Ophthalmology Transformation at East Sussex Healthcare NHS Trust
HOSC Update – March 2025
· enable redesigned ophthalmology pathways 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.
Recommendation 1
The Committee endorses the reasons for reconfiguring ophthalmology 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.
Recommendation 2
The Committee notes that the proposed choice of the Bexhill Hospital to consolidate ophthalmology services and recommends that mitigation measures are put in place to address the concerns about travel and access to this site.
Recommendation 3
The Board recommends:
3a. A package of measures is put in place to mitigate the travel and access impacts of the proposals on patients, families, and carers, including but not limited to:
· the establishment of a Travel Liaison Officer post is essential.
· 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.
· the provision of information on the travel support available in referral letters via a separate leaflet or information sheet in an accessible format and links to the website.
· the CCG (now ICB) 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.
· encourage providers to provide clear explanations of the eligibility criteria for Patient Transport Services.
· increasing and maximising the number of on-site parking spaces at the Bexhill Hospital site.
· 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.).
3b. Ongoing monitoring of Did Not Attend 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 the light of this information.
Recommendation 4
The Board recommends:
· Patients are given a choice of hospital site for referral where appropriate.
· Consideration is given to providing some specialist treatments at the Eastbourne DGH site in addition to Bexhill Hospital.
Recommendation 5
The Board recommends:
· Detailed implementation plans are drawn up as soon as possible to facilitate the timely implementation of the proposals, once a decision is made.
· The opportunity is taken to make early changes to services where this is possible.
Recommendation 6
The Board recommends:
· Regular monitoring of staffing levels is undertaken post implementation to ensure the sustainability of the service.
· Further staff recruitment and retention measures are developed.
* Notes/Assumptions
1. No further business case approval process required following agreement of Decision-Making Business Case and East Sussex Healthcare NHS Trust internal approvals.
2. External funding sources / capital budget have been and are agreed by the system for all works.
3. Regarding reprovision of X Ray service space, this assumes the planned Community Diagnostic Centre in Bexhill opening as per plan in autumn 2022, and not later than December 2022.
4. Location of Physiotherapy to be confirmed. Assumes Physiotherapy move and works to accommodate new Physiotherapy can be completed to fit with Ophthalmology timescales.
Implementation Phasing
Phase 1 work has been completed and consisted of:
· X-ray provision ay Bexhill Hospital was relocated to the new Community Diagnostic Centre (CDC) which was opened in the Bexhill area.
· A critical digital infrastructure upgrade was installed at the Bexhill Hospital site.
· Work was completed on structural and roofing elements of the Bexhill Hospital site, in the areas that were planned for Ophthalmology.
· The old X-ray area at Bexhill Hospital was then refurbished for use by ophthalmology, creating additional clinical rooms and capacity.
· Ophthalmology service provision continued as normal throughout this period at Conquest Hospital and Bexhill Hospital, while phase 1 work was completed.
There were some delays to beginning phase one of the works, as well as an extension to the required timeframes to complete the necessary estates work. This was largely due to three factors:
· There were some small delays in moving the X-ray activity to Bexhill due to delays in the national CDC process which was being rolled out at a similar time.
· Prior to phase 1 estates work starting, it was necessary to upgrade the digital infrastructure at Bexhill, the urgency of this work was unforeseen and had not been planned in, but was needed to be completed before the ophthalmology refurbishment could start. This work included trenching, which was required around much of the Bexhill site.
· Phase 1 work also coincided with essential structural and roofing works that were emergent and only fully recognised at the time the phase 1 build was started.
Work between the radiology unit and the structural and roofing elements needed to be coordinated and phased in order to plan around sustaining clinical activity during opening hours, in order to minimise potential impact on patients.
Mitigations were put in place in order to ensure that there was minimal impact on transformation plans and to patients. This included progressing other elements of the plans where possible, such as:
· Designing and testing the new operational pathways where this was feasible.
· Completing a demand and capacity exercise for phases 1 and 2 in order to allocate rooms to staff and activity type.
· Ensuing preparations for the Staff Consultation with HR were ready to launch at the right time to ensure staff could move from Conquest when phases 1 and 2 were complete.
Planning for phase 3 was separated out at this point, as it became apparent that the assumptions for phase 3 space had materially changed. This will be covered below in the section on phase 3.
Phase 2 work consisted of:
· Decant of the then current ophthalmology service and equipment from the old Dowling Unit space into the new ophthalmology space created in phase 1 (Staff who were already based at Bexhill Hospital moved into the newly refurbished space).
· Refurbishment and redesign of the old Dowling Unit space, to allow for additional capacity, and to address access issues in the old unit.
· Ophthalmology service provision continued as normal across the Conquest and Bexhill Hospital sites while phase 2 work was completed.
· Limited piloting of new pathways was tested during phase 2, following pathways work conducted throughout phases 1 and 2.
Estates work for Phase 2 was completed with minimal delays but was affected by the later than planned start for phase 1, which affected the timescales for the phase 2 procurement and contracting process. The minimal delays that did occur during phase 2 were largely due to supply and demand issues with materials from the contractor’s, responding to market volatility at the time the work was caried out.
Ophthalmology staff took ownership of the new space in the weeks following completion of phase 2 building works (between October and November 2024).
Communications were planned around the phasing to help publicise the changes to the public. Further communications are planned as part of our ongoing Communications and Engagement plan.
Following the completion of phase 2, it was possible to move some Ophthalmology staff over from Conquest Hospital to Bexhill Hospital, which required a Staff Consultation with the HR department.
The HR Consultation had been prepared during phase 1, and was completed simultaneously with estates works for phases 1 and 2. This allowed for staff to move into the phase 1 and phase 2 units at Bexhill from Conquest as soon as the building works were completed, and the rooms were ready to be used.
Feedback from the staff during the consultation was largely positive, and staff were on board with the changes; this was especially the case as the model of care had been clinically led throughout the public consultation phase. Only a light touch Staff Consultation was required due to positive feedback from the staff, and the large the amount of engagement with the workforce which had been completed to date.
Workforce planning was completed following the demand and capacity exercise conducted during phase 1, and this allowed the medical workforce to move from Conquest to Bexhill when the new unit opened.
Please note, the Optometry and Orthoptist workforce currently remains at Conquest, awaiting review and development of plans for phase 3 (see below).
Work on phase 3 has been temporarily paused and is currently under review. This is due to several factors, the main ones of which are indicated below:
· Initial planning for phase 3 recognised in the assumptions of the DMBC that the MSK service currently provided in that space had to be relocated. A location had to be found within close proximity to the current site as to minimise impact to patients.
· An alternative MSK location was identified by way of a rental solution, and initial preparations were made to lease a space for the MSK team. However, during the planning phase it became apparent that the costs required to bring this space up to the standards required for clinical activity were more than anticipated, and were in excess of capital estimates.
· There was not the capital funding available at the time in order to complete the required works, which prompted a re-review of the phase 3 plans. This also coincided with a capital reprioritisation programme which was being conducted due to an oversubscribed capital plan, and constrained capital across the system was being reviewed and re-prioritised.
· This resulted in a review of the immediate need for the additional space which would have been provided by phase 3. The review found that:
o Phases 1 and 2 could be used to relocate the medical workforce in its entirely (as outlined above), and this would allow us to achieve the majority of the benefits outlined in the business case – this has now been completed.
o The phase 3 space concerned the consolidation of the Orthoptist and Optometrists. However, these staffing groups can continue to safely and effectively work at the Conquest site, as this work does not require consultant supervision.
o The activity and growth included in the business case was a 10-year model. Updated demand and capacity revealed that the additional phase 3 space at Bexhill was not imminently needed.
o This has allowed us time to re-evaluate what phase 3 looks like and investigate alternative and viable options from a capital perspective, before committing public money to phase 3. This work is currently underway.
o It was acknowledged that phase 3 would still be needed in the future, in order to provide the training and development required to enable the non-medical workforce (Optometrists and Orthoptists) to see activity that would traditionally be seen by medical staff, and to ensure that we can meet the modelled growth in the 10-year forecast period.
o Additionally, this re-review came at a time where independent sector providers were increasing their footprint in East Sussex, possibly affecting the assumptions behind the future growth model included in the DMBC.
o As result, it was felt that the impact of a growing independent sector presence should be understood and modelled before making a firm decision on the future of phase 3, as it may lessen the hospital footprint required.
o This work is ongoing and will feed into an options appraisal for phase 3.
Updates on the above ongoing work are report and monitored on a monthly basis at the ESHT Transformation Board, who will review the development of phase 3 proposals.
All delays and developments are reviewed by the ICB Joint Steering Board, who oversee decision making, risk, and issues. Delays have been escalated to the ICB JSB in each case, and assurance has been sought in each case that delays have been mitigated as far as possible.
The JSB are also received reports monitoring the impact of the increased footprint in independent sector ophthalmology providers across Sussex.
Groundwork is currently being conducted to expand the car park at Bexhill, and ahead of any phase 3 plans which will bring further activity to the site.
The design and planning process for the new car park allowed for us to maximise the number of spaces, achieving an additional 13 spaces, which are in excess of the number of spaces that were required during consultation in order to subsume the additional ophthalmology activity which would be brought to the site due to the transformation.
The work on the expansion of the care park is due to be completed in March 2025.
Furthermore, the Trust is in early discussions around the possibility of a phase 2 car park expansion, which may provide a further 8 spaces if plans are successfully approved.
Improvements and Benefits in Place
Benefits Realisation Plan
Our Case for Change and developing our Pre-Consultation Business Case (PCBC)
· Care provided
· Equality and diversity
· Access and transport
· Clinical services
· Community optometry.
· 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.
· 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 Principlesto 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.
Public Consultation
Travel and Transport Review Group
Plans for implementation
Approval, endorsement and implementation
The purpose of the Decision-Making Business Case was to ensure that the proposals were adequately consulted upon, were clinically sound, financially viable, and in line with the improved outcomes agreed in the Pre-Consultation Business Case.
At their meeting in public on 11 October 2022, East Sussex Healthcare NHS Trust noted the development of the Decision-Making Business Case, including the feedback from the public consultation; and following their review of the summary Decision Making Business Case, endorsed the case for consideration by the NHS Sussex Integrated Care Board.
NHS Sussex Integrated Care Board then met on the 2nd of November and approved the recommendations in the Decision-Making Business Case.
Following this, the DMBC was submitted to the East Sussex Health Overview and Scrutiny Committee (HOSC), who endorsed the DMBC at their public meeting on the 15th of December 2022, and the programme moved to implantation phase.
Themed actions in response to public consultation and recommendations
These key recommendations were largely focused on travel and transport issues that had been highlighted during consultation and included investigating provision of numerous travel and access support options for local people.
In response to these recommendations, an update was provided at the HOSC meeting on the 15th of December 2022, where it was recognised that some actions had already been implemented, others had been committed to and were progressing as we moved to implementation, and others had been investigated but were not viable options. As such, the recommendations were distilled to the 6 HOSC recommendations which are the subject of section 2 of the above report.
All actions have been under constant review during the implementation phase and have been discussed at the ICB Joint Steering Board on a quarterly basis as part of the ‘Mobilisation Assurance Action Log’.
Themes, recommendations and progress updates are given in the table below in order to provide additional detail and context for the HOSC members.
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) |
Measures developed and recent recruitment drives have been successful in attracting candidates. Collaboration across the Sussex ICS is ongoing and is a continuing programme, as workforce challenges continue 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. This will be included in benefits realisation. |
|
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. An update is provided as part of the body of the main report. Travel and transport actions are reviewed quarterly at the ICB Joint Steering Board. |
· Travel support options including communication |
The establishment of a Travel Liaison Officer post is essential (HOSC) |
This role is covered by the single point of contact as part of the NEPTS contract, as well as via the ECLO role in Ophthalmology. |
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 to expand the parking at Bexhill will complete in March 2025, with an additional 13 spaces. Furthermore, there is a potential opportunity to further expand parking by an additional 8 spaces which is currently being explored. |
|
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 has been completed, and communications are ongoing. Our communications plan is a live document and is continually being re-reviewed by the Joint Steering Board where it is a standing item. |
|
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 benefits realisation work. Early indications are positive showing a decline in DNAs for patients attending Bexhill rather than Conquest, when compared to baseline. |
|
· 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 has been discussed at GP forums by the ICB, to raise awareness of including this at point of referral. This is being continually 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 required. |
|
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 new NEPTS contract and the ECLO role in Ophthalmology supports 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. An update to the shuttle bus and volunteer transport services is provided as part of the main body of the report. |
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) |
A viability assessment was conducted into the Trust operating a shuttle bus which concluded that we were unlikely to reach the patients that required our help, that these patients were likely covered by other schemes, and that operating an inter-site shuttle bus was not financially viable or a responsible use of public money. |
|
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 complete. The compiled list is now maintained by the NEPTS team to help advise patients under the single point of contact arrangements. |
|
Explore details and arrangements of shuttle bus services that other Trusts have implemented. |
This was factored into the travel and transport review of the shuttle bus, as well as the viability assessment options that were considered. |
|
Explore progress of the Trust’s potential plans to have an in-house patient transport service. |
The Trust use the new NEPTS contract that was procured by the ICB following the transformation plans. The NEPTS contract covered the issues raised as part of this consultation. |
|
· 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 was conducted and completed and is reported on in the main body of the report. Immediate opportunities were explored but there was no funding available as the bus improvement plan had already been set and prioritised. The transport manager is aware of the transformation and will consider future plans dependent on funding availability. |
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 reviewed a range of transportation solutions with the transport manager at ESCC and with Stagecoach. It was not financially viable for stagecoach to alter current services. Historic route data showed that previous routes around Bexhill Hospital were underutilised. |
|
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 reviewed the bus service improvement plan with the Transport manager. Proposals were considered, but funding was already prioritised for other areas and was not available to be used for proposed improvements. |
|
· 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 has formed part of our implementation plans ensuring that the design of our new service is accessible and user friendly for all our local population as possible. |
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 has formed part of our implementation plans ensuring that the design of our new service is accessible and user friendly for all our local population as possible. We have not yet conducted mystery shopper activities, but have invited feedback on improvements, and monitor patient feedback closely. |
· 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) |
Implementation plans started to be drawn up immediately following approval of the DMBC. As part of the workforce planning, this included mitigation of workforce risks posed during the development. HR consultation has now been completed and was positive. Plans were drawn up and phased in order to preserve service provision and minimise impact to patients using Bexhill Hospital. |
· 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 was included in the Decision-Making Business Case. |