Agenda and minutes

21.1     The Committee agreed the minutes of the meeting held on 29 September 2016.

22.1     Apologies for absence were received from Cllr Sam Adeniji (Lewes District Council), Cllr Bridget George (Rother District Council) and Julie Eason (Speak Up).

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

23.1     There were no disclosures of interest.

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part 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 urgent.

24.1     There were no urgent items.

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.

1.1.        The Committee considered a report informing it of the work being undertaken to redesign urgent care services in Eastbourne, Hailsham and Seaford and Hastings and Rother as part of the East Sussex Better Together (ESBT) health and social care transformation programme.

GP recruitment and GP sign up to urgent care redesign

1.2.        Dr Mark Barnes, ESBT Clinical Director, highlighted the fact that GP shortages were a national issue but the Urgent Care Programme Board is working very hard to make the role of GPs in the Eastbourne, Hailsham and Seaford and Hastings and Rother areas as attractive as possible, for example, by developing a locum bank for GPs so that newly qualified doctors can work in GP surgeries as locums in the hope that it will encourage them to take up the position long term; and offering mixed portfolio careers for young doctors where they are jointly appointed by the CCGs and East Sussex Healthcare NHS Trust (ESHT) so that they split their time between GP surgeries and other clinical areas.

1.3.        Dr Barnes explained that the urgent care workstream involves plans to encourage GPs to work together within localities and as part of GP federations in order to ensure that there is consistency within the new urgent care system. However, GP surgeries are independent business and so it can be difficult to enforce changes on their working practices.

1.4.        Amanda Philpott said that the extent to which GP practices want to become involved in ESBT wide initiatives and new contracting arrangements will vary. Some GPs will wish to continue as completely independent businesses; others may see benefits to taking up different options.

1.5.        Amanda Philpott added that one of the challenges in developing the Accountable Care Model for ESBT will be how to include independent GP services within the model.

Role of Health and Social Care Connect (HSCC) and face to face contact

1.6.        Dr Mark Barnes explained that the role of the Health and Social Care Connect (HSCC) within the new urgent care model will be as a consistent triage point for patients. Patients not in need of emergency care will be transferred by 111 to HSCC, where they will be assessed and potentially referred to the new Urgent Care Integrated Hubs located at the walk-in centres in Eastbourne and Hastings for same day urgent care access. HSCC will be upskilled to include doctors and nurses who will carry out the triage. Patients advised by HSCC to visit the Urgent Care Integrated Hubs will be able to see a clinician within thirty minutes of arriving.

1.7.        The two walk-in centres will provide face-to-face contact for patients in Hastings and Eastbourne. There may be potential to develop further face-to-face contact hubs in places such as Hailsham, Seaford and Rye to ensure that advice and assessment is spread across the county.

Role of 111

1.8.        Pauline Butterworth, Programme Director for Urgent Care, explained that 111 services will be re-procured to become a call handling service acting as a first  ...  view the full minutes text for item 26.

1.1.        The Committee considered a report providing an update on the Patient Transport Service (PTS) in Sussex.

1.2.        Alan Beasley, Chief Finance Officer, High Weald Lewes Havens (HWLH) Clinical Commissioning Group (CCG) updated the Committee on recent developments with the PTS:

·         Performance continues to improve according to the statistics, although the data is subject to quality assurance by the CCG’s PTS specialist and there remain performance issues to be worked on.

·         The sudden closure of Docklands Medical Services (DMS) has had minimal impact on patients as Coperforma has secured alternative capacity.

·         Payments were made to all staff of DMS by HLWH CCG in September and October and have been organised for November. They have also been organised for December if required.

·         Coperforma wrote to the seven CCGs that commission the PTS to say that it was not economic for the company to continue to provide a PTS in Sussex. Although this communication was unexpected, the CCGs activated their contingency arrangements which involved approaching South Central Ambulance Service to take over the contract. SCAS is rated good by the CQC and has recently been awarded the PTS contract for Surrey.

·         HLWH CCG welcomes the six ‘areas of improvement’ issued by the Care Quality Commission (CQC) following its inspection, and welcomes the CQC’s involvement in the transition process.

·         The CCGs are undertaking a transparent, phased process of transferring the contract to SCAS that will begin early next year and be complete by 31 March 2017. This process is based on the recommendations of the independent report by the TIAA into the adequacy of the mobilisation arrangements for the PTS contract.

·         Coperforma will continue to deliver the remainder of its contract and is committed to continuing to improve its performance.

·         Other subcontractors have expressed concerns to the media about alleged underpayment by Coperforma. HWLH CCG is mediating between the parties and talks are progressing well.

1.3.        Alan Beasley and Maninder Dulku, PTS Programme Director, HWLH CCG, gave the following responses to questions from the Committee.

Reason for a ‘no fault’ termination

1.4.        Alan Beasley explained that all CCGs involved in the PTS contract agreed that a managed transfer to SCAS would be in the best interests of patients, and in order to do that it was necessary to declare a ‘no fault’ termination of the contract. The CCGs looked at the financial costs, impact on patients, and timescales to change the contract without a managed transfer, and agreed that the risk and cost to patients was too high, particularly as the contingency plan with SCAS was already in place. 

Recommendations of the independent report

1.5.        Alan Beasley said that the TIAA review included a recommendation to hire a patient transport specialist which has been actioned – HWLH CCG has employed Maninder Singh Dulku as the PTS Programme Director. The review also made recommendations regarding managing transfers between providers and the CCG is acting on these by agreeing a phased transfer between Coperforma and SCAS to be completed by 31 March 2017.

Transfer  ...  view the full minutes text for item 27.

28.1     The Committee RESOLVED to agree the work programme.