Report Template (formal meetings)

Report to:	East Sussex Health Overview and Scrutiny Committee (HOSC)
Date of meeting:	2 March 2023
By:	Assistant Chief Executive
Title:	New Elective Surgery Hub at Eastbourne District General Hospital (EDGH)
Purpose:	To provide HOSC with information on the proposals for the development of a new Elective Surgery Hub at Eastbourne District General Hospital (EDGH) and to consider whether the proposals constitute a substantial variation to health services requiring formal consultation with the HOSC.

RECOMMENDATIONS: The Committee is recommended to

1) agree that the service change proposals set out in Appendix 1 do not constitute a ‘substantial variation’ to health service provision in East Sussex requiring statutory consultation with HOSC; and

2) consider any further scrutiny work it would like to undertake on the proposals.

1 Background

1.1 Elective hubs are part of national policy aimed at reducing the number of people waiting for surgery, and the length of time they have to wait. Hubs will focus on high-volume routine surgery so more patients can get seen more quickly, making efficient use of resources, and creating extra capacity.

1.2 As part of this programme, East Sussex Healthcare NHS Trust (ESHT) was successful in bidding for national Targeted Investment Funding to build an Elective hub at the Eastbourne District General Hospital (EDGH) site. This is supported by NHS Sussex and would create additional surgical capacity for the local population and will supplement existing day surgery and inpatient procedures for patients at both Eastbourne and Hastings sites as well as ophthalmology at Bexhill Hospital.

1.3 This report provides the opportunity for the HOSC to be informed of the proposals and consider whether the proposals are minor in nature, or constitute a substantial variation to services requiring formal consultation with the Committee. The NHS locally does not anticipate this to be substantial service variation as this creates additional capacity for the local area with a small differential impact on current service provision.

2 Supporting information

Proposals for the new Elective Hub

2.1 The report from NHS Sussex, which is the responsible organisation for service changes, is attached as Appendix 1 and sets out the proposals for a new Elective Surgery Hub at EDGH.

2.2 East Sussex Healthcare NHS Trust’s plan is to create a dedicated day surgery unit at the EDGH site to go live in 2024/25. This will have four theatres and associated support facilities and the increased capacity would mean:

· A reduction in the length of time patients wait for their day surgery procedure. This in turn will also reduce the waiting times for patients who require overnight or longer stays in hospital after their procedure

· A reduced risk to patients from acquiring an infection while in hospital, as patients will go home on the same day and the dedicated unit will be attached to, but accessed separately from the main hospital

· A reduction in procedures being cancelled due to a lack of hospital beds during any periods of high demand as the Elective Hub will be a dedicated standalone unit

· Improved patient experience as the Elective Hub would provide modern up to date and co-located facilities and be staffed by a dedicated team focussed on supporting patients through their journey starting from pre-assessment through to their discharge following surgery.

2.3 Day surgery and elective activity will continue across the Trust’s sites as it is now, with the exception of some activity at the Uckfield Community Hospital. The type of procedures that the hub will focus on relate to a range of specialties including: general surgery, urology, breast surgery, vascular, maxillofacial, ear nose and throat, gynaecology, orthopaedic and community dental.

2.4 As part of developing this proposal ESHT has reviewed the day surgery activity currently undertaken at Uckfield Hospital to make the best use of resources and maximise improvements in waiting times. Consequently, under the new proposal approximately 29% of this activity would in the future be undertaken at the new Elective Hub in Eastbourne once it is established. This represents approximately 179 day surgery procedures each year that would in the future be undertaken at the hub. The type of surgery this relates to is vascular procedures for minor treatment of varicose veins; circumcisions; and maxillofacial (nose and ear) procedures.

2.5 The majority of patients currently having minor day surgery procedures at Uckfield Hospital originate from across East Sussex. For most patients it will result in slightly shorter journey times to travel to Eastbourne than to Uckfield based on the current catchment area.

2.6 The data for the six month period from 1 April 2022 – 30 September 2022 shows that around 47% (42/89) of patients having minor day surgery procedures at Uckfield Hospital are coming from the Eastbourne catchment (including Eastbourne, Pevensey, Polegate and Seaford), and a further 34% (30/89) from the ‘eastern’ end of the ESHT catchment (Bexhill, Hastings, St Leonards, Robertsbridge, Battle, Rye, and Winchelsea). In this period, there were 7 patients from Uckfield and Heathfield that had procedures identified as suitable to be undertaken in the Elective Hub who would have to travel further for their procedure.

HOSC’s role

2.7 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.

2.8 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.

2.9. 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 a consultation if one is undertaken, informal HOSC board meetings to scrutinise the proposals in more detail, and further reports to the Committee as the proposals are agreed and implemented.

2.10. 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 NHS Sussex 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.

3. Conclusion and reasons for recommendations

3.1 This report presents HOSC with proposals for the development of a new Elective Surgery Hub at EDGH which will provide additional capacity for routine day case surgery procedures for residents in East Sussex. This will be an addition to services currently provided across ESHT’s hospital sites.

3.2 The Committee is recommended to agree that the service change proposals set out in Appendix 1 do not constitute a ‘substantial variation’ to health service provision in East Sussex requiring statutory consultation with HOSC. The Committee is also recommended to consider any further scrutiny work it would like to undertake on these proposals, such as receiving an update report at a future HOSC meeting.

PHILIP BAKER
Assistant Chief Executive

Contact Officer: Martin Jenks, Senior Scrutiny Adviser
Tel. No. 01273 481327
Email: martin.jenks@eastsussex.gov.uk