Agenda item

Report by the Assistant Chief Executive

An introduction to this major transformation programme designed to integrate health and social care services in the county and to identify areas for further scrutiny.

37.1     The Committee considered a report of the Assistant Chief Executive on the East Sussex Better Together (ESBT) programme.

37.2     Paula Gorvett, Programme Director East Sussex Better Together, made a presentation to HOSC providing:

·         The background and an overview of the ESBT programme

·         The vision and framework of ESBT

·         A description of the whole system transformation that ESBT aims to achieve in health and social care

·         Aims, challenges and next steps of the ESBT programme.

37.3     In response to questions from HOSC, Paula Gorvett and Ashley Scarff, Head of Commissioning and Strategy, made the following clarifications and responses:

Funding and decision making

• ESBT is ‘apolitical’ and therefore unlikely to be significantly affected by the outcome of the general election. The programme is in keeping with the principals of the NHS Five Year Forward View, which has support amongst all of the main national political parties. All of the main national parties have indicated support for the integration of health and social care and the move towards adopting preventative health and wellbeing strategies.
• All commissioning decisions are taken by the governing bodies of the constituent commissioning organisations: the three Clinical Commissioning Groups (CCGs) and East Sussex County Council (ESCC).  To ensure that the commissioning bodies are making collective investment decisions, an underlying governance structure for ESBT has been established which provides a shared forum for the commissioning organisations to meet and discuss spending decisions. During the process so far, discussions have been focussed on how resources are spent rather than who has the budget.
• The ESBT governance structure should help to overcome the significant challenge of re-organising services whilst recognising that healthcare is free at the point of delivery and social care is based on needs assessments and eligibility criteria. The work that the four commissioning organisations have undertaken over the past six months to develop a shared vision is evidence of the effectiveness of ESBT.

New services created as part of ESBT

• The Single Point of Access delivery model involves bringing a number of access point services currently provided by ESCC and ESHT under a single management structure to form an integrated and responsive service. The new service will require additional staff, training, education and professional supervision to become fully operational. The service begins in April 2015 and is funded by investment from the Better Care Fund.
• Planning is underway (until October 2015) for the integrated community health and social care teams based on patient and provider feedback of the existing services. Integrated community teams will be responsible for clearly defined populations and, as far as possible, will be based within their designated local community.
• The community services procurement that High Weald Lewes Havens (HWLH) CCG is currently undertaking has a built in requirement that the winning provider must integrate into the wider health and social care system, including working alongside, and performing some of the functions of, the integrated community health and social care teams.
• A large range of self-management and self-care services are already available to people, such as Telecare and Telehealth, but their availability is unevenly distributed. ESBT is developing a self-care strategy based on an understanding of what is currently provided, where it is provided, and how well it works.
• ESBT commissioners are talking with Brighton & Sussex University Hospitals NHS Trust (BSUH) and ESHT about the recruitment of four full time consultant geriatricians to new community geriatrician teams that will be in operation across East Sussex. The new services will work with primary care and the multidisciplinary teams; visit patients in nursing homes; make home visits; and hold clinics around the county.

37.4     HOSC’s findings and comments:

• The successful integration of health and social care is one of the biggest issues that is facing the local health economy. This means that the ESBT programme has the potential to provide huge benefits for residents of East Sussex. The CCGs, healthcare trusts and ESCC are to be commended for tackling this issue.
• ESBT is currently in week 39 of the 150-week programme. Whilst significant progress has been made, it is acknowledged that there is much work to undertake to deliver the programme.
• ESBT carries a significant amount of risk and ensuring that the programme is successful will be a difficult task. Stakeholders recognise that there will be financial implications if it fails, for example, in its Annual Business Plan 2015/16, ESHT cites “the loss of income from ESBT initiatives” as a significant cost pressure. A Provider Impact Assessment Forum has therefore been established to review the impact of all proposed changes across the health and social care economy.
• The third sector has a key role in this programme. However, there is a risk in relying on the sector to reach communities if resources diminish; the third sector plays significant role in prevention focus at community level. A Provider Impact Assessment Forum has therefore been established to review the impact of all proposed changes across the health and social care economy.

37.5     RESOLVED:

1)    HOSC will retain an overview of ESBT and will work alongside the County Council’s Joint ESBT Scrutiny Review Board.

2)    To request a future report on the progress of the ESBT timetable in light of developments following the election, with particular focus on:

• the development of the Single Point of Access delivery model
• the development of Integrated locality teams
• the results of the whole system urgent care and self-care prevention survey
• the development of the community geriatricians team
• the role of the third sector.