Agenda and minutes

21.1     The Committee agreed the minutes of the meeting held on 1 October 2015.

22.1     Apologies for absence were received from Cllr Pam Doodes (substitute Cllr Johanna Howell) and Cllr Michael Wincott.

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.

23.1     Cllr Michael Ensor updated the Committee on two recent health issues:

·         Matthew Kershaw, the Chief Executive of Brighton & Sussex University Hospital NHS Trust (BSUH), will be departing from the Trust at the end of 2015. Amanda Fadero, the current Deputy Chief Executive, will step into the role of Acting Chief Executive until a permanent Chief Executive is appointed.

·         BSUH had informed Cllr Ensor that the Trust still intends to progress with the construction of the cancer radiotherapy unit at Eastbourne District General Hospital (EDGH). The pause in its implementation was due to a funding issue that the Trust assured Cllr Ensor would be resolved.

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.

25.1     The Committee considered a report by the Assistant Chief Executive providing information on South East Coast Ambulance NHS Foundation Trust’s (SECAmb) planning for 2015/16 winter pressures and other issues.

25.2     Paul Sutton, Chief Executive, and Geraint Davies, Director of Commissioning, provided HOSC with a PowerPoint presentation and, in response to questions from the Committee, provided the following additional information:

Winter period

·         SECAmb considers that the key focus period during winter takes place between 1 December and 12 January – even though the worst winter weather may come after that period – because it is during that time when the availability of NHS staff is at its lowest. After 12 January, the system begins to get back to its normal availability.

Handover times

·         There is a national standard for handover time of 15 minutes after arrival at hospital. However, because three-hour delays are a routine occurrence in some hospitals in the South East, this target is nowhere near to being met.

·         SECAmb considers it to be inappropriate from both a clinical and patient experience perspective that patients often have to wait for hours at a time on an ambulance trolley. As a result, the Trust continues to point out to Monitor, NHS England, and the NHS Trust Development Authority (TDA), that the 15 minute handover time is being ignored. 

·         It is the policy of SECAmb to tolerate a certain amount of delay in the handover time between ambulance crew and the hospital staff and the Trust tries to support the situation by both keeping its ambulance crews on site for as long as it can, and employing a Hospital Ambulance Liaison Officer (HALO) to try to help coordinate and speed up the process of handover.

·         SECAmb now has in place an Immediate Handover Policy that is used when there is a very serious incident that necessitates the immediate withdrawal of ambulance crews who are waiting to handover patients at a hospital, for example, when there is a cardiac arrest in the community that requires an immediate response and there are no free ambulance crews to attend to it. The ambulance crew inform the HALO and hand over their patient to the care of hospital medical staff. 

·         If the national standard for handover times was enforced, it is arguable that acute trusts would recognise that responsibility for the cohort of patients in the hospital rested firmly with them and would do more to achieve the handover time, for example, by employing handover nurses who fulfil the role currently performed by ambulance staff. ESHT and BSUH have carried out initiatives that have improved handover times at the Royal Sussex County Hospital in Brighton, EDGH, and Conquest Hospital. The Sussex-wide Urgent Care Network is meeting on 16 December to discuss handover times.

111 patient triage

·         During the winter period 2014/15, 111 activity was at its peak and there was low confidence within the organisation of the accuracy of the categorisation of those 111 calls. In response, the Trust Board developed a pilot programme  ...  view the full minutes text for item 25.

26.1     The Committee considered a report by the Assistant Chief Executive providing an update on the planning across the local health economy to deal with seasonal demand surges, extreme weather, and other issues associated with the winter months.

26.2     Wendy Carberry, Chief Officer, HWLH CCG; and Dr Susan Rae, Clinical lead for urgent care and health inequalities, Hastings and Rother Clinical Commissioning Group (HR CCG); provided the Committee with a presentation on System Resilience Planning - which is used to prepare for and manage periods of increased demand such as winter, and other periods, throughout the year.

26.3     In response to questions from HOSC, Wendy Carberry, Dr Susan Rae, and Nicky Young, Whole Systems Programme Manager, provided the following additional information:

·         The CCGs have invested £4.1m to address additional patient flow to ESHT during winter – this is additional money provided by the Government specifically for investing in services that mitigate against winter pressures. Some of that funding is to support additional wards opened up in either acute or community hospital sites called “escalation areas”. The funds have also been spent on additional social workers and therapists to support the flow out of these beds both in the community and in A&E departments. The CCGs are also investing in out of hours services, for example, to ensure that there is a prescribing pharmacist to deal with repeat prescriptions over the weekend to free up GP capacity.

·         As part of the System Resilience Planning, CCG project managers work across the healthcare system to assess the number of beds that will be needed, and where best they should be located, for example, an extra 12 step-down beds were identified as being needed in the Eastbourne area. The CCGs then discuss with the private sector home care and care home providers about their available bed capacity to meet this demand, for example, Milton Grange is providing these step down beds. This system resilience work also provides the CCGs with the opportunity to test and evaluate commissioning strategies that, if successful and popular, could be rolled out across East Sussex.

26.4     The Committee RESOLVED that it had considered and commented on the report, its appendices, and the presentation.

27.1     The Committee considered a report by the Assistant Chief Executive to provide an update on a) plans to reconfigure East Sussex dementia assessment beds; and b) on recent performance and new developments in diagnosis.

27.2     Martin Packwood, Head of Joint Commissioning (Mental Health), East Sussex County Council; and Dr Mokhtar Isaac, Clinical Director East Sussex, Sussex Partnership NHS Foundation Trust (SPFT); provided the following responses to the Committee’s questions about the dementia assessment bed reconfiguration plans:

·         The reason for the delay in the implementation of the reconfiguration of dementia assessment beds is that the project has had to pause twice in order to build a stronger consensus between stakeholders. In the long term, the project has to command the confidence clinically of SPFT and the CCGs.

·         The first pause was made in order to carry out clinical engagement with SPFT to ensure that the Trust was absolutely content with the proposed numbers of beds, and the proposed levels of reinvestment in community services that would be made using the savings generated through the closure of existing bed capacity.

·         The second delay was due to decision to engage with partners – such as Healthwatch and Care for the Carers – to ensure that the proposed site – St Gabriel’s Ward at Conquest Hospital – was the most inclusive and appropriate site for the long term inpatient dementia care. 

·         The reason that it will take two years to implement the reconfiguration is that the St. Gabriel ward will be refurbished into a purpose built dementia intensive care unit. This will be, effectively, a new build that will require significant capital planning and expenditure.

·         Significant interim refurbishment of the Beechwood Unit in Uckfield has been undertaken to ensure that it is safe and effective enough to deliver services whilst the St. Gabriel Ward is redeveloped.

27.3     Martin Packwood, and Kim Grosvenor, Dementia Programme Lead, HWLH CCG; provided a presentation on the Memory Assessment Services in East Sussex. They provided the following information in response to questions:

Golden Ticket

·         Golden Ticket is a new model of care being piloted in the HWLH CCG area. The Golden Ticket pilot included 40 patients living in their own homes with their carers. However, the principals of the Golden Ticket – to support dementia patients throughout the dementia journey – will also apply to patients in nursing and residential homes. In addition, some of the interventions for the 40 pilot patients have been delivered to nursing homes in the Buxted area; and the CCG is working with the Care Home In-reach Team and the GPs who do home visits to care and nursing homes to raise awareness of the Golden Ticket programme.

·         At the start of the Golden Ticket pilot, each of the 40 patients and their carer was visited in their own home by a GP to explain the purpose of the project and the organisations involved in delivering it. All patients had to sign a document to say that they were happy to be  ...  view the full minutes text for item 27.

28.1     The Committee considered a report by the Assistant Chief Executive providing an update from High Weald Lewes Havens (HWLH) CCG on maternity pathways in the High Weald.

28.2     Ashley Scarff and Richard Hallett also provided presentations to the Committee.

28.3     Ashley Scarff added that the patient records used in Crowborough Birth Centre will not be the same format as Pembury Hospital, Tunbridge Wells, but there will be fewer differences between the formats in future. Maidstone and Tunbridge Wells NHS Trust (MTW) and ESHT use the same ICT system but they use different versions of it; in the coming months they will go onto the same version which will also reduce the differences between patient records.

28.4     The Committee RESOLVED that it had considered and commented on the report and its appendices.

29.1     The Committee considered a report by the Assistant Chief Executive containing information on the Committee’s progress against current work programme items and suggestions for additional issues to consider at future meetings.

29.2     The Committee RESOLVED to agree the proposed work programme.