Report to:

East Sussex Health Overview and Scrutiny Committee (HOSC)

 

Date of meeting:

 

23 September 2021

By:

Assistant Chief Executive

 

Title:

Urgent Care in East Sussex

 

Purpose:

To consider an update on a number of issues relating to urgent care in East Sussex

RECOMMENDATIONS

The Committee is recommended to:

1)    Consider and comment on the update on NHS 111 attached as appendix 1;

2)    Consider and comment on the update on Eastbourne Station Health Centre, Hastings Station Plaza and Crowborough Minor Injuries Unit attached as appendix 2;

3)    Agree a future update on Eastbourne Station Health Centre; and

4)    Consider whether to request a further report on any of the other areas covered in the update.

 

1.    Background

1.1.        Urgent care services are healthcare services that provide the diagnosis and treatment of non-emergency, minor injuries or illnesses that ideally need to be seen on the same day, such as strains and sprains, ear and throat infections and feverish illnesses. 

1.2.        NHS England has in recent years raised concerns that many people are using Emergency Departments (ED) for non-emergency healthcare when they should be using urgent care or same-day primary care services.  A key factor driving this trend, according to data compiled by NHS England, appears to be a widespread confusion amongst the public about the array of urgent care services available that leads individuals to conclude that ED seems like their only option. In response, NHS England has required local Clinical Commissioning Groups (CCGs) to develop a new integrated urgent care system in their local area comprising primarily of Urgent Treatment Centres (UTCs); an enhanced NHS 111 service; and evening and weekend GP appointments.

1.3.        HOSC has undertaken considerable scrutiny of the new urgent care system in East Sussex over the past three years. This report provides an update on several strands of this work, specifically:

·         performance of the new NHS 111 Clinical Assessment Service (CAS) provided by South East Coast Ambulance NHS Foundation Trust (SECAmb) and the NHS 111 First national programme.

·         progress of the closure of the Eastbourne Station Health Centre

·         the development of the service at Hastings Station Plaza to date; and

·         the temporary closure of the Crowborough Minor Injuries Unit

2.    Supporting information

NHS 111

2.1.        The NHS Long Term Plan, published in January 2019, included a requirement for CCGs in England to have commissioned by 2019/20 an enhanced NHS 111 service with the ability to book people into urgent face to face appointments and provide a proportion of callers with advice from a clinician via a Clinical Assessment Service (CAS).

2.2.        South East Coast Ambulance NHS Foundation Trust (SECAmb) provides the NHS 111- CAS service for Sussex, Kent and Medway. The new 111 service went live on 1st October 2020.

2.3.        The HOSC has followed the procurement process of the new NHS 111 service, which includes the development of a CAS, over the past three years. The Committee also identified the enhanced NHS 111 service as a key element of the new urgent care system developed in East Sussex during its review of the Eastbourne Station Health Centre. The HOSC most recently received an update on NHS 111 at its meeting on 4th March 2021 as part of a wider report on SECAmb’s work.

2.4.        SECAmb has spent a considerable amount of time over the past year and a half responding to the COVID-19 pandemic. The Trust, however, has continued to develop its NHS 111 service. The report attached at Appendix 1 provides an update on NHS 111.

2.5.        The Committee may wish to consider whether it wants updates in future on any of the specific areas above at a future meeting.

Eastbourne Station Health Centre

2.6.        On 29 March 2018, HOSC considered a report by the local CCGs on the proposed closure of the Eastbourne and Hastings Walk-in Centres (WIC) as part of the development of UTCs at the Eastbourne District General Hospital (EDGH) and Conquest Hospital, respectively.

2.7.        Under health scrutiny legislation, NHS organisations are required to consult HOSCs about a proposed service change which would constitute a ‘substantial development or variation’ to services for the residents of the HOSC area. The HOSC may then make comments in response to the proposals consulted on prior to the CCG’s decision.

2.8.        The Committee resolved that the proposals constituted a substantial development or variation to services requiring formal consultation by the CCGs with HOSC.

2.9.        The CCGs subsequently revised their proposals for Hastings WIC and the Committee agreed on 26 September 2019 that the proposals no longer constituted a substantial variation to services.

2.10.      The WIC was located at the Eastbourne Station Health Centre alongside a GP practice. The CCG proposed to close the WIC and disperse the GP patient list, resulting in the closure of the whole facility.

2.11.      HOSC established a Review Board to consider the evidence in relation to the proposed closure of the Eastbourne Station Health Centre in detail and prepare a report and any recommendations as the Committee’s response to the consultation.

2.12.      The HOSC agreed on 10th September 2020 to endorse the draft report, subject to further amendments after considering the outcome of the public consultation, and submitted the final report to the CCG Governing Body ahead of its meeting on 9th December 2020.

2.13.      At that meeting, the East Sussex CCG’s Governing Body agreed to approve the post-consultation Decision Making Business Case, specifically to:

•       carry out a managed dispersal of the Eastbourne Station Health Centre GP list to the new Victoria Medical Centre only once the centre’s branch surgery in Eastbourne town centre has been established;

•       commission GP and community nurse drop-in clinics (at least weekly) in the town centre to meet the medical and nursing needs of rough sleepers and homeless patients;

•       decommission the WIC function at Eastbourne Station Health Centre; and

•       following the list dispersal, continue to commission the walk-in aspect of the service at Eastbourne Station Health Centre  for a short period (likely three to four months).

2.14.      The CCG further agreed to develop a wide-ranging communication and engagement programme, including the recruitment of care navigators.

2.15.      At its 10th December meeting, the HOSC agreed by a vote of seven to five that, based on the assurance that alternative services will be in place prior to the closure of the Eastbourne Station Health Centre, the decision is in the best interest of the health service in East Sussex.

2.16.      The Committee also requested an update on the progress of the implementation of the decision once the Eastbourne Station Health Centre had closed, which it did so on 30th August 2021. 

2.17.      The report attached as Appendix 2 provides an update on the implementation of the CCG’s decision in relation to Eastbourne Station Health Centre, including an update against the recommendations of the HOSC report.

2.18.      The HOSC will wish to consider whether a future update is necessary to allow further analysis of the performance of the new urgent care services in Eastbourne.

Hastings Station Plaza

2.19.      The CCGs initially planned to close the Hastings Station Plaza WIC, however, the proposal was revised due to various reasons including the consistent increase in demand for walk-in centre services in Hastings; and a small but significant group of patients in Hastings with multiple and complex needs who struggle to navigate healthcare services and who, therefore, accessed their healthcare through the WIC.

2.20.      The CCGs presented a report to HOSC on 26th September 2019 in which it was explained that the Hastings WIC would instead be replaced with a Primary Care Led Hub on a temporary basis before deciding on a final clinical model for the site in April 2021. This process was delayed due to COVID-19 and the site remains as a Primary Care Led Hub as at 23rd September 2021.

2.21.      The report attachedas Appendix 2 includes an update on the Hastings Station Plaza.

Crowborough Minor Injuries Unit

2.22.      Sussex Community NHS Foundation Trust (SCFT) provides a Minor Injuries Unit (MIU) located at Crowborough War Memorial Hospital. The HOSC was informed recently that the decision was taken to temporarily close Crowborough MIU from 8pm on Sunday 15 August for approximately eight weeks due toparticular challenges around staffing.

2.23.      The CCG advised that closing the MIU for the short-term would enable staff to be redeployed to Uckfield MIU and Lewes UTC, ensuring that an effective and comprehensive service is available to the local community. The CCG committed to review the situation every fortnight with a view to reopening the unit as soon as possible.

2.24.      The report attachedas Appendix 2 includes an update on the Crowborough MIU.

 

3          Conclusion and reasons for recommendations

3.1       The reports attached as appendices provide an update to the Committee on the urgent care system in East Sussex. HOSC is recommended to consider the reports and decide whether future updates are needed on any of the areas covered in the reports, particularly the Eastbourne Station Health Centre closure, as this was subject to a substantial variation to services review by the HOSC in 2020.

 

PHILIP BAKER
Assistant Chief Executive

Contact Officer: Harvey Winder, Democratic Services Officer
Tel. No. 01273 481796
Email: Harvey.winder@eastsussex.gov.uk