Agenda and minutes

1.1       The minutes of the meeting held on 29 March 2018 were agreed as a correct record.

2.1       Apologies for absence were received from Cllr Janet Coles.

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       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.

4.1 There were no urgent items.

1.1.        The Committee considered a report on the recent Care Quality Commission (CQC) Inspection Report on East Sussex Healthcare NHS Trust (ESHT) and an update on the Trust’s work to improve End of Life Care (EOLC).

1.2.        Dr Adrian Bull, Chief Executive, ESHT, and Vikki Carruth, Director of Nursing, ESHT, introduced the report and answered the following questions from the Committee.

Making financial savings without compromising quality and safety performance

1.3.        Dr Bull said that the trust has had troubled finances for a number of years and had a deficit of £48m prior to his arrival in mid-2016. The underlying financial position was worse than that at the time, however, and was being enhanced by one or two one-off in-year contributions. A report by Dame Ruth Carnall in 2016 said that the finances were on a rapidly deteriorating trajectory and were heading towards a deficit of more than £60m. The Trust has arrested this deterioration and the deficit for 2017/18 was £54m, with plans for a deficit of £45m for 2018/19.

1.4.        Dr Adrian Bull said that the Trust’s aim is to maintain quality and safety improvements made over the last two years whilst reducing its financial deficit. He was clear that whilst ESHT would work to tackle financial issues, the trust would not do so by making short-term cost saving measures that would imperil quality and safety. He clarified that it was not the case that financial improvements were being ignored in order to improve quality and safety.

1.5.        Dr Bull explained that a range of initiatives have been undertaken to achieve this financial position, for example, significantly improving financial reporting, and allowing devolved responsibility for budgets to the service level, rather than top down corporate budget planning. Dr Bull explained that every financial initiative the trust develops goes through a formal quality improvement assessment process to ensure that the initiative will not have an adverse effect on clinical performance. Large areas of financial inefficiency that still need to be addressed include agency staff, drug costs and length of stay of patients.

1.6.        Dr Bull said that many of the trust’s initiatives to improve quality will also deliver financial savings because poor quality care costs money, for example, unnecessary lengths of stay, avoidable readmissions, and extra treatments for preventable infections.  He explained how two years ago the length of stay for emergency care was over 6 days but is now 4.6 days. This meant that despite the significant increase in admissions over the past two years, the total number of bed days has fallen and the trust has been able to reduce the number of beds it is running, thus saving money.

Exiting Financial Special Measures

1.7.        Dr Bull said that it is less clear how the trust can emerge from financial special measures compared to quality special measures. This is in part because the latter happens as the result of a CQC recommendation whereas there is no equivalent for financial special measures. He believed that the NHS Improvement  ...  view the full minutes text for item 5.

1.1.        The Committee considered a report providing an update on the redesign of the urgent care system as part of both the Connecting 4 You and East Sussex Better Together programmes, and the pause of the NHS 111 procurement process.

1.2.        Ashley Scarff,  Director of Commissioning Operations, HWLH CCG; Hugo Luck, Deputy Director of Primary and Community Care, HWLH CCG; Jessica Britton Chief Operating Officer, EHS/HR CCG; and Mark Angus, Urgent Care System Improvement Director, EHS/HR CCG; introduced the report and answered the following questions from the Committee.

Continuation of existing NHS 111 contract

1.3.        Mark Angus said that the CCGs are about to enter discussions with current NHS 111 providers to ensure continuity of service beyond the end of the current contract in April 2019. He is confident that continuity of service can be achieved.

NHS 111 procurement process

1.4.        Mark Angus said that the CCGs are intending to do further engagement with the market and see whether there are any learning opportunities from other NHS 111 system plans being developed elsewhere in the country. This will help to ensure there is a positive response from providers to the procurement process when it is reinitiated. He said it was important to reflect that the decision to pause the procurement process was not an indication of a flawed procurement process and this view is supported by NHS England.

1.5.        Jessica Britton said that the redesign of Urgent Treatment Centres (UTCs) in the East Sussex Better Together (ESBT) area of East Sussex is on pause until the impact of the pause in NHS 111 procurement can be determined. She did not anticipate that it would impact the plans significantly but it was necessary to ensure that the new specification UTCs will be deliverable within the revised timescales. Ms Britton said that further update on the effect on UTCs would be presented at the next HOSC meeting.

Lewes Victoria Hospital

1.6.        Hugo Luck confirmed that the Lewes Health Hub and Lewes Victoria Hospital (LVH) UTC would not be duplicating services as the two services will be integrated together into a single urgent care system. He explained that the three GP practices that have combined to create the Lewes Health Hub will treat patients with long term conditions at the Health Hub (or in the individual practices prior to the completion of the Hub) and patients requesting urgent care will be asked to go to the UTC at the LVH where some of the Lewes GPs will be present, along with emergency nurse practitioners (ENPs). Mr Luck illustrated this separation by explaining that a patient may ring their GP practice with an urgent care need and be directed to go to the LVH instead, or they may book an appointment at the UTC online, or via NHS 111. The triaging of patients at the UTC will be undertaken by a doctor and around 50 patients a day who would otherwise have seen their GP at a practice will see an ENP  ...  view the full minutes text for item 6.

1.1.        The Committee considered its work programme.

1.2.        The Committee RESOLVED to:

1) agree the work programme;

2) agree that the Chair writes a letter to the relevant CCGs requesting more detailed information about the reasons for the NHS 111 procurement delay;

3) request a report to be circulated by email on the progress of improving cancer care services in East Sussex;

4) agree to nominate Cllr Bowdler as a member of the HOSC working group for Sussex Partnership NHS Foundation Trust (SPFT);

5) request a briefing on post-natal mental health care in East Sussex; and 

6) raise the issue of mental health waiting times at the next HOSC working group for SPFT.