Agenda and minutes

16.1     The Committee agreed the minutes as a correct record of the meeting held on 21 September.

17.1 Apologies for absence were received from Cllr Bridget Hollingsworth and Geraldine Des Moulins.

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.

18.1     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.

19.1     There were no urgent items.

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20.1.      The Committee considered a report providing an update on the Connecting 4 You (C4Y) health and social care transformation programme.

20.2.      Ashley Scarff, Director of Commissioning and Deputy Chief Officer, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG); Dr Phil Wallek, GP, School Hill Medical Practice in Lewes; Hugo Luck, Associate Director of Operations, HWLH CCG; Kim Grosvenor - Senior Programme Manager – Mental Health and Dementia Transformation, HWLH CCG; and Sam Tearle - Senior Strategic Planning & Investment Manager, HWLH CCG, provided a presentation and answered questions from HOSC members.

20.3.      Jennifer Twist explained that she represented Speak Up on the C4Y Programme Board and welcomed the involvement of the voluntary sector at all levels of the transformation programme.

Role of Central Sussex and East Surrey Area South

20.4.      Ashley Scarff explained that Central Sussex and East Surrey Area (CSESA) South’s main purpose is to integrate the constituent CCGs’ leadership and governance arrangements in order to increase their capacity and ability to work collectively. He confirmed that it would not replace C4Y as the place-based plan for transforming health and social care in the HWLH area of East Sussex. This is because transformation workstreams will be undertaken at the most appropriate level, and for community and primary care services this will be at C4Y level. 

Communities of Practice

20.5.      Ashley Scarff elaborated that the four Communities of Practice in HWLH area are broadly analogous to the Integrated Locality Teams that have been developed in the East Sussex Better Together (ESBT) area. Communities of Practice is the name given to integrated services that are provided by East Sussex County Council, Sussex Community NHS Foundation Trust (SCFT) Sussex Partnership NHS Foundation Trust (SPFT), GP practices and the voluntary sector across 4 geographical locations that cover populations of 30-50,000. At this size services can be delivered at a responsive local level whilst still being financially sustainable and the scale is based on national guidelines. He said that within the Communities of Practice ‘outer shell’ are other services such as the Lewes Health Hub, which is the name given to combined GP-led services within the Lewes Communities of Practice area.

Future priorities of C4Y

20.6.      Ashley Scarff said that frailty has been chosen as the main priority of C4Y for 2017/18 as it encompasses a number of elements of out of hospital care, such as falls prevention, proactive care and urgent care. Developing services around how best to support people living with frailty will also help to determine the optimum configuration for the Multispeciality Community Provider (MCP) accountable care system, i.e., how community, primary and social care services ultimately be integrated into a single system in the C4Y area.

GP Streaming service

20.7.      Hugo Luck explained the GP Streaming Services at Royal Sussex County Hospital (RSCH), Princess Royal Hospital (PRH) and Tunbridge Wells Hospital (TWH)  and provided assurance that it will not  ...  view the full minutes text for item 20.

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21.1.      The Committee considered a report providing an overview of cancer performance in East Sussex.

21.2.      Jessica Britton, Chief Operating Officer, EHS/HR CCG; Joe Chadwick-Bell, Chief Operating Officer, East Sussex Healthcare NHS Trust (ESHT); Lisa Elliott, Senior Performance and Delivery Manager, EHS/HR CCG; Garry East, Director of Performance and Delivery, EHS/ HR CCG and Ashley Scarff, Director of Commissioning and Deputy Chief Officer, responded to questions from HOSC members.

2 week initial referral meeting

21.3.      Joe Chadwick-Bell explained that, where appropriate, patients will generally receive a diagnostic test before their initial referral meeting with a consultant, rather than this referral meeting being their first point of contact with secondary care. Lisa Elliott said that in the case of suspected lung cancer, for example, a patient would, where possible, not see a consultant until they had been for a CT Scan as it is more useful for the consultant to see the scan to determine next steps. She added that a suspected cancer patient will be fast tracked through diagnostics, indicating they are treated with some urgency.

21.4.      Joe Chadwick-Bell said that the aim is for patients to have the first consultant referral meeting within 7 to 8 days rather than the national target of 2 weeks. Lisa Elliott said that if a patient has not heard back from a hospital they can ask their GP to chase the referral status for them, or the patient can do this directly.

Patient Choice

21.5.      Joe Chadwick-Bell said that a significant number of the breaches of the 62-day time to treatment target are due to patient choice, i.e., patients choosing not to attend their appointments – sometimes because they forget and sometimes because they choose not to go. There is a specialist nurse whose role is to contact patients to explain the importance of attending the initial referral appointment and this helps to ensure that ESHT meets its 2 week referral time. Some of the very long wait time breaches are due to patients who are very anxious and for them attempts are made at alternative diagnostic methods. Lisa Elliott added that a root-cause analysis is conducted for each 62-day breach to determine the cause of the breach, and a clinical harm review of the patient is also carried out. Joe Chadwick-Bell clarified that a target of 85% of patients being treated within 62 days of diagnosis takes into account the number of patients who exercise patient choice. The failure to meet that target indicates that there are other reasons beyond patient choice that account for the target not being met.

One-stop consultancy visit

21.6.      Joe Chadwick-Bell explained that each cancer pathway has been reviewed in order to determine whether a ‘one-stop’ diagnostic clinic could be established for patients attending the initial consultancy meeting, enabling them to see all of the necessary specialists in one go, which is established practice in  ...  view the full minutes text for item 21.

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22.1.      The Committee considered a report providing an overview of the review of stroke services underway in Kent and Medway and to consider the potential implications for East Sussex residents.

22.2.      Ashley Scarff, Director of Commissioning and Deputy Chief Officer; and Michael Ridgwell, Programme Director, Kent and Medway Sussex and East Surrey Sustainability and Transformation Plan, responded to questions from HOSC members.

22.3.      Michael Ridgwell said that the consultation is likely to include four reconfiguration options, although the details of the options have not yet been finalised. Meeting certain travel times is a requirement for all of the shortlisted options, specifically that a patient – including those outside Kent and Medway – is able to reach the stroke unit within one hour. This travel time analysis is being developed in close collaboration with South East Coast Ambulance NHS Foundation Trust (SECAmb). Access considerations are also being considered by an independent company, particularly for disenfranchised or isolated populations.

Capital investment

22.4.      Michael Ridgwell confirmed that all hospitals in the Kent and Medway area will require capital investment in order to make the necessary changes to create 24/7 Hyper Acute Stroke Unit (HASU) with a co-located Acute Stroke Unit (ASU).

Attracting consultants

22.5.      Michael Ridgwell said that there are significant issues with attracting stroke consultants to all of the hospital in Kent and Medway, so it is difficult to say which would be the most difficult to attract consultants to. He explained, however, that being able to say that a HASU reconfiguration is underway has resulted in some increase in the ability to recruit staff, including the recruitment of one consultant; this appears to be the case in other areas that have gone through this process.  Ashley Scarff added that there is tangible evidence that following the consolidation of stroke services the Royal Sussex County Hospital (RSCH) is now more attractive to medical staff, and it would be reasonable to expect the same across Kent.

Thrombectomy

22.6.      Michael Ridgwell said that thrombectomy – the surgical removal of a clot – is a new service commissioned by NHS England that is not yet widely provided by hospitals outside of London. NHS England is, however, recommending that CCGs and trusts begin developing their own thrombectomy centres. He confirmed that each of the four reconfiguration options will include the opportunity for one of the sites to develop as a thrombectomy centre in the future. He added that developing a thrombectomy centre will require a complex process of developing other services that sit alongside a HASU, but it is being given consideration.

RECOMMENDATIONS

The Committee RESOLVED to:

1) note the report;

2) agree that the proposed reconfiguration of stroke services in Kent and Medway is likely to constitute a ‘substantial development or variation’ to services for East Sussex residents requiring formal consultation with HOSC;

3) authorise the Chair, in consultation with  ...  view the full minutes text for item 22.

23.1     The Committee agreed the work programme subject to the following amendments:

1) defer the Connecting 4 You report from the 29 March to 28 June 2018 meeting;

2) accept the update on the BSUH Stroke Services Review by email in March 2018, and include the update as an appendix to the 29 March 2018 Work Programme item;

3) defer the update on End of Life Care to the 28 June 2018 meeting; and

4) add an item on the quality of maternity services, to include consideration the findings of an Eastbourne Borough Council survey, to the 29 March 2018 meeting.