Surrey Heartlands Health and Care Partnership System Board

of 4

Surrey Heartlands Health and Care Partnership System Board

Date & time

Place

Contact

Wednesday, 21 October 2020 at 9.00 am

Remote Meeting

Huma Younis Room 122, County Hall Tel 07866899016 [email protected]

Board Members

Tim Oliver Leader of the Council (Chairman) Sarah Billiard Chief Executive, First Community Health and Care Daniel Elkeles CEO, Epsom & St Helier David Fluck Interim CEO Ashford & St Peter’s Hospitals Ruth Hutchinson Director of Public Health Karen McDowell Director of Finance Surrey Heartlands CCGs and ICS Julius Parker Local Medical Committee Representative Louise Stead Chief Executive Royal Surrey County Hospital Justin Wilson Medical Director, Surrey & Borders NHS Partnership Trust Philip Astle Chief Executive Officer, South East Coast Ambulance Service Charlotte Canniff Clinical Chair, Surrey Heartlands CCG Steve Flanagan CEO, CSH-Surrey Mark Hamilton Clinical Director, Surrey Heartlands Academy Marianne Illisley Medical Director, Royal Surrey County Hospital Simon MacKenzie Medical Director, System Improvement SE Region NHSE&I Pramit Patel Lead PCN Clinical Director for Surrey Heartlands Matthew Tait Joint Accountable Officer: Surrey Heartland CCGs Michael Wilson CEO Surrey and Sussex Healthcare NHS Trust Ed Cetti Consultant Respiratory Physician, Medical Director, SASH Fiona Edwards CEO Surrey and Borders NHS Partnership Trust Claire Fuller Senior Responsible Officer, (SHH&CP) (TBC) Director of Children’s Services, Surrey Council Joanna Killian Chief Executive, Surrey County Council Jon Ota Chief Nurse & Director of Quality and People FCH David Radbourne NHS England and NHS Improvement Simon White Interim Director of Adult Social Care Sarah Parker Director of Transformation and SH Academy

Please note that due to the COVID-19 situation this meeting will take place remotely. Please be aware that a link to view a live recording of the meeting will be available on the Surrey Heartlands Health and Care Partnership System Board page on the Surrey County Council website. This page can be accessed by following the link below: https://mycouncil.surreycc.gov.uk/mgCommitteeDetails.aspx?ID=827 If you have any queries relating to accessing this agenda please email

[email protected]

https://mycouncil.surreycc.gov.uk/mgCommitteeDetails.aspx?ID=827

of 4

AGENDA

1 WELCOME, MINUTES, UPDATES AND CONTEXT

Item Purpose Lead Paper

a. Apologies

and conflict of

interests

agree the

minutes and

check progress

against actions.

Chair, Tim

Oliver, Chair of

Surrey

Heartlands

Partnership

Board

Verbal

b. September

System

Board action

notes

For approval

1b

c. National and

regional

updates from

NHSE/I

To set the

scene for the

meeting.

Claire Fuller Senior Responsible Officer, Surrey Heartlands ICS

Verbal

(Pages 5 - 10)

2 KEY UPDATES AND ESCALATIONS FROM ICS SYSTEM OVERVIEW AND ASSURANCE GROUP (SOAG)


a. Overview

from SOAG

Key areas of

discussion for

noting and

those for

escalation

Claire Fuller Verbal

b. Finance Karen McDowell,

ICS Director of

Finance

2b

c. Quality and

Performance

Gill Edelman,

Chair Quality &

Performance

Board

Verbal

d. Turning the

Tide:

Addressing

racial

inequalities

across our

workforce

and

communities

Russell Hills Equality, Diversity and Inclusion Lead & Gillian Francis-Musanu, Director of Corporate Affairs for SASH and Executive lead for BAME

2d

(Pages 11 - 24)

of 4

3 FOCUS ON MENTAL HEALTH


Suicide Prevention

For noting and discussion

Dr Helen Raison, Consultant Public Health, SCC and Heather Caudle, Director, SABP

Attached

(Pages 25 - 50)

4 INTEGRATED CARE PARTNERSHIPS -UPDATE FROM SURREY DOWNS INTEGRATED CARE PARTNERSHIP (ICP)

Purpose Lead Paper


Daniel Elkeles and Colin Thompson

Attached

(Pages 51 - 60)

5 UPDATE FROM GROWTH BOARD

Purpose Lead Paper


Chair, Tim Oliver,

Chair of Surrey

Heartlands

Partnership Board

Attached

(Pages 61 - 64)

6 KEY UPDATES AND ESCALATIONS FROM RECOVERY BOARD


a. Key

updates

from

Recovery

Board

For noting and

discussion

Steve Flanagan,

Chair of

Recovery Board

and CEO CSH

Surrey

Verbal

b. Update on

Emotional

Wellbeing

Helen Rostill,

Director SABP

6b

c. Digital

Inclusion

across

Surrey

Heartlands

Katherine Church and Non Hill from Surrey Healthwatch

6c

(Pages 65 - 92)

7 HOT TOPICS AND AOB

of 4

8 PAPERS ATTACHED FOR NOTING

a. September Board communication briefing

(Pages 93 - 96)

9 FUTURE DATES OF SYSTEM BOARD MEETINGS 18 November 2020- 09:00-11:00

16 December 2020- 09:00-11:00

20 January 2021- 09:00-11:00 (Public)

17 February 2021- 09:00-12:00

17 March 2021- 09:00-12:00

FIELD_TITLE

Surrey Heartlands Health & Care Partnership Integrated Care System Board

16 September 2020 Minutes - Virtual Teams meeting

Members (Present: P Apologies: A)

Tim Oliver, Leader of the Council (CHAIR)

TO P Julius Parker, Local Medical Committee, Rep

JP A Ruth Hutchinson, Interim Director of Public Health

RH P

Charlotte Canniff, Clinical Chair, Surrey Heartlands CCG

CC P Justin Wilson, Medical Director, Surrey & Borders

JW P Sarah Billiard, Chief Exec, First Community Health and Care

SB P

Claire Fuller, Senior Responsible

Officer, (SHH&CP)

CF P Karen McDowell, Director of finance

Surrey Heartlands CCGs and ICS

Johnathan Perkins standing in

KM

JP

P Sarah Parker, Director of

Transformation and SH Academy

SP P

Daniel Elkeles, CEO, Epsom & St

Helier

DE P Louise Stead, Chief Executive, covered by LS A Simon MacKenzie, Medical

Director System Improvement SE Region NHSE&I

SM A

David Fluck, Medical Director, Ashford & St Peter’s Hospitals

DF P Marianne Illisley, Medical Director, Royal Surrey County Hospital

MI P Simon White Interim Director of Adult Social Care

SW P

David Radbourne, NHS England and

NHS Improvement

DR P Mark Hamilton Clinical Director Surrey

Heartlands Academy

MH A Steve Flanagan, CEO CSH Surrey SF P

Ed Cetti, Consultant Respiratory

Physician, Medical Director, SASH

EC A Michael Wilson, CEO Surrey& Sussex

Healthcare NHS Trust - covered by

MW P Suzanne Rankin, CEO Ashford &

St Peter’s Hospitals

SR A

Fiona Edwards CEO, Surrey and

Borders NHS Partnership Trust

FE P Philip Astle, Chief Executive Officer, South

East Coast Ambulance Service

PA P Tom Edgell, NHSE TE A

Joanna Killian, Chief Executive SCC JK A Pramit Patel Lead PCN Clinical Director for Surrey Heartlands

PP P Zak Faris, Interim Medical Director Ashford & St Peters

ZF A

Jon Ota, Chief Nurse & Director of Quality and People FCH

JO A

In attendance:

Susan Sjuve Chair RSCH SS Sue Tresman, Chair Guildford & Waverly ICP ST Sian Jones, Clinical Chair SJ

Fiona Poulter, Executive Business

Support (taking notes)

fP Sinead Mooney Cabinet Member for Adult

Social Care SCC

SM Gill Edelman, Independent Co-Chair of

Quality and Performance Board, SH

GE

Giselle Rothwell, ICS AD:Comms and engagement

GR Ralph McCormack ICS and CCG Development Consultant, SH

RM Helen Coe , ICS Recovery Director HC

Florence Barras Karen Thorburn Alison Griffiths

Andy Field Nick Sands Ross Dunworth

Indiana Pearce

1 WELCOME AND APOLOGIES Apologies were noted (above).

Vicky Stobbart sent apologies, Sue Tresman has stepped in to present the Guildford and Waverly update in her stead.

TO opened the meeting. explained that this meeting was intended to be publicly broadcast but due to a technology clash will be private. The next meeting on 21 Oct will be webcast.

As Victoria Berry is on leave, Rosie Roberts will assist with any slide presentations.

To note that Surrey CC have appointed Rachael Wardell as the new Executive Director Of Children, Families And Lifelong Learning. Following on from Dave Hill’s work, Rachael will be an excellent appointment and formally starts in post in December.

System Board updates are now being circulated with the second being sent out last week, making sure they

Item 1b

Item 1

are relevant and informative for the wider system. Any comments to be feedback to GR

a. Conflict of interests No conflict of interests declared at the meeting.

b. Notes from August meeting TO said that R Mc has been inaccurately referenced as a system board member. He is in attendance in his capacity as ICS Development Consultant at the invitation of Dr Claire fuller, ICS SRO CC noted that her title was incorrect on the minutes and they should be amended to ‘Clinical Chair’

Minutes agreed with the amendments above Note the action log is up to date with nothing outstanding

c. Update from NHSE/I Region – update from CF There is increasing pressure on the national team, particularly around the 52 week waits in cancer targets. Phase 3 session was yesterday and we were described as having an exemplar pack. We received the financial envelope last night with a lot of guidance which we will need to work through to understand what it means. We remain at level 3 incident under constant scrutiny, submitting weekly assurance packs to region on response to recovery and restoration. Because we started planning recovery and restoration 6 months ago, we are in stronger position than other areas.

CF had circulated to members a letter from CF and Julia Ross as co-chairs of Confed ICS network. Confed are asking for views on future direction of ICSs particularly around legislative changes. Sarah Parker is co-ordinating responses as a system. Action: SP will circulate the consultation document and questions following this meeting

DR spoke about the need to make sure that collectively we give the population of 9 million in the South East better prospects moving forward. We encourage you to keep your ambition around challenging ways of working, the benefit of local approach in Surrey has been to have a broader based strategy around population health inequalities in at risk groups.

Members gave their comments and concerns

TO summed up - there is a need to look again at strategy, we are leading from the front and should be clear about what we as an ICS are seeking to achieve and maybe share at regional level if appropriate Action: To be put on agenda for next meeting.

2 UPDATE/ESCALATION FROM CONTINUING BOARDS / SOAG

a) Overview from SOAG – presented by CF

The September SOAG meeting had been cancelled due to annual leave. Issues remain the concern about testing and about critical care capacity, to be discussed later on agenda.

b) Finance – presented by KMc

The summary circulated provided an update on a number of key finance issues including:

Strategic Finance & Assurance Board (August 2020)

Transformation Funds for 2020/21

Month 4 Reporting Phase 3 Planning including the Financial Regime for the remainder of 2020/21

Some key headlines discussed this month were assurance on Covid reimbursement on the audit, discharge costs and healthcare being a risk within the system, the governance recovery paper was presented for comments, and discussions on the regional ICS efficiency pack.. KMc made members aware that on Phase 3, there was a planning submission which was shared with the regional team. Resubmission date has been moved to 5 October.

The envelope came out last night but need more detail and to understand the guidance. Unable to give any idea of gap at the moment until worked through. and should be able to update next week on what is included in the cash envelope.

RD – In Surrey Heartlands we need to see a bit more realism of what we actually need in terms of capacity and safety. KMc - will pick up discussions offline.

c) Quality and Performance - GE gave a verbal update

GE gave a summary of items featured at the last meeting. There were discussions around access to primary care, surge planning and winter flu vaccination programme. More work is being done on hidden harm and on rapid needs assessment and we would like to bring the final report back to the October Board. There was a focus on learning disability with a spike in deaths in wider vulnerable population, identified issue of communications particularly with care homes not being able to liaise with trusts. Ongoing theme of annual health checks not being completed. On emerging issues, increasing concern about isolation of all vulnerable people and the impact on their physical and mental health. There is emerging evidence of a lack of digital access for some patients. The report shows that on the childhood immunisations programme, we are maintaining good coverage during Covid and starting to work with schools. We have asked for the outcomes to be discussed at the next Q&P meeting. Concerned as we go into winter that we are light on Q&P, attendance is problematic at the moment and if we are any lighter we cannot provide the assurance needed.

TO asked what would help to reassure? GE - When we revise our terms of reference, there is a sense that we should be moving towards a quality lead in the ICP. The demands on ICP directors is enormous, so we are in the position of only having 1 or 2 directors presenting at meetings which means we are not getting the full overview.

d) Other Key Updates Including Response to COVID19 – presented by RH

RH gave high level Covid overview. Covid rates are currently lower than national figures at 16.1 per 100,000 against 26.7 for rest of England but the rates are increasing. Spelthorn has gone amber at 40.1 per 100,000. There are incident management meetings around what more action can be taken. All data is available online on the Surrey CC website. Testing is an issue. Jane Chalmers who is heading up the testing cell, is working hard to find possible local solutions. At Regional meeting yesterday, there was discussion around the impact on public services, health education in particular where people are isolating and not receiving the test, there was a high degree of frustrations across the country so we are working on local solutions to that issue.

3 KEY UPDATES FROM HEALTH AND WELLBEING BOARD – 10 SEPTEMBER

RH gave an overview of the impact assessment work and a summary of H&W Board outputs . There is a strategic needs assessment with big plans to update before Covid hit. The CIA takes a rapid overview of the impact of Covid on the health and wellbeing of the population. The aim is to have all the work completed and in the public domain by mid-October. This work will form the new system-wide JSNA. RH talked through a slide presentation highlighting key points.

The next steps will be published in Surrey I (?) and communicating the interim findings on an ongoing basis and taking to the various reference groups. If any Board members would like more a presentation on one (or more) of the Rapid Needs Assessments, please get in touch with RH or her colleague Naheed ([email protected]).

TO said the hope is that all organizations will get involved, important that everyone up to speed in terms of what the data is showing and to incorporate those findings into organisation strategies.

CF told members that thematic review of adolescent suicides would be brought back to the next meeting with update on mental health and wellbeing workstream.

Action: slides will be circulated, feedback any comments to RH.

4 INTEGRATED CARE PARTNERSHIPS –UPDATE FROM GUILDFORD & WAVERLEY ICP ST presented, standing in for VS (slides)

ST updated on progress so far through collaboration, aligned to the ICS and Health & Wellbeing Board priorities. Guildford and Waverly are seeking to make a difference for residents through partnership working and to assure ourselves of the quality, finance and performance of those services within the system. Using slides ST talked through the journey to date and gave examples of transformative work through partnership.

Members were informed about a population health management pilot which will help to further understand how we can work to reduce inequality within local footprint.

NS talked about the approach to transformation across Guildford & Waverly ICP and some lessons learned. We now have one programme of work with a single view of where we want to get to. Starting to support partners through QI training for example to practice managers in GP surgeries. With transformation, one of the challenges is to support recovery while changing the way we do things across the system.

RD - We will need to streamline governance but building on the transformation work in particular and the adapted financial recovery plan will lead Guildford & Waverly ICP successfully into April next year within the overall ICS architecture.

Helpful comments and questions from board members followed

TO - invite back for update towards end of next year.

5 KEY UPDATES AND ESCALATIONS FROM RECOVERY BOARD

a) Phase 3 draft response - presented by CF

CF introduced the response which had been circulated to members. HC – Final submission is on 21 September. Brought to System Board to delegate approval for final Phase 3 submission for HC and CF to sign off. HC drew attention to the impact of a second wave on activity levels. The ask was for approval to sign off on Friday.

MW said that before sign off, there is a need to work through finance RD expressed similar concern

Board agreed sign off with caveats in consultation with relevant organizations.

b) Local response to the People Plan

IP – NHS published the people plan on 30 July and there was a requirement for ICS to develop whole system ‘Local People Plans’. These plans need to be specific and time sensitive and be able to adapt as we progress into our recovery phase. The plan has been developed in consultation with partners across health and social care..

This plan was very well received by members who fed back with helpful comments.

IP responded that there is further work to be done on the governance, where this will sit and who will have oversight of the plan.

c) Update from Recovery Board

i) Workstream 2 Interdependencies of Health & Care SF said the Recovery Board agreed to close the Interdependence of Health and Care workstream, as a result of the successful delivery of the immediate Recovery objectives and the transition of ongoing commitments to the appropriate core business functions.

SW gave update. We set up workstream to respond to care home resilience plan. The main issue was going from emergency response which was around possible discharge which has now been replaced by NHS funded period of care. Working hard to have ready for the beginning of next financial year.

Workstream 3 – Surge ii) MW – With the first phase of the pandemic in the spring, there was a national campaign for people

to stay safe at home which meant hospitals had a significant amount of capacity available at that time. We now have huge backlogs of patients who have waited longer than a year on top of which, we have winter approaching and also specific issues around pediatrics With the absence of any additional capacity, this will undoubtedly impact on our ability to treat patients. There is also a big issue around the psychological impact on clinicians. MW felt that we are heading for a car crash, without additional capacity we cannot do it all. Even if we received the number of beds asked for, there is no additional revenue for staff to manage the ventilated beds.

There was further discussion amongst members who supported those concerns Action: CF / MW to write to Region to express Board’s concerns

MW also raised the significant issue of no facility this year for critical care transfers for children.

iii) Workstream 6/7 Estates PB gave a brief overview of the paper with some key points highlighted: The baseline assessment is showing that as a system we are spending £171m on our estate of

which £44m is spent on leasing property. How small can we make this estate so that we can release revenue funding to put back into the system for care? Surrey Heartlands are leading the charge in terms of moving non-clinical space for offices into one hub. We need to see this replicated across the system.

in relation to primary care there are a number of redevelopment opportunities. But we are also seeing a lack of cohesive information and data, currently working with NHSEI on that data. This workstream will enable a number of efficiencies going forward.

Need to keep sight of the greener futures agenda. `

6 HOT TOPICS AND AOB

a) Epsom St Helier 5 Year Strategy DE introduced a video showing the next Epsom St Helier strategy for 2020 to 2025.

This was very well received by members as being an excellent presentation with clear messages.

b) Hot Topics & AOB

SF asked about impact of Covid testing and the affect on staffing. Is there anything we can do to get priories right to get people back to work? - CF responded that we are looking to see what we can do about a local solution.

DF - children being sent home from school with suspected Covid is causing an issue. There is confusion about who needs to be tested and, as a system, everyone should be clear about who needs testing to be the most effective. RH responded that system wide comms are trying to give a clear message that only those with symptoms need testing.

7 PAPERS ATTACHED FOR NOTING

7a System Board Terms of Reference have been updated to reflect change in membership, frequency of meetings and recognising CCG merger. Any comments to be feedback

The next meeting on 21 October that will be a meeting in public which will then be held on a quarterly

basis.

ICS System Board

21 October 2020

Integrated Care System Board - Finance Update

Author: Vicki Taylor – Deputy Chief Finance Officer – System Finance

Executive Lead/Sponsor(s):

Karen McDowell – ICS Director of Finance and CCG Deputy Accountable Officer

Action required: To Note

Attached: Finance Summary

EXECUTIVE SUMMARY

This summary provides an update on a number of key finance issues including:

Strategic Finance & Assurance Board (September 2020)


Month 5 Reporting

Phase 3 Financial Regime for the remainder of 2020/21

Date of paper 06.10.2020

For further information contact:

Karen McDowell – [email protected]

Vicki Taylor - [email protected]

Item 2b

Item 2

mailto:[email protected]


Executive Summary

This summary provides an update on a number of key finance issues including:

Strategic Finance & Assurance Board (September 2020)


Month 5 Reporting

Phase 3 Financial Regime for the remainder of 2020/21

1) Strategic Finance & Assurance Board (September 2020)

Key headlines from the meeting held on 29th September 2020 were as follows:

ICS system financial envelope was discussed. System discussions in place and meetings established to work through the issues and draft plans. Submission due on 5th October at an ICS system level with organisational returns due on 22nd October.

Estates update – work plan presented and timescales noted. This will be regularly reviewed in the SFAB forward plan.

Covid-19 capital and revenue reimbursement for Month 5 was noted. An updated position on costs to date was presented and the Committee noted the ongoing scrutiny to ensure costs were robust and reasonable. The process for reimbursement of costs for both the Providers and the Commissioner was discussed.

Assurance from recent Covid-19 audits across organisations in the system was discussed.

Month 5 finance report – High level system update was provided for Surrey Heartlands CCG and all partner organisations. Noted the requirement for the System to breakeven as per current financial regime. Position at SaSH was noted – the forecast reported a deficit in line with their draft September plan numbers rather than a breakeven as per the current regime. An improvement in this number was noted for the October planning submission and Month 6 reporting.

Committee received headlines from SOAG meeting

Current challenges discussed and a system update provided by partners. A number of areas were discussed including: restarting the CRESH recovery programme, preparation for ICP budget delegation, restoring elective services, Specialist Commissioning and SECAmb.

2) Transformation Funds for 2020/21

As previously reported to the Board, 2020/21 is the final year of the Transformation funding for the system. Information has been worked through to reconcile the Commissioner and NHSE/I information to confirm the level of Transformation funding within allocations / block contracts. Funds have now been received within the envelopes provided as part of the planning exercise which include National and Local Transformation funding. There is an outstanding query with the National team on 2 of the items within the national programme awaiting resolution. Also some of the National schemes are subject to conditional funding where specific criteria are set.

3) Month 5 Reporting

As reported last month, the system continues to operate under a temporary financial regime covering the period April to July 2020 (Months 1-4) which has been extended to cover Months 5 & 6. During this period, both the Providers and Commissioner are expected to breakeven.

In order to achieve this breakeven position, Commissioner allocations will be adjusted non-recurrently and CCGs will be monitored against the adjusted allocation position. Providers will be monitored against their “indicative” plan for the period.

A retrospective adjustment “Top up” or vice versa, will be actioned for reasonable variances between actual and expected monthly costs within the Commissioner position mirroring the regime in place with NHS Trusts.

The Commissioner expected monthly expenditure for monitoring is based on 19/20 costs up to Month 11. The only exception is acute contracts where PbR has been suspended and blocks have been put in place based on month 9 Agreement of Balances.

The system financial position for the first 5 months shows a year to date position requiring a top up of £8.0m to achieve breakeven and £15.2m forecast outturn up to month 6 – the end of the current financial regime. The top up required to deliver breakeven is primarily due to expenditure on coronavirus and it is expected that this adverse variance will be retrospectively funded under the revised financial regime. This means the CCG will breakeven against its resource limit.

Phase 3 financial planning guidance and system financial envelopes have now been released and discussed in section 4 below.

4) Phase 3 – Financial regime for the remainder of 2020/21

Phase 3 letter received detailing requirements for all organisations and confirming extension to current financial regime for Months 5&6.

The “Implementing phase 3 of the NHS response to the COVID-19 pandemic” brings together guidance regarding inequalities, mental health, community health, patient initiated follow-ups, updates around COVID-19 weekend collections, as well as the Phase 3 submission guidance

A first draft submission was completed in September 2020 at a system level based on activity only and the system wide ICS financial planning submission was made on 5th October 2020. A further return at an organisational level mirroring the 5th submission is due by 22nd October 2020.

System financial envelopes were received and inform the 5th October submission with a number of issues still outstanding for resolution with the regional finance team .

Specific guidance relating to Mental Health and the delivery of the Mental Health Investment Standard (MHIS) has been issued and a first draft return was made on 1st September 2020.

The Board is asked to note the contents of the finance summary.

Implications

What is the health impact/ outcome and is this in line with the CCGs’ strategic objectives?

Objective 1: Continue to work towards achieving sustainable systems

Objective 2: Develop collaborative working and organisational change, at both place and scale

What is the financial/ resource required? No implication

What legislation, policy or other guidance is relevant?

N/A

Is an Equality Analysis required? Not indicated

Any Patient and Public Engagement/ consultation required?

N/A

Potential risk(s)? (including reputational) Significant costs

Monitoring and recording of costs

(1) The Board is asked to note this report

(1) None

Recommendation(s)

Next Steps

This page is intentionally left blank

ICS System Board

21st October 2020

Turning the Tide Transformation and Oversight Board

Author: James Miller, Sian Sallis


Dr Russell Hills, Gillian Francis-Musanu

Action required: To Approve

Attached: Turning the Tide Paper

EXECUTIVE SUMMARY

Turning the Tide Transformation and Oversight Board has been established to address BAME employment and health inequalities for our staff and local population. This paper provides an overview of the Board and its key objectives.

Date of paper 9th October 2020


Dr Russell Hills

[email protected]

Item 2d


Surrey Heartlands

I HEALTH AND CARE PARTNERSHIP

Turning The Tide

Turning the Tide Implementation

Turning the Tide Transformation and Oversight Board is established to address BAME population and health inequalities for our staff and local population.

Underpinned by:

• Turning the Tide Strategy

• NHS People Plan

• NHSEI phase 3 operational planning

• Public Health England: Beyond the Data Report

TTT Frimley

TTT BOB

TTT K&M

TTT Sussex

TTT HIOW

TTT Surrey

Communication / Governance - National

People Board Turning the Tide Transformation and Oversight Board

Senior Leadership Team

Strategic Oversite Assurance Group

SOAG (Decision Making)

Surrey Heartlands ICS System Board

(Decision Making)

Surrey Heartlands ICS Turning The Tide Board

(Decision Making)

Surrey Heartlands ICS Governance

Surrey Heartlands ICS People Board

(Decision Making)

Surrey Heartlands ICS BAME Alliance

(Decision Making)

Surrey Heartlands ICS Health Inequalities Board (Decision Making)

Communication Support

BAME Workforce Steering Group

BAME and wider Health Inequalities Steering Group

Governance for the TTT Board: • The BAME Alliance will report into the Turning The Tide board for progress and assurance on BAME

inequalities work for workforce and population. The Health Inequalities will also provide assurance and reporting to the Turning the Tide board on wider health inequalities

• The BAME Alliance retains a report to SOAG to keeps progress of the BAME agenda and enable to the opportunity to raise issues directly with chief executives from the system.

• To ensure the BAME work remains at the fore the BAME population steering group will have a split agenda allowing the continued focus on delivering outcomes for BAME population and allowing for time to focus and deliver on wider health inequalities.

• The BAME Health Inequalities steering group will report into the Health Inequalities Board to align with work taking place across the ICS

• The BAME Workforce Steering Group will report to the BAME Alliance and to the ICS People Board

Key Objectives of the TTT Board: • Review and define the local challenges relating to BAME workforce inequalities for Surrey Heartlands utilising workforce data

• Oversee delivery of the priorities and actions outlined by the Turning the Tide Implementation Panel and strategy to reduce

workforce and health inequalities with a primary focus on our BAME staff.

• Demonstrate outcomes that have improved the workplace experience for BAME colleagues

• Demonstrate outcomes that have reduced health inequalities for BAME communities

• Develop and monitor a system level operational delivery plan incorporating workforce risk assessments; corporate workforce

solutions; population need and communications and engagement

• Support EDI initiatives

• Build a network of HR and OD leads to develop this area of work, supported by training and sharing of good practice.

• Provide expert support and guidance to stakeholders and organisations across the system to ensure Turning the Tide priorities are

achieved

• Collaborate with and support system partners to ensure BAME health inequalities within the local population are addressed and are

drivers for service improvement.

System – Development of system level operational plan and development of balance scorecard on addressing racial inequality

Implementation Strategy Identifies key priorities to be completed 31st March across 5 themes, including:

Population - Population Needs Assessment of the BAME population in ICS & develop plans for minimising risks including diabetes, hypertension and obesity

Communications and Engagement – development of external webpages to share research and good practice and ensuring BAME staff and communities are a focus in all campaigns

Workforce - Support NHS Boards to publish an action plan showing how over the next five years its board and senior staffing will match the overall BAME composition of its overall workforce / community

Corporate Workforce – targeted talent management offer, reverse mentoring programme , improved demographic data on ESR, action plan to achieve aspirational goal of 19% BAME at each bay band

ICS System Board

21st October 2020

Suicide Prevention in Surrey

Author: Helen Raison and Nanu Chumber-Stanley


Ruth Hutchinson, Director of Public Health

Action required: System Board to consider and discuss content of attached presentation, specifically will System Board partners:

1. Continue support for Suicide Prevention Partnership and representation on the partnership

2. Commit to vision of zero suicides and support implementation of the strategy

3. Suicide Prevention Training across the ICS – contribution to ongoing resourcing and/or release of staff to training

4. Wave 4 Suicide Prevention Funding – system to commit to ensure funding is spent well across prevention, intervention and transformation

Attached: ‘Suicide Prevention in Surrey - System Board 21 Oct 2020 FINAL’

EXECUTIVE SUMMARY

Suicides send shock waves through families and communities. Suicides are preventable, but action on prevention does not sit in one place.

The rate of suicide in Surrey is 8.2/100,000 population (equivalent to 255 suicides in 2017-2019). The rate of suicide in Surrey rose during the most recent recession. A suicide audit of Coroner’s files is planned which will improve our understanding of suicides. Suicides in certain settings, or with certain population groups, have been the subject of more detailed exploration and action by partners in Surrey.

Item 3

Surrey has a Suicide Prevention Partnership with broad membership, including those with lived experience. The partnership is co-chaired by Public Health, Surrey County Council and SABP.

The Surrey Suicide Prevention Strategy has six priority areas:

1. Understanding suicide and attempted suicide in Surrey – Intelligence

2. Tailor approaches to improve emotional wellbeing in particular groups

3. Reduce access to means by promoting suicide safer communities

4. Reduce attempted suicide and self harm - especially amongst children and young people

5. Provide better information and support to those bereaved by suicide

6. Prevention of suicide among identified high risk groups particular those with known mental ill health

Progress is being made across all six priorities of the strategy, but issues remain. These are described more in the paper.

For our population, the COVID-19 pandemic has caused an increase in anxiety, despair, financial worries, isolation, a probable rise in domestic abuse and alcohol use, as well as loss of contact with usual support systems and daily routines. Whether these have translated into an increase in suicides is not yet clear, but indicators are that the patterns and contributing factors to suicides may be changing. Access to bereavement support, new ways to reach people during lockdowns, community action, workforce wellbeing, suicide prevention training, and support for financial worries have been the focus of work of partners during the pandemic. There has been very high demand for suicide prevention training. The suicide prevention strategy is being refreshed to reflect learning as it emerges.

Wave 4 funding for suicide prevention is being made available to Surrey Heartlands (£625,524 across 3 years), and this should be spent on prevention, response and transformation.

Date of paper 13th October 2020


Helen Raison, Co-chair Suicide Prevention Partnership [email protected]

Heather Caudle, Co-chair Suicide Prevention Partnership and SABP Lead [email protected]

Nanu Chumber-Stanley, Public Health Suicide Prevention Lead [email protected]




Suicide Prevention in Surrey

System Board 21st October 2020

Overview • Why action to prevent suicide is important

• Data on suicides in Surrey

• Surrey Suicide Prevention Partnership and governance

• Suicide Prevention Strategy and recent progress

• Covid-19 and suicides

• Asks of the system

Why is action to prevent suicides important? • Suicides are preventable

• Every suicide sends shockwaves through families & communities

• Family/friends/carers of those who die have 1 in 10 risk of attempting suicide

• National agenda NHS Year Forward View for Mental Health with target to reduce suicides by 10%,

Cross Gov. SP Work plan, Zero Suicides in MH services ambition

• Only 1/3 of cases in England have been in contact with secondary mental health services in the 12

months prior to their death, 2/3 no contact with secondary mental health services.

• Self-harm (including attempted suicide) is the single biggest indicator of suicide risk and approx.

50% of people who have died by suicide have a history of self-harm

• No single risk factor, suicide prevention does not sit with one organisation

Surrey suicide profile compared to South East region- Published September 2020 (suicide rate is per 100,000 of population) Source PHE fingertips

For period 2017 - 2019, 255 suicides in residents ( 8.2 deaths per 100,000 population)

Source PHE Fingertips, Sept 2020 based on population size 1,150,000

- T-

0

0

OJ

.. . l. l SurreyHear t la nds Suicide rate all persons in Surrey from 2001- 2019

HEALTH AND CARE PARTNERSHIP

Source: PHE fingertips September 2020

(ii SURREY COUNTY COUNCIL

Suicide rate (Pe sons) IUIH·!I Surrey Directly standardised rate - per 100,000

Export chart as image Show confidence intervals Show 99.8% Cl values .!. Export table as CSV file

30 Recentt rend: -

0 20

0

0- 0. 1 0

=O O= .

Surrey

Period 95% '95% South East Engl and Count Value

Lowe r C l Upper Cl

2 0 08 - 10 0 282 ,9 _5 8.5 10.8 9.3 9.4

2009 - 11 0 292 9.9 8.8 11-1 9.5 9.5

◆ Englan d 2010 - 12 0 265 8.8 7 .8 10.0 9.3 9.5

2011 - 13 0 278 9.1 8.1 10.3 9.9 9.8

2012 - 14 0 277 9.0 8.0 10.1 10.1 10.0

2013 - 15 0 280 9.1 8.0 10.2 10.2 10.1

Recession 2014 -16 0 260 8.4 7.4 9.5 9.8 9.9

2015 - 17 0 246 8.0 7.0 9.0 9.4 9.6

2016 - 18 0 249 8.0 7.0 9.0 9.2 9.6

2017 - 19 0 255 8.2 7.2 9.2 9.6 10.1 Source: Office for National st alistic:,

2001 - 03 241 8.7 7.6 9.9 100 10.3

2002 - 04 0 245 8.8 7 .7 10.0 10.0 10.2

2003 - 05 0 257 9.2 8.1 10.4 9.8 10.1

2004 - 06 0 233 8.3 7 .3 9.4 9.6 9.8

2005 - 07 229 8.0 7.0 9.1 9.1 9.4

2006 - 08 0 217 7.5 6.6 8.6 8.9 9.2

2007 - 09 0 257 8.8 7.8 10_0 9.1 9.3

0

2001 2005 2009 201 3 20 1 7 - 03 - 07 - 1 1 - 1 5 - 1 9

Public Health Suicide Prevention Lead meets with Districts and Borough about local action on suicides.

There is no significant difference between rates in different boroughs.

Suicide Prevention Partnership

• Suicide Prevention Partnership meets 4 times a year (membership next slide)

• New co-chairs are Director of Public Health’s deputy (Helen Raison) and Director SABP (Heather Caudle)

• Public Health Team at SCC has a dedicated suicide prevention lead who is responsible for managing the partnership and elements of the strategy

2004- 2006 2008 2010- 2017 2018 – 2019 2019 – 2020

Concerns about high risk locations

Suicide prevention group set up driven by those with lived

experience

First Suicide prevention strategy

Drafted new all age strategy, based on consultation and

peer review

Strategy signed off by HWWB

Partnership and subgroups established

Suicide Prevention Partnership - Current membership

Service user voice Agency or Partnership

Voluntary Healthcare Specific Surrey County Council

• Independent Mental Health Network

• Survivors Of Bereaved by Suicide (SOBS)

• Lucy Rayner Foundation (postvention)

• Surrey Police • British Transport

Police • Network Rail • Rail providers • Surrey University • Woking Borough

Council • Autism Partnership

Board • Surrey Police & Crime

Commissioner rep • Public Health England

• Mind • Samaritans • Richmond Fellowship • Catalyst • Mary Frances Trust • Oakleaf Enterprise • Faith Services

• SABP- Suicide prevention Lead ((co- chair)

• SABP Quality Improvement & Meds, Psychiatrist

• Safe Haven • ICS and CCG

Commissioners- Mental health

• IAPT services • Rep children’s

safeguarding

• Surrey Fire and Rescue • Public Health team

(co-chair) • Children's Services • Adult Social Care • Deputy Cabinet

Member for Health • Coroner

We are currently reviewing membership to ensure that the different parts of the system are linked in at the appropriate seniority Inviting- Department for Work and Pensions, Citizens Advice Bureau, MASH, Surrey University

Suicide Prevention Partnership - Governance

Key:

Accountable to

Reporting to

Suicide Partners: District and Boroughs, ICS commissioners, Public

Health, Mental health providers (SABP, IAPT), VCS/third sector

STP/ICS Mental

Health Steering

/Delivery

Groups

Health and Wellbeing

Board

Suicide

Prevention

Partnership

Surrey Suicide Prevention Strategy priority areas

Priority 4:

Reduce attempted suicide and self harm - especially

amongst children and young people

Priority 5:

Provide better information and support to those bereaved by suicide

Priority 6:

Prevention of suicide among identified high risk

groups particular those with known mental ill health

Priority 1:

Understanding suicide and attempted suicide in Surrey

Intelligence

Priority 2:

Tailor approaches to improve emotional

wellbeing in particular groups

Priority 3:

Reduce access to means by promoting suicide safer

communities

Strategy priority areas: key progress Priority 1 Understanding suicide and attempted suicide in Surrey

Priority 2 Tailor approaches to improve emotional wellbeing in particular groups

Priority 3 Reduce access to means by promoting suicide safer communities

Priority 4 Reduce attempted suicide and self harm - especially amongst children and young people

Priority 5 Provide better information and support to those bereaved by suicide

Priority 6 Prevention of suicide in identified high risk groups particularly those with known mental ill health

• Surrey Police have a force suicide prevention adviser who is leading on real-time surveillance data. As a result we now have more timely early indications of the pattern of suicides in Surrey

• Planned suicide audit- subject to Coroner approval

• 20 people trained to deliver “Six steps to wellbeing workshops” to people working with high risk groups

• Release the pressure campaign

• Mental health training

• Suicide prevention training

• Woking station • Site reviews of high

risk locations • Monitor high-risk

locations • Ongoing media

monitoring • Developing a local

guidance/worksho p on embedding suicide safer communities and building planning (Woking BC)

• Children’s Safeguarding Partnership has completed a thematic review into child/young people probable suicides and a process for addressing the findings has been agreed with the Suicide Prevention Partnership

• 2 services in Surrey

• Surrey Suicide bereavement service KPI deliver 1:1 support to 230 people a year

• 5 peer support groups being set up in Surrey

• Workshops on understanding needs of people bereaved by suicide early 2021

• Suicide Prevention Information Network (SPIN)

• Finding Your Way – Postvention Bereavement Resource booklet

• SP training for SABP, GPs & Recovery College

• Early work on undisclosed compliance

• QI work through Inpatient Safety Learning Collaborative

An example of progress in more detail: Priority 1:Understanding suicide

Explore

methods to identify and collate data

on attempted suicide

Real time surveillance

data

Surrey Police-

Create a consistent

Police bereavement

support process

and attempted suicide in Support delivery of

Suicide Prevention Force Advisor

Drawing

Surrey • 1 year post based in the police

funded by Public Health (details of role see diagram)

• Looking to extend this post beyond one year

education and awareness

raising programmes

Promotion of support services

including third sector, virtual

spaces and social media

together of existing police

suicide prevention practices

An example of progress in more detail: Priority 5: Provide better information and support to those bereaved by suicide

• Research into the need for suicide bereavement services was led by Public Health, and used to focus Surrey Heartlands transformation funding on developing suicide bereavement support.

• Bereavement service offers 1:1 support within a few days

• SOBS are developing 5 peer groups • Both charities have co-written a workshop

Current issues with implementing the strategy

Priority 1 Understanding suicide and attempted suicide in Surrey

Priority 2 Tailor approaches to improve emotional wellbeing in particular groups

Priority 3 Reduce access to means (methods) by promoting suicide safer communities

Priority 4 Reduce attempted suicide and self harm - especially amongst children and young people

Priority 5 Provide better information and support to those bereaved by suicide

Priority 6 Prevention of suicide among identified high risk groups particular those with known mental ill health

Director of Public Health has asked Coroner for permission to carry out a full suicide audit. Awaiting reply.

COVID19 has meant our high risk groups have changed. Employment problems, financial concerns and isolation pressure are now more prevalent factors

Our ambition is for every district and borough to have a local suicide prevention plan Woking and Epsom and Ewell a plan. Capacity to do this is an issue

• C&YP is a very complex, and we are working to identify a lead.

• Last year set up working group and had a poor response

• CAMHS

• Only funded until 2021/22

• Threshold between primary care and secondary care

• People fall through the gaps

• A&E, crisis care discharge

• Sustaining delivery of Suicide Prevention training to system due to workforce issues

Covid 19 and Suicides Globally previous pandemics associated with increased rates of suicides (e.g. Spanish flu and 2003 SARS in Hong Kong)

Nationally

In adults – Office for National Statistics *provisional* data for second quarter 2020 (peak of first pandemic wave) has not

identified any rise in suicides. Longer term the consequences of the pandemic may increase suicides in certain groups

In children – National Child Mortality Database collects data on *probable* suicides in children and young people and has

identified a slightly higher rate of probable suicide during first 56 days of lockdown in March/April 2020. Factors noted in

some cases were school closures, loss of usual care arrangements, tension at home, isolation.

National recommendations for prevention include action on financial stress, domestic abuse, alcohol consumption,

isolation and bereavement, access to means and irresponsible media reporting (see later slide)

In Surrey

• Police real time surveillance suggests that while we are not clear if numbers have gone up, the pattern and contributing factors may have changed (?more suicides at home, ?even higher proportion suicides in males ?Age groups affected)

• Rapid Needs Assessment on Mental Health found several contributing factors to poor mental health for individuals and that there had been an impact on services (see later slide)

Surrey Mental Health Rapid Need Assessment- impact of Covid-19 Impact on people: • social isolation due to lockdown (particularly on working-age adults living alone and

those in poor health), • loss of coping mechanisms (e.g. ability to connect with friends and family and taking

daily outdoor exercise), • fear of becoming infected, • conflicting information (e.g. in patients with OCD), • ability to access care (patients as well as carers) • working in frontline jobs.- due to both fear of infection and PPE access. • More complex cases

Impact on services :

• Increase in number of out of area beds

• Reduction in number of referrals to community services

• Reduction in community service provision due to lockdown

• Prioritising more severely ill people on MH wards / crisis

• Staff MH

Focus groups./ interviews wordcloud: Key informants and stakeholders

National recommendations for universal interventions for suicide prevention during COVID-19

Source: Suicide risk and prevention during the COVID-19 pandemic; The Lancet. Published: April 21, 2020 Professor Appleby et al

Work of the Partnership during COVID19

COVID19 Emotional

mental health

working group

Workforce training Mental

health on awareness

training

Data: surrey police

Suicide

prevention partnership

Further

developing suicide

bereavement support

Campaigns- Release the Pressure

High risk groups-

LGA workshops

• Suicide and Autism • Self harm in adults • Future local

workshop- self harm in C&YP

• 600 Mental health awareness training places

• 40 Six steps to wellbeing workshop commissioned

• 12 online Suicide first aid training courses

• First aid for mental health train the trainer course- December

Suicide Prevention Strategy refresh in light of Covid

• Review of the priorities in relation to the emerging risk factors and place-based intelligence

• Mapping of current initiatives (from prevention to high risk intervention) in line with the latest evidence to identify gaps

• Embedding sound data collection and surveillance methodologies for a robust monitoring process:

• Suicide audit • MH rapid Need Assessment • Ongoing evidence from police real-time surveillance • Data from the child mortality database

Prevention Wave 4 funding in 2021/22

• Surrey Heartlands will receive Wave 4 funding as one of the 12 remaining STPs not in receipt of funding to date. Value is £208,508 per year for 3 years. Surrey Heartlands will need to submit proposals for transformation plans

• 9th Oct 2020 STP receive proposal documentation, 18th November final plans to be submitted to national team, w/c 23rd

Nov STP present plans to regional teams, 18th Dec deadline for revised proposals, Jan 2021 finding officially confirmed, April 2021 mobilisation

STP Name to receive Wave 4 funding

2021/22

2022/23

2023/24

Surrey Heartlands £208,508 £208,508 £208,508

Nottinghamshire £209,161 £209,161 £209,161

Leicester, Leicestershire and Rutland £219,514 £219,514 £219,514

Cambridgeshire and Peterborough £186,856 £186,856 £186,856

South East London £384,242 £384,242 £384,242

North East London £429,906 £429,906 £429,906

Buckinghamshire, Oxfordshire and Berkshire West £356,807 £356,807 £356,807

Frimley Health £150,913 £150,913 £150,913

North West London £468,655 £468,655 £468,655

South West London £323,848 £323,848 £323,848

Hertfordshire and West Essex £303,198 £303,198 £303,198

Milton Keynes, Bedfordshire and Luton £197,742 £197,742 £197,742

Suicide

How will we know if things are improving?

1) Developing an evaluation framework based on evidence-based indicators, for example:

• PH Outcomes Framework reduction in suicides & self harm admissions

• Reduction seen in database to monitor suicides & attempted suicides

• Number of people trained in Suicide Prevention

• Reduction in number of self harm as reported in SABP system Datix

• Achieving Zero Suicides in inpatient areas

• SABP overall experience Data

2) Improving regular monitoring process to review data and intelligence with all the partners to track progress

3) As well as data, what communities and individuals tell us is an important aspect of our assessment of whether things are improving

Support

• Samaritans telephone 116 123 (24 hours a day, 365 days a year)

• Surrey mental health crisis line telephone: 0800 915 4644 (24/7 days)

• Healthy Surrey website for details on emotional mental health and crisis support https://www.healthysurrey.org.uk/mental-wellbeing

https://www.healthysurrey.org.uk/mental-wellbeing

https://www.healthysurrey.org.uk/mental-wellbeing

Asks of the system 1. Continued support for Suicide Prevention Partnership – if an organisation feels they

are not represented please put themselves forward

2. Commit to vision of zero suicides and support implementation of the strategy – particularly actions that are relevant to their sector

3. Suicide Prevention Training across the ICS – contribution to ongoing resourcing and/or release of staff to training

4. Wave 4 Suicide Prevention Funding – partners to commit to co-ordinating to ensure funding is spent well across prevention, intervention and transformation

5. What else would you like to see?

ICS System Board

21st October 2020

Author: Daniel Elkeles


Daniel Elkeles and Colin Thompson

Action required: For noting and discussion

Attached: Presentation

EXECUTIVE SUMMARY

This item outlines the progress made by Surrey Downs ICP.

The presentation provides further details on our ICP development journey and proposed next steps, including our aspirations for our population, Surrey Downs ICP vision and values, as well as a case study on what this journey will mean to residents in reality.

Date of paper 21st October 2020


Daniel Elkeles, Chief Executive, Epsom and St Helier University Hospitals NHS Trust ([email protected]) Colin Thompson, Director, Surrey Downs ICP ([email protected])

Integrated Care Partnerships- update from Surrey Downs Integrated Care Partnership (ICP)

Item 4



Surrey Downs Integrated Care Partnership

Update to Surrey Heartlands ICS System Board

21st October 2020

Our Population

Large variation in the prevalence rates of long-term

conditions across PCNs

Learning disability to grow by 4%

through to 2022

Surrey Downs has a large Gypsy/Roma/Traveller

population who generally have much poorer health

outcomes

Rate of admission of for alcohol-

related conditions for under-18s

is worst in Surrey Downs & South

East region in Mole Valley

Large range in Smoking rates across localities, from 9%

in Nonsuch ward to 25% in Preston ward.

Rates are particularly high for those working in routine

and manual jobs and those who are more deprived.

Lowest life expectancy for males

in Surrey in Preston

The Surrey Downs population is generally healthier and more affluent compared with England – however there are pockets of deprivation and poorer health outcomes when you look more closely at the local level.

3

1. Helping people in Surrey to lead healthy lives

Creating targeted, local interventions through the community hubs

Working with Surrey County Council to focus on prevention and proactive

care

Conducting more secondary care services in the community hubs

•

•

•

2. Supporting the mental health and emotional wellbeing of people in Surrey

• Supporting parity between mental and physical health through community

hubs

3. Supporting people in Surrey to fulfil their potential

• Integrating children’s services further within the community hubs

• Focusing on effective resource usage for our growing population with

learning disabilities

• Reducing inequalities that exist in our most deprived wards (Court,

Holmwood and Ruxley

Surrey Health & Wellbeing Priorities Localising these aims in Surrey Downs will include…

Our Aspirations for Our Population

2016

2017

2018 2019

The partnership deepens its commitment to each other and widens its reach… • Integrated stroke services achieve

consistent SSNAP A rating • Integrated secondary/community &

primary care contract awarded • Partnership widened to cover all 3 GP

Federations forming Surrey Downs Health and Care

• SDHC integrated joint venture established to deliver the contract

The ICP starts to develop alongside the establishment of PCNs… • Six PCNs established with all practices

covered • ICP Partnership board established • Shared vision & objectives agreed • Delegation local commissioning

model with the CCG agreed • First joint Financial Recovery Plan

agreed

The partnership increasingly focuses on population health… • First population health pilot PCN, Dorking

goes live • SDHC commissioned to mobilise and run

NHS Seacole Centre • Committees in Common agreed with

partners (forms the alliance at ICP board) • Radical service change in response to COVID • Community adult health and GPs on same IT

platform

2020

Our Journey So Far

The new approach starts to show impacts for people and the system… • @home service achieves 6% reduction in emergency admissions against national 6% increase • Provision of integrated, end to end stroke services

Providers start coming together to face shared challenges… • @home service commences with MDT approach across primary, secondary & social care • Partnership Board established

DIGNITY

“If we are driven by people and communities, we will always put their

experience first and build their confidence”

To build strength in agency and ownership of health

TRUST

“We will go on this journey trusting the system we build, each other and

the communities we work with”

To build a strong sense of belonging and community

MUTUAL RELATIONSHIPS

“Strong collaboration and leadership comes from all areas. We respect and

trust the knowledge of the practitioners and patients, and strive

to nurture those relationships ”

To build a collective understanding of health

The ICP is built around people and communities to ensure we are wholly serving the needs and

aspirations of our local people

The ICP is continually evolving to ensure we are working in a

transformational mindset and constantly critiquing our model to fully serve our people

and communities through co-created iterations

The ICP pioneers collaboration and co- creation in health to show new, innovative

ways of working that value leadership across all levels of the system and in our

local communities

Our Vision & Values

Our Model of Care has been tested and developed through

our @home service for frail elderly patients since 2016

It has delivered:

Change for citizens and patients

Clinical change

System change

Financial change

The purpose of our ICP is…

Build Resilient Communities

Flexibility to achieve our aims

Effective & responsive decision making

Innovation & agile problem solving

Efficiency

Be a great place to work

Model of Care

• Develop plan to tackle health inequalities at the PCN / community level

• Identify staff for the ICP

• Develop financial plan for 21/22

• Develop and test the new governance model

• Implement health inequalities reduction plan

• New governance and finance arrangements in place for April 2021

• Place based leadership team in place and working as one by Spring

• Roll out population health management approach to all communities

• Widen focus of community hubs on wider determinants of health and work closely with Districts & Boroughs

• Full implementation of revised financial arrangements

2020 2021 2022

Putting Our Plans into Action

Support and listened to his needs both in hospital and in nursing home

Able to provide intensive support in the nursing home

Quicker access to more specialist services to organise complex multi-disciplinary working

Close trusted relationships built up

Innovative solutions to local problems

David back living at home

What our ICP will do for our Residents – David’s story

ICS System Board

21 October 2020

Author: Dawn Redpath: Director for Economic Development and Prosperity


Cllr. Tim Oliver

Action required: To note progress being made with the One Surrey Growth Board and alignment with the HWB objectives.

Attached: Summary update below.

EXECUTIVE SUMMARY

The One Surrey Growth Board was set up in summer 2020 with the objective of acting as the voice for the whole Surrey economy and place. It provides a single Surrey perspective across the range of interests which underpin growth and includes representation from key stakeholders, including business. The Board was set up to have a focus on economic growth and aligns strategies across:

The Surrey economy

Digital and transport infrastructure

Whole Surrey place-making

COVID Economic Recovery Plans

LEPs

Climate Change

Skills and Inclusion

Health and Wellbeing

The role of the Growth Board

The main aim of the Growth Board is to respond to key economic challenges and opportunities that Surrey has. It brings together public and private stakeholders and provides leadership and streamlined governance across Surrey. The Growth Board will ensure alignment of spatial, economic and infrastructure plans for Surrey in order to safeguard and

Update from the One Surrey Growth Board

Item 5

maintain Surrey’s quality of life and economic prosperity. The Board will provide a formal partnership which secures agreement between Surrey’s key stakeholders about how we will work to manage future growth. The Growth Board is also responsible for developing a Strategic Plan for Growth which will be used to underpin our vision for long term growth funding including a potential Growth Deal with Government. As part of this work, the Board will develop a long-term strategic vision that sets out the broad spatial economic and infrastructure framework for Surrey to 2050.

In addition, the Growth Board will act as the voice of Surrey to Government, the emerging Sub National Transport bodies, Homes England, Highways England, Network Rail, TfL, Energy and Utility providers to ensure Surrey’s infrastructure needs (including Digital Connectivity) are heard and recognised in future investment priorities and funding.

Linking strategies

The Growth Board will operate as the senior economic partnership for the county acting as the interface between the economy and wider, related objectives including those related to climate change, health, wellbeing and skills and inclusion. Each strategy will be considered alongside the development of the Growth Board’s Plan for Growth and, by routing objectives through the Growth Board, there will be improved coordination and strategic alignment. It will also enable partners to maximise available resources around a single Plan and, through this improved co-ordination, the County will be able to undertake more effective lobbying of the Government.

One key element of the Plan for Growth is the emerging Surrey 2030 Economic Strategy which includes parallel outcomes relating to Surrey’s digital infrastructure and skills and inclusion. The element relating to Skills and Inclusion is being developed alongside Priority 3 of the Health and Wellbeing Strategy to ensure complementarity of outcomes. The 2030 Strategy will also be underpinned by the recommendations of the Surrey Economic Commission (see below).

Work undertaken to date

The Growth Board has met twice and begun to develop its vision and Plan for Growth working towards its proposition for a Growth Deal with Government. At its October meeting, the Board received a detailed report from the Lord Philip Hammond as Chair of the Future Economy Surrey Commission setting out significant economic evidence and data with a focus on the impacts of the Coronavirus pandemic. The Growth Board will be using these recommendations and wider evidence to develop its Plan for Growth which will act as a basis for a potential Growth Deal with Government. The Board will consider a first draft of the proposition at its next meeting in December 2020. Four initial priorities have been identified for further consideration;

Surrey’s intra-County economic disparities

Building a better business ecosystem in Surrey including potential to develop Surrey’s 5G / AI / technology presence through Hubs and Corridors

A ‘Healthy and Inclusive Surrey’ (including retention of our young talent)

Improved coordination of local governance

A number of wider economic challenges and opportunities have also been identified for Growth Board consideration, these include;

Reinventing our High Streets

Surrey’s Rural Economy

Impact of the pandemic on the Aviation sector

Surrey’s health economy

Date of paper 21 October 2020


Dawn Redpath Director for Economic Development & Prosperity [email protected] Mobile: 07812 488160


Item 6b

EXECUTIVE SUMMARY

This report provides the Board with an update on progress made by the Emotional Wellbeing and Mental Health Recovery Workstream follow the first full month of reporting. We are still in the process of mobilising some of our governance but delivery against plan is moving forward reasonably well. The workstream encompasses 7 high-level objectives (HLOs) and the overall programme is rated as ‘amber’ with delays due to the very challenging operating environment in mental health. The report provides examples of progress against each HLO along with the register of risks.

Date of paper 21 October 2020


[email protected]

ICS System Board

21 October 2020

Author: Professor Helen Rostill


Fiona Edwards

Action required: To note the Emotional Wellbeing and Mental Health Recovery Workstream

Attached: Report

Emotional Wellbeing and Mental Health Recovery Workstream Update

Item 6

Prof. Helen Rostill/Oct 2020

Emotional Wellbeing and Mental Health Recovery Workstream Update

1. Introduction

The Emotional Wellbeing and Mental Health (EWMH) Recovery Workstream is a multi-sector task and finish

group of the Surrey Heartlands ICS Recovery Board, set up as part of the system Covid-19 response. It

provides strategic oversight, assurance and co-ordination of the ICS’s restoration and recovery of emotional

wellbeing and mental health services. This includes getting back on track with the NHS Long Term Plan

priorities for mental health, co-ordinating the system response to the expected Covid-19 generated demand

surge and building resilience ahead of winter pressures. The workstream governance is shown below:

Figure 1: Emotional Wellbeing and Mental Health Recovery Workstream Governance

2. Emotional Wellbeing and Mental Health Context

Growing Demand: Evidence has shown that the Covid-19 pandemic has had a significant impact on the

emotional wellbeing and mental health of the general population as a direct result of contracting the virus,

the measures taken to protect people from contamination, and the economic and social fallout. Across

Surrey Heartlands we have witnessed a similar profile

of activity in the mental health system to that seen

nationally, with an initial dip in some areas during the

first phase of the pandemic and a more recent

increase to pre-Covid levels. The initial slowdown in

activity is likely to reflect changes in the support offer

from in-person to digital media, as well as changes in

help seeking behaviour as people ‘stayed away to

ease pressure on the NHS’ or avoided contact with

services due to contamination fears. In the last

quarter, as infection rates reduced and lockdown

eased, we have seen an escalation in activity and

demand. For example, requests for inpatient beds have Figure 2: Bed requests by lockdown phases

EWMH REFERENCE GROUP Multi-sector stakeholder group

EWMH RECOVERY WORKSTREAM Sponsor: Fiona Edwards

Delivery Director: Helen Rostill


increased from 6 per day pre-Covid to 10+ per day, community mental health services have seen a 28%

increase in activity, and demand for trauma-based therapy is beginning to outstrip capacity. These demand

pressures are in line with our surge modelling where we anticipated a 20% to 30% p.a. increase in activity

concentrated between September and November 2020.

Increased Acuity: We are certainly beginning to see and feel the pressure in the mental health system as we

continue to experience greater complexity and acuity in presentations, for example:

More presentations of serious mental illness and admissions into acute psychiatric beds - including people who have not been admitted for many years and some people previously unknown to services

Significant increase in use of emergency powers under the Mental Health Act leading to more detentions. s135/s136 activity from January-August is approximately 30% higher than 2019 with a higher percentage of those people also requiring admission (37% compared to approx. 30% in 2018 and 2019). This increase is particularly notable in recent months after the initial Lockdown period

Increasing numbers of people with autism presenting to inpatient services

More evidence of alcohol related presentations – the national level of problem drinkers has risen from 4.2m to over 8m during the pandemic

An increase in safeguarding referrals due to domestic abuse

Pressures on the voluntary sector provision and higher rate of mental health welfare support calls. Between April and June over 6721 calls were made to vulnerable individuals

Anecdotal reports from Primary Care services indicate an increase from pre-Covid levels of 30% of the caseload presenting with mental health needs to 45% to 55% currently.

Higher rates of anxiety, self-harm and suicidal ideation reported amongst people aged over 65 years

The dark blue bars in figure 3 demonstrate the reduction in bed stock overtime which is linked to the

introduction of social distancing measures, improvement and safety works, and changes in the number of

contracted beds at Langley Green Hospital. Pre-Covid, Surrey was already under bedded for the weighted

population when benchmarked against local comparators. Given the escalating pressures in the system

linked to Covid-19 and winter, we estimate that an additional 35 to 40 beds will be needed to get us through

the year and ensure people’s needs are met in the most appropriate settings.

Figure 3: Adult inpatient bed profile and out of area placements (OAPs) Jan to August 2020


3. Emotional Wellbeing and Mental Health (EWMH) Recovery Workstream

The first reporting period for the EWMH Recovery Workstream was at the end of September. We are still in the process of mobilising some of our governance but delivery against plan has not slowed. The workstream encompasses 7 high-level objectives (HLOs) and has a detailed plan and key success factors underpinning these. This can be made available to the Board on request. Table 1 describes the workstream status at the end of September. Table 1: EWMH Recovery Workstream RAG Status

Emotional Wellbeing and Mental Health Recovery Workstream Workstream Status

# Project Status Items for Escalation 1

Restoration of services

DELAYED

2

Enhance provision and access to 24/7 crisis services DELAYED

3

Ensure people with acute mental health needs can access safe and respectful environments

DELAYED

4

Proactively follow-up known 'at risk' patients and outreach to vulnerable groups

ON TRACK

5

Suicide prevention and mental health First Aid training across the system

ON TRACK

6

Integrated mental health support across PCNS ON TRACK

7

Provide critical care follow-up and bereavement support

ON TRACK

8

Extend workforce wellbeing support

ON TRACK

3.1. Restoration of Services

Restoration of services to ‘near normal’ pre-Covid levels is critical to managing the demand and acuity

pressures in the mental health system. Our aim is to ensure people have access to mental health support as

early as possible and close to their communities. Service restoration is going well, with appointments

available via telephone, virtual media or in person depending on needs and choice. In-person services have

been challenging to restore in some areas, such as older people’s services where risks and fears of

contamination are higher. Secondary care services have employed a robust quality impact assessment (QIA)

process and the majority of services are now operating at 100% pre-covid levels, with some exceptions such

as bed capacity (see above comments) and group work activity (of which alternative virtual meetings have

been trialled).

More assurance is required about restoration in other sectors. For example, although Surrey Increasing

Access to Psychological Therapies (IAPT) services were meeting the national target for access pre-Covid,

rates reduced in the first quarter of 2020/21. Quarter 2 data is awaited, and providers are being asked to

review their restoration plans. It is important to note that in quarter 1 waiting time targets (both 6 and 18

weeks) were met and national recovery rates were exceeded. Since the outbreak of Covid-19 IAPT providers

have lowered their access age from 18 to 17 years and they have developed a fast track offer for the health

and care workforce.


The Voluntary Sector continues to play a vital role in the mental health system. They have seen increased

demand for services throughout the first phase of Covid-19, with a rapidly accelerating number of welfare

calls being made to vulnerable individuals with mental health needs. The development of the Surrey Virtual

Wellbeing Hub has provided an innovative single gateway for people to self-refer to a range of 3rd sector

services, including virtual coffee mornings, recovery groups and one-to-one sessions. The VCFS has the

potential to do more outreach work to vulnerable communities to provide early intervention support and

allow headroom to build in specialist mental health services. However, both short-term investment and the

longer-term financial sustainability of the VCFS requires urgent review if they are going to step-up their

capacity.

Our Surrey Heartlands Phase 3 planning return indicated that we expect to meet all Long-Term Plan trajectories for mental health by the end of the year, except for:

Reducing out of area placements to zero by the end of March 2021

Ensuring 60% of people with Serious Mental Illness on the Primary Care QOF register have had a physical health check

Meet Dementia diagnosis rates of 67.7%.

Detailed mitigation plans are in place to manage these risks and they are common across most areas of the country. We are working with NHS England to share learning and good practice.

3.2. Enhance provision and access to 24/7 crisis services

The mental health demand and acuity data outlined above provides a compelling case for enhancing provision and access to 24/7 crisis services, including inpatient beds. Undoubtedly the challenging operating environment and estimated bed shortage has impacted on progress, but good work is underway to improve capacity and ensure the resilience of our community crisis offer. By making crisis support as accessible of as possible our aim is to divert people away from high-intensity inpatients services wherever appropriate to do so. We also want to focus on helping people who are medically fit to transfer from hospital back to their homes and communities with the care and support they need to aid ongoing recovery and wellbeing. Examples of progress with this HLO is described below:

Enhance provision and access to 24/7 crisis services: Progress examples DELAYED

Enhanced bed capacity:

Contracts with Independent Sector Providers for increased bed capacity are in place.

Participating in an NHS England led process across the South East to identify collaborative bed-based solutions.

Completed NHS England assurance return on national mental health bed shortages. This will be used to raise the profile of need with Government.

Enhanced bed management and bed flow processes:

A virtual ward is set up to increase the visibility of bed use/availability - including out of area placements, people waiting for beds and expected discharge dates.

Daily sitreps provide a unified picture of demand and capacity for all stakeholders and OPEL reporting is being introduced to manage and communicate demand surge.

Senior bed management functioning operating 7-days per week, with reviews of all stays over 30-days to enable a timely discharge and reduce length of stay.

App in place to manage Out of Area bed approval.

Reset week from 5th to 9th October bringing together a multi-agency team to focus on reducing out of area placements, length of stay and tackling delayed transfers of care.


Effective discharge planning:

Weekly multidisciplinary and multiagency meeting established to support the safe discharge of people with complex needs.

New hospital discharge social work team in place since April 2020.

Improved access to testing kits in place.

Establishing a team to review all s117 aftercare placements and identify any individuals ready to move on.

Exploring ‘Home First’ and ‘Discharge to Assess’ initiatives.

Crisis Response:

All age 24/7 crisis lines in place.

Enhanced crisis pathway with increased evening staff in Home Treatment Teams, Single Point of Access and virtual Safe Havens.

HOPE and Extended HOPE support for children, young people and families.

Acute liaison nurses in place to support children and families in DGHs.

Assessment Suite and Home Treatment Team escalation calls in place to manage flow through Health Based Places of Safety and assessment suites.

Mental Health Liaison services operating at 100% pre-Covid levels and available in all hospitals across the footprint.

Workshops have taken place with a wide range of stakeholders to review crisis care pathways.

NHS England are supporting our bid to establish two 24/7 Safe Havens with crisis bed facilities. This is now with HM Treasury for a final decision.

3.3. Ensure people with acute mental health needs can access safe and respectful environments

A lack of national investment in NHS mental health hospitals has resulted in a number of Trusts continuing to

provide dormitory-style wards in dilapidated buildings. Nationally around 1300 inpatient beds are still in

dormitories, which often results in unnecessary time in hospital, and poor patient experiences and

outcomes. This not only infringes on people’s rights to privacy and dignity but makes it challenging to create

a therapeutic environment that is safe, calm and conducive to recovery. Staff should also expect to work in

conditions that enable them to provide the highest quality care and support. In June 2020 the Prime Minister

announced that mental health dormitories will be "eradicated" as part of the economic Covid-19 recovery

plans. As a result, capital funding commitments were made by NHS England to accelerate delivery of this

vision. This HLO is focused on improving the environments where people receive acute inpatient mental

health care in Surrey and is linked to 3.2 above. Some examples of how we are working to make

improvements are outlined below.

Ensure people with acute mental health needs can access safe and respectful environments: Progress examples

DELAYED

Environmental Improvements:

Building works underway at the Abraham Cowley Unit

Patients transferred to Elysium Farmfield while works are underway

Fixtures and fittings standardisation

Technology introduced to enhance safety and quality24/7 capital programme ongoing for rebuild of the Abraham Cowley Unit and development of a new hospital site in East Surrey

Capital cases have been submitted to NHS England for the elimination of mental health dormitories which could accelerate the mental health 24/7 build programme to create a sustainable bed solution.


3.4. Proactively follow up known at risk patients and outreach to vulnerable groups

Emotional wellbeing in the general population saw the largest decline in April 2020, with some evidence of recovery since lockdown eased but not to pre-pandemic levels. Some people’s mental health has been disproportionally affected by the direct and indirect impact of Covid-19. For example, people with pre-existing mental health conditions, disabilities (including learning disabilities and Autism), people who are isolated, and those already exposed to socioeconomic hardship and health inequalities. By proactively outreaching to at risk and vulnerable groups we aim to intervene early to prevent people escalating in crisis and needing higher intensity services.

Proactive outreach: Progress examples DELAYED

Identifying at risk and vulnerable groups:

Zoning and risk management is active across all secondary care services – including proactive follow up of red risk patients

Rapid needs analysis completed by Public Health to identify the impact of Covid-19 on at risk populations

Follow up of shielded individuals has been in place during the first wave of Covid-19 (these are not always the most vulnerable in terms of mental health and emotional wellbeing needs)

Linking in with Local Resilience Forum Welfare Cell to ensure a joined-up approach

Proactive outreach projects:

Scoping key touchpoints to provide emotional wellbeing and mental health prevention messaging (e.g. Surrey Fire and Rescue, SECAMB, District & Borough Councils, Foodbanks, Supermarkets).

Provide ‘Making Every Contact Count’ training for volunteers

Care homes support offer is available, including workforce support and direct work with residents.

Welfare calls in place from the Voluntary Sector to connect with isolated and at-risk people with mental health needs

Tech to Connect project providing access to technology and support for those who are isolated and digitally excluded

Surrey Virtual Wellbeing Hub is providing a gateway to Voluntary Sector support including virtual coffee morning, groups and 1:1 sessions. We are increasing the number of organisations that can be reached through this platform

Emotional wellbeing advice and support collated and available via the Healthy Surrey Website.

Working group in place to those who are unemployed or at risk of losing their jobs due to the pandemic. This includes Citizen’s Advice Bureau, Job Centres, Community Connections and SABP

Providing mental health support to the ‘Bridge the Gap Pilot’ for people who are homeless.

High Impact Drinkers pilot in place

3.5. Suicide prevention and mental health First Aid training across the system

The Surrey Suicide Prevention Strategy and approach needs to reflect learning arising from Covid-19 and other pandemics. Our local data shows that more people are entering the mental health crisis pathway with depression and suicidal thoughts than pre-Covid, including those not known to services before and people who have had a long period of symptom stability. Economic pressures resulting from Covid-19 restrictions is an area of growing concern. Unemployment is rising and in the financial crash of 2008 to 2010 suicide rates increased by 10%, especially amongst males. Therefore, suicide prevention and equipping people to respond to individuals in crisis is an essential part of our response. Our progress is outlined below:


Suicide prevention and mental health First Aid training across the system: Progress examples

ON TRACK

Real-time Surrey Police surveillance data now accessible to Public Health

Full programme of suicide prevention training in place

Planning review of the Surrey Suicide Prevention Policy through the lens of Covid-19 and learning from research

First cohort 5 people in the system to be trained up as First Aid for MH trainer (by end of Dec 2020) Second cohort of 6 later in the year from provider arm (By May 2020)

Setting up working group to oversee MH First Aid training as a system and developing a trainer network and buddying system

3.6. Integrated mental health support across Primary Care Networks (GPIMHS)

Our integrated mental health teams in Primary Care (GPIMHS) provide an easily accessible resource for people with Serious Mental Illness and those with complex needs who can get caught between service thresholds and are often managed solely by their GP. Anecdotal reports from GPs indicate that more people are presenting to them with mental health needs since lockdown eased so having integrated mental health support is essential. The GPIMHS team provide risk assessments, intervention, bridging to community assets and training for Primary Care practitioners.

Integrated mental health support in Primary Care: Progress examples ON TRACK

GPIMHS mobilised to time and target with the service fully operational in 11 PCNs by October 2020.Since January 2020, the GPIMHS programme has actively recruited 38 new posts to ensure all participating PCNs have a full team available

The teams have supported almost 3000 patients during this service implementation phase

All resources are working remotely Development of an enhanced pathway for people with Personality Disorder (PD) traits is underway

with 10 out of 21 new roles recruited to

Development of the 18 to 25 Young Adults’ pathway is underway

3.7. Provide critical care follow-up and bereavement support

Based on previous research, it is expected that at least 20% of people treated for Covid-19 in critical care

settings will experience significant symptoms of PTSD during the first 12 months post discharge. Pre-existing

anxiety or depression are major risk factors for PTSD following any episode of intensive care. However,

evidence emerging from other countries has also shown patterns of post-traumatic stress symptoms in

Covid-19 patients who did not need receive intensive care require, which suggests that psychological

interventions or follow up assessments could be required for a larger population of Covid-19 patients. This

HLO focuses on embedding psychological support within community rehabilitation pathways for people who

contracted Covid-19 and also developing bereavement support for those who may have lost loved ones due

to the pandemic.

Provide critical care follow-up and bereavement support: Progress examples ON TRACK

Engaged in system working group mapping rehabilitation pathways for people who have experienced Covid-19

Current emotional/psychological support for people post Covid-19 mapped and gaps identified

Feeding into system-wide business case

Initial discussions about training partners in approaches such as trauma informed care


Health Psychology Teams embedded in DGHs

IAPT Bereavement support offer in place and resources available on the Healthy Surrey Website

3.8. Extend workforce wellbeing support

Evidence indicates that health and care workers, particularly those in frontline roles, are at greater risk of

experiencing adverse mental health outcomes as a result of Covid-19. Nearly a third of people infected by

the pandemic are health and social care workers so risk of infection is a cause of significant stress and

anxiety. These workers also have the added worry of contamination risks for family members and/or having

to socially distance from loved ones. This HLO focuses on providing emotional wellbeing support to our

system workforce to help build resilience and prevent burnout.

Provide critical care follow-up and bereavement support: Progress examples ON TRACK

• Proposals/ business case for wellbeing roles being signed off • Workforce support offer available in majority of Surrey Heartlands organisations • Workforce wellbeing resources developed and collated on the Healthy Surrey Website • IAPT and secondary care fast track workforce psychological support programme available • Care Home workforce support offer developed and delivered • Risk assessments completed across all organisations with a bespoke approach for vulnerable groups • Stocktake of workforce support offer submitted to NHSE • South East Workforce Resilience Hub proposal submitted to NHS England

4. Risks

There are a number of key risks that the EWMH Recovery Workstream is managing. These can be seen in table 2. The most critical risks relate to the demand and acuity pressures and meeting the Long-Term Plan trajectories for 2020/21. There are detailed mitigation plans linked to these risks.

ID Title Description Type Date logged Owner Impact Score

Probability

Score (Risks

Only)

Overall RAG

Score

Actions to mitigate /

manageDue date

1

Not meet the

phase 3 trajectories

specifically in SMI

PHC, dementia

diagnosis & OAPS.

There is a risk that the System

will continue to not meet the

phase 3 trajectories specifically in

Perinatal, SMI PHC & OAPS. If this

occurs this will not support

patient outcomes and potentially

impact finances and perception

of the System.

Risk 09/09/2020Professor Helen

Rostill3 4 12

Mitigations include

increasing bed capacity and

resilience in the crisis

pathway. Working with ICPs

to improve access to health

checks and diagnosis.

Improve recording and local

oversights.

Exploring digital solutions

and enhanced model of

delivery in the community

for the SMI PHC trajectory.

Q4 2020/21

2

Not maintaining &

developing

sufficient mental

health bed

capacity.

There is a risk that the System

may not maintain & develop

sufficient mental health bed

capacity for example Resilience

Hub bid & Langley Green beds

(Dec 2020), note current rebuild

programme not expected to

complete until 2024 & outreach

work i-access & Alcohol

dependent on ongoing funding. If

this occurs this may result failure

to optimise patient outcomes

and inefficiencies in the System

from failure to benefit from long

term planning.


Rostill3 3 9

Continued discussions

currently being facilitated

by Tracey Tipping from NHS

E/I and risk management

such as this.

This is further mitigated by

a consistent focus on flow

in the system to maximise

availability of beds.

?

3Increased acuity of

demand

There is a risk of a deterioration

in patient outcomes and failure

to maintain sufficient mental

health bed capacity due the

increase in mental health crisis

presenting at acute Trusts,

increased acuity of demand and

increase in safeguarding issues. If

this occurs this may result failure

to optimise patient outcomes &

inefficiencies in the System.


Rostill4 4 16

Continued risk

management, capacity

building and crisis

prevention work. Contual

focus on flow management.

Recognition by the System

of the allocation of effort

against this priority.

?

4

Ability to deliver

due to changes in

staffing level

caused by the

emotional and

mental wellbeing

pressure on staff.

There is a risk that the System's

ability to deliver due to changes

in staffing level caused by the

emotional and mental wellbeing

pressure on staff in responding to

the pandemic. If this occurs this

may impact patient outcomes &

the System’s ability to deliver the

Phase 3 trajectories.


Rostill3 2 6

This is mitigated by delivery

of work by the workstream

in the form of system

workforce support e.g. fast

track IAPT support,

available preventative

resources, Resilience Hub

bid.

01/12/2020

(for 1st cohort

to be trained

up as First Aid

for MH

trainer)

5

Access to BI

support to facility

capacity and

resource planning.

There is a risk that the

workstream may not get timely

access to BI support to facility

capacity and resource planning. If

this occurs the System may fail to

identify those in need and will

not support patient outcomes.


Rostill2 2 4

Continued risk management

such as this in work against

this priority and recognition

by the System and

allocation of effort against

this priority. ?


5. Summary

This report has provided the Board with an update on progress made by the Emotional Wellbeing and

Mental Health Recovery Workstream follow the first full month of reporting. We are facing a very

challenging operating environment that has delayed progress in some areas, but significant cross sector

work is in place to support people with mental health needs and their carers/families in Surrey. This crisis

has galvanised integrated working and cross sector support and it has resulted in teams working together to

generate creative solutions to unprecedented circumstances.

ICS System Board

21st October 2020

Digital Inclusion – A system approach to ensuring health and care is accessible for all

Author: Katherine Church/ Non Hill (Surrey Healthwatch)


Katherine Church, Joint Strategic Chief Digital Officer, Surrey Heartlands

Action required:

For information

Attached: Presentation

EXECUTIVE SUMMARY

Up to 200k people across Surrey may be digitally excluded and therefore less able to engage with new digital care and health delivery models. During lockdown, we had to move rapidly to remote and digital models of care.

This paper looks at how we have responded and how we will continue to develop our models of care to meet the needs of all citizens, engaging with and addressing the needs of the digitally excluded in a systematic way.

Date of paper 21st October 2020


Katherine Church, Joint Strategic Chief Digital Officer, Surrey Heartlands

Tel: 07971091484 Email: [email protected]

Item 6c


Digital exclusion

What it means, why it matters and what we’re doing to ensure digital inclusion - and respect people’s choices

Katherine Church – Chief Digital Officer, Surrey Heartlands Integrated Care System

Non Hill – Digital Citizen Ambassador, Healthwatch Surrey

What is digital exclusion? Someone could be classed as ‘digitally excluded’ because:

• They cannot connect to the internet due to technological or financial barriers (including

networks and connectivity)

• They do not have access to technology through financial or access barriers, especially physical access to equipment (e.g. in lockdown), or access to personal and private devices

• They lack literacy, digital literacy skills or confidence to use technology

• They cannot use technology due to physical or other disabilities, including cognitive impairments

• They do not want to use technology due to distrust of providers, privacy fears or fears about how data will be used - or due to other reasons

Why does digital exclusion matter? • There is an overwhelming correlation between social exclusion and digital exclusion.

• The more lonely and isolated someone is, the more likely it is that they cannot access digital services, further widening health and broader inequalities in society.

• Digital exclusion can affect many

groups in society including the homeless, refugees, those with English as a second language, people with mental health issues or learning difficulties and the socially isolated.

• Digital exclusion is closely linked to

the wider social determinants of health, including poverty, income and employment

Source: WADDS Inc.

What does this means for our citizens? • In July 2020, 11% of the Surrey population had not accessed the internet in the last 3 months (this

includes citizens who have never accessed the internet)

• At least 133,000 residents in Surrey lack the digital literacy skills, or access, to engage with digital services – and this number is probably much higher

• Around 200,000 residents in Surrey lack at least one of the digital skills needed to fully participate

with fully digital services

• With an ageing population, many of our residents live in care homes or sheltered accommodation, or live alone with limited, or no, access to digital services – something we are trying to change following our experiences during Covid-19

• In Surrey there is also an overwhelming correlation between social

exclusion and digital exclusion, linked to areas of greater deprivation and the communities that live in these areas

Changing how we worked – a rapid shift to digital

Accelerating roll out of our Surrey Care Record to join

up care during our Covid response - 90% of GPs

Virtual mental health assessments to ensure

access to vital services for vulnerable people

Launched virtual consultations across all community and acute services, including mental health and social care.

Creative use of engaged and sharing data, along with adult social care, mental health and acute trusts.

Virtual Safe Havens enabling services to continue in lockdown

Shifted talking therapy services to digital with

therapy and bereavement support

social media to

promote the support available

staff from self help packs and training to psychological support

supported by virtual consultations

Digital support to care homes and supported living settings

New online training packages

to support staff

Facebook portals deployed free of charge so residents could keep in touch with loved ones, helping to reduce isolation

Launched NHS mail to

improve connectivity and information flow between the NHS and care homes

Digital virtual Multi- Disciplinary Teams and assessments across

Range of digital support available to primary, secondary care,

Rapidly launching new services to support our most vulnerable

Virtual wellbeing hub launched, with over 3,000 visits in its first few weeks and over 200 courses available

Addressing digital inequality to reduce loneliness and isolation by supporting non-digital

users to get online. Led by the Surrey Coalition, the project is connecting people through focused digital training at scale.

TIHM remote monitoring and AI for people with dementia and vulnerable households to overcome the physical boundaries of lockdown

The next chapter for us?

Embedding people’s experiences to shape how we deliver services

Listening to what our citizens have told us We use a wide range of research and engagement methods, including working with partners such as Healthwatch, to gain insight into how our citizens are feeling and how they want to access health and social care services. These study outcomes inform our plans and priorities.

What we found…

Engaging with non digital users during and after COVID was challenging. Due to social distancing and other restrictions, we currently have a heavy reliance on engaging with people digitally (through online meetings and events). We need to be creative and work harder to connect with citizens who cannot engage digitally and hear their views.

Understandably, we have also seen lower levels of engagement over recent months. We need to overcome this to reach those who are more likely to face digital exclusion

Attitudes towards digital access to Health and Care services Virtual consultations, online support groups and shifting from face-to-face to more virtual services has been received positively by the majority of residents

“In many respects, the service is even better than it was before, with all the options like telephone or video appointments. I think the GPs are able to be more productive because they’re not waiting for patients to arrive, or to walk slowly down corridors, and because they aren’t having to do so much paperwork to do with routine things which have been cancelled. They are able to triage things really quickly.”

75% of our frontline agencies have reported positively to new virtual methods of delivering their services and 80% of those agencies plan to continue to deliver services in this way, as part of a blended face-to-face and digital model

GP

Hospital Acute Service

Emergency Services

Social Care

Community Health

Pharmacy

Attitudes towards sharing digital Health and Care records People want their health and care team to be able to

access their shared care records, but are less sure about

digital and independent health services

100% of people agreed: I think shared care records

might lead to improved care for me

“I moved back to Surrey from Southampton and

needed to go over medical history even though my

old GP had records. I felt there is a stigma to sharing

sensitive information many times over so this would

support sharing of my information”

Who should have access to shared

care records?

“My elderly neighbour kept having falls. I

only had access to his current medication.

He was unable to recall information at 89

and I felt for ambulance crew as they have

a lot of questions to ask. Wastes a lot of

valuable time”

Optician

Dentist

App

How do we ensure our research and patient and public engagement is inclusive and reaches the digitally excluded?

• Clear correlation between social and digital exclusion – this should help us identify those at risk of digital exclusion – along with the criteria we have developed

• No simple way to describe or measure ‘digital exclusion’ but some indicators around access, literacy, income, geography

• We need more sophisticated metrics to identify

categories of digitally exclusion

• Then we can develop a robust framework to ensure those who may be digitally excluded are represented in engagement activities (similar to how we consider protected characteristic groups under the Equality Act)

Next steps • Continue our engagement work to gain greater insight and understanding of digital exclusion

• Develop system-wide outcomes for inclusion, addressing the factors already identified

• Digital inclusion to be owned by the ICS Executive (linked to health inequalities), with ambitious targets around improving participation, digital access and embedding inclusion

• Work on our digital infrastructure, achieving faster broadband to get more people online

• Review our digital, engagement and broader strategies to ensure digital inclusion is considered (and plans for a new NHS Digital Health Technology Standard)

• Build digital inclusion into the design of all our projects and into procurement criteria

• Build digital inclusion criteria into our governance for all projects that have a digital element

• Create a cross Surrey Heartlands digital champions programme across health, the voluntary sector and the council to create a digital training programme for people who want support

Final thought

Accessing services digitally is a choice

So this is about inclusion – including those who want to use digital services and giving them the access, technology and skills they need, whilst also recognising that some people will never want to engage digitally

We must respect this and always remember that digital is an option for some, but not all

System Board, Wednesday 16th September 2020

Sent on behalf of: Tim Oliver, Surrey Heartlands Chair and Leader of Surrey County Council

Welcome to my now regular update following this month’s Surrey Heartlands System Board meeting on 16th September. This is part of our plan to provide more public transparency across our health and care system and to make sure you are kept up to date with our discussions at Board level. As I referenced previously, System Board will be held in public on a quarterly basis, starting with our meeting on 21st October. The meeting agenda, papers

and details on how to join will be published here.

-----------------------------------------------------------------------------------------------------------------------------------------------

Appointment of Rachael Wardell as Executive Director of Children, Families and Lifelong Learning

We began with the announcement that Rachael Wardell has been appointed as the new Executive Director of Children, Families and Lifelong Learning at Surrey County Council. Rachael will be joining us from her current role as Director of Children, Schools and Families in the London Borough of Merton and is a very experienced Director of Children’s Services. We look forward to welcoming Rachael to Surrey.

Covid-19 update in Surrey

Ruth Hutchinson, Director of Public Health, brought colleagues up to date with the current Covid-19 situation in Surrey. The latest data for Surrey is published every Monday here.

System finance update

Highlights from the recent Surrey Heartlands Strategic Finance Board meeting (28th August) were reported where partners discussed issues including the process for reimbursement of Covid costs, hospital discharge costs and heard a system update on financial governance from partners. 2020/21 is the final year we will receive transformation funding and we are still working through exact details of how this has been allocated within existing national schemes to understand how much we can allocate to local projects.

The temporary (Covid) financial regime will continue until the end of month 6 during which time providers and commissioners are expected to breakeven. A new regime will operate from month 7. Phase 3 financial allocations were announced immediately prior to this meeting, and are currently being worked through with more detail expected from the region shortly.

Item 8

https://mycouncil.surreycc.gov.uk/ieListMeetings.aspx?CommitteeId=827

https://www.surreycc.gov.uk/people-and-community/emergency-planning-and-community-safety/coronavirus/testing/figures-and-statistics

Health and wellbeing update

Director of Public Health, Ruth Hutchinson, gave the Board an overview of the Community Impact Assessment which takes a rapid and detailed look at the impact of Covid-19 on different people and communities across the county and the support they might need in the event of another outbreak. The outputs will be incorporated into the Health and Wellbeing Strategy as part of our work to reduce some of the increasing health inequalities caused by Covid-19. A number of different methodologies have been used, including geographical impact assessments, a temperature check survey of around 1,600 households and a recovery progress index; the results will be made available on Surrey-I towards the end of October and presented to various stakeholder and reference groups.

One of the key elements, the community rapid needs assessment, comprises of ten in-depth assessments of how vulnerable communities have been affected using interviews with individuals and those working in local services and existing data. These ten areas include: BAME communities; care home residents; people with mental health and those with long-term physical conditions; the Gypsy, Roma Traveller community; people experiencing domestic abuse; the homeless; children/adults with special educational needs; people with drug or alcohol problems; and young people out of work – all of which reflect some of the highest levels of differential impact, whilst recognising there are other areas to consider.

Results will be built into the Joint Strategic Needs Assessment (the JSNA) as well as making up part of our evidence base for Phase 3 planning, particularly around health inequalities.

Ruth then gave a brief update on priority areas from the Health and Wellbeing strategy, highlighting work done by the multi-agency group around housing (looking at homelessness and drug use), the launch of the Virtual Mental Health Wellbeing Hub (more here) and work being undertaken in the Surrey Downs area to prevent isolation and loneliness. A detailed report can be found here as part of the Health and Wellbeing Board papers.

Update on the Guildford and Waverley Integrated Care Partnership (ICP)

Sue Tresman, Independent Chair of the Guildford and Waverley ICP and Nick Sands, Transformation Director at Royal Surrey NHS Foundation Trust gave an overview of the partnership’s aims and work to date. Based on collaboration, not only between partners but also with citizens, patients and staff, the ICP is seeking to make a real difference for residents and has set up a Citizen’s Advisory Group to make sure local people are at the centre of its work.

With a collaborative approach to planning, transformation and service delivery, Covid-19 has underlined the importance of local relationships and how the system has needed to come together. From November staff from across the ICP will be joining the new cohort of the Surrey 500 leadership programme, alongside alumni from the previous programme. Examples of recent achievements include:

The Guildford East primary care network has been piloting video group consultations on dietary change for patients recently diagnosed with Type2 diabetes, led by Merrow Park Surgery.

‘Whose shoes’ event in February – planned and hosted by a Darzi fellow, hearing directly from patients to understand more about their experiences; the joint transformation team is now reviewing a number of pledges made at the event so their lived experience can be incorporated into the ICP’s priorities.

The ICP has done a lot of work supporting social prescribing – as part of the presentation Sue described the case study of ‘Margaret’, a 78 year old lady caring for her husband with Alzheimer’s whose referral suggested she would benefit from some support while she went shopping; after several conversations with the link worker, to really understand more about her situation and concerns, Margaret benefited from two days’ respite while her husband spent time in a local care

https://www.healthysurrey.org.uk/mental-wellbeing/adults/virtual

https://mycouncil.surreycc.gov.uk/ieListDocuments.aspx?CId=328&MId=7436&Ver=4

home which significantly improved her overall wellbeing and demonstrating the value this kind of non-clinical intervention can bring.

Mobilising the Reconnections service to address social isolation and loneliness in the over 65s – service manager now in post and team appointed. The service is due to go live in November.

Nick Sands described how the single transformation team is working, helping to build trust between partners and reduce duplication of effort. Clinical teams are starting to work with colleagues in primary care and the CCG in the course of their work to deliver transformation together, which is helping to cement the feeling of shared purpose.

Recovery and Restoration update Overall the system is making good progress with restoration planning, albeit with recognised areas of challenge. We have now completed our Phase 3 submission to NHS England/Improvement setting out how we plan to get services back up and running, and our activity projections. Full recovery will be partly dependent on any future impact from surges in Covid-19. Other recovery workstream updates included:

Interdependencies of health and care – initially aimed at delivering support for care homes, this work is also exploring how we can develop new pathways of care that go beyond hospital discharge, working together across health and social care to target specific population cohorts which will also support decisions around continuing healthcare needs.

Surge planning – looking specifically at winter capacity, including the flu vaccination programme, and how we plan effectively for surges in demand due to winter pressures and/or increases in Covid-19. This includes the development of a system-wide early-warning system, and incorporating learning from the initial wave of Covid-19. Critical to this workstream is how we can increase critical care capacity across Surrey Heartlands to meet any further Covid-19 surges.

Estates – this workstream is looking at how we maximise the use and efficiency of our health and care estate across Surrey Heartlands; a baseline assessment has been completed, with a number of opportunities emerging. An integrated estates workplan is in development which will be presented at October’s system board. As part of this wider work, we will also be considering the impact of housing growth and the ‘greener futures’ agenda.

NHS People Plan - following publication of the NHS People Plan at the end of July, all health and care systems have been asked to develop their own local plan. The Surrey Heartlands plan was presented to the Board; it mirrors what’s in the national plan, setting out our ambitions for our workforce along with an achievable action plan. Initial feedback from NHS England/Improvement has been positive and the Board endorsed the plan.

Epsom and St Helier Hospitals – new five year strategy

Daniel Elkeles, Chief Executive at Epsom and St Helier Hospitals introduced the Trust’s new five year

strategy, which is summarised in a short video you can watch here.

Our next System Board meeting is being held on Wednesday 21st October and will be held in public, details here.

https://www.youtube.com/watch?v=pyOi_rWQ0Kg

https://mycouncil.surreycc.gov.uk/ieListMeetings.aspx?CommitteeId=827

Surrey Heartlands Health and Care Partnership System Board

Documents

Transcript of Surrey Heartlands Health and Care Partnership System Board