• Elimination of a projected 2020/21 deficit of £864 million;
• To increase integration of care;
• Improvements in self-care and prevention services;
• The development of community hubs to reduce the demand on hospital services;
• Shared patient records.

Like other areas the STP aims to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services. The plans are designed to cut £530 million of spending leaving a deficit of £60 million by 2020/21.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations.

This STP is divided into three 'places' - Coastal Care, Central Sussex & East Coast Alliance, and East Sussex Better Together. Each 'place' is to be developed with a different model of care.

Coastal Care

This 'place' will form an accountable care organisation (ACO) with a single budget.

Urgent care will be redesigned.

The aim of the changes is to reduce spending on hospital care by £44 million by 2020/21.

Central Sussex & East Coast Alliance

This 'place' is set to be a Multispeciality Community Provider (MCP).

The aim of the changes is to reduce spending on hospital care by £80 million by 2020/21.

East Sussex Better Together

This 'place' will form an accountable care organisation (ACO) with capitated funding and pooled budget.

An update on this 'place' in the Eastbourne Herald in July 2017 noted that the an ACO would be established by 2020. This would involve the creation of a new East Sussex Health and Care NHS Trust taking a lead role across the health system and providing the majority of services in the ESBT area.

The aim is to have a pooled budget (NHS and council) and an integrated single leadership structure for strategic commissioning by April 2018.

The STP will create ten community hubs that will support care outside of hospital in an effort to reduce A&E admissions and the need for hospital care. The STP notes that the funding will come from 'Commercial capital partnerships & commercial loans'.

The STP also notes that £112 million of social care efficiencies have been identified.

A plan for a new primary care centre in Hailsham has been revealed, which will include a range of consulting and treatment rooms, a pharmacy space and a minor operations suite.

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain over-spending CCG areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; this is the capped expenditure process (CEP). The 14 CEP areas include Sussex and East Surrey. The measures under discussion include the following:

• Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations;
• Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average;
• Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence;
• Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures;
• Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year;
• Selling estate and other “property related transactions”;
• Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.

At the end of 2017 the care quality commission (CQC) carried out a review of this STP and concluded that it had “not begun to function effectively”  due to “a lack of investment and infrastructure”.

Campaigners have been critical of the lack of public engagement in the plans and secrecy that has surrounded the STP's development. As of January 2018, there was no public consultation process underway on the STP. Campaigners also believe that the STP will lead to numerous cuts in services.

The STP aims for some form of hospital reorganisation, however no details were given. Care pathways will be reviewed.

One target for consolidation is acute stroke care, which could be merged to form a hyper acute stroke unit in Brighton. The changes could see the closure of stroke wards in Crawley and at the Princess Royal in Haywards Heath.

A new set of response standards for ambulances have been introduced in Sussex. The changes, known as the Ambulance Response programme, will see that the current Red 1, Red 2 and Green categories will be replaced with new-nationally determined requirements that have been designed so that the NHS trust can send the right resources first time to patients.