· High Weald Lewes and Havens Clinical Commissioning Group (CCG)
· Eastbourne, Hailsham and Seaford CCG
· Hasting and Rother CCG
9.1 The Board considered updates from the three NHS CCGs in East Sussex.
High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG)
· The CCG entered a deficit for the first time in 2017/18. The deficit was £8m.
· A deficit plan has been agreed for 2018/19 with NHS England that, if achieved, will enable the CCG to secure Commissioner Sustainability Funding that will cancel out the deficit.
· NHS England’s annual assurance process has downgraded HWLH CCG from Good to Requires Improvement due to the financial pressures. NHS England did highlight some good areas of work such as the Dementia Golden Ticket.
· The Dementia Golden Ticket is now rolled out to 11 GP Practices and has reduced A&E admissions by 25% and GP appointments by 20%.
· The Enhanced Care in Nursing Homes project has rolled out across most nursing homes and has seen an 80% reduction in falls and 50% reduction in A&E admissions from the nursing home population.
· The CCG has launched the Big Health and Care Conversations that have resulted in 2,500 contacts with patients. One event at Newhaven drew in over a 100 local people and the CCG welcomed the helpful and strategic comments that were made by attendees of the event.
· HWLH CCG has been involved in the consultation for the reconfiguration of stroke services in Kent and Medway (which may affect Pembury Hospital).
Hastings and Rother Clinical Commissioning Group (HR CCG) Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG)
· The CCGs posted a deficit of £37m in 2017/18 and ESHT posted a deficit of £57m.
· The CCGs have been put into financial legal directions. Several other CCGs in the STP have previously been put in legal directions and Brighton CCG came out of them after 2016/17. Legal directions give NHS England the legal means to give direction to the CCGs in how they allocate their resource. Normally the CCGs are directly accountable to the Secretary of State.
· The legal directions require the CCGs to submit a financial recovery plan and Deloittes will review the CCGs’ governance arrangements to make sure decision making and leadership capacity is sufficient to deliver the plan.
· Legal directions only apply to CCGs but ESHT, which is already in financial special measures, will be required to work with the CCGs in order to ensure a system-wide approach to tackling the deficit.
· NHS England and NHS Improvement have undertaken analysis of the causes of the deficit in the three East Sussex CCGs. The analysis concluded that support is required for Musculoskeletal services (MSK), frailty, medicines management, and long term hospital stays (which integrated ESBT teams have done a lot to tackle recently). The help will include support from national specialists in areas such as frailty and orthopaedics to develop services.
· The CCGs have established a Clinical Leadership Forum with ESHT where primary and secondary care clinicians can work more closely to develop better and more efficient care pathways for patients; identify variation in services; and improve the interface between primary and secondary care.
· The CCGs had in previous years financially helped neighbouring CCG, East Sussex County Council (ESCC), and NHS England, however, the CCGs are judged on the 2017/18 outturn only and not previous years. ESCC received funding of £2m and £5m over two years from the CCGs to assist with pressures on its Community Care budget.
· The CCGs are not looking to make drastic cuts but need to address rising demand and costs. Demand is increasing, albeit less than the national average but costs is going up even greater than demand.