Issue - meetings

1.1.        The Committee considered a report which provided an update on the work undertaken to develop maternity services as part of East Sussex Healthcare NHS Trust’s (ESHT) Quality Improvement Plan (QIP) and the current performance of the services.

1.2.        The report was introduced by Dr Adrian Bull, Chief Executive, and Catherine O’Callaghan, Service Manager for Maternity, ESHT.

1.3.        Dr Adrian Bull apologised for some incorrect figures supplied in the Births Before Arrival (BBA) statistics and agreed to provide the amended figures.

Number of transfers

1.4.        HOSC asked whether 40% of patients having to be transferred from the  Midwifery Led Unit (MLU) at Eastbourne District General Hospital (EDGH) to the obstetric unit at the Conquest Hospital was too high.

1.5.        Dr Adrian Bull clarified that the 40% referred to those women transferred from the MLU who are having their first baby. Of the 320 women who started their birth at the MLU 62 were transferred, which is closer to 20%, and less than 10% of women having a second or third baby needed to be transferred. Of those 62 who did transfer, 52 transferred before they had gone into full labour, and the other 10 transferred in second stage labour after having been individually reviewed. These 10 women then spent considerable time at the Conquest Hospital before delivery or caesarean section.

1.6.        Dr Bull said transferring patients is a managed and controlled process and the likelihood of transfer to the obstetric unit is part of the discussion clinicians have with women during the antenatal period. They will also be aware that when choosing to have their first baby at the MLU there is a reasonable chance they may be transferred to the obstetric unit.

Configuration of services

1.7.        HOSC asked how many additional births would be necessary to support two viable consultant –led services in East Sussex; and whether a minimal consultant-led service could be returned to EDGH.

1.8.        Dr Adrian Bull said the total number of births across both sites is 3,300 per year and the recommended minimum number for a single sustainable obstetrics unit is 2,500. Dr Bull said ESHT has agreed that it will continue to look at whether circumstances are changing and whether this means that there is a case for service reconfiguration.

1.9.        Dr Adrian Bull disagreed that a minimal consultant-led service could be provided safely at EDGH as the low number of births would only support a part-time consultant service. One of the biggest risks to patients is to blur the lines between a MLU and an obstetric unit by having a part time consultant presence. This is because a MLU monitors emerging risks more closely than in an obstetric unit.

1.10.      Dr Bull said that under the current maternity configuration, if an emergency transfer for a caesarean had to be made then it would indicate that the risk management protocols put in place at the MLU had gone badly wrong, and this has not happened over the past three years. He said that the  ...  view the full minutes text for item 19

1.1.        The Committee considered a report by the Assistant Chief Executive which included a response from ESHT to HOSC’s report on the Trust’s Quality Improvement Plan (QIP).

1.2.        Julie Fitzgerald, Chief Executive, Healthwatch, provided a summary of Healthwatch’s work with ESHT in relation to the QIP. HOSC thanked Healthwatch for their involvement in the process.

1.3.        HOSC asked further questions in relation to specific areas identified as a concern in the Care Quality Commission (CQC) report.

Patient records

1.4.        HOSC asked for an update on funding for the digital tagging system for patient records, and the progress of the records storage site at Apex Way.

1.5.        Dr Adrian Bull, Chief Executive, confirmed that the digital tagging system was in place and as a consequence the number of missing patient records at outpatient appointments had fallen significantly. The move to Apex Way had begun following extensive consultation with affected staff and the performance of the new system was being carefully tracked. A formal opening of Apex Way was due to take place on 12 July 2016.

Patient involvement

1.6.        HOSC asked what ESHT was doing to ensure patients were involved in the quality improvement process.

1.7.        Dr Bull said that ESHT involved patients in service design well in an ad-hoc manner but agreed that the Trust needed to do more to ensure patient involvement in its service design at all levels as a matter of course. He said that ESHT will develop a well thought through plan to achieve this. He used the example of the work ESHT had undertaken with Healthwatch, including a recent mock inspection in preparation for the next CQC visit, that was very helpful to illustrate effective patient involvement. 

Maternity services

1.8.        HOSC asked for an update on the capital works proposed as part of the reconfiguration of maternity services in 2014, and asked whether it would affect the decision to single-site consultant-led services at the Conquest Hospital.

1.9.        Dr Bull said that the capital improvement spend in 2013/14 for maternity services was just over £100,000 at Eastbourne District General Hospital (EDGH). In the 2017/18 capital programme there is a further £130,000 planned to improve the environmental surroundings of the midwife-led unit. ESHT has limited capital funds and there is a list of proposed capital projects which total greater than the £45m annual capital budget. Included in this list is the significant and substantial rebuilding of the maternity unit at EDGH, but this cannot be accommodated in the current capital programme because of other urgent works which take priority. ESHT is planning to create a business case for further external capital funding to enable the Trust to carry out more of its proposed capital projects.

1.10.      Dr Bull clarified that ESHT has no plans at present to bring consultant-led maternity services to back to EDGH, but the Trust would continue to listen to the concerns of the residents it serves.

Seven day working

1.11.      HOSC asked ESHT to clarify its seven day working plans, including how it  ...  view the full minutes text for item 9

38.1     The Chair welcomed David Clayton-Smith, the new Chair of East Sussex Healthcare NHS Trust (ESHT) to the meeting. Mr Clayton-Smith told the committee that the new ESHT Chief Executive, Dr Adrian Bull, will be starting work soon. The trust has also recently appointed a new Finance Director and a new Non-Executive Director. Mr Clayton-Smith thanked Richard Sunley for all he had done as Acting Chief Executive. Mr Clayton-Smith also told members that he was determined to rebuild ESHT’s relationships with stakeholders.

38.2     The Chair commended the Scrutiny Review Board report to the committee and thanked all the ESHT witnesses who had agreed to take part in the review.

38.3     Cllr Angharad Davies commented that the surgery sub-committee was impressed by the improvements that had been made to surgical wards. However, it was worrying that surgical beds were being taken up by medical patients: ESHT needs to think innovatively about how to accommodate medical patients without impacting on surgery.

38.4     Julie Eason commented that the maternity sub-committee had found that the maternity wards were cleaner and less cluttered than previously. It is too early to tell whether there has been a genuine change for the better in terms of culture.

38.5     Cllr Bob Standley commented that the pharmacy sub-committee had found a very positive team of workers who communicated openly with each other. It was particularly good to see that the team recognised that the CQC had made valid criticisms of previous arrangements. Delays in the discharge of patients from hospital, including delays caused by having to wait for discharge medicines, remain a concern.

38.6     Cllr Alan Shuttleworth commented that the patient records sub-committee had been impressed by the actions taken to address this issue. However, it remained unclear whether the funding to digitally tag all records had been found and whether there had been a final decision to store all records at the Apex Way site.

38.7     Cllr Frank Carstairs commented that the outpatients sub-committee was impressed with both the quality and motivation of staff in the department and by the improvements made to the call centre.

38.8     The Committee RESOLVED to: 1) endorse the Review Board report on ESHT Quality Improvement; and 2) agree to refer it to ESHT, the NHS Trust Development Authority and to the Care Quality Commission for consideration.

38.9     Richard Sunley, Acting ESHT Chief Executive, welcomed the report, which he described as very fair. The trust will respond formally in writing to the report recommendations. ESHT does recognise the medical bed pressures described in the report: speeding up the discharge of those patients medically fit for discharge is a priority for the trust and for the local health and care system. ESHT has added an additional 100 beds across its two hospital sites in recent years. The challenge now is principally to reduce length of stay.

38.10   Richard Sunley added that maternity wards had previously not been audited for cleanliness frequently enough and standards had slipped. This has now been addressed. There has also  ...  view the full minutes text for item 38

24.1     The Committee considered a report by the Assistant Chief Executive providing an update on the progress of the Scrutiny Review Board established to examine East Sussex Healthcare NHS Trust’s (ESHT) quality improvement planning in response to recent Care Quality Commission (CQC) inspection reports. The report also included an update from ESHT on the progress of their Quality Improvement Plan (QIP).

24.2     Richard Sunley, Chief Executive of ESHT, and Alice Webster, Director of Nursing, provided the Committee with a PowerPoint presentation on the progress of ESHT’s QIP to November 2015.

24.3     Richard Sunley, Alice Webster, and Susan Bernhauser, Interim Chair, provided the following additional information in response to questions from HOSC:

Recruitment

·         ESHT is recruiting 40 nurses from the Philippines. This is the maximum number that can be recruited at this time, but the Trust will look to recruit a similar number in 2016.

·         The nurses recruited from the Philippines must first obtain visas and so are unlikely to join the Trust until March or April 2016. They will not become nurses registered with the Nursing & Midwifery Council until summer 2016 as they must first complete a period of consolidation and competency and sit a competency exam at the University of Northampton.

·         These nurses will not be affected by the Government’s recent changes to visa requirements as nurses are on the special occupational list.

·         ESHT has increased the number of student nurse placements it provides and is in discussions with Health Education England to increase the number of student nurses it receives to fill these placements. However, these additional students will take three years to fully train so the benefits of the increase in student nurses will not be felt until 2018. The Trust recruited all 23 student nurse graduates in October 2015.

·         There is a national problem recruiting middle grade doctors – particular in A&E – that is putting considerable and increasing pressure on the hospital services. ESHT has had great difficulty in recruiting sufficient numbers of middle grade doctors and the Kent, Surrey and Sussex Deanery (KSS) has found it difficult to provide staff to fill middle grade training posts; between 70-80% of locum staff at ESHT are middle grade doctors.

·         The shortage of middle grade doctors is predominantly due to the fact that middle grade doctors are joining employment agencies. These agencies pay considerably higher wages than NHS trusts are permitted to pay permanent members of staff under the NHS pay scales scheme, which makes it financially attractive for middle grade doctors to join an agency.

·         ESHT is working with the KSS to focus the limited resource of middle grade doctors, for example, by developing a physician’s assistant role. A physician’s assistant would carry out some of the middle grade doctors’ non-clinical roles which would allow them to focus on clinical care.

Culture

·         ESHT’s Trust Board recognises that addressing the cultural issues that the CQC identified will be a slow and difficult process, but it is putting in place a number of initiatives:

o   Holding Quality  ...  view the full minutes text for item 24