• Sussex and East Surrey STP had “not begun to function effectively” due to lack of investment
  • CQC report says STP was “sometimes unwieldy as a decision making forum”
  • Local leaders hopeful of improvement under new chair Bob Alexander

A sustainability and transformation partnership had “not begun to function effectively” when the Care Quality Commission carried out a local system review at the end of 2017.

The East Sussex review covered part of the area of the Sussex and East Surrey STP – which was put in the “needing most improvement” category in last year’s STP ratings. Former NHS Improvement deputy chief executive Bob Alexander was appointed as chair in October, taking over from Michael Wilson, the chief executive of Surrey and Sussex Healthcare Trust.

Bob Alexander

Bob Alexander took over as STP chair last autumn

The review said the STP had not started to function properly “due to a lack of investment and infrastructure”.

System leaders acknowledged that the STP “had not had effective oversight of all services within the East Sussex footprint”; had “previously been too passive as a body”; and was “sometimes unwieldy as a decision making forum”. They were hopeful that things could improve under Mr Alexander.

The CQC praised the strong commitment and trust between system leaders but said joint working was hindered by financial pressures and “people’s experience of a blame culture”. It found that despite there being two transformation strategies covering different areas, system leaders had a clear and aligned vision for health and social care services.

Professor Steve Field, chief inspector of primary care services, said: “I am pleased to see that the local system is working together to help people avoid being admitted to hospital and remain well in their own home. I am also pleased to note the improved performance in relation to delayed transfers of care and that older people are having a more positive experience when being discharged home.

“Nevertheless, local system leaders still have work to do to develop a common framework for setting priorities and specifying accountabilities across the county.”

DTOCs were above the national average with nursing home and domiciliary care places in short supply. The NHS and its partners tried to drive the market by funding some beds at an enhanced rate and supporting retention and recruitment of domiciliary staff through increased payments to agencies. However, the report said more needed to be done to “shape the market”.

The inspection also revealed some of the pressures on the system:

  • community services were sometimes unable to support people who needed care at home at weekends;
  • staffing was inadequate on one ward at the Conquest Hospital, near Hastings, leaving a security guard to provide support to a patient with dementia; and
  • not all patients were getting home quickly because of problems co-ordinating complex support from different organisations.

The report highlighted the lack of joined up IT systems, saying GPs in the urgent care centre were having to make decisions without access to information about patients held in practices – even though the IT system was the same. Information about people who accessed primary care out of hours services was communicated with GPs by fax or courier. There were also missed opportunities for system wide training and development, with learning from pilots such as discharge to access not being cascaded, the CQC said.