Issue - meetings

5.1       The Committee considered a report updating on the outcomes of the changes to the paediatric service model at EDGH, and East Sussex Healthcare NHS Foundation Trust’s (ESHT) response to the recommendations of the Committee’s review report. Dr Matthew Clark, Chief of Women and Children Division ESHT, introduced the report and highlighted that there had been a slight decrease in the number of children being transferred to Conquest Hospital in Hastings, and that no patient safety incidents had been raised since the implementation of the new model.

5.2 The Committee asked for an update how the Scott Unit would be used in the future.

5.3 Dr Clark confirmed that the Scott Unit, which had previously housed the short-stay paediatric unit, was reserved for paediatric services. The area was currently being used as a paediatric outpatient area as the usual area on Friston Ward had needed to be temporarily closed for fire safety work. There was ongoing work on how the space could be used in the future to create a child-friendly environment for both acute and community paediatric services.

5.4 The Committee asked why the Committee’s recommendation of having the paediatric consultant responsible for GP telephone triage on-site at Eastbourne was not being progressed.

5.5 Dr Clark noted that presently there was a split between where the paediatric consultant doing telephone triage was located depending on where they were based. Roughly a third to half of the time the consultant was based at EDGH, and half to two thirds of the time they were based in Conquest. Having run the new model for six months there had been no noticeable advantage of having the consultant permanently based on-site at Eastbourne. Extensive discussions had taken place with the consultant body where there was an almost unanimous view that they did not need to be based at Eastbourne and the independent review had agreed. Dr Clark also confirmed that staffing of all services were under constant review, and where staff were based could and would be moved to match need and demand.

5.6 The Committee asked if ESHT had data on whether any families were travelling independently to Conquest Hospital in Hastings as a result of the changes.

5.7 Dr Clark noted that there was not a robust way for capturing this information, recognising that the ability of patients to choose where to be treated was a feature of how people accessed NHS healthcare. Dr Clarke added that if a child is unwell enough to be taken to hospital by ambulance, the ambulance would take them to the Conquest hospital and this has not changed.

5.8 The Committee asked for confirmation of whether there were any trainee paediatric consultants working at EDGH.

5.9 Dr Clark confirmed that there were currently no resident doctors (previously known as junior doctors) training to be paediatric consultants.

5.10     The Committee asked if there had been any changes in the number of complaints from staff, patients or families.

5.11     Dr Clark noted that the number of complaints  ...  view the full minutes text for item 5

34.1     The Committee considered a report by the HOSC Review Board into Changes to Paediatric Services at the EDGH, which included 13 recommendations. The Committee also considered an update report from East Sussex Healthcare NHS Trust (ESHT) outlining monitoring data of implementation.

34.2     Cllr Alan Shuttleworth, who had been a member of the Review Board, noted that he agreed with the recommendations in the report, but outlined a number of areas where he remained concerned. His concerns with the new model were:

·       That the implementation of changes had been rushed and that ESHT had not sufficiently prepared for the changes, including that a number of clinical pathways were not in place from the beginning of the implementation.

·       The staffing model was not sustainable, and that the number of Advanced Paediatric Nurse Practitioners (APNPs) was too low to support the new model. He therefore felt that having a paediatric consultant on-site to support APNP staff at the EDGH was critical.

·       There would not be enough space following the closure of the Short Stay Paediatric Assessment Unit (SSPAU), and that would leave children without a quiet and relaxing space to be in while being treated given the new unit’s proximity to the Emergency Department (ED).

·       Families with planned care had not been sufficiently informed and updated on the changes being made, and more consultation with all interested groups should have been done ahead of the changes being made.

·       That more patients and families would potentially need to travel from Eastbourne to the Conquest Hospital in Hastings, and that the long-term sustainability of services remaining at Eastbourne was in doubt.

34.3     Joe Chadwick-Bell, ESHT Chief Executive, thanked the Review Board for their work and comments. She noted that the points made by Cllr Shuttleworth had been responded to in the meetings of the Review Board, and that the recommendations in the Review Board’s report would be responded to in full following discussions with clinicians and the ESHT senior leadership team.

34.4     The Committee asked why changes were implemented before everything necessary (such as the new unit) were in place to support the new model.

34.5     Joe Chadwick-Bell responded that there were several reasons. First was that it made it possible to put additional resource into ED, which had allowed children to be seen much more quickly than they had been previously. The beginning of January (which was when the changes were implemented) was one of the busiest times of year when more children presented to ED, so the changes had been introduced then to improve children’s experience by allowing them to be seen quicker and go home quicker. There was a dedicated area for children in the ED already so having the new unit in place was not vital for providing necessary care. In an ideal world the new unit would have been in place from the start, however the Trust took the view that delaying the implementation of changes would have meant delaying an improvement in services for children. There were a  ...  view the full minutes text for item 34

24.1     The Committee considered a report on planned changes to the delivery of paediatric services at Eastbourne District General Hospital (EDGH). Joe Chadwick-Bell, East Sussex Healthcare NHS Trust (ESHT) Chief Executive recognised that the planned changes would be a change in working practices for some staff at EDGH, and noted that there had been media coverage and public representations made to the Committee that related to the planned changes. Joe Chadwick-Bell and Dr Matthew Clark, Consultant Paediatrician and ESHT Chief of Women and Children reiterated what was in the report, that there would be no planned activity moves from the EDGH to the Conquest Hospital in Hastings.

24.2     The Committee asked why NHS Sussex did not consider the planned changes to be a substantial variation.

24.3     Jessica Britton, NHS Sussex Executive Managing Director, East Sussex responded that NHS Sussex did not view the planned changes to be a service change as they were related to how services were organised within the hospital. NHS Sussex anticipated that the changes would increase access and hours of access for children and young people, and therefore not a substantial variation.

24.4     Cllr Alan Shuttleworth shared his view that due to a lack of detailed information having been provided, the implementation of planned changes should be paused until there had been a review and a full consultation with all stakeholders. Cllr Shuttleworth also shared his concern that an unintended consequence of the planned changes could be that more children and families have to travel to the Conquest for treatment.

24.5     Joe Chadwick-Bell recognised Cllr Shuttleworth’s request, and reiterated that the same activity for planned care or urgent care would still come to Eastbourne, and there were no changes that would lead to children going to the Conquest. She emphasised that it was an internal reorganisation of where children would be seen within the hospital. The first stage of the planned implementation was of urgent care and was due to start on 8^th January 2024, and the second stage was of elective care and would begin in February 2024. Dr Matthew Clark noted that there had been a lot of discussions with staff and other stakeholders in the lead up, and no patient safety issues had been raised despite some differences in views over the proposed model of care. Rotas were in place to implement on 8^th January and to move away from the planned date would be disruptive and operationally difficult.

24.6     The Committee asked for more detail on how planned care and urgent care pathways would change when the planned changes were implemented.

24.7     Dr Clark explained that under the current model most children who presented at the EDGH Emergency Department (ED) would be triaged and the vast majority directed to the Urgent Treatment Centre (UTC) as they did not require input from a paediatric specialist. Any children who could not be treated at the UTC would be seen in the ED by emergency physicians, and only if they could not solve  ...  view the full minutes text for item 24