Transformation of health and social care services in East Sussex is an ‘opportunity we must take’, according to one senior figure.
In an exclusive joint interview, two of the county’s most senior health bosses reflected on the challenges and successes of the East Sussex Better Together (ESBT) programme, which was set up three years ago in response to increasing demand on services due to an ageing population, and explained its next stages.
The partnership has seen two of East Sussex’s clinical commissioning groups and the county council working with East Sussex NHS Healthcare Trust, which runs both Hastings’ Conquest Hospital and Eastbourne’s District General Hospital, and Sussex Partnership NHS Foundation Trust to both improve and integrate health and social care services.
The next step is to create an accountable care model through the East Sussex Better Together Alliance, which provides a legal vehicle to formalise the changes and involves a shift away from payment by activity.
Amanda Philpott, chief officer of both Hastings and Rother CCG and Eastbourne, Hailsham, and Seaford CCG, said: “We are doing our level best to use everybody’s best brain to try and make our health and care system as good as it can be and as sustainable as it can be for the future.”
She added: “From my perspective there is no other programme and no other vehicle. Unless we all try our level best to try and reduce barriers we will fall earlier.
“For all of us who work in the public sector, who care about the NHS and our social care services, I think it’s the opportunity we must take. It’s our responsibilty to do this.”
Keith Hinkley, director of adult social care and health at East Sussex County Council, explained how integrated care had been talked about for a long time but ‘proved very difficult to do in practice’, as improving patient services and reducing the need for costly acute care has been a goal for the NHS over the past 25 to 30 years.
However they had worked hard with patients through ESBT to develop services that would ‘make a real difference in their lives’.
Ms Philpott explained how when the 150-week programme examined the causes of financial challenges in East Sussex they found it was not about hospital services but more about how they enabled people to live well in the community and look after their own health and wellbeing more independently.
Changes brought in by the programme over the last three years include Health and Social Care Connect, which offers both the public and professionals a single point of access for adult health and social care enquiries, assessments, services, and referrals.
Meanwhile doctors initially invested £5m in the Healthy Hastings and Rother programme to tackle health inequality in the area. It delivered a range of projects, from working to improve sheltered accommodation to training 500 staff on Making Every Contact Count, which encouraged them to use opportunities during routine interactions with people to have brief conversations on how they can make positive changes to their health or wellbeing.
Another project provided bursaries to every single nursery in East Sussex to encourage children to exercise more and eat more healthily.
Ms Philpott said: “Getting in early prevention and healthy habits are really important parts of what we are doing.”
Meanwhile Mr Hinkley raised the work of their integrated locality teams and the joint reablement service which are both ‘making a huge difference to how people are supported’, while they were also helping patients become more resilient in partnership with volunteer and community groups, and district and borough councils.
The ESBT Alliance, which is undergoing a ‘test-bed year’ in 2017/18 and would come into full force in April 2018, would put ‘legal rigour around the goodwill’, according to Ms Philpott.
Changes will look at how the collective organisations can best use the £850m they spend every year to meet the health and care needs of East Sussex.
Ms Philpott said the changes would not ‘magically create more money’, but were about ‘collectively agreeing what the best way of spending that resource is’.
The arrangements would look at things such as improving patient flow, patient information, estate management, and cutting out silo working.
Mr Hinkley added: “We are managing a health and social care system as one system, one budget, and one set of outcomes we are trying to deliver. That’s what we are doing this year.”
Shared priorities have been set using comprehensive public health data and these will be used to focus future investment in areas such as prevention, reablement, and primary care.
Outcomes for the area include reducing preventable mortality, improving health related quality of life for the elderly, and reducing child obesity.
One of the other major challenge for East Sussex Better Together has been tackling is health inequality as there is a noticeable difference in life expectancy between prosperous and deprived areas.
Ms Philpott said: “We know we are having a good impact on obesity overall, but we are not reducing the gap between less deprived and more deprived communities.”
An increased proportion of the overall health budget in the area would be spent on GP services by 2020/21, up from 8.5 to 12 per cent, with the aim of treating more patients in the community rather than seeing them admitted to acute hospitals.
Health teams were looking at a range of actions to improve services, including investment in digital solutions given challenges with the rural nature of parts of East Sussex and recruitment and retention of staff.
One of Eastbourne’s GPs is leading on a pilot project called ‘See What I See’, which uses head-mounted technology to conduct remote clinical assessments which would otherwise require a GP to attend the care home in person to assess the patient.
Innovative telecare solutions are also being explored for patients living in their own homes or extra care facilities.
Meanwhile partnership working will continue to look at improving general health and wellbeing, in particular addressing social isolation given the ‘big impact’ it has on frailty and dementia.
Mr Hinkley stressed the need to give people the right information on how they can manage elements of their own care as making patients feel in more direct control can improve their wellbeing.
Lastly Ms Philpott talked about their desire to ensure all conversations are in public with all the information on the programme available on the website.
CONNECTING 4 YOU
The High Weald Lewes Havens CCG area is covered by a separate programme called Connecting 4 You.
Mr Hinkley explained that some elements of the ESBT programme, such as the Health and Social Care Connect, and joint community reablement services were county-wide, adding: “Our aspirations are the same but we are in a much earlier part of that journey.”`
Connecting 4 You was discussed at the last East Sussex Health Overview and Scrutiny Committee meeting in late June.
Ashley Scarff, director of commissioning and deputy chief officer for the CCG, explained how their aim was to ‘defragment’ services, ‘improve the offer and get best value for money out of our health and social care investments’, and further develop a community model of care.
The separate programme from East Sussex Better Together allowed the CCG to ‘engage and operate with multiple systems in quite a different way’ as many of the patients in the area use services in Brighton, Kent, and Mid Sussex.
He added: “It’s not that the pressures are unique to us in any way, it’s about the delivery and the solutions and we have got the opportunity to tailor it to our population and our particular infrastructure.”
Colin Belsey (Con, Eastbourne - Ratton), chair of the committee, asked if the CCG would now be in a better position if it had not pulled out of the East Sussex Better Together programme.
Mr Scarff responded: “I would say categorically no. I think it was absolutely the right decision. I would venture to suggest had we continued down a collective path with East Sussex Better Together we might well be much further ahead and be in a much better place for ten to 15 per cent of the population.”
Meanwhile Ruth O’Keeffe (Ind, Lewes), vice-chairman of the committee, said she was convinced about the geographical argument, but added: “Since we have started behind I would like to see more catching up.”
Mr Scarff said they were ‘working at pace’ with ‘real progress’ in their multi-agency working, and their combined financial plan.
Cllr O’Keeffe described the answer as ‘very encouraging’.
Meanwhile Sarah Osborne (LDem, Ouse Valley West and Downs) asked if any more concrete timescales could be provided by the CCG.
Sam Tearle, senior strategic planning and investment manager for the CCG, explained how a detailed timeline was due to be presented to the CCG’s board later this month.
Cllr Belsey asked if the CCG could give a further presentation on timescales to its autumn meeting, and a further update at its March 2018 meeting.