Issue - meetings

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

23.2     The Committee asked about the implications of SECAmb ambulance response times on the door to balloon (treatment) times for those patients affected by the proposed changes to the location of specialist cardiac procedures, especially during busy periods.

23.3     Professor Nik Patel, Clinical Lead for Cardiology (ESHT) outlined that for heart attack management patients who need urgent treatment there are around 190 patients a year which is less than 3% of the total. At present, out of hours, these patients do travel to either the Eastbourne District General Hospital (EDGH) or the Conquest Hospital in Hasting for treatment. Irrespective of site the Trust is well within the 75% door to balloon and national target times for treatment. The Trust works very closely with SECAmb who prioritises heart attack patients and the Trust has worked with them on the proposed changes to the service in all the patient pathways. There is a pre-alert system in place to make sure patients are seen quickly and by the right people when they get to hospital. Patients are also assessed by ambulance crews who have access to specialist advice before they leave for the hospital. Professor Nik Patel confirmed that performance against door to balloon times (e.g. for primary angioplasty) during normal working hours and busy periods are within the national performance thresholds.

23.4     Some Committee members expressed concerns about the travelling times for patients experiencing a heart attack and asked if ambulance crews have a problem stabilising a patient whether they would be taken to the Conquest Hospital first and then transferred to EDGH.

23.5     Professor Patel responded that this will depend on the circumstances of the individual patient and the decision of the ambulance service at the time. In the last 12-18 months the Trust has had the opportunity to improve the pathway for patients experiencing a cardiac arrest with a pre-alert system. This enables ambulance crews to notify the hospital of a heart attack patient and have the right people in the right place to treat the patient. This has resulted in better outcomes for the patients and taking patients to the designated site first is preferred by SEACamb. This was made possible because the changes in the proposed model of care allow the right people to be in the right place to receive and treat patients when they get to hospital. It is not just about travel times but having the people with the right expertise to treat these highly complex conditions in order to achieve positive outcomes for patients.

23.6     The Committee asked how moving patient treatment from the Conquest Hospital to EDGH and patients having to travel further would help reduce health inequalities in Hastings which is one of the most deprived areas in the County.

23.7     Professor Patel outlined that the people who need urgent specialist treatment for heart attack management  ...  view the full minutes text for item 23

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

5.2          The Committee asked for an outline of the next steps that would be taken before NHS representatives return to the HOSC with the final decisions for cardiology and ophthalmology.

5.3          Jessica Britton, Executive Managing Director of East Sussex Clinical Commissioning Group (CCG), explained that, should the HOSC agree the Review Board’s report and submit it to NHS Sussex (which replaces the CCG from 1^st July), there are a few activities that will take place. NHS Sussex will produce for both cardiology and ophthalmology a Decision Making Business Case (DMBC), which builds on the Pre-Consultation Business Case (PCBC) and will be informed by both the analysis of the public consultation and the HOSC recommendations, stating how the NHS will respond to the HOSC recommendations. In addition, for cardiology, the DMBC will be preceded by a site options appraisal, which is an extensive process to determine which of the two proposed sites would best deliver the outcomes agreed for the interventional element of cardiology.  The DMBC will then be agreed through NHS Sussex’s governance process culminating in the Integrated Care Board (ICB) meeting on 7^th September. The HOSC will then consider whether the ICB’s decision is in the best interest of health services locally at its meeting on 22^nd September [Note: the Committee has been subsequently advised that the decision will be reported to HOSC meeting on 15^th December].

5.4          Michael Farrer said that the Trust and CCG are in the process of drawing up a detailed implementation timeline as part of the DMBC, in consultation with the Trust’s Estates and Finance Teams. The intention is to implement the decisions, subject to endorsement by the HOSC, as soon as possible and in the right way for patients.

5.5          The Committee asked for clarification whether the impact on patient flows from the north of East Sussex (the High Weald area) as a result of the decision by Kent & Medway CCG to centralise interventional cardiology services provided by Maidstone and Tunbridge Wells NHS Trust (MTW) to Maidstone Hospital has been considered by the CCG.

5.6          Jessica Britton said that the impact of the MTW reconfiguration would feed into the options appraisal. Michael Farrer confirmed that patient flow modelling for patients in the north of the county had already been undertaken and the CCG and Trust were aware of the decision by MTW and the Kent and Medway CCG to move interventional cardiology services to Maidstone Hospital. Michael Farrer said that the CCG and Trust is confident that the changes to patient flows for patients in the north of the county would be negligible. He clarified that MTW does not provide Primary Percutaneous Coronary Interventions (PPCIs) at either of its sites – either in the current or future configuration – so the emergency patient flows for patients in the north of the county would not  ...  view the full minutes text for item 5

20.1.    The Committee considered a report providing an overview of the proposals for reconfiguring cardiology services currently provided by East Sussex Healthcare NHS Trust (ESHT).

20.2.    The Committee asked what the impact of the reconfiguration would be on the current pressures on ambulance services and the EDs.

20.3.    Prof. Nik Patel, Cardiology Clinical Lead at ESHT, explained that SECAmb, despite the pressures currently on it, is maintaining a very good service for patients having an acute heart attack. Prof. Patel agreed that the issue of bottlenecks at ED was exactly the area the reconfiguration aims to rectify through the creation of a cardiac response team within the ED. This will mean patients should be able to be seen in 30 minutes to an hour rather than more than four hours wait they currently experience, and this was demonstrated to work when the model was tested during the pandemic. The creation of hot clinics that allow imaging, mainly ultrasound, in ED will also mean decisions can be made more swiftly about what to do with a patient. Prof Patel added that the temporary reconfiguration of cath labs at times during the last 18 months have allowed the Trust to admit any patient arriving in cardiac arrest directly to a cath lab where cardiologists, nurses and anaesthetists are waiting on hand, rather than taking them to the ED and calling them all down to attend. SECAmb has helped improve this pathway and prefers to admit patients directly to the cath labs.

20.4.    The Committee asked whether the reconfiguration would increase capacity for imaging and diagnostics such as MRI scans.

20.5.    Prof Patel said ultrasound is the most important test for diagnosing cardiac conditions and the hot clinics will enable swifter use of ultrasound. The Trust has excellent magnetic resonance imaging (MRI) scanners, but the use of MRI scans is not necessary to make a cardiac diagnosis. In addition, ESHT’s computed tomography (CT) scanning times for acute stroke in 1 hour are one of the highest in the country and the Trust receives an A rating for it.

20.6.    The Committee asked whether staff are being consulted on both proposed changes at ESHT.

20.7.    Tom Gurney, Executive Director of Communications and Public Involvement, said there is a communications and engagement plan for staff separate to the public consultation. This engagement will focus on ESHT staff, but also to a lesser degree on all provider staff including those working for SECAmb. Joe Chadwick-Bell, Chief Executive of ESHT, added that both cardiology and ophthalmology have been driven by clinical teams themselves and are not top-down reorganisations, meaning the main affected teams have been fully engaged throughout the process. Dr Patel has also engaged with other specialities’ clinical teams across the Trust quite significantly over the last four years. The Chief Executive clarified that once a site is chosen by the CCG and Trust, there will need to be a further conversation with staff who will need to move site, however, this is  ...  view the full minutes text for item 20