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Sustainability and Transformation Partnership for our local communities

What is the STP?

The Sussex and East Surrey Sustainability and Transformation Partnership (STP) brings together 24 organisations involved in the planning and provision of health and care services across the region. 

This includes CCGs, acute hospital trusts, mental health, community services, and local authorities. 

Together they are focused on how the NHS and social care can work together to improve and join-up services to meet the changing needs of all of the people who live in our area.  

As our population grows, and grows older, we need more health care and different services. Some of the services we have now, were not designed to meet the needs of today or the future and do not make the most of medical advances. 

We want to do more to prevent illness, support people to manage existing health conditions and to stay independent. To do this we need seamless health and social care services. 

The STP is a partnership and a new way of working. It ensures that all the health and care organisations in Sussex and East Surrey are working together in a joined-up way. 

One of our priorities is to develop more community-based services, helping people to stay well closer to home. This will reduce demand on our hospitals, enabling them to improve their specialist services.  

Working together in this way means that we can offer local people better care and better outcomes and make more efficient use of the resources available to us.

BBC One took a unique approach in trying to explain STP on Monday 18 September 2017. Inside Out South East sent a journalist on a bike ride around Brighton, seeking an explanation of the new proposals for improvements to the NHS. You can catch it on the BBC iPlayer here.

Why do we need the STP? 

As our population grows, and grows older, we need more and different health and care services. The services we have now were not all designed to meet the needs of today or the future and it is becoming harder to keep up with rising costs. In addition, we need to do more to prevent illness and support people to manage existing conditions and stay independent. There are large gaps between what we have now and what we need and local people deserve better.

Health and wellbeing gap

We have a growing and aging population and more and more people are living with long-term conditions. We have a large older population and people living in some of our coastal towns experience significantly worse health than people living elsewhere. We also have above average rates of smoking among 15 year olds, adult obesity and hospitalisation for self-harm.

Care quality gap

We face challenges in primary care, with a growing number of vacancies for GPs and premises that are no longer fit for modern healthcare. People can’t always get appointments quickly and this means diseases might not get detected early enough or existing conditions get worse.

Many of our hospitals also face significant challenges. Waiting times for routine surgery, cancer treatments and emergency care are not improving as we want them to, and it is difficult to recruit the right staff.

Finance and efficiency gap

Like all parts of the health and care system, demand for our services is growing much faster than the resources we have available.  

If we simply carry on providing services in the way we have in the past and do nothing to change the way we work, then by 2020/21 the gap between the resources available and the money we will have spent across the STP will be close to £900m. 

That is why we make take the opportunity of the partnership to work together to make the best use of the available resources. 

We believe that integrated and community-based health and social care, a focus on supporting people to stay well, more joined-up specialist services and a more effective use of our hospitals will enable us to offer people better health and better services within the available resources.  

In addition, we are working together to ensure that every penny of the health and care budget is well spent. For example, reducing the reliance on expensive bank and agency staff, back-office costs, and the cost of ineffective treatments and wasted medicines.

In November 2016, we published our ambitions for improving health and care for local people. 

Download our STP document 

We need to radically change the way we work if we are to successfully address the challenges we face. There has been a strong focus on developing the relationships and the processes for working together in this new way.

We have also established a clinical board, bringing together senior doctors, nurses, public health experts and other care professionals from all the partner organisations to oversee the development of health and care services. 

The STP partners have agreed three priority areas for collective action to improve services, supporting any work that is already happening locally: 

  • Urgent and emergency care
  • Mental health
  • Cancer care 

 

In order to deliver our aspirations for improved health and care, and the most efficient use of resources, we are also coordinating our approach through the STP to workforce development, information technology and estates.

A lot of work has gone into developing the relationships and the processes for working together. We have also established a clinical board, bringing together senior doctors, nurses, public health experts and other care professionals from all the partner organisations to oversee the shape of future care services. 

Involvement and accountability

The STP is a partnership and a way of working. It has no powers to make decisions on behalf of the individual partner organisations. These powers continue to sit with each partner organisations’ board. 

Partner organisations also remain responsible for involving their local communities, patients, the public, staff and clinicians in their plans and decision-making. The plans that make up the STP do not currently include any proposals to change clinical services that will require formal consultation. But we have a lot more work to do. In the months ahead we will be doing more to involve staff, patients, carers and others in this work. 

Your Views

We are at a very early stage in the planning process, but it will soon be time to work alongside you – our patients, the public and NHS staff – to develop and shape our NHS. No final decisions have been made about any services and will not be made without our patients and public being given the opportunity to be involved and voice their opinions.

Our overarching approach is to ensure that there are local ‘place based plans’ so that people can get the care they need as close to home as possible. Each of the four places is developing its own model of care to meet local needs, but they share the same aims. 

The plans will deliver community based, integrated health and care services through ‘accountable care systems’. These involve health and care organisations working together to share resources and take joint responsibility not just for treating people but helping them to stay healthy, tailoring their services to the needs of individuals. The aims are to: 

  • Help people to stay well
  • Support people to manage existing conditions and retain their independence
  • Avoid unnecessary hospital visits. 

More community-based care is not only better and more convenient for local people, it also reduces the pressure on our hospitals. The evidence shows that we will not have enough hospital beds across the STP to meet future needs if demand continues rising as it has done. 

The four place based plans are: 

  • Coastal Care (Coastal West Sussex)
  • Central Sussex and East Surrey Alliance – North (*see more on the CSESA plan below)
  • Central Sussex and East Surrey Alliance – South (*see more on the CSESA plan below)
  • East Sussex Better Together 

[Note: External-facing names for CSESA North and South places being developed.] 

East Sussex Better Together is well developed, having begun work several years ago. The East Sussex Better Together Alliance, bringing organisations together to provide integrated health and social care services, is operating in shadow form in 2017/18 to test the best new care models before becoming an accountable care system in 2018. 

Work to develop the place based plans in the other areas will be moving forward quickly over the summer. The plans are being developed locally, led by the CCGs and local authorities, and are being incorporated into the STP, rather than the other way around. Much of the work that underpins the place based plans would be going on already even if it were not for the STP; the STP ensures that it is joined-up. 

About our place based plan

The five CCGs of Brighton & Hove, High Weald Lewes Havens, Horsham & Mid Sussex, Crawley and East Surrey have formed a partnership known as the Central Sussex and East Surrey Alliance (CSESA) in order to transform services in line with the Five Year Forward View. In April 2016 it was agreed to split CSESA into north and south.

Working with partner organisations our aim is to transform our model of care from one that is reactive and often delivered in a crisis to one which promotes wellbeing, provides early detection and diagnosis of illness and helps people to manage their own health more effectively.   

Built around collaborative clusters of General Practice serving populations of approximately 50k, there are 20 ‘care hubs’ across the CSESA footprint (four in HMS and two in Crawley) currently in the process of integrating community health, mental health, social care and third sector support in order to improve the care provided to our local population, improve health outcomes and drive a greater level of efficiency across the whole system.  These care hubs will become the delivery units for a new organisational entity known as a Multi-Specialty Community Provider (MCP) which will be in place by 2020. 

Already, through projects like Communities of Practice, the Primary Care Home Vanguard, Social Prescribing and improvements to our Urgent Care Centre at Crawley Hospital, we are beginning to see the impact of working more proactively and coordinating care, albeit in a narrow cohort of patients or geographical area. 

Our challenge across Central Sussex and East Surrey is to drive a level of scale and pace for our transformation programmes in order to improve outcomes for patients and also address the underlying financial problems we face as a system.

Staff, clinicians, partners, providers, patients, carers and members of the public are all encouraged to engage with this process as we move forwards – everyone has a role to play in co-designing those services. 

The right hospital services for the future 

With better community-based services in place, we need to make sure that we have the right hospital services to meet the needs of the future. 

Initial work commenced on reviewing our acute services review earlier this year. We have been analysing the data to confirm the expected capacity and demand across our acute hospitals over the coming years. It shows that our hospitals face significant challenges and we will not have enough acute hospital beds if demand and length of stay continue to rise at the current rate. 

Further work needs to be carried out over the coming months by each area on its place based plan before we can be clear on the level of acute activity that could be avoided by better integrated community care. We also need to understand where there are opportunities for hospitals to work more closely together to share expertise and resources, particularly where there are recruitment challenges. 

This work will enable us to develop a comprehensive and robust strategy for acute services. Clinicians will be leading this work with involvement from patients and the public. If any significant changes are proposed they would be formally consulted on before the relevant local organisations made any decisions. 

Changing how we commission services 

Changing the way we provide health and care services means we also need to change the way we commission them. Commissioners (who plan, buy and quality assure services of behalf of their local populations) have decided to work together to make it easier to commission services jointly and so they can better share resources and expertise.

The CCGs are working together to agree how to pool resources, manage risks, and simplify arrangements for commissioning services that span more than one area through a number of joint ways. This will become increasingly important as the accountable care systems developed through the place based plans are implemented as they are likely to operate across multiple CCGs.

Several services are already commissioned jointly, but the process could be simpler in certain instances.  

The plans for new commissioning arrangements are currently being developed with the aim that they are approved by CCG boards in the autumn and implemented from April 2018.

The new commissioning arrangements will build on the current strengths of the CCGs and local places. Each CCG and place will remain accountable to its local community for the services they receive and each will retain its governing body and board, the strong clinical leadership of GPs and continued engagement with local people. 

Service improvements 

The STP partnership has agreed three priority areas for collective action to improve services: 

  • Urgent and emergency care 

Organisations are working together to improve urgent and emergency care. This includes making it easier to book GP appointments and get advice over the phone and online, thereby reducing demand for urgent care. Urgent treatment centres will offer extended opening hours and a standardised service. We are also working together to enable faster ambulance response times and reduced waiting times for emergency admissions by supporting the prompt discharge of people who are in hospital but no longer need to be. 

  • Mental health 

We are developing a joined-up approach for mental health services and new models of care to enable us to deliver our aspirations for seven-day access, integration with physical health, and to promote good mental health. Work is underway to develop new integrated health and care services to meet the often very complex needs of people who have severe and enduring mental ill health. 

  • Cancer care 

We will be working with the Sussex and Surrey cancer team to support the implementation of the delivery plan for improved cancer care across our STP area. 

Enabling workstreams 

In order to deliver our aspirations for improved health and care and to make the best use of our resources, we are working together – and with other partners such as Health Education England and NHS Property Services – to coordinate our approach in three key areas: 

  • Workforce – Ensuring we can recruit, retain and develop the right staff with the right skills to meet the needs of the future. 
  • Estates – Ensuring that we have the right buildings and facilities in the right places and that we are using all of our property as effectively as possible.
  • Digital – Developing IT and information management systems to support clinicians to deliver high-quality, integrated patient care.  

Closing the gap in our finances 

If we simply carry on providing services in the way we have in the past and do nothing to change the way we work, then by 2020/21 the gap between the resources available and the money we will have spent will be close to £900m. 

That is why it is imperative that we take the opportunity of the STP to work together to make the best use of the available resources. We believe that integrated community-based care, a focus on supporting people to stay well, more joined-up specialist services and a more effective use of our hospitals will enable us to offer people better health and better services within the available resources. 

In addition, we are working together to ensure that every penny of the health and care budget is well spent. For example, we are working to reduce the reliance on expensive bank and agency staff and reducing back-office costs and the cost of ineffective treatments and wasted medicines. 

Involvement and accountability 

The STP is a partnership and a way of working. It has no powers to make decisions on behalf of the individual partner organisations. These powers continue to sit with each partner organisations’ board. This could change in the future, but not without Parliament first passing new legislation. 

Partner organisations also remain responsible for involving their local communities, patients, the public, staff and clinicians in their plans and decision-making. Many of the elements of the STP, such as East Sussex Better Together, and Brighton and Hove’s ‘Caring Together’ programme have already been built on on-going patient, public and clinical engagement. In Coastal West Sussex, the ‘Our NHS’ programme has involved more than 1,000 local people in thinking about how health and care services can meet the challenges they face. 

The plans that make up the STP do not currently include any proposals to change clinical services that will require formal consultation. But we have a lot more work to do. In the months ahead we will be doing more to involve staff, patients, carers and others in this work. This isn’t simply about formal public consultation where that may be required; it’s about involving people in talking about the challenges we face and how we can address them. 

  • Brighton & Hove City Council
  • Brighton and Hove CCG
  • Brighton and Sussex University Hospitals NHS Trust
  • Central Surrey Health
  • Coastal West Sussex CCG
  • Crawley CCG
  • East Surrey CCG
  • East Sussex County Council
  • East Sussex Healthcare NHS Trust
  • Eastbourne Hailsham and Seaford CCG
  • First Community Health and Care
  • Hastings and Rother CCG
  • High Weald Lewes Havens CCG
  • Horsham and Mid Sussex CCG
  • Integrated Care 24
  • Queen Victoria Hospital NHS Foundation Trust
  • South East Coast Ambulance Service NHS Foundation Trust
  • Surrey and Borders Partnership NHS Foundation Trust
  • Surrey and Sussex Healthcare NHS Trust
  • Surrey County Council
  • Sussex Community NHS Foundation Trust
  • Sussex Partnership NHS Foundation Trust
  • West Sussex County Council
  • Western Sussex Hospitals NHS Foundation Trust

Find out more

Programme Board

The Programme Board sets the direction and priorities for the STP. It includes the chief officers or accountable officers of the eight CCGs, chief executives of the 12 NHS trusts and other providers, and the chief executives of the four local authorities within our partnership. 

Programme board meeting agendas, papers and minutes:  

 

Resources and documents

On 25 November 2016 the NHS, social care and public health in Sussex and East Surrey published its STP.