Tuesday 18th October, 4pm-6pm

Suite 1, Jury’s Inn Brighton

How will the planned infrastructure developments

affect the people that live, work and visit our city?

Outline for Todays Meeting

We will consider this from the perspective of:

• Public Health

• Adult Social Care

• Primary and Acute Care

• Families, Children & Learning

Workshops

What are the implications of these developments, both positive and challenging? Consider:

• How will the developments affect people?

• What is the current situation?

• Can we look at good practice elsewhere? What are other places doing in response to the challenges?

• What happens when things go wrong?

Public Health

Public Health

• Our population:

– Growing and ageing

– Births, deaths, migration

• Key health needs

• Health inequalities

• Development and planning

– Social determinants of health

– Healthy urban planning embedded in the City Plan

A Growing Population

2015: 284,300 residents in the city (12.5% more than 2005) 2024: 301,800 (7.4% increase from 2014) 2034: 322,100 (14.6% increase from 2014)

An Ageing Population

Higher population increases among older people, for example

Age % increase

2014 2034

55 - 64 25,111 33,993 35%

75 - 79 6,685 9,372 40%

90 and older 2,372 3,856 63%

Brighton & Hove England

Health Warning

• Projections can be, and often are, “wrong”

• ONS projections look at births, deaths and migration (UK

internal and external) and project these trends forwards to

produce population projections

• They do not take into account other drivers of population

change e.g. housing development, university expansion, policy

and legislation changes e.g. the impact of withdrawal from the

EU

Births and Deaths

International Migration

Health Needs

• 19.5% of pupils have Special Educational Needs

– Higher than SE (15%) and England (16%)

• 44,600 people whose daily activities are limited a

little or a lot by a long term health problem or

disability

– 16% similar to 16% SE and 18% England

Inequalities by ward:

3x difference in % reporting bad/very bad general health

Brighton & Hove: all in it

together?

Healthcare alone can’t solve the health and

wellbeing gap

Social Determinants of Health

Air Quality

• Monitoring across the city shows some air quality indicators

have improved in recent years.

• However, estimated that 5.1% of annual mortality in >30

years in B&H is attributable to fine particles (as a proportion

of total deaths in that age range) (England 5.3%).

• Exposure more prevalent at recognised roadside locations

within the 2015 Air Quality Management Area (AQMA).

• Distribution of NO2 and PM10 can largely be explained by

road transport sources in urban areas.

Air Quality

• Key factors: stop-start traffic, heavy vehicles, diesel

vehicles and the proximity of building & traffic.

• Key interventions include

– Progress the ongoing Air Quality Action Plan

– Promote active travel

– Ongoing retrofit of buses and taxis and continued

procurement of new cleaner low emissions buses and taxis

– Work with construction companies regarding low emission

lorries

Importance of City Plan for

Public Health

Strategic Objective 22: Apply healthy urban planning and work with partners to achieve equality of access to community services, opportunities and facilities for sport and recreation and lifelong learning.

Strategic Objective 23: Ensure that Brighton & Hove is a city where all people feel safe in public places and within their neighbourhoods through working with partners to create a safer environment, reduce crime and reduce the fear of crime

Importance of City Plan for

Public Health

CP18: Healthy City: reduce health inequalities and promote healthier

lifestyles through:

• Health Impact Assessments on all planning policy and strategic developments.

Larger developments demonstrating how they minimise negative impacts and

maximise positive impacts on health

• Encouraging development that works towards Lifetime Neighbourhood

principles; promotes health, safety and active living for all age groups,

including healthy living options for older people, active space for children and

encourages physically active modes of transport.

• supporting delivery of accessible health facilities taking into account future

growth and demand for health services in the city

Adult Social Care

Health & Adult Social Care Vision

Statement – 2016-2020

Purpose

• Provide context for the current Adult Social Care

Redesign programme

• To provide an overview of proposed changes in the

delivery of adult social care services 2016-2020

• This overview supports a clear communication plan

that has been shared with our staff, trade unions,

other Directorates and external stakeholders

Reduction in funding; approx £24 million over 4 years

Care Act 2014

Better Care Programme

Workforce

Context

Health & Adult Social Care Vision

Statement – 2016-2020

4 Key Pillars of Our Vision for Adult Care

• Signposting

• Stronger Communities

• Getting People on the Right Track

• Citizens in control of their own care

Assessment Services Health & Adult Social Care Vision Statement

• Health and Adult Social Care will give advice and information to those who request it to enable them to live an independent life .We aim to get the right support locally by promoting the use of our online self-service / self-assessment tools, and access to good and relevant information

• We will promote healthy living and wellbeing and encourage active participation in the life of the City. Our staff will be working with the most vulnerable people in a way to increase their life choices and help them to remain safe and promote their rights and freedoms

• We will work with partners in a new way where our citizen’s will experience an integrated approach in relation to their health, care and support needs

Assessment Services Health & Adult Social Care Vision Statement

• In house assessment services will focus on most complex needs/where the level of risk to the individual is high.

• Other assessment/review activity will be delivered through integrated teams or commissioned externally

• The workforce balance between qualified and unqualified staff will shift towards a higher ratio of qualified staff

• In house care services will decrease

Assessment Services Health & Adult Social Care Vision Statement

• Review of commissioning and consideration of joint arrangements to promote efficiencies

• Self assessments & supported self assessments will be fully implemented

• Significant increase in people using direct payments / SDS

• Asset/strengths based approach

• Financial/brokerage services will be reviewed to ensure they are streamlined and integrated

Provider

• Focus on what we are good at and what we can deliver

effectively

• Stop doing what others can do more cost effectively

• Maintain quality

This means:

• Most existing Council run services will be commissioned externally.

• We will disinvest in our building-based care to invest in personalised care.

• Our remaining provision will be specialist and short term in nature but will

still need to demonstrate value (financial & quality).

Primary and Acute Care

Health Services - Context

• Central government/NHS Executive guidance:

– Five Year Forward View 2020

– Sustainable Transformation Plans

– NHS Planning Guidance Priorities 2017-19

Sustainable Transformation Plan

• STP Footprints:

– Sussex and East Surrey

– Central Sussex and East Surrey Alliance

• Pressures on A&E, planned care and primary care

• Poor health outcomes (Cancer, Stroke, mental health)

• Pressures on workforce

• Challenged health and care system finances

Sustainable Transformation Plan Priorities

• 3 priority areas for frontline improvement:

– New models of care for population-based catchments

– Public Health, prevention and self-care

– New models of care for acute service delivery and

networking (BSUH Re-development)

Integrated Health and Social Care - Brighton

and Hove Caring Together

• Aim - To commission for improvement in population outcomes and experience through the provision of coordinated care, organised around and responsive to the needs of individuals

• The ambition for integration covers the whole population of the city

• The scope of integration covers both commissioning and provision of prevention, care and support

• It includes: adults and children’s services; physical and mental health; social care; public health; primary care; community and hospital services

• To deliver this we will take a ‘one place, one budget’ approach to our entire health and social care commissioning budget

Integrated Health and Social Care - Brighton

and Hove Caring Together

• Care provided out of hospital and close to home where possible

• 7 day services

• Proactive approach to identify people at risk of becoming unwell

• Cluster Care teams; GPs, therapists, community nurses, mental

health, social care, voluntary sector (30-50,000 pop’n) +

specialist ‘hubs’

• Better use of technology and IT

• Bespoke service for homeless people

• People and communities supported to know where to get help

and how to manage their own care and wellbeing

Primary Care Development

• Sustainability of local GP services

• Primary Care Co-commissioning (local regulation and

development)

• Development of general practice Federation/Multi-

Specialty Community Providers (supports Brighton

and Hove Caring Together delivery)

• Acquiring premises for Primary care at a cost and

size that is viable

Where we are with our Health Estate

• 44 practices of varying sizes in varying buildings and no

records on size, quality and usability and

leaseholds/freeholds of the buildings

• Practices and clusters are supporting diverse populations,

wide disparities of wealth and a profile of health needs.

• Growing and ageing population with a relatively high number

of young adults, particularly students, and there are particular

needs related to mental health, substance misuse and sexual

health services.

Where we are with our Health Estate

• Royal Sussex County Hospital is the oldest patient facing accommodation in

the NHS, £486m to redevelop much of the hospital site.

• The largest community asset is Brighton General Hospital, (BGH) owned by

SCFT, which no longer provides inpatient beds and houses a range of

community, acute outpatient, mental health and support functions. The site

is c. 50% under-utilised and SCFT are working with partners to work up

development proposals for a community hub and release surplus land for

other uses (including potentially housing, social care, or education).

• SPFT own the third largest site in the city – a campus in Neville Road Hove,

which includes Millview Hospital (mental health), Hove Polyclinic (mental

health, community health and acute outpatients for diagnostics with

expansion for MSK service delivery proposed subject to business case

approval).

Where we are with Primary Care

Where we are going

Where we are going

• A fundamental shift of core services from secondary care provision into the community so that patients can access effective and high quality services out-of-hospital and closer to home

• A much greater degree of integration of community health and social care based around GP cluster practice.

• The longer term model will be to develop one integrated team with all staff linked to GP practices.

Where we are going

• In addition, the CCG is supporting General practice

in the provision and review of the associated

estate as follows:

– To continue to support the emerging clusters of

practices and the integrated models of care.

– To assess current GP estate in terms of accessibility,

scale and fitness for purpose and assess opportunities

around this estate that will support both general

practices as well as the population they serve.

What we plan to do

• To provide services to planned housing

developments in locations that currently have little

or no spare capacity (e.g. Toad Hole Valley, Marina,

Churchill Square and Preston Barracks).

• To support practices in accessing money, through

the NHS Transformation Funds and One public

estate to aid modernisation and development of

premises and future proofing of key infrastructure

What we plan to do

• Detailed predictive modelling of demand for health services

• Benchmarking use of health services across the local health

economy

• Modelling of the configuration of health services required for

future delivery

• Full assessment of provider and primary care estate – a gap

analysis

• Development of model of care, in line with STP, 5YFV, local

commissioning intentions

What we plan to do

• Hypothesis testing for future models of care and

estates solutions

• High level options appraisals to identify preferred

investment priorities based on robust cost benefit

analyses

• Greater collaboration across the health and care

system as the process is led by the commissioner

but is jointly owned

What we need to do

What are the opportunities for new

premises

• 6 facet survey- having basic information about practices to be

able to support investments in primary care

• Cluster working and delivering wider range of services to

meet populations needs and reduce pressure on primary care

• Being ready to submit plans for funding- have business cases

ready

• Think differently about how we use our buildings (e.g.

sweating the asset) and thinking about how people will

access services differently in the future

What are the opportunities for new

premises

• Offering a wider range of services to support cluster

populations needs (outside core GP hours)

• Using IT/telephony and different ways of working

• Co-commissioning

• Wider engagement on options moving forward as

opposed to Ad hoc buildings.

Families, Children &Learning

Families, Children & Learning

• We have a collective responsibility to ensure that

children, young people and their families are happy,

healthy and safe

• It takes a city to raise a child – not just their

immediate family

• The built environment can support this or make this

more difficult

Universal Provision

• Children need access to good quality early years childcare,

schools and routes that support them into employment

• Our early years provision has been strong for many years.

Last year standards in primary schools was 22nd highest in

the country and standards in secondary schools 45th highest

(out of 152 LA areas – both continuing to improve each year

• There are no ‘Failing Schools’ in Brighton & Hove

• Children & young people across out schools are in the main

‘happy’ – but there are concerns with self-harm

Challenges

• To close the disadvantage and educational attainment gap

• To tackle remaining young unemployment and boost

apprenticeships

• Provide sufficient school places in the right place at the right

time

• Maintain a collaborative approach to education and learning

across a range of diverse institutions

• Ensure this is a city with opportunities for children and

families to wander and wonder

Targeted Provision

• Rates of substance misuse, mental ill-health and domestic

violence are a toxic trio that provides increased risks for

some of our children and young people

• As well as interventions when things go wrong all partners

need to ensure that earlier help is in place

• Families with a range of additional needs can draw on a

range of agencies for support and intervention

• There are always new challenges: CSE, radicalisation, the

next ‘Baby P’