Can Do Health & Care - Our Integrated Care Strategy Summary

OUR INTEGRATED CARE STRATEGY Summary How should we be December 2022

Suffolk and North East Essex Integrated Care System (ICS) brings together the full spectrum of partners responsible for planning and delivering health and care across North East Essex, Ipswich and East Suffolk and West Suffolk to ensure shared leadership and joint action to improve the health and wellbeing of the one million people who live locally. The Health and Care Act 2022 created a statutory basis for Integrated Care Systems by creating a statutory Integrated Care Partnership (ICP) and an NHS Integrated Care Board (ICB) for each ICS. The ICP works in the best interests of residents in Suffolk and North East Essex by bringing together the NHS, local authorities, social care providers, voluntary and community organisations, social enterprises, and other key stakeholders as equal partners to agree how to improve outcomes and experience through the integration of health and care. The Suffolk and North East Essex ICP is co-chaired by Cllr. Andrew Reid from Suffolk County Council, Cllr. John Spence from Essex County Council and Professor William Pope from NHS Suffolk and North East Essex ICB and is supported by Susannah Howard as ICP Director. A key role for the ICP is to generate an Integrated Care Strategy that sets the direction of the system across the whole ICS footprint. The strategy sets out the ambition of all partners to improve health and care outcomes and experiences for the population of Suffolk and North East Essex. It sets out how commissioners in both the NHS and local authorities, working with providers and other partners, can deliver more joined-up, preventative, and person-centred care for their whole population, across the course of their life. The Integrated Care Strategy presents an opportunity to do things differently to before, such as reaching beyond ‘traditional’ health and social care services to consider the wider determinants of health or joining-up health, social care and wider services. This document sets out a high level summary of the initial Integrated Care Strategy for the Suffolk and North East Essex ICS. This builds on and brings together earlier work and thinking from across partners in the Suffolk and North East Essex ICS and describes a shared vision from the perspective of ‘what matters’ to people living in Suffolk and North East Essex and ‘our Collective Ambition’ as local health and care partners. The strategy has been developed through an inclusive process involving stakeholders from across Suffolk and North East Essex including people with lived experience, clinicians and other professionals, elected leaders and others. The Suffolk and North East Essex ICS website then sets out our Integrated Care Strategy in full with significantly more detail for each key area including population outcomes, data and indicators, our understanding of the story behind these outcomes based on lived experience and published evidence, information about what matters to local people, our ambition for how things will be different in Suffolk and North East Essex, case studies and links to wider resources. As an ICP we want to encourage and enable deeper crosssector understanding, thinking and planning in health and care. We also want this work to be informed by evidence and lived experience. Our Integrated Care Strategy provides a flexible, collective, central resource that is accessible by all, to enable everyone to be part of the work of the ICS going forward. INTRODUCTION 2

OUR INTEGRATED CARE STRATEGY IN SIX NUMBERS 1 4 5 6 2 3 ON E M I L L I ON P E O P L E We are ONE team with a shared vision of the best possible health outcomes being a reality for every ONE of the ONE million people that we all serve. F I V E E QUA L S E C T OR PAR T N E R S We believe in parity between all FIVE sectors in the ICS – NHS, primary care, social care, public health and the voluntary community social enterprise and faith (VCSEF) sector. TWO COUN T I E S We work flexibly with wider partners across the TWO counties of Suffolk and Essex T H R E E L OCA L A L L I ANC E S We co-ordinate delivery as locally as possible through our THREE local place-based alliances F OU R CO L L E C T I V E AMB I T I ON S We are united around our FOUR collective ambitions: the best health and wellbeing a genuine reality for all the opportunity of health equality for everyone everyone able to ‘Live Well’ – Start Well, Be Well, Stay Well, Feel Well, Age Well, Die Well a genuinely ‘Can Do’ Health & Care System that people can trust. S I X ‘ CAN DO ’ VA L U E S The way we work together as a ‘Can Do’ Health and Care System is underpinned by our SIX core values: Collaborative, Creative, Courageous, Compassionate, Cost Effective, Community Focused 3

OUR INTEGRATED CARE SYSTEM: WORKING TOGETHER “Thinking differently about the future of health and care is that we don’t just say ‘health and social care are together’, but we actually mean ‘they are together’.” What matters to me is that all the different parts of my local health and care system are genuinely ‘Working Together’ for me and my family – this means that: There is genuine partnership and parity between the different sectors and partners involved in my health and care, including: NHS Acute, Community and Mental Health Services, NHS Commissioners Primary Care – GPs, Dentists, Optometrists and Pharmacists County Councils – Social Care and Public Health Voluntary, Community, Faith and Social Enterprise (VCFSE) Organisations District and Borough Councils Organisations representing patients and the public. Our Collective Ambition is ‘Working Together’ as ONE team with the shared vision of the best possible health outcomes being a reality for every ONE of the ONE million people living in Suffolk and North East Essex. We will do this by: Working Together Across the System – through our Integrated Care Partnership (ICP), NHS Integrated Care Board (ICB), ICS VCFSE Assembly, ICS Chairs Group and NED Forum and Provider Collaboratives Working Together in Place Based Alliances – co-ordinating delivery as locally as possible through our THREE local place-based alliances in North East Essex, West Suffolk and Ipswich and East Suffolk Working Together Across Counties – working flexibly with wider partners across the TWO counties of Suffolk and Essex including working together through local Health and Wellbeing Boards Working Together in Neighbourhoods – through local Integrated Neighbourhood Teams and Primary Care Networks. “I think if we treat everyone equally, we will get it right and we will improve in terms of our health outcomes… we need to respect each other, trust each other, work together and love one another.” 4

COLLECTIVE AMBITION: BEST HEALTH AND WELLBEING Our Collective Ambition is that the ‘Best Health and Wellbeing’ will be a genuine reality for everyone living in Suffolk and North East Essex. We will do this by: taking action across our Integrated Care System to support people and communities to improve their health and wellbeing and prevent physical and mental ill-health which could result in the need for future care and support, loss of independence and premature death enabling people and communities to be resilient by developing a sense of belonging, safety and purpose focusing on where we believe that we can make the most difference to individual health, minimising the risk factors that drive the most death and disability in our population e.g. smoking, alcohol use working with partners to address the wider determinants of health – the conditions in which people are born, grow, live work and age; and inequities in power, money and resources moving our focus away from just treatment towards being a health and wellbeing service supporting rehabilitation, recovery and promoting self-care considering how all partners can intervene earlier to support people to remain healthy and independent for as long as possible valuing the role of local community organisations in strengthening communities, delivering social value and helping families and carers to support independence, health and wellbeing for people and communities. “Just to focus thinking of my physical health… Because if like myself, they’ve got a mental health disability and or a physical health problem like I have, sometimes you feel self conscious and some people aren’t as understanding as others when you go out. And maybe… creating a safe space where people can go and speak to kind of personal trainers, people who are kind enough to volunteer their time to do that.” “At this point in time I am needing support, not care. If I have the correct support now then it will mean that I won’t need care for some years to come.” What matters to me is that the ‘Best Health and Wellbeing’ is a genuine reality for me, because I am able to: be resilient through a sense of belonging, safety and purpose live a healthy life in a healthy neighbourhood with a good home, good work or education, a good environment and a good local community adopt and maintain healthy behaviours – I am able to be active, eat well, sleep well and maintain good mental wellbeing avoid needing treatment and care for physical or mental health conditions in the first place prevent any condition from getting worse, by intervening early and/or slowing or reducing disease progression be able to manage the impact of any lasting illness or condition for either ourselves or those who care for us avoid harmful substances and be protected from avoidable diseases. 5

What matters to me is that I have ‘Health Equality’ – this means that I have the same opportunity of good health and wellbeing, dignity and respect regardless of: my ethnicity, race or religion my age, gender or if I identify as LGBTQ+ if I am living with a physical, sensory or learning disability my circumstances – if I am experiencing deprivation, homelessness or growing up in care if I live in a coastal, rural or traveller community. COLLECTIVE AMBITION: HEALTH EQUALITY “I really believe that if you think about others, care about others, we will make this place a better place and completely remove racism from the NHS. And care for others and treat each other equally with dignity and respect.” “I think that thinking differently in health and care is to have every part of the ethnic minorities in Ipswich and in Suffolk .... come together, and to kind of express but what is needed, and what support and more information that can be given.” Our Collective Ambition is to enable ‘Health Equality’ to be an opportunity for everyone in Suffolk and North East Essex. We will do this by: ensuring that a focus on health equality is woven through every aspect of our work as an Integrated Care System recognising and focusing on overcoming the many different barriers to health equality that exist through health equity, inclusion and social justice being allies to people experiencing marginalisation or disadvantage, speaking out against discrimination and injustice being aware of both our own individual unconscious bias and the structural and institutional discrimination that exists in our wider health and care system assessing the equality and health inequality impact of what we do both as individual organisations and collectively as a health and care system everyone being accountable for maintaining continued effort over time and monitoring the impact of our actions in the short, medium and longer term t aking a population health management approach that maintains a strong focus on prevention and helps keep people healthier longer taking action in our ICS at every opportunity to reduce health inequalities in smoking cessation, early cancer diagnosis, high blood pressure, supporting those with chronic respiratory disease and severe mental illness and improving maternity care taking action in our ICS at every opportunity to reduce health inequalities for children and young people in asthma, diabetes, epilepsy, oral health and mental health. 6

Our Collective Ambition is to enable everyone in Suffolk and North East Essex to ‘Live Well’. We will do this by: not just ‘Thinking Differently’ but ‘Doing Things Differently’ together delivering wherever the work is best done. This could be in: local neighbourhoods place based alliances across the counties of Essex or Suffolk across the Suffolk and North East Essex system across the East of England region improving access to high quality support, diagnosis and treatment supporting people to wait well when there are delays in accessing support, diagnosis or treatment working across sectors and organisations to co-produce with people and families, genuinely collaborative programmes that we know, based on evidence, will improve their health and wellbeing outcomes. COLLECTIVE AMBITION: LIVE WELL “Being independent, having that ability to continue to be independent in your own home and not stay in hospital for longer than you need to, so you’re not vulnerable.” What matters to me is that I can continue to ‘Live Well’ – this means that I am able to: START WELL – before conception, during pregnancy and birth, through childhood and into adolescence BE WELL – maintain good oral and dental health, good eye and ear health and good health for my gender STAY WELL – if I am living with cancer or any other long term condition, if I am living with obesity, if I require urgent or emergency care or if I am living with a disability FEEL WELL – if I am living with a mental health problem or addiction, or if I am a survivor of trauma or abuse AGE WELL – as I grow older, particularly if I am living with frailty or dementia DIE WELL – for myself and those close to me when I reach the end of my life. “How do you think we should think differently in health and care? I think this is about getting everyone involved. Getting me involved, getting the next person involved. It is my health, it is my care. I should know what works best for me, so everybody should be involved.” 7

COLLECTIVE AMBITION: ‘CAN DO’ HEALTH AND CARE What matters to me is that I am supported by a genuinely ‘Can Do’ Health and Care System that I can trust – this means that: I am both listened to and heard I am treated with kindness, dignity, respect and compassion I can access support, diagnosis and treatment when I need to I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place I have care and support that is co-ordinated and everyone works well together and with me. “I think there should be some more joined up thinking between the two social care and health… at the moment I’ve got a very difficult health condition I’m trying to come to terms with and, which is bad enough, without other stressful situations which I don’t think should be there.” Our Collective Ambition is to enable everyone in Suffolk and North East Essex to be supported by a ‘Can Do’ Health and Care system that people can genuinely trust. We will do this by: Working together as an Integrated Care System that is: COLLABORATIVE – by focusing on system leadership and culture, supporting our people and workforce across all sectors and using population health management through linked data and analytics COMPASSIONATE – by focusing on personalised care in all sectors, supporting family carers and enabling genuine co-production COURAGEOUS – by focusing on enabling equity, inclusion and social justice, ensuring clinical and care quality across all sectors and enhancing the roles of all clinical and care professionals COMMUNITY FOCUSED – by focusing on enabling a resilient VCFSE sector, the importance of volunteering and the roles of Community Connectors, Anchor Institutions and community pharmacy CREATIVE – by focusing on the use of digital, data and technology, innovation and research and environmental sustainability COST EFFECTIVE – by focusing on financial sustainability and the effective use of our collective health and care estate. “What matters to me is that I’m treated with dignity and respect and that people are kind and approachable and that I’m listened to.” 8

INTEGRATED CARE PARTNERSHIP: GET INVOLVED What matters to me is that I can ‘Get Involved’ in shaping my local Integrated Care System – this means that: I can find out what is happening in the ICS: I can access information in the right language and format for me, that explains how the Integrated Care System works and our local Integrated Care Strategy I can find out about the statutory boards and committees responsible for local health and care, read the meeting papers, attend public meetings and ask questions if I want to I can find out about informal meetings, attend events on the topics that interest me, and access any written reports. I can share my views and influence the ICS: I can share my views and my story with the ICS in different ways, so that local health and care organisations can learn from my experiences I have independent support from my local Healthwatch organisation who can make sure my voice is heard, and influence how health and care services are provided locally I can see, through improved strategies, plans and services, how the views of different people with diverse perspectives have influenced the ICS. “I care, we do care, I am part of the change and I’m here to listen and work with everyone and amplify those voices that have been supressed and oppressed for quite a while.” (mental health practitioner) “It’s important to me to share my lived experiences of good practice in the NHS to shine a light on when things have gone well, and to share poor practice so that other people don’t have to experience the same mistakes I have.” (patient) Our Collective Ambition is to enable everyone in Suffolk and North East Essex to be able to ‘Get Involved’ in our work as an ICS. We will do this by: providing information on how the different parts of Integrated Care System work, our local Integrated Care Strategy and the evidence that underpins it, available online and in other formats upon request for formal meetings of the statutory boards and committees responsible for local health and care: publishing details and papers online, livestreaming proceedings, and offering people the means to attend meetings and ask questions sharing on the ICS website and social media details of forthcoming informal ICS meetings, community ICS events and online events, ways to participate, and reports of past events putting lived experience at the heart of our Integrated Care Strategy embedding it in an outcome based approach providing both traditional and new opportunities for people to share their lived experiences about health and care (e.g. pop up video booths, film competitions, lived experience facilitators), in places and ways that are convenient and accessible supporting and upholding the statutory role of our local Healthwatch organisations to independently represent the views and experiences of local people and enable their voice to be heard being proactive about enabling diversity of engagement in the work of the Integrated Care System, including providing information in different languages or formats, including translation and easy read summaries. 9

Further details for the Suffolk and North East Essex Integrated Care Strategy is available at: