Background and context
Integrated care system (ICS): Suffolk and North East Essex ICS
Number of places in the ICS: Three
Key partners in the North East Essex place:
- Essex Partnership University NHS Foundation Trust which delivers community and mental health services
- East Suffolk and North Essex NHS Foundation Trust provides acute and specialist physical health services in North East Essex. It is a large acute trust delivering services across multiple hospitals sites in both Suffolk and North East Essex ICS and Mid and South Essex ICS.
- The East of England Ambulance Service NHS Trust delivers ambulance and other emergency care services across the region, including in North East Essex
- Essex County Council, which is an upper tier local authority
- Colchester Borough Council
- Tendring District Council
- Suffolk and North East Essex ICB (formerly commissioning functions were led by North East Essex CCG)
- Primary care services
- Voluntary and community sector organisations.
Key features of the North East Essex population:
- 360,000 people
- mix of urban and rural communities, including some coastal communities which are among the most deprived in England.
Role of the trusts at place
The trusts working in the North East Essex place have a key role in developing and promoting new models of care that can keep local people well in the community, and tackle health inequalities. The trusts in the footprint, all of which operate over multiple place geographies, contribute as strategic and operational partners in the place, contributing service design expertise, providing leadership capability via the alliance, and developing bespoke place-focused collaborative programmes for North East Essex.
Since 2018, health and care partners in North East Essex have been developing a place-based partnership, called the North East Essex Alliance (NEE Alliance). The NEE Alliance has developed its model and ways of working over the last few years: broadly it has moved from being a comparatively informal grouping of local partners, overlaid on traditional planning and commissioning structures, towards becoming a more formal part of the local architecture that facilitates collective decision-making on resources and operational coordination.
One aspect of this shift was the decision to effectively ‘house’ the NEE Alliance within the North East Essex CCG. The CCG governance structure was adapted to establish an Alliance Committee as a sub-committee of the CCG Board. The Alliance Committee comes together to set the strategic direction for the alliance, with a focus on investing in prevention and reducing health inequalities, implementing an asset-based community model of care, building system resilience, and taking a joined-up approach to workforce planning.
An Alliance System Executive Group (SEG) brings together executive leaders from the partnership organisations. This group leads on implementation and operational decision-making in pursuit of the direction of travel set by the Alliance Committee. Different workstreams for the partnership, which are organised using a life course approach, report to the executive group. The Alliance’s strategic objectives have been informed by the Essex health and wellbeing strategy, which provides a county wide view of the population’s health aspirations.
Throughout its existence, the NEE Alliance has modelled multi-agency collaboration in its leadership team. Executive leads from the partner organisations participate in the alliance SEG and lead specific portfolios, alongside their substantive roles in providers or commissioners. The Alliance has sought to ensure some focused non-executive oversight at place level through appointing a chair drawn from the partner organisations. The trusts have reorientated their operational divisions to places; for instance, Essex Partnership University NHS Foundation Trust has created place-focused operational leads for community and mental health services.
Approach to managing collective resources
NHS commissioners and local authorities have worked together to align decision-making where it makes sense, but have not entered into pooled budget arrangements, beyond meeting national expectations around the Better Care Fund. Oversight of the Better Care Fund arrangement for the CCG has sat with the Alliance Committee.
Leaders have increasingly sought to model a mindset of managing resources collectively with minimal technical changes. In that context, alliance forums have provided spaces where leaders can collectively discuss how to prioritise resources and identify opportunities for synergies.
Going forward, the intention is for the NEE Alliance to become the default forum for all key commissioning decisions, acting as a sub-committee of the ICB, and will work with partners across the ICS wherever this will add most value. Similarly, it is expected that alliances will form the basis for the commissioning and management of the Better Care Fund, supporting closer joint working between NHS and local authority services.
Benefits, learning and future priorities
North East Essex has developed in this way for a number of reasons: it is a place within a large two-tier local authority; it is part of an ICS that bridges two upper-tier counties; and the trusts operating in North East Essex are delivering services across more than one place.
Notwithstanding these inherent complexities, the NEE Alliance has provided a focal point for deepening collaboration across the NHS and social care, between trusts, and with wider partners. The trusts see further potential in developing a joined up approach to local planning and delivery.
Trusts in North East Essex also see place-based collaboration as enabling operational improvements, and supporting system partners to think differently about how care models can support early intervention and promote wellbeing. East of England Ambulance Service NHS Trust has identified opportunities to trial new ways of working, for instance, trialling a scheme in which paramedics work more closely with local hospices. East Suffolk and North Essex NHS Foundation Trust and Essex Partnership University NHS Foundation Trust are core partners in a new consortium, along with a range of others including primary and voluntary sectors, to develop an integrated community services offer in North East Essex.