Agenda and minutes

30.1     The minutes of the meeting of 03 December 2015 were agreed.

31.1     Cllr Rob Blackman attended as substitute for Cllr Sam Adeniji (Lewes District Council representative).

31.2     Cllr Mary Barnes attended as substitute for Cllr Bridget George (Rother District Council representative).

31.3     Cllr Johanna Howells (Wealden District Council representative) sent apologies.

31.4     Jennifer Twist (Community Sector representative) sent apologies.

31.5     The Chair welcomed Cllr Tania Charman to the committee as replacement for 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.

32.1     The Chair informed members that he had asked Sir Peter Dixon, the newly appointed interim Chair of South East Coast Ambulance Trust (SECAmb); and Geraint Davies, acting SECAmb Chief Executive, to detail recent events affecting the trust.

32.2     Sir Peter Dixon informed the committee that he had been appointed SECAmb Chair by Monitor, the NHS Foundation Trust regulator. His appointment is initially for six months, although this may well be extended for a further six months. Sir Peter has a long track history of assisting NHS organisations that are experiencing problems.

32.3     The recently published Monitor report on the SECAmb 111-999 triage scheme describes an initiative that was hastily introduced, with poor risk and clinical governance mechanisms. Details of the initiative were poorly communicated to SECAmb’s commissioners.

32.4     From investigations to date, it appeared that the scheme caused no actual patient harm, although this will not be confirmed until the publication of a second report in June. The only trust staff criticised in the Monitor report are very senior officers. Disciplinary procedures against some of these officers are ongoing. To date there has not been a significant impact on organisational morale.

32.5     Geraint Davies added that SECAmb has agreed a joint recovery plan with Monitor and with its commissioning CCGs.

32.6     The context in which the triage scheme was undertaken was that of increasing service pressures which meant that SECAmb was struggling to meet its response time targets. However, the trust’s priority should been to provide a safe and effective service, even if this meant missing targets. There will be a full and open examination of what went wrong at the trust.

32.7     The 111-999 triage scheme aside, the ambulance service and indeed the whole health system are currently experiencing severe pressures. James Pavey, SECAmb Paramedic and Senior Operations Manager, told members that ambulance demand is currently 15% higher than predicted volumes (SECAmb had forecast demand to be 5% higher than last year). Similar demand pressures are being faced across the system – and particularly in hospital emergency departments. Dealing with this level of demand calls for a holistic response, with more being done to share the burden across the health and care system. Changing ambulance or A&E ways of working alone will not be sufficient as these services have already made significant changes to cope with increased demand – SECAmb is already dealing with around 50% of ambulance call-outs by means other than taking patients to A&E.

32.8     James Pavey told members that it is uncertain why demand is 20% higher than a year ago. This may in part be because we are currently experiencing a flu outbreak – there has been a significant increase in patients reporting shortness of breath which could be indicative of flu. In part it is also likely to be because patients are presenting with increased acuity, due to complex co-morbidities which may often be age-related. Hospital emergency departments are reporting similar problems.

32.9     Difficulties with hospital handover inevitably impact  ...  view the full minutes text for item 32.

33.1     This item was introduced by Wendy Carberry, High Weald Lewes Havens Clinical Commissioning Group (HWLHCCG) Chief Officer; Ashley Scarff, HWLHCCG Director of Strategy; Alan Beasley, HWLHCCG Chief Finance Officer; and by Siobhan Melia, Director of Partnership and Commercial Development, Sussex Community NHS Trust (SCT). The speakers also introduced and took questions on the HWLHCCG Annual Operating Plan item (item 6) at this point.

33.2     Wendy Carberry told the committee that HWLHCCG patient flows differ considerably from those of the other East Sussex CCGs. For Eastbourne, Hailsham & Seaford CCG (EHS) and Hastings & Rother CCG residents, the great majority of healthcare activity takes place within the county. In particular, most people living in these areas access secondary care services at either Eastbourne District General Hospital or at the Conquest Hospital, Hastings. However, although HWLHCCG residents receive the majority of primary and community services within East Sussex, the great majority of people access secondary care services from out of county providers – particularly from hospitals in Brighton, Hayward’s Heath and Tunbridge Wells.

33.3     This means that HWLHCCG has to contribute to planning for better integration and co-working across three health systems: East Sussex, Brighton & Hove & Mid Sussex, and West Kent.

33.4     Wendy Carberry told the committee that HWLHCCG has been criticised for over-emphasising flows into acute care when one of the principle strategic NHS goals is to reduce reliance on acute care. However, the CCG believes that district general hospitals have an integral role to play in designing effective health and care systems; a view which is supported by NHS England and by NHS Five Year Forward View planning guidance. The CCG’s plans fit well with the requirements of NHS Sustainability & Transformation Plans (STPs)

33.5     The CCG felt that too much of its time was being spent on East Sussex Better Together (ESBT), when only around 10% of HWLH residents receive their healthcare exclusively within East Sussex. The CCG was also uncomfortable with the pace of change involved in year two of the ESBT project.

33.6     In consequence, HWLHCCG withdrew from ESBT. The CCG is committed to working with partners towards better system integration in East Sussex and in the other areas that it works with. This includes working with Brighton & Hove and Horsham & Mid Sussex CCGs on an ‘A23 South’ programme; working with Kent CCGs on an integration programme centred upon Maidstone & Tunbridge Wells hospitals; working directly with Sussex Community Trust and Brighton & Sussex University Hospitals Trust to develop the Queen Victoria Hospital, Lewes as a hub for community services; and working with MTW and Kent CCGs on developing Crowborough Community Hospital as a community and gerontology hub. In East Sussex, the CCG has launched its ‘Connecting 4 You’ programme and has invited the County Council and other key partners to join the Programme Board.

33.7     The CCG is committed to implementing the NHS Five Year Forward View. One area of focus will be on improving community services, working in close partnership with Sussex Community Trust. Another focus will be on  ...  view the full minutes text for item 33.

34.1     This issue was considered together with Item 5 and a minute of the relevant discussion is included under Item 5.

35.1     This item was introduced by Murray King, Associate Director of Strategic Investment; and by Allison Cannon, Chief Nurse, EHS and H&R CCGs.

35.2     Murray King told members that CCG priorities for the coming year included the development of locality teams and of federated GP practices; Health & Social Care Connect; getting services working together effectively; and planning for the creation of an Accountable Care Model. ESBT has a five year investment plan in which CCG and social care budgets are undifferentiated.

35.3     In reply to questions on research and/or evidence reviews supporting the accountable care model, Murray King agreed to provide a written response to members.

36.1     This item was introduced by Ashley Scarff, Director of Strategy, High Weald Lewes Havens CCG; and by Allison Cannon, Chief Nurse, Eastbourne, Hailsham & Seaford and Hastings & Rother CCGs.

36.2     Ashley Scarff told the committee that the stroke review is ongoing. The current focus is not on services within East Sussex, but on services at hospitals used by a number of county residents such as the Royal Sussex County hospital, Brighton; the Princess Royal hospital, Hayward’s Heath; and Tunbridge Wells hospital. Any significant service changes will be reported back to the HOSC.

36.3     In response to a question on cross-border funding, Ashley Scarff told members that a good deal of work had been done on this issue via the Sussex Collaborative, but that more still needs to be done.

36.4     Replying to questions on staffing for language therapy services, Allison Cannon informed the committee that there were long-standing issues with recruitment of some workers, particularly in terms of speech and language and of physiotherapists. It was important to think innovatively, for example, using easier to recruit lower grade staff to undertake appropriate tasks.

36.5     As well as seeking to improve stroke services and fill the gaps between services, the stroke review will focus on rehabilitation and on preventative measures.

37.1     This item was introduced by Wendy Carberry, Chief Officer, High Weald Lewes Havens CCG; and by Murray King, Associate Director of Strategic Investment, Eastbourne, Hailsham & Seaford and Hastings & Rother CCGs.

37.2     Wendy Carberry told the committee that HWLHCCG was now fully in control of GP commissioning, and that this is progressing well. There is a nationwide shortage of GPs which poses inevitable challenges. One partial solution is to increase the use of non-GPs to take on some GP workload: for example pharmacists based in GP practices.

37.3     Murray King told members that the ESBT programme will address the fragmentation of GP services via an accountable care model and the federation of GP practices. CCG commissioning of GP services is particularly useful because it facilitates localised decision-making.

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.

39.1     It was agreed to add items on: ESHT response to Scrutiny Review Board report; SECAmb; and HWLHCCG integration action plan to the work programme for the next HOSC meeting.