Agenda and minutes

31.1     The minutes were agreed as a correct record.

32.1     Apologies for absence were received from the following Board Members:

• Councillor Carl Maynard
• Stuart Gallimore (Substitute: Brian Hughes)
• Deborah Tomalin

32.2     Apologies for absence were received from the following Invited Observers with Speaking Rights:

• Councillor Sue Beaney
• Councillor John Barnes
• Mark Andrews (substitute: David Kemp)

33.1     Councillor John Ungar declared a personal interest as a member of the patient panel for Green Street Clinic in Eastbourne.

Notification of items which the Chair considers to be urgent and proposes to take at the end of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgently

34.1     There were no urgent items.

·         Report by the Acting Director of Public Health

35.1     The Board considered a report in relation to the Annual Report of the Director of Public Health 2017-2018.

35.2     The Board thanked Cynthia Lyons, Acting Director of Public Health, for her dedication to public health over the years and wished her well in her retirement.

35.3     In response to questions from the Board Members, officers provided the following responses:

·         Environmental Impact Assessments (EIA) are undertaken for every planning application, including for new schools. An EIA would help to inform planners of the potential pollution risk to pupils and the school would likely be designed in such a way as to reduce this risk.

·         There is no proposed reduction in the Public Health Grant. This means that the Public Health team is able to push ahead with investment in prevention services.

35.4     The Board RESOLVED to note the report.

·         Report by the Director of Adult Social Care and Health

36.1     The Board considered a report on the Care Quality Commission’s (CQC) Local Area Review of East Sussex, along with the comments provided by the East Sussex Better Together (ESBT) Scrutiny Board.

36.2     In response to questions from the Board Members, officers provided the following responses:

·         There has been an improvement in quality of nursing and domiciliary care, albeit not to the extent that was hoped, however, there are nationwide issues with the capacity of nursing homes and domiciliary care organisations. This issue is one of the key causes of Delayed Transfer of Care (DTOC) from hospitals that are attributable to Adult Social Care Departments. 

·         East Sussex County Council (ESCC) has stabilised the nursing home market in parts of East Sussex by significantly increasing fees for nursing homes places, however, further work is needed to stabilise the rest of the county. Additional work is also necessary to strengthen the relationship with the domiciliary care market.

·          A revised bedded care strategy is being developed alongside the Council’s Estate Strategy in partnership with the NHS. There is already infrastructure in place to procure care from the market jointly with the NHS to ensure greater influence in the market.

·         The CQC has changed their methodology for inspecting nursing homes and domiciliary care organisations. The CQC will now focus on monitoring the care providers whilst local authorities will focus on supporting the providers to improve the quality of care they provide.  This change will ensure a more collective approach between the CQC and local authorities and avoid duplicating the inspection role.

·         There is an ongoing review of the intermediate care provided by Milton Grange and Firewood House that will lead to a report to the ESCC Cabinet on 26 June. This report will not include proposals to change these services unless there is a clear picture of viable alternatives that can be provided at lower cost whilst retaining the current service’s capacity, which is necessary to ensure patient flow out of acute hospitals.

·         When the CQC conducted the area review they considered whether ESBT and Connecting 4 You (C4Y) were producing different outcomes. Broadly speaking the systems, processes and priorities are the same, albeit with some differences that were highlighted by the CQC, to ensure that what is offered to patients is consistent across East Sussex.  Previous discussions at the HWB have been clear about the difference of views as to whether there should be 1 or 2 integration programmes across East Sussex, with the Council expressing a clear view that a single programme would make most sense in terms of deploying capacity and ensuring there was a coherent commissioning strategy for the local population. The Council continues to remain open to a single East Sussex approach but only if the partner organisations were willing and there was a clear governance arrangement in place.

·         The ESBT and C4Y community resilience work is designed around building strong links with communities and community voluntary sector (CVS) organisations. This is part of a considerable amount of investment  ...  view the full minutes text for item 36.

·         High Weald Lewes and Havens CCG

·         Eastbourne, Hailsham and Seaford CCG

·         Hasting and Rother CCG

37.1     The Board considered updates from two of the NHS CCGs in East Sussex.

Hastings and Rother Clinical Commissioning Group (HR CCG) Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG)

·         Staff across the system were acknowledged and thanked for their work during the particularly difficult winter period.

·         East Sussex Healthcare NHS Trust (ESHT) is not reaching the target of 95% of patients being seen within 4 hours at A&E, but its relative performance puts it in the top 2 performing Trusts in the South East and top 25% in the country. 

·         In order to maintain a responsive service and to avoid too much pressure on staff during the winter period, there were some cancellations of planned care. Once emergency demand has stabilised, the CCGs and ESHT will use all available capacity to reduce the backlog of planned care caused by these cancellations. ESHT did not book a lot of planned care over winter in anticipation of this increased emergency care demand, however, the extended period of inclement weather and flu is having an additional impact.

·         The health economy is very challenged. Both CCGs in the ESBT area will be in deficit for the 2017/18 financial year and only one CCG in the STP is likely to end the financial year in surplus.

·         ESBT has undertaken significant investment in primary care to ensure that the practices are resilient and can treat people in the community. This is in line with all national evidence that points towards integration of health and social care, and investment in care earlier on in the system.

·         17,000 patients from the Cornwallis Plaza GP practice were distributed to other practices in the area. The CCG supported these practices becoming a federation which enabled them to develop the resilience necessary to absorb these patients.   A huge amount of work is being undertaken to increase the GP and GP practice workforce, for example, clinical pharmacists who work across 3-4 practices, and localities of networked practices with multi-professional workforces that support local populations.