Report to:

East Sussex Health Overview and Scrutiny Committee (HOSC)


Date of meeting:


2 December 2021


Assistant Chief Executive



Transformation of Cardiology Services at East Sussex Healthcare NHS Trust (ESHT)


To update HOSC on proposals to redesign cardiology services at ESHT


The Committee is recommended to:

1. Consider whether the service change proposals relating to East Sussex Healthcare NHS Trust (ESHT) cardiology services set out in Appendices 1 and 2 constitute a ‘substantial variation’ to health service provision requiring statutory consultation with HOSC under health scrutiny legislation.

2. Agree that HOSC, if the proposals are a substantial variation to services, will undertake a detailed review of the proposals in order to prepare a report and recommendations.

3. Comment on the NHS East Sussex Clinical Commissioning Group’s plan for undertaking public consultation on the proposals (Appendix 3)

1.            Background

1.1.        East Sussex Healthcare NHS Trust (ESHT) provides acute cardiology services from both the Eastbourne District General Hospital (EDGH) and Conquest Hospital in Hastings.

1.2.        In March 2021 HOSC received a report on the progress to date in developing proposals to change how cardiology services at ESHT were delivered. The Committee agreed to consider a further report once further details of the proposals were made available.

1.3.        At a Joint Committee of Clinical Commissioning Group (CCG) Governing Bodies on 17th November, East Sussex CCG – which is the responsible organisation for service reconfigurations – agreed in principle, subject to the outcome of the ESHT Trust Board meeting on 30 November 2021, a pre-consultation business case (PCBC) setting out specific proposals, developed in partnership with ESHT, to reconfigure the Trust’s cardiology services and agreed to undertake a public consultation on these proposals from 6th December 2021 to 11th March 2022.

1.4.        This report provides the opportunity for the HOSC to consider whether the proposals constitute a substantialvariation to services requiring formal consultation with the Committee alongside and separately to the public consultation.

2.            Supporting information

Proposals for cardiology services

2.1.        The report from the East Sussex CCG and ESHT attached as Appendix 1 and 2 sets out their proposals for the transformation of acute cardiology services in East Sussex.  

2.2.        Cardiology is the branch of medicine dealing with the diagnosis and treatment of heart disorders and related conditions.  While there are many clinical conditions that can affect the heart in people of all ages, many heart conditions are age-related, making cardiology services more and more important as people get older. Cardiology is also constantly evolving with new developments in disease prevention, diagnostics and therapeutics. 

2.3.        The current operating model of cardiology services involves both hospital sites providing a weekday service for acute inpatient cardiac services, but at evening and weekends an element of the service – Primary Percutaneous Coronary Intervention (PPCI) – is provided from a single site that alternates between the two. PPCI is also known as an angioplasty and is a procedure used to treat the narrowed coronary arteries of the heart in patients. Therefore, it is used as an emergency treatment for patients who have had a heart attack.”

2.4.        The CCGand ESHT set out a case for change for cardiology services that concluded, amongst other things:

2.5.        As a result, the CCG and ESHT are proposing the following changes to the acute cardiology services provided by ESHT:

2.6.        The CCG has agreed to conduct a public consultation from 6th December 2021 to 14th March 2022 on the following proposals:

2.7.        Under Option 5A, the following patient activity provided at the Conquest site would be moved to Eastbourne (based on 2018/19 data):


Number of Conquest patients

Percentage of total cardiology activity







Day Case



2.8.        Under Option 5B, the following patient activity provided at the EDGH site would be moved to Conquest (based on 2018/19 data):


Number of Eastbourne patients

Percentage of total cardiology activity







Day Case




2.9.        The CCG does not have a preferred option. The CCG says the benefits of the proposals include:

2.10.      Plans for the public consultation are set out in Appendix 3, including plans for engagement with groups identified in the Equality and Health Inequalities Impact Assessment (EHIA).

HOSC role

2.11.      Under health scrutiny legislation, NHS organisations are required to consult affected HOSCs about a proposed service change that would constitute a ‘substantial development or variation’ to services for the residents of the HOSC area.

2.12.      There is no national definition of what constitutes a ‘substantial’ change. Factors such as the number or proportion of patients affected; whether the service provides planned care (outpatient appointments or day case surgery) where patients and carers make arrangements for travel beforehand or un-planned care (emergency and urgent care) where patients may be admitted via ambulance or travel to an Emergency Department; the level of improvement offered by the new service; and the availability of alternative services nearby are often taken into account in coming to an agreement between the HOSC and the NHS on whether formal consultation is required. NHS England also recommends that CCGs conduct a public consultation for proposals that the local HOSC considers to be a substantial variation to services, so the CCG plans to consult publicly may be an indication the proposals could be deemed ‘substantial’ by the HOSC.

2.13.      If HOSC agrees that the proposals do constitute a substantial change, the Committee will need to consider the plans in detail in order to respond to the CCG with a report and recommendations. The Committee may wish to consider how it would undertake this task, which could be through establishing a Review Board to conduct a review on behalf of the full HOSC, with the Committee agreeing any recommendations before they are submitted to the NHS.

2.14.      Where the HOSC does not consider a proposal to be a substantial variation to services there are alternative options for further scrutiny work including submitting a written response to the public consultation, informal HOSC board meetings to scrutinise the proposals in more detail, and further reports to the Committee as the proposals are agreed and implemented.

2.15.      Finally, the NHS England assurance process for any planned service reconfiguration requires a CCG to demonstrate evidence that the local HOSC(s) considers the NHS public consultation process to be adequate. The Committee is, therefore, invited to comment on the planned public consultation as set out in Appendix 3.

3.            Conclusion and reasons for recommendations

3.1.        This report presents HOSC with proposals for the development of cardiology services in East Sussex, in particular the proposal to co-locate all catheterisation laboratories and specialist cardiology inpatient services on one of the two hospital sites, alongside the establishment at both sites of Cardiac Response Teams in A&E and hot clinics providing rapid assessments.

3.2.        The Committee is recommended to agree that the service change proposals set out in Appendices 1 and 2 constitute a ‘substantial variation’ to health service provision requiring statutory consultation with HOSC; to agree to undertake a detailed review of the proposals; and to comment on the CCG’s plan for undertaking public consultation on the proposals as set out in Appendix 3.



Assistant Chief Executive

Contact Officer: Harvey Winder, Policy and Scrutiny Officer

Tel. No. 01273 481796