Agenda and minutes

12.1     The Committee agreed the minutes of the meeting held on 30 June 2016 as a correct record.

13.1     Cllr Sam Adeniji, Cllr Frank Carstairs (substitute: Cllr Mike Pursglove), Cllr Bob Standley (substitute: Cllr Peter Pragnell), Cllr Tania Charman and Cllr Bridget George gave their apologies.

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.

14.1     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.

15.1     The Chair informed the Committee that the Care Quality Commission (CQC) had just published its inspection report on South East Coast Ambulance Service NHS Foundation Trust (SECAmb) which rated the Trust ‘inadequate’ and recommended that it be placed in special measures. He acknowledged that the Trust had been rated ‘good’ under the caring domain and said that was a reflection of the dedication of the staff at the Trust. The Chair added that he had attended the Quality Summit held by CQC and NHS Improvement on 28 September.

15.2     In recognition of the logistical difficulties of SECAmb reporting on progress to each of the six health scrutiny committees in the Trust area, the Committee RESOLVED to:

1) permit the Chair and Vice Chair to scrutinise SECAmb’s response to the inspection report and overall recovery plan at a separate joint meeting with representatives of the other five HOSCs;

2) be presented with all of the information to be considered by the joint group before each meeting to afford Members the opportunity to propose questions for the Chair/Vice-Chair to ask SECAmb;

3) request that the joint group report its findings to HOSC; and

4) agree that the joint meeting be conducted publically as far as is practicable.

1.1.        The Committee considered a report on the findings of a recent Care Quality Commission (CQC) inspection of Brighton & Sussex University Hospitals NHS Trust (BSUH) and the Trust’s response.

1.2.        Lois Howell, Director of Clinical Governance, BSUH, provided an update and answered a number of questions from HOSC in relation to the CQC report and BSUH’s quality improvement programme.

A&E Department waiting times

1.3.        HOSC asked whether the improvements to the A&E Department made since the CQC’s warning notice was issued in April had made any difference.

1.4.        Lois Howell said that improvement in the A&E Department had been significant. BSUH has reduced the number of 12 hour waiting time breaches from 12 during April 2016 to five in total between May and the end of September 2016. The longest a patient had to wait since April had been more than 26 hours, but this had been for patient safety reasons and was now the subject of a serious incident review. BSUH had also improved 4 hour waiting times to 86% compliance, although the 95% target is unlikely to be met until after this financial year when building works at the Royal Sussex County Hospital (RSCH) – designed to improve patient flow and capacity in other wards – are completed.

1.5.        Lois Howell said that the improvements to the A&E Department included:

·         changing staffing rotas at both hospital sites, in particular altering staffing levels at the Princes Royal Hospital (PRH) to match the increased attendance levels during the evenings;  

·         requiring staff to use a checklist to monitor patients’ welfare and a checklist to monitor signs of patient’s deterioration, based on the National Early Warning Scores. There is currently a 100% compliance with both checklists;

·         carrying out audits of patients’ notes to ensure that they are being treated properly and that staff are using checklists.

Patients in corridor area at A&E Department

1.6.        HOSC asked whether it was acceptable to allow patients to wait in corridors, and what BSUH was doing to reduce or eliminate the need for this practice.

1.7.        Lois Howell explained that a corridor area is used when there are no available cubicles for patients who have entered the A&E Department on ambulance trollies, or who are too sick to go into the waiting room; it is safer to have them in the corridor area where a nurse is allocated to them than to put them in the waiting area. She said that putting a patient in the corridor is a difficult judgement call based on what is the safest place for the patient within the circumstances. It is not a situation that the Trust is happy with and is one that the Chief Executive has apologised for.

1.8.        Lois Howell said that if more than five patients are in the corridor a trust wide escalation policy is initiated. Less than 10% of patients now have to spend any time in the corridor, these patients have to wait in the corridor for  ...  view the full minutes text for item 16.

1.1.        The Committee considered a report which provided a further update on the performance of the Patient Transport Service (PTS) in Sussex.

1.2.        Wendy Carberry, Chief Officer; Alan Beasley, Chief Finance Officer; and Sally Smith, Director of Delivery, attended on behalf of High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG). Michael Clayton, Chief Executive, attended on behalf of Coperforma.

Accuracy of PTS data

1.3.        HOSC asked what the PTS data anomalies were; why there was a mismatch between the large improvements in the data and the continued negative anecdotes HOSC members have been receiving; how occasions when no ambulance arrived for a booked journey were recorded; and to what extent HWLH CCG trusted the data it received.

1.4.        Michael Clayton said that all journeys which do not meet the standards agreed in the service level agreement are recorded by Coperforma as ‘service exceptions’. They are then categorised on their severity and investigated accordingly – the categories are critical, high, medium or low. Medium or low exceptions are dealt with together whereas each high or critical level exception – for example, a vehicle not arriving at all – is investigated individually. The continuous improvement team works together with the operations team to record and resolve the service exceptions.

1.5.        Alan Beasley confirmed that Coperforma is providing the data as requested by the CCG. The data is of a good quality but it requires further analysis, which is being undertaken by the specialist Patient Transport Advisor who has now been recruited by the CCG. The Patient Transport Advisor had identified data anomalies and is working with Coperforma to understand whether the anomalies represent issues with the service or faulty recording methods. These findings will be fed into the CCG’s contractual discussions with Coperforma.

1.6.        Wendy Carberry added that the PTS contract specifies exactly what information the providers must provide to CCGs, rather than this being determined by the provider. One of the performance notices issued to Coperforma was around the data being provided. The CCG also triangulates Coperforma data with other sources, such as feedback from Trusts, in order to gain assurance about its accuracy.

1.7.        Alan Beasley said that HWLH CCG had not seen any evidence from the data that if one patient’s pick-up slot is missed they are then de-prioritised in favour of a different patient on the grounds that the target had already been missed. 

Complaints about PTS

1.8.        HOSC asked how the CCGs are recording and addressing complaints about the PTS.

1.9.        Sally Smith said that reports from patients about delays to their patient transport appointments are classed in the CCG’s complaints process as ‘incidents’. CCGs analyse the complaints through their Patient Safety Groups –whose remit is to investigate incidents and complaints. All acute trusts and other healthcare providers have an incident reporting process and any complaints about the PTS made to them are shared with Coperforma. HWLH CCG also holds a monthly forum with the patient transport leads of all acute trusts that use the PTS  ...  view the full minutes text for item 17.

1.1.        The Committee considered a report which provided an update on the Sussex Stroke Review, specifically relating to services provided by Brighton and Sussex University Hospitals NHS Trust (BSUH) to residents in central Sussex.

1.2.        The report was introduced by Dr Peter Birtles, Urgent Care Clinical Lead, and Ashley Scarff, Director of Strategy, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG).

Viability of other options

1.3.        HOSC asked whether the preferred option to develop a fully compliant Hyper Acute Stroke Unit (HASU) with a co-located acute stroke unit (ASU) at Royal Sussex County Hospital (RSCH) was the only viable option and whether, as an alternative, it would possible to have a service where patients are stabilised locally before being transferred to a HASU.

1.4.        Dr Peter Birtles said that all options were considered in significant detail but, taking into account a number of factors, the option being put forward was strongly favoured by clinicians because:

·         centralising stroke units provided better outcomes as evidence suggests that, even if the journey time is 10-15 minutes longer, travelling to a properly resourced HASU is likely to result in a better outcome. Although the NICE guidelines recommend treatment of a stroke patient within an hour, in terms of actual outcomes the evidence suggests it is not as time critical as that;

·         option 4 (the preferred option) would ensure that there was a stroke service caring for more than the 600 patients per year, which is the minimum number required to be able to gather sufficient clinical expertise to ensure that people have the best outcomes;

·         interventional radiology is increasingly used for treatment of strokes and RSCH has a new radiology unit under development;

·         neuro-surgeons need to be on site, and they are located only at RSCH where the intensive care unit is located – this cannot be located at two sites;

·         guidance says that the HASU should be co-located with a major trauma site like the one being built at RSCH;

·         only 50 HWLH CCG patients a year previously using the ASU at Princess Royal Hospital (PRH) would need to travel further. Patients in the east will generally go to Eastbourne District General Hospital and patients in the north will travel to Pembury Hospital.

Consideration of West Sussex stroke service proposals

1.5.        HOSC asked how the proposed HASU at RSCH would align with services provided by Western Sussex Hospitals NHS Foundation Trust (WSHFT).

1.6.        Ashley Scarff assured HOSC that HWLH CCG was working with colleagues in West Sussex CCGs and any future configuration of stroke services at WSHFT would not impact on the proposal for BSUH. However, the timing of the implementation of any WSHFT changes may be impacted.

1.7.        Dr Peter Birtles said that having a single stroke site at RSCH would mean that no matter what configuration is chosen in West Sussex, RSCH will have above the minimum threshold of patients. However, it is only if the West Sussex HASU was to be located at Worthing Hospital that a HASU at  ...  view the full minutes text for item 18.

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.

20.1     The Committee RESOLVED to note their work programme.