Agenda and minutes

32.1     The minutes of the meeting held on 27 November 2014 were agreed as a correct record.

33.1    Apologies for absence were received from Councillors Angharad Davies (Rother District Council) and Jackie Harrison-Hicks (Lewes District Council). Cllr Bridget George was present as a substitute representing Rother District Council.

33.2   The Chair announced that this would be the last meeting attended by Councillor Di Philips (Lewes District Council). The Chair paid tribute to Councillor Phillips’ work on HOSC over the last 10 years since HOSC started and wished her well for the future.

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

34.1   Cllr Sue Beaney declared a non-prejudicial interest in respect of item 8 (update on the acute mental health inpatient beds Sussex) as an associate partnership manager at Sussex Partnership NHS Foundation Trust (SPFT).

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.

35.1     There were none.

36.1   Copies of the reports dealt with in the minutes below are included in the minute book.

Report by the Assistant Chief Executive

An introduction to this major transformation programme designed to integrate health and social care services in the county and to identify areas for further scrutiny.

37.1     The Committee considered a report of the Assistant Chief Executive on the East Sussex Better Together (ESBT) programme.

37.2     Paula Gorvett, Programme Director East Sussex Better Together, made a presentation to HOSC providing:

·         The background and an overview of the ESBT programme

·         The vision and framework of ESBT

·         A description of the whole system transformation that ESBT aims to achieve in health and social care

·         Aims, challenges and next steps of the ESBT programme.

37.3     In response to questions from HOSC, Paula Gorvett and Ashley Scarff, Head of Commissioning and Strategy, made the following clarifications and responses:

Funding and decision making

• ESBT is ‘apolitical’ and therefore unlikely to be significantly affected by the outcome of the general election. The programme is in keeping with the principals of the NHS Five Year Forward View, which has support amongst all of the main national political parties. All of the main national parties have indicated support for the integration of health and social care and the move towards adopting preventative health and wellbeing strategies.
• All commissioning decisions are taken by the governing bodies of the constituent commissioning organisations: the three Clinical Commissioning Groups (CCGs) and East Sussex County Council (ESCC).  To ensure that the commissioning bodies are making collective investment decisions, an underlying governance structure for ESBT has been established which provides a shared forum for the commissioning organisations to meet and discuss spending decisions. During the process so far, discussions have been focussed on how resources are spent rather than who has the budget.
• The ESBT governance structure should help to overcome the significant challenge of re-organising services whilst recognising that healthcare is free at the point of delivery and social care is based on needs assessments and eligibility criteria. The work that the four commissioning organisations have undertaken over the past six months to develop a shared vision is evidence of the effectiveness of ESBT.

New services created as part of ESBT

• The Single Point of Access delivery model involves bringing a number of access point services currently provided by ESCC and ESHT under a single management structure to form an integrated and responsive service. The new service will require additional staff, training, education and professional supervision to become fully operational. The service begins in April 2015 and is funded by investment from the Better Care Fund.
• Planning is underway (until October 2015) for the integrated community health and social care teams based on patient and provider feedback of the existing services. Integrated community teams will be responsible for clearly defined populations and, as far as possible, will be based within their designated local community.
• The community services procurement that High Weald Lewes Havens (HWLH) CCG is currently undertaking has a built in requirement that the winning provider must integrate into the wider health and social care system, including working alongside, and performing some of the functions of, the integrated community health and social care teams.
• A large range of self-management and self-care services are already available to  ...  view the full minutes text for item 37.

Report by the Assistant Chief Executive

To consider a progress report on the implementation of the service reconfiguration.

32. 

33. 

34. 

35. 

36. 

37. 

38.1     The Committee considered a report of the Assistant Chief Executive updating it on the implementation of decisions made by East Sussex CCGs in relation to the configuration of maternity, paediatric and gynaecology services provided by ESHT.

Maternity pathways

38.2     In response to questions from HOSC there emerged the following clarifications and responses relating to maternity pathways:

• ESHT stated that it is examining the viability of providing sonography from the Crowborough Birthing Centre (CBC). However, there is a limited number of sonographers in East Sussex, meaning that ESHT will need to be first be certain that the availability of sonography to women elsewhere in the county would not compromised by opening a new service at the CBC.
• ESHT said that sonography at CBC will be dependent on cross-trust working, so firm dates for the start of a sonography service will require further discussion with the new Head of Midwifery at Maidstone and Tunbridge Wells NHS Trust (MTW) when they are in post and agreement over cross-border working.

• ESHT explained that it has developed pathways for cross-border working that work well, for example, women in the Seaford area wanting to use maternity services provided by Brighton & Sussex University Hospitals NHS Trust (BSUH) are able to access the Trust’s services seamlessly. ESHT intends to try to adopt the same model of cross-border working for maternity services in the North Weald area.
• ESHT stated that it is in the process of negotiating cross-border pathways with MTW. However, the situation had become challenging because MTW had not accepted ESHT’s proposed pathways. ESHT stated that discussions were progressing and that it was confident that it could satisfactorily address the outstanding problems given that it has the same aims as MTW. Further discussion will occur with the new Head of Midwifery at MTW.
• The HWLH CCG considered that if MTW were to take over maternity services at Crowborough, the ‘border’ (between MTW and ESHT) would ‘move south’ and simply displace any outstanding pathway problem to another geographical location. (However, HOSC considered that such a move would probably result in a more “natural” border were this to happen which would be welcome).

Serious incidents data (p53)

38.3     HOSC expressed concern at the serious incidents data. In response to questions from HOSC there emerged the following clarifications and responses:

• The CCGs acknowledged that the very small number of serious incidents made it difficult to demonstrate statistically significant impacts on safety since the reconfiguration. However, they had been looking at the pattern and nature of serious incidents, rather than just the number, and prior to the temporary reconfiguration a pattern of failure had begun to emerge that looked as though it would worsen unless the temporary reconfiguration was put in place. Since the reconfiguration, the pattern of serious incidents indicated that there had been improvements in safety.
• ESHT said that there is a clear national definition of a “serious incident”, for example, the admission of a baby or mother to intensive care, meaning  ...  view the full minutes text for item 38.

Report by the Assistant Chief Executive

To consider a progress report on the development of a business plan for the future provision of NHS dementia assessment beds in East Sussex.

39.1     HOSC considered a report of the Assistant Chief Executive updating the Committee on the progress of the redesign of the dementia assessment bed service in East Sussex.

39.2     Ashley Scarff and Martin Packwood outlined progress with the development of the business plan.

39.3     HOSC registered its concern at the extended delays in implementing this project. 

39.4     The CCGs and ESCC shared HOSC’s disappointment with the delays and confirmed:

• There was full clinical support for the reconfiguration of the crisis services to provide a more proportionate response in line with option 4 as recommended by the original HOSC scrutiny review.
• There had been an underestimate in the scale of capital investment required for the redesign - albeit this was a minimal contributor to the delay.
• Sussex Partnership NHS Foundation Trust (SPFT) is a partner in the project and the organisation putting up the capital investment for the redesigned service. The Trust’s Board needs to be satisfied that the location and capital cost of the redesigned service is as robust as it can conceivably be before going ahead.

39.5     RESOLVED: to agree that HOSC should maintain a watching brief over this matter and request a report back when there is a conclusion (HOSC would expect this to happen later in 2015).

Report by the Chair

To consider a report of a joint scrutiny meeting between Sussex Partnership NHS Foundation Trust and representatives from East Sussex, Brighton and Hove and West Sussex health scrutiny committees.

40.1   The Committee considered a report by the Chair of HOSC updating the Committee on the outcome of the most recent joint HOSC committee meeting with SPFT. The meeting was held to discuss the provision of acute mental health inpatient beds in Sussex.

40.2   RESOLVED: that the joint committee with West Sussex and Brighton and Hove HOSCs will continue and that HOSC members be urged to submit questions and issues to the Chair for the joint committee members to raise with SPFT.

41.1       It was agreed that the following items should be progressed in addition to the reports already requested for future meetings:

CQC Quality Report on ESHT

• HOSC noted with considerable concern that the CQC report had still not been published given that the inspection had taken place in September 2014.  The Chair reported that the ‘usual process’ was that, prior to publication, the CQC would hold a ‘Quality Summit’ of stakeholders to present their findings to which he would be invited. HOSC would be notified as soon as information was available as to the likely publication timescale. HOSC agreed to add the item to the agenda for the June 2015 HOSC.

ESHT Clinical strategy:

• The full business case was still outstanding and would appear on the HOSC agenda when available.

Commissioning GPs surgeries

• The Chair reported that he had learnt that two of the three CCGs were accepting the devolution responsibilities whereas one (Hastings and Rother CCG) were not. HOSC requested a briefing at its 16 June meeting as to the implications for East Sussex residents and reasons for the differing views.

Recommissioning of community health services in High Weald Lewes Havens

• The HWLH CCG reported that it was close to making a decision on a new provider for community services in its area and expected to be able to provide an update to HOSC at its 16 June meeting as previously agreed.

GP vacancies

• The Chair undertook to request the CCGs for further statistics on GP vacancies in East Sussex and to report the response back to the Committee.

HIV diagnosis

• Cllr O’Keeffe reported on her meeting with Terence Higgins Trust to and with Public Health officers. She considered that her discussions had revealed a difference of view on how best to improve HIV diagnosis and that HOSC members may benefit from hearing about the issue in more detail.
• Given that commissioning of sexual health services is undertaken by Public Health (an activity that falls within the remit of the Audit, Best Value & Community Services Scrutiny Committee),  the Chair considered that that Committee should be asked to consider this question in the first instance and that HOSC members be invited to any resulting event.

Health inequalities

• HOSC requested a briefing from the CCGs on recent additional investment in health inequalities issues.

41.2RESOLVED to:

1) note and update the work programme

2) note that the HOSC meetings for 2015 will now take place on 16 June, 1 October and 3 December 2015.