Agenda and minutes

8.1.        The minute of the meeting held on 16 July were agreed subject to the inclusion of the following amendments:

8.2.        Amend 5.8 to include:

The Board asked about what is being done to reduce differences in deprivation and life expectancy and whether a useful surrogate is available to measure improvements in life expectancy, given that it takes many decades for policy changes to be reflected in increased life expectancy.

8.3.        Amend 7.13 to read:

“People’s expectations also need to change so they don’t always expect to see a GP as clinical pharmacists, advanced nurse practitioners, and paramedics are all able to provide health care advise as effectively as GPs in certain circumstances, and sometimes more so due to their specialities.

8.4.        Amend 7.14 to read:

“It is hoped similar figures could be seen in East Sussex as PCNs become established.”

9.1       Apologies for absence were received from the following members:

·         Cllr Trevor Webb

·         Deborah Tomalin

·         Siobhan Melia

9.2       The following substitutions were made:

·         Cllr Leah Levane substituted for Cllr Ruby Cox

·         Rob Tolfree substituted for Darrell Gale

·         John Childs substituted for Samantha Allen

·         David Kemp substituted for Mark Andrews

10.1     Cllr Rebecca Whippy declared a personal interest as the CEO of Embrace.

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

11.1     There were no urgent items.

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.

11.       

12.       

13.       

13.1.      The Board considered a report providing an update of progress against the priority objectives and lead Key Performance Indicators for the health and social care programme in 2019/20.

13.2.      The Board asked whether there was sufficient funding in the system to deliver the objectives of the health and social care programme.

13.3.      Keith Hinkley explained that the objectives have been identified with the help of clinical leadership as objectives that, if delivered, will have the greatest impact on the health outcomes of the local population based on the best use of available resources. Significant progress has been made in terms of developing new integrated services and developing a structure within which the objectives of the health and social care programme can be delivered, however, there remains issues with clinical and financial sustainability of the health and care system and further work is still needed to integrate the health and care system. This work includes developing how the commissioning partnership will work and how providers will work to deliver care within an Integrated Care Partnership (ICP).

13.4.      The Board asked whether extra financing will be made available to help meet the objectives of “growth prevention in A&E attendances not to exceed plan” and “Growth prevention in non-elective admissions”.

13.5.      Dr Adrian Bull clarified that these objectives refer to demand for A&E and not its performance. The Trusts two A&Es are not achieving the 95% 4-hour referral to A&E but are currently at 90% or above, making the trust one of the top 20 performing trusts in the country. He attributed this in large part to the integration work within the health and care system. The red ‘RAG’ rating was reflecting the higher than planned number of people attending A&E, as the trust is seeing continued increase in demand above that which was predicted.

13.6.      The Board asked why there was still a rising tide of demand for health and social care across the country despite increasing efficiency of the system.

13.7.      Dr Adrian Bull explained that the East Sussex Urgent Care Board has commissioned some work to understand the reasons for the increase in attendance at A&E and a report will be published in due course. He said there was an increase nationally, but it has been faster in East Sussex. However, it worked out as a slower increase if you normalise the age demographic to the national average.

13.8.      He said that the increase in non-elective admissions is due to an increase in the acuity of patients attending at A&E, although ambulatory care capacity is in place to treat people within a shorter timeframe. Attendance in A&E was also increasing due to a greater number of working age people attending who could otherwise have attend a primary care appointment but were worried about their GP’s availability and knew they could get a same day appointment if they attended A&E.

13.9.      Dr Bull agreed  ...  view the full minutes text for item 13.

11.       

12.       

13.       

14.       

14.1.      The Board considered a report providing a summary of the Better Care Fund (BCF) requirements for 2019/20, summary of the East Sussex plans and arrangements for the Section 75 Pooled Budget.

14.2.      The Board asked whether, once the cost inflation of health and social care was taken into account, the figures for BCF funding for 19/20 was higher than 18/19.

14.3.      Keith Hinkley explained that the national funding formula for the baseline BCF funding allocation are adjusted for inflation, although in some service areas costs will have inflated above the previous funding amounts. It is also important to remember the funding from the BCF is targeted in the areas that will have the greatest effect on financial and health outcomes. Furthermore, it is a pooled budget required nationally but is one aspect of a far broader agreement between health and care services locally to invest resources together.

14.4.      The Board asked whether an investment of £135,000 was sufficient for the High Intensity User Service given their cost to the system.

14.5.      Keith Hinkley confirmed that this is one specific project and all elements of the BCF are in effect targeted at patients with complex and multiple needs, as was pooled funding more broadly, as they are now the core business of the health and social care system.

14.6.      The Board asked whether the difference in urban and rural need is measured.

14.7.      Keith Hinkley said demand and available resources are modelled across health and social care in East Sussex. There is no simple answer to whether demand is greater in urban or rural areas, however, because the modelling is needs and demand-led, rather than locality, and services in urban and rural have different costs depending on whether the rural or urban area is more or less deprived, e.g., there is greater demand for mental health care in Hastings than Lewes. It is required in the Long Term Plan, however, that commissioning is organised around populations at a locality-level, and there are also specific actions required around reducing health inequalities.

14.8.      The Board RESOLVED to:

1) Note the requirements for 2019/20 Better Care Fund

2) Approve the East Sussex Better Care Fund Plans for 2019/2020 and their alignment with the East Sussex response to the NHS Long Term Plan

3) Note the plan for a single Section 75 Pooled Budget to be in place by 15th December, in line with BCF planning requirements

15.1     The Board RESOLVED to agree the work programme subject to the following amendments:

·         Addition of a a report on the children and young people mental health and emotional wellbeing review;

·         Addition of the Healthwatch Rural listening tour to the 10 December meeting; and

·         Moving the next annual Healthwatch report to the 14 July 2020 meeting