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Healthy lives, healthy people: East Sussex Health and Wellbeing Board Strategy

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Executive summary

This is the East Sussex Health and Wellbeing Board’s refreshed strategy. It is a rolling strategy covering a period of five years, until 2027. Over this timeframe the strategy will enable the Health and Wellbeing Board and our local partnerships to continue to promote the health and wellbeing of East Sussex residents, now and in the future.

Since the strategy was last updated, the world has changed dramatically as a result of the Covid-19 pandemic. The pandemic accelerated the way communities and organisations work together to protect and support everyone. It also further emphasised the inequalities and vulnerabilities that exist in our society and communities, which have been highlighted in previous versions of this strategy.

Learning from this will be crucial to future progress. There is likely to be an increasing need for all types of services and support across health, social care, housing, mental health and wellbeing because of the interruptions to normal provision during the past two years, and the overall experience of the pandemic. We need to work together to ensure we can provide safe, high quality and affordable services for future generations. Furthermore, services need to be accessible to everyone and build on the strengths and skills people and communities have.

This strategy highlights our plans for health and care services in our county. Health and wellbeing for all is not just about services. It is improved by access to good jobs, transport, housing and green space as well as opportunities for lifelong learning, exercise, good nutrition and supportive networks and relationships between people and within communities. The strategy signposts to other key strategies and plans relating to these crucial ‘wider determinants of health’ which are led by various members of the Health and Wellbeing Board and encourages us all play our part in ensuring that everyone in the county can lead a healthy, happy, fulfilled life.

An integrated approach across the NHS, local government and wider voluntary and independent sector services plays a key role in supporting people to manage their own health and wellbeing effectively. At the local level that integration is managed through the East Sussex Health and Care Partnership. This brings together:

  • East Sussex County Council
  • our new NHS Sussex Integrated Care Board
  • East Sussex Healthcare NHS Trust
  • Sussex Community NHS Foundation Trust and Sussex Partnership NHS Foundation Trust
  • primary care networks
  • district and borough councils
  • Healthwatch
  • voluntary, community and social enterprise (VCSE) organisations
  • East Sussex Fire and Rescue Service
  • South East Coast Ambulance Service
  • education providers, registered landlords and a wide range of public and private organisations

Key health and care organisations are also members of our new statutory Sussex Integrated Care System (ICS), set up to work together in four areas:

  • Improving outcomes in population health and healthcare.
  • Addressing inequalities in outcomes, experience and access.
  • Enhancing productivity and value for money.
  • Supporting broader social and economic development

East Sussex is one of three places in our Sussex ICS (alongside West Sussex and Brighton and Hove) that are working together to deliver our shared priorities through a shared plan. The Health and Wellbeing Strategy provides the overall framework for our partnership work in East Sussex, and with the public, aimed at improving the health and wellbeing of local people and transforming the way we provide health and care.

Each organisation is responsible for making decisions about their resources and delivering improvements to services. The Health and Wellbeing Board’s role is to oversee how well we work together to make the most of opportunities where a more joined-up approach will help to improve outcomes, reduce inequalities and deliver efficiency savings that can be reinvested in service improvements.

 This includes supporting the strengths and capabilities that exist in our diverse communities and neighbourhoods, to make the best use of our collective resources. The strategy will also inform our shared work across Sussex. We would expect everyone to use it when making decisions about spending money and planning services, and our joint working and collective action over the next few years in East Sussex.

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East Sussex – our population and the health challenge

The Health and Wellbeing Strategy is informed and supported by:

In summary, our approach and the need for change is driven by these factors:

  • East Sussex is a county with a growing and ageing population. By 2026, almost one in four people here (24%) will be aged 65 to 84. For England as a whole, that figure is nearer one in six (17%). More than 4% of our population will be over 85. This compares to less than 3% for England as a whole. 
  • With more older people, which includes those who are frail and have multiple conditions, East Sussex is likely to have higher health and care needs than other areas of our size. This rise in demand is just one part of our health and care for the whole population.
  • By 2028, around 20,000 more people in East Sussex will be living with two or more long-term health conditions than was the case a decade earlier.
  • The number of children in need of help and protection is rising locally and nationally, linked to the increase in families with financial difficulties. There is also a rise in the number of children with statements of special educational needs and disability (SEND), some of whom will have complex medical and care needs.
  • East Sussex is both rural and urban, which brings challenges in ensuring the right access to services and at the right quality. Our coastal communities reflect the patterns of inequality and poverty highlighted nationally in the Chief Medical Officer’s report from 2021 and there is also hidden poverty in our rural areas.
  • On average, our population’s health is similar to England’s but there are wide variations within East Sussex. People in deprived areas tend to be affected by poorer health. The gap in life expectancy between our most and least-deprived areas is more than 11 years for men and almost 10 years for women.
  • A person’s chance of enjoying good health and a longer life is influenced by the social and economic conditions in which they are born, grow, work, live and age. These affect the way people look after their own health and use services throughout their life. The poorer your circumstances, the more likely you are to have poor health and wellbeing, spend more of your days with life-limiting illness and die prematurely. This requires joining up NHS and social care with other services provided by the County Council, district and borough councils, the voluntary, community and social enterprise sector and other services and businesses that affect people’s lives, health, and social or economic wellbeing
  • Heath inequalities and their impact on people’s lives have been highlighted by the Covid pandemic which affected some more than others, with both immediate and longer-term consequences for health and wellbeing. There have been disproportionate effects on young people, disabled people, ethnic minority communities and care home residents.

There is much more of interest about our population. More detail can be found about its needs and assets on our Joint Strategic Needs Assessment (JSNA) website.

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Vision

The vision of the Health and Wellbeing Board is to protect and improve health and wellbeing and reduce health inequalities in East Sussex, so that everyone has the opportunity to have a life that is as safe, healthy, happy and fulfilling as possible.

Services are one part of the picture and they need to be high quality and effective in empowering people to support their health and wellbeing. For health and care services, our aim is to work towards a fully integrated health and care system by 2026. By doing this we will ensure people receive high quality, coordinated care, enabling them to live good lives. This Health and Wellbeing Strategy is designed to support the progress of the East Sussex health and care transformation programme to ensure it achieves health benefits for the people of East Sussex.

Through our work together we want to promote health and wellbeing for everyone, and make sure those who need it benefit from care and support that:

  • intervenes early
  • works with their strengths
  • supports their resilience, as much as possible

What will this look like?

  • Health and wellbeing will be improved and health inequalities reduced.
  • Personal and community resilience will be supported. Prevention and early intervention will be at the heart of everything we do.
  • The quality of care and people’s experience of using services will be outstanding. Our staff will be working in a way that really makes the most of their dedication, skills and professionalism.
  • The cost of care will be affordable, sustainable and secured for the next generation.

Delivering the vision: Our approach

For most people their day-to-day health, care and support needs will be expressed and met locally in the place where they live. Therefore, the role of East Sussex as a 'place' within our Sussex ICS is an important building block for health and care integration, and an offer to our local population to ensure that everyone can access:

  • clear advice on staying well
  • a range of preventative services 
  • digital services (with non-digital alternatives) that put the citizen at the heart of their own care 
  • proactive support that keeps people as well as possible, where they are vulnerable or at high risk

Our joint work will also support:

  • Approaches to employment, training, procurement and volunteering activities and use of estates, to allow all our organisations to play a full part in social and economic wellbeing and environmental sustainability.
  • Strong links across the full range of public and voluntary services that have an impact on people’s day-to-day health – for example, through improving local skills and employment or ensuring high quality housing and accommodation. This means working collectively to create better opportunities for everyone in our community, such as people recovering from mental ill-health or homelessness, and young people leaving care.

In delivering the vision and our priorities we will:

  • Take a 'whole life' approach from conception to death and enable links to be made throughout life, especially at key stages
  • Value and build on the strengths, skills, knowledge and networks that individuals, families and communities have and can use, to overcome challenges and build positive and healthy futures
  • Promote strong awareness of the impact of the wider determinants of health and wellbeing and seek to engage everyone to play their part to ensure those determinants are as positive as possible in our county
  • Increase prevention and early intervention to improve people’s chances of a healthy life and to help us to manage demand for health and care services in the future
  • Develop an integrated system of empowering health and care services so that people get the right care, at the right time and in the best place, whether that is in the community, primary care, secondary care or specialist care
  • Reduce the inequalities that exist within and between different parts of the county and different groups of people, in terms of access to services and information, advice and support. Ensuring we record and understand the characteristics of people using our services, and tailor support. 

Delivering the vision: Working with everyone

Our East Sussex Health and Care Partnership brings together the contributions of a range of partners to deliver this strategy, including the NHS, county, district and borough councils, the voluntary, community and social enterprise sector, and Healthwatch East Sussex. 

Together, we will explore the new opportunities in the White Paper Health and social care integration: joining up care for people, places and populations and as part of our ICS to further strengthen collaboration on our priorities. These include more formal arrangements to plan services and share resources, aimed at increasing integrated care and responding better to the needs of our population.

In delivering the vision and our priorities we recognise that:

  • Working with people, carers, families and communities is crucial to designing services and support that works. We will continue to build on the strengths of our communities, involving people in ways that suit them through a wide range of existing arrangements and new approaches.
  • Healthwatch will continue to play a role at both a local and national level, ensuring that the views of the public and people of all ages who use health, care and other related public services are taken into account
  • Health and care services can offer joined-up high quality care that anticipates needs and intervenes as soon as possible, to have a positive impact on people’s day-to-day life and deliver better outcomes.
  • District and borough council actions have a positive effect on public health, and an enabling role in the health of their populations and communities through innovation in service delivery.
  • Voluntary, community and social enterprise (VCSE) organisations play a key role in mobilising local social action that can bring communities together, both in times of need and more generally, as well as being a part of health and care delivery that supports people’s health and wellbeing.
  • Family hubs, early years settings, schools and colleges play a vital role.

  • Working together at a local and neighbourhood level with our partners will give a strong platform to deliver initiatives which improve health, wellbeing and services.

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Focus: The wider determinants of health

Our work on the factors that influence our health more broadly, such as social and economic wellbeing, is delivered through a wide range of partnerships and strategies in the county. This involves a variety of local government services, town and parish councils, schools, fire and rescue services, private businesses, and the role voluntary and community organisations play as part of wider civil society. The Health and Wellbeing Strategy complements these plans and does not seek to duplicate them.

Our overall health and our ability to stay healthy can be affected by the following factors: 

  • Safe, good places to live
  • Transport
  • Education, skills and lifelong learning
  • Good work opportunities
  • Culture and tourism
  • Exercise and leisure
  • Healthy weight and reduced harm from alcohol and tobacco
  • Relationships and feeling connected

Partnership work on these influencing factors spans statutory, voluntary and independent sector services. It is led by various members of the Health and Wellbeing Board.

Find out more about our work on our shared priorities using these links:

Housing strategies and polices

Safer communities

Transport

Lifelong learning, education and skills

Good work opportunities

Culture and tourism

Exercise and leisure

Healthy weight and reducing harm from alcohol

Partnership work is also underway to develop shared plans in other areas that influence the health of our local population. An important step will be to make sure that all of our organisations, large and small, can play an effective part in delivering all of these strategies and plans. For example to:

  • promote high quality care for children.
  • reduce harm from tobacco.
  • promote financial inclusion and combat the rising costs of food, fuel and other essentials. When combined with existing disadvantage and vulnerability within our communities, these put many households at greater risk of immediate hardship and reduced opportunity and wellbeing. This includes targeting help at those facing the most complex challenges.
  • strengthen the connections between people, families and communities to tackle loneliness across all age groups and improve resilience and wellbeing.
  • support the local work of the South East Local Enterprise Partnership carried out by Team East Sussex and regional work to stimulate the recovery of our tourism, cultural and creative economies.
  • work through the Local Strategic Partnerships led by district and borough councils, and involving other local planning authorities to bring together plans that are specific to local populations. This is aimed at creating healthy and sustainable places across the built and natural environment, and other factors that affect health and wellbeing locally.
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Focus: Priorities for integrated health and care services

Organisations across the public, private and voluntary sector are responsible for delivering a wide range of health and care plans and services. Through our partnership work, we will focus on a small number of shared priorities where we can achieve better results if we work together to offer more integrated care. These are organised under the following headings:

  • Children and young people
  • Mental health
  • Community
  • Urgent care
  • Planned care

We work with our citizens in a range of ways to ensure that the way these priorities are delivered fits with what people have told us is important about their health and care. This includes Healthwatch and Young Healthwatch, Youth Infrastructure Forum, the Mental Health Action Group, East Sussex Seniors Association and patient participation groups.

Shared priorities for children and young people

Partners in East Sussex work closely to promote the best possible outcomes for children and young people. The Children and Young People’s Plan sets out the current set of key priorities for the partnership.

Key health and wellbeing priorities include the following:

  • We have worked together with colleagues across Sussex to develop a Sussex wide strategy to promote emotional wellbeing and mental health for children and young people through the Sussex review of emotional health and wellbeing support and the Sussex children and young people’s mental health and emotional wellbeing local transformation plan. Locally we are developing an implementation plan which will be published in due course.
  • We will be implementing locally a county-wide strategy for children’s physical health.
  • We will be publishing a refreshed version of our partnership Special educational needs and disability (SEND) strategy, taking into account the proposals which the Government set out for consultation in spring 2022. This will include providing a clearer, more effective route to support for families of children who are neuro-diverse.
  • We are developing a partnership strategy to promote the best start in life and best outcomes for babies and young children.
  • We continue to focus our collective efforts on how we promote the health and wellbeing of our most vulnerable children and young people, including 'looked after' children, young people involved in the criminal justice system, and unaccompanied asylum seekers.

Shared priorities for mental health

Greater access to a range of services and support will be available through primary care to help people with their emotional and mental wellbeing. Enhanced support will be provided in the community to help people stay in their own homes and recover after episodes of mental ill-health. People who experience serious mental health difficulties will have improved access to stable and secure housing and accommodation-related support. 

Specific joint work includes:

  • increasing the range of emotional wellbeing services available from GPs and primary care to direct people to the right support, including mental health practitioners in their area.
  • enhancing specialist community-based services for people with eating disorders, complex emotional needs and support with rehabilitation needs.
  • joining up support with housing, healthcare, employment, benefits and work opportunities for people with serious mental illness.
  • bringing together action that promotes better mental health in our population.

Shared priorities for community

We will continue to enhance community services and strengthen our overall model for integrated community health and social care services. This is aimed at better supporting people with long-term complex care needs and their carers in their own homes, care homes and other community settings, through embedding proactive and seamless wraparound care, including when people are approaching the end of their lives.

Specific joint work includes:

  • Work with our Primary Care Networks and local voluntary, community and social enterprise organisations (VCSEs) to design and develop our model for jointly planning and delivering services in our localities and neighbourhoods, including the use of more integrated data and insight. This will help us to:
    • ensure strong links between the primary care, community health and social care, mental health, housing and key VCSE teams and services that support individuals with long term and complex care needs
    • improve and proactively manage the health of local populations and enable longer lives that are independent and healthy by affecting the wider determinants of health and wellbeing
  • Implementing a strategic approach to our enhanced Discharge to Assess (D2A) services to improve outcomes for patients, including linking this to other services such as rehabilitation and reablement and pharmacy support.
  • Reviewing our proposed integrated urgent community response model across acute, community health and social care. This will support people to avoid going into hospital where there is a better alternative service, and enable them to get home quickly when they are ready to leave hospital.
  • Identifying and implementing Trusted Assessor opportunities, for example NHS staff being able to commission simple social care packages and telecare.
  • Supporting the local implementation of ‘virtual wards’ to increase proactive care coordination at home for very frail people with complex care needs.

Shared priorities for urgent care

As part of our wider Sussex integrated care system (ICS) work, in East Sussex we will continue to improve support for people with urgent care needs, that help avoid attendance at A&E departments and admission to hospital, where there are more appropriate alternative services. 

Specific joint work includes:

  • Increasing the use of 111 as the first point for contact and pre-booking of appointments in the Urgent Treatment Centre.
  • Developing same day emergency care pathways to avoid hospital through access to community and social care.
  • Ensuring that patients have timely access to primary care.
  • Ensuring that ambulances are not delayed at hospitals.

Shared priorities for planned care

As part of our wider Sussex ICS work, in East Sussex we will continue to improve access to planned care services and outcomes for local people. This focusses on:

  • coordinated care tailored to people’s needs, strengths and capabilities
  • making sure that the right person is seen in the right place, at the right time to meet their needs.

This does not cover all of our work in this area, but our specific local focus includes:  

  • Recovery of waiting lists and waiting times following the pandemic.
  • Ensuring people are supported while they wait for appointments and treatments.
  • Initially focusing on respiratory pathways, identifying areas of concern where there may be inequality in access to services and opportunities for further integration of pathways, to ensure seamless care.
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Common themes

There are some common themes throughout these priorities which will be a part of everything we deliver over the next three to five years. These are:

  • improving health and reducing health inequalities
  • improved access to local services
  • bringing together health and social care
  • urgent and emergency care.
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Improving health and reducing health inequalities

We’ll build on our existing progress to:

  • empower people to stay healthy and well for as long as possible
  • reduce health inequalities and the gap in life expectancy and healthy life expectancy in the county.

We’ll do this by working with all the services that influence health, like housing, employment and leisure as described in the wider determinants of health section. We believe that collectively our organisations can make a real difference to our population’s economic and social wellbeing

We have groups of people, communities and individuals living in East Sussex who experience worse health than other people. These inequalities are caused by factors including a person’s income, their housing, education and employment status. These differences are avoidable and need more of a focus to tackle. 

Some people find it hard to get the care they need due to physical, sensory and mental health issues, the language they speak, the attitudes of other people and difficulties in getting and understanding information. We want everyone to have the same opportunities to lead a healthy life, no matter where they live or who they are.

The Covid-19 pandemic also further highlighted how a combination of structural inequalities in our society (for example, income and housing) and inequalities experienced due to ethnic background and other characteristics, led to increased risks for some groups.

We want to reduce health inequalities for our population. This will be measured by inequality in healthy life expectancy at birth. It will require us to work differently on how resources are used, how we assess the impact of the decisions we make and look at new ways in which everyone can have equal access to appropriate services. This includes identifying where some groups may require more intensive support and additional help to access services. Health and care also needs to be delivered with an awareness of the differences between groups and within our population, and tailored to each individual’s strengths and potential vulnerabilities. Every opportunity will be explored to make sure we improve our ability to do this.

We are monitoring our progress with delivery of our priorities across the four areas below to make sure we are having the most impact:

  • Addressing the causes of ill health to prevent premature death and the overall prevalence of disease. This includes specific action on:
    • early cancer diagnosis
    • chronic respiratory disease
    • hypertension case finding to minimise risks of heart attacks and strokes
    • continuity of maternity care
    • annual health checks for people living with serious mental illness and learning disabilities.
  • Supporting individuals and populations to adopt healthy behaviours, including promoting and supporting healthy weight, and action to reduce harm from alcohol and tobacco.
  • Addressing the social and emotional factors that influence health in our communities, including the economic wellbeing of our population.
  • Further developing our capability as a system, including through locality and neighbourhood working and a ‘Population Health Management’ approach. This is a way of working supported by data and insight, to help frontline teams understand current health and care needs and what factors are driving poor outcomes in different population groups. This will result in more proactive models of care which will improve health and wellbeing today and in future years.
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Improved access to local services

Too often people have to travel to hospitals to receive services that could be provided just as well, or better, at home or in the community. We are investing in improving the range of services available in the community, including GP practices and other places outside of hospitals.

Local people will still have choice and we will ensure they have care tailored to their needs to support their recovery when they leave hospital.

We also continue to improve our digital health and care services to give people, and those who care for them, the tools, information and services they need to manage their conditions or treatment at home.

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Bringing together health and social care

We want to remove the barriers between our health and social care teams to support very frail and vulnerable people with long-term complex care needs and conditions. This will enable us to proactively coordinate care for people in their own homes and care homes and offer age-appropriate integrated care to children and young people.

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Urgent and emergency care

Our health services are currently experiencing high levels of demand. Teams across the NHS – at GP practices, NHS 111, hospitals, mental health services, ambulance and community services – are all working incredibly hard to make sure people receive high quality services.

The NHS is always here to help, but people are being asked to use services wisely to make sure they can get the most appropriate support. We want to make sure people get seen in the right place, at the right time by the right healthcare professional, and there are many different services available including NHS 111, pharmacies, minor injury units, urgent treatment centres and emergency departments at our hospitals.

All of the work described in this strategy contributes to delivering these priorities and themes, and there are a range of commissioning and delivery plans which cover specific services and objectives in more detail. To find out more about our plans and work on our shared priorities for integrating health and care, please visit Health and Care News and Sussex Health and Care.

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What does this mean for people in East Sussex?

  • For patients and service users, some services are likely to be provided in a different way or different place or by different organisations, but there will also be new services available. Overall, services should be better and more convenient.
  • More services will be available closer to home – at a GP surgery, in a community clinic or in a person’s own home. And it will be easier to speak to a primary care professional at more convenient times when needed.
  • Convenient and appropriate alternatives to accident and emergency when you need urgent help and advice.
  • High quality hospital services will continue to be available if needed. If someone needs very specialist care, it may mean travelling further so that they can be treated by highly skilled experts with access to the very best equipment.
  • If someone has a long-term condition, or are old or frail, there will be more support to help people manage their condition or needs at home, maintaining independence and quality of life.
  • There will be more services and support to help people lead healthy lives and avoid illness.
  • Health and care services will be more joined-up. Mental health will also be more integrated with other services.

For everyone in East Sussex, it will mean that you can be confident of having high quality, safe, affordable health services for the future.

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Challenges

There are huge challenges and we can’t meet them alone. We are committed to developing solutions in equal partnership with the public, local patients, users of social care, staff and all others.

We need to work together to realise our ambition of achieving joined-up, high quality services that fit with the way we live our lives in the 21st century. 

The strategy recognises the challenges we are facing across our system and our need for a sustainable model of care that can address the following issues:

  • While the Covid-19 pandemic saw health and care staff working closer together and in different ways to maintain safe access to services, it has also increased some of our waiting lists and affected some people more than others in terms of their health and wellbeing. It is also likely to increase the need for services in the coming years
  • Ensuring there is capacity within community and social care to support timely and safe discharge from hospital for people who may need extra support
  • With an ever-growing population it’s very important that we recruit and retain the best staff to work and stay in the East Sussex system, supporting them to develop their skills and provide a high quality of health and care services. We are working to join up our approaches across all of our organisations, large and small, to have the most impact.
  • We know that it is distressing when people experience a long wait for their hospital appointments or treatments. All our staff have worked tirelessly through the pandemic to save lives and keep people safe. Though we must continue to prioritise the most critically unwell patients, we are doing everything we can to address the backlog of appointments with extra clinics and surgical sessions when possible. We will continue to support people while they wait with information and advice designed to help them manage their conditions and overall health, so they arrive for their appointments in the best possible physical and mental health.
  • Society and changes in the way we live have intensified problems and pressures, such as obesity, smoking, drinking and lack of exercise.
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How will we measure progress?

To support shared accountability for delivering the vision and the outcomes, our Health and Wellbeing Board has brought together a small number of strategic outcomes that we all share and have agreed we will work together to measure and improve. We are continuing to make sure that these align with our developing ICS strategy and framework.

The outcomes are based on what local people have told us is important about their health and care services and other areas. These have been used to inform this strategy as well as our East Sussex Health and Care Plan and programme and the other strategies and plans that will support delivery of this strategy.

Outcomes are set out under four headings:

  • Population health and wellbeing
  • The experience of care
  • The quality of care
  • Transforming services for sustainability

We are finalising a small set of shared indicators so that our Health and Wellbeing Board can start to measure progress on these outcomes and provide updates to local people.  These will be developmental initially, so that we can test the right approach in light of the expectations about shared accountability for outcomes in the White Paper: Health and social care integration: joining up care for people, places and populations | GOV.UK.

The Health and Wellbeing Board will also receive regular monitoring reports on our health and care integration programme of work that supports delivery.

From 1 July 2022 these plans will also take into account the Sussex Integrated Care System strategy and delivery plans as they are developed, and our district and borough council contributions to health and wellbeing.

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Shared outcomes framework

Our shared outcomes and indicators are set out in our Shared outcomes framework [44.0 KB] [docx]: 

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Information about Healthwatch East Sussex

Healthwatch East Sussex provides an independent voice on health and social care for the people of East Sussex.

We work hard to ensure that all sections of the community are represented in the delivery and decision-making processes for health and social care services in the county, and that your views are listened to, recorded and reported to policy makers, commissioners and service providers.

We are one of 152 local Healthwatch organisations in England. The network is overseen and supported by our national body, Healthwatch England, who provide a formal link to the Department of Health and Social Care and Secretary of State. 

For more information visit Healthwatch East Sussex

Or contact us via:

Phone: 0333 101 4007

Email: Healthwatch East Sussex

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