Coastal Care

In October 2016, health and care partners in Coastal West Sussex developed a shared plan for our population called ‘Coastal Care: Inspiring Healthier Communities Together’. It set out our bold ambition for the future of the local NHS. It was one that made integrated care a reality for Coastal West Sussex.

Coastal Care: business case

Coastal Care: delivery plan 2017-19

Integrated care means caring for people as a whole, rather than separating them out into their problems and conditions; it means looking at the health of whole communities rather than just the ‘sick’ people within them, and preventing illness before it takes hold.

The Coastal Care plan is aligned to the Sustainability and Transformation Partnership (STP) plan, which covers the wider area of Sussex and East Surrey.  Coastal Care is the place-based plan for Coastal West Sussex within the STP.

A transcription is available (click to reveal)

As the CCG responsible for commissioning NHS services in the Coastal West Sussex area, It’s our job to make sure that the services we have in place already are working and to help make plans for the future. We help decide which NHS services get funding and how much funding they need to get the best health outcomes for our population.

We want to change how that happens.

I know this sounds like it could be a bit dull... but keep listening because it gets interesting, and if we want a healthy population with easy access to the right healthcare for everyone, it’s also really important.

Right now, service providers (the people who run hospitals and provide services in the community) can feel that they compete with each other for our attention and funding.

Every year, they let us know how much they think they are going to spend.

We discuss with them how many operations they plan on doing, how many medicines prescribed, the number of babies they’ll birth or broken bones they’ll mend, or just the total amount of money they’ll need to keep going for another year.

Each individual unit, specialisation and department is competing for a piece, of our NHS funding pie.

While this is very flattering for us there are some problems with the current system.

Firstly there’s no incentive to be doing less treatments… so no incentive to keep people well.

Secondly, in order to preserve their bit of the budget, departments sometimes argue about whose responsibility a particular patient is. 

Not just within hospitals and primary care, but also in terms of social care where things can get even messier.

We can forget that we are all on the same side and that we all have the same mission: to get and keep people ‘healthy, happy and well’.

For doctors, nurses and other practitioners, this political in-fighting is frustrating; for patients, who don’t know which department deals with their particular needs, finding the right one can be maddening.

Imagine you’re a patient with a mental and a physical illness, perhaps even more than one illness.

You may be rejected from some of the care you need because another one of your other ailments is seen as more urgent.

Or worse, your care may be delayed while departments face confusion over whose responsibility you are.

Having several things wrong with you is something we deal with more and more as our population gets older and, with a predicted funding gap as well as cuts to social care putting more and more pressure on the overall NHS budget, we simply cannot afford to waste time squabbling internally while our patients suffer and their symptoms progress.

To find a better way, we launched the embarrassingly named ‘Let’s Talk’ campaign.

We’ve spent the last three years talking to people, patients and health care professionals.

We’ve found that there has been a movement growing within the NHS towards integrated care.

Integrated care means caring for people as a whole, rather than separating them out into their problems and conditions; it means looking at the health of whole communities rather than just the ‘sick’ people within them. 

It’s about dealing with how one condition impacts another and treating them all at once and how preventing illness before it takes hold is just as important as curing it.

This is sometimes seen as hopelessly idealistic, but we don’t think it is.

We heard about great systems in the United States, in Spain and New Zealand, so in addition to ‘Let’s Talk’, we studied those as well. 

And now, having done our research, we are ready to make a few changes.

What we want to do is work with health-care providers that can show us that they have integrated care in mind; providers willing to work in different ways together, that have shown that they know the specific issues which affect the communities on the Sussex coast, and have a joined up plan to tackle them.

From now until 2020 we are going to be doing this more and more, but in the run up to 2017 our particular focus will be in two key areas: integrating GP care with Community Services, and transforming Urgent Care.

We want to look at patient flow; stripping away organisational barriers so that the entire patient pathway can be covered under a single budget.

We want to provide incentives based on patients getting well, rather than the number of times they are seen, so that each of the departments they pass through is taking some responsibility for their over-all journey.

We’re going to look at what people do when they start to feel ill or have an accident, and how to decide who is the best person to treat them.

Redesigning the front door, to make it easier and faster to get where you need to be so that the utopian dream of each patient getting the right care, in the right place, first time, every time, can take another small step, or one giant leap, towards becoming a reality.

We also want to look at GPs because this is where 90% of patient interaction takes places.

We want to work with GPs who are able to network and partner with existing community services to generate and promote health.

We want to find ways to use new technology to group patients differently and identify and tackle health risks before they become health problems.

We want to work with them to plan and combine individual specialisms into primary-care multidisciplinary teams.

We want to see them partnering with housing associations, mental health provision or charities.

We want to see how working with their communities can counteract the negative effect that social isolation or depression can have on a chronic conditions.

Basically, we want to see a change and It may sound a little daunting, it may be tricky to set up but that's ok. We are prepared to work hard.

For three years we’ve listened to what you want and now we want to give it to you.

We think that by doing this we will save money in the long term. That we will make the lives of health professionals more rewarding, and ultimately lead to much healthier people, living in healthier communities across the West Sussex coast. So If you are interested in working together for one NHS…

Start believing that integrated care can work, because in many places, it's already is.

So if you are involved in local health and care, start working as one now, and together we will make it happen.

Our vision for accountable Coastal Care

Our ambition is to take our good care and make it excellent, working together as partners to improve the health and wellbeing of the population, to improve outcomes for individuals and to deliver better value for money.

Organisational boundaries will no longer be barriers to our patients or to our staff. We will improve the way we deliver care (introducing a new model of care) and improve the way organisations work together (establishing Local Community Networks / LCNs and an Accountable Care Partnership), through which we will deliver the new model of care).

The key components of this are:

  • A population health approach that encourages prevention, strong primary care and out of hospital care
  • A single strategy and operating plan for our system
  • A single financial plan and capitated budget
  • Commissioner contracts that rewards delivery of health improvement rather than activity
  • Integrated delivery
  • A single leadership team.

Progress so far

Health and care partners have been working over the last year to develop further how care can be delivered differently for people in Coastal West Sussex. This will mean changing the way services work together, and how organisations work. To move this forward in May 2017 a Business Case for Coastal Care was agreed by all of the accountable officers of the partner organisations.

We have also established Local Community Networks which will provide NHS and social care services closer to people’s homes and we have refreshed our financial plans.

Our priorities this year

This year our focus is on:

See more on these on each of the programme pages.

Talking to you

It is really important that our communities are part of the development of these plans, and they are shaped in partnership with you.

Engagement events took place last year as the plans went through their initial development, and events are taking place currently at Local Community Network level. See more details and how you can get involved.