Supporting people to lead healthier lives
‘We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support’
We work in close partnership with the Communities and Partnerships directorate, Public Health and the VCSE and other partner agencies to increase the range of options open to people to support their wellbeing as well as reaching people earlier in their lives to prevent escalation of needs.
West Sussex Wellbeing is a county-wide adult health improvement programme delivered in partnership between the council and the district and borough councils to support residents with their health and wellbeing.
The service provides free, evidence-based interventions or support and advice to those aged 18 years and over who live or work in West Sussex. This programme addresses a range of issues including:
Prevention Assessment Teams are an area that we have highlighted as being most proud of. 71% of staff agreed that people could get information and advice about their health, care and support and how they can be as well as possible – physically, mentally and emotionally, citing PAT as proactive and collaborative. The PATs are multi- agency, multi-disciplinary teams delivering preventative services across our county. The team includes health advisors (qualified health professionals) employed by the local community health trust, social care workers and support workers from the voluntary sector who can advise over the telephone or visit people in their homes. The objective of the teams is to improve quality of life, promote health and wellbeing and prevent, reduce, and delay the development of more complex needs. The service is for adults and older people who might not be eligible for other statutory services and who have unmet physical, psychological, social, functional or environmental needs.
In 2023-24, PAT completed 1,213 assessments and received 1636 telephone calls. 1,658 referrals were received. Of these referrals:
In 2023-24, the NHS nurse advisors completed 424 health checks.
In partnership with our Communities directorate, East Sussex County Council, and the University of Leeds, we are piloting the development of a volunteer Life Transitions digital app. The app and volunteer service adds value by concentrating on the psychosocial dynamics of preparing for and experiencing change, and building resilience, adaptability, and self-efficacy.
Over the past few years, in partnership with Arun District Council, Mid Sussex District Council, Eldon Housing Association and Housing 21, we have supported the development of two new extra care housing services open in East Grinstead and Eastergate. The developments have provided an additional 108 units of Extra Care Housing to adults in West Sussex, of these twenty-nine are shared equity and seventy-eight affordable rents. Work is ongoing to develop further Extra Care Schemes across the county.
These developments have been made possible by close working across operational and commissioning teams, with local planners, developers, landlords and care providers. We have also invested in a dedicated team of operational staff, who lead on assessing, reviewing and supporting people living in extra care. This ensures a timely response to issues and concerns and provides a consistency of approach and management of risk, which offers assurance to providers, thus enabling people to remain living in their extra care home, for as long as possible.
We have expanded our focus from the national older person model to all age provision, recognising the benefits that extra care can bring to people’s lives. This approach has already provided new opportunities for people who would have otherwise been limited in their care options with Avila House, the county's first all-age extra care service, opening in 2023. It has had success in delivering outcome focused services with people at the heart of care planning and delivery. We have successfully utilised extra care as a step down from residential care settings, as well as a step up from care in a person’s own home.
We utilise creative approaches to ensure the extra care schemes are firmly rooted in local communities, by encouraging access to the schemes for local community groups and supporting people to engage with external community activities.
Reablement services are designed to support people to regain or retain as much independence as possible, either after they leave hospital or prior to implementing a long-term service. We value these services highly and therefore have developed a model of bed-based reablement to support with hospital discharge. These beds are funded by the Better Care Fund (BCF) and enable people to be discharged from hospital to a placement where they can continue their recovery, supported by twenty-four-hour carers who deliver an individually tailored reablement plan devised by our occupational therapists. In West Sussex, between April 2023 and March 2024, 170 individuals were discharged into social care Reablement Beds, and of these 57% returned to their own home.
We commission a community reablement service for people which is delivered in their own homes, provided by an external specialist. This is a time-limited service, provided free of charge while people are receiving focused reablement support. The aim of the service is to improve physical and emotional wellbeing and support people to manage activities of daily living as independently as possible.
The outcome of this intervention may be that the person is fully independent again (currently 73% of people exit reablement as independent), or that they require a reduced level of care following the reablement intervention to manage their daily life. The community reablement service applies practice principles that focus on a person's strengths and ensures person-centred engagement and support. Customers work together with occupational therapists and the commissioned reablement provider to identify goals that are important to them. As part of the reablement programme, functional skill development, equipment, adaptations and technology all provide a framework to support independence and improve wellbeing. We believe there are greater opportunities for reablement in the future and this is therefore identified as an area for improvement under Theme 2, with a new Community Reablement Service being commissioned for commencement in April 2025.
To support this increased focus on reablement and to ensure we are supporting more people to regain and retain their independence, a programme to review and implement changes to internal systems, practice and resources has also commenced to deliver a more effective approach. We are also working alongside our NHS colleagues on an Improved Intermediate Care programme to ensure our hospital discharge and reablement services are maximised across the health and social care system.
Home First in West Sussex is a joint health and social care programme that started in 2019 which supports people to discharge from hospital, and avoid admission, prior to an assessment of need. The council supports the Home First pathway by directly commissioning hospital discharge care services that provide care and support at home services to work alongside Sussex Community (NHS) Foundation Trust (SCFT) staff to enable people to return home when they are ready to discharge. Home First is operationally led by SCFT and provides the initial support to people across the county to allow them to return home and settle before discussions and assessment of on-going health and social care needs. In some situations, people do not require any further support following a short period of Home First, whereas others may commence with the Community Reablement Service or SCFT rehabilitation programmes.