Agenda and minutes

8.1       The Committee agreed the minutes of the meeting held on 29 June 2017 as a correct record.

8.2       The Chair thanked Dr Adrian Bull, Chief Executive of East Sussex Healthcare NHS Trust (ESHT), for the tour of the Midwife-Led Unit and Cardiology at Eastbourne District General Hospital (EDGH) and the seminar on the progress of reconfigurations to the Trust’s General Surgery and Maternity services.

9.1       Apologies for absence were received from Cllr Johanna Howell (substitute: Cllr Roger Thomas), Cllr Sarah Osborne, and Cllr Andy Smith.

9.2       The Chair welcomed Geraldine Des Moulins as the new member of HOSC representing the voluntary sector.

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.

10.1     There were no disclosures of interest.

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.

11.1     There were no urgent items.

12.1     The Committee considered a report providing an update on developments in urgent care services, including redesign of the urgent care system as part of the East Sussex Better Together (ESBT) programme; and the Sussex-wide redesign and re-procurement of NHS 111.

12.2     Mark Angus, Urgent Care System Improvement Director, East Sussex Better Together; Jessica Britton, Chief Operating Officer for the two ESBT Clinical Commissioning Groups (CCGs); Adrian Bull, Chief Executive, and Joanne Chadwick-Bell, Chief Operating Officer, of East Sussex Healthcare Trust; and Colin Simmons, Programme Director for 111 Transformation, provided answers to questions raised by HOSC Members.

Urgent Care Treatment Centres

1.1.        Mark Angus explained that the development of Urgent Care Treatment Centres (UTCs) is a national requirement that is being undertaken locally through the East Sussex Better Together (ESBT) Whole System Urgent Care transformation programme. NHS England (NHSE) requires that detailed urgent care plans are developed by March 2018 and the plans are in place by 1 December 2019.

1.2.        Mr Angus said that commissioners within ESBT were currently working out where UTCs will be located based on three potential options:

·         co-locating UTCs with the A&E Departments and the new Primary Care Streaming Services at Eastbourne District General Hospital (EDGH) and the Conquest Hospital;

·         developing existing walk-in centres to the higher UTC specifications, including diagnostic facilities like an X-ray machine; or

·         building new UTCs, although limited access to capital funds makes this option more challenging.

1.3.           Jessica Britton said that there will likely be two UTCs in the ESBT area and confirmed that there were no current plans for the development of one in Seaford. She added that in addition to UTCs the transformation programme will include the development of a range of urgent primary and community services available across the ESBT area – including extended opening hours for GP surgeries, and a re-developed Out Of Hours (OOH) GP Service.

Paediatric Urgent Care

1.4.           Mark Angus said that the ESBT Whole System Urgent Care transformation programme include provision for paediatric care, but commissioners would need to be confident that any provider would be able to provide the service safely and effectively.

1.5.           Joanne Chadwick-Bell added that A&E Departments on both hospital sites have specialist paediatric nurses that can support children with urgent or emergency care need. There are also paediatric units on both sites for children who require more specialist consultant support and there are no plans to change this configuration.

Primary Care Streaming Service

1.6.           Joanne Chadwick-Bell said that the Primary Care Streaming Service is due to commence as a pilot from October. ESHT has received a number of CVs from GPs interested in the position and one full-time GP has been appointed so far to the EDGH A&E Department. The Trust is negotiating funding for the role and will be employing GPs directly to help with their indemnity insurance. The service will be divided into shift patterns of four hours at a time to make it easier for GPs to carry out the role  ...  view the full minutes text for item 12.

13.1     The Committee considered a report providing an update on the most recent developments with the Sussex and East Surrey Sustainability and Transformation Plan (STP).

13.2     Wendy Carberry, Senior Responsible Officer for the STP provided a presentation and answered questions from Members of HOSC.

Effect of STP on Connecting 4 You

1.1.        Wendy Carberry said that the CCGs in the Central Sussex and East Surrey Area (CSESA) South plan to merge some back-office functions by April 2018. She confirmed that this will not affect the implementation of High Weald Lewes Havens Clinical Commissioning Group’s (HWLH CCG) Connecting 4 You (C4Y) programme – which is the model of care for the HWLH population – or its constituent services such as Communities of Practice, the frailty pathway, and the Golden Ticket dementia pathway. She argued that these services are starting to come together rapidly and the C4Y programme is not as far behind other placed-based plans as it may appear.

CSESA boundary

1.2.        Wendy Carberry confirmed that the boundary between CSESA North and South has been fixed. The North will comprise Horsham and Mid Sussex, Crawley and East Surrey CCGs and the South will comprise Brighton & Hove and HWLH CCGs. She said that some functions will be carried out jointly with Brighton & Hove CCG, some with the other CCGs in the CSESA area, and some across the whole STP.

Funding for healthcare

1.3.        Wendy Carberry explained that there is no specific extra money that will be provided to deliver the placed-based plans such as C4Y or ESBT. Dr Bull added that the predicted funding gap by 2020 is based on comparing the trend for healthcare funding with the trend for increasing healthcare needs. The prediction is that the increase in healthcare need is much greater than the expected funding increases but funding itself will not decrease relative to the current levels, so there is no expectation that CCGs will have to reduce spending below current levels. He said that the health and social care organisations must align themselves in such a way as to reduce future demand by using existing resources better. The challenge and tension at the moment, however, is to protect investment in community based care to reduce future demand whilst also addressing significant funding challenges in acute care.

Use of ICT in healthcare

1.4.        Dr Adrian Bull said one of the main initiatives across the NHS is to improve the adoption rate of new technologies that help clinicians deliver healthcare. The NHS will increasingly need to support the development of apps and other ICT that will enable patients to take control of their patient records so that expert patients can manage their own conditions, such as diabetes. NHS Digital is encouraging this through an accreditation programme for new healthcare apps, such as those that remind you when to take prescription medicine, which are listed on its website. Dr Bull added that technology can also be used to help detect diseases, for example, a handheld device that has been rolled  ...  view the full minutes text for item 13.

14.1     The Committee considered a report providing an update on Clinically Effective Commissioning.

14.2     Ashley Scarff, Deputy Chief Officer and Director of Strategy, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG); and Dr Shivam Natarajan MS FRCS, Clinical Lead from Clarity Consulting, answered questions from the Committee.

Reason for reviewing procedures with limited clinical effectiveness

1.1.        Dr Shivam Natarajan explained that there are approximately 2,500 hip and knee operations in the STP area per year. Out of those, 150 were for revisions of previous operations which means that they were either not done appropriately or properly.

1.2.        An initial knee operation costs £5-10k but a revision costs £110k. The Clinically Effective Commissioning (CEC) programme is looking at the first point in the surgical pathway at which these unnecessary revisions can be prevented, which is to ensure that the policies of all CCGs in the STP area are clear about who the appropriate people are who should receive the surgery and when the appropriate time is in the clinical pathway for them to receive it. This has two benefits: appropriately giving the right person the knee operation will avoid the unnecessary expense of complications, and by having the right people have the surgery additional people who do require the surgery can receive it in a timely manner.

1.3.        Dr Natarajan explained that the appropriate thresholds for patients to receive each type of surgery will be set out in STP-wide policies that are in line with the Royal College guidelines and clinical best practice, for example, the current policies for a hysterectomy differ across each CCG, with some saying patients may have one after six months of conservative management and others after 12 months. However, the clinical evidence says there should be three stages/ types of conservative management that should be tried if possible before major surgery. The policy being developed, therefore, says that patients should go through three stages of conservative management before going to surgery. Changing the eligibility for surgery to fit with clinical best practice is not a purely financial exercise but in the interest of good patient care; and may result in more surgeries for some CCGs, or a greater number of surgical procedures for some illnesses.

1.4.        Dr Natarajan added that Clinically Effective Commissioning will also tie into other clinical work such as Get it Right First Time and the STP’s acute care workstream by highlighting the various avoidable variations in care and eliminating waste. Within the STP only half the surgeons involved with hip and knee replacements are carrying out 30 or more knee or hip operations per year the remaining half are only doing a handful. This variation in quality that this causes should be avoided and is something that could be addressed through this other work, for example, agreeing as part of the acute care workstream to do knee operations in only three major centres of excellence. Ashley Scarff clarified that this process would not result in a limitation in choice but balance  ...  view the full minutes text for item 14.

15.1     The Committee considered its work programme and the notes of the three joint HOSC working groups set up to meet with and scrutinise NHS organisations that provide services across multiple local authority areas.

15.2     The Committee RESOLVED to:

1) note the report;

2) note the minutes of the working groups; and

3) add a report on cancer care performance to the 30 November agenda.