5,500 staff working across more than 200 sites. At any one time, EPUT cares for more than 100,000 people.

1.5.2 Strategy

Essex Partnership University Trust

The EPUT Trust Board agreed a new vision, purpose, values, and strategic objectives in September 2021.

Since summer 2022, the Trust has been developing a five-year strategic plan (2023/24 to 2027/28) to deliver EPUT’s vision, purpose, values, and strategic objectives.

EPUT’s vision is “to be the leading health and wellbeing service in the provision of mental health and community care.” This is demonstrated through the Trust’s values:

• We Care: better care leads to better outcomes. Our care will be individualised, therapeutic and trauma-informed, and we will support our staff to be resilient at work by prioritising their health and wellbeing.
• We Learn: we will develop our culture of learning, reflecting carefully when things go wrong and championing continuous improvement. We will embed gold standard learning processes and cycles that help us create new knowledge.
• We Empower: e will create a culture of co-production, with lived experience and staff experience informing all our plans. We will empower our service users, their families, and their supporters to set their own care and recovery goals and empower our staff to draw on and apply their managerial and clinical expertise.

The Trust also sets out a series of strategic objectives:

• We will deliver safe, high-quality integrated care services close to where service users live, achieve world-class outcomes, with a focus on recovery, empowering service users, families, and carers and embed a digital mindset and culture
• We will enable each other to be the best we can by ensuring EPUT is a preferred employer, and an excellent place to work and train; building capabilities to deploy a flexible, multi-skilled workforce model, including volunteers, and lived experience roles; developing future leaders, growing our own workforce, and improving organisational digital literacy
• We will collaborate with our partners to make our services better by continuing to build partnerships with services users, carers, and their families; driving collaboration and integration through partnerships across Southend, Essex, Thurrock, and the East of England region; continuously improving quality, experience, access, and outcomes through collaboration and better enabling local joint working

• We will help our communities to thrive by reducing health inequalities, supporting, and working to maximise the strengths of local communities, reduce environmental impact and preventing illnesses

NSFT

NSFT’s revised Trust strategy is currently in development, and due to be published in May 2023. Its current 2019-2023 strategy has five strategic objectives, each with a set of specific outcomes, which are as follows:

Engage, develop, and inspire our staff

• A more diverse culture reinforced through our EDI strategy
• No one in the Trust feels physically or emotionally threatened, bullied, or harassed and is able to speak up
• Improve staff wellbeing
• Enhance recruitment, retention, and supervision processes, attracting and keeping skilled expertise
• Focus on teams as part of our cultural development programme
• Improve flexible working and work life balance
• Talent management and succession planning

Co-production, partnerships, and recovery

• Meaningful service user and carer participation/engagement and increased service user/carer-led QI projects
• Service users, carers and partners involved and leading recruitment, appraisals and quality and safety reviews
• Being active leaders in our ICSs and provider collaboratives, helping to improve the health of our population and tackle health inequalities
• Increased working with the VCSE sector and community partners, particularly to support our transformation programmes
• Collaborating with our Governors to ensure the voice of the membership informs our service improvements

Align our governance and systems

• Integrated dashboards and technology so that robust data continues to inform our QI
• Putting in place a new accountability framework, to give us clarity about responsibilities and expectations
• Reviewed governance systems, supporting accountability and decision making, releasing time to care, and supporting partnership working
• Developing operational, estates, digital and sustainable environmental plans underpinning our clinical strategy
• Best use of our resources to ensure sustainability

Building improvement skills

• Expanding our QI approach to accelerate improvements
• Increasing QI capability to improve outcomes
• Sharing and implementing changes
• Harnessing experience and knowledge of service users and carers, clinicians, research, and managers to improve outcomes

Improve access and quality of care

• Lived experience supporting our learning from incidents
• Enhanced demand forecasting and management with system partners to improve access, waiting times and eliminate out of area placements
• A new clinical strategy to inform new models of care, QI, and innovation
• Co-designed Children’s, Families and Young People’s services to improve the experience of children and young people
• Service user and carer feedback shapes and helps communicate our service offers
• Improved clinical assessment, multidisciplinary working and sharing of information to ensure service users and carers experience continuity and consistency of care.

Essex Disability Strategy

This document sets out the four most important things people with disabilities have told the Council they want from their lives; good relationships, a place to call home, to be safe and well, and meaningful activity. It outlines actions including:

• growing the inclusive employment support service.
• making sure more people can access short-term help to learn independent living skills
• “Move On Workers” to help adults move to the most suitable home for them.
• teaching people to be more aware of disabilities and how to make sure services are easy to access

1.6 Local Government

1.6.1 Upper Tiers

Context

Three tiers of local government operate in both Suffolk and Essex – County Councils: District, Borough and City Councils and Parish Councils – with each tier contributing to their local population’s health and wellbeing.

Both Essex and Suffolk local county council strategies align to this plan. Collectively, there is a shared drive to tackle the drivers of deprivation and enhance community resilience; to help people to live healthy lives, age well and maintain independence; and to collaborate with partners, improve efficiency and be more responsive to the needs of local communities across both local authorities.

Strategy

Essex County Council

Everyone’s Essex: our plan for levelling up the county 2021 to 2025 sets out 20 commitments for the next four years, built on four areas where outcomes really matter for the quality of life for all people in Essex.

The Economy

• Good jobs
• Deliver and maintain high quality infrastructure
• Future growth and investment
• Green growth, developing Essex as a centre for innovation, supporting innovative technologies and business models
• Levelling up the economy by addressing the drivers for socioeconomic inequality

The Environment

• Net zero by ensuring that the council significantly reduces its carbon footprint, whilst also supporting an acceleration in sustainable housing, energy, and travel
• Transport and built environment
• Minimise waste and its impact on the environment
• Green communities – providing advice and support to enable and empower local action
• Levelling up the environment helping them to enjoy a high-quality environment

Families

• Education outcomes – achieve educational excellence and high standard for all children and young people
• Strengthen family resilience and stability, as part of thriving communities
• Safety for Essex residents including children and young people
• Outcomes for vulnerable children
• Levelling up outcomes for families by focusing on recovery from the pandemic, tackling family poverty, mental health support, emotional wellbeing, and healthy active and productive lifestyles

More detail on our approach to supporting children and families across the county can be found in our Early Years and Childcare Strategy.

Promoting health, care, and wellbeing for all ages

• Healthy lifestyles, increasing the proportion of people able to live healthy lifestyles
• Promoting independence, to help individuals to live free from abuse and neglect and to live independently
• Place based working will deliver better care that meets the needs of residents through joined up care with local partners in a place
• Carers of all ages helped, whose caring duties are impacting most on their wellbeing
• Levelling up health by bringing together partners and communities to address the socio-economic drivers that underpin poor health outcomes, such as housing, poverty, economic insecurity, and low skills

Essex local authorities have started discussions about pursuing a devolution deal for Greater Essex that can help bolster the area’s powers to boost economic development and help tackle the wider determinants of health. Work is currently underway on the drafting of a devolution bid to enable authorities across Greater Essex to engage with Government on an ambitious devolution deal for Greater Essex during 2023.

Essex Joint Health and Wellbeing Strategy

Supporting people to live healthier lives is reflected in our new Joint Health and Wellbeing Strategy. The strategy has identified five key overarching priorities:

• improving mental health and wellbeing
• physical activity and healthy weight
• supporting long-term independence
• tackling alcohol and substance abuse
• addressing health inequalities and the wider determinants of health

The strategy recognises that tackling health inequalities for any cohort requires the support of the wider system, and this is reflected in the membership of our Health and Wellbeing Board and local Alliances including local authorities, health, wider public sector, and voluntary sector organisations.

Essex Carers’ Strategy

The strategy outlines how the County Council, along with and partners, will support unpaid carers of all ages undertake the invaluable contribution they make to society.

Commitments to carers included within the strategy include:

• to ensure carers can easily access the information, advice, guidance, and support when they need it, early into their caring role.
• to develop professional practice and processes to improve identification and support to carers.

• to improve transitions for carers as they move through specific phases or life events in their caring role
• to ensure carers have increased opportunity to access good quality support, including opportunities for breaks, to maintain their own wellbeing and those they care for.
• to ensure carers’ needs and rights will be understood and recognised across Essex communities.
• to recognise that carers will be the experts that influence, shape and be involved in the decisions that are intended to improve their support and wellbeing.

SET Dementia Strategy

Essex has worked with people with lived experience, the NHS and our neighbouring unitary authorities of Southend and Thurrock to develop a dementia strategy for the period 2022-26. This sets out priority areas to improve, including around diagnosis and support, improving IAG, and improving support at moments of crisis. We have developed some excellent partnerships with schools to connect children and young people with adults with dementia and have also developed dementia friendly communities.

Essex Children and Young Peoples Plan

This plan explains how partners across Essex are working together to improve outcomes for children, young people, and their families.

The outcomes it seeks to achieve are:

• resilient children and young people
• stable and thriving families
• inclusive and supportive schools and communities

Safe and accessible neighbourhoods Suffolk County Council

Suffolk County Council’s ‘Corporate Strategy 2022-2026’ comprises four objectives, with action against them updated in the Council’s Annual Plan. They are also reflective of the proposed Suffolk devolution deal published on 8 December 2022. It is expected that greater devolution of powers and funding offered in the proposed Deal will enhance opportunities to deliver these objectives and help local communities and businesses fulfil their potential. These key objectives are shown below:

Promote and support the health and wellbeing of all people in Suffolk

• Work with NHS, district and borough councils, and other partners to prioritise the physical and mental health of all people in Suffolk
• Enable residents to lead healthier, active lives and address health inequalities, including working to combat isolation and loneliness and tackling obesity as we recover from Covid-19
• Continue to prioritise vulnerable older people, adults, young people, and children through our services

Strengthen Suffolk’s local economy

• Look to stimulate a stronger, fairer local economy, promoting procurement opportunities for Suffolk businesses as we recover from and learn to live with Covid-19
• Work with our partners – the Local Enterprise Partnership, Chamber of Commerce, and councils – to develop jobs, skills, and infrastructure
• Help young people into work and older people to switch careers or start a business
• Promote economic growth that strengthens communities, reduces inequalities, and encourages our residents to fulfil their potential and prevents them from falling into crisis

• Maximise growth through our decisions and actions to support more people and businesses in Suffolk to do well. This, in turn, can support a stronger, sustainable local economy that produces good jobs, good housing and connectivity, while protecting the natural environment

Protect and enhance Suffolk’s environment

• Accelerate work to deliver on the county council’s pledge to be carbon neutral by 2030. 2026 is a staging post on the way to 2030 carbon neutrality
• Lead, support and contribute to activities in Suffolk’s Climate Emergency Action Plan to achieve a net zero Suffolk by 2030
• Take collaborative action with partners to build sustainable homes, promote and adopt low carbon transport, use cleaner power, and reduce industrial and commercial energy use
• Promote biodiversity and conserve natural habitats and open spaces
• Promote clean air and carbon capture through nature
• Instal hundreds of electric vehicle charging points and support discounts on solar panels and energy efficiency grants

Provide value for money for the Suffolk taxpayer

• Redesign services and processes to drive productivity and value for money
• Continue our strong track record of sound financial management and governance
• Invest in technology and use the internet and innovation to improve communication, services, and our efficiency

1.6.2 Districts and Boroughs

Although not a perfect match between respective boundaries, the SNEE ICS footprint is overlaid across several borough and district councils, comprising:

• Colchester City Council
• Tendring District Council
• Ipswich Borough Council

• West Suffolk District Council
• East Suffolk District Council
• Mid-Suffolk District Council
• Babergh District Council

For planning and delivery, Mid-Suffolk and Babergh have a joint administration.

Strategy

The councils’ strategic priorities are diverse, reflecting local needs and circumstances. However, all plans share two major themes which align closely with the JFP and SNEE ICS Strategy.

Economic development which benefits all residents

Key to tackling deprivation and health inequalities, all strategies prioritise economic growth and opportunities. Plans across the districts include, for example:

• enabling better job opportunities
• workforce development through education, training, and opportunities
• provision of suitable and sustainable housing
• collaborating with partners to construct an anti-poverty strategy

With a focus on healthy living and resilient communities, plans include:

• partnership work across public services and the VCSE sector to expand health provision and improve the health, wellbeing and safety of families and communities
• fostering supportive community and multi-agency networks and facilitating community-based solutions to locally identified issues
• embedding prevention and early intervention principles in service delivery, commissioning, activities, and campaigns
• championing healthier lifestyles and well-being
• supporting vulnerable people to live independent lives in their communities
• contributing to the successful delivery of mental health outcomes through housing and addressing isolation
• improving access to services, especially in rural areas
• reducing fuel poverty
• reducing homelessness
• targeting support to the most deprived residents and communities

1.7 Voluntary, community, and social enterprise

1.7.1 Context

“Charities are the eyes, ears, and conscience of society. They mobilise, they provide, they inspire, they advocate, and they unite. Charities play a fundamental role in our civic life. They are often in the front line of support for the most vulnerable and are therefore in the best place to assess their needs.”

‘Stronger Charities for a Stronger Society,’ House of Lords Select Committee on Charities, 2017

Like our public sector, our VCSE organisations are driven to address need and provide opportunities to create the best lives for our population. The VCSE sector in SNEE is largely made up of a diverse network of small and medium sized organisations.

Suffolk

• 2,943 registered charities operating in Suffolk active, with an estimated 12,000-15,000 other small community groups and organisations too small to register or without charitable aims
• Over 3,000 not for profit organisations registered with other bodies such as Companies House CIC, Companies Ltd, FCA for Mutuals/Co-ops
• 88% of registered charities, 2,594, have turnover of less than

£100,000 and the majority of these will be volunteer only organisations

Colchester

• 186 active charities are registered in Colchester, plus other national and regional charities and faith and sports groups
• Of those registered, 52% have an annual income of under £25,000 and so are likely to be volunteer led
• Another 73 have an income of under £500,000

Tendring

• Estimated 900 voluntary groups with 20,000 volunteers including trustees
• There are almost no large charities based in Tendring or Colchester
• Most Tendring VCSE groups’ income is below £50,000

Suffolk and Essex Community Foundations are independent charities, part of the UK Community Foundation network of 46 Foundations across the UK. Together, the network members are the fastest growing charitable foundations in the country.

The Community Foundation model aligns and channels funding from public sector, other trusts and foundations and local philanthropy and works with local businesses to encourage giving. They provide grant funding and play a significant role convening and supporting the sector to make an impact in local communities. Recent examples have been the Equity in Mind Programme working alongside the NHS and connecting funding with charities.

1.7.2 Strategy

Our local VCSE infrastructure organisations see a range of opportunities to increase the impact of our sector and build on the commitment to the VCSE sector being an equal partner within the ICS. These opportunities include:

• more effective engagement between VCSE and public services on key challenges and solutions to maximise reach into communities and manage demand together. This starts with a principle of how, not whether the VCSE sector can be a delivery partner
• embedding our VCSE Resilience Charter, including a more consistent approach to grant funding and commissioning by local and national funders, and an approach which: identifies and supports what is already working; makes best use of assets and partnerships; and focuses on tackling unmet need across SNEE
• committing to a greater proportion of funding being spent on the VCSE sector to support delivery of the priorities set out in the JFP
• supporting individuals to engage in wider and more varied volunteer and social action and providing parity to volunteers in our programmes of work
• developing more effective business/employer volunteering and social mobilisation to include time credits, local giving, and other forms of engagement

• supporting VCSE organisations to improve their sustainability through effective financial planning, marketing, support for training and development and supporting 21st century fundraising and income generation opportunities
• developing digital solutions to provide efficiencies, resilience through new forms of income generation and smarter tracking of impact and outcomes

The ICB fully endorses these opportunities and is committed to turning them into a reality.

1.8 Care Homes

1.8.1 Context

In SNEE demographic change will significantly increase demand for care and support, especially among frail elderly people and working age adults with learning disabilities over the coming years. Local authorities will be using limited resources more effectively through a growing emphasis on prevention and early intervention, to enable people to stay in their own homes for longer.

Independent living, supported living, technology and preventive services will be key to achieving this, as will innovative cost-effective solutions and models. We will move increasingly towards outcome- based commissioning and develop more person-centred models of support that are outcome focused.

1.8.2 Strategy

Suffolk Joint Residential and Nursing Care Homes Strategy 2018-23

The council and the ICB continue to work in partnership with Suffolk’s care market to deliver key priorities in the Joint Strategy (2018-2023). The key aim is to support choice and control for people, their families, and carers to make successful care accommodation choices. This vision is approached through seven objectives. The objectives of the strategy were reviewed in early 2022 to align with the Adult and Community Services Care and Support Market Sustainability Strategy as well as the Enhanced Health in Care Homes (EHCH) framework. The following areas were identified as key priorities based on the current state of the care homes market as well as changing needs and demand:

1. Quality of care: for all residential and nursing care homes in Suffolk to be good or outstanding CQC rated. Continue to develop a care market that is financially sustainable through robust contract management, advice and guidance and provider support, built on a collaborative and joint approach between health and social care
2. Customer choice: more opportunities for prospective residents, and carers to find information to support their choices and manage their experience
3. Managing demand: support the changing demographic in Suffolk by working in an integrated way to design flexible and fluid solutions to maximise local strengths. This includes the delivery of specialised care and support in the community that is responsive to individuals with complex health and social care needs including enhanced care
4. Cost, Pricing and Supply: creating a market that is stable and is delivered by sustainable businesses, recognising the need to find the balance between quality and cost of care

• Care market workforce development: developing and securing a vibrant workforce as well as developing the skills of existing staff to enable them to deliver care that meets the needs of people including those with complex care needs. To support the ongoing recruitment and retention of staff, and to design collaboratively the pathway for future staff carer development
• Customer engagement including engagement with staff working within care homes
• Market shaping, future planning, and development: providing co-designed care homes fit for the 21st century, recognising the changes in demand and demographic in Suffolk, working closely with planning departments in district and borough councils

Essex County Council Residential and Nursing Framework for Older People

Essex County Council has worked in collaboration with health across all three ICSs to develop an Integrated Residential and Nursing Framework for Older People across Essex. Essex Adult Social Care’s key strategy is to support people to remain at home within their community, ensuring their independence and wellbeing is maximised providing choice and control for the people and their families to make the right decisions. Where people require residential or nursing care the objectives are to:

• ensure people are placed in good or outstanding homes across Essex
• commission services through our contracted providers, investing in our strategic providers and that our most valued care homes remain sustainable

• work in collaboration with health to support discharges for those entering short term residential or nursing placements from hospital, to maximise their opportunity to return to their long-term homes as soon as they are able
• work in collaboration with health partners for adults entering a residential or nursing placement on the continuing health care pathway, end of life or for those with complex needs
• support the market to recruit, retain, upskill, and develop care staff within the sector and promote social care as a valued profession
• ensure technology supports the provision and oversight of adults within a residential or nursing setting utilising tech to enable care and equipment to support people to retain their independence
• upskill our carer workforce to manage demand for complex care or nursing care and to work to increase carer levels across Essex
• ensure that there is a robust enhancement tool for providers for complex adults
• ensure there is the appropriate level of capacity to support adults that require complex support

Essex County Council Care Market Strategy 2017-21

Essex County Council is currently working on a new market shaping strategy 23-28. In April 2022, the Council published the Market Position Statement on the Essex Provider Hub.

The Council’s vision is to facilitate a diverse, vibrant, and sustainable health and social care market that is able to offer choice and build upon people’s strengths and assets to ensure they are able to meet their outcomes and are kept safe. It has nine priorities:

• reshape the market to be able to respond to increased personalisation, independence, and prevention
• agree a clear approach for investing in the market to ensure sustainability and improve quality
• create a clear engagement framework to ensure we have the right conversations, at the right time and in the right place, with care providers
• work with service users and providers to develop collaborative models of working in commissioning and assessing services
• develop approaches that promote the voice of the user and support co-production to promote self- management and/or community solutions
• work with providers to help recruit and retain more care staff
• develop a joint strategy to develop and upskill care workers and care managers, building on existing approaches such as ‘My Home Life’ and ‘Prosper’
• ensure providers are paid on time
• develop trusted assessor approach and home to assess model across Essex to improve transfers of care and make better use of provider skills

1.9 Healthwatch

1.9.1 Context

SNEE is informed by Healthwatch Suffolk and Healthwatch Essex. Under the Health and Social Care Act 2012 and superseded by the Health and Social Act 2022, our Healthwatch organisations have a duty to:

• promote and support the involvement of people in the commissioning, provision, and scrutiny of local care services
• obtain the views of people about their needs for, and experiences of, local care services
• make recommendations and reports about how local care services could or ought to be improved

• provide information and signposting about access to local care services and about the choices available.

1.9.2 Strategy

By providing an independent voice for local communities, amplifying the voice of people, through research and by engagement with service providers and commissioners, our Healthwatch organisations are working to address a number of strategic priorities.

In 2020, Healthwatch Essex published their strategy covering the period 2020-2023. This is due for refresh following the recent changes in Health and Care 2022. This document focused on being able to collect, challenge and change the local health and social care for the residents and users of services in Essex. The strategy is supported by the operational plan, decision making tool kit and wellbeing policy that enable Healthwatch Essex to deliver high quality research, engagement, advice, and guidance to its local people.

Healthwatch Suffolk’s strategy is to be reviewed in 2023. The strategic priorities are unlikely to change. They are:

• mental health and emotional wellbeing
• children and young people and their families
• primary health care
• adult social care
• secondary health care

These objectives are heavily influenced by two cross-cutting themes (ethos), namely ‘Co-production,’ and ‘Addressing health inequalities.

1.10 Hospices

1.10.1 Context

Our hospices play an essential role in improving end of life care in SNEE. Three adult hospices serve our population: St Elizabeth Hospice in Ipswich and East Suffolk, St Helena Hospice in North East Essex, and St Nicholas Hospice Care in West Suffolk and one hospice for children and young people: East Anglia’s Children’s Hospice.

Hospices offer support to people and their families as they face dying, caring, death and grief. Together they support over 10,000 people a year and have a combined annual turnover of nearly £40m. The majority of the funding for their care comes from charitable sources. As well as being active leaders in palliative and end of life care in the three Alliances, the hospices are represented on the SNEE ICP and work together to share learning across the system.

1.10.2 Strategy

St Elizabeth Hospice

Our vision is to ensure that all in our community affected by a life- limiting illness can live fully and die with choice and dignity. We aim to achieve this by:

• providing multi-disciplinary holistic specialist and dedicated palliative care services to people, their families, and carers
• working alongside other statutory and voluntary agencies to provide specialist and dedicated palliative care where the person wishes to be
• acting as a resource to the local community regarding palliative care to increase confidence and competence in improving life for people living with a progressive illness and their families

• providing care that respects the choices made by people and their families so that people are treated in their preferred place and die in their place of choice where possible
• working towards equitable provision of all services, leading to increased use of services by people with non-malignant progressive disease, and those from seldom-heard communities

St Helena Hospice

We help local people facing incurable illness and bereavement across North East Essex. We want all local people to live well and die with dignity and choice.

Our strategic priorities include:

• extending our community engagement and service provision from last year of life to last phase of life
• increasing our virtual ward and intermediate care offer to the local system
• significantly extending our compassionate communities’ programme
• exploring the potential for a new site with additional community facilities and a St Helena owned and operated nursing home
• increasing our contribution as a partner within the North East Essex Integrated Community Services collaborative
• further increasing the number of people on the My Care Choices Register
• building on our value-based population health model for end-of-life care collaborating with partners to increase investment in community care and reduce deaths in hospital

St Nicholas Hospice Care

Our vision is that everyone in our communities has choice, dignity and support when facing dying, death, and grief. We are here so that no- one in our communities must face dying, death, and grief alone.

We continually strive for something better by aiming to:

• provide excellent, innovative, responsive, and accessible specialist palliative care that puts the person at the centre of all we do
• support our communities to use their assets, become more resilient, support each other and for individuals to remain independent for as long as possible
• develop robust and strategic partnerships to ensure that best end of life care for the people of West Suffolk and Thetford is a reality
• develop and sustain an open culture where hospice values are lived and practiced in all that we do
• thrive as a safe, strong, sustainable, effective organisation which drives a culture of evidence-based innovation

East Anglia’s Children’s Hospices (EACH)

Our vision is to aspire daily to lead the way in providing world-class care for children with life-threatening conditions. Every child deserves support, alongside their families, whenever and wherever they need it. Our mission is to improve the quality of life and wellbeing of every child and family member under our care by always providing individual and comprehensive services.

Our strategic commitments are:

• we will develop and deliver excellent palliative care services that meet the need of children and their families, making the most effective and efficient use of available resources
• we will support children and families by working more closely with the NHS and health and social care providers, as well as other hospice and charitable organisations

• we will inform and contribute to the evidence base underpinning children’s palliative care. We aspire to be national and international sector leaders in the field
• we will reintroduce and expand face to face services that families have told us are important to them. This will include the full range of services at our three hospices and in the community
• we will develop our online and digital services to reach more children and families in ways that are convenient and accessible to them.

We make the following commitments to our staff, partners, supporters, and customers to:

• operate in a way consistent with the EACH value
• communicate clearly and transparently
• respond quickly and effectively when called upon
• ensure careful stewardship of our finances, relentlessly focusing on frontline service delivery