Issue - meetings

34.1     The Committee considered an update report on the implementation of the ophthalmology transformation programme at East Sussex Healthcare NHS Trust (ESHT), including updates on the areas that HOSC made recommendations on as part of its review of the service change.

34.2     The Committee asked how many disabled bays would be at Bexhill Hospital after the changes to parking had been made.

34.3     Lesley Carter, Matron for Ophthalmology, explained that there would be at least six disabled bays on the left hand side of the main entrance to the hospital. There would also be an additional two disabled bays in the car park on the right hand side of the hospital road going down, and that would be designated for patients only. This would result in an extra four disabled bays.

34.4     The Committee asked whether phase 3 of the transformation programme had been paused due to the Government’s announcement on changes to the New Hospitals Programme, and when phase 3 was now expected to be completed.

34.5     Richard Milner, ESHT Chief of Staff, explained that the pause to phase 3 was unrelated to the New Hospitals Programme as the ophthalmology transformation programme had been funded through ESHT’s own regular capital programme. Mike Farrer, ESHT Head of Transformation, explained that phase 3 was still required however there was more time to deliver it because it related to ensuring there was sufficient capacity to meet the 10 year activity projections. Phase 3 would be taken forward at the appropriate time in line with the Trust’s priorities and sufficient capital being available. 3 options were being explored as part of delivering phase 3, and the future demand and capacity model was being refreshed to ensure the new unit was the right size given recent activity changes. An options appraisal would be taking place in summer, after which implementation timelines could be determined.

34.6     The Committee asked if there were enough staff to maintain the service at its current level.

34.7     Lesley Carter, explained that phase 1 & 2 of the transformation programme had created space in outpatients which would allow the appointment of an additional full-time glaucoma consultant. There had also been an increase in the number of middle-grade doctors, and funding to support and expansion in nursing and non-medical staffing levels to support the service.

34.8     The Committee asked whether the service was sufficient without the implementation of phase 3.

34.9     Pantellis Ioannidis, Clinical lead for Ophthalmology, explained that at the moment the service is fully functional and available for patients. The benefits of phase 3 would be to bring optometrists and orthoptists who currently work out of Conquest Hospital into the same unit. The optometrists and orthoptists at Conquest could work safely and independently without consultant supervision, but bringing the whole ophthalmology unit together would benefit staff by increasing the skill mix of staff and have the full service under one roof.

34.10   The Committee asked about issues with non-emergency patient transport and how ESHT would be able to ensure patients  ...  view the full minutes text for item 34

24.1     The Committee considered a report on the proposed changes to Ophthalmology services in East Sussex which have been agreed by the NHS Sussex Board.

24.2     The Committee noted that under the proposals around nine to ten additional patients per hour will be attending the Bexhill Hospital site. It asked how many additional parking spaces, including disabled parking spaces, will be provided.

24.3     Jessica Britton outlined that additional parking at the Bexhill Hospital site has been factored into the Decision Making Business Case (DMBC) and capital money has been allocated for this to reduce the impact on local residents.

24.4     Mike Farrer, Head of Strategic Transformation, added that as a result of HOSC’s recommendations there will be an increase in the amount of parking available and this is reflected in the DMBC. There will be at least ten additional parking spaces and the Trust is looking at whether it might be possible to add more.

24.5     The Committee commented that the service is very good but waiting times needed to be lowered.

24.6     Mr Kashif Qureshi, ICS Speciality Clinical Lead for Ophthalmology acknowledged that waiting times were longer that the Trust would like. Reducing waiting times is one of the reasons for the proposed changes and is addressed by the DMBC. The new service model will have more space and a multi-disciplinary team which will be able to see more patients and provide faster diagnosis. At present there is a limit on the number of patients the service can see. The DMBC will address waiting times for procedures such as cataract surgery with more staff and the one-stop clinics which will speed up the assessment process.

24.7     The Committee asked what the timescales are for getting the Travel Liaison Officer role in place.

24.8     Michael Farrer outlined that the Travel Liaison Officer will be in place by the time the changes take place and patients are transferred from being seen at the Conquest Hospital. He added that this proposal is being taken further with the re-commissioning of the non-emergency Patient Transport Service which will have within it a single point of access for all patients when they come for their appointments. As well as having the Travel Liaison Officer for Cardiology and Ophthalmology patients the Trust is discussing with NHS Sussex having this role available for all outpatients and it looks like this might be possible as part of the re-commissioning of the non-emergency Patient Transport Service.

24.9     The Committee RESOLVED unanimously to agree that NHS Sussex’s decision as set out in paragraph 2.1 of the report in relation to the changes to the future provision of Ophthalmology services by the East Sussex Healthcare NHS Trust (ESHT) is in the best interest of the health service in East Sussex.

6.1          The Committee considered a report seeking agreement of the HOSC Review Board’s report on NHS proposals to reconfigure ophthalmology services in East Sussex.

6.2          The Committee asked whether the proposed changes would help address the waiting lists for consultations and procedures in ophthalmology.

6.3          Richard Milner said that a key aim of the Trust this financial year is to reduce the waiting list across all specialities and not just ophthalmology. This will involve reducing the backlog of outstanding appointments caused by COVID-19 whilst also managing additional new appointments based on clinical need. This can be achieved in part by optimising the available medical workforce to see more patients, and one of the key aims of the ophthalmology proposals is to increase capacity of the existing workforce by concentrating them on two sites. In addition, there is a wider ophthalmology transformation programme across NHS Sussex to train community ophthalmologists to enable people to receive ophthalmology care in the high street, where appropriate. By consolidating the acute service, ESHT will be able to free up its consultant ophthalmologists to train some of the community ophthalmologists. This will not only increase capacity and help reduce the backlog but will also improve patient outcomes by allowing them to be treated earlier, quicker and closer to home.

6.4          The Committee asked for further details on the expansion of available parking at Bexhill Hospital as part of the proposals.

6.5          Michael Farrer said the Travel and Access Group’s remit included looking at the opportunities for increased parking at the Bexhill Hospital site. He said that the CCG and Trust know that the additional number of ophthalmology patients attending the site, based on an increase of eight patients per hour for the clinics, will equate to 10 additional parking spaces. The Trust is confident it can absorb that number of spaces on the site, however, that is a minimum number, and the Trust is exploring with its Estates Team options for further expansion of parking on the site. The parking details will be included in the DMBC.

6.6          The Committee asked whether data for ‘did not attend’ patients would be collected to understand what barriers there were for patients attending.

6.7          Michael Farrer said the CCG and Trust fully agreed with the HOSC Review Board’s recommendation around collecting ‘did not attend’ (DNA) data. At the moment, the Trust systems do not allow the collection of DNA data, as the patients did not attend an appointment to be asked that question. The Trust does, however, follow up DNAs to make sure they rebook their appointment and are not discharged back to their GPs, and there is an opportunity then to have a conversation about why they did not attend and to record that reason. Anecdotally, the reason people did not attend is not because they physically could not get to the Bexhill site, for example, during the pandemic when services were single-sited at Bexhill, there did not appear to be an increase in the number of  ...  view the full minutes text for item 6

21.1.    The Committee considered a report providing an overview of the proposals for reconfiguring ophthalmology services currently provided by ESHT.

21.2.    The Committee asked what the Trust was doing to attract more specialist nurses and consultants given the growing demand for ophthalmology.

21.3.    Mr Kash Qureshi, Clinical Lead for Ophthalmology at ESHT, said the Trust has been quite successful recruiting consultants because it offers an attractive job specification that allows consultants to focus on operating and seeing patients. The change in model will also provide optometrists, orthoptics and nursing staff with expanded roles that enable them to deliver clinical treatments and eye clinics themselves, which does not usually happen at other trusts and will make the roles more attractive. Mr Qureshi added that all three roles between them already provide the majority of injections for patients with macular degeneration, which patients prefer as it provides continuity of care. The ophthalmology service is also providing opportunities for community optometrists to learn new skills in the hospitals, such as training them to do laser interventions. Very few trusts offer this service and it benefits patients by increasing the skill set of community optometrists. 

21.4.    The Committee asked whether the new one stop clinics established at Bexhill Hospital and Eastbourne District General Hospital (EDGH) will be open seven days per week.

21.5.    Mr Kash Quershi said there is seven-day access for emergency and urgent eye care problems and waiting list activity is currently being carried out seven days per week due to the backlog, however, there are no plans to carry out routine care via a seven day service. The Trust is, however, planning to provide three sessions per day with the addition of an evening slot from 5-8pm, which will provide more capacity for adult clinics.

21.6.    The Committee asked whether the proposals will involve purchasing new equipment and whether this will be funded by additional capital investment.

21.7.    Mr Kash Quershi said rationalising services from three sites to two will mean the service will need less equipment and can use what it has more efficiently.  Joe Chadwick-Bell added that the capital funding is nationally allocated to Integrated Care Systems (ICS), which then allocate it to individual providers based on need. Each provider trust determines its capital needs through an annual process of prioritising investment for digital, medical equipment, and building works. Any replacement of ophthalmology equipment will be considered within this process. The Chief Executive added that charitable organisations also often provide equipment to the Trust, which the Trust is very grateful for.

21.8.    The Committee asked whether Bexhill Hospital will be able to accommodate the additional parking demands of staff from Conquest Hospital.

21.9.    Michael Farrer, Strategic Transformation Manager at ESHT, said a lot of the patients who attend Bexhill are driven there by family or friends, as many will not be able to travel home afterwards. Parking is an issue that will be picked up during the consultation process and possible solutions will be developed with stakeholders as the  ...  view the full minutes text for item 21