Agenda item

1.1.        The Committee considered a report on the Sussex and East Surrey Sustainability and Transformation Plan (STP).

1.2.        Wendy Carberry, Accountable Officer, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG), and the nominated Senior Responsible Officer (SRO) for the STP, provided the Committee with a presentation. Keith Hinkley, Director of Adult Social Care and Health, East Sussex County Council (ESCC); Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG)/ Hastings and Rother Clinical Commissioning Group (HR CCG); and Dr Adrian Bull, Chief Executive, East Sussex Healthcare NHS Trust (ESHT), were also in attendance.

Place based plans

1.3.        Keith Hinkley clarified that, due to the complexity of the STP’s footprint, the STP was not a single individual plan but instead comprised three place based plans within its footprint: East Sussex Better Together (ESBT), Central Sussex and East Surrey Alliance (CSESA) (of which the Connecting 4 You (C4Y) programme in HWLH is a part), and Coastal Care. This means that the details of the STP in East Sussex have largely already been set out in ESBT and C4Y and have been through, or are going through, full governance and engagement processes.

Composition of STP Executive and Board, and representation of district and borough councils

1.4.        Wendy Carberry explained that the STP Executive comprises 10 Members including a Chair, Senior Responsible Officer, commissioning leads for the three footprints, and specialised commissioning leads (including for community health and mental health). Keith Hinkley, as Commissioning Lead for the East Sussex Better Together programme, is the only local authority representative on the Executive.

1.5.        The STP Programme Board comprises 23 representatives, including representatives of each of the four top tier local authorities: Brighton & Hove City Council, East Sussex County Council, West Sussex County Council and Surrey County Council.

1.6.        Keith Hinkley explained that although there was no direct district and borough council representation on the STP Board, each of the three place based plans was developed locally by the upper tier local authorities and CCGs in consultation with district and borough councils.

Development of ESBT

1.7.        Amanda Philpott said that ESBT formally launched in August 2014. However, planning for an integrated health and social care system had started at an earlier date as a means to address the challenges in the East Sussex health and social care economy which had been unsustainable for a number of years, and is set to become more so with the ageing population, increased healthcare costs, and tightening budgets.

1.8.        Keith Hinkley explained that the implementation of ESBT is more advanced than the other place based plans. An integrated Strategic Investment Plan (SIP), commitment to developing an Accountable Care Model, and commitment to a transitional year of Accountable Care during 2017/18, have all been agreed by ESCC, HR CCG and EHS CCG with provider partners. The C4Y programme is expected to develop in a similar way.

Public engagement

1.9.        Keith Hinkley said that ESBT is in week 122 of implementation and engagement with the public has been ongoing for two years. The ESBT development process has been open and transparent, with the necessary policy and resource decisions taken through the governance processes of ESCC (Cabinet meetings and the Reconciling Policy, Performance and Resources (RPPR) process) and the CCGs (via the public CCG Governing Body meetings).

1.10.      Amanda Philpott outlined some of the ways in which the ESBT programme had been publicised:

·         a dedicated ESBT website containing the draft 5-year investment plan, high level outcome measures and meetings of the ESBT Programme Board;

·         briefings provided for the local MPs;

·         engagement for each of the eight ESBT workstreams, for example, 500 people were involved with the urgent care workstream engagement;

·         Healthwatch East Sussex has facilitated public and patient engagement forums;

·         staff engagement events have been held; and

·         information about ESBT has been included in newsletters such as Your County.

1.11.      Amanda Philpott said that because of this commitment to transparency the ESBT element of the STP contains no surprises.

1.12.      Keith Hinkley clarified that the STP consultation will take place in 2017 and will use the same communication and engagement mechanisms as the place based plans.

STP-level transformation plans

1.13.      Amanda Philpott clarified that whilst the placed-based plans are committed to provide care locally wherever possible, an STP-wide approach will be taken in relation to specialist and tertiary services, such as vascular, stroke and cancer services as these services will continue to need to work in wider clinical networks.

1.14.      Wendy Carberry explained that an STP-level approach to workforce is being developed to work with all providers across the STP footprint to develop ways to retain staff within the area and make changes to the workforce in line with the recommendations of the Lord Carter Review of Operational Productivity in NHS providers. Any workforce planning will be done in a consultative way.

1.15.      Dr Adrian Bull told the Committee that he is leading the STP-level digital transformation plan. One of its key tenets is to ensure that technology makes it possible for patients to manage their long term conditions and have access to professional advice via phone or other devices, for example, the pilot of a Virtual Fracture Clinic. Rolling out technology will result in increased efficiency that will help organisations provide more for less.

Benefits of STP footprint

1.16.      Wendy Carberry argued that the advantage of working across the STP footprint was that it would help acute providers develop sustainable services by integrating more closely with primary and community care; acute providers cannot become sustainable in isolation.

1.17.      Keith Hinkley believed that co-terminosity of footprints around existing partnerships would have been preferable, for example, ESBT, and this was argued at the time that the STPs were first put in place by NHS England. However, the wider STP footprint does offer  advantages for addressing digital and workforce issues and it has not undermined the place-based plans – which have become the building blocks of the STP.

Use of private providers

1.18.      Dr Adrian Bull assured HOSC that that core principles of the NHS – taxpayer funded and free at the point of use – underpin the STP process and there was nothing in the STP plan to suggest that privatisation was the goal of the process. He said that the judicious use of private providers should not be ruled out as they can prove beneficial to the healthcare system in some circumstances, for example, the CCGs commissioned Vanguard to bring in a temporary facility and locum consultants to reduce ESHT’s endoscopy waiting times – with less than 1% of patients now waiting more than 6 weeks for diagnosis.

1.19.      Amanda Philpott said that CCGs and ESCC are legally obliged as corporate entities to adhere to European procurement law so services developed through ESBT will adhere to that process where required.

Financial  situation

1.20.      Dr Adrian Bull clarified that the financial deficit anticipated across the health economy by 2020/21 is calculated on the increasing demand and cost for health and social care, not a reduction in resources. This means that the goal of the STP is to make the available resource stretch further, rather than cutting existing resources.

1.21.      Dr Bull explained that NHS Improvement (NHSI) has signed off ESHT’s financial recovery plan to reduce its deficit to £42m by the end of the financial year (from a £48m deficit in 2015/16). If ESHT achieves this reduction then it will realise £10m of Sustainability and Transformation Funds (STF) held by NHSI, reducing the deficit further to £32m. Dr Bull said that the STF was not related to the STP and it was not a requirement for the Trust to be out of deficit to receive STF support – only that the Trust reaches its agreed deficit target.

Achievements of ESBT and collaborative work in East Sussex

1.22.      Dr Adrian Bull said that he has been hugely impressed by the genuine collaboration of colleagues in health and social care across all levels in East Sussex; he thought that the collegiality in East Sussex is second to none.

1.23.      Amanda Philpott described a number of schemes developed as part of ESBT that demonstrated collaborative work had been a success, for example, Health and Social Care Connect, Integrated Locality Teams, the review of urgent care, the establishment of frailty practitioners, the use of clinical pharmacists, developing award winning medicine management, a daily operational flow management board (to unblock the system on a daily basis), a scheme to tackle obesity in nursery schools, and the Healthy Hastings and Rother programme to tackle local health inequality.

Winter plans

1.24.      Dr Adrian Bull explained that the challenges faced when recruiting staff was mainly around recruiting registered nursing and medical staff. Increasing the capacity to care for people at home means that more healthcare assistants can be used to provide care. These healthcare assistants are based in the integrated locality teams alongside healthcare professionals and are being given the appropriate training.

1.25.      Dr Bull said that the increased community bed capacity would come from a variety of sources including Rye and Bexhill Hospitals, and a contract to reserve beds in nursing homes where patients can be assessed for ongoing care, rather than having to stay in hospital for this assessment; ESHT is also helping St Wilifred and St Michael hospices to increase their hospital flow to community locations and helping St. Wilifred open five additional beds.

1.26.      The Committee RESOLVED to:

1) note the report;

2) request a further update at its 23 March 2017 meeting.