Agenda item

16.1     The Board considered a report on East Sussex Health and Social Care Shared Delivery Plan (SDP) Integration Programme update introduced by Vicky Smith, Programme Director, East Sussex Health and Social Care Transformation. The report was in two parts. The first part provided an update on the eight priorities with further detailed information in appendix 1 of the report. Most work is currently on track, however there are some delays around improvements in hospital discharge where we are experiencing both increases in the numbers of patients and the complexity of their onward care needs. The second part of the report covered the actions to strengthen the role of the Health and Wellbeing Board (HWB), including the strategy session held on 5 September 2024 on Strategic Stewardship. A draft summary of the session is contained in appendix 2 of the report.

16.2     Ashley Scarff, Director of Joint Commissioning and ICT Development (East Sussex), NHS Sussex commented that the progress on SDP deliverables was encouraging with the exception of hospital discharge. The strategy sessions provide an important forum to think about and discuss delivery in future years.

16.3     Mark Stainton, Director of Adult Social Care and Health commented that the progress made against the SDP priorities is not to be underestimated given the operational pressures all parts of the Health and Care System are experiencing. Good progress has been made against the priorities with the exception of hospital discharge. Delayed discharge is a multi-agency pan-Sussex issue and other Systems are experiencing similar challenges, although Sussex is one of the most challenged. The issue of discharges has been escalated to a senior level in all the organisations involved, who are working well together to tackle the problems. A report has been presented to the Integrated Care Board setting out the challenges and steps being taken by partners to improve performance in this area. There are four main areas of work:

·       Work to support safe patient flow through our system

·       Support for patients to remain active and avoid further deconditioning whilst they are in a hospital bed

·       Optimising the transfer of care hubs which coordinate the discharge of patients across the different pathways

·       Developing a needs-based demand and capacity model

16.4     The fourth area is probably the most important one for East Sussex. It would appear that we have reached a tipping point in terms of hospital discharge and the wider population. There is an 11% increase in the number of people over 90 years of age that are being supported and a 12% increase in the number of people over 80 years of age. Overall, there has been a 9% increase in the number of people supported by Adult Social Care, and this is heavily weighted towards those older age groups which drives a level of complexity that has not been seen in the County to date and provides the context for the challenges around discharge.

16.5     Mark Stainton added that he had found the strategy session enjoyable and that it had really signalled a change in the role of the HWB to a more strategic stewardship group, whilst discharging the statutory duties of the Board. The Chair commented that he agreed with the comments made about the strategy session.

16.6     Stephen Lightfoot, Chair of NHS Sussex commented that in terms of discharge it is important to consider some numbers that illustrate the level of challenge. At the beginning of September there were 793 patients, which represents a quarter of all acute community and mental health beds across Sussex, who were medically ready to be discharged who did not need to be in hospital. This is a System wide issue and in East Sussex the number was around 311 patients. The scale of the challenge is important but there is not an easy solution, and a lot of effort has gone into tackling this issue. A new approach is needed which is being led by chief officers across the System to start to address this challenge. The NHS Sussex Board was encouraged that the challenges of discharge are being grasped and it will receive an update in two months time. This is especially important as the number of patients medically fit for discharge who are still in hospital needs to come down before the winter period.

16.7     Stephen Lightfoot added that in regard to the strategy session he found the session excellent. He noted that a lot of the issues outlined in the report are around communication in terms of discharge, our strategy and how we take things forward. He asked whether we have enough communications capability in the respective organisations, as getting communications right is very important in trying to explain to the public what we are trying to achieve.

16.8     Councillor Webb asked whether people not being able to access GP appointments was driving up the number of people using A&E departments. Stephen Lightfoot responded that there were two issues. There are difficulties in seeing some GPs in some parts of Sussex, but access in other areas is very good. Not being able to access a GP appointment in some areas is driving up the number of people going to A&E. However, the discharge issue is around people already in hospital for treatment or an operation who are not able to leave hospital when they are medically fit to do so. This has an impact on admissions and slows admissions if people need to be admitted from A&E.

16.9     Mark Stainton commented that as we go into winter there needs to be a focus on discharge, but it also makes sense to look at admission avoidance through community services, the ambulance service hear/see and treat, community rehabilitation service and homecare services. Outcomes for people improve if they are not admitted unnecessarily into hospital as they often de-condition whilst in hospital.

16.10   The Board RESOLVED to:

1. Note the early in-year progress highlights against the Health and Wellbeing Board Shared Delivery Plan (SDP) objectives for East Sussex in 2024/25 set out in Appendix 1;

2. Note the steps that have been taken to enact the previously agreed proposals for a new way of working, to further strengthen the HWB’s existing statutory role as the key strategic stewardship group for the health and care system in East Sussex, and;

3. Agree the summary briefing note (Appendix 2) of the first informal HWB deep-dive session, and the suggested initial follow up actions (as set out in the table in paragraph 2.9 of this report), for sharing more widely with organisations and partners.