Supporting change
The following areas and initiatives will support the delivery of our strategic priorities and improve health outcomes for our residents.
Armed Forces Community
The Armed Forces Act 2021 required public sector bodies to take account of the unique needs of the armed forces community and legislation came into effect in November 2022.
We have worked closely with our two upper-tier local authorities (Hertfordshire and Essex County Councils) as well as our voluntary sector including both Healthwatch organisations, who provide specific Joint Strategic Needs Assessments for our armed forces community, which includes serving personnel and reservists, veterans and their families.
We work closely with both Counties Armed Forces Covenant Boards and chair a Health subgroup of the Hertfordshire Armed Forces Community Board.
We are focused on four key areas 1) Social prescribing 2) General Practice - accreditation with the Royal College of General Practitioners as ‘veteran friendly’ 3) Local NHS Trusts and the Veteran Healthcare Alliance to gain accreditation as ‘veteran aware’ as well as achieving Employers Recognition Scheme accreditation and 4) Improving the identification and coding of veterans and the armed forces community in our commissioning and service delivery.
Our 5-year vision is to help deliver locally the national vision of England being the best place to be a veteran, with a fully integrated system wide approach to improve outcomes for our armed forces community.
Climate Change and Sustainability
The delivery of our Green Plan 2022 – 2025 will support the ICB and our partners to deliver against the national NHS net-zero targets. This will also help to mitigate the health harms of climate change, for instance air pollution alone contributes to 1 in 20 deaths in the UK and increases the number of cases of cancer, heart disease and asthma.
We will continue to share and learn from our colleagues, such as the Cheshire 10-point plan, to support general practices to reduce their environmental impact in line with the NHS net zero ambitions, by adopting similar approaches in our estates planning and procurement.
In addition to our ICS wide Green Plan each HCP and its partners are committed to creating stronger, greener and healthier communities and working to reduce their environmental impact through reducing resource consumption in support of delivering the national Net Zero NHS targets. Each of our providers within our HCPs have published their sustainability commitments and Green Plans to deliver their individual goals. All business cases that are considered by each HCP must demonstrate its commitment to achieving our green goals as part of the governance process.
Clinical Leadership
We are committed to local implementation of programmes aimed at clinical and care professional leadership, as identified in Chapter 4 of the NHS Long Term Plan.
In keeping with system objectives with a greater emphasis on partnership working across health, inside and outside the NHS, and the broader public sector, the following are three key components in our plan for clinical and professional leadership:
- Broadening the clinical and professional backgrounds of those in clinical and professional leadership positions.
- Promoting clinical and professional leadership at all levels of seniority, including but not limited to, leadership for quality improvement, development of future senior leaders and encouraging practice at the top of one’s licence.
- A multidisciplinary forum, similar to a Clinical Senate, which establishes broad-based clinical and professional oversight of the above activities and other appropriate multi-professional initiatives such as medicines management and research.
Digital
We have recently agreed our 10-year Digital Strategy which focuses on digital improvements that will help us to improve patient care. We have identified five key themes as our digital strategy mission, covering new technology, strengthening our digital skills as a workforce, helping our residents access online services, and collaborating and sharing information to improve care.
Estates
We recognise the need to ensure our buildings are fit for purpose, suitable to meet the health and care needs across our geographical footprint, now and in the future. Estates transformation and modernisation is a critical enabler of our strategic priorities and provides an opportunity to improve access, deliver efficiencies across our health and care system. We will build on our estates plans to include additional and flexible capacity in primary care; development of integrated neighbourhood care hubs; and acute hospital estate improvements. This will build on existing organisational and system estate plans, including our work on a major capital investment at Epping and Bishop’s Stortford to improve community diagnostic treatments.
To deliver our ambitions, we are working in collaboration with NHSE national and regional colleagues, building on our previous strategies and learning, incorporating the outputs from the National Primary Care Network Estates Toolkit. There are exciting plans in development to improve hospital provision for the benefit of patients in our area through the New Hospitals Programme, which include funding for a new Princess Alexandra Hospital in Harlow and a new Watford General Hospital. This investment in our hospital infrastructure will be welcomed by communities and staff – and make it easier to deliver the modern, integrated health and care services that we all want to see.
Core ICB capital allocations for 2022/23 to 2024/25 have already been published and remain the foundation of capital planning for future years. These allocations broadly cover operational lifecycle costs and equipment replacement, with limited scope for major strategic change. Capital funding for large scale programmes is currently retained by NHSEI for targeted allocation. Capital allocations in 2023/24 will be topped-up by £300 million nationally, with this funding prioritised for systems that deliver agreed budgets in 2022/23. The ICS expects to receive approximately £7m of this funding and will develop plans for its deployment.
Finance
Information about the ICB’s financial duties is included in Appendix 2 of the PDF.
NHS England has issued two-year revenue allocations for 2023/24 and 2024/25. At national level, total ICB allocations [including COVID-19 and Elective Recovery Funding (ERF)] are flat in real terms with some limited additional funding available to expand capacity.
The national planning assumption was that to deliver a balanced net system financial position for 2023/24 and to achieve the core service recovery objectives, efficiency and productivity improvements equivalent to 2.2% would be required in 2023/24 with at least the same again in 2024/25. In reality the likely requirements for the next 2 years are closer to 4-5% efficiency and productivity improvement. Whilst future allocations beyond 2024/25 are still to be published, it is to be expected that future year efficiency and productivity targets will be at least 2% per year.
In order to deliver such improvement the ICB and its providers are working together on a series of plans that are outlined in section 5.7.
Longer term the system will need to be more transformative and increase investment on prevention services to deliver the triple aim – optimising health system performance through the simultaneous pursuit of three dimensions: improve population health, improve quality, improve value for the system.
To support the delivery of financial balance, the ICB and partner trusts work together as a single system, but also in Place-based collaboratives to explore clinical and service delivery models and opportunities for transformation of services. Whilst each individual organisation agrees through its own governance processes an operational and financial plan for its organisation, this plan does reflect the spirit of the duty to collaborate.
Risk management remains a vital part of system planning and system plans take account of financial risks and how they will be managed. A key aspect of the system’s approach to risk and performance management is the regular sharing of data in a transparent way. This helps to identify any increasing likelihood of risks crystallising and affecting underlying financial performance. This allows for peer review and discussions on the opportunities to mitigate emerging financial problems. To support this the Finance Directors across the system meet regularly to review performance and agree actions to be taken.
The ICB’s Finance and Investment Committee regularly sees financial performance information relating to the ICB and also for each of the partner trusts mapped to the ICS. The protocol for changes to in-year revenue financial forecast, published by NHSEI in November 2022, is followed with the Finance and Investment Committee taking a leading role in the oversight of partner trusts where necessary.
Broadly, this means that where organisations are performing consistently with submitted and approved plans, they may have limited engagement on their own operational financial matters. However, where an organisation within the system is departing from their plan, or is forecasting a divergence from plan, engagement would be increased.
Patient Choice and Personalised Care
Personalised care represents a shift in focus from traditional medical models to approaches that enable people to have greater choice and control over the way their care is planned and delivered, based on what matters to them and their individual strengths, needs and preferences.
We are working hard to improve opportunities for people to make choices about their care. We want to ensure that all patients can discuss with their GP or healthcare professional the different options available including pros and cons, and where appropriate, whether to have treatment. By enabling choice of provider and services that best meet people’s needs, we will uphold people’s legal rights in line with statutory requirements and guidance.
Patient choice has both constitutional and legal commitments which are embedded in key policy drivers within the NHS, including the NHS Long Term Plan and Universal Personalised Care. Choice is also highlighted as a key enabler of elective care recovery within the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care. The ICB has a Choice policy statement available on our website and we will engage with healthcare providers and professionals to promote choices available to ensure patient awareness, and information on patients’ legal rights to choose is publicised and promoted.
Population Health Management (PHM)
In five years our system will have built the capabilities described within the NHSE PHM Maturity Matrix and through our partnerships deliver our overarching system level outcomes. The platform and tools enable identification of needs and opportunities including scenario modelling, measure the impact of evidence based, high impact interventions and support new financial models and incentive schemes.
Procurement
We will review our approach to contracting and procurement during 2023/24 to identify opportunities to streamline workloads and determine the most cost-effective way of delivering procurements to maximise efficiency. This will identify opportunities to draw from a pool of resources across the Health Care Partnerships, ICS, EoE Region and the Clinical Networks (e.g. Cardiology).
We have over 80 procurement projects planned for year 1 of the Joint Forward Plan, not including pipeline transformation / commissioning decisions and non-health care contracts.
To make best use of resources we plan to bring the following procurement functions back ‘in-house’ during 2023-24:
- Contracts that fall under the threshold for formal tendering thresholds within the Public Contract Regulations.
- Drafting and development of policy.
- Developing a consolidated ICB workplan to capture proposed projects.
- Reports for Audit and Risk Committee.
- Reviewing our procurement plan and identify the ‘must do’ priorities for 2023 /24 and identify which ones can be deferred, consolidated, or awarded through Tender Waivers.
Quality
Our goal is to set out a single vision of quality in our system based on the need to provide high quality personalised and equitable care for all now and into the future, ensuring that quality is central to planning and decision making within our health and care system. To meet our ambitions and support deliver, we will adopt the National Quality Board (NQB) ‘Seven Steps’.
To support the delivery of quality improvement the ICS has developed a 5-year Quality Strategy, which has 5 principles:
- Developing and providing services which listen, learn and above all, are person centred
- To effectively collaborate across organisations to continually improve care
- To ensure the services we provide are available to everyone
- To use information and technology in the best possible and most effective way
- To create a healthy and positive environment for both staff and patients to provide and receive the best possible and safe care
Each of our Quality Principles have a part of play in addressing and reducing health and care inequalities in our population, as well as ensuring the Hertfordshire and West Essex Integrated Care System is a great place to work.
Reducing Health Inequalities
Our 5-year plan sets out its ambition to continue to improve health equity, in line with our Integrated Care Strategy and principles of the NHS Long term plan. This plan sets out the approach we will take in closing the gap in variances of outcomes for people that may be due to ethnic background, circumstances in which they live or factors outside of their control. In the first year of the plan, we will work to clarify our performance in the Core20Plus 5 framework for adults and commence mapping against the newly published CYP framework. This plan outlines the ambition to ensure performance metrics are clear for Core20Plus 5 for adults and CYP and ensure that inclusion health groups are a key feature of this data. By the end of year 1 we aim to deliver an overall picture of health including wider determinants to this, targeting some specific groups such as unpaid carers, veterans and members of the gypsy, roma traveller community, refugees and migrants, victims of domestic violence and those living with a serious mental health issue or learning disability. Over year one, a concise dashboard framed by the Core20plus 5 for adults and CYP will be developed with clear performance metric that identify areas where modifiable risk factors can be better prevented through the use of assess based community development, community connectors and social prescribing.
In Hertfordshire and west Essex we have areas of significant deprivation and inequalities, through partnership work with colleagues including the Voluntary, Community, Faith, and Social Enterprise (VCSFE) sector the ambition of our 5-year plan is to narrow the gap in varied outcomes, building longevity into actions, ensuring they are sustainable and benefiting our communities.
To achieve this aim, we will need to collaborate with partners to better understand their data, ensure data collected and categorised is correct allowing for better and easier data manipulation and interrogation. Working with our Population Health Management team and system partners, we will develop an in-depth understanding of the local population needs and areas of inequity, supported by the continued development of system partnerships.
During years 2 to 5 of our plan we will continue to work to drive down inequalities in outcomes for members of communities most at risk, through enhanced neighbourhood working between PCNs and VCSFE partners, enhancing current partnership working with sustainable models for engagement, communication and delivery.
Research and Innovation
Hertfordshire and west Essex has well established research capabilities embedded within our provider organisations. The Health and Care Act 2022 enables our ICS to develop an integrated approach to research and ensure this capability and capacity aligns with the delivery of our key priorities. The ICS is currently in the process of developing an ICS Research Strategy which will incorporate the findings of a recent project to understand our systems research capacity and ensure representation in research for our whole HWE ICS population.
We are working with the University of Hertfordshire as a key local partner, to support and develop our approach to research and innovation.
Safeguarding
Legislation, statutory guidance, multiagency policies and procedures support organisations, practitioners, drive the agenda of safeguarding children and adults. The recent legislation of Domestic Abuse Act 2021, Serious Violence duty January 2023 will drive our system to embed practice to meet these legislative requirements. In Essex we are working collaboratively with the other two ICBs that cover Essex to develop an evidence based Strategic Needs Assessment and operational plan.
The Liberty Protection Safeguards will provide protection for people aged 16 and above who are or who need to be deprived of their liberty in order to enable their care or treatment and lack the mental capacity to consent to their arrangements. These safeguards will deliver improved outcomes for these people.
Our safeguarding teams work in partnership with our local authorities’ children’s and adult services to promote the health and welfare of children and support adults at risk. This work is supported by several partner plans and strategies including Hertfordshire 2022-2024 for adults, strategic priorities 2023-2025 for children and Essex Children Board plan 2022-27, Southend Essex Thurrock Domestic Abuse Board strategy 2020-2025, Hertfordshire Domestic Abuse Strategy 2022-2025 and our Safeguarding Strategy for children.
We monitor and share with partners safeguarding children and adult key performance indications (KPIs) on a quarterly basis to understand trends in referrals to children’s and adult services, domestic abuse referrals by health, local authorities and police.
Supporting wider social and economic development
Part of our role as an ‘anchor institution’ is to support the NHS to develop broader social and economic development. We will use all the levers at our disposal and partners support as anchor institutions to improve the economic wellbeing of residents as one of the key determinants of health and wellbeing. This includes improving employment outcomes for our residents and improved social value through our commissioning and procurement activities. We are developing our role to support this in several ways, which are outlined below:
- Anchors Network - 30 public sector organisations in Essex, including the West Essex Health & Care Partnership, have come together as the Essex Anchor Network (EAN) to drive greater prosperity and a better quality of life for their local population – through employment and workforce strategies, procurement and supply chain policies, investments and use of estates. This is with an aim of raising aspiration within a community, by engaging with schools and mentoring people.
The west Essex Anchors Group within this network is currently focusing on bringing employers and colleges closer together to specify skills needed for the future. The group is also looking to improve opportunities for work placements and apprenticeships.
Building on the learning from Essex, we have engaged with the University of Hertfordshire to support our plans to develop our local anchor institutions’ roles across Hertfordshire and West Essex. This year we will develop a plan which focuses on how we can work in partnership with the university to enhance our system approach to research and innovation, as well as utilising the knowledge and expertise within the university to positively impact the local workforce.
- VCFSE sector and the VCFSE Alliance - This sector is worth more than £1bn and is a large employer. The website Working Herts has three functions, all of which will develop further during year 1 of the JFP. The first is to promote working in the VCFSE sector in Hertfordshire, the second is to provide free promotion of jobs to encourage more people into the sector, and the third is to provide an easy way for registered partners to fill short term and part time roles by drawing on the capacity of those currently working in the sector who wish to build a portfolio.
It also uses thousands of volunteers, with positive impacts for the volunteer’s wellbeing and, where appropriate, their acquisition of new skills and employability. The VCFSE Health Creation strategy has a workstream on further developing volunteering roles to fit 21st Century lifestyles and to encourage Anchor Institutions to offer their staff opportunities to contribute to their communities too.
This sector is also crucial in helping the most disadvantaged residents’ access full benefit entitlements and other help. The Herts Cost of Living Group and the Better Life Chances partnership are forums where VCFSE and statutory sector work together to maximise the impact on those facing the greatest financial challenges.
- Unpaid Carers - A significant segment of the working population has caring responsibilities including 30% of the national NHS workforce. The pressure on social care is making it harder for many carers to work and care. We have been awarded ‘Accomplished’ (level 2) status by Employers for Carers for our work to support carers who are juggling their unpaid carer role with being employed by the ICB. Work with local authority partners also focuses on helping carers to stay in or return to work where possible.
Workforce
Our workforce is recognised as a key enabler as part of the broader Integrated Care Strategy, as part of that we must support and utilise our existing and future workforce effectively through strengthening integrated working across our system.
Our People Strategy sets out a transformational agenda for the forthcoming three years. Within it we set out a road map to ensure the supply and retention of a skilled, sustainable workforce that supports the vision of the Integrated Care System (ICS). It also meets the needs of our residents and the changing population demography, and supports the outcomes required of the Joint Forward Plan, as well as individual stakeholder strategies and operational plans.
Key to the delivery of our People Strategy and Joint Forward Plan will be an improvement and triangulation of workforce data. We are working with colleagues within performance, quality and across the system, to improve our understanding, analysis and forecasting of workforce requirements across health and social care. We believe delivering our People Strategy will make Hertfordshire and west Essex a great place to live, learn, work and stay.
Our People Strategy aims to achieve the following system ambitions, which are monitored and governed by the systems’ People Board, and directed by respective sub-committees:
- We will produce a long-term workforce plan for the whole system, based on the needs of our population and accounts for the skills required to deliver those services.
- We will create communities empowered and enabled to provide the best possible care through innovation and integrated working.
- We will develop sustainable workforce attraction strategies, particularly through domestic supply routes, to reduce system vacancies.
- We will ensure that our staff are representative of our local population by making Hertfordshire and west Essex a place of equal opportunity and inclusion.
- We will reduce staff turnover by delivering the best possible staff experience and ensuring our workforce are healthy and happy.
- We will ensure ALL staff are given the opportunity to develop their skills and careers, with talent effectively and equitably identified and nurtured across the system.