Agenda item - The Sussex Health & Care Plan - local response to the NHS Long Term Plan

Report of the Executive Lead, Strategy Governance & Law (copy attached)

28.1    This item was introduced by Ashley Scarff, CCG Director of Partnerships and Commissioning, and by Lola Banjoko, CCG Managing Director (South). Ms Banjoko noted that the local response to the NHS Long Term Plan (LTP), the Sussex Health & Care Plan (SHCP), is a system response, involving all local NHS Trusts and commissioners, but also local authorities and the community & voluntary sector (CVS).

28.2    The key objectives of the SHCP are:

·         To reduce health inequalities.

·         To improve outcomes.

·         To be person-centred.

·         To accurately reflect local need – the local plan is informed by the Joint Strategic Needs Assessment and the Brighton & Hove Joint Health & Wellbeing Strategy (JHWS). The main areas of SCHP focus, cancer, multiple long term conditions, children & young people, and mental health, are also the main issues facing Brighton & Hove as identified by the JHWS.

·         Better utilising local assets, including CVS capacity, via social prescribing.

·         More joined-up working (e.g. the local homeless care pathway).

·         Better use of workforce (e.g. reducing duplicated visits to care homes)

·         Using data and digital to underpin improvement (e.g. South East Coast Ambulance Trust should be able to access people’s care plans/end of life plans when responding to emergency calls.

·         Delivering a shared vision with partners working positively together.

·         To deliver as much care as possible via ‘neighbourhoods’, with 30-50,000 populations. These represent the smallest unit that can realistically sustain a range of community and primary health services, care services and services linked to the wider determinants of health such as housing. Neighbourhoods represent the fundamental planning block for both the SHCP and the JHWS.

·         To deliver primary health services via a Primary Care Network (PCN) for each Neighbourhood. PCNs will help support GP Practice resilience, a key issue given intense workforce pressures currently being experienced. They will also collectively provide services such as physiotherapy and social prescribing, advancing the LTP’s preventative agenda and transferring activity away from the acute sector.

·         To develop the Sussex Health & Care Partnership on a Sussex-wide footprint, reflecting the fact that all local NHS Trusts work across local authority areas. The Sussex Health & Care Partnership will bring commissioners and providers of health and care together to plan services, spread good practice and work together to improve delivery.

28.3    Mr Scarff noted that the LTP introduces no new organisations or entities. This is about existing organisations working together in different ways.

28.4    In response to a question from Cllr Hugh-Jones, Ms Banjoko confirmed that all city GP practices have chosen to join a PCN. The LTP does not mandate the consolidation of GP practices, although practices within a PCN might opt for consolidation if it increased their sustainability.

28.5    In answer to a query from Cllr Hugh-Jones on data integration, Ms Banjoko acknowledged that the NHS had a patchy history with major IT projects. However, lessons have been learnt from past experiences and the technology to enable data sharing has improved in recent years. The initial focus will be on the integration of summary acre records.

28.6    In response to a question from Cllr Hugh-Jones on whether plans to ensure that any LTP changes requiring additional patient journeys would be supported by sustainable and affordable travel options, Ms Banjoko responded that this would be explored in individual service change planning. It should however be noted that the 3Ts development at the Royal Sussex will enable the repatriation of some specialist services to the city, reducing patient and family journeys.

28.7    In answer to a query from Cllr Hugh-Jones about LTP engagement, Mr Scarff informed members that previous engagement exercises such as “Our health, our care, our future” had informed the local response to the LTP. More engagement is planned, and there will be specific engagement and consultation relating to implementation of any service changes.

28.8    In response to a question from Cllr McNair on whether the LTP would entail the redistribution of primary care assets across the city, Ms Banjoko told the committee that this would be up to GP practices. Mr Scarff added that PCNs may seek to differentiate between patients who require generic GP services and those who need continuity of care from a named GP in order to ensure that finite resources are deployed as effectively as possible.

28.9    In response to a question on whether the ability to book Urgent Treatment Centre (UTC) appointments was yet in place, Ms Banjoko promised to provide a written response.

28.10  In answer to a query from Cllr Hills on membership of the Integrated Care System (ICS) Executive Group, Mr Scarff confirmed that the Chief Officers of NHS providers and commissioners would be invited, as would local authority Directors of Adult Social Care (DASS). There would also be support from the medical and clinical directors of the member organisations. Mr Scarff stressed that the ICS would have no delegated authority to make decisions, with accountability retained by member organisations. There is no elected member representation on the ICS, with Health & Wellbeing Boards expected to be the key vehicle for democratic accountability.

28.11  Cllr Knight commented that she was unconvinced by the term ‘neighbourhoods’: areas of 30-50,000 people are catchment areas rather than homogenous communities. She also noted that the language used to explain some of this information was unclear. Mr Scarff noted that ‘neighbourhood’ is a term being used by the NHS nationally. Whilst accepting Cllr Knight’s point, he stressed that ‘neighbourhoods’ present a more granular scale for commissioning than is typically the case; it would not be possible to deliver sustainable service provision at a smaller scale.

28.12  Cllr Powell asked questions about the steps taken or planned to ensure that there was engagement with a wide range of city communities representing people with protected characteristics. Ms Banjoko assured members that equalities issues were being taken very seriously. Engagement materials will be made available in (easy to read) print, braille and sign forms; engagement events will be accessible; there will be dedicated events for certain groups (e.g. people with a learning disability); the CCG will work closely with community & voluntary sector groups when planning engagement; the CCG will work with public health to ensure they have accurate data on people with protected characteristics; the CCG will actively use its staff networks to support engagement with specific groups (e.g. involving BAME staff in engagement with BAME communities).

28.13  In response to a question from Fran McCabe on engagement with the private sector, Ms Banjoko told members that the local private sector is essentially domiciliary care and residential care: there are no significant local private healthcare providers. There will be engagement at a neighbourhood level: e.g. linking hospital gerontologists to local residential care homes in order to reduce unnecessary hospital admissions. Mr Scarff added that it was more challenging to engage with domiciliary care providers, but this is something the system is committed to doing. There is also a commitment to engage effectively with carers, including support via the Better Care Fund.

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