East Sussex Better Together Alliance - Governance to enable cross sector delivery

Abstract

Our problem, what we did and how: ESBT is a partnership between two local Clinical Commissioning Groups CCGs, the acute and community NHS Trust, mental health NHS Foundation Trust and the County Council. The partners’ aim is to integrate the whole system to ensure they use their combined £860m annual budget to achieve the best possible services for their local population approximately 370,000 people. To facilitate this in 2017/18 ESBT came up with a transitional governance model within the current UK legislative context, in order to enable the partners work differently together as a whole health and care system to achieve their ESBT objectives. The integration transformation programme of work started in 2013 and the new governing arrangements have been in place since April 2017. Highlights innovation, Impact and outcomes: Tangible outputs of this work to date include for example: A single integrated point of contact hub for all health and care services; A Crisis Response service supporting older people at risk of emergency admission to hospital; Fully staffed and operational integrated locality teams in 6 localities; A welfare benefits Project that has supported over 7,000 people; 183schools with developed whole school health improvement plans; 136 nurseries – 82% total / rising to 93% in areas with highest inequalities have signed up to the nursery transformation programme Healthy Active Little Ones HALO; rocess and outcome measures that indicate the impact that the programme has had to date include: Activity change between 2013/14 and 2016/17 is lower for ESBT and the acute provider, than in STP CCGs and nationally in all points of delivery bar AE Comparators showing CCG activity rates per 100,000 weighted population against the average for England are lower across almost all points of delivery other than bed days; 72% of people seen by the Crisis Response have not been re-admitted to hospital within a month; Improved access to psychological therapies– target 75% actual; Eastbourne Hailsham and Seaford 85.5% / Hastings and Rother 89% Healthy Living PharmacistHLP - 53 pharmacists and 10 pharmacy staff in wider roles attended leadership training in preparation for new ways of working. Conclusions: In order to develop and shape proposals for further strengthening the ESBT Alliance in 2018/19 we have mapped and reviewed the existing governance arrangements of our sovereign commissioning member organisations, as well as the key elements of our new ESBT Alliance governance structure, to further develop our understanding of the following: what is currently delegable to our Alliance and what isn’t; where lay, clinical and elected members’ roles could be used to best effect in assuring plans as we move forward on a system-wide basis in 2018/19; an initial screening exercise of potential equalities and health inequalities impacts, and; the transitional timetable that will be necessary to test system-wide governance and leadership arrangements over the year. The process of developing the new governance model should be transferable to any context.