Sussex Health and Care brings together health and care partners across Brighton and Hove, East Sussex and West Sussex. The integrated care system (ICS) serves a diverse population of more than 1.7 million people, with areas of both significant affluence and deprivation.

Addressing challenges with patient flow across Sussex Health and Care ICS

The Sussex Health and Care ICS is facing some of the highest numbers of delayed discharges in the country. At any one time, there can be several hundred people waiting to be discharged from an acute hospital, a community bedded facility or a mental health setting.

System partners are all concerned about the impact this can have on patient experience and outcomes, elective care recovery and financial pressures, with the ICS spending approximately £100m in 2022/23
on discharge cost of delays. Reflecting this, system leaders in Sussex are committed to taking action to address discharge delays across the system to improve patient experience and reduce the risk of patient deconditioning.

The system has agreed a comprehensive discharge and improvement transformation programme which includes action to improve the use of integrated data and digital care solutions to improve system flow.

The role of data and digital in Sussex Health and Care ICS

System leaders in Sussex identify challenges with data collection and sharing as key to helping to reduce discharge delays. There is currently no 'one version of the truth' to track and enable patient flow across the system making it difficult to identify root causes of delay, to inform demand and capacity planning and to ensure alignment of improvement actions. We are therefore working with system leaders to ensure we have a single oversight.

To combat this, the ICS is in the process of developing a business information platform which will give health and care teams across the three places within the system full visibility of discharges, patient-level information, reasons for a delayed discharge and the ability to share intelligence. This will also support system leaders to establish where there are delays between the different steps in the discharge pathway, and where there are opportunities to address these with the support of the ICS. The tool aims to enable data sharing between health and social care partners, which can often be challenging.

The integrated care board (ICB) is working with North East Commissioning Services who have developed the OPTICA platform, an application built in collaboration with NHS trusts and local authorities to track patients and tasks relating to discharge in real-time, to develop the business information platform. This work been undertaken with the backing of the NHS England digital team.

We as a system have been innovative in working with the OPTICA team to develop the platform to be able to integrate data flows across health and social care. The system is working in collaboration with another frontrunner site, Humber, and North Yorkshire ICB, to jointly develop a detailed data specification, which will enable full visibility of data sets across acute, local authority and community. The development of this integrated data flow will also operationally support the system's developing Transfer of Care Hub model.

Key enablers

Strong leadership and relationships within the social care and discharge delivery board, which sits within the ICB, are cited as a key enabler to developing this work. The system senior responsible officer for the discharge improvement programme is an acute provider chief executive who is supported by the ICB chief delivery officer. The ICS has established a system discharge and social care delivery board, chaired by the system senior responsible officer for discharge, alongside the three ICB place directors, the three local authority directors of adult social care, all chief operating officers from the trusts in the system, programme director and the ICB Discharge Frontrunner programme management team.

The delivery board is driven by a shared ambition to improve patient experience and reduce the risk of patients deconditioning by significantly reducing discharge delays across the system and establish a more sustainable and effective discharge model. There is a system agreed principle that increasing the number of patients discharged to their normal place of residence, as part of a Homefirst approach to deliver better patient outcomes and value for money. This is a key enabler which will require strong collaborative and integrated working, to address the continued challenge of delayed discharges.

Key barriers

Although addressing delayed discharges is a key priority for Sussex Health and Care ICS, there are still challenges in getting a clear and shared understanding about where the key contributing factors lie. This constrains the delivery board's ability to have the right conversations about where the opportunities for improvements are and to inform decisions in respect of capacity investments.

Challenges also remain around information governance, where the chief digital information officer is working with system leaders across health and social care, by seeking an agreement to develop a memorandum of understanding to address these issues.

Looking to the future

The business information tool is just one of the five main strands of work being delivered as part of the discharge frontrunner scheme by the social care and discharge board. Other programmes of work include: 

  • Developing digital care solutions which optimise the use of current systems to improve patient outcomes. 
  • Developing an integrated workforce to deliver an effective discharge system. 
  • Developing an economic framework which brings together baseline costs, workforce activity and operational metrics to ensure future sustainability and create an efficient discharge system.  
  • Building on the work of previous winters to continue discharge improvement.  

While this work is still at the early phase of development, system leaders see the business information tool as the grounding that will enable them to take forward the wider programme of work. They are optimistic that improved data on delayed discharge will help optimise how multi-disciplinary teams work to support discharge, inform strategic decisions, and enable the ICS to progress other areas of transformation and improvement work.