Agenda and minutes

Cllrs Davies and Osborne were present for items 5 and 6.

23.1     The minutes of the meeting held on 29 November were agreed as a correct record.

24.1     Apologies for absence were received from:

·         Cllr Ruth O’Keeffe (substitute: Cllr Charles Clark)

·         Cllr Janet Coles

·         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.

25.1     Cllr Belsey declared a personal interest as an long-time acquaintance of  Ray Savage.

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.

26.1     There were no urgent items.

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27.1.      The Committee considered a report providing an update on the Clinical Commissioning Groups’ (CCG) and East Sussex Healthcare NHS Trust’s (ESHT) expected financial outturn for 2018/19 and their future financial plans.

27.2.      The Committee received a number of responses to its questions from the witnesses in attendance.

Areas targeted for savings

27.3.      Jessica Britton, Managing Director, Eastbourne, Hailsham and Seaford CCG (EHS CCG)/ Hastings and Rother CCG (HR CCG), explained that Quality, Improvement, Productivity and Performance (QIPP) savings made by the CCGs are designed to help improve patient care and at the same time make healthcare more cost effective. Jessica Britton provided some examples of QIPP savings for 18/19:

• a communities pathway programme that involves training community-based staff to treat certain ailments that frail people are often admitted to hospital for that could better be treated in their home, for example, a blocked catheter, or non-injury fall;
• a programme to target and case manage persistent users of A&E (who often use it for non-medical reasons) to keep them out of hospital and better support them at home; and

·         a programme to ensure that GPs are referring patients to hospital outpatient appointments appropriately using the best possible clinical evidence to avoid instances of outpatient diagnostics being carried out unnecessarily.

27.4.      Jessica Britton added that medicine management is an area that can deliver £3-5m of savings per year whilst also providing a better service for patients through, for example, introducing medicine reviews for patients. QIPP savings have been identified in this area.

27.5.      Keith Hinkley, Director of Adult Social Care and Health, East Sussex County Council, said that there is a continued commitment in 19/20 towards a comprehensive programme of integration across community health and social care in East Sussex that will help significantly increase productivity and use the available funding more efficiently by managing people in the community; responding more quickly to people in crisis in their own homes; and facilitating speedier discharge from hospital. A report setting this out will go through the governance process of the CCGs and the Council in the next few months.

27.6.      Jonathan Reid, Finance Director, ESHT, said that Cost Improvement Plan (CIP) savings are also aimed at providing a better quality service whilst reducing costs. He said CIP savings include:

• better recruitment, retention, and workforce plans to reduce the reliance on costly agency staff;
• increasing productivity of community staff by rolling out laptops to them, allowing them to do more for less; and
• recruiting a Head of Procurement who looks for the best possible deal for purchasing medical supplies.

Risk assessment of savings plans

27.7.      Jessica Britton confirmed that the CCGs QIPP schemes all go through a both an Equality Impact Assessment, and a Quality Impact Assessment that are shared with the governing bodies to help them when taking a decision about a proposed QIPP scheme. All QIPP schemes  ...  view the full minutes text for item 27.

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28.1.      The Committee considered a report providing an update on the quality and performance of services provided by South East Coast Ambulance NHS Foundation Trust (SECAmb).

28.2.      The Committee received a number of responses to its questions from the witnesses in attendance.

Category 3 wait times

28.3.      James Pavey, Regional Operations Manager, explained that the Ambulance Response Programme (ARP) Categories are nationally set and are designed to ensure that those patients who are the sickest get the quickest response, but also the most appropriate response and are then conveyed to the most appropriate place of care. This means that during periods of high demand on the service there can be a backlog of less urgent calls (category 3 or 4) which is the result of prioritising the more serious calls and, as identified in the Demand and Capacity review, it is at these times there is insufficient resource to send a response to all calls. He agreed that it is not acceptable that patients triaged to category 3 or 4 have to wait too long and he apologised for the excessive waits that some patients experience, however, he said the additional funding from the Demand and Capacity review would help to address response times in the longer term.

28.4.      Mr Pavey explained that there are escalation plans in place for when the backlog of calls reaches a certain level of approximately 70-80 calls across the Kent, Surrey and Sussex region. This occurs when there are more calls than resources, the service is under severe pressure, and there is a high level of patients waiting for an ambulance, including patients who may not need one. It is during these times the trust does quite a bit of ‘no sending’ to deal with those patients who do not need an ambulance by giving them advice over the phone on other alternative sources of care available to them. He explained that staff will try and give the right advice to these patients over the phone where it appears that they do not need an ambulance, however, sometimes it is difficult to tell what is happening over the phone and it is necessary to dispatch a clinician to visit the patient and determine what care they require.

Falls

28.5.      James Pavey explained that falls are initially categorised under Category 3 (response time of 2 hours) provided there are no other serious symptoms such as shortness of breath. The Trust also carries out welfare call backs for patients who are waiting, and their category will be upgraded if they are displaying more serious symptoms.

Hear and treat

28.6.      It was explained that only about 60% of patients seen by ambulance crews need to be conveyed to hospital, so it is possible to diagnose and treat some patients over the phone through a process called Hear and Treat. James Pavey  ...  view the full minutes text for item 28.

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29.1.      The Committee considered a report about whether the decision of the Joint Committee of Clinical Commissioning Groups in relation to stroke services in Kent and Medway is in the best interest of health services in East Sussex.

29.2.      The Committee received a number of responses to its questions from the witnesses in attendance.

Number of patients affected by changes

29.3.      Ashley Scarff, Director of Commissioning Operations, HWLH CCG, confirmed that modelling by the CCGs had indicated the total number of patients in East Sussex affected by the planned changes would be approximately 50 per year. These comprise patients who currently use Pembury Hospital in Tunbridge Wells and who would in future use Eastbourne District General Hospital (EDGH).

Additional capacity at the Eastbourne District General Hospital

29.4.      Dr Adrian Bull confirmed that ESHT has modelled the likely impact of the additional patients and considers it relatively small compared to the number of patients currently served by the EDGH Hyper Acute Stroke Unit (HASU). He confirmed the additional patients could be accommodated.

Travel Times

29.5.      James Pavey explained that SECAmb is effective at identifying whether someone describing their symptoms over the phone (or the symptoms of someone else) is having a stroke. Someone suspected of having a stroke will be placed in a Category 2 response call, which has a target response time of 18 minutes. The ambulance crew will assess the patient on arrival to check that they are having a stroke and they will be then taken to the closest appropriate hospital with a stroke unit. There is a two-hour ‘call to needle’ time for patients who need to go to a stroke unit and receive thrombolysis (if it is a clot causing the stroke) and SECAmb is confident it can achieve this timescale. He added that strokes are one of the most straightforward conditions to identify clinically, which is a real advantage when determining which hospital to convey a patient to.

29.6.      James Pavey confirmed that it will depend on the individual case and will be decided on-scene, but as a general rule an ambulance would convey a patient straight to a HASU first time. An ambulance crew would not take the patient to the nearest hospital in order to have them stabilised before moving them on to a specialist centre. He explained that this was because:

• taking patients to the nearest hospital may add further delays in treatment when transferring them on to a specialist unit; and
• an ambulance crew can manage the straightforward medical needs of a patient with a stroke – such as keeping airways clear – on the way to a specialist unit, so this would not need to be performed at an intermediary hospital.

29.7.      He compared the conveyance straight to a HASU as analogous to other medical conditions where it is more important to go to the  ...  view the full minutes text for item 29.

30.1     The Committee considered its work programme.

30.2     The Committee RESOLVED to agree the work programme subject to the addition of reports identified during previous items and a report at an appropriate time in relation to the East Sussex response to the NHS Long Term Plan.