Agenda item - Sustainability & Transformation Plan (STP)

John Child (Brighton & Hove Clinical Commissioning Group Chief Operating Officer) and Brian Doughty (Brighton & Hove City Council Acting Director of Health and Adult Social Care) will present on the STP initiative to transform health and social care.

241.1  This item was presented by Brian Doughty, Acting Director of Adult Social Care (ASC), Brighton & Hove City Council; and by John Child, Chief Operating Officer, Brighton & Hove Clinical Commissioning Group (CCG).

241.2  JC explained that Sustainability & Transformation Plans (STP) have been introduced as part of NHS Planning Guidance to implement the NHS Five Year Forward Vision. Local NHS bodies and councils are mandated to work together to develop STPs at a sub-regional ‘footprint’ level. To date, a local STP footprint has been agreed (Sussex and East Surrey), a diagnostic process has been undertaken, and co-working arrangements have been developed.

241.3  The STP footprint has been further split into three localities. Brighton & Hove CCG area is grouped together with High Weald Lewes Havens, Horsham & Mid Sussex, Crawley, and East Surrey CCG areas. (There are also West and East Sussex localities.) This grouping reflects the catchments of Brighton & Sussex University Hospitals Trust (BSUH) and Surrey & Sussex Healthcare Trust (SASH) for the acute hospitals at Brighton, Hayward’s Heath and Redhill. A place-based plan is being developed for this locality. This is not a wholly new piece of work: it builds on existing local integration plans and recognises significant commonalities across the area – e.g. everyone has similar workforce problems.

241.4  STP governance is a complex issue and this is now starting to be addressed. Local authorities are fully engaged with this process – for example, Health & Wellbeing Board Chairs have begun meeting jointly to look at this and other issues.

241.5  Integration is about reducing barriers and minimising overlaps between health and social care. This may well entail pooling funding and staff in the longer term. This is not a very short term project, although full plans for integration must be in place by 2020. BD stressed that it was important to recognise that we are not starting from scratch: there is a long history of integrated NHS and social care working in Brighton & Hove.

241.6  In response to a question about public engagement/consultation, JC stated that STP plans would go through the normal public consultation and engagement processes of STP member organisations once there are clear decisions on which to consult. There is currently no set date by which detailed plans must be ready for public consultation:  although there are the October 2016 dates for submission.

241.7  In response to a question on action to tackle delayed transfers of care (DToC), BD told members that DToC was a local priority and much good work is taking place, such as the Discharge to Assess and Hospital at Home initiatives. There is no issue with timeliness of social workers assessments, all of which are up to date. However, there are significant issues with the lack of local care home places and home care availability. Commissioners have attempted to support the local care home market, and things have recently stabilised, but this will remain a major risk going forward. JC clarified that work on DToC was formerly overseen by the multi-partner System Resilience Group (SRG). The Department of Health has recently required that SRGs be re-badged as A&E Delivery Boards, with a particular focus on improving hospital A&E services.

241.8  BD explained that social care commissioners contract manage care providers, the great bulk of whom are and have long been independent sector organisations. The whole sector is regulated and inspected by the Care Quality Commission (CQC). JC added that clinicians also have a duty to feedback any concerns they may have about the environment that their clients live in.

241.9  In answer to a query about whether it was realistic to expect STP areas to clear provider deficits of hundreds of millions of pounds by 2020, JC replied that STP areas are charged with developing credible plans to address deficits; these plans will not necessarily lead to zero deficits by 2020. STPs are required to work within the current NHS and care funding envelopes and local authorities and NHS organisations have no influence on the level of Government funding they receive. If people feel strongly that funding should be increased, then this is something to lobby local MPs about.

241.10 JC told members that the STP is not just about reducing deficits: it must also improve quality and support social care. A framework for measuring quality improvements will be developed. This will draw on contract key performance indicators (kpi), but will focus more on achieving better outcomes for people than on hitting process targets. BD added that annual user surveys are likely to be integral to measuring quality.

241.11 In response to a question about NHS capital investments, JC told members that there is very significant current capital investment in city services, particularly in terms of the ‘3Ts’ development of the Royal Sussex County Hospital. There is also a commitment to re-invest proceeds from the sale of city NHS estates into Brighton & Hove services. The position on additional NHS capital funding to implement STP plans is not currently clear.

241.12 The Chair thanked JC and BD for their contributions. Both speakers stressed that they would be happy to come back to the OPC to talk about Brighton & Hove integrated care plans.