Agenda and minutes

8.1       The minutes of the meeting held on 28 June 2018 were agreed as a correct record.

9.1       Apologies for absence were received from Cllrs Boorman, Earl and Murray; and Jennifer Twist.

9.2       The Committee wished Cllr Earl a swift recovery from his illness.

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.

10.1     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.

11.1     There were no urgent items.

1.1.        The Committee considered a report about the financial and clinical sustainability of the NHS in East Sussex including the Financial Recovery Plans (FRP) of the three Clinical Commissioning Groups (CCGs); the progress of the Sussex and East Surrey Sustainability and Transformation Partnership (STP); and the Clinically Effective Commissioning (CEC) workstream of the STP.

1.2.        Dr Adrian Bull, Chief Executive, East Sussex Healthcare NHS Trust (ESHT); Jessica Britton, Managing Director, Eastbourne, Hailsham and Seaford CCG (EHS CCG)/ Hastings and Rother CCG (HR CCG); Ashley Scarff, Director of Commissioning and Deputy Chief Officer, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG); and Samantha Williams, Assistant Director of Planning, Performance and Engagement, East Sussex County Council (ESCC); provided answers to a number of questions from HOSC.

Financial Recovery Plans (FRP) of the CCGs

Details of savings plans

1.3.        Ashley Scarff explained that the C4Y FRP involved delivering £9.2m of savings in order to reach a deficit control total of £10.7m. If this target is reached the CCG will receive £10.7m of Commissioning Sustainability Funding (CSF) that will mean it ends the year without a deficit. The FRP comprises a mixture of short and long term savings plans, for example, a major MSK redesign a number of years ago now delivers cumulative savings of £1.25m per year, which is identified in the FRP. Short term savings are to be made from discretionary spend such as overheads and corporate costs that can be stopped more swiftly and that do not have an impact on patient care, for example, vacancy freezes in CCG offices.

1.4.        Jessica Britton explained that the East Sussex Better Together (ESBT) CCGs’ FRP includes the delivery of £18m of Quality, Improvement, Productivity and Prevention (QIPP) schemes in order to contribute to reaching a combined deficit control total of £32m across both CCGs. As with the C4Y FRP, achieving this deficit control total will result in a CSF payment of £32m.  The QIPP programme includes 18 schemes, some of which aim to improve the organisational efficiency of the CCGs; some of which involve reviewing contracts to ensure they are cost effective;  and some of which involve the development of new services or pathways that are more cost effective, for example, pharmacists supporting GP practices and community health services to ensure people are given the right medications; and the High Intensity User Service that involves community-based services providing pro-active care to high users of hospital services to reduce instances of them reaching a crisis point and presenting in A&E, which is a more costly outcome to the health system. In addition the CCGs are working to ensure all other spend is contained within current budgets.

Unmitigated risk in FRP

1.5.        Ashley Scarff said that HWLH CCG has identified savings schemes for all but a few hundred thousand of the target £9.2m savings in its 2018/19 FRP. These identified savings, however, are on a spectrum from assured delivery at one end to savings that are at a high risk of  ...  view the full minutes text for item 12.

1.1.        The Committee considered a report providing an update on the progress of the NHS 111 re-procurement; the Urgent Treatment Centres (UTCs) redesign in Eastbourne and Hastings; and the progress of the roll out of Primary Care Extended Access across East Sussex.

1.2.        The Committee considered reports on these areas from Ashley Scarff, Director of Commissioning Operations, HWLH CCG; Hugo Luck, Deputy Director of Primary and Community Care, HWLH CCG; Jessica Britton, Managing Director for ESBT CCGs; and Mark Angus,Urgent Care System Improvement Director for ESBT CCGs.

NHS 111

Revised model of service

1.3.        Ashley Scarff explained that the existing NHS 111 service has huge demand on it that has in many ways outstripped the planned activity of the service. The new service will be based on increasing clinical engagement with patients over the phone via a clinical assessment service (CAS) that will help to reduce the number of onward referrals to A&E and GP practices.

1.4.        Mark Angus explained that over the past year a greater understanding has developed of what an integrated urgent care system should look like. This has helped commissioners articulate to the market more clearly what is wanted from an NHS 111 service and has helped providers develop a greater understanding of what is required for delivering a successful service. There has also been improvement in the detail of key performance indicators required of the new service model. Ashley Scarff confirmed NHSE has oversight of the procurement process and approves of it.

Penalties for not hitting national deadline

1.5.        Mark Angus clarified that the new NHS 111 service will be in place by April 2020 but CCGs are due to have delivered the nine mandatory NHS urgent care outcomes by March 2019. Work is ongoing to ensure that the current providers are able to deliver those outcomes to patients by March next year.

Urgent Treatment Centres (UTCs)

Viability of UTC and walk-in centre

1.6.        Mark Angus explained that two main factors will be taken into consideration when designing options for the proposed  UTC service:

·         The majority of people who access current walk-in centres do so because they find access to GP practices both in and out of hours difficult. To assist with this, the CCGs’ primary care extended access service will provide out of hour’s access to GPs at five hubs in the Eastbourne area and four in the Hastings area from 1 October.

·         The CCGs estimate that 7% of patients using the Hastings walk-in centre and 16% of people using the Eastbourne walk-in centre would benefit from the additional services of a UTC.

1.7.        Mark Angus explained that feedback, including feedback around the viability of a primary care hub at Hastings Station Plaza, has been used to identify different potential options for the UTCs.  The next step is to do due diligence to test the financial and clinical viability of the different options in the next few weeks before returning to HOSC in due course with final proposals.

Location of  ...  view the full minutes text for item 13.

14.1     The Committee considered its work programme and RESOLVED to:

1) add a report to the November meeting to agree the terms of reference for a Joint HOSC to  consider potential future Clinically Effective Commissioning (CEC) proposals;

2) request the policy for prevention of smoking within the hospital boundary at ESHT is circulated to the Committee by email.