Agenda and minutes

29.1     The Committee agreed the minutes of the meeting held on 1 December 2016.

30.1     Apologies for absence were received from Cllr Carstairs (substitute: Cllr Howson), Cllr Coles, Julie Eason and Jennifer Twist.

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.

31.1     There were none.

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     There were none.

1.1.        The Committee considered a report on the Care Quality Commission’s (CQC) follow-up inspection of East Sussex Healthcare NHS Trust (ESHT).

1.2.        Catherine Ashton, Director of Strategy, and Alice Webster, Director of Nursing, answered questions from the Committee.

Performance of A&E Department

1.3.        Alice Webster explained that shortages of available clinical staff, including consultants, are a major reason for the performance of the A&E Department. The difficulty in recruiting and retaining staff is a nationwide issue and is the result of a shortage of available candidates not lack of resources. Alice Webster added that the CQC had inspected the emergency departments at a particularly busy period when there were a large number of patients and flow issues throughout the Trust that were causing delays in A&E.

1.4.        Alice Webster outlined some of the ways that the Trust is working to improve A&E performance:

·         increasing consultant cover at both A&E departments, and recently recruiting an additional emergency consultant;

·         strengthening clinical management by employing a clinical lead to manage the whole department whilst retaining a clinical lead for both A&E departments at Eastbourne District General Hospital (EDGH) and Conquest Hospital who are present at all times;

·         put in place an extra nurse on each shift to see patients who are waiting but are not in a cubicle, e.g., waiting in an ambulance, or ‘off loaded’ onto the department;

·         monitoring the number of patients in A&E four times a day to improve patient flow and ensure patients are safe; and

·         entering discussions with NHS Improvement about the physical appearance of both A&E Departments.

1.5.        Alice Webster said that it was important to make clear that A&E Departments do not work in isolation of the rest of the Trust. Staff will try to identify patients that can move out of A&E to elsewhere in the hospital or could go home, and implement this with immediate effect, to manage the throughput of patients in A&E. ESHT also works closely with South East Coast Ambulance NHS Foundation Trust (SECAmb) to manage hospital handover; the A&E department has an action plan that encompasses hospital handover.

1.6.        Alice Webster confirmed that there has been change in staffing at the Ambulatory Care Unit at Conquest Hospital but people continue to receive care at the Unit.

1.7.        Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EH CCG) and Hastings and Rother CCG (HR CCG) said that urgent care is a system-wide service that hospital A&E departments play a major part in. Every health system is required to have a local A&E delivery board to oversee urgent care and the East Sussex A&E Delivery Board is working on five workstreams to improve urgent care, including:

·         improving the minor injuries discharge rate within 4 hours from 95-98% to 100%;

·         developing protocols for ensuring consistency in seeing, diagnosing and treating patients;

·         establishing equal clinical leadership on both hospital sites;

·         improving discharge planning to begin when  ...  view the full minutes text for item 33.

1.1.        The Committee considered a report on the progress of the Sussex and East Surrey Sustainability and Transformation Plan (STP).

1.2.        Amanda Philpott, Chief Officer, EHS CCG/HR CCG provided a presentation to the Committee on behalf of Wendy Carberry, who is the Senior Responsible Officer for the STP and who had to give her apologies for the meeting.

Date for competition of STP review of acute care

1.3.        Amanda Philpott said that the CCGs are anticipating three or four options from the STP review of acute care to be publically available by June or July, with pros and cons for each option – due to the pressure on resources there are unlikely to be any risk free options.

STP Review and refresh

1.4.        Amanda Philpott explained that one of the reasons for the STP review and refresh is member organisations’ desire to adapt how they work together within the STP to ensure that the STP adds value to the population it serves.

1.5.        Amanda Philpott said that NHS England had a good insight into the reason for creating the 44 STP footprints, for example, around trauma and tertiary care areas, and has an important role in ensuring that national and strategic issues are considered by CCGs when redesigning services within the footprints – the STP wide work needs to complement the place-based plans, i.e., ESBT and C4Y for East Sussex.

1.6.        Amanda Philpott told HOSC that the ESBT place-based plan has materially influenced the STP as its core building blocks, and in that sense the STP process has been ‘bottom-up’. However, that influence is within the wider context of an STP programme that is nationally mandated and overseen by NHS England. For the STP to succeed, these place-based plans have to succeed in enabling greater and more efficient care to be provided in the community.

1.7.        The Committee RESOLVED to:

1) note the report; and

2) request a further update on the progress of the STP in September unless there is significant progress with the development of the STP prior to the Committee’s June meeting.

1.1.        The Committee considered a report on the latest developments regarding the Patient Transport Service (PTS).

1.2.        Maninder Singh Dulku, PTS Programme Director, Sussex CCGs; Paul Stevens, Director of Commercial Services, South Central Ambulance Service NHS Foundation Trust (SCAS); and Stacey Warren, Business Manager, SCAS, responded to questions from the Committee.

Key lessons from previous contract

1.3.        Mr Dulku said that a key recommendation of the independent report into the previous mobilisation of PTS was to employ a specialist PTS advisor. The CCGs appointed one in August 2016 and they have been pivotal in the process, and will be retained for a further six months to ensure an ongoing monitoring of the new contract. The CCGs have also avoided the mistake of attempting a one day contract transfer and have instead opted for a two phase transfer: phase one commenced on 1 March and phase two will commence on 1 April. Some lessons were learned from phase one that have been adopted for phase two.

Online booking systems

1.4.        Paul Stevens explained that there was a problem with the online booking system during phase one. SCAS quickly had the software supplier resolve the issue and, following further testing, there have been no further issues. Online booking will be available from 1 April.

Capacity of SCAS to take on both Surrey and Sussex PTS

1.5.        Paul Stevens explained that the Sussex contract will have its own management team that will report to SCAS’s Board. It is standard practice throughout the area in which the trust operates for SCAS to have a local contract team manage the PTS, as each area has their own locations and demands.

1.6.        Paul Stevens said that he did not expect every aspect of the new contract to be perfect from the outset and it will take time to embed and understand some of the issues and concerns about the service over the past year. However, the transition team has worked extremely hard and has carried out 150 one-to-one TUPE meetings with future team members– this is resource heavy and demanding but must be done in order to get TUPE contracts right. SCAS will continue with its established managers for the first 2 weeks of April, rather than bringing in new managers, to help reduce issues with the transition.

1.7.        Paul Stevens added that the activity levels experienced from 1 March were different to the expected levels developed beforehand from the data provided – certain assumptions are now being made about the level of demand from 1 April.

1.8.        Catherine Ashton said that ESHT considers that the PTS it is in a better position than it was this time last year. There have been a few problems but they have been nothing more than anticipated for a new service and are being resolved in the way ESHT would want to see. The Trust has no clinical risks or safety concerns that have been identified about the PTS. 

Complexity of phased approach

1.9.        Paul Stevens argued that  ...  view the full minutes text for item 35.

36.1     The Committee considered a report of the Central Sussex Stroke Services Scrutiny Review Board.

36.2     The Review Board thanked the witnesses for their contributions. Ashley Scarff, Director of Strategy, High Weald Lewes Havens CCG, said that the review process had been a worthwhile and helpful exercise.

36.3     The Committee RESOLVED to

1) agree the report and its recommendations;

2) agree to submit the report to the appropriate NHS organisations; and

3) request an update on the progress of the new stroke service for March 2018.

37.1     The Committee considered its future work programme.

37.2     The Committee RESOLVED to note the report.