12.1. The Board considered a report on the progress with developing the East Sussex Health and Social Care Plan.
12.2. The Board whether further integration of Children’s Services Department (CSD) with the NHS is planned in East Sussex
12.3. Stuart Gallimore, Director of Children’s Services, said that there has been a clear commitment to further integration of age appropriate care with the NHS, for example, Sussex Partnership NHS Foundation Trust’s (SPFT) Child and Adolescent Mental Health Services (CAMHS) have moved into the Children’s Services Single Point of Advice (SPOA) to ensure anyone calling the service about a young person will be able to receive the relevant advice from the appropriate person in a single phone call.
12.4. The Board asked what plans the CSD had to consult with the health services about contributing towards the cost of Education, Health and Care Plan (EHCP) assessments.
12.5. Stuart Gallimore said that the CSD’s Inclusion, Special Educational Needs and Disability (ISEND) Service works with health colleagues on producing EHCPs, but he agreed that further collaboration is always possible and that he would raise this matter with his ISEND managers.
12.6. The Board asked why autism appeared to be listed as a mental health disorder and not a disability.
12.7. Keith Hinkley, Director of Adult Social Care and Health, agreed that this point been fed back during the engagement activity and autism would be presented as a disability in the future. Dr Adrian Bull, Chief Executive of East Sussex Healthcare NHS Trust (ESHT), agreed that autism was not a mental health disorder but that many of the interventions for autism are provided by the mental health trust, SPFT. He said there is currently an issue where autism is assessed by one organisation and ADHD by another but there is a significant overlap of these two population groups. Work is therefore underway at ESHT and SPFT to create a single assessment service.
12.8. The Board asked whether it was possible to align funding streams with the integrated health and care programme by removing the Payment by Results method of funding NHS providers.
12.9. Jessica Britton, Managing Director of Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) and Hastings and Rother CCG (HR CCG), explained that different ways of commissioners contracting providers to deliver services are being tested across the country. This year the CCGs in East Sussex have begun testing with ESHT ways to ensure that incentives are aligned to reduce demand and avoid perversely incentivising organisations at the cost of the wider system.
12.10. Dr Adrian Bull added that a specific example of avoiding perverse incentives was the decision this year to agree to remove the charge NHS organisations are able to levy on a local authority where a patient’s stay in hospital beyond a medical need to do so – known as Delayed Transfer of Care (DTOC) – is the fault of the local authority. Instead of this arrangement, ESHT and East Sussex County Council (ESCC) have agreed a joint budget to invest in ways to reduce DTOCs by improving the rate at which patients are discharged back into the community.
12.11. The Board asked whether referrals by statutory bodies to the voluntary sector are funded by the statutory bodies, and questioned whether statutory bodies were providing sufficient funding to the voluntary sector.
12.12. Stuart Gallimore confirmed that the CSD’s SPOA holds no budget for paying voluntary sector for referrals, however, unless the CSD has a contract with a particular organisation, the SPOA will simply highlight to a caller the services that are available in the voluntary sector. The caller may then choose to approach the organisation separately for support.
12.13. Jessica Britton said that it is recognised that the voluntary sector may find themselves under pressure due to the growing demand for their service. She said that the CCGs and ESCC work closely with the sector and continue to commission a number of voluntary organisations in the county that support our shared priorities and demonstrate they will have a positive impact on outcomes for local people.
12.14. Keith Hinkley added that the voluntary sector exists and thrives without the funding from NHS and ESCC, however, the Council has continued to prioritise funding voluntary sector organisations as they add so much value. There is a broader issue with how the health and care and the voluntary sector work holistically together, but ESCC does and will continue to fund the sector.
12.15. The Board asked whether additional funding would be forthcoming for the voluntary sector once the Primary Care Networks’ (PCNs) social prescribers are in place.
12.16. Keith Hinkley said that the establishment of social prescribing flagged an issue that there needs to be a collective conversation between the NHS, ESCC and the voluntary sector about how funding is deployed in the system and what the expectations are for each of the partner organisations.
12.17. The Board asked whether the Integrated Care System (ICS) in Sussex will be in place by the deadline of April 2021
12.18. Keith Hinkley explained that the Long Term Plan is a broad strategic plan but there will be more detailed business plans developed year on year that will more clearly detail how the health and care system in Sussex will achieve ICS status by April 2021.
12.19. The Board asked whether financial incentives could assist with recruitment of GPs.
12.20. Dr Martin Writer, Chair of EHS CCG, said that the primary care system appears to now be in a better place than it was a couple of years ago. He said that the training scheme for GPs is now fully subscribed to, when in previous years it had not been. Furthermore, the introduction of Primary Care Networks (PCNs) will bring in additional funding to recruit allied healthcare professionals, such as pharmacists, physiotherapists and paramedics, who can take pressure off GPs, as they are often better placed to treat certain patients due to their specialisations. East Sussex CCGs are also investing above and beyond the core contract amounts for PCNs.
12.21. Dr Writer said that paying GPs more money is also not practical, as the tapered annual allowance charge puts a generous cap on what GPs can earn each year and going above this can lead to severe financial penalties.
12.22. Dr Elizabeth Gill, Chair of High Weald Lewes Havens CCG (HWLH CCG) added that for this new primary care system to work, people’s expectation that they should always be seen by a GP when attending primary care setting – when in fact it will not always be necessary to do so – will need to change over time. Dr Gill acknowledged that changing this expectation would be difficult.
12.23. The Board asked whether there should be more emphasis in plans for patients with multiple and complex needs, given their need for services and cost to the system.
12.24. Keith Hinkley explained that a lot of the integration work between health and social care to date has effectively been about creating integrated teams that can help move patients with multiple and complex needs more effectively through the system, for example, through improving discharge from hospital into care or nursing homes. He agreed that this could be made more explicit in the Long Term Plan.
12.25. The Board asked for confirmation whether families identified as having tier 4 need meet the criteria for support from ESCC.
12.26. Keith Hinkley said that there are eligibility criteria that are nationally set in legislation such as the Care Act 2014 and ESCC, despite challenges over the past 8 years, continues to meet these statutory duties. Stuart Gallimore added that tier 4 involved safeguarding issues and children coming into the Looked After Care system. The Ofsted inspection found the criteria used by CSD was appropriate, known by refers and being acted upon.
12.27. The Board asked about whether there was scope for GP practices to take repeat prescriptions over the phone, and why children cannot be registered for online access to their records.
12.28. Dr Martin Writer explained that GP practices will only accept prescriptions over the phone in exceptional circumstances due clinical safety concerns. This is because there is a risk that if the details are taken incorrectly, there is no way for the practice to say where the error occurred. He said a repeat prescription can requested from a GP practice via online service, email or letter; and a community pharmacist may order it on a person’s behalf too.
12.29. Dr Writer explained that providing online access for a young child would effectively mean their parent managing their healthcare needs and this was against data protection regulations. Once a child has competence to make decisions, they can request and receive treatment without their parent’s permission, and there is no way for the online system to recognise when this threshold in a child’s development has been crossed.
12.30. The Board RESOLVED to:
1. Note the proposed approach to developing a longer-term East Sussex County Council and NHS Plan for East Sussex and East Sussex place based contribution to the Sussex Health and Care Partnership response to the NHS Long Term Plan;
2. Endorse the draft principles and priorities underpinning the development of the East Sussex Plan as set out in Appendix 1, and plans to test these with local stakeholders; and
3. Note that further work will be taking place in the coming weeks to support the high level planning for the next phase of the East Sussex Health and Social Care Programme and priority-setting for 2020/21.