Issue - meetings

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7.1.        The Committee considered a report providing an update on the progress of the implementation of the reconfiguration of Ear, Nose and Throat Services (ENT) provided by ESHT. The Committee then asked the witnesses present a number of questions.

7.2.        The Committee asked for an update on any success with the recruitment of clinicians and whether consultants have sufficient time allocated to training junior doctors.

7.3.        Dr Bull explained that the trust currently has an overall 10% vacancy rate compared to a national average of 16%. The turnover was 9.5% compared to an average of 15-16%. He added that there were variations around those numbers and difficulties remain recruiting to specialities, which included ENT. To help improve recruitment in ENT the two joint consultant posts are being advertised in conjunction with Brighton & Sussex University Hospital NHS Trust (BSUH). This will enable consultants to have access to both the tertiary work that goes on in Brighton and the district general work at Eastbourne District General Hospital (EDGH).

7.4.        Adrian Bull said there is no doubt that the reputation of the trust is much better. As a result, he was mostly shortlisting two or three applicants for most advertised consultant specialities, except in those few areas where there were shortages, and a new generation of young consultants was beginning to develop at the trust. He added that many consultants were attracted to district general work generally, and East Sussex specifically, and not all wanted to go work in a tertiary centre and its associated academic pressures. Some, though, enjoyed exposure to both, and the relationship with BSUH and Kings College NHS Trust helps to attract those seeking this balance. ESHT also continues to support the medical schools at the University of Brighton and the emerging one in Kent.

7.5.        The Committee asked for clarification whether the addition of an adult surgery list at Conquest Hospital didn’t run against the proposal to centralise the service at EDGH

7.6.        Dr Adrian Bull clarified that the original purpose of the reconfiguration was to centralise adult ENT surgery at EDGH, not the entire ENT service. The final configuration has adult inpatient surgery centralised at EDGH but with a monthly day list retained at Conquest Hospital. This was at the request of ENT surgeons who wanted to ensure that the theatre teams had the opportunity to practice the skill set required for ENT surgery so that in the event of an emergency procedure there was sufficient knowledge and resources in place. Dr Bull said it was possible to accommodate this additional day list and still address the issues of ENT medical staffing being over stretched over two sites because the previous planned surgery lists at Conquest included patients who needed an overnight stay at the Conquest, meaning that ENT doctors then had to travel from the EDGH inpatient ward to see them the next day.

7.7.        Adrian Bull added that the paediatric list at the Conquest, on the other hand, was for children who  ...  view the full minutes text for item 7

19.1.      The Committee considered a report providing details of the proposed reconfiguration of Ear, Nose and Throat (ENT) services currently provided by East Sussex Healthcare NHS Trust (ESHT).

19.2.      Joe Chadwick-Bell, Chief Operating Officer, explained that the proposed reconfiguration is driven by workforce challenges, in particular:

·         A shortage of ENT consultants. There are currently three consultants covering the two sites, whereas there should be five or six. This makes it very hard to recruit any additional consultants as they would have to be on call on a 1-in-4 or 1-in-3 basis. One of the three consultants has retired and returned on an almost full time basis.

·         A shortage of middle grade doctors. There are currently no registrars or training grade doctors to fill the six middle grade rota posts. Instead there are four speciality doctors, one of whom acts up to the consultant rota. They are also close to retirement age and could potentially hand in their notice, despite the current work they are doing now to support the service

·         Reliance on the ad hoc support of 10 Sussex-based doctors, particularly at the A&E department at the Conquest Hospital.

·         There are two trainee ENT doctors but there is a risk that the Deanery could remove them without providing them with more training opportunities.

19.3.      Dr Adrian Bull, Chief Executive, and Joe Chadwick-Bell provided answers to a number of questions from HOSC.

Emergency ENT pathway

19.4.      Joe Chadwick-Bell explained that patients currently present as emergency ENT patients either by calling 999 or attending A&E. South East Coast Ambulance NHS Foundation Trust (SECAmb) know to bring such patients to the Eastbourne District General Hospital (EDGH) where emergency admissions are currently located. Self-presenters at Conquest Hospital can mostly be dealt with on site but those few patients who need the intervention of an ENT surgeon would be transferred across via ambulance.

Ensuring Supportive Professional Activities (SPA) for consultants

19.5.      Dr Adrian Bull said that Supportive Professional Activities (SPAs) are part of a consultant’s contract and the Trust is committed to protecting SPA time as an important part of the training process.

Recruitment difficulties due to sub-specialisation

19.6.      Dr Bull explained that recruitment rates are improving across the trust except for in areas where there is an increasing tendency towards sub-specialisation, rather than generalisation, and in which there are more frequent on-call requirements; the ENT service is faced with both of these issues. Therefore, the future service needs to be attractive to surgeons who are looking to specialise in ear issues, nose issues, or throat issues, given the increasingly few number of ENT generalists.

Impact on deprived communities

19.7.      Dr Adrian Bull said that he did not believe deprivation was relevant to the proposals, as the key consideration of the Trust is to provide a service that provides the right quality of care to residents of East Sussex. In addition, outpatient services would continue as before at Conquest Hospital so access to the opinion of an ENT consultant, who can provide an  ...  view the full minutes text for item 20