Our vision is to deliver equity of health outcomes for all pregnant and birthing people across Sussex, and equality of experience for maternity and neonatal staff delivering their care, so pregnant and birthing people in Sussex achieve health outcomes that are as good as the groups with the best health outcomes in our population.

We will achieve this by empowering all birthing people in Sussex to make informed choices about their care – supported by collaborative relationships with healthcare staff, access to care in the community, and services which are co-produced to meet their needs.

Through this work, in future we will not only ask if our services are safe, compassionate, and accessible overall, but if they are equitably safe, compassionate, and accessible for everyone, measuring our progress and success. To do this we will need to:

• Improve equity for pregnant and birthing people from BAME groups, those living in the most deprived areas, and those whose young maternal age makes them at-risk
• Improve the equality of experience for maternity and neonatal staff from BAME groups

Our additional aims for where we want to be at the end of each of the three years from 2022 to 2025 are expressed as System-wide goals in Section 3.

Our maternity services transformation will be based on three fundamental principles:

• Proportionate universalism – deliver universal service improvements for all, whilst targeting effort and investment in a way that reflects the needs of the most disadvantaged groups
• Collaboration – work together with the widest possible range of partner organisations at Place-level, because maternity and neonatal services cannot alone improve perinatal equity and equality
• Co-production – continuously involve service users and staff in planning and design, ensuring that a representative range of voices and experiences informs how we identify and deliver improvements. (To demonstrate our positive track record in successful co-production, case study examples feature throughout this document in pale blue boxes.)

This plan is the delivery mechanism for the perinatal equity aspects of Sussex Health and Care Partnership’s (SHCP) Core20PLUS5 approach, and a key mechanism for meeting the ambitions set out in Sussex 2025: Our vision for a healthier future and the Sussex Strategic Health Inequality Framework. It is a vital step in delivering fairer and more equitable care across Sussex.

Sussex has a population of 1.7 million people, of which 15% – 25% are women aged between 16 – 44 years of age. Birth rates have been broadly stable since 2013 and are forecast to remain constant through to 2025, with the picture consistent across the region.

Sussex LMNS brings together the maternity service providers, perinatal mental health service providers, commissioners for health and public health and local authority colleagues with maternity and neonatal service user representatives, known as Maternity Voices Partnerships (MVPs).

Together the maternity and neonatal service providers – University Hospitals Sussex NHS Foundation Trust (UHSx), East Sussex Healthcare NHS Trust (ESHT), and Surrey and Sussex Healthcare NHS Trust (SASH) – provide care for approximately 16,500 Sussex births each year, delivering maternity services within three acute providers and across seven sites. Maidstone and Tunbridge Wells NHS Trust (MTW) also provide some maternity services in East Sussex. Additionally, Sussex Community NHS Foundation Trust (SCFT) and ESHT provide health visiting services, while Sussex Partnership NHS Foundation Trust (SPFT) provides specialist perinatal mental health services across the system. The Sussex LMNS works collaboratively with the Sussex Mental Health Programme on perinatal mental health and wellbeing.

There are significant pockets of multiple deprivation across Sussex. These are shown in darker purple below, and include areas such as Rother in the east, parts of Hastings, Wealden and Brighton and Hove in the south, and Arun (particularly Littlehampton and Bognor Regis) in the west. In the north, Crawley has the highest number of deprived areas.

There are three Local Authorities in Sussex – Brighton & Hove City Council, East Sussex County Council and West Sussex County Council – who are responsible for commissioning health visiting, prevention services and a range of other services that impact on the wider social determinants of health and wellbeing.

The perinatal population of Sussex access maternity and neonatal services from providers in three Local Maternity and Neonatal Systems – Sussex, Surrey Heartlands and Kent & Medway LMNS – and two Neonatal Operational Delivery Networks – Hampshire, and Kent, Surrey, Sussex – making it one of the most complex in the country.

We are committed to delivering a safe, high-quality, and personalised maternity journey for all. In our 2019 LMNS Plan, we identified health inequalities and unwarranted variation as a key challenge and have been working to improve and address this.

Whilst we have made significant progress, we know there are still differences in how birthing people from different populations access and experience maternity and neonatal care and the outcomes associated with this. For Sussex, the key challenges are:

1. Large and diverse population with differing needs
2. Increased risk of poor maternal and foetal outcomes in some underserved groups
3. Variation in risk factors, healthy behaviours and health and care needs between cohorts
4. Workforce inequalities, including underrepresentation of minority groups at senior levels and differential workforce experience

Large and Diverse Population with Differing Needs

Sussex has one of the largest geographical footprints in the country with a diverse population, which presents challenges to delivering a standardised, high-quality service and reducing inequities.

Whilst our overall Sussex population is predominantly white (93.7%) with large areas of relative affluence, we have significant pockets of need. Our local communities vary substantially in terms of deprivation, rurality, ethnicity, and age distribution – these factors can be associated with significantly worse maternal and foetal outcomes and poor access to care.

• Ethnic Minority groups (incl. Traveller and refugee groups): 1.5-2 times higher infant mortality rates for BAME birthing people than for White birthing people, 2-4 times increased risk of maternal death, increased risk of miscarriage and poor antenatal care. During COVID, women and birthing people from an Asian background were four times more likely to be admitted to hospital.
• Deprivation: babies born to women and birthing people in the 20% most deprived areas have a 30% increased risk of neonatal mortality, a higher likelihood of congenital abnormalities, increased risk of low and very low birthweight, and poor access to care with late booking. There is a 2 times higher risk of maternal deaths for those living in the 20% most deprived areas.
• Young birthing people: 60% higher infant mortality rate for babies born to teenagers, a 20% higher risk of low birthweight babies and a 30% higher risk of perinatal mental health issues. Babies born to teenagers experience poorer long-term socioeconomic outcomes (for example, by age 30, 22% are more likely to be living in poverty).
• Older birthing people: greater risk of maternal morbidity incl. gestational diabetes and eclampsia, higher risk of miscarriage, growth restriction and preterm birth, reduced choice of birthplace offered and greater rate of interventions
• Those living with disabilities: poorer maternal wellbeing and pregnancy outcomes, including pre-eclampsia, pre-term birth, low birth weight and 2 times higher risk of stillbirth or infant death
• Rural populations: poor access to care including emergency and routine specialist services, reduced choice (especially birthplace), increased risk of mental illness
• Coastal communities: poorer health outcomes, including higher perinatal mortality and perinatal mental health disorders than in non-coastal Sussex communities, and increased prevalence of maternal and neonatal risk factors

We need to reduce these inequalities for our populations – this will require us to work differently in terms of how we use resources, how we assess the impact of the decisions we make and how we look at new ways in which everyone can have equitable access to appropriate services.

Some groups may require more intensive support and additional help to access services – this plan sets out how we will tailor our services to target the needs of our local populations and offer a personalised maternity journey that wraps around the individual and their family.

Increased Risk of Poor Maternal and Foetal Outcomes in Some Underserved Groups

Nationally, the 2021 MBRRACE-UK and National Child Mortality Database (NCMD) reports show the stark differences in outcomes and experience for birthing people from Black, Asian and Mixed ethnic groups, and those that are socioeconomically deprived. The reports show that while neonatal mortality rates are improving, they aren’t improving equally for women and birthing people of different ethnicities, or women and birthing people from affluent and deprived areas. Also, there is national variation in the quality of care for neonates.

We believe this picture to be consistent locally. Although we do not consistently record our outcomes by ethnicity, age, or deprivation, where data is present it is in line with the national picture. Going forwards, capturing, and reviewing outcomes by cohort will be key to tailoring our maternity and neonatal services and taking a population health approach for our perinatal population Sussex.

Delivering improvements in perinatal and maternal mortality and personalised maternity services will require engagement and outreach to these seldom heard groups, to build trust for effective co-production and understanding of their experience. We will work to co-design services to target the specific needs of these populations, giving all women and birthing people a greater voice in the perinatal services they use and enabling shared decision-making in their care. This collaborative relationship is essential to improving safety and quality in maternity services, including morbidity and mortality.

Variation in Risk Factors, Healthy Behaviours and Health and Care Needs

Historically, Sussex has seen a high prevalence of modifiable maternal risk factors, namely maternal smoking – particularly in East Sussex – and – as identified in our 2019 LMNS Plan – obesity rates above national targets.

Maternal smoking is associated with a 47% increase in risk of stillbirth, a 27% increased risk of pre-term birth and an 82% increased risk of a low birthweight baby as well as increased risk of congenital abnormalities of the heart, limbs, and face. Women and birthing people who are overweight or obese have an increased risk of experiencing complications in pregnancy and/or labour such as gestational diabetes, thromboembolism, miscarriage, and death.

We have put in place targeted interventions to address these risk factors and promote healthy behaviours but need to tailor these further to target groups that have disproportionately higher risk. We know:

• Maternal smoking rates, especially in early pregnancy are higher than national average for those in the most deprived 20% and for those from white backgrounds
• Most minority BAME groups have higher rates of abstinence and lower levels of drinking compared to people from white backgrounds
• Like smoking, women and birthing people from more deprived backgrounds are more likely to be obese at booking, with rates decreasing in line with increasing affluence.
• Nationally, Black women and birthing people are more likely to be overweight or obese in pregnancy (66.6% compared to 49% national average, according to analysis of the 2017 Maternity Services Dataset)

There is a complex relationship between risk factors and population demographics. For example, while we know smoking rates are higher in deprived groups around Hastings and East Sussex, this high rate is driven mainly due to high maternal smoking rates in teenage and young birthing people. Building on the regional ‘Ready for Pregnancy’ and ‘Ready for Parenthood’ campaigns we will develop targeted, culturally nuanced prevention interventions, using the Making Every Contact Count approach to health promotion.

Workforce Inequalities

UHSx has a maternity and neonatal team of over 1000 people (807 WTE), and ESHT has a team of 399 (331 WTE) across clinical and non-clinical roles.

The overall ethnicity profile is broadly in line with the surrounding population (85% from a white background at UHSx, 91% at ESHT). A higher portion of medical staff are from BAME backgrounds (54% white background at UHSx, 40% at ESHT), with midwifery and nursing and support staff more likely to be from white backgrounds (91% – 93% white backgrounds at UHSx and ESHT.

We know that staff from a BAME background face disadvantages – this has been shown nationally, and local data supports a similar picture in Sussex. This includes:

• Lower representation in senior, very senior, and Board level roles. At UHSx the proportion of BAME WTE per band (clinical and non-clinical roles) consistently declines from 25.8% at Band 1 to 6.2% at Band 9. 71% – 81% of BAME employees believed that there are equal opportunities for career progression vs 86 – 89% of white employees across ESHT and UHSx, (WRES 1).
• Lower likelihood of staff being appointed from shortlisting. Locally, white applicants are 1.62 times more likely to be appointed to senior roles at UHSx East (previously BSUH), 1.55 times more likely at UHSx West, and 1.07 times more likely at ESHT, (WRES 2).
• Greater likelihood of staff entering the formal disciplinary process. The local picture is mixed – at UHSx West, BAME staff are 1.88 times more likely to enter formal processes, while at UHSx East, white staff are 0.19 times more likely to be subject to a formal process. There is no significant difference in rates at ESHT, (WRES 3).
• Lower likelihood of staff accessing non-mandatory training/CPD. White staff are 1.07 times more likely to access training compared to BAME counterparts across UHSx, but the reverse is true at ESHT, (WRES 4).
• Greater percentage of staff experiencing harassment, bullying, or abuse from staff. Across UHSx and ESHT, 15% – 16% of BAME staff reported discrimination from managers, team leader, or colleagues compared to 6-7% of white staff, (WRES 6).
• Greater percentage of staff experiencing harassment, bullying, or abuse from patients, relatives, or the public. 29.3% of BAME staff at ESHT and 33% – 34% at UHSx reported experiencing this, vs 23.4% and 28% – 31% of white staff respectively, (WRES 5).
• Lower percentage of staff believing there are equal opportunities for career progression or promotion Across UH Sx and ESHT 71.6% – of BAME staff report that they believe there are equal opportunities compared to 85.7% – of white staff, (WRES 7).
• WRES 8 – A greater percentage of staff personally experiencing discrimination from their manager, team leader of colleagues – Across UHSx and ESHT 15.5% – of BAME staff report they experience discrimination from their manager, team leader, or colleagues compared to 7.1% of white staff, (WRES 8).

For Our Users and Our Population

• Safer, more personalised care delivery offered by small teams who get to know and understand their population groups’ health needs and target their services accordingly
• Pregnant and birthing people consistently achieve health outcomes that are as good as those who currently have the best outcomes
• Babies and infants consistently receive the best possible start in life – improving readiness to learn, educational achievement, income, and economic status over their lifetime
• Continuity of Carer is offered to all pregnant and birthing people and provided to at least 75% of BAME birthing people and those from 20% most deprived areas through targeted and enhanced models to help reduce the risk of adverse outcomes in for these groups. Women and birthing people who receive continuity of midwife-led care are 16% less likely to lose their baby and 19% less likely to lose their baby before 24 weeks. They are also 24% less likely to experience pre-term birth

For Our Teams and Our People

• Maternity and neonatal staff have consistently high levels of support to flourish in their work and provide the best possible care
• Increased staff satisfaction through ability to form personal, collaborative relationships with women and birthing people and follow them through their journey
• A workforce that is better representative of the population it serves and more able to deliver personalised, culturally sensitive care
• Unlocking the potential of all our staff will strengthen our community and our ability to sustainably provide high-quality care

For Our System and Organisations

• Support from perinatal services is universally available to all and additionally targeted to where it is most needed
• Staff and service users are proactively and systematically involved in co-production across service design, improvement, and delivery – to ensure services are matched to population need
• Long-term system benefits including improved health and quality of life, reduced demand and reduced cost to health and social care services

Our plan starts from an in-depth understanding of the communities we serve, their needs and how our services can be adapted to better meet these. It builds on a detailed understanding of where we are now against the five national priorities – see Appendix 2.

We have defined an initial 3-year plan – setting out the key milestones and system-wide goals to deliver against the five national priority areas. The actions needed to deliver this are grouped into six areas comprised of nationally mandated interventions, best practice guidance and local actions. Each Place has co-designed a targeted local plan, bringing together providers, commissioners, service users, the LMNS, public health and local authorities.

To have the largest impact we are starting with the largest population groups (those from a BAME background, those from the 20% most deprived areas, young birthing people), whilst we further develop our granular understanding of local populations’ needs at district/ neighbourhood levels.

Our approach builds on the work to date in three keyways:

1. By focusing on common population groups in each Place, we can identify and understand common needs which need to be addressed regardless of location and level of deprivation
2. By developing local analyses, we will be able to increasingly understand the needs of that community in the context of their local environment and the wider social determinants of their health – preventing us viewing population groups in a fixed way due to single or limited characteristics
3. We are developing our capacity to understand intersectionality within our population

We recognise this approach is not comprehensive, and there are several groups that will need enhanced support and targeted services to ensure equity of outcomes. This includes those living with disabilities, those from refugee and migrant backgrounds, those from the Traveller community and those with other protected characteristics (e.g., religion, sexual orientation, marital status).

We commit to continuing this work. By further developing our understanding of local communities we will deep dive into the needs of these groups, engaging service users to co-produce and further tailor our actions to meet these. We will take a continuous improvement approach to ensure our services are equitable and designed around the needs of the people and families we serve. Further detail of the metrics to be measured can be found in Appendix 3.

Our Sussex LMNS is crucial to delivering this plan – fulfilling three key roles for the ICS (as set out in our 2019 Local Maternity System Plan):

1. Co-designing services with users and families
2. Supporting organisations to deliver local change
3. Leading system-wide collaboration and transformation

To fulfil all three roles, we will operate both as an “LMNS at Place” and “LMNS at system”.

For this plan to be effective it needs to be adapted and implemented at a Place level, allowing it to be fully owned and matched to local need. We will support delivery through Place-based perinatal equity steering groups – these groups have been mobilised during planning and will now take a lead role in overseeing and delivering our plan.

The Place-based groups will report into both the LMNS Board and Place-based Executive Leadership Groups, with subsequent upwards reporting through to the SHCP Executive Board.

Governance via the Place-based Executive Leadership Groups will provide the ICS with oversight and assurance of local plans, as well as driving wide-ranging collaboration at local level to support maternity and neonatal service providers. For example, this could entail involving local Equity and Equality Teams, Teenage Pregnancy Leads or One-Stop Drug and Alcohol services.

At the same time, we will assure overall progress against this programme on behalf of the ICS. In addition, some areas of work will benefit from Sussex-wide collaboration at a system level; to support this, the LMNS Board will informally report to and share information with both the Turning the Tide Oversight Board and Population Health and Prevention Board.

Co-production is key to improving our services in the way that best meets the needs of our local population. Sussex has a strong track record of co-production, evidenced by successful examples highlighted throughout this plan. We are committed to involving women and birthing people, their families and support, and staff, in reviewing and refining this plan over the next three years.

To co-produce this plan, we facilitated weekly Place-based working sessions with:

• Maternity Voices Partnership (MVP) Chairs and/or Co-Chairs
• Staff from maternity and neonatal services, including heads of midwifery, matrons, Better Births leads, and service managers for the health visiting service and a specialist young birthing people’s service
• Commissioning leads
• System partners, including representatives from population health, public health, and local authorities

Tactically, we will build on this work in the short-term by:

• Supporting the Place-based working groups who co-produced the plan to transition into formal groups taking a lead role in oversight and delivery
• Circulating the plan to MVP service user representatives and signposting to opportunities for co-production in their relevant neighbourhood or Place
• Uploading the plan onto its website and signposting staff to opportunities for co-production in their relevant Place or organisation

Strategically, we are committed to supporting partners systematically embed co-production into business-as-usual processes. In practice, this means incorporating the following ingredients LMNS-wide – with strong involvement from MVPs:

Right purpose

• Agree a definition and set of guidelines for co-production, distinct from consultation
• Build a culture where co-production is valued and appreciated across all providers and Places
• Identify opportunities for systematic and purposeful co-production – e.g., as a pillar of developing Equality and Health Inequalities Impact Assessments

Right positioning

• Agree principles for how co-production outputs should feed directly into service design and improvement
• Agree principles to identify opportunities for co-production at project initiation stage

Right participation

• Expand targeted outreach to underrepresented groups (building on successful co-production approaches from other programmes such as vaccinations) – e.g., working with trusted community leaders and faith groups to identify community assets, potential service user representatives and accessible physical locations
• Include a range of participation routes – e.g., drop-in sessions, 1:1 feedback with trusted staff, on-the-ground walks, virtual sessions
• Invite MVP representatives to formal governance forums

Right processes

• Put in place a feedback loop to show co-producers the impact of their contributions
• Agree an expanded support offer for co-production participants, including an involvement payment where appropriate
• Coordinate lesson-sharing across the LMNS so providers and Places benefit from shared resources and minimise “feedback fatigue”
• Establish opportunities for regular review of co-production mechanisms in each Place to ensure they follow agreed and best-practice principles

At a Place and neighbourhood level, co-production approaches will be tailored to the local context – supported by these LMNS-wide ingredients. For example, the BAME peer support programme in Brighton run by The Motherhood Group has been working with BAME service users on perinatal mental health and wellbeing to co-produce and inform ongoing support. As another example, UHSx co-produced with Arabic-speaking service users a series of antenatal classes delivered in Arabic.

Places’ core co-production activities are described in the Place-based plans set out earlier in this document. Places will supplement these core activities with specific meetings and dates as they undertake more detailed implementation planning. Activities include, but are not limited to:

1. Co-producing communications – e.g., to inform service users about what the Continuity of Carer pilot roll-out means for them
2. Developing and tailoring key documents – e.g., learning from staff and service users what it takes for Personalised Care and Support Plans to be effective and used well
3. Bringing perspectives from underrepresented voices into service design and delivery – e.g., supporting MVPs engage harder-to-reach groups
4. Further understanding and acting on poor experiences of BAME staff in the workplace – e.g., through curated listening and storytelling exercises
5. Identifying requirements for further training – e.g., informing additional requirements for cultural competency training to supplement ICS-wide training

Appendix 4a sets out the key groups in each Place who can support co-production initiatives. Appendix 4b provides a fuller map of the community assets in each Place.

Implementation Framework

Implementation of this plan will occur at Place level, driven forward by the Place-based perinatal equity steering groups. We will support these groups to effect change on the ground and maintain a focus on delivery at system level. The implementation framework set out below will support the groups to do this. The framework sets out key questions related to what it will take to implement this plan effectively. It will also support a cycle of planning, doing and evaluation through the life of this plan to ensure that the approach set out in the plan become business as usual.

Roles and Responsibilities

We have defined the roles and responsibilities of system partners in delivering this plan, including who will be accountable (A), responsible (R), consulted (C) and informed (I) for delivery of each improvement opportunity sitting underneath the national priorities. A summary is provided in the table below – more detail can be found in Appendix 5.

The Programme Director of the LMNS is the senior responsible owner of this plan for the LMNS. The ICS board-level sponsors of the plan are the LMNS CEO Executive Sponsor and the ICS Chief Nursing Officer who sits as the LMNS Executive Chair. The ICS Executive Manager Director for West Sussex provides ongoing executive oversight of the plan and support to the LMNS Programme Director. The ICS has agreed an NHSE/I funded LMNS core team who will support these senior personnel with their sponsorship and oversight responsibilities.

The Chief Nursing Officers of UHSx and ESHT are the provider board-level safety champions overseeing this plan, leading on maternity and neonatal disparity. They also lead on perinatal health inequalities for their organisations. The Directors of Public Health, CCG Chief Medical Officer and ICS Clinical Director lead on Population Health Management, Prevention and Health Inequalities across the ICS. They are supported by the Programme Director for Population Health Management and Prevention and the core programme team who support these senior personnel with their sponsorship and oversight responsibilities.

Supporting continuous clinical quality improvement

Delivering our vision for maternity services will require ongoing work and improvement – we will continually review our performance as a system, identifying key gaps, unmet needs, and opportunities to improve the quality and experience of our services.

This will need: 1) relationships and collaboration between partners, 2) granular up-to-date performance data, and 3) system-level structures to review and identify target improvement opportunities.

The LMNS Board is our primary mechanism to drive transformation, integrating our work on health inequalities with wider improvements in perinatal safety and mortality, maternal choice, and personalisation. This forum brings together clinicians from across partner organisations to disseminate and implement learnings across the system, including corrective actions from adverse events, new evidence and best practice, and innovative new models of care. These forums will allow us to engage the passion and drive of individuals within local teams, engaging all members in quality improvement and supporting the development of grassroots initiatives.

Multi-professional learning and discussion helps break down boundaries between individuals and organisations and instil an academic rigour in quality improvement projects. This will help service improvements deliver the greatest possible impact and value, whatever their scale.

The LMNS Quality and Safety Forum sits alongside the Board. The Forum will be responsible for reviewing performance data and identifying gaps and priorities – this will feed into the LMNS Board to design and implement mechanisms to address. The Maternity dashboard will develop to include reporting by ethnicity and deprivation for key outcome metrics.

The Quality and Safety Forum will regularly monitor trends in the data to ascertain where changes might be needed in the system approach (e.g., new service user needs leading to new requirements for audit or co-production) and will conduct, at minimum, an annual review to incorporate lessons from national and regional best practice and analysis, including the MBRRACE report. We will facilitate lesson-sharing and spreading of clinical best practices across the LMNS, as per the Perinatal Quality Surveillance Model, to support information flow and improvement across Sussex.

Strong, multi-professional clinical leadership to translate system-level planning into action, within individual organisations. The LMNS has existing membership from the provider Heads of Midwifery and nominated LMNS Obstetric and Neonatal consultant leads. As our role evolves to take on more of an assurance function alongside transformation, we will review our clinical leadership requirements and support for individuals to ensure we have the right seniority and level of clinical engagement needed.

Monitoring of outcomes and progress against the plan

We will champion ongoing high-quality data collection to understand how well the plan is addressing the needs of local populations. The key tool for monitoring outcomes will be the maternity services dashboard, with priority metrics broken down by key demographic groups. See Appendix 2 for a detailed breakdown of where national indicators are already in place, and where these will be broken down by key demographic groups.

Whilst the LMNS will coordinate monitoring of outcomes and progress against the plan, responsibility for this sits at all levels within the ICS:

• Providers will monitor how their service delivery is reducing inequality for users, to understand the impact of interventions and direct local efforts to where they are most needed
• Places will monitor how inequalities are reducing for the population within their geographical area, to identify trends and changing patterns of needs
• The LMNS – on behalf of the ICS – will monitor system-wide progress against deliverables in the plan, together with their impact on reducing inequality, at a system level

To coordinate monitoring of outcomes and progress against this plan we will support the following new information flows to be put in place:

• Following presentation to the Place-based Executive Group, a highlight report will be sent to the LMNS Board. These highlight reports will include progress made against the plan since the last report, next steps, and any requests for additional support from the LMNS
• Annual system-level stocktakes against the plan, reviewing progress, current challenges and additional support needed. This will be aligned with and inform the annual planning round

Managing interdependencies with other ICS workstreams

We will proactively manage key interdependencies with cross-cutting enabler ICS workstreams:

Given the close ties between the vision for this plan and the ICS’s overall Population Health Management, Prevention, and Inequalities programme, we will build on existing links with this programme team and put in place arrangements for regular information sharing – for example, via the existing Place-based weekly meetings that oversee work on addressing health inequalities. When the ICS Population Health Strategy is published, we will conduct a review to ensure that this plan is aligned with the strategy.

There are also close ties between the staff equality elements of this plan and the work of the Turning the Tide Transformation Oversight Board, which has oversight of the BAME population and workforce inequalities. A representative from Turning the Tide was involved in the working groups to develop this plan so far, as well as being involved in additional focussed discussion on the race equality elements. This relationship will continue to develop through delivery of the plan to share best practice. We will proactively engage with the Turning the Tide board to manage interdependencies and report on progress as appropriate.

Financial implications

This plan does not entail committing to increased levels of spending. The key difference will be in how we use the existing money available to us. Our commissioning will be increasingly needs-led and focused on priority target demographics – until this becomes business-as-usual. In line with the principle of proportionate universalism, we will target spending in a way that meets the needs of our most disadvantaged groups whilst still providing service improvements for all. Where any additional revenue or capital investment is needed, system partners will develop specific business cases as per normal ICS processes. Where additional transformation money from national sources is made available, we will ensure that is targeted and spent as intended.

Resourcing

We will map out the extent to which existing programme resourcing, at both system and Place level, covers the capacity and capabilities required to deliver the actions set out in this plan. Following collaboration with Places on this exercise, we will be well-placed to determine if there are any resourcing gaps and how best to address these.

In addition, system partners are committed to this work and will provide resourcing on a business-as-usual basis as part of their involvement – for example, analytical support from the ICS Population Health & Prevention Team, and involvement of local authority public health and commissioning teams in the Place-based perinatal equity steering groups.

The following matrices detail the national improvement opportunities that the LMNS must deliver on in response to NHSEI guidance from September 2021, and the role of relevant organisations and partnerships in achieving them.

The level of involvement, reporting and monitoring describes all levels at which delivery against each improvement opportunity should be reported and monitored on an ongoing basis – System (i.e., LMNS Board), Place (i.e., East Sussex, West Sussex, or Brighton & Hove Executive Steering Group, when established) or Neighbourhood/Organisation (i.e., local organisation Executive Board).

Roles in implementing improvement define responsible, accountable, consulted, and informed organisations and partnerships across the system for implementation of each improvement opportunity, according to the following definitions:

• Responsible (R): the organisation(s) who complete the task.
• Accountable (A): the organisation who is ultimately answerable for the activity or decision. This includes “yes” or “no” authority and veto power. Only one accountable organisation can be assigned to an action.
• Consulted (C): organisation(s) that needs to feedback and contribute to the activity
• Informed (I): organisation(s) that needs to know of the decision or action.

For simplicity, the matrices group all providers into one category. Providers include acute, mental health, primary care, community, health visiting, and where relevant local authorities and early years providers. It is recognised that the RACI category ascribed to the providers category may not apply to all providers equally.

For simplicity, the matrices group all commissioners into one category. Commissioners include CCGs, ICSs, NHS England, Local Authorities, and others where relevant.

Partnerships listed include Sussex Health and Care Partnership (SHCP), Perinatal Mental Health Network (PMHN), Neonatal Operational Delivery Network (NODN), Maternity Voices Partnerships (MVPs), Voluntary, Community and Social Enterprise organisations (VCSEs), and Local authorities (LA).