16.1. The Board considered a report and presentation providing an update on the key developments and progress in 2019/20 of the East Sussex Health and Social Care Plan (ESHSCP).
16.2. The Board asked about the financial performance of the ESHSCP and whether the financial incentives within the system now support co-operation rather than work against it.
16.3. Vicky Smith, Programme Director - East Sussex Health and Social Care Transformation, said broadly speaking the payment by results system has now been replaced by aligned incentive contracts. These contracts incentivise developing patient pathways throughout the health and care system, rather than encouraging acute hospitals to maximise the volume of health interventions they perform like a payment by results contract does. The financial framework for managing the collective resources of the organisations within the ESHSCP will build on existing framework agreements such as the Better Care Fund. This financial framework, however, will need to be reviewed in light of the impact of Covid-19 on the finances of the ESHSCP member organisations.
16.4. The Board asked how patients react moving from the six weeks of free social care they are entitled to into paid for care.
16.5. Adrian Bull said that as long as two funding models exist side by side, there will be some issues surfacing when someone transfers from free at the point of use NHS care to means tested social care. In his experience, however, the elderly patients tend to accept this arrangement and the issues are often around their children feuding over their inheritance rather than prioritising their parent’s care. The process of integration between health and social care teams that deal with the discharge of patients from hospital or assessment beds has made this process much easier to manage and better for patients. He explained as a result of Covid-19 that the NHS is currently paying for the up to six weeks of care that patients are entitled to free of charge, and which is normally funded by local authority responsible for adult social care, to help ensure there are no delays in the discharge process in order to free up bed space to deal with Covid-19.
16.6. The Board asked about the involvement of primary care in the integration programme and the progress of improvement in primary care.
16.7. Jessica Britton said that Covid-19 had been a challenging time for the whole health and social care service, including primary care. Infection control measures put in place to continue operating safely during the pandemic mean people now access primary care in a different way, although people will be able to have a face to face appointment if clinically appropriate to do so. Adrian Bull said he thought telephone booking and consultations had improved significantly over the Covid-19 outbreak.
16.8. Jessica Britton said the performance of primary care varies across East Sussex due to the number of practices in the county. There is very good General Practice (GP) coverage in some areas and in other areas the CCG is working with practices to boost capacity. The whole of primary care is benefiting this year from additional national investment via the Primary Care Networks (PCNs) foo recruit additional healthcare professionals to work alongside GPs, such as paramedics, physiotherapists and pharmacists. Jessica Britton offered to consider how best to demonstrate this integration with primary care in future updates to the Board.
16.9. Julia Rudrum, Lay Member of the CCG, added that she chaired the Primary Care Commissioning Committee where the strategy and delivery of primary care in the county is considered, including looking at the resilience of GP practices and identifying those that need further support. She said that primary care should be included int the ESHSCP outcomes framework to ensure that it shows performance across the whole health and care system. She emphasised that during Covid-19, primary care colleagues have been working hard to deliver their core contract as well as locally commissioned services such as supporting care homes.
16.10. Adrian Bull said ESHT is working with the PCNs to help train their pharmacists using the considerable pharmacist resources that the Trust possesses. First contact physiotherapists employed by the PCNs may also be able to benefit from the podiatrist, physiotherapists and occupational therapists employed by ESHT.
16.11. The Board asked how the impact the ESHSCP has had could be demonstrated.
16.12. Adrian Bull said that the improvements made at ESHT absolutely depended on the relationships and joint working with the County Council and primary care colleagues formed through the ESHSCP. He advised that over the past four years the length of stay of patients at the hospitals has been halved and there was no doubt that a significant cause of that was the integrated care programme. Without this reduction, the Trust would have required an additional 100 beds over the winter period. This meant the Trust was able to make a significant financial improvement by reducing the amount of beds needed, whilst still containing the demand that the Trust had.
16.13. The Board asked about A&E attendance during the first wave of the pandemic.
16.14. Adrian Bull said that in the first three months of the pandemic, attendance at A&E halved due to fear of Covid-19. These were not all unnecessary attendances that could have been dealt with elsewhere and the presentation of more serious conditions such as stroke also reduced. Over the past few weeks, activity has increased and is now above pre-Covid levels at around 200 people per day at each site, at least a couple of times per week. The Trust cannot have crowded A&E departments due to the risk of Covid-19 so is now in the vanguard of the new NHS 111 First system. This involves the new NHS 111 Clinical Assessment Service (CAS) taking a call from patients and booking them into the A&E, if they need to go there, rather than wait in the A&E for several hours. This effectively moves the waiting room into people’s homes. He clarified this would not apply to those with acute trauma, stroke or any other serious emergency condition.
16.15. The Board RESOLVED to note the report