· Report by the Director of Adult Social Care & Health
31.1. The Board considered a report on the proposals for future partnership arrangements and priorities for integrated health and social care in East Sussex.
31.2. The Board sought assurance that the further work to simplify and standardise pathways would not affect patient choice.
31.3. In response it was explained that:
· Revised pathways for discharging patients from hospital will still allow patients to exercise their right to choose where they receive care, but not to the extent of allowing them to remain in an inappropriate setting, for example, patients ready for discharge from a hospital may be discharged out of an acute setting to avoid them losing muscle tone and being at risk of infection, rather than wait in hospital unnecessarily for a particular nursing home to become available.
· Simplifying the pathway for accessing care into a single point of access – Health and Social Care Connect (HSCC) – during the first stage of integration actually improved patient choice, as it made health and care practitioners who called HSCC on behalf of a patient more aware of what services could be available to them.
· Pathways will also be standardised around access to services in order to ensure patients receive the most appropriate clinical care to meet their need and avoid unnecessary admissions of patients to A&E, which wastes resources that could better be used in the community.
31.4. The Board asked whether there should be greater integration of Children Services as part of the integrated health and social care plans.
31.5. In response it was argued that such integrated services do already exist, for example, Health Visitor services for children are commissioned by East Sussex County Council and provided by East Sussex Healthcare NHS Trust (ESHT). They represent a good model of joint children’s care, as social workers and nurses work together under a joint arrangement supervised by a joint Board.
31.6. The Board asked how East Sussex’s integration plans fit in with the wider Sussex and East Surrey Sustainability and Transformation Partnership (STP).
31.7. In response officers said that:
· The STP has a new Executive Group containing a non-executive chair, Bob Alexander, a Senior Responsible Officer, Adam Doyle, and non-executive directors.
· The STP leadership is clear that the STP footprint is too large to be a single integrated care provider. Instead it will comprise integrated place based health and social care planning that will be based on local authority footprints that will commission services for their local populations, including in East Sussex, and a configuration of four integrated care providers. There will, however, be some more specialist care commissioned across the whole STP footprint where appropriate.
· Discussions are ongoing whether the East Surrey CCG will leave the STP and join Surrey Heartlands STP.
· Local authorities have not been involved in the STP for some time but will be involved in commissioning this more specialist need across the whole STP in future now that the core element of place-based plans has been established.
· The new integration plan will involve bringing together the best elements of the East Sussex Better Together (ESBT) and Connecting 4 You (C4Y) programmes.
31.8. The Board asked how the community and voluntary sector (CVS) could be more involved in the integration of health and social care, including representation at the executive level.
31.9. In response it was argued that:
· The delivery of further integration plans will require the involvement of the CVS, particularly in relation to providing proactive care. The CVS, however, already makes a significant contribution to the East Sussex programmes, particularly the community resilience and prevent agenda, which the Care Quality Commission (CQC) highlighted as good practice during their East Sussex area review.
· The East Sussex Strategic Partnership (ESSP) agreed to review how the statutory sector and CVS can work better together, both within health and social care and in other areas that form part of the wider determinants of health, such as housing. The ESSP published online.
· Further engagement with the CVS will be undertaken as part of the East Sussex integration plans, including how the CVS is represented at the Executive level – both in terms of their involvement with individual workstreams and membership of the core governance structure.
· The HWB itself will need to be clear about its strategic role and will need to challenge and hold to account individual organisations within the East Sussex partnership, both to maintain cohesion and help understand and prevent future occurrences of the financial challenges that occurred in the East Sussex NHS organisations during 2017/18.
31.10. The Board RESOLVED to:
1) Endorse the approach being taken to resetting health and social care system governance, including agreeing to take forward a single joint programme across East Sussex;
2) Note that consideration is being given to replacing the East Sussex Better Together Strategic Commissioning Board from April 2019 with the new arrangements under the single East Sussex-wide joint programme, which will be subject to strategic oversight by the East Sussex Health and Wellbeing Board.
3) Endorse the scope and projects within the new integrated community health and care services joint programme.