Agenda and minutes

1.1       The Committee agreed the minutes as a correct record of the meeting held on 24 March 2016.

2.1.      Cllr Joanna Howell gave her apologies (Cllr Jo Bentley substituted).

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.

3.1.      Cllr Mike Turner declared a personal interest because he intended to refer throughout the meeting to a document titled Emergency Ambulance Services in England written by his son Nick Turner on behalf of the NHS Support Federation.

3.2.      Cllr Jo Bentley declared a personal interest as someone who had received a service from Coperforma.

3.3.      Cllr Ruth O’Keeffe declared a personal interest as an active member of Healthwatch East Sussex.

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.

4.1.      There were no urgent items.

1.1.        The Committee considered a report by the Assistant Chief Executive, East Sussex County Council, on the performance of the Patient Transport Service (PTS) in Sussex following a change of provider on 1 April 2016.

1.2.        High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG) and Coperforma apologised unreservedly for the failures of the PTS since 1 April, and promised to look at the learning from the independent incident review.

1.3.        Michael Clayton, Managing Director of Coperforma, updated HOSC regarding a meeting on 29 June following the news that VM Langford (a provider of ambulances for the PTS) had gone into administration. At the meeting Coperforma met with staff-side representatives and local management to assure staff that, whatever happened to VM Langfords, their pay, staff benefits, and pension contributions for June would be funded by Coperforma. All staff would also be able to take employment with designated Coperforma ambulance providers in the area that would protect their terms and conditions. Staff-side representatives were comfortable with the proposed changes and staff were appreciative.

1.4.        HOSC expressed concern at the performance of the PTS over recent weeks and more than one HOSC member spoke about the effect the PTS had on local residents who had contacted them directly with their experiences of the service.

1.5.        The Committee asked the witnesses from HWLH CCG, Coperforma and South East Coast Ambulance Service NHS Foundation Trust (SECAmb) a number of questions relating to the Patient Transport Service.

The tendering process and due diligence by CCGs

1.6.        HOSC queried the extent to which HWLH CCG had carried out due diligence on Coperforma, and asked whether the CCG was concerned that there was only one formal tender. The Committee also asked whether the CCG had considered the concerns of the GMB trade union about the tendering process.

1.7.        Alan Beasley, Chief Finance Officer, HWLH CCG, said that although Coperforma was the only organisation that submitted a final tender, the CCGs had looked into why the two other organisations which were invited to tender did not ultimately submit a bid. The feedback from SECAmb was that the Trust could not provide a substantive bid within the financial envelope that was offered. Arriva Transport Ltd. responded that it did not have the capacity to submit a tender in line with the timescale required.

1.8.        Alan Beasley did not take the view that the issues with the performance of the contract since 1 April were due to the funding provided by the CCGs for providing the PTS. He said that Coperforma did not express concerns about the funding offer during the tendering process.

1.9.        Alan Beasley assured the Committee that, although only one tender was submitted, the same process was followed as if there had been multiple submissions, for example, the same financial evaluations and due diligence.

1.10.      Alan Beasley said that HWLH CGG did review the capacity and capability of Coperforma and in turn Coperforma reviewed the capacity and capability of its subcontractors. Assurance was given by Coperforma  ...  view the full minutes text for item 5.

1.1.        The Committee considered a report by the Assistant Chief Executive on the extent of delays in handover of patients from ambulances to hospital emergency departments, how handover is managed, and actions in place to address this issue.

1.2.        East Sussex Healthcare NHS Trust (ESHT), Brighton & Sussex University Hospital NHS Trust (BSUH) and South East Coast Ambulance Service NHS Foundation Trust (SECAmb) provided presentations on their role in the hospital handover process.

1.3.        HOSC asked the witnesses from the three Trusts a number of questions.

Impact on ambulance services

1.4.        HOSC asked when SECAmb would reach a critical point in terms of handover delays.

1.5.        Geraint Davies said that SECAmb was already at a tipping point and there were regularly days where there were ‘planned wipeouts’ ( i.e. no ambulances available to respond to new calls). These occurrences did not necessarily fit a pattern.

1.6.        Tim Fellows, Operational Manager, SECAmb, said that the delays in hospital handover meant that most ambulances were having to travel from one of the three hospitals in Brighton, Eastbourne and Hastings to respond to emergency calls, making response times more lengthy. If hospital handover times could be improved then ambulances could be redistributed strategically across a wider geographic area so that there would always be an ambulance close to most residents. He clarified that patients, in the main, had not been suffering any harm as the response times were still good and the quality of care remained high.

Causes of handover delays

1.7.        Dr Adrian Bull, Chief Executive, ESHT, said that hospital handover was not an issue just for the A&E department, or even the hospital, but the health system as a whole. The delays in hospital handover were a symptom of a wider problem that was also affecting ESHT’s 4 hour and 12 hour A&E waiting time targets.

1.8.        Dr Bull accepted that hospital handover times were unacceptable but made the point that it was dangerous when considering a system–wide issue to focus on just one parameter and try to fix it at all costs. He said that handovers were taking so long because busy staff were attending to patients who need care elsewhere; a patient waiting in an ambulance with paramedics may be safe whilst another patient may arrive at A&E in urgent need of care. Focusing exclusively on handover would have knock-on effects elsewhere. It was a complex interdependent problem with a lot of competing issues that need resolving,

Actions to reduce handover times

1.9.        HOSC asked what actions are being taken to reduce handover times, in particular the recruitment of staff, and what the timescales for these actions having an effect would be.

1.10.      Geraint Davies said that the main issue for SECAmb was for acute trusts to get the appropriate capacity at A&E departments to enable ambulance crews to handover patients in a timely way. He recognised the pressure this put on acute trusts, which was why the ambulance and acute trusts needed to work  ...  view the full minutes text for item 6.

1.1.        The Committee considered a report by the Assistant Chief Executive providing an update on a number of developments in relation to SECAmb’s services. 

1.2.        HOSC asked a number of questions in relation to these developments.

Patient triage and patient safety

1.3.        HOSC raised concerns about the safety of SECAmb’s ‘hear and treat’ and ‘see and treat' policies; the effect on patient safety of the use of non-paramedic staff on ambulances; and the reasons for a disparity between the number of incidents recorded by SECAmb and NHS England.

1.4.        Geraint Davies said that neither SECAmb nor any other ambulance trust in the country has an all paramedic workforce. There is a skill mix in the organisation comprising paramedics, technicians, and emergency care support workers.

1.5.        Geraint Davies said it was a challenge for SECAmb to ensure that when a call comes into the organisation it is triaged properly. The hear and treat policy involves putting clinicians into control rooms so that calls can be reviewed by clinical staff. This ensures that calls are triaged correctly and responded to in the most appropriate way. The see and treat policy involves ensuring that the right crew with the right skill mix is present for the clinical need of the patients, maximising the opportunity to provide the necessary care in situ and reducing the need to convey to other services. The triage system used by SECAmb is a national system that is quite risk averse. As part of the ambulance triage programme, SECAmb is working with partner organisations to understand how to adapt the triage system to effectively manage patients in a manner that is as safe as possible.

1.6.        Mr Davies added that nationally the Ambulance Response Programme had been set up to look at how best to ensure ambulance trusts hear and treat and see and treat effectively – there are five ambulance trusts involved in the pilot and if successful it will be rolled out across England in the autumn. The programme should allow ambulance trusts more time to triage patients up front and then re-categorise calls.

1.7.        Geraint Davies said that when a ‘Serious Incident’ (including a death related to an incident) occurs, SECAmb investigates it, learns lessons, and changes its pathways accordingly.

SECAmb culture

1.8.        HOSC asked about the bullying culture and staff morale issues identified by the Care Quality Commission (CQC) in a letter to SECAmb following its recent inspection and what the senior management team would be doing to address these concerns.

1.9.        Geraint Davies said that he would remain as Acting Chief Executive until a new Chief Executive was recruited, which was estimated to be in 4-6 months – he said he would not apply for that role himself. He said that his remit as Acting Chief Executive would be to: stabilise the organisation; ensure that there are plans in place to address the recommendations of the external review into the red 3 triage pilot; and plans to deliver performance improvements over the next few  ...  view the full minutes text for item 7.

1.1.        The Committee considered a report by the Assistant Chief Executive which provided an update on recent CQC activity in relation to Brighton & Sussex University Hospitals NHS Trust (BSUH).

1.2.        Dr Steve Holmberg, Medical Director, provided HOSC with a presentation.

1.3.        HOSC agreed that it was clear there were significant issues with BSUH, but until the full CQC inspection report had been released, the Committee did not know enough to comment fully. It was particularly important that HOSC understood the details as BSUH was both a regional referral centre and a teaching hospital.

1.4.         HOSC asked whether the waiting times for outpatient appointments at BSUH, in particular neurology, had improved.

1.5.        Dr Holmberg said that BSUH has a real problem with the timeliness of offering treatments, which includes outpatient appointments, and that is highlighted in the CQC notice to the Trust. BSUH had not understood the scale of the problem but a lot of work has been done over recent months to analyse this and measures will be put in place to improve the issue over time. He said that BSUH is working with its Clinical Commissioning Groups (CCGs) to access additional capacity where there are insufficient staff or facilities to enable a rapid enough improvement by the Trust alone.

1.6.        Dr Holmberg also referred to ongoing operational difficulties with the Trust’s booking hub. BSUH was beginning to deliver significant improvements in performance but it was a journey that was not yet completed.

1.7.        With regard to neurology, Dr Holmberg said that there was triage in place early on in the patient referral process which aims to mitigate risk to patients. To some extent, neurology is a victim of its own success due to a number of referrals to the service outside of its natural catchment area because it is seen as a good service. This meant that not all patients could be seen in a timely manner.

1.8.        The Committee RESOLVED to:

1)    Agree to co-ordinate ongoing scrutiny of BSUH’s CQC report with neighbouring Health Overview and Scrutiny Committees;

2)    Request a report on the outcome of BSUH’s CQC inspection on 29 September; and

3)    Circulate the CQC report electronically as soon as it is published.

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.

10.1     The Committee considered a report by the Assistant Chief Executive about the purpose and process of developing a Sustainability and Transformation Plan for Sussex and East Surrey.

10.2     The Committee RESOLVED to request a further update in December 2016 focusing on the implications for East Sussex.

11.1           The Committee RESOLVED to note the work programme.