Agenda and minutes

1.1       The Committee RESOLVED to agree the minutes of the meeting on 28 March 2019.

2.1       Apologies for absence were received from:

·         Cllr Mary Barnes

·         Cllr Johanna Howell (Substituted by Cllr Bob Bowdler)

·         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.

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.

5.1.        The Committee considered a report and presentation on the financial plans of the three East Sussex Clinical Commissioning Groups (CCGs) for 19/20 and the proposal to merge into a single East Sussex CCG from April 2020.  The Committee then asked the witnesses present a number of questions.

5.2.        The Committee asked what Brighton & Hove CCG (BHCCG) was doing differently compared to the other CCGs in Sussex and East Surrey in order to achieve a ‘green’ rating on both the finance and leadership ratings given by NHS England (NHSE) to CCGs.

5.3.        Adam Doyle, Chief Executive Officer, Sussex and East Surrey CCGs, explained that three years ago BHCCG was rated red by NHSE and was in financial difficulties. It was the first CCG he was appointed to as Accountable Officer in Sussex, and required a full change of governance, a refresh of its leadership team, and the development of a plan to deliver financial balance. Since then, the CCG has had a track record of achieving and sustaining its financial and leadership goals.

5.4.        Mr Doyle added that all other CCGs in the Sussex and East Surrey Sustainability and Transformation Partnership (STP) had subsequently fallen into financial difficulties. Since taking over as the chief officer at each CCG in turn, he has enacted the operational principles applied to BHCCG and is confident that they are all improving and are closer to achieving financial targets than they were last year.

5.5.        The Committee asked how local representation will be maintained on the proposed East Sussex CCG Governing Body.

5.6.        Adam Doyle explained that the three CCG Governing Bodies are being asked for indicative approval of the merger during June and July. Discussions with local representatives will then take place over the summer about the constitution of a new East Sussex CCG, including how local representation will feature in the membership of its Governing Body. The current working view, which will be subject to this engagement process, is that GP members of the Governing Body will represent populations of about 100,000 residents. He added that, in order to safeguard localism within the larger organisation, each GP Governing Body member will need to have an infrastructure around them to ensure they can be made aware of and represent local views at governing body meetings.

5.7.        The Committee questioned whether the additional infrastructure needed to support governing body members representing larger areas would not cancel out any potential savings from merging the three CCGs; and whether there was scope for voluntary organisations to provide this information.

5.8.        Adam Doyle explained that running the eight statutory CCG Governing Bodies (across the whole STP) has a cost to it. He said he believed that the right operating model can be developed that will both meet the required 20% back office saving and provide the appropriate level of support the people on the new CCG governing bodies would need.

5.9.        He said that this will be aided by the new Primary Care Networks (PCNs), which are required  ...  view the full minutes text for item 5.

5.1.        The Committee considered a report on the procurement of a Sussex-wide Out of Hours (OOH) Home Visiting Service. The Committee then asked the witnesses present a number of questions.

5.2.        The Committee asked why the OOH Home Visiting Service was being procured separately to the new NHS 111 service.

5.3.        Colin Simmons, Integrated Urgent Care Programme Director, Coastal West Sussex CCG, explained that the procurement that was paused last Summer had been for a Sussex-wide NHS 111 service. He said he could not go into all the reasons why it was stopped, due to procurement confidentiality, but it did include an OOH Home Visiting Service. The reason for the changes included:

• the proposed NHS 111 service now includes Kent, where there is a different home visiting arrangement in place; and
• separating out the service and commissioning a shorter contract for the Home Visiting Service allows testing of what model of home visiting works best with the new NHS 111 service.

5.4.        The Committee asked whether there was a risk that recruitment to the service would interfere with attempts to recruit to other emerging urgent care services.

5.5.        Colin Simmons agreed workforce recruitment and retention was an issue but was also an issue across the whole of the NHS. To tackle this issue, the OOH home visiting service will have a mix of clinical skill sets – whereas the current service is predominantly GP-based – enabling patients to see paramedics, or advanced nurse practitioners in certain circumstances. Plans are also being developed to use the workforce in the most flexible, constructive way, for example, establishing whether clinicians in the NHS 111 Clinical Assessment Service (CAS) could work for a different provider, i.e., the provider of the Home Visiting Service, to enable the clinician to vary their workload in a way that suits them.

5.6.        The Committee asked how the CCGs can ensure that providers deliver on any promises to provide the workforce set out in the service specification.

5.7.        Colin Simmons explained that part of the role of all commissioning organisations is to hold providers to account to deliver on their promises, but CCGs can also encourage providers to work together to help ease workforce issues.

5.8.        The Committee asked how the service might overcome the issue of a shortage of GPs

5.9.        Colin Simmons explained that the shortage of GPs would be overcome in part by developing a multidisciplinary team including paramedics, advanced nurse practitioners and GPs. Whilst GPs will still be required for certain clinical interventions, these other staff could help support the GPs’ workload. It will also be necessary to develop ways of making the  service seem more attractive to prospective GP, given the traditional issues with OOH services appearing unattractive employment opportunities.

5.10.      The Committee asked about how oversight of this potentially complex urgent care system could be ensured.

5.11.      Colin Simmons explained that the CCGs’ role in ensuring different providers work together across the urgent care system will involve being clear about the expected outcomes  ...  view the full minutes text for item 6.

5.         

6.         

7.         

7.1.        The Committee considered a report providing an update on the progress of the implementation of the reconfiguration of Ear, Nose and Throat Services (ENT) provided by ESHT. The Committee then asked the witnesses present a number of questions.

7.2.        The Committee asked for an update on any success with the recruitment of clinicians and whether consultants have sufficient time allocated to training junior doctors.

7.3.        Dr Bull explained that the trust currently has an overall 10% vacancy rate compared to a national average of 16%. The turnover was 9.5% compared to an average of 15-16%. He added that there were variations around those numbers and difficulties remain recruiting to specialities, which included ENT. To help improve recruitment in ENT the two joint consultant posts are being advertised in conjunction with Brighton & Sussex University Hospital NHS Trust (BSUH). This will enable consultants to have access to both the tertiary work that goes on in Brighton and the district general work at Eastbourne District General Hospital (EDGH).

7.4.        Adrian Bull said there is no doubt that the reputation of the trust is much better. As a result, he was mostly shortlisting two or three applicants for most advertised consultant specialities, except in those few areas where there were shortages, and a new generation of young consultants was beginning to develop at the trust. He added that many consultants were attracted to district general work generally, and East Sussex specifically, and not all wanted to go work in a tertiary centre and its associated academic pressures. Some, though, enjoyed exposure to both, and the relationship with BSUH and Kings College NHS Trust helps to attract those seeking this balance. ESHT also continues to support the medical schools at the University of Brighton and the emerging one in Kent.

7.5.        The Committee asked for clarification whether the addition of an adult surgery list at Conquest Hospital didn’t run against the proposal to centralise the service at EDGH

7.6.        Dr Adrian Bull clarified that the original purpose of the reconfiguration was to centralise adult ENT surgery at EDGH, not the entire ENT service. The final configuration has adult inpatient surgery centralised at EDGH but with a monthly day list retained at Conquest Hospital. This was at the request of ENT surgeons who wanted to ensure that the theatre teams had the opportunity to practice the skill set required for ENT surgery so that in the event of an emergency procedure there was sufficient knowledge and resources in place. Dr Bull said it was possible to accommodate this additional day list and still address the issues of ENT medical staffing being over stretched over two sites because the previous planned surgery lists at Conquest included patients who needed an overnight stay at the Conquest, meaning that ENT doctors then had to travel from the EDGH inpatient ward to see them the next day.

7.7.        Adrian Bull added that the paediatric list at the Conquest, on the other hand, was for children who  ...  view the full minutes text for item 7.

8.1       The Committee considered its work programme and the minutes of a joint HOSC working group meeting with Brighton & Sussex University Hospital NHS Trust (BSUH).

8.2       The Committee RESOLVED to:

1) note the work programme subject to removing the NHS Long Term Plan item and adding it as the subject of an away day to discuss potential future scrutiny subjects;

2) request a briefing providing the details of dentistry services in East Sussex is circulated by email.