Agenda item

33.1     This item was introduced by Wendy Carberry, High Weald Lewes Havens Clinical Commissioning Group (HWLHCCG) Chief Officer; Ashley Scarff, HWLHCCG Director of Strategy; Alan Beasley, HWLHCCG Chief Finance Officer; and by Siobhan Melia, Director of Partnership and Commercial Development, Sussex Community NHS Trust (SCT). The speakers also introduced and took questions on the HWLHCCG Annual Operating Plan item (item 6) at this point.

33.2     Wendy Carberry told the committee that HWLHCCG patient flows differ considerably from those of the other East Sussex CCGs. For Eastbourne, Hailsham & Seaford CCG (EHS) and Hastings & Rother CCG residents, the great majority of healthcare activity takes place within the county. In particular, most people living in these areas access secondary care services at either Eastbourne District General Hospital or at the Conquest Hospital, Hastings. However, although HWLHCCG residents receive the majority of primary and community services within East Sussex, the great majority of people access secondary care services from out of county providers – particularly from hospitals in Brighton, Hayward’s Heath and Tunbridge Wells.

33.3     This means that HWLHCCG has to contribute to planning for better integration and co-working across three health systems: East Sussex, Brighton & Hove & Mid Sussex, and West Kent.

33.4     Wendy Carberry told the committee that HWLHCCG has been criticised for over-emphasising flows into acute care when one of the principle strategic NHS goals is to reduce reliance on acute care. However, the CCG believes that district general hospitals have an integral role to play in designing effective health and care systems; a view which is supported by NHS England and by NHS Five Year Forward View planning guidance. The CCG’s plans fit well with the requirements of NHS Sustainability & Transformation Plans (STPs)

33.5     The CCG felt that too much of its time was being spent on East Sussex Better Together (ESBT), when only around 10% of HWLH residents receive their healthcare exclusively within East Sussex. The CCG was also uncomfortable with the pace of change involved in year two of the ESBT project.

33.6     In consequence, HWLHCCG withdrew from ESBT. The CCG is committed to working with partners towards better system integration in East Sussex and in the other areas that it works with. This includes working with Brighton & Hove and Horsham & Mid Sussex CCGs on an ‘A23 South’ programme; working with Kent CCGs on an integration programme centred upon Maidstone & Tunbridge Wells hospitals; working directly with Sussex Community Trust and Brighton & Sussex University Hospitals Trust to develop the Queen Victoria Hospital, Lewes as a hub for community services; and working with MTW and Kent CCGs on developing Crowborough Community Hospital as a community and gerontology hub. In East Sussex, the CCG has launched its ‘Connecting 4 You’ programme and has invited the County Council and other key partners to join the Programme Board.

33.7     The CCG is committed to implementing the NHS Five Year Forward View. One area of focus will be on improving community services, working in close partnership with Sussex Community Trust. Another focus will be on aligning HWLH GP practices and other primary/community services in ‘communities of practice. The CCG hopes that social care services will be included in the communities of practice.

33.8     Siobhan Melia explained that communities of practice will link community health and GP services with acute healthcare and mental health trusts via the Sussex Healthcare Alliance.

33.9     Alan Beasley told members that the CCG will balance its budget for 15/16. However, this has required the CCG to use all of its contingency funding. Next year’s financial targets will be very demanding: the CCG will have a £7M uplift (about 2% of budget) but will be required to find £9M of savings at the same time as investing more in providers (particularly in the acute sector to bring down waits for elective procedures). Better Care Fund (BCF) funding will be maintained at its current level: the HWLH contribution to BCF is C£10M pa.

33.10   Keith Hinkley, East Sussex County Council Director of Adult Social Care & Health, told the committee that he agreed that patient flows for HWLHCCG were complex. However, this complexity is explicitly recognised by the ESBT programme, which is predicated upon devolving responsibilities down to localities so that decision-making is fully responsive to specific local need and circumstances.

33.11   Current ESCC plans will have to be revisited in light of HWLHCCG’s withdrawal from ESBT. ESCC is committed to working with the CCG to deliver high quality care for residents, but there will be challenges here – particularly for ESCC management capacity now that there is no single integration programme for the whole of East Sussex. HWLHCCG’s decision also threatens to delay the implementation of the transformational changes planned through ESBT which are likely to  impact upon the council’s Medium Term Financial Strategy. There has already been an impact on managerial capacity within the Adult Social Care (ASC) service.

33.12   There is an urgent need to consider the ESCC  plans developed within ESBT with those of HWLHCCG, and to then develop a joint programme to improve health and social care outcomes in High Weald, Lewes and The Havens. This will need to be signed-off by ESCC Cabinet in June 2016 so it can form part of the final STP submission (end of June 2016).

33.13   Keith Hinkley also told members that ESBT was designed to reduce hospital admissions whilst recognising that acute providers are an integral part of an integrated health and care system. The devolution of responsibilities to localities was explicitly intended to recognise that different parts of the county require the autonomy to address specific local issues.

33.14   Wendy Carberry told members that, although HWLHCCG had initially been committed to ESBT, it had recently become apparent that the demands of the ESBT programme were too high, given the other integration projects the CCG is involved in and the need to send more and more time addressing the deteriorating situation at the Royal Sussex County Hospital – the main hospital for many HWLH residents.

33.15   Alan Beasley responded to questions by confirming the CCG’s commitment to providing more care in the community. The CCF seeks a 3:1 return for community investment, and this is achievable. Mr Beasley also confirmed that investment in BCF had been maintained. The CCG analysed the costs of leaving ESBT versus the benefits, and is convinced that the benefits will outweigh any costs. Keith Hinkley noted that calculating returns on investment in this context is complex, particularly when it involves funding leaving East Sussex.

33.16   Keith Hinkley explained that based on the joint modelling undertaken through ESBT the sustainability of the entire East Sussex health and social care system required transformational change in the immediate future. This is the case nationally, but is a particularly pressing issue for the county because of demographic pressures caused by an ageing population. In terms of the financial impact of HWLHCCG’s withdrawal from ESBT, ESCC has not yet fully modelled the cost of withdrawal although there will undoubtedly be additional management costs.

33.17   Members agreed to note the update on the CCG’s withdrawal from ESBT and on its annual operating plan. The committee welcomed the opportunity to learn more about HWLHCCG’s integration plans for East Sussex (Connecting 4 You) as these evolve.