Agenda and minutes

15.1     The minutes of the meeting held on 27 September were agreed.

16.1     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.

17.1     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.

18.1     There were no urgent items.

19.1.      The Committee considered a report providing an update on planning across East Sussex to deal with seasonal surges in demand, extreme weather and other issues associated with the winter months.

19.2.      Ashley Scarff, Director of Commissioning Operations – High Weald Lewes Havens CCG; Jessica Britton, Managing Director of East Sussex Better Together CCGs; Mark Angus, Winter Director, Sussex and Surrey CCGs; Andy Cunningham, Head of Care Management (Hospitals), (in attendance from the Adult Social Care Department); Dr Adrian Bull, Chief Executive, East Sussex Healthcare NHS Trust (ESHT) and Joe Chadwick-Bell, Chief Operating Officer, ESHT, provided answers to a number of questions from HOSC.

Maintaining 85% bed capacity over the winter period

19.3.      Mark Angus explained that 85% is recognised nationally as the ideal occupancy rate for beds in an acute hospital. However, it is also recognised that occupancy rates will usually be higher than 85% over winter months due to the fact that, whilst the number of admissions are not necessarily much higher, patients who are admitted tend to be sicker and therefore are admitted for longer periods. He said that the winter resilience plans aim to manage this period of generally higher occupancy safely and effectively within hospitals, whilst also ensuring that the whole healthcare system can respond in a co-ordinated way to individual surges in demand.

Avoiding unnecessary readmissions due to early discharge of patients

19.4.      Mark Angus said that the healthcare system in East Sussex performs relatively well in relation to readmission rates. This is due to a number of checks and balances that are made during the discharge process that ensure patients are only discharged when ready to leave hospital. He confirmed that this process does not change during the winter period. Joe Chadwick-Bell added that figures showed that since introducing same-day ambulatory care at the A&E Departments readmissions rates had not risen. This demonstrated that whilst patients were receiving a shorter period of care than they would if admitted as an emergency inpatient they were not experiencing worse outcomes.

Personal Management Plans for patients with chronic conditions

19.5.      Joe Chadwick-Bell explained that patients with a long term condition generally have a shared care plan agreed between their consultant and GP that clinicians will have access to. The East Sussex Better Together (ESBT) Alliance has amended the care pathways for five long term conditions so that should a patient with one of these conditions be in crisis they are referred to the ESBT Crisis Response Team and managed in the community, where possible.

Readiness of NHS 111 over winter and ability to book appointments

19.6.      Mark Angus said that there is a detailed plan for NHS 111 over the winter based on lessons learned from last year, including ensuring that there is sufficient workforce in place to meet expected demand. Recruitment to 111 has been encouraged by introduction of a national career framework, which clearly defines the career path opportunities for both non-clinical and clinical call-handlers to improve the attractiveness of the role  ...  view the full minutes text for item 19.

19.1.      The Committee considered a report providing details of the proposed reconfiguration of Ear, Nose and Throat (ENT) services currently provided by East Sussex Healthcare NHS Trust (ESHT).

19.2.      Joe Chadwick-Bell, Chief Operating Officer, explained that the proposed reconfiguration is driven by workforce challenges, in particular:

·         A shortage of ENT consultants. There are currently three consultants covering the two sites, whereas there should be five or six. This makes it very hard to recruit any additional consultants as they would have to be on call on a 1-in-4 or 1-in-3 basis. One of the three consultants has retired and returned on an almost full time basis.

·         A shortage of middle grade doctors. There are currently no registrars or training grade doctors to fill the six middle grade rota posts. Instead there are four speciality doctors, one of whom acts up to the consultant rota. They are also close to retirement age and could potentially hand in their notice, despite the current work they are doing now to support the service

·         Reliance on the ad hoc support of 10 Sussex-based doctors, particularly at the A&E department at the Conquest Hospital.

·         There are two trainee ENT doctors but there is a risk that the Deanery could remove them without providing them with more training opportunities.

19.3.      Dr Adrian Bull, Chief Executive, and Joe Chadwick-Bell provided answers to a number of questions from HOSC.

Emergency ENT pathway

19.4.      Joe Chadwick-Bell explained that patients currently present as emergency ENT patients either by calling 999 or attending A&E. South East Coast Ambulance NHS Foundation Trust (SECAmb) know to bring such patients to the Eastbourne District General Hospital (EDGH) where emergency admissions are currently located. Self-presenters at Conquest Hospital can mostly be dealt with on site but those few patients who need the intervention of an ENT surgeon would be transferred across via ambulance.

Ensuring Supportive Professional Activities (SPA) for consultants

19.5.      Dr Adrian Bull said that Supportive Professional Activities (SPAs) are part of a consultant’s contract and the Trust is committed to protecting SPA time as an important part of the training process.

Recruitment difficulties due to sub-specialisation

19.6.      Dr Bull explained that recruitment rates are improving across the trust except for in areas where there is an increasing tendency towards sub-specialisation, rather than generalisation, and in which there are more frequent on-call requirements; the ENT service is faced with both of these issues. Therefore, the future service needs to be attractive to surgeons who are looking to specialise in ear issues, nose issues, or throat issues, given the increasingly few number of ENT generalists.

Impact on deprived communities

19.7.      Dr Adrian Bull said that he did not believe deprivation was relevant to the proposals, as the key consideration of the Trust is to provide a service that provides the right quality of care to residents of East Sussex. In addition, outpatient services would continue as before at Conquest Hospital so access to the opinion of an ENT consultant, who can provide an  ...  view the full minutes text for item 20.

21.1     The Committee considered a report recommending the establishment of a Joint Health Overview and Scrutiny Committee (JHOSC) along with Brighton & Hove, West Sussex and Surrey for the purposes of considering possible future substantial variations to services affecting two or more local authority areas, as required under health legislation.

3.2       The Committee RESOLVED to:

1) Agree to establish a JHOSC with membership from Brighton & Hove City Council, East Sussex County Council, Surrey County Council and West Sussex County Council;

2) Agree the JHOSC Terms of Reference and rules of procedure attached at Appendices 1 and 2;

3) Appoint Cllrs Colin Belsey, Bob Bowdler, and Sarah Osborne as voting members and Geraldine Des Moulins as a non-voting member to the JHOSC to represent the East Sussex Health Overview and Scrutiny Committee.

22.1     The Committee considered a report on its work programme which included an update on the progress of the Urgent Treatment Centre reconfiguration (UTC) in the Eastbourne and Hastings area.

22.2     The Committee RESOLVED to:

1) ) agree the work programme subject to the addition of:

·         A further report on the performance of cancer services in East Sussex to be circulated by email in the new year, with a report to the committee, if necessary, in June;

·         A report on the outcome of the Children and Adolescent Mental Health Services (CAMHS) review at a future meeting; and

2) note the delay in the UTC reconfiguration process and continued work of the UTC Review Board.