Report for: East Sussex Heath Overview and Scrutiny Committee
From: NHS Sussex and East Sussex Healthcare NHS Trust
Eastbourne District General Hospital: Elective Hub Proposal
1.Context
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 taxpayer resources, and creating extra capacity so emergency cases do not disrupt operations and cause cancellations or delays.[1]
1.2 This is in line with NHS England’s ‘Delivery plan for tackling the Covid-19 backlog of elective care’ (February 2022) which outlines the requirement to deliver significantly more elective care to reduce waiting times for patients requiring elective surgery, through the expansion and separation of elective and non-elective services which will allow elective activity to be ring-fenced to protect surgical activity during further pandemic outbreaks or winter pressures.
2.Background
2.1 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 site. This is supported by NHS Sussex. Eastbourne has the capacity to support this development and the initiative aligns with ESHT’s clinical strategy and ambition to create the facilities to provide best-in-class day case operations for the local population.
2.2 The facility
would create additional surgical capacity for our local populations
and will supplement existing day surgery and inpatient procedures
for patients at both Eastbourne and Hastings sites as well as
ophthalmology at Bexhill Hospital.
2.3 The proposal is currently at business case stage and would go live by November 2024 if this progresses as planned and the necessary approvals are received. The purpose of this paper is to brief the East Sussex Health Overview and Scrutiny Committee (HOSC) on the proposal and its significant benefits and to outline any changes this may mean for local people. 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. However, HOSC will want to consider these changes and the improvements this would bring at this early stage of the proposal. There will be a programme of communication and engagement as this develops further and the local NHS would like to work with the HOSC as this rolls out to ensure a consistent and helpful approach that ensures all stakeholders have the information they need.
3. Benefits to patients
3.1 The
development of an Elective Hub and resultant increase in surgical
activity 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 any during 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.
4. What would this mean for East Sussex?
4.1 The Trust’s plan is to build a new dedicated day surgery unit at the Eastbourne DGH site which would be connected to the main hospital building via a series of link corridors. The new facility is planned to go live in 2024/25 and would comprise four new operating theatres and associated support facilities. As a result of the Elective Hub, there would be more capacity to deliver day surgery and inpatient surgery for the benefit of the local population, together with increased capacity and flexibility of case mix on planned operating lists. This, in turn, leads to higher theatre utilisation and increased productivity. It will also provide the opportunity for patients across Sussex to be offered the choice of this facility should they wish to access it.
5. Proposed Elective Hub Activity
5.1 The procedures the hub would focus on relate to a range of specialties including: general surgery; urology; breast; vascular; maxillofacial; gynaecology; ear nose and throat; orthopaedic and community dental surgery. This will be extra capacity and will reduce the time people wait for a procedure. The modelling, based on ESHT’s 2022/23 activity plan, indicates the proposed Elective Hub would deliver a total of 8,453 day surgery cases per annum; this represents 17% of the Trust’s total day surgery activity. Planned day surgery and inpatient operations will continue across the Trust’s sites as it does now, with the exception of some activity at the Uckfield Community Hospital.
5.2 As part of developing this proposal the Trust has reviewed the day surgery activity currently undertaken at Uckfield Hospital. To make best use of resources and maximise improvements to waiting times, under the new proposal approximately 29% of this activity would be undertaken at the Elective Hub in Eastbourne once established. This equates to approximately 179 day surgery procedures each year relating to vascular procedures for minor treatment of varicose veins, circumcisions, and maxillofacial (nose and ear) procedures.
6. Changes for our local population
6.1 All of the procedures undertaken at Uckfield identified as being suitable to be undertaken in the Elective Hub are also currently undertaken at either EDGH or Conquest Hospital and this would continue. Patients are booked for their procedures based on clinical requirements, and only those undergoing a procedure under local anaesthetic are offered Uckfield as a suitable option.
6.2 The activity that would change with the introduction of the Elective Hub has been reviewed and affects relatively small numbers of potential patients. We would want to ensure good communication and engagement as the proposal progresses but would not consider this to be a substantial variation to existing services. This is supported by the information regarding current use as follows.
6.3 The activity
currently undertaken at Uckfield that in the future would be
undertaken at the Elective Hub originates from a wide catchment
area across East Sussex and beyond. For most patients this would
result in slight shorter journey times based on the current
catchment; please see appendix 1 for information on current flow.
The data for the first six months of this year shows that around
47% (42/89) of patients reside in Eastbourne catchment (including
Eastbourne, Pevensey, Polegate and Seaford), and a further 34%
(30/89) from the ‘eastern’ end of the Trust catchment
(Bexhill, Hastings, St Leonards, Robertsbridge, Battle, Rye, and
Winchelsea). In the 6-month period this data covers, there were 7
patients from Uckfield and Heathfield that had procedures
identified as suitable to be undertaken in the Elective Hub. In
addition, it should be noted that these types of procedures will
still take place at the Conquest in Hastings and in line with
current practice, choice would be offered to patients. In line with
all activity, patients will be provided with information and
support about travel and transport where needed.
6.4 This will free up a small amount of capacity at Uckfield and we will be reviewing all opportunities to ensure we maximise use of this capacity for the best benefit of local people.
7. What happens next?
This proposal
represents an excellent opportunity to increase the capacity
available for day surgery that would benefit local people through
the ability to support more than 8,000 additional procedures each
year with minimal impact on current choices available. We will
continue to ensure HOSC is briefed on this development that brings
improvements for the local population. We will also ensure
communication and engagement with patients, the public and wider
stakeholders as the proposal develops.
Appendix 1
Uckfield Hospital Activity by Patient Postcode – 1st April 2022 to 30th September 2022 (inclusive)
|
Postcode |
Post town |
Procedures identified as unsuitable to be undertaken in the Elective Hub |
Procedures identified as suitable to be undertaken in the Elective Hub |
Grand Total |
|
BN20 |
Eastbourne |
20 |
7 |
27 |
|
BN21 |
Eastbourne |
20 |
5 |
25 |
|
BN22 |
Eastbourne |
18 |
6 |
24 |
|
BN23 |
Eastbourne |
23 |
6 |
29 |
|
BN24 |
Pevensey |
14 |
2 |
16 |
|
BN25 |
Polegate |
15 |
11 |
26 |
|
BN26 |
Seaford |
18 |
5 |
23 |
|
BN27 |
Hailsham |
21 |
4 |
25 |
|
TN21 |
Heathfield |
6 |
5 |
11 |
|
TN22 |
Uckfield |
7 |
2 |
9 |
|
TN31 |
Rye |
3 |
4 |
7 |
|
TN32 |
Robertsbridge |
1 |
1 |
2 |
|
TN33 |
Battle |
7 |
2 |
9 |
|
TN34 |
Hastings |
11 |
5 |
16 |
|
TN35 |
Hastings |
1 |
4 |
5 |
|
TN36 |
Winchelsea |
1 |
1 |
2 |
|
TN37 |
St Leonards-on-sea |
4 |
2 |
6 |
|
TN38 |
St Leonards-on-sea |
2 |
6 |
8 |
|
TN39 |
Bexhill-on-sea |
12 |
3 |
15 |
|
TN40 |
Bexhill-on-sea |
5 |
4 |
9 |
|
BN1 |
Brighton |
1 |
1 |
|
|
BN7 |
Lewes |
1 |
1 |
2 |
|
BN9 |
Newhaven |
1 |
1 |
|
|
RH10 |
Crawley |
1 |
1 |
|
|
RH16 |
Haywards Heath |
1 |
1 |
|
|
TN19 |
Etchingham |
1 |
1 |
|
|
TN5 |
Wadhurst |
1 |
1 |
|
|
Grand Total |
|
213 |
89 |
302 |