13.1. The Board considered a report providing an update of progress against the priority objectives and lead Key Performance Indicators for the health and social care programme in 2019/20.
13.2. The Board asked whether there was sufficient funding in the system to deliver the objectives of the health and social care programme.
13.3. Keith Hinkley explained that the objectives have been identified with the help of clinical leadership as objectives that, if delivered, will have the greatest impact on the health outcomes of the local population based on the best use of available resources. Significant progress has been made in terms of developing new integrated services and developing a structure within which the objectives of the health and social care programme can be delivered, however, there remains issues with clinical and financial sustainability of the health and care system and further work is still needed to integrate the health and care system. This work includes developing how the commissioning partnership will work and how providers will work to deliver care within an Integrated Care Partnership (ICP).
13.4. The Board asked whether extra financing will be made available to help meet the objectives of “growth prevention in A&E attendances not to exceed plan” and “Growth prevention in non-elective admissions”.
13.5. Dr Adrian Bull clarified that these objectives refer to demand for A&E and not its performance. The Trusts two A&Es are not achieving the 95% 4-hour referral to A&E but are currently at 90% or above, making the trust one of the top 20 performing trusts in the country. He attributed this in large part to the integration work within the health and care system. The red ‘RAG’ rating was reflecting the higher than planned number of people attending A&E, as the trust is seeing continued increase in demand above that which was predicted.
13.6. The Board asked why there was still a rising tide of demand for health and social care across the country despite increasing efficiency of the system.
13.7. Dr Adrian Bull explained that the East Sussex Urgent Care Board has commissioned some work to understand the reasons for the increase in attendance at A&E and a report will be published in due course. He said there was an increase nationally, but it has been faster in East Sussex. However, it worked out as a slower increase if you normalise the age demographic to the national average.
13.8. He said that the increase in non-elective admissions is due to an increase in the acuity of patients attending at A&E, although ambulatory care capacity is in place to treat people within a shorter timeframe. Attendance in A&E was also increasing due to a greater number of working age people attending who could otherwise have attend a primary care appointment but were worried about their GP’s availability and knew they could get a same day appointment if they attended A&E.
13.9. Dr Bull agreed the East Sussex health and care system is becoming more efficient at discharging patients and illustrated this using the average length of stay of non-elective patients, which had reduced from 6.2 to 3.7 days in two years and which if it had not been achieved would have meant the trust would have needed 111 more beds.
13.10. The Board asked whether the UTCs will reduce the volume of attendance at the A&E departments in Eastbourne District General Hospital (EDGH) and Conquest Hospital.
13.11. Adrian Bull explained that some A&E consultants are concerned that UTCs will make patients feel it is more convenient to attend the A&E (where the UTC is located) than see their GP, so it is seen as important that UTCs are introduced as part of a wider range of urgent care services for patients to access – including additional GP appointments and the new NHS 111 service that will be able to diagnose and book patients into appointments over the phone – and not just as a stand-alone entity for patients to go to whenever they need access to NHS services.
13.12. The Board asked whether are plans for the Council’s ISEND team to share its database of information with NHS providers to help them carry out their service in a more person-centred way.
13.13. Stuart Gallimore said there are no plans currently to go beyond the existing information sharing agreements and criticism is often levelled at organisations that share personal information, however, it is something that is kept under review.
13.14. The Board RESOLVED:
1) Note the report; and
2) request that future reports include additional details of performance in different areas of East Sussex.