Agenda item

13.1     The Committee considered a report providing an update on the most recent developments with the Sussex and East Surrey Sustainability and Transformation Plan (STP).

13.2     Wendy Carberry, Senior Responsible Officer for the STP provided a presentation and answered questions from Members of HOSC.

Effect of STP on Connecting 4 You

1.1.        Wendy Carberry said that the CCGs in the Central Sussex and East Surrey Area (CSESA) South plan to merge some back-office functions by April 2018. She confirmed that this will not affect the implementation of High Weald Lewes Havens Clinical Commissioning Group’s (HWLH CCG) Connecting 4 You (C4Y) programme – which is the model of care for the HWLH population – or its constituent services such as Communities of Practice, the frailty pathway, and the Golden Ticket dementia pathway. She argued that these services are starting to come together rapidly and the C4Y programme is not as far behind other placed-based plans as it may appear.

CSESA boundary

1.2.        Wendy Carberry confirmed that the boundary between CSESA North and South has been fixed. The North will comprise Horsham and Mid Sussex, Crawley and East Surrey CCGs and the South will comprise Brighton & Hove and HWLH CCGs. She said that some functions will be carried out jointly with Brighton & Hove CCG, some with the other CCGs in the CSESA area, and some across the whole STP.

Funding for healthcare

1.3.        Wendy Carberry explained that there is no specific extra money that will be provided to deliver the placed-based plans such as C4Y or ESBT. Dr Bull added that the predicted funding gap by 2020 is based on comparing the trend for healthcare funding with the trend for increasing healthcare needs. The prediction is that the increase in healthcare need is much greater than the expected funding increases but funding itself will not decrease relative to the current levels, so there is no expectation that CCGs will have to reduce spending below current levels. He said that the health and social care organisations must align themselves in such a way as to reduce future demand by using existing resources better. The challenge and tension at the moment, however, is to protect investment in community based care to reduce future demand whilst also addressing significant funding challenges in acute care.

Use of ICT in healthcare

1.4.        Dr Adrian Bull said one of the main initiatives across the NHS is to improve the adoption rate of new technologies that help clinicians deliver healthcare. The NHS will increasingly need to support the development of apps and other ICT that will enable patients to take control of their patient records so that expert patients can manage their own conditions, such as diabetes. NHS Digital is encouraging this through an accreditation programme for new healthcare apps, such as those that remind you when to take prescription medicine, which are listed on its website. Dr Bull added that technology can also be used to help detect diseases, for example, a handheld device that has been rolled out to all GP practices in East Sussex to detect atrial fibrillation and is being rolled out elsewhere.

STP Engagement plans

1.5.        Jessica Britton clarified that there are no STP plans currently being developed that would require a formal consultation on the grounds that they were a substantial variation to services. ESBT and C4Y programmes have involved local people in engagement and consultation every step of the way, for example, through Shaping Health and Care events and the development of the Health and Wellbeing Stakeholder Group – which will have representation on the ESBT Strategic Commissioning Board from December. 

STP ensuring patient choice

1.6.        Wendy Carberry confirmed that patient choice is enshrined in the NHS Constitution and would be adhered to during the development of services as part of the STP or the place-based plans in East Sussex.

Impact on STP of NHS England’s rating

1.7.        Wendy Carberry confirmed that the STP was rated by NHS England “requires greatest improvement”. This was in part due to the size and complexity of the STP, significant financial pressures, a number of NHS providers in special measures, and four CCGs in special measures. She said that the STP will be rated on an annual basis and the current rating forms the baseline score.

1.8.        Wendy Carberry explained that the STP works closely with NHS Improvement (NHSI) and NHS England (NHSE) and the STP considers that it is on the trajectory to improvement. The STP is in discussions with NHSE about what support it can provide to help overcome the STP’s challenges, after which point the STP’s Executive Chair role will be appointed to.

1.9.        Dr Adrian Bull added that he is confident that the right plans are emerging from the STP but there is a real challenge to make the necessary changes on the scale required to address the current significant financial challenges that already exist across the STP. He said that at the moment there is no quick solution, but he was confident that the STP will be where it needs to be in the next 3-5 years.

STP Acute Strategy

1.10.      Dr Adrian Bull said that it has been agreed that there will be no single overarching strategy for acute care. Instead, acute providers will continue to develop their strategies for the placed-based plans of which they are part, whilst at the same time BSUH will develop a strategy for tertiary care. BSUH will work alongside ESHT and the other providers to ensure that the tertiary strategy complements their place-based strategies. BSUH has committed to develop this tertiary strategy in consultation with partners before Christmas 2017. Dr Bull added that a commitment to joint approach towards elective care has been agreed across the STP but it has not been defined how it will be done yet.

Purpose of STPs

1.11.      Dr Adrian Bull that the purpose of STPs is to enable the NHS to meet the healthcare demand of local populations within existing resources. He argued that this can be done by providing better care for patients in the community and avoiding more costly acute admissions. This will also benefit the patient and provide them with better care because it will prevent their condition deteriorating to the point where they need to go to hospital. Describing them as purely money saving exercise is, therefore, overly simplistic.

1.12.      The Committee RESOLVED to:

1) note the report;

2) request an update on the STP in either March 2018, or when the Chair considers that it has progressed to the stage where a report would be worthwhile. If a report is not appropriate for March 2018, the reasons why will be provided.