Future Shift Our collective vision for a more viable future using our ‘untapped potential’ in Suffolk and North East Essex ICS Suffolk and North East Essex ICS Integrated Care Strategy
Suffolk and North East Essex Integrated Care System 2 Foreword We’ve been on a journey together as an Integrated Care System (ICS) in Suffolk and North East Essex for some time now. Across the NHS, local government, social care and the VCFSE sector we now work together more closely than ever before. Our culture is increasingly ‘Can Do’ and we collaborate wherever and however we need to because we know that this is the right thing to do for people and communities. Having better alignment between partners has brought about many improvements and we have good examples of where new ways of working are making a real difference in the lives of local people. But is this really what success looks like for an Integrated Care System? Have we done enough? Or are we still only in the foothills of discovering the ‘untapped potential’ of what we ‘Can Do’ for our population if we really pull together as local health and care partners. Wherever I go and whoever I meet across the Suffolk and North East Essex ICS, people talk about the same key issues we now face in health and care. These are that: • the challenges for people, communities and local health and care services have never been greater; • the solutions lie in enabling a ‘Left Shift’ in health and care for our population; and • we won’t achieve the depth of impact that we need to just by aligning the way that we work in health and care. We need to go further. We also need to go faster. We need to work together towards a genuine ‘Future Shift’ in health and care in Suffolk and North East Essex. This document sets out how we can enable that ‘Future Shift’ to happen and also what we ‘Can Do’ - starting today – to move towards a more viable future. Susannah Howard Integrated Care Partnership Director - Suffolk and North East Essex ICS The recent report commissioned by the government from Lord Darzi highlighted the depth and breadth of challenges faced by the NHS in England. Whilst Suffolk and North East Essex shares many of these challenges, I believe that through ‘Future Shift’ we have a unique opportunity to move forward at pace towards achieving better health and care for our local population. The principles of ‘Future Shift’ reflect closely the ‘three strategic shifts’ proposed by the Secretary of State for Health and Social Care in response to Lord Darzi’s report: move from hospital to community care; transition from analogue to digital technology; shift focus from treating illnesses to preventing them. The government have launched ‘Change NHS: help build a health service fit for the future’ to ask the public and health and care staff in England their views, experiences and ideas in preparation for a new NHS plan to be published in spring 2025. Our local work on ‘Future Shift’ in Suffolk and North East Essex makes an important contribution to this national discussion. As we move forward we should not constrain the level of either our ambition or our creativity in developing solutions. We also need to work together as a wider health and care community with our colleagues in our neighbouring systems in the East of England. Ed Garratt OBE Chief Executive - NHS Suffolk and North East Essex Integrated Care Board
Future Shift 3 Contents Executive Summary 4 ‘Future Shift’ at a glance 6 1. Introduction 8 1.1 Our Integrated Care System 8 1.2 Our ICS Integrated Care Strategy 10 1.3 From ‘Left Shift’ to ‘Future Shift’ 11 1.4 Why this document is important 12 2. Our vision for WHY we need a ‘Future Shift’ 13 2.1 Our changing world 13 2.2 Our changing population 14 2.3 The state of health and care 17 2.4 Our local system learning 21 2.5 New opportunities in medicine, science and technology 23 3. Our vision for HOW we can enable a ‘Future Shift’ 25 3.1 ‘Three Horizons’ of change 25 3.2 How we lead and work together 27 3.3 How care is delivered in a more viable Future 33 3.4 How we invest our time and resources 40 3.5 How we innovate 46 3.6 How we approach transformation 51 4. Our vision for WHAT we ‘Can Do’ to enable a ‘Future Shift’ 54 4.1 ‘We Can’ co-produce and co-deliver with people and communities 54 4.2 ‘We Can’ prevent ill health, inequalities and injustice 62 4.3 ’We Can’ deliver more holistic, neighbourhood based care 66 4.4 ‘We Can’ make more use of technology and innovation 75 4.5 ‘We Can’ learn from data, evidence, knowledge and intelligence 79 4.6 ‘We Can’ make better use of our existing resources 84 5. Our collective accountability for enabling a ‘Future Shift’ 91 References 92
Suffolk and North East Essex Integrated Care System 4 Executive Summary ‘Future Shift’ serves as an extension to the existing ICS Integrated Care Strategy for Suffolk and North East Essex ICS. It presents a vision for taking bold and ambitious steps towards creating a health and care system that is truly responsive to the needs of the people it serves. By embracing the principles and actions outlined, we can pave the way for a future in Suffolk and North East Essex where health and wellbeing are prioritised, ill-health is prevented, care is delivered more locally and everyone has the opportunity to live a longer, healthier life. WHY we need a ‘Future Shift’ The need for a ‘Future Shift’ in health and care is prompted by our changing world, evolving population needs, and the increasing challenges faced by the NHS and social care. We need a health and care system that can meet people’s needs by providing accessible and high-quality care, delivered by a workforce that understands and responds to people’s needs. We need to harness the benefits that new technologies will give us so that people can self-care and be supported more effectively. And we need to be efficient in everything we do, learning from what works and when things go wrong, removing unnecessary bureaucracy, and ensuring we deliver value for public money. ‘Future Shift’ proposes a transition from a reactive, siloed, fragmented and inequitable health and care model to a more proactive, preventative, community-based approach. HOW we can enable a ‘Future Shift’ We want to move towards a future where we collaborate to support people by focusing on their needs, rather than our systems and processes. We need to create a safe and supported workforce able to innovate with local people and local partners to design and deliver better care. We need to invest wisely to ensure our resources are targeted where they are most needed, for our most vulnerable populations. And we need to know whether what we do is really making a difference to local people. • Leadership and Collaboration: Embracing collective accountability, fostering a culture of courage and risk-taking, promoting candour and compassionate leadership, and encouraging intuitive, ‘Can Do’ leadership that avoids micromanagement and better realises the ‘untapped potential’ in the ICS. • Delivery of Care: Shifting from a sickness-focused model to a wellbeing-centred approach. This involves empowering individuals and communities to co-design and co-deliver care, leveraging technology for self-managed care, and promoting integrated care models at the neighbourhood level. • Resource Allocation: More proactive investment strategies that prioritise prevention, community care, and innovation. This includes adopting new commissioning models, aligning funding with long-term goals, and exploring sustainable funding and payment mechanisms that better support transformation. • Measurement and Evaluation: Moving beyond traditional activity-based metrics to focus on outcomes that matter to people and communities. This involves developing a framework that better captures the benefits and impact of interventions on health inequalities, and using data to drive continuous improvement.
Future Shift 5 • Innovation and Transformation: Embracing a culture of innovation grounded in the ‘Jobs to Be Done’ framework. This means understanding the deeper needs of the population, leveraging new technologies, and fostering collaboration with innovators. • Approaching Transformation: Acknowledging that system transformation is a progressive journey that requires building strong foundations, ‘doing things smarter’, then progressing to ‘doing smarter things’, and ultimately reimagining health and care. WHAT we ‘Can Do’ to enable a ‘Future Shift’ We need to continually improve, building on what works, and being brave enough to stop doing what doesn’t work. We need to co-produce with people and communities the types of care and support that they tell us they need to keep themselves and their families well, and to support them when they need it. We need to take a local approach, being flexible to respond to local needs and challenges and we need to continually learn and improve, always pushing further to create the best possible health and care system for local people. • Co-production and Co-delivery with People and Communities: Placing people’s experiences and expertise at the heart of health and care service development and delivery. This includes embedding co-production principles, ensuring adequate resources for community partnerships, and empowering people to lead in service transformation. • Preventing Ill-Health, Inequalities, and Injustice: Embedding prevention and health inequalities into all aspects of work. This involves improving data quality, co-producing equality impact assessments, ensuring reasonable adjustments, and actively addressing social injustice. • Delivering Holistic, Neighbourhood-Based Care: Further developing more local neighbourhood-based services involving a broader range of partners. This includes leveraging the expertise of VCFSE and social care providers, reforming general practice, and expanding the role of allied health and advanced practice professionals. • Making Greater Use of Technology and Innovation: Developing shared aims and strategies, robust governance, and transparency to enable the adoption of new technologies. This involves focusing on the needs of the people served, building relationships for collaboration, training the workforce, and committing to sustainable funding for innovation. • Learning From Data, Evidence, Knowledge, and Intelligence: Improving the quality of data on population health, sharing care records, and using data insights to inform equitable commissioning and resource allocation. This includes segmenting population data and learning from complaints to drive continuous improvement. • Making Better Use of Existing Resources: Embedding sustainability principles, using social value principles to benefit communities, streamlining care systems, and sharing ‘back-office’ resources. This involves promoting lifelong learning and minimising environmental impact. Our collective accountability for enabling a ‘Future Shift’ ‘Future Shift’ emphasises the importance of collective accountability across all partners within the Integrated Care System. To enable and sustain the local flexibility and autonomy that local partners and networks need, this document deliberately does not set out a detailed ‘top down’ action plan but instead provides a powerful set of principles that we can use and be collectively accountable for applying to the way that we work together going forward.
Suffolk and North East Essex Integrated Care System 6 Guiding principles HOW we can enable WHAT we can do to WHY we need a ‘Future Shift’ A ‘Left Shift’ in health and care based on the following five principles 1. Start with Why? 2. Prevent disease and slow progression 3. More neighbourhood and community solutions 4. Address inequalities 5. ‘Can Do’ Health and Care Using the ‘Three Horizons Framework’ we have identified five principles for how we can drive genuine transformational change over time. 1. How we lead and work together • Collaboration and collective accountability • Being brave and taking risks • Leading with candour • Cultural and psychological safety • Compassionate leadership • Intuitive ‘Can Do’ leadership We can make progress in the following areas using our progression framework for system transformation and innovation. 1. ‘We Can’ co-produce and co-deliver with people and communities • Integrated Community Care • Insight and Oversight • Co-production • Community-centred approaches • Co-delivery with people and communities • Reward, recognition, remuneration, and communication 2. ‘We Can’ prevent ill health, inequalities and injustice • Preventing ill-health • Tackling inequalities • Addressing injustice The following factors are driving our need for a ‘Future Shift’ in health and care 1. Our changing world 2. Our changing population 3. The state of health and care 4. Our local system learning 5. New opportunities in medicine, science and technology
a ‘Future Shift’ enable a ‘Future Shift’ 2. How care is delivered in a more viable future • More local, holistic and seamless care • Care led by people and communities • More technology enabled self-managed care • Workforce development • Building trust with the population 3. How we invest our time and resources • Moving on from the status quo • Investing in system working • Risk, governance and regulation • Financial investment • Commissioning and transformation • What we measure 3. ’We Can’ deliver more holistic, neighbourhood based care • General practice • Integrated Neighbourhood Teams (INTs) • The Voluntary, Community, Faith and Social Enterprise (VCFSE) Sector • Residential and domiciliary care • Allied Health Professionals (AHPs) • Advanced practice 4. ‘We Can’ make more use of technology and innovation • Innovation • New technologies • Artificial Intelligence (AI) 4. How we innovate • Innovating based on the ‘Jobs to be Done’ • Innovation and using new technology • New treatments • Ethics • Working with innovators 5. How we approach transformation • A progression framework for system transformation and innovation • Building the right foundations • Doing things smarter • Doing smarter things • Reimagining health and care 5. ‘We Can’ learn from data, evidence, knowledge and intelligence • Integrated care records • Population Health Management (PHM) • Learning from evidence and research • Learning when things go wrong 6. ‘We Can’ make better use of our existing resources • Anchor organisations • Simplifying our system • Doing it once, doing it well, doing it together • Educating our workforce for the future • Environmental sustainability ‘Future Shift’ at a glance
Suffolk and North East Essex Integrated Care System 8 1. Introduction 1.1 Our Integrated Care System We know that joining up care leads to better outcomes for people. When as local partners – the NHS, councils, voluntary sector and others – we work together, we can create better services based on local need. Integrated Care Systems (ICSs) were set up to make this happen with the aim of improving health and care services – and a focus on prevention, better outcomes and reducing health inequalities. Suffolk and North East Essex ICS is one of 42 ICSs in England that were formally established under the Health and Care Act (2022). Each ICS is a local partnership that brings health and care organisations together to develop shared plans and joined-up services. They are formed by NHS organisations and upper-tier local councils in that area and also include the voluntary sector, social care providers and other partners with a role in improving local health and wellbeing. The aim of Integrated Care Systems is to: • improve outcomes in population health and healthcare • tackle inequalities in outcomes, experience and access • enhance productivity and value for money • help the NHS support broader social and economic development In Suffolk and North East Essex we see our ICS as an organic ‘ecosystem’ rather than a hierarchical or mechanistic structure. Our ICS includes a range of ways that partners work together: • Integrated Care Partnership (ICP) – the NHS ICB and upper-tier local authorities in the ICS – Suffolk County Council and Essex County Council – co-chair a statutory joint committee called an integrated care partnership (ICP). This is a broad alliance of partners who all have a role in improving local health, care and wellbeing including social care providers, the voluntary, community and social enterprise sector and others with a role in improving health and wellbeing for local people. The ICP sets the long-term strategy to improve health and social care services and people’s health and wellbeing for the whole ICS and also has some additional responsibilities to enable system learning and support continued development of the system. • NHS Integrated Care Board (ICB) – this is the NHS organisation responsible for planning health services for the local population. There is one ICB in each ICS area. The ICB manages the NHS budget and work with local providers of NHS services, such as hospitals and GP practices, to agree an NHS Joint Forward Plan which says how the NHS will contribute to the ICP’s integrated care strategy. • County Councils are responsible for social care and public health services in the ICS area, as well as other vital services that contribute to health and wellbeing such as housing,
Future Shift 9 education, leisure and transport. They also must have regard to the ICP’s integrated care strategy when planning and making decisions. • Alliances – three place-based partnerships that design and deliver integrated services for a particular local area. Like the ICP, they involve a range of people interested in improving health and care, including the NHS, local councils, the voluntary, community and social enterprise sector, and other local organisations, working alongside local people. • Voluntary, community, faith and social enterprise (VCFSE) organisations bring their local expertise in working with people in the communities where they live. In Suffolk and North East Essex ICS local VCFSE organisations come together through our ICS VCFSE Assembly and are represented on our Integrated Care Partnership and the NHS ICB Board. • Social care providers bring expertise in supporting wellbeing and independence for people with disabilities, with mental ill-health and older people. They provide specialist care and support to people who can no longer live independently. Care associations in Suffolk and Essex represent the view of local residential and domiciliary care providers. • Provider collaboratives bring together providers of local services to plan, deliver and transform. They are partnership arrangements of at least two trusts, working across multiple places with a shared purpose. NHS England has asked all acute and mental health trusts to be part of a provider collaborative. • Other mechanisms – we also have a whole variety of other mechanisms within our system, that convene groups of people, using their collective knowledge, expertise, and experience to build networks and partnerships that ensure the right people and partners work together in a focussed way. These allow the right voices to contribute to improve health and care at different geographic and sector levels. Suffolk and North East Essex ICS – three alliance areas
Suffolk and North East Essex Integrated Care System 10 1.2 Our ICS Integrated Care Strategy A key role for the ICP is to generate the ICS Integrated Care Strategy that sets the direction of the whole system across the ICS footprint. Our Suffolk and North East Essex ICS Integrated Care Strategy sets out the collective ambition of all partners to improve health and care outcomes and experiences for our local population. It has evolved over time through an inclusive process involving stakeholders from across Suffolk and North East Essex including people with lived experience, clinicians and other professionals, elected leaders and others. A simple way to summarise our ICS Integrated Care Strategy is as our ambition to achieve a ‘Left Shift’ in the health and wellbeing of people living in Suffolk and North East Essex by enabling more people to live well for longer. We believe that this can be achieved by weaving each of the following five principles through everything that we do: Children and Young People Start Well Be Well Stay Well and Feel Well Age Well Die Well 2. Support more people to live well for longer by preventing disease and slowing progression 5. Build a culture of ‘Can Do’ Care – person centred, innovative, integrated, safe, compassionate, just and fair Specialist Centres Acute Settings Primary Care & Neighbourhood Health VCFSE Sector & Local Communities People Powered Health & Care People who are Healthy People with a Long Term Condition People with multiple Long Term Conditions People Living with Frailty People at End of Life Suffolk and North East Essex ICS Integrated Care Strategy - guiding principles 1. Start with Why?’ better outcomes for everyone 3. More neighbourhood and people powered solutions 4. Address both health and healthcare inequalities for everyone
Future Shift 11 1.3 From ‘Left Shift’ to ‘Future Shift’ Over the last year we have further developed our thinking about how we can achieve a ‘Left Shift’ moving the conversation in our ICS further forward. We have challenged ourselves deeply about what may be stopping us from transforming our current service system and delivering our ‘Left Shift’ ambition. We have considered honestly how we can achieve a ‘Future Shift’, drawing on the ‘untapped potential’ in our ICS. These conversations about ‘Future Shift’ have been cross sector and whole system considering a broad variety of perspectives - including public health and communities, general practitioners, secondary care clinicians, allied health professionals, VCFSE sector organisations, university students, social care providers, workforce planning leads, digital programme leads, universities, frontline integrated neighbourhood teams, NHS commissioners, place based alliances, local health and wellbeing boards and others. Content gathered during these discussions is available on our ICS website: sneeics.org.uk ‘Future Shift’ events, summer 2024
Suffolk and North East Essex Integrated Care System 12 1.4 Why this document is important This document is important because it builds on and is a significant extension to our ICS Integrated Care Strategy. It describes our collective vision for working towards a more viable future through the ‘untapped potential’ of Suffolk and North East Essex ICS. Over the last few months it has become increasingly apparent that our renewed ambition for a ‘Future Shift’ in Suffolk and North East Essex is both timely and similar to the ‘three strategic shifts’ recently outlined by the Secretary of State for State for Health (2024) in response to the report by Lord Darzi who was commissioned by the new government to undertake an ‘Independent Investigation into NHS Performance’ (see section 2.3): • Move from hospital to community care. • Transition from analogue to digital technology. • Shift focus from treating illnesses to preventing them. Our system is complex, with many different strategies and plans underpinning the diverse elements of our ICS ecosystem and our individual organisations. We have agreed as an ICS to devolve decision-making and action planning to those best placed to make changes at a local level, with the support of leaders who can embrace and manage complexity. To enable and sustain the local flexibility and autonomy that local partners and networks need, this document deliberately does NOT include a detailed action plan. Instead, it sets out powerful principles to hold one another collectively accountable for enabling a ‘Future Shift’. PERSON We find THIS model works BETTER for US! Our ‘Future Shift’ in Suffolk and North East Essex ICS – the short version!
Future Shift 13 2. Our vision for WHY we need a ‘Future Shift’ 2.1 Our changing world Our world is changing. The twenty-first century has brought with it unprecedented challenges including globalisation, new social and economic trends, climate change, defence and security issues and population change. Significant developments across the fields of science, medicine, technology and artificial intelligence impact every part of our lives. In the health and care sector in particular they offer the opportunity to transform not just what we can do, but also the way that care can be delivered, where and by who. The consequences of all of this are fundamental to health and care. In England we are seeing changes to both the scale and profile of demand with pressures on health and care services. There is unprecedented and increasing demand for many services driven by a rising population particularly among older age groups, more people with complex health and care needs and more people living in deprivation. Spending on health and care continues to increase not only in terms of taxpayer funded public services and also personal expenditure on private optical, dental and other areas of healthcare. Health and care is a significant employer with the largest and most diverse workforce of any industry sector. And yet, people’s experience of health and care regularly falls short of the quality and standards that we want to achieve and we know that far too often people, communities and our staff experience a broad range of injustice and inequalities. In short we know that we simply cannot sustain current expectations of service performance and care quality without changing the way that we work. We need to respond to all of these changes now and work together towards building a health and care system that aims to meet the needs of our citizens, leveraging the opportunities from the foundations we have, working smarter and working towards a renewed vision for the delivery of health and care in Suffolk and North East Essex.
Suffolk and North East Essex Integrated Care System 14 2.2 Our changing population Our population is changing. It is increasing, and people’s needs are becoming more complex. Understanding how it changes over time will be essential to preparing for the increased demands we anticipate across our health and care system. Thinking differently about how our system needs to change and grow will be crucial to developing an effective response that protects health and care services for the most vulnerable. Meeting these challenges will mean taking a longer term approach to our strategic, workforce and financial planning. Forecast percentage change in Suffolk and North East Essex population by age group, 2018-2032 All ages 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 -20% -10% 0% 10% 20% 30% 40% 50% 60% 70% 80% Around 1.1million people are registered with general practices in Suffolk and North East Essex. Our population is growing and is, in many parts of our geography, older than the national average. By 2032, our local population will be around 8% larger than it was in 2018, with approximately an extra 75,000 people living in the area. The greatest increase in this demographic growth will be amongst the 60+ year olds and especially amongst the eldest age groups e.g. 80+ year olds. By 2032, there could be around 33,000 additional 80+ year olds living locally, an increase of around 54% on the 2018 population.
Future Shift 15 An ageing population is expected to place additional demands on health and care services. For instance, locally, the average 80 to 89 year old sees their GP nine times per year, compared to just three times for a working age adult. Life expectancy is expected to increase, but the average age at which people are expected to be living with major illness is projected to remain constant. Consequently, we can expect more people to be living with comorbidities, many of which are typically managed in primary care but can lead to complex healthcare needs when not identified early and treated. Projected total number of diagnosed cases for the ten conditions with the highest impact on health care use and mortality among those aged 30 years and older England 2019-2040* Dementia Constipation Heart Failure COPD Atrial fibrillation Chronic Kidney disease Cancer Anxiety or depression Diabetes Chronic pain 1m 2m 3m 4m 5m 6m 7m 8m +45% +45% +92% +37% +51% +34% +31% +16% +49% +32% 2019 2040 From our population segmentation modelling we know that long-term conditions already drive much of the demand and associated costs in our ICS, largely due to the high number of people living with long-term conditions. Conditions associated with cardiovascular disease, including hypertension and atrial fibrillation, which can contribute to stroke or heart failure, feature consistently as drivers of demand and associated costs locally, along with other long term conditions including diabetes, asthma, and chronic kidney disease. Frailty and hospital admissions for falls and fractures can also lead to lengthy stays in hospital as well as complex care needs in the community. Using our data and analytics we can obtain insights on what the future looks like and start making decisions on how best to plan for these challenges. The first Marmot Review; Fair Society, Healthy Lives (2010), was published by the Institute of Health Equity, and identified the health inequalities challenge facing us. In particular, it drew
Suffolk and North East Essex Integrated Care System 16 attention to how our health is closely linked to ‘wider determinants’ – the conditions in which people are born, grow, live, work and age, and inequities in power, money and resources. Inequalities in health and life expectancy follow the social gradient, and the gradient in healthy life expectancy is steeper than that of life expectancy, meaning that people in more deprived areas spend more of their shorter lives in ill-health than those in less deprived areas. This situation has declined further since that initial report. A follow up report ten years on (Marmot et al., 2020) showed that life expectancy had stalled since 2010, the amount of time people spend in poor health has increased, mortality rates have also increased for people under 50, having been undermined by social and economic conditions. This creates a greater than ever imperative to work together as an Integrated Care System to address the causes of health inequalities. Insights into our population in Suffolk and North East Essex The greatest increases in segment sizes are observed in high-cost segments, meaning system costs will grow disproportionately to population size Half the population is ‘living well’ 1 in 4 have a long-term condition People living with long-term conditions and/or frailty have a greater level of healthcare need and account for When isolating the effect of a single condition, factors associated with feel well, such as homelessness, self-harm, and drug abuse, have the greatest direct impact on average individual’s care costs The cost of caring for those with long-term conditions has the greatest impact on total system cost, due to the large size of the segment. Frailty, as well as falls and fractures, and dementia, is also associated with high cost, as is end of life care We can assess the impact of long-term conditions on how they affect people moving from good health to poor health or into poorer health. Additionally, we can assess if the conditions are directly linked to high care costs or are associated with high costs due to frequency of comorbidity Across these perspectives, cardiovascular conditions feature consistently, along with diabetes, asthma, and chronic kidney disease of system costs
Future Shift 17 2.3 The state of health and care The Independent Investigation of the NHS in England 2024 In July 2024, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS (Darzi, 2024). In September 2024 this was published. Lord Darzi’s report outlined a number of findings, however the opening messages were very clear; the National Health Service is in serious trouble. This sits within the context that NHS performance has been affected by the deterioration in the health of the nation, following a plateau during the 2010s and a decrease in life expectancy during the COVID-19 pandemic. The following is based on the findings and data from the Darzi report, together with a small amount of local data for context. The report details that performance issues are characterised by several challenges: Access Waiting times missed consistently for a decade and satisfaction at all time low, people struggle to see a GP. We have almost 16% fewer fully qualified GPs than other high-income countries. “GPs are seeing more patients than ever before, but with the number of fully qualified GPs relative to the population falling, waiting times are rising and patient satisfaction is at its lowest ever level. There are huge and unwarranted variations in the number of patients per GP, and shortages are particularly acute in deprived communities.” ...and 1 in 4 people (24.8%) are not satisfied with their overall GP experience 24.8% Last year we increased the size of the workforce in General Practice but almost one in five (18%) people are waiting over two weeks to see their GP... 18% ...General Practice delivered a record number of appointments, almost six million in total (5.84 million). 5.84m For Suffolk and North East Essex, in 2023-24... A number of GP appointments are not urgent or emergency in their nature: planned in advance for more than 2 weeks; 18.3% of local GP appointments are for planned clinics, and 16.7% are for planned clinical procedures. Community waiting lists have hugely increased. More than 1 million people are waiting for community services, including more than 50,000 people who have been waiting for over a year, and about 1 million people are waiting for mental health services (April 2024). Accident and Emergency Services are in a bad state and long waits contribute to 14,000 additional deaths per year. In 2010, 94% people attending a type 1 or type 2 A&E were seen within four hours; by May 2024 that figure had dropped to just over 60%. Elective waits have increased massively with 15 times more people waiting more than a year.
Suffolk and North East Essex Integrated Care System 18 ...though the number of people waiting over 65 weeks has decreased to around 900, down from over 2,000 at the end of 2021-22 experience. 900 Over 5,600 people have been waiting more than one year... 5,600 ...there are now over 120,000 people on the elective waiting list, up by a third from 2021-22. 120k In Suffolk and North East Essex... Quality of care Cancer care lags behind other countries. In the UK no progress whatsoever was made in diagnosing cancer at stage I and II between 2013 and 2021, and referral to treatment times take longer than they should. Since then, rates have risen from 54% to 58% in 2023, with notable improvements in the early detection of lung cancer due to the targeted lung check programme. Early cancer detection is at 61.4% in Suffolk and North East Essex Previous improvements made in premature mortality rates from cardiovascular disease have declined, as rapid access to treatment has deteriorated. The time for the highest risk heart attack patients to have a rapid intervention to unblock an artery has risen by 28%. Dementia has higher mortality rate in the UK than other OECD20 countries, and only 65% of people diagnosed, with no improvements in dementia diagnosis rates for years. Funding According to the Darzi report, funding is misaligned to strategy. There is too great a share of funding in hospitals – increasing from 47% to 58% since 2006, and 13% of people in acute beds are waiting for social care support or care in more appropriate settings. The number of hospital staff has increased sharply – 17% since 2019, yet there has not been a proportional increase in appointments, operations, and procedures. There have not been similar staff increases in primary care, community, and mental health. Between 2009 and 2023 the number of nurses working in the community fell by 5%, while the number of health visitors, who can be crucial to development in the first five years of life, dropped by nearly 20% between 2019 and 2023. Patients are no longer flowing through hospital properly, leading to 7% fewer outpatient appointments per consultant and 18% less activity for each clinician working in emergency care.
Future Shift 19 The Darzi report also details a number of main drivers of the NHS performance reduction. These include declines in social determinants of health, an increase in multiple long-term conditions and a reduction in the uptake of health protection measures. The Darzi report states that the 2010s were the most austere decade since the NHS was founded. In this period many of the social determinants of health – such as poor-quality housing, low income, insecure employment, drove increased ill health and therefore demand. At the same time, spending grew in real terms at just 1% per year, against a long-term average of 3.4%, when adjusted for demographic change, it effectively flatlined. There was no increase in capital spending, medical training, or public health spending. Capital budgets were used to cover revenue deficits. A £37 billion shortfall in capital means that there are outdated facilities and diagnostic equipment. There is too little automation, and parts of the NHS are yet to enter the digital era. The combination of austerity and capital starvation helped define the NHS’s response to COVID-19. The NHS entered the pandemic with higher bed occupancy, fewer clinicians, and capital assets than comparable systems. The NHS delayed, cancelled, or postponed far more routine care during the pandemic than any comparable health system. There is strong evidence that post-pandemic, more staff felt disengaged, burnt-out, and exhausted. Patients feel less empowered to make choices about their care and the patient voice has not been loud enough, with patient satisfaction with services declining and the number of complaints increasing. British Social Attitudes Survey The Darzi report underlines the findings of the British Social Attitudes Survey 2023 (Jeffries et al., 2024). This found that public satisfaction with the NHS is at an all-time low, due to problems accessing services, deteriorating NHS performance and funding problems. People are also dissatisfied with social care resourcing and the support available for unpaid carers. However, the public overwhelmingly supports the founding principles of the NHS, and wants a well-resourced and functioning health and social care system. British Social Attitudes Survey Findings The public still agree with the three principles of the NHS: 91% agree it should be free of charge 82% agree that the NHS should be available to everyone 82% agree that the NHS should be primarily funded through taxes Satisfaction with services: 34% were satisfied with GP services 24% were satisfied with NHS dentistry services 44% were satisfied with outpatient services 35% were satisfied with inpatient services 31% said they were satisfied with A&E services Survey respondents said their highest priorities for the NHS were: Making it easier to get a GP appointment (52%) Increasing the number of staff in the NHS (51%) Improving waiting times for planned operations (47%) Improving waiting times in A&E (45%)
Suffolk and North East Essex Integrated Care System 20 The challenges for people navigating a siloed and fragmented health and care system We all know that navigating the health and care system to find help can be a frustrating and lengthy experience. The system often creates barriers to people moving into and between services, through access criteria and eligibility thresholds, and the bureaucracy of referral processes and pathways. As a result, people can miss out on potential support or fall between service gaps. “Last time I rang up the surgery I said, ‘Would the doctor come out please, I’m not feeling at all well and I can’t get to the surgery.’ They just told me to call an ambulance, so that’s what I had to do.” Our health and care systems are traditionally founded upon the idea of eligible needs, that the individual has a health problem or a function of daily living that they need support to manage or resolve. This is a medical model of health that takes an individualised approach, assuming that treating or managing an illness or impairment will resolve the person’s problem. By contrast, the social model of health recognises that people’s needs are complex, involving not only their mind and body but the contexts in which they live. Disabled people are disabled by society’s inflexibility to adapt to their needs for independence and a fulfilled life. Ethnic minority communities live with the daily pressures of entrenched racism in our society. The misogyny embedded in society means women’s needs are routinely minimised, leading to delays in diagnosis and care. Within a social model, it is health and care services who need to change, not the individual. We need to see people as whole, complex beings, not simply a list of diagnoses. Without this we will never succeed in enabling people to have the best possible health and wellbeing. “Believe me, if I could get out that door and walk to the top of the road, then I’d be in my element. All I want is to go to the front door, stand there for some fresh air, and if I feel like it then I could take a few steps and walk for a bit. But I can’t even open the windows on my own.” People face barriers to accessing health and care services for numerous and complex reasons. Some are simply not aware of services, due to lack of available or accessible information. Others may not understand information about the support they could be entitled to, through their own impairments or because those around them do not communicate information, options and choices in an effective way. Many people face significant pressures in their lives, including work, family or caring responsibilities; these, as well as limited options for travel, mean that accessing services available only in limited places or at limited times in the day, can seem impossible. Life stresses can also lead people to place the health and wellbeing needs of others, those they care for, before their own. A failure to recognise the causes of these barriers, and a failure to adapt services around people’s needs, perpetuates the inequalities that people face. “I have had a good life, I’m not complaining, but I’ve never been so unhappy as I am now. You get to over 80 and they don’t want to know. It’s just sad.” With grateful thanks to Elsie, who shared her story with us.
Future Shift 21 2.4 Our local system learning In Suffolk and North East Essex we are committed to sharing and learning from experience. There are a number of key messages from campaigns over the last four years which have demonstrated to us why we need a ‘Future Shift’. Reflections on System Learning from COVID-19 (March - September 2020) During summer 2020, after the first wave of COVID-19, we carried out a system learning review of our experiences during this extraordinary time. We found that COVID-19 had further amplified the many existing inequalities in our communities, and going forward we would need to plan for everyone, the many and the few. However, we had also underestimated the adaptability, flexibility and resilience of communities, and that maintaining our workforce’s safety and resilience was now vital. In recovering our services we knew that we would need to build a better future where we use technology more effectively, have the right data and intelligence, and invest in a joined up way, so that together we can make more informed decisions and deliver high quality care. COVID-19 Vaccination Inequalities We know that many people experience inequalities in accessing and achieving good outcomes from services, and this was seen most starkly during the COVID-19 pandemic, with ethnic minority communities and disabled people dying from the disease at much higher rates than the general population. When the COVID-19 vaccines became available, we quickly realised that not everyone had access to them due to lack of knowledge or assurances about their safety, difficulties in accessing clinics, or worries about the vaccination experience. We assessed the potential impact of inequality of access and co-produced solutions to ensure people had the information and experience they needed to access the vaccine. We learned that a co-produced person-centred approach is vital to delivering services in the right way. ‘How do we Heal?’ from COVID-19 As the pandemic progressed and we started to enter a ‘new normal’ in our daily lives, we started as a system to consider ‘How do we Heal?’ as individuals and families, as communities, Bishop Martin Seeley, Bishop of St Edmundsbury and Ipswich As the pressures of Covid19 begin to subside we are all beginning to think about how we will move forward again into the future. Suffolk and North East Essex Integrated Care System | 1 How do we Heal? System Learning Summit Suffolk and North East Essex Integrated Care System (ICS) Online event Wednesday 16 June 2021 1. Introduction We know that Covid19 has affected each of the one million people living in Suffolk and North East Essex in very different ways. So for us all to move forward we need to think about how each of us feel and how we can build on our experiences of the past year. We all need to think about ‘How do we heal?’. Our event brought together thinking from a broad range of conversations that have taken place across Suffolk and North East Essex as part of the ‘How do we Heal?’ Campaign. The programme also included the announcement of the winning films from the ‘How do we Heal?’ community equalities film competition ‘How do we help everyone heal?’. Our Chair was Bishop Martin Seeley, Bishop of St Edmundsbury and Ipswich. Bishop Martin opened the event by reflecting that healing is always about hope so where there is healing there is hope and we have seen this throughout the pandemic with the focus on, and gratitude for healthcare workers and the NHS. The work that they have done and do has brought hope into uncertainty and anxiety. As we look ahead, we are asking what healing do we need that will not just enable us to recover but will bring hope? Healing relates to medical, physical , mental, and spiritual but also to communities, relationships and the divisions and distinctions that have painfully and shockingly come to the fore: divisions around wealth and poverty, race, age and disability – divisions brought into sharp focus by the virus. We have learned to recognise that globally we are in the same storm, but we are not all in the same boat. As some pass by, apparently unaffected in their luxury yachts, others are grasping at a plank to stay afloat. Others started in what seemed like a seaworthy boat but the storm has been just too great. Healing is about individual and communal health and healing our divisions so that no one is left out as we move forward. These are the themes we are going to explore – asking ‘How do we help everyone heal?’ You can learn more about ‘How do we Heal?’ including our Community Conversations, our Equalities Film Competition and the reports of our events here. We want to encourage more Community Conversations, if you are interested in holding a conversation please get in touch by clicking here.
Suffolk and North East Essex Integrated Care System 22 as a workforce, and as a health and care system. In Spring 2021 we listened in varied ways to people’s experiences and their priorities for the future and held two system learning events to capture a range of perspectives from across the system. Among our learning about ‘How do we Heal?’ we identified the need for kindness and compassion, as everybody matters. We also committed to listening and helping our workforce recover from trauma, grow and develop, and be resilient. System Learning from Winter Pressures 2022/23 In May 2023, ICS partners came together to reflect and learn from the unprecedented system pressures that had been experienced the previous winter. We learned that people seeking care were more unwell, with increases in mental illhealth and more complex needs due in part to the impacts of the pandemic and recent cost of living crisis. Collaboration with partners and communities, innovation and the best use of technology would be key to moving to a more viable future. In September 2023, Integrated Care Partnership members identified further opportunities to prepare for increased pressures, including focusing on the causes of poor health outcomes, setting priorities and planning early, providing compassionate care, and empowering our workforce to innovate and lead change. ‘Uncomfortable Truths’ Our ‘Uncomfortable Truths’ campaign during 2023-24 explored why entrenched inequalities persist in health and in wider society and what we should do to tackle them in a more effective way. We held three events for system leaders, the first considering why we need to address culture to improve outcomes for people. We explored the evidence and recognised that we know the right thing to do but still don’t do it; we don’t take the time to understand inequalities and poor experiences; we don’t do enough to create and value a diverse workforce; and we don’t take responsibility for our action and inaction. We concluded we need to come together to take effective collective action against injustice. Reports of all our ICS system learning campaigns are available on our ICS website: sneeics.org.uk 1. Introduction Friday 12 May 2023 - Adastral Park, Ipswich ICS System Learning from Winter Pressures 2022/23 Dr. Ed Garratt, CEO NHS Suffolk and North East Essex, Susannah Howard, ICP Director and Dr. Tim Nye, West Suffolk Hospital After a short introduction to the day from ICP Director Susannah Howard, Ed began by thanking everyone present for their considerable efforts over the past year, recognising it was a year like no other in terms of the impact of the pressures upon services. We now have an opportunity to take stock and think about how we can redouble our efforts in the coming year. In Suffolk and North East Essex we have a culture of learning, and this report will help us to be stronger as we move forward together. This is important for our communities because as ESNEFT says, ‘Time Matters’. Too often local people have been on the wrong side of time. Currently we have over 110,000 patients on waiting lists, and over 5,000 people waiting over a year for elective care. We have concerning patient safety issues: in our emergency departments we have seen a steep rise in waits over 12 hours which increases risks of ill-health and morbidity, and delays in ambulance handovers which prevent ambulances from a timely response to support people back in the community. There have been concerns about access in primary care, particularly in dentistry, and a steep rise in mental health issues, particularly self harm among children and young people. Our communities want us to improve in these areas. We thank our staff, who are very creative, compassionate and committed. But they are facing a very difficult situation, they have been under huge pressure, having to sustain increased demand but also facing shortages in resources, together with the cost of living and concerns about fair pay. Even with all these concerns, we have seen incredible innovations in the past year. For example, we now have some of the most sophisticated technology in social care today, the Cassius service in Suffolk has received over 3,000 referrals in the past year with a 98% satisfaction rate and a demonstrable impact on keeping people healthy and independent. Our neighbourhood teams are making a real impact, now with the benefit of population health management technology capabilities. Our Alliances continue to mature and see the benefits of joined-up working with the NHS, social care and community organisations. We are modelling integrated care in the community hub recently developed with the ambulance trust, which is proactively supporting people waiting for ambulance response and successfully keeping them independent in their community. 1 | Suffolk and North East Essex Integrated Care System 10 November 2023 WON’T DO CAN DO WeWON’T DO Injustice in WHY? UNDERSTANDING INJUSTICE HOW? TACKLING INJUSTICE WHAT? ENDING INJUSTICE CAN DO Uncomfortable Truths Part 1: WHY as system leaders we need to address culture to improve outcomes Thanks to Colin Gray of East Suffolk and North Essex NHS Foundation Trust for the powerful photographs of staff in masks during the outbreak. Chair, Amanda Lyes, Interim ICS Director of Workforce As the significant recent pressures of Covid-19 begin to subside we are beginning to think about how we will move forward again into the future as a health and care system. We know that Covid-19 has affected each of the one million people living in Suffolk and North East Essex in very different ways. So for us all to move forward we need more than just a plan – we need to think about how each of us feel and how we can build on our experiences of the past year. We all need to think about ‘How do we heal?’. Amanda Lyes, Chair of this event, explained that today’s event had been organised as part of our wider ICS ‘How do we heal?’ Campaign in Suffolk and North East Essex specifically to consider the issues for our health and care workforce as we move out of the Covid-19 pandemic. The outputs of the event will contribute to the forthcoming ICS ‘How do we heal?’ summit on 16 June 2021. The event focused on three main themes: WHY we need to heal, HOW we can heal, and WHAT we can do moving forward, followed by a panel discussion. ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page Suffolk and North East Essex Integrated Care System | 1 How do we Heal? Our Health and Care Workforce Suffolk and North East Essex Integrated Care System (ICS) Online event Wednesday 2nd June 2021 ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page ESNEFT life...your magazine Issue 4: Autumn 2020 10 Hospital amateur photographer captures eyes behind the masks These powerful photographs of ESNEFT colleagues wearing personal protective equipment (PPE) were taken by hospital colleague Colin Gray (pictured right). Colin is a clinical skills technician who worked in a COVID-19 ward at Ipswich Hospital during the height of the pandemic. He said: I wanted to give the people I work alongside something to look back on in years to come.” We shared a selection of the photographs online and they were viewed by more than 25,000 people. 11 Send your items to...ESNEFT life See back page for details See more photographs on our ESNEFT Facebook page 1. Introduction
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