1
Context
1.1
NHS Sussex works in partnership with health and care organisations
across Sussex as part of our Integrated Care System. Our aim is to
ensure better health and care for all now and in the future.
Our ambition is for every person living in Sussex to have access to
the best health and care from the moment they are born and
throughout their lives. We want:
·
People to live for longer in good health.
·
To reduce the gap in life expectancy between people living in the
most and least disadvantaged communities.
·
People’s experience of using services to be better.
·
Staff to feel supported and work in a way that makes the most of
their dedication, skills and professionalism.
·
The cost of care to be affordable and sustainable in the long
term.
1.2
Our proposals sit within this context and focus on the improvement
of ophthalmology services to benefit our population in East Sussex.
We want to ensure sustainable services into the future. This
means that there is a focus on expanding services within local
communities and recognising that for some of our more specialist
services, consolidating these in one place will ensure the
retention of this specialist expertise within East Sussex in a way
that offers the best outcomes for local people. Our commitment to
two thriving district general hospital sites, both with Emergency
Departments (ED) and a wide range of services, is supported by
specialist services at one or other site in order to deliver the
best outcomes for patients.
East Sussex Healthcare NHS Trust services
1.3
East Sussex Healthcare NHS Trust has made significant improvements
for patients and local residents in recent years. The Trust is
rated ‘good’ by the CQC, with several
‘outstanding’ services and has ambitious plans,
enabling residents to access the best care in the most appropriate
place: at home; in the community; or when they need to come into
hospital.
1.4
As an integrated acute and community provider, an important part of
the Trust’s five-year strategy to best meet the healthcare
needs of our population is to increase and improve the care
provided outside of hospital. This means being proactive in
supporting the health of local residents, preventing avoidable
hospital visits and stays, improving patient outcomes and
experience and making better use of resources. This has helped the
Trust to focus their hospitals to build on their strengths while
improving how services work together across the whole health and
care system.
1.5
The Trust has two acute hospital sites, Conquest Hospital in
Hastings and Eastbourne District General Hospital. Both the
Conquest and Eastbourne District General Hospital sites provide
urgent and emergency services, with some services already located
solely or primarily at one or other of these sites.
1.6
Eastbourne District General Hospital looks after serious stroke
cases, ear nose and throat inpatients and is also home to the
trust’s urology service, for which we have recently invested
in a dedicated investigation suite, robotic surgery and
non-invasive treatment for kidney stones. The hospital also
provides for patients needing inpatient diabetes care, day case eye
surgery (undertaken in the Jubilee Eye Suite) and a diabetic foot
service. In addition, inpatient endocrinology beds are only at
Eastbourne District General Hospital.
1.7
Conquest is the Trust’s trauma unit and looks after emergency
surgical services and complex elective surgical services, including
general, vascular, gynaecology and orthopaedic surgery, and
patients needing closer medical monitoring and support when giving
birth. The hospital also includes paediatric inpatient
services.
1.8
Both hospitals are supported by a range of clinical support
services, operate 24/7 emergency departments and intensive care
units (ITUs).
1.9
The Trust also operates services at Bexhill Hospital. Bexhill
Hospital is a community-based facility with an emphasis on
ophthalmology and rehabilitation services. East Sussex Healthcare
NHS Trust provides ophthalmic day surgery (mainly cataract and
glaucoma), outpatient clinics, wet age-related macular degeneration
(AMD) services at the Dowling Unit and diabetic retinal screening
from Bexhill Hospital. The site also provides short-stay
rehabilitation services at the Irving Unit for patients admitted
with a range of conditions and offers radiology and physiotherapy
services for patients.
1.10 We are
committed to improving hospital services across our sites including
at both acute sites, Conquest Hospital and Eastbourne District
General Hospital. As detailed above, each hospital site has its own
profile of services, and we are working to strengthen and develop
these to make best use of the resources at each site to best serve
our patients; having two thriving acute hospital sites is central
to this plan.
1.11 Looking
further ahead, the trust’s Building for our Future programme,
funded as part of the government’s commitment to build 40 new
hospitals, will deliver a complete redesign of both our ageing
hospitals, taking advantage of new technologies and improvements in
healthcare to ensure that we can meet the future needs of our
population.
2
Introduction
2.2
This summary also describes the wide engagement to date, including
the public consultation, and the processes East Sussex Healthcare
NHS Trust and NHS Sussex have followed in developing proposals,
ensuring clinical assurance of the model, seeking wide engagement
and feedback, and finalising proposals for decision-making.
2.3
The full Decision-Making Business Case has been published online
and is available to all committee members on request. The full
Decision-Making Business Case is available
here. It recommends one option to take forward for
implementation, which has been approved by the NHS Sussex
Integrated Care Board, and is now submitted to the East Sussex
Health Overview Scrutiny Committee for their consideration.
2.4
The Decision-Making Business Case follows the approved
Pre-Consultation Business Case and subsequent formal public
consultation and shows how all available information and evidence
has been considered, together with feedback captured from the
public consultation. This has informed the final proposal to
transform ophthalmology services that has been developed by NHS Sussex, in partnership with the
East Sussex Healthcare NHS Trust (ESHT). Subject to the outcome of
the East Sussex Health Overview and Scrutiny Committee,
mobilisation of the transformation proposal can begin for
implementation within the timeframe outlined, by December 2023
– May 2024. Early implementation of some elements of
the model will be sooner than this, to realise quality benefits as
quickly as possible.
2.5
The document provides a summary of the context and of the case for
change as outlined in the Pre-Consultation Business Case. It also
provides an analysis of the feedback received from the public
consultation and the consultation with the East Sussex Health
Overview and Scrutiny Committee, and the updated post-consultation
proposal approved by NHS Sussex that has been informed by the
feedback received from local people and stakeholders during the
consultation process.
2.6
There was broad recognition for the need to make changes to address
challenges and deliver improvement, and broad agreement on the
proposed model of care across the public consultation feedback. NHS
Sussex recognises the importance of access to services and has
carefully and systematically analysed the consultation outcomes and
balanced it with evidence that has been collected since the
Pre-Consultation Business Case (PCBC) and in response to the
consultation. This process informed NHS Sussex’s
considerations during the Decision-Making Business Case development
process to ensure consultation feedback informed final
proposals.
2.7
The model of care has been confirmed throughout the process as the
right strategic proposal to improve ophthalmology services and
outcomes for the local population and is supported by stakeholders
across local communities. It remains unchanged from the previously
approved Pre-Consultation Business Case.
2.8
The model of care sets out that services would deliver improvements
for all local people with the development of one-stop clinics at
both sites, Bexhill Hospital and Eastbourne District General
Hospital, and a diagnostic eye hub at Bexhill Hospital. Outpatients
and day case surgery that currently takes place at Conquest will be
moved to Bexhill. Emergency and general anaesthetic surgical
ophthalmology cases (including cases which require an overnight
stay) will continue to be at Conquest Hospital: these services will
not be affected by these proposals. The model is based on clinical
best practice and national guidance and evidence including NHS High
Impact Intervention, the national Getting It Right First Time
programme, the Royal College of Ophthalmologists, NHS National
Elective Care Outpatient Transformation Programme, the College of
Optometrists and the Clinical Council for Eye Health Commissioning.
Alongside local clinical engagement and leadership in the
development of the model of care, it has also been reviewed by the
South East Clinical Senate. The one-stop clinics at both hospitals
and diagnostic eye hub at Bexhill Hospital will enable a redesigned
ophthalmology pathway that will increase quality of care ensuring
patients are seen by the right person, in the right place, and at
the right time, meaning we can better meet service standards so
that patients receive care in a timely manner, meaning faster
diagnosis, shorter waiting times, fewer repeat appointments for
tests and therefore less travelling for patients thereby improving
outcomes for local people.
2.9
The approved Pre-consultation Business Case upon which we consulted
was very clear as to why Bexhill Hospital was preferred rather than
the Conquest Hospital. This was detailed as part of a full options
appraisal in the Pre-Consultation Business Case explaining the
limitations of current theatre capacity at Conquest Hospital;
ophthalmology not having clinical interdependencies that mean that
it can be sited at Bexhill whilst other specialities could not;
adapting the Conquest site would be prohibitively costly in terms
of capital requirements; and there are physical space limitations
that would make it difficult to expand and build the infrastructure
required.
2.10 In
summary, the proposal approved by NHS Sussex, is to improve the
services at both hospital sites through forming one-stop clinics,
and at Bexhill Hospital through forming a diagnostic eye hub, both
of which will provide rapid assessment for patients which will
reduce waiting times and the number of appointments needed. It
demonstrates that we believe this is the right strategic proposal
to improve ophthalmology services for the local population and is
supported by stakeholders across local communities.
2.11 The
proposed transformation, with the one-stop clinics and diagnostic
eye hub, will make key quality improvements to the service, such
as:
·
enable a redesigned ophthalmology pathway that will increase
quality of care ensuring patients are seen by the right person, in
the right place, and at the right time
·
ensure that we can better meet service standards so that patients
receive care in a timely manner, meaning faster diagnosis, shorter
waiting times, fewer repeat appointments for tests and therefore
less travelling for patients
·
provide a consultant-led model of working that efficiently utilises
skill mix across the workforce and provides training
opportunities
·
ensure staff and expert knowledge are consolidated, allowing for
improved supervision and opportunities for training and educational
needs for staff who wish to upskill. Thereby, gradually improving
the skills in the workforce to improve the service quality and care
provided to our population.
2.12 This
proposal will have positive impacts for our patients, as well as
workforce, and will improve patient experience, patient outcomes
and our performance against national standards in the long term by
reducing waiting times alongside repeated travel for patients,
whilst making the service more efficient and sustainable for the
future. It also
supports the wider Sussex Ophthalmology
plan enabling future training and supervision
from ophthalmology consultants to upskill the community
Optometry workforce.
3
Considerations
3.1
The Case for Change was developed by a wide range of
stakeholders including clinicians, operational staff and experts by
experience. It was recognised that the current service is
unsustainable. We have reviewed the strategic drivers for change
and the existing ophthalmology services. This led us to the
following conclusions:
·
Quality: healthcare systems are required to minimise the risk of
significant harm, through delivering timely follow-up for patients
with chronic conditions. The high and growing number of these cases
within ophthalmology makes this a challenge.
·
Service performance: nationally, ophthalmology outpatient services
are the largest of all outpatient services that people use, with
East Sussex Healthcare NHS Trust seeing 18,075 new outpatients and
65,511 follow-up appointments in 2019-20[1].
The Covid-19 pandemic has impacted heavily on ophthalmology
provision and this, coupled with the very high levels of need for
care, has led to East Sussex Healthcare NHS Trust no longer meeting
national waiting time standards.
·
Growing need: It is estimated that, over the next 20 years, the
need for cataract services will rise by 50%, glaucoma cases by 44%
and medical retina by 20%.
·
IT / Digital: making the best possible use
of modern digital technology in ophthalmology services would be a
significant benefit to patients, for example Electrical Eyecare
Referral System (EERS)[2].
Modern technology presents opportunities to improve patient
pathways and better manage the growing need for ophthalmology
services. This system will improve patient safety, deliver eye care
more efficiently and effectively, and facilitate other improvements
for optometrists and dispensing opticians who work with hospital
colleagues. This includes the development and improvement of
communication, advice and guidance, feedback, shared care,
discharge to primary care and supporting extended primary eye care
services.
·
Workforce: a census carried out by the Royal College of
Ophthalmologists (RCOphth) in 2019 identifies gaps in recruitment
for ophthalmologists and workforce planning, amid a predicted 40%
increase in need for ophthalmology services over the next 20
years.
·
Net Zero NHS: the NHS is committed to reach net zero carbon by 2050
which means we need to significantly reduce carbon emissions caused
by procedures, travel, estates, etc. The NHS Long Term Plan
encourages service delivery to happen virtually, where
appropriate.
·
Estates and equipment: diagnosis and monitoring of ophthalmic
patients is highly dependent on equipment. Much of the equipment
currently used by the department across its three sites is old,
which impedes the service’s ability to work efficiently and
effectively. There are limitations of physical space in the current
service configuration limiting the capacity of the service to meet
the current and growing need of the local population which
contributes to challenges in meeting service standards.
·
Making best use of our resources: we want to ensure that our
services are delivered in a way that gives the greatest benefit for
local people.
·
The national Getting it Right First Time (GIRFT)[3]
programme reviewed the ophthalmology service in March 2018. It was
recommended that:
o Review
pre-assessment clinics and review/audit coding for complex
cataracts to ensure the patient pathway for cataract surgery is
optimised.
o Continue
to develop health care professional staff by training and
developing all members of the multi-disciplinary team, whilst
utilising competency frameworks to increase the number of
non-consultant clinical staff.
o Look into
using consultant-led and technician-provided virtual clinics for
age-related macular degeneration (AMD) and glaucoma to improve
refinement of treatment plans.
o Review of
coding practices to ensure accuracy, particularly around complex
cataracts, corneal grafts, strabismus follow-ups and vitreo-retinal
conditions.
o Continue
to refer to the Royal College of Ophthalmologist’s “The
Way Forward”document
to identify options to help meet demand and the Common Competency
Framework to support health care professional staff
development.
Covid-19 Pandemic
3.3
In response to Covid-19, East Sussex Healthcare NHS Trust had to
reconfigure their hospital services to ensure they operated in a
safe manner and also increased the number of beds available for
Covid patients. With adult and paediatric ophthalmology services
operating at a reduced level of capacity, the service was moved to
operate solely from Bexhill during the first peak with particular
focus on urgent services. This was also important from the
perspective of infection, prevention and control and services
responding to the pandemic. With its staff together at one location
it enabled the department to deliver whole-team training events for
its staff and learn from different ways of arranging services that
had not been previously explored.
3.4
The requirement of the service to respond to the needs of local
people in a different way during the early stages of the Covid-19
response, coupled with the service being temporarily consolidated
on one site, led to the service working in new ways including new
diagnostic pathways and virtual clinics. Feedback from the service
is that working in this way has been positive, improving the
working relationships of the team through improved communication,
and more supervision and support for junior staff.
4
Process to date
Our Case for Change and
developing our Pre-Consultation Business Case
4.1
Following analysis of the current service provision and the
emerging future needs of local people, we developed a Case for
Change that outlined the key drivers for service transformation.
This provided the basis for our engagement with local people,
clinicians and other professionals to further understand what is
important to them about ophthalmology services. This initial
engagement indicated several key themes as important to local
people:
·
Care provided
·
Equality and diversity
·
Access and transport
·
Clinical services
·
Community optometry.
4.2
Alongside finding out what is important to local people and
clinicians, we reviewed local health needs in East Sussex. This
told us that there are some groups of local people who have
particular needs and may be disadvantaged in accessing current
services. We took account of these needs in our proposals and
sought to mitigate those disadvantages through the proposals
outlined in the Pre-Consultation Business Case (more detail on this
can be found in Appendix 1 and Appendix 2 of the Decision-Making
Business Case).
4.3
Following pre-consultation engagement, three options development
and appraisal workshops (independently chaired and facilitated by
Opinion Research Services - ORS)
took place, during March 2021, to identify and consider a longlist
of possible options for the future provision of acute ophthalmology
services, including sites where the service would be delivered
from, to appraise these options and make recommendations for
preferred viable options.
4.4
Following this, and as part of our in-depth comparative analyses
for the Pre-Consultation Business Case, we also reviewed quality
indicators, travel analysis, the impact this transformation could
have on other services within Sussex and outside of Sussex, the
impact this transformation could have on the equality and health
inequalities of our population, and the financial feasibility of
each option.
4.5
A Pre-Consultation Business Case was developed to make the case for
change and set out the plans for a Public Consultation around the
transformation of ophthalmology services at East Sussex Healthcare
NHS Trust. It was approved by East Sussex CCG and East Sussex
Healthcare NHS Trust, on 17 and 30 November 2021 respectively, and
submitted to the East Sussex Health Overview and Scrutiny Committee
on 2 December 2021 prior to formal public consultation. An
independent report on the findings of the consultation has been
produced and this report presents the feedback from those who
participated in the consultation. This is
found at Appendix 3 of the Decision-Making Business Case.
·
We considered the outputs from engagement and consultation with
local people and clinicians and used these to inform the
Pre-Consultation Business Case and Decision-Making Business
Case.
·
We developed the Pre-Consultation and Decision-Making Business
Cases with due regard to our duties to reduce inequalities and
promote integration of health services where this will improve the
quality of those services, in addition to ensuring compliance with
all relevant equality duties.
·
We assessed the impacts of our proposals by undertaking a Quality
Impact Assessment and an Equality and Health Inequalities Impact
Assessment to identify any potential negative impacts and
identified appropriate mitigating actions.
·
We commissioned an independent travel analysis to understand the
impact of the proposals in this regard.
·
We took into account the recommendations of the South East Clinical
Senate.
·
We considered opinions and insight from a number of service leads
and managers within our acute hospitals in East Sussex that
represent a broad range of clinical specialties.
·
We were informed by feedback from the East Sussex Health Overview
and Scrutiny Committee including the East Sussex Health Overview
and Scrutiny Committee Review Board.
·
We assessed our proposals against the NHS Four Tests for service
reconfigurations.[6]
·
We undertook stage one and stage two process with NHSE to assure
our plans prior to public consultation.
·
We developed our proposals and associated consultation plans in
line with the Gunning Principles[7]
to ensure that:
o a
decision would not be taken until after public consultation.
o local
people and stakeholders had information that enabled them to engage
in the consultation and inform our decision.
o there was
adequate time for people to participate in the consultation.
o we could
demonstrate how we have taken account of engagement and formal
consultation by publication of a consultation feedback report
describing this.
o we could
demonstrate how we have taken account of engagement and formal
consultation by publication of a consultation feedback report
describing this.
Public
Consultation
4.7
The formal public consultation
into the proposal to transform ophthalmology services at East
Sussex Healthcare NHS Trust began on 6 December 2021 and ended on
11 March 2022. It set out the quality improvements anticipated from
the proposed transformation, together with the site options.
Opinion Research Services (ORS), was appointed to advise on,
independently manage and report on the public consultation
programme of engagement with service users, their families and
carers, clinicians and other NHS staff and other stakeholders. The
Public Consultation Feedback Analysis report outlined that our
consultation was open, accessible, and following ‘good
practice’ guidelines in both the scale and the balance of
elements used, and that we took appropriate action to ensure any
potential impacts of the Covid-19 pandemic were mitigated
throughout undertaking the consultation process. The full report is
Appendix 3 of the Decision-Making Business Case.
4.8
The public consultation was well promoted and included virtual
public meetings, stakeholder events and face-to-face listening
events, and included a wide range of activities including a focus
on groups identified by the Equality and Health Inequalities Impact
Assessment (EHIA).
·
Travel and access, for example:
o Older
people and families with young children, people with significant
visual impairment, particularly those with macular degeneration who
require regular and frequent treatment.
o People
with other disabilities and long-term conditions or additional
needs.
o People
with low incomes and from deprived communities – particularly
those living in and around Hastings – and anyone without
access to a private vehicle.
·
Potential loss of services from Conquest Hospital.
·
Buildings at Bexhill Hospital were reported to be older with poorer
accessibility and facilities.
·
Sufficient investment required to develop Bexhill site.
Key actions following
public consultation
4.10 Alongside
public consultation, East Sussex Health Overview and Scrutiny
Committee established a Review Board to carry out a detailed review
of the proposals and produce a report and recommendations on behalf
of the Committee. In addition, following feedback from the public
consultation regarding travel and access, we established a Travel
and Transport Review Group to review our developing proposals and
make recommendations. The feedback from the Health Overview
and Scrutiny Committee Review Board and the Travel and Transport
Group are outlined below, followed by the recommendations, and
associated planned action.
Engagement with East
Sussex Health Overview and Scrutiny Committee (HOSC) – Health
Overview and Scrutiny Committee Review Board
4.11 The
Review Board carried out its review between April and June 2022. A
full report (Appendix 4 of the Decision-Making Business Case) sets
out the evidence the Board considered, along with its conclusions
and recommendations. The HOSC review board report is available
here and the travel and transport review group report is
available
here. The East Sussex HOSC was presented with the Review
Board’s report, findings and recommendations at their meeting
on 30 June 2022, where it was approved by the membership. The
recommendations made by the East Sussex HOSC were as follows:
1. The
Committee endorsed the reasons for reconfiguring ophthalmology on
30 June 2022, including:
·
Clinical case for change and the potential for new services to
improve patient care and experience.
·
The creation of the ‘Centre of Excellence’ diagnostic
hub, one-stop clinics, and measures to support staff recruitment
and retention.
2. The
Committee noted the proposed choice of the Bexhill Hospital to
consolidate ophthalmology services and recommended that mitigation
measures are put in place to address the concerns about travel and
access to this site, such as:
·
increasing and maximising the number of on-site parking spaces at
the Bexhill Hospital site.
·
ongoing monitoring of Did Not Attend (DNA) information is
undertaken after implementation of the proposals to establish the
reasons why patients do not attend appointments and review the
travel and access mitigations in light of this information. It was
reported that Bexhill Hospital had the fewest number of patients
that Did Not Attend.
4.12 The
Health Overview and Scrutiny Committee Review Board carefully
considered the clinical case for change and the anticipated
benefits for patients from the proposed service reconfiguration.
The Review Board also examined the proposed choice of the Bexhill
Hospital site for the consolidation of some services serving the
east of the county and noted that the Bexhill site presents a
number of challenges for travel and access to services based
there.
4.13 On
balance, the Health Overview and Scrutiny Committee Review Board
considered that the proposed changes to the ophthalmology services
in East Sussex are in the best interests of patients and asked that
adequate mitigations to be put in place to address the travel and
access issues that were identified.
4.14 These
recommendations have been taken into account and further details on
how these have been considered and addressed, for our
post-consultation proposal and as part of the development of the
Decision-Making Business Case, can be found in section 6 of the
Decision-Making Business Case, summarised in 4.21 and 4.22 below.
Of particular note, our Decision-Making Business Case proposal
includes provision of additional car parking at Bexhill Hospital
and a range of travel and transport support for local people.
At
this stage, initial actions in response to insight from the public
consultation included a review and update of the Quality Impact
Assessment, Equality and Health Inequalities Impact Assessment, as
well as updating of previous Equality and Health Inequality Impact
Assessment actions, and the establishment of a Travel and Transport
Review Group
Travel
and Transport Review Group
4.16 During
the public consultation, travel and transport (public and private
transport, including access and parking) were raised by many
respondents as issues to be addressed. Therefore, we established a
Transport and Travel Review Group to consider the issues
raised.
4.17 The group
was tasked with reviewing findings from the pre-consultation
engagement processes, options development and appraisal processes,
Equality and Health Inequalities Impact Assessment (EHIA), the
Public Consultation, as well as independent travel analysis carried
out by external consultants, and considering the conclusions to
make suggestions and recommendations on possible transport
solutions for those who may be affected by the proposed service
change.
4.18 People
responding to the consultation identified key groups who may be
adversely affected by transport and travel impacts created by the
proposals, e.g., some people having to travel further to see their
loved ones and some staff having longer journeys to work. Alongside
this, respondents made some suggestions, e.g., to work with
authorities in relation to public transport, consider parking,
consider financial reimbursement.
Following the review outlined above including insight from the
public consultation, the Travel and Transport Review Group made
several recommendations some for implementation and some for
further investigation. These are outlined below.
4.20 The
Health Overview and Scrutiny Committee Review Board and the Travel
and Transport Review Group made a range of recommendations which
have been taken into account in our final proposal and our
developing draft mobilisation planning. These key recommendations
were focused on travel and transport and included providing travel
support for local people; the introduction of Travel Liaison
Officer at East Sussex Healthcare NHS Trust; improved parking at
Bexhill Hospital; improved communication about travel options;
liaising with patients about their individual travel and access
needs; supporting patients with information and processes about
accessing financial reimbursement where eligible; improving
information for patients about alternative transport options and
exploring over the longer-term improvements to public transport;
and measures to support recruitment and retention of staff.
·
The programme has committed to improve car parking on the Bexhill
Hospital site. This has been included in our final proposals to
ensure it is implemented in line with this transformation
·
The establishment of a travel and transport liaison officer has
been committed to by the Trust and will be implemented alongside
these proposals
·
Work has taken place within the Trust to ensure information
provided via its website, patient letters and patient information
leaflets is clear for patients around travel, transport and access
options and parking to it various sites. This work will continue to
be reviewed and updated as additional actions and recommendations
are addressed
·
Work has taken place to update
communications to ensure patients who are eligible for
reimbursement of travel costs know that they are able to reclaim
their expenses on arrival via the hospital cashier. The travel
liaison officer will also be able to support eligible patients that
are otherwise unable to travel to access this this scheme
·
Work has taken place to ensure staff are aware of travel
opportunities, such as Trust schemes, are promoted and this will be
included in staff messages on a frequent basis
·
Work has taken place with Integrated Care System colleagues to
understand learning around travel arrangements for the recent
vaccination programme
·
A commitment has been made to monitor staff recruitment and
retention measures and these have been included in the Key
Performance Indicators (KPIs) of this programme
·
As part of the upcoming communications plan, post decision, further
work will take place to ensure information around the changes will
be shared with our local stakeholder and population, including a
Frequently Asked Questions document
·
Working with Trust and primary care colleagues to ensure individual
needs of patients are recognised and taken account of when booking
appointment and procedures, along with clear communications to
patients to raise awareness of the options available to them
·
Work is in progress to compile a directory of any, and all,
transport services, including community, volunteer and charity
organised services, and their eligibility criteria where necessary,
that patients could be signposted to
·
Work with voluntary, community and social enterprise and patient
representatives to ensure changes to services and facilities is
co-designed.
·
Consideration by the Trust of a long-term travel and transport
strategy.
4.22 There are
also a number of recommendations which are being explored by the
wider NHS Sussex system, which relate to patients who attend East
Sussex Healthcare NHS Trust, such as:
·
Exploring the options for a pilot shuttle bus service.
·
Working with NHS colleagues on additions to the Non-Emergency
Transport Service (NEPTS), such as a digital tracking element and
eligibility criteria.
·
Working with local authority and public transport providers on and
potential future services.
Plans
for implementation
4.24 If the
post-consultation proposal is formally supported by the East Sussex
Health Overview and Scrutiny Committee, we would enact our
implementation plan from December 2022 for full implementation in
December 2023 – May 2024, although early implementation of
some elements of the model will be sooner than this, to realise
quality benefits as quickly as possible.
Decision-making
5
Implications
Financial implications:
5.1
There would be a positive financial impact on the Trust of
implementing the changes outlined, this is as a result of
implementing best practice and benefiting from resulting economies
of scale.
Revenue
5.2
The case shows that under co-location there will be net efficiency
savings, which takes into account the cost of
capital, resulting in a favourable revenue position from
year 2 for the preferred option (two sites).
|
£’000
|
Yr1
|
Yr2
|
Yr3
|
Yr4
|
Yr5
|
Yr6
|
Yr7
|
Yr8
|
Yr9
|
Yr10
|
|
Preferred Option vs. Do
Nothing
|
(85)
|
49
|
232
|
427
|
658
|
902
|
1,160
|
1,433
|
1,692
|
1,959
|
Capital
5.3
The total capital required for the recommended option is
£3.5m, with capital expenditure phased over two financial
years between 2022/23 and 2023/24. Full implementation of the model
of care is planned from quarter 3 2023/24.
5.4
The levels of capital outlined in this case for the recommended
option can be funded within the Integrated Care System’s
capital allocation, in agreement with system partners.
Legal implications:
5.5
NHS Sussex has a legal requirement under the NHS Act 2006 to ensure
patients and the public are involved in service changes. Therefore,
the Gunning Principles as outlined above have been followed.
5.6
This underpins the pre-consultation
engagement and the public consultation processes that have been
followed for this programme.
5.7
Our Pre-Consultation
and Decision-Making Business Cases
have demonstrated compliance with former Clinical Commissioning
Group and now Integrated Care Board statutory duties.
Other compliance:
Data and Privacy Impact Assessment
(DPIA)
5.8
The proposal has no impact or changes to data that would be
processed nor how it would be processed. There would be no new or
different organisations and/or providers involved in accessing
and/or sharing patient information, and no new data processing
systems would be utilised. No further Data Privacy Impact
Assessment is, therefore, required.
NHSE/I Five Tests for service
reconfiguration
5.9
Part of the evaluation of any service reconfiguration is the
demonstration that five specific areas have been considered to
ensure best practice has been followed and affordability in terms
of capital and revenue costs.:
1. that
service users and the public are involved in the development of the
proposals
2. whether
any proposed redevelopment would maintain the availability of
service user choice
3.
demonstration of sufficient clinical evidence and clarity on the
case for change
4. assurance
that the proposals have the approval of local commissioners
5. relates to
any proposal including plans to significantly reduce hospital bed
numbers
5.10 Full
consideration has been given to these points, details of which have
been included in our Decision Making Business Case. In brief, the
process has been clinically informed and led. Defining the vision
for improved ophthalmology services across East Sussex involved a
wide range of partners, these included service users, carers and
their families, clinicians, including the service’s
workforce, and other local communities and interested organisations
such as Healthwatch. Feedback collated from the pre-consultation
engagement was provided to inform decision-making and a wide range
of stakeholders were involved in the options development and
appraisal process to ensure different perspectives could be heard
and accounted for in the decisions made. There will be no reduction
in bed numbers.
Quality and Safety
implications
5.11 The aim
of transforming these services is to deliver significant clinical
improvements that will improve quality, outcomes, and safety for
patients.
Equality, diversity, and
health inequalities
5.13
Integrated Care Boards have a duty to reduce inequalities between
patients in respect to outcomes and access and this transformation
has embedded health inequality considerations into the redesign
process.
5.14 A
screening Equality and Health Inequalities Impact Assessment was
initially developed, followed by a full Equality and Health
Inequality Impact Assessment. taking account of feedback from
Integrated Care System colleagues and NHSE/I. This Equality and
Health Inequality Impact Assessment is a live document and has been
re-iterated throughout each phase of the programme. Action from
this has been undertaken, is reflected in the model of care,
informed our public consultation and communications and engagement
delivery plan, and our communications plan post-decision. The
Equality and Health Inequalities Impact Assessment is Appendix 1 of
the Decision-Making Business Case.
Patient and public
engagement:
5.15 Following
historical informal engagement, full pre-consultation engagement
took place to understand what is important to local people. The
information gathered during this engagement process informed our
model of care and options appraisal process.
5.16 The
transformation programme has been further informed by local people
through our formal public consultation process, where the proposals
were broadly welcomed with overall agreement on the proposed model
of care, as there was recognition for the need to make changes to
address challenges and deliver improvement to ophthalmology
services.
5.17 The
feedback was helpful, and a number of common themes were identified
during the public consultation process, and initial actions in
response to insight from the public consultation have included a
review and update of the Quality Impact Assessment, Equality and
Health Inequalities Impact Assessment, as well as updating of
previous Equality and Health Inequality Impact Assessment` actions,
and the establishment of a Travel and Transport Review
Group, the actions of which have been, or
are currently being, taken forward as part of the programme and
when informing our final Decision-Making Business Case and
recommendations
Health and wellbeing
implications:
5.18 The
transformation of services in East Sussex is expected to improve
access to care and health outcomes for our patient population,
supporting the health and wellbeing agenda and reducing
inequalities.
6
Conclusion
6.1
The process to develop these proposals has been comprehensive and
the recommended model will deliver benefits for our local
populations. Services will deliver improvements for all local
people with the development of one-stop clinics at both sites,
Bexhill Hospital and Eastbourne District General Hospital, and a
diagnostic eye hub at Bexhill Hospital. Outpatient and day case
surgery that currently takes place at Conquest will be moved to
Bexhill. Emergency and general anaesthetic surgical ophthalmology
cases (including cases which require overnight stay) will continue
to be at Conquest Hospital: these services will not be affected by
these proposals. The introduction of one-stop clinics and a
diagnostic eye hub will ensure faster diagnosis, reduce waiting
times, reduce number of appointments required for patients to
attend and repeated tests. These are key quality improvements to
the ophthalmology service.
6.2
To deliver this model of care we need to bring staff together
across a range of disciplines into multidisciplinary teams and the
proposal enables the physical space for these staff to work
together in this way. This also improves access to senior decision
making and input when it is required in relation to patient care,
so that patients will see the right people at the right time and
repeat attendances will be reduced.
6.3
Through our engagement and options development and appraisal
process we developed five potential model of care options. During
the Pre-Consultation Business Case, and public consultation, with
patients, the public and local stakeholders, the conclusion was to
recommend the post-consultation proposal detailed in the
Decision-Making Business Case. This is the same model of care that
was appraised (as part of our options development and appraisal and
pre-consultation processes) as the one that will best provide good
patient experience, support improved outcomes for local people and
a high-quality sustainable service; enabling the model of care to
be implemented that will realise these benefits and is
deliverable.
6.4
We recognise that this will represent a change for some people who
currently use these services and we will continuously engage with
local people and stakeholders throughout the implementation and
evaluation processes to continue to understand the implications of
our proposal. All new information and evidence gathered as part of
an evaluation will inform how the final proposal is working.
6.5
Subject to the outcome of the East Sussex Health Overview and
Scrutiny Committee’s consideration as to whether the
proposals are in the best interests of local people, mobilisation
will begin. During any implementation and transition stages we will
ensure that changes are communicated in a clear and timely manner.
This would include working with local people and stakeholders to
understand how best to provide easily accessible information, to
support local people and professionals, about the changes; and to
communicate the changes to existing services, the nature of new
services and how to access them to ensure people who use these
services at East Sussex Healthcare NHS Trust continue to access the
care and support they need.
Annex 1: Themed
actions in response to public consultation and recommendations
Following the feedback from the
public consultation, the HOSC Review Board and the Travel and
Transport Review Group made a range of recommendations which have
been taken account of as we have developed our proposals and our
developing draft mobilisation planning. These key recommendations
were focused on travel and transport and included providing travel
support for local people; the introduction of Travel Liaison
Officer at East Sussex Healthcare NHS Trust; improved parking at
Bexhill Hospital; improved communication about travel
options; liaising with patients about their individual travel and
access needs; supporting patients with information and processes
about accessing financial reimbursement where eligible; improving
information for patients about alternative transport options and
exploring over the longer-term improvements to public transport;
and measures to support recruitment and retention of
staff.
In response to these
recommendations, some have been implemented and others have been
committed to and we are progressing them as this programme
continues and we implement our proposals. There are also several
actions/recommendations which are being pursued and/or explored by
the wider Sussex system, as these do not solely relate to
ophthalmology patients who attend East Sussex Healthcare NHS Trust.
Themes, recommendations and progress updates are detailed in the
table below.
|
Theme
|
Recommendations
from HOSC Review Board and Travel and Transport Review Group
(TTRG)
|
Progress
update
|
|
Workforce
|
Further measures to
support the recruitment and retention of staff are explored in
collaboration across the Sussex ICS, which address the workforce
challenges of the service (HOSC)
|
Collaboration
across the Sussex ICS is ongoing and is a continuing programme, as
workforce challenges are widespread across the system and multiple
services.
|
|
Staff recruitment
and retention is monitored to ensure the workforce challenges are
being met and to assess whether additional measures to support
recruitment and retention are needed (HOSC).
|
Monitoring of
recruitment and retention has been built into the programme’s
KPI reporting to ensure we can incorporate this important element
in our future evaluations to demonstrate the impact the proposed
changes will have.
|
|
Trust to ensure
travel opportunities for staff, such as pool cars and salary
sacrifice schemes, are advertised and widely known to staff (TTRG
for implementation)
|
This has been
completed, and this information is shared with staff on a frequent
basis.
|
|
Travel
and Access
|
The Board
recommended a package of travel and access mitigation measures is
put in place to assist those patients who will have to travel
further under the proposals, and those on low incomes or without
other forms of support, including but not limited to those outlined
below; the Travel and Transport Review Group recommendations are
also outlined:
|
These have been
completed, are in progress or being further explored as part of the
programme timeline.
|
|
·
Travel support
options including communication
|
The establishment of a
Travel Liaison Officer post is essential (HOSC)
|
The Trust has
committed to this and it will be implemented as this programme is
implemented.
|
|
Trust to introduce a
“Travel and Access Liaison Officer” role, possibly
within PALS, who will provide patients and families bespoke
support, information/advice and, if needed, arrangements to be made
for around travel (TTRG for implementation)
|
As
above.
|
|
Trust
to increase and maximise the number of on-site parking spaces at
the Bexhill Hospital site (HOSC)
|
The programme has
committed to improve car parking on the Bexhill Hospital site. This
has been included in our final proposals within the Decision-Making
Business Case (incorporating additional car parking) to ensure it
is implemented in line with this transformation.
|
|
The
communication and clear messaging of advice and guidance on travel
support options, including accessing financial support, including
the ability to claim back travel costs following appointments, etc
(HOSC)
|
This has been
completed, and this information will continue to be shared on a
frequent basis via our websites, social media, patient letters,
etc., to ensure patients are aware of these
opportunities.
|
|
The
provision of information on the travel support available in
appointment letters via a separate leaflet or information sheet in
an accessible format and links to the website (HOSC).
|
This has been
completed and will be updated as additional work around this
programme and related actions progress.
|
|
Encourage providers to
provide clear explanations of the eligibility criteria for Patient
Transport Services (HOSC)
|
This has been
completed, and this information will continue to be shared on a
frequent basis via our websites, social media, patient letters,
etc., to ensure patients are aware of these
opportunities.
|
|
Trust to provide clearer
parking information for people attending Bexhill (TTRG for
implementation)
|
This has been
completed and will be updated as additional work around this
programme and related actions progress.
|
|
NHS Sussex to explore
the opportunities for digital tracking element when the
Non-Emergency Patient Transport Services is re-commissioned, so
patients have a clearer idea of when they will be picked up (TTRG
for investigation).
|
This is being
pursued and/or explored by the wider NHS Sussex system, as this
does not solely relate to ophthalmology patients who attend East
Sussex Healthcare NHS Trust.
|
|
Following agreement of
decisions, ensure all FAQs are updated to explain proposed
recommendations and resolutions for these programmes (TTRG for
investigation).
|
This will form part
of our communications plan post-decision, pending the decision that
is agreed. Our communications plan is a live document and is
continually being re-iterated as we get closer to our
post-decision/implementation phase.
|
|
Programme to monitor Did
Not Attend (DNA) information following implementation of proposals
to establish reasons why patients do not attend appointments and
review the travel and access mitigations in light of this
information (HOSC).
|
This will form part
of our implementation, monitoring and evaluation as the programme
progresses. Key Performance Indicators (KPIs) have been
drafted to monitor implementation including Did Not Attend
rates.
|
|
·
Establishing travel
needs in advance of appointment
|
The CCG and ESHT explore
processes to ensure patients are asked about their travel and
access needs at the point of referral or at an appropriate point in
the patient pathway (HOSC)
|
This is being
pursued and/or explored by the wider Sussex system, as this does
not solely relate to ophthalmology patients who attend East Sussex
Healthcare NHS Trust.
|
|
Trust to include travel
and transport information, hospital site map and signposting
information and advice in patient letters and/or patient
information leaflets (TTRG for implementation)
|
This has been
completed and will be updated as additional work around this
programme and related actions progress.
|
|
NHS Sussex and Trust
colleagues to identify when/where in a patient’s pathway is
the most appropriate opportunity for their individual needs to be
highlighted, e.g., if a longer appointment is needed or it needs to
be held at a specific time of the day due to other conditions or
learning/physical disabilities, dementia, etc., and then ensure
this is built in and embedded to the pathway working with key
stakeholders (TTRG for investigation).
|
This is being
pursued and/or explored by the wider Sussex system, as this does
not solely relate to ophthalmology patients who attend East Sussex
Healthcare NHS Trust. NHS Sussex has a personalised care programme
committed to embedding a personalised care approach in all
pathways, including ophthalmology, to give people choice and
control over the way their care is planned and
delivered.
The Trust’s agreed Travel
and Access Liaison Officer will support individual patients with
this.
|
|
·
Other transport
options
|
Actions
to improve access via other transport alternatives (e.g.,
development of a shuttle bus service, volunteer transport services,
community transport, taxi services, liaison with bus operators and
the local authority etc (HOSC)
|
Discussions with
the local authority regarding transport alternatives are ongoing
and will be included in implementation planning as appropriate.
|
|
NHS Sussex and East
Sussex Healthcare NHS Trust to investigate potential options to
pilot a shuttle bus service between the Trust’s hospital
sites for staff and/or patients (TTRG for investigation)
|
The programme team
will continue to assess the requirement and the feasibility of a
shuttle bus as part of the implementation plan. This will be
resolved ahead of go live.
|
|
NHS Sussex to compile a
directory of any, and all, local charity, and volunteer transport
services that patients could be signposted to if they are
ineligible for other services, such as Non-Emergency Patient
Transport Services (NEPTS) (TTRG for implementation).
|
This is currently
ongoing and will be ready prior to implementation.
|
|
Explore details and
arrangements of shuttle bus services that other Trusts have
implemented.
|
The programme team
will continue to review other Trust transportation solutions prior
to implementation as part of the travel and transportation
workstream.
|
|
Explore progress of the
Trust’s potential plans to have an in-house patient transport
service.
|
The programme team
will continue to review other Trust transportation solutions prior
to implementation as part of the travel and transportation
workstream.
|
|
·
Exploring
improvements to existing public transport
|
NHS Sussex and Trust
colleagues to discuss potential resolutions to public transport
concerns with local public transport providers (TTRG for
investigation).
|
This work will form
part of implementation plans and wider trust approach.
|
|
NHS Sussex and Trust
colleagues to initiate discussions with East Sussex County Council
(ESCC) and Stagecoach to investigate potential future bus provision
to meet the needs of the re-configured ophthalmology services (TTRG
for investigation).
|
Working with local
authority partners, the programme team will continue to review a
range of transportation solutions, including bus service
improvement, prior to implementation as part of the travel and
transportation workstream.
|
|
NHS Sussex and Trust
colleagues to approach ESCC to discuss how the local
population’s transport and travel needs could be considered
as part of its Bus Service Improvement Plan (TTRG for
investigation).
|
Working with local
authority partners, the programme team will continue to review a
range of transportation solutions, including bus service
improvement, prior to implementation as part of the travel and
transportation workstream.
|
|
·
Insight from local
people and communities in implementing travel and transport
action
|
All decisions and
recommendations taken forward will be co-designed with voluntary,
community and social enterprise members who represent the patient
population (TTRG for implementation).
|
This will form part
of implementation plans, to ensure our new service is accessible
and user friendly for all our local population.
|
|
NHS Sussex to
investigate learning from the vaccination programme, as travel
arrangements have been arranged to support patients to get to their
vaccination programmes (TTRG for investigation).
|
This has been
completed.
|
|
·
Evaluating impact
of travel and transport actions
|
Trust and NHS Sussex
colleagues to work in partnership with voluntary, community and
social enterprise organisations and patient groups to review access
to hospitals, e.g., a mystery shopper exercise, to focus on those
groups highlighted in the programme Equality and Health Impact
Assessment, pre-consultation engagement, options development and
appraisal processes, and public consultations who have experienced
access issues (TTRG for implementation).
|
This will form part
of implementation plans, to ensure our new service is accessible
and user friendly for all our local population.
|
|
·
Strategic
approach
|
Trust to consider
drafting a long-term Trust-wide transport and travel strategy to
meet all patient, carer, family, and staff needs across East Sussex
(TTRG for investigation).
|
This is being
explored by Trust colleagues, as this do not solely relate to
ophthalmology patients who attend East Sussex Healthcare NHS
Trust.
|
|
Timely
implementation
|
Implementation of
the proposals is undertaken as soon as possible, and consideration
is given to mitigating the risks posed by workforce challenges and
the development of other competing services to ensure no loss of
services in the implementation plan (HOSC)
|
This
Decision-Making Business Case sets out high level implementation
plans and timescales to reflect how soon we can safely and
appropriately fully implement this transformation proposal. This is
to ensure we are not negatively impacting the continuity of care
for our patients or services at East Sussex Healthcare NHS
Trust.
|
|
Assurance on impact
on other services
|
The
Decision-Making Business Case contains assurance that other
services provided at the two hospitals will not be affected by the
implementation of the proposals for ophthalmology (HOSC)
|
This has been
completed and assurance included in the Decision-Making Business
Case.
|