NHS Coastal West Sussex Clinical Commissioning Group

Coastal West Sussex has one of the oldest and rapidly ageing populations in England and this is set to grow.

Life expectancy in some areas of Worthing, Littlehampton and Bognor Regis is ten years shorter than Pulborough or Arundel.

To help support our local population, Coastal West Sussex needs to be one of the best in England at supporting large numbers of  older people with chronic diseases, multiple conditions and frailty and bring responsive timely care closer to home.

A number of evidence-based programmes have been planned that are focussed on the local ageing population. These are:

• Care co-ordination, planning and management
• Falls prevention and management
• Reablement
• Dementia

What we mean by "care co-ordination, planning and management"

A population-based approach to identifying those Coastal West Sussex residents who are frail, at the end of life, those with dementia and those in care homes, and enabling integrated  cross organisational working  to develop LCN-level frailty multi-disciplinary teams.

What we mean by "falls prevention and management"

• The prevention of falls in patients of known risk
• Better support for those who fall using a fast response service and/ or short term managed care
• Supporting discharge to a reduced risk environment

What we mean by "reablement"

The role played by Health and Social Care in support individuals to regain and develop skills to live as independently as possible, being delivered within the context of wellbeing, prevention and resilience.

What we mean by "dementia"

A set of symptoms that may include memory loss and difficulties with thinking, orientation, problem-solving , visuospatial skills or language.  These symptoms are severe enough to affect daily life.

Our vision is one of promoting physical, mental and social well-being by enabling early and appropriate intervention and supporting people with dementia to better manage their care - moving from reactive to proactive; having parity of esteem where mind and body are considered holistically.

What will this mean for patients?

We believe the benefits of this integrated approach will enable us to:

• achieve improved patient outcomes e.g. enhance planning for discharge and reduce length of stay,  enhance management for those who have fallen closer to home.
• focus on quality to support the achievement of best practice, for example  in care planning and dementia identification.
• support people to be as independent as possible.
• reduce inappropriate admissions to A&E, by focusing initially on admissions from nursing homes.