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.
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.
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.
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.
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.