20.1. The Board considered a report on the progress made with developing a long-term health and social care plan for East Sussex.
20.2. The Board asked whether the closer working between health and social care would help improve the process of completing education, health and care plans (EHCPs) for children and young people in a timely manner.
20.3. Stuart Gallimore, Director of Children’s Services, agreed there were sometimes issues with the production and co-ordination of the EHCPs between health and social care organisations. He said that the integrations plans designed to improve the disability pathway for children and young people would include addressing issues such as the co-ordination of the EHCPs.
20.4. The Board asked why the Plan did not include more detail of the prevention agenda, for example, what was being done to reduce obesity and homelessness.
20.5. Keith Hinkley, Director of Adult Social Care and Health, said that the Plan as presented to the HWB focuses on the integration between health and social care in East Sussex and includes a broad description of the key strategic objectives. There is more work being undertaken than is included in the Plan, including the core commissioning work of the individual organisations and individual programmes to develop joint working. He explained that there will be future iterations of the Plan produced that will provide more detail of these specific projects and programmes, which are designed to address issues such as housing and homelessness. These include engagement with the new Primary Care Networks (PCNs) to ensure they are involved in future joint working with social care and health teams; and bidding for further homelessness support grants to expand the rough sleeping initiative developed in Hastings. The HWB will have the opportunity to consider and comment on these projects at an appropriate time.
20.6. The Board asked how plans to develop integrated community-based services could be reconciled with the closure of services like Little Oaks respite service in Eastbourne.
20.7. Keith Hinkley said that there are significant demographic and funding challenges in East Sussex that can only be addressed in a sustainable way by reducing demand for acute care. This involves the long-term investment in integrated services and a greater focus on preventative and proactive care. At the same time, difficult decisions have to be made on a short-term basis about where to prioritise available resources year on year. This has led to situations, for example, like 2018/19 where the Council had to make significant savings to its Adult Social Care Department budget but at the same time invested in joint services with East Sussex Healthcare NHS Trust (ESHT) such as the Joint Community Reablement teams; Health and Social Care Connect (HSCC); new rough sleeping and homelessness services; and integrated locality teams.
20.8. Stuart Gallimore added that sometimes it is more appropriate to provide a service in a different and more innovative way, rather than maintain it in its current state. In the case of Little Oaks, by working with partner organisations it was possible for the Children’s Services Department to identify alternative opportunities for those children using Little Oaks that provided more time and a greater amount of respite than was previously the case. He also clarified that the service had not been closed, rather there had been a staffing issue that resulted in parents being contacted at the time and recommended to temporarily seek the alternative respite solutions that had been identified.
20.9. The Board asked whether there was confidence that the system leadership is able bring about the necessary behaviour change within organisations so that they are prepared to work in a more integrated way.
20.10. Keith Hinkley said that the two main challenges to integration in East Sussex are the risk that leadership changes over time, meaning that leaders who are less enthusiastic about integration could enter the system; and the newly established PCNs, who are vital to further integration plans, are independent and so must be engaged and encouraged to work with the rest of the system rather than be compelled. Leaders across East Sussex, in comparison to many other systems, have a shared commitment to integrate and a shared approach and plan for doing so. Some senior roles are also now shared between ESHT and the Council.
20.11. Vicky Smith,Integrated Care System Strategic Development Manager (East Sussex), said that the East Sussex Health and Social Care System Partnership Board has a clear role in developing the proposals for an Integrated Care Partnership (ICP), which will be the next step in further integrating the NHS organisations with the Council. Further details of the ICP will come to the next Board meeting.
20.12. The Board asked about the method of aligning and pooling budgets in East Sussex.
20.13. Keith Hinkley said that the ICP agreement will include a shared approach to the collective use of resources. The ICP development process will include testing ways of sharing funding and risk across the health and social care system based on existing arrangements, such as the Bet Care Fund and Integrated Equipment Service. The NHS already has an aligned risk sharing contract between CCGs and ESHT, but the ICP will require a broader approach that includes the Council’s social care function.
20.14. The Board asked about whether life expectancy was a suitable measure for health outcomes.
20.15. Darrell Gale, Director of Public Health, agreed that life expectancy and quality of life expectancy were a crude measure of population health, but the levelling off and decline in male life expectancy could indicate a rise in issues such as homelessness, drug and alcohol use, and suicide, which are worth investigating.
20.16. The Board asked whether it would be possible to produce a timeline of the programme of work for the ESHSCP, and whether an annual review of progress could be provided to the Board.
20.17. Keith Hinkley said that detailed timescales for the ESHSCP would be produced for the HWB at its next meeting and an annual review of progress of the plan could be provided to the HWB in future.
20.18. The Board asked whether the public will be engaged about the planned changes to health and social care services.
20.19. Keith Hinkley explained that there is already a broad engagement infrastructure in place that includes Patient Participation Groups; Healthwatch; and reference groups for the Adult Social Care and Children’s Services Department and for individual patient pathways. These groups have been provided with evidence of the impact their engagement has had, which encourages them to continue being involved.
20.20. The Board RESOLVED to:
1. Endorse the draft East Sussex Health and Social Care plan as set out in Appendix1, and plans to further test this with local stakeholders;
2. Note that further work will be taking place in the coming weeks to support the nextphase of planning, including developing initial proposals for an East SussexIntegrated Care Partnership to help support delivery of our objectives in 2020/21and in subsequent years; and
3. request an annual presentation to the Board on the progress of the ESHSCP over the past year.