Issue - meetings

11.       

12.       

12.1.      The Board considered a report on the progress with developing the East Sussex Health and Social Care Plan.

12.2.      The Board whether further integration of Children’s Services Department (CSD) with the NHS is planned in East Sussex

12.3.      Stuart Gallimore, Director of Children’s Services, said that there has been a clear commitment to further integration of age appropriate care with the NHS, for example, Sussex Partnership NHS Foundation Trust’s (SPFT) Child and Adolescent Mental Health Services (CAMHS) have moved into the Children’s Services Single Point of Advice (SPOA) to ensure anyone calling the service about a young person will be able to receive the relevant advice from the appropriate person in a single phone call. 

12.4.      The Board asked what plans the CSD had to consult with the health services about contributing towards the cost of Education, Health and Care Plan (EHCP) assessments.

12.5.      Stuart Gallimore said that the CSD’s Inclusion, Special Educational Needs and Disability (ISEND) Service works with health colleagues on producing EHCPs, but he agreed that further collaboration is always possible and that he would raise this matter with his ISEND managers.

12.6.      The Board asked why autism appeared to be listed as a mental health disorder and not a disability.

12.7.      Keith Hinkley, Director of Adult Social Care and Health, agreed that this point been fed back during the engagement activity and autism would be presented as a disability in the future. Dr Adrian Bull, Chief Executive of East Sussex Healthcare NHS Trust (ESHT), agreed that autism was not a mental health disorder but that many of the interventions for autism are provided by the mental health trust, SPFT. He said there is currently an issue where autism is assessed by one organisation and ADHD by another but there is a significant overlap of these two population groups. Work is therefore underway at ESHT and SPFT to create a single assessment service.

12.8.      The Board asked whether it was possible to align funding streams with the integrated health and care programme by removing the Payment by Results method of funding NHS providers.

12.9.      Jessica Britton, Managing Director of Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) and Hastings and Rother CCG (HR CCG), explained that different ways of commissioners contracting providers to deliver services are being tested across the country. This year the CCGs in East Sussex have begun testing with ESHT ways to ensure that incentives are aligned to reduce demand and avoid perversely incentivising organisations at the cost of the wider system.

12.10.   Dr Adrian Bull added that a specific example of avoiding perverse incentives was the decision this year to agree to remove the charge NHS organisations are able to levy on a local authority where a patient’s stay in hospital beyond a medical need to do so – known as Delayed Transfer of Care (DTOC) – is the fault of the local authority.  Instead of this arrangement, ESHT and East Sussex County Council (ESCC) have agreed a joint  ...  view the full minutes text for item 12

13.1     The Committee considered a report providing an update on the most recent developments with the Sussex and East Surrey Sustainability and Transformation Plan (STP).

13.2     Wendy Carberry, Senior Responsible Officer for the STP provided a presentation and answered questions from Members of HOSC.

Effect of STP on Connecting 4 You

1.1.        Wendy Carberry said that the CCGs in the Central Sussex and East Surrey Area (CSESA) South plan to merge some back-office functions by April 2018. She confirmed that this will not affect the implementation of High Weald Lewes Havens Clinical Commissioning Group’s (HWLH CCG) Connecting 4 You (C4Y) programme – which is the model of care for the HWLH population – or its constituent services such as Communities of Practice, the frailty pathway, and the Golden Ticket dementia pathway. She argued that these services are starting to come together rapidly and the C4Y programme is not as far behind other placed-based plans as it may appear.

CSESA boundary

1.2.        Wendy Carberry confirmed that the boundary between CSESA North and South has been fixed. The North will comprise Horsham and Mid Sussex, Crawley and East Surrey CCGs and the South will comprise Brighton & Hove and HWLH CCGs. She said that some functions will be carried out jointly with Brighton & Hove CCG, some with the other CCGs in the CSESA area, and some across the whole STP.

Funding for healthcare

1.3.        Wendy Carberry explained that there is no specific extra money that will be provided to deliver the placed-based plans such as C4Y or ESBT. Dr Bull added that the predicted funding gap by 2020 is based on comparing the trend for healthcare funding with the trend for increasing healthcare needs. The prediction is that the increase in healthcare need is much greater than the expected funding increases but funding itself will not decrease relative to the current levels, so there is no expectation that CCGs will have to reduce spending below current levels. He said that the health and social care organisations must align themselves in such a way as to reduce future demand by using existing resources better. The challenge and tension at the moment, however, is to protect investment in community based care to reduce future demand whilst also addressing significant funding challenges in acute care.

Use of ICT in healthcare

1.4.        Dr Adrian Bull said one of the main initiatives across the NHS is to improve the adoption rate of new technologies that help clinicians deliver healthcare. The NHS will increasingly need to support the development of apps and other ICT that will enable patients to take control of their patient records so that expert patients can manage their own conditions, such as diabetes. NHS Digital is encouraging this through an accreditation programme for new healthcare apps, such as those that remind you when to take prescription medicine, which are listed on its website. Dr Bull added that technology can also be used to help detect diseases, for example, a handheld device that has been rolled  ...  view the full minutes text for item 13

- Presentation by Chief Officer Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) / Hastings and Rother Clinical Commissioning Group (HR CCG)

9.1       The Board considered a presentation providing an update on the progress of the Sussex and East Surrey Sustainability and Transformation Partnership (STP).

9.2       In response to questions from the Board, the following answers were provided:

·         The recruitment of a Chair for the STP Executive Board is on hold following the national assessment of the progress of all STPs by NHS England. NHS England has recognised the size and scale of the challenges in East Surrey, and Sussex and the plans to address them, and has rated the STP in the category needs most improvement.

·         The investments made so far through ESBT in crisis response and frailty services have led to a 78% reduction in readmissions to hospital after 90 days, which is bucking the trend of emergency admissions nationally.  This shows the value in investing in community based care. The STP-wide workstreams, such as those around ICT and shared care records, will help to underpin these improvements.

·         There is a recognition that the scale of the STP is important for certain workstreams, such as those around workforce, that are not economical at place-based plan level.

·         The ESBT programme has taken considerable time and effort to make the progress it has made to date, and further integration is still required. ESBT is a lot further ahead than other place-based plans in the STP area, so the lessons and best practice from the ESBT programme need to be passed to the others.

·         Engagement with stakeholders, staff and the public is critical to the success of the STP. The place-based plan level, however, is a more appropriate level for meaningful patient engagement on behalf of the STP.

9.3       The Board RESOLVED to note the presentation.

1.1.        The Committee considered a report on the progress of the Sussex and East Surrey Sustainability and Transformation Plan (STP).

1.2.        Amanda Philpott, Chief Officer, EHS CCG/HR CCG provided a presentation to the Committee on behalf of Wendy Carberry, who is the Senior Responsible Officer for the STP and who had to give her apologies for the meeting.

Date for competition of STP review of acute care

1.3.        Amanda Philpott said that the CCGs are anticipating three or four options from the STP review of acute care to be publically available by June or July, with pros and cons for each option – due to the pressure on resources there are unlikely to be any risk free options.

STP Review and refresh

1.4.        Amanda Philpott explained that one of the reasons for the STP review and refresh is member organisations’ desire to adapt how they work together within the STP to ensure that the STP adds value to the population it serves.

1.5.        Amanda Philpott said that NHS England had a good insight into the reason for creating the 44 STP footprints, for example, around trauma and tertiary care areas, and has an important role in ensuring that national and strategic issues are considered by CCGs when redesigning services within the footprints – the STP wide work needs to complement the place-based plans, i.e., ESBT and C4Y for East Sussex.

1.6.        Amanda Philpott told HOSC that the ESBT place-based plan has materially influenced the STP as its core building blocks, and in that sense the STP process has been ‘bottom-up’. However, that influence is within the wider context of an STP programme that is nationally mandated and overseen by NHS England. For the STP to succeed, these place-based plans have to succeed in enabling greater and more efficient care to be provided in the community.

1.7.        The Committee RESOLVED to:

1) note the report; and

2) request a further update on the progress of the STP in September unless there is significant progress with the development of the STP prior to the Committee’s June meeting.

– Report by Chief Operation Officer High Weald Lewes and Havens CCG

27.1     The Board considered a report by the Chief Officer, High Weald Lewes Havens CCG, providing an update on the progress of the development of the Sussex and East Surrey Sustainability and Transformation Plan (STP).

27.2     In response to a query from the Board, the Chief Officer clarified that the Acute Clinical Strategy was in a 12-week option appraisal stage that would be completed by the end of March.

27.3     The Chair highlighted to the Board that Hastings Borough Council (HBC) had passed a motion at its 14 December 2016 Full Council meeting about the STP. The motion called on East Sussex County Council to reject the STP unless it adhered to the British Medical Association’s ‘Five Asks’, and was redesigned to be made coterminous with county boundaries. The motion instructed the leader of HBC to write to Amber Rudd MP, Cllr Keith Glazier, and the Secretary of State for Health to make them aware of its concerns.

27.4     The Board RESOLVED to note the report.

1.1.        The Committee considered a report on the Sussex and East Surrey Sustainability and Transformation Plan (STP).

1.2.        Wendy Carberry, Accountable Officer, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG), and the nominated Senior Responsible Officer (SRO) for the STP, provided the Committee with a presentation. Keith Hinkley, Director of Adult Social Care and Health, East Sussex County Council (ESCC); Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG)/ Hastings and Rother Clinical Commissioning Group (HR CCG); and Dr Adrian Bull, Chief Executive, East Sussex Healthcare NHS Trust (ESHT), were also in attendance.

Place based plans

1.3.        Keith Hinkley clarified that, due to the complexity of the STP’s footprint, the STP was not a single individual plan but instead comprised three place based plans within its footprint: East Sussex Better Together (ESBT), Central Sussex and East Surrey Alliance (CSESA) (of which the Connecting 4 You (C4Y) programme in HWLH is a part), and Coastal Care. This means that the details of the STP in East Sussex have largely already been set out in ESBT and C4Y and have been through, or are going through, full governance and engagement processes.

Composition of STP Executive and Board, and representation of district and borough councils

1.4.        Wendy Carberry explained that the STP Executive comprises 10 Members including a Chair, Senior Responsible Officer, commissioning leads for the three footprints, and specialised commissioning leads (including for community health and mental health). Keith Hinkley, as Commissioning Lead for the East Sussex Better Together programme, is the only local authority representative on the Executive.

1.5.        The STP Programme Board comprises 23 representatives, including representatives of each of the four top tier local authorities: Brighton & Hove City Council, East Sussex County Council, West Sussex County Council and Surrey County Council.

1.6.        Keith Hinkley explained that although there was no direct district and borough council representation on the STP Board, each of the three place based plans was developed locally by the upper tier local authorities and CCGs in consultation with district and borough councils.

Development of ESBT

1.7.        Amanda Philpott said that ESBT formally launched in August 2014. However, planning for an integrated health and social care system had started at an earlier date as a means to address the challenges in the East Sussex health and social care economy which had been unsustainable for a number of years, and is set to become more so with the ageing population, increased healthcare costs, and tightening budgets.

1.8.        Keith Hinkley explained that the implementation of ESBT is more advanced than the other place based plans. An integrated Strategic Investment Plan (SIP), commitment to developing an Accountable Care Model, and commitment to a transitional year of Accountable Care during 2017/18, have all been agreed by ESCC, HR CCG and EHS CCG with provider partners. The C4Y programme is expected to develop in a similar way.

Public engagement

1.9.        Keith Hinkley said that ESBT is in week 122 of implementation and engagement with the public has  ...  view the full minutes text for item 25

-       Report by Chief Officer, High Weald Lewes and Havens CCG

7.1       The Board considered a report by the Chief Officer of High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG) providing an update on the progress of the Sussex and East Surrey Sustainability and Transformation Plan (STP).

7.2       The Chair argued that, due to the changing landscape of health and social care, the STP cannot afford to be anything but transformational; sustaining the status quo for health and social care was not an option and new ways of working would need to be developed.

7.3       In response to questions, officers made the following key points:

·         The STP is attempting to address the same questions as the ESBT and Connecting 4 You programmes around the radical transformation of how care is provided in communities. It is critical to the success of the STP that it is built around place-based ‘systems of care’ where services are delivered collaboratively and built around communities. STP comprises four Places: ESBT, Coastal Care, A23 North, and A23 South (which encompasses the Connecting 4 You area). Successful place-based systems of care will require collaboration between NHS organisations and service providers – including district and borough councils and the community and voluntary sector. As a result, engagement with stakeholders will be ongoing across organisations.

·         The engagement process will be through the ESBT and emerging Connecting 4 You programme infrastructure. Healthwatch East Sussex has been working with other Healthwatch organisations in the Sussex and East Surrey area to ensure that the community and voluntary engagement looks the same across the STP footprint.

·         The development of the Sussex and East Surrey STP – although a national initiative – has been heavily shaped by local NHS and social care organisations. For example, the integration of health and social care via ESBT has helped to shape the plans for the STP including the use of integrated teams, and the key role of small district general hospital – such as the Eastbourne District General Hospital – in place-based solutions.

7.4       The Board RESOLVED to note the report.

10.1     The Committee considered a report by the Assistant Chief Executive about the purpose and process of developing a Sustainability and Transformation Plan for Sussex and East Surrey.

10.2     The Committee RESOLVED to request a further update in December 2016 focusing on the implications for East Sussex.