The future of the NHS and social care in Sussex & East Surrey

Not one big organisation

Most people think of the NHS and social care as being one big organisation but it’s not. Healthcare is funded and provided by the NHS and social care by the local authority, in our case, this is Brighton and Hove City Council.

How things work in Health & Social Care

• Healthcare is everything you might need when you are unwell – physically or emotionally - and the NHS is arranged around where treatment happens and the type of care needed. These organisations are called the ‘providers’ of healthcare:
  • Primary Care – GP surgeries;
  • Pharmacies, Dentists, Opticians;
  • Community Trusts;
  • Hospital Trusts;
  • Mental Health Trusts;
  • Ambulance Trusts.
• Most healthcare is free in the UK but there are charges for some things and lots of services are provided by people who are employed by the NHS. For example most GPs are self-employed or employed by their ‘Practice’ and they sell their services to the NHS.
• NHS England and the Brighton and Hove NHS Clinical Commissioning Group (CCG) look after NHS money; they decide what services should be provided and who will provide them. They buy our healthcare from the ‘providers’. NHS England and Brighton and Hove CCG are called the ‘commissioners’ because they commission or purchase healthcare on our behalf.

• Most Social Care is provided by the private sector and voluntary and community organisations – care homes, nursing homes and practical support in your own home (called domiciliary care). In the past the local Council provided lots of social care; these days they are much more likely to help and provide advice, and sometimes pay for social care provided by the private sector.

• There is no system in the UK for linking together all the different parts of the NHS and social care and that is one of the big jobs being tackled by Sustainability and Transformation Partnerships (STPs). In Brighton and Hove we want to get health and care integrated by 2020. There is already lots of good co-operation and the main partners are:

• Brighton and Hove City Council – Child and Adult Social Care, Safeguarding and Public Health;
• Voluntary and Community organisations and private sector care organisations;
• Brighton and Hove CCG (the NHS Commissioners);
• All the GPs;
• The Royal Sussex County Hospital (managed by Brighton and Sussex Universities Hospital Trust);
• Sussex Community Foundation Trust (SCFT) provides nearly all the healthcare people who visit you at home;
• Sussex Partnership Foundation Trust;
• South East Coast Ambulance Service (SECAmb).

The Future

The STP have published information on why they think things need to change and how they are starting to sort out those changes.

In summary:

• Why change things?
  • More people are living longer and will need more care and treatment;
  • There are big differences and inequalities across Sussex and East Surrey in the services available, the quality of those services, how well people are and how long they live for. So we need to make services fairer and easier for people to access;
  • We have limited money and growing demands.

• The commissioners – the section of the NHS and City Council that buys and arranges our health and social care - are carrying out the following:
  • Reviewing the system and ensuring a more integrated approach;
  • Dividing the STP into four parts (‘Places’) – North (Crawley and East Surrey), South (Brighton and Hove, High Weald, Lewes, Horsham), East (Eastbourne and Hastings), West (Worthing, Chichester) to make things more manageable;
  • Setting up a special team to buy and arrange all the health care that is County and STP-wide, for example, most emergency & hospital care;
  • Locally – in the City and a little wider in the STP South ‘Place’ - they are starting to integrate health and social care – mostly around community or ‘out of hospital’ services.

• How to choose what to change?
  • The doctors and other health and care professionals are agreeing what is going to change for patients and why – this is called the ‘clinical case for change’;
  • They want to ensure equality throughout the NHS and Care Partnership to avoid a ‘postcode lottery’. This means all parts of the NHS and social care agreeing about who gets what services, when, where and how quickly;
  • Making sure changes to one part of health and care Partnership does not push demand, staff pressures or financial problems from one place to another.

• How do we make a start?
  • The STP are responsible for ensuring that funds are used in the most effective way possible.
  • However, individuals can be encouraged to take more responsibility for their own health and care arrangements.
  • Making better use of available technology - from using text messages to remind people of their appointments to helping people order their prescriptions on line and book their appointments in the same way.

A long way to go

"The STP Partnership, having made all of these changes may need to ‘think the unthinkable’ if cost savings are to be made: longer waiting lists, travelling further to get specialist treatments and further rationing of treatments.

There is still a long way to go however before any final decisions are reached. A number of public consultations are planned so that you can voice your opinions and Healthwatch Brighton and Hove will continue to act on your behalf and challenge the STP on any recommendations it makes to ensure patient care is provided as effectively as possible."

David Liley
Chief Officer
Healthwatch Brighton and Hove
13/8/2017