Agenda and minutes

38.1.      The minutes of the meeting held on 10^th December 2020 were agreed as a correct record.

39.1.      Apologies for absence were received from 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.

40.1.      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.

41.1.      There were no urgent items.

42.1.      The Committee considered a report on the redesign of Inpatient Mental Health Services in East Sussex, with a focus on the services provided at the Department of Psychiatry being moved on to a new site within the next three years.

42.2.      The Committee asked what the advantages were of having services on a single site compared to the current spread of services over three sites.

42.3.      Paula Kirkland, Programme Director, said that the CCG and Sussex Partnership NHS Foundation Trust (SPFT), together with other stakeholders, had identified that as a longer term vision there could be several advantages of co-locating all services on a single site operating as a centre of excellence. These were principally around better staff recruitment and retention, patient experience, safety and capacity and clinical excellence.  This would be because:

• the site would appeal to staff as a place where they could get the best possible clinical experience from a variety of specialities and benefit from higher quality teaching;
• staff could be moved between wards to cover gaps in staffing rather than move around the county between the existing three sites;
• wards could be adapted over time to match changing demographics, such as turning working age into older peoples wards; and
• the service would meet the minimum recommended guidance for co-locating at least three-wards. Uckfield dementia ward is currently a single, isolated ward.

42.4.      The Committee asked for clarity as to whether there are plans to move all inpatient mental health services onto a single site

42.5.      Jessica Britton, Executive Director, East Sussex CCG, clarified that a potential longer term vision for a campus approach has emerged from engagement with stakeholders. This does not form part of the more  immediate and concrete plans being developed for the future of the Department of Psychiatry (DoP) currently at the Eastbourne District General Hospital (EDGH) site. The current priority is to eradicate the dormitory wards at the DoP – both to meet the national requirement and to deliver significant improvements to local people – however, any replacement service for the DoP will be designed in such a way as to be able to accommodate any future plans that might include the services that are currently located at Beechwood unit at Uckfield and Woodlands Centre at Conquest Hospital.

42.6.      The Committee asked for confirmation that any plans to replace the DoP or create a single mental health inpatient site would take into account the impact on travel times and on residents in more deprived areas such as Hastings.

42.7.      Simone Button, Chief Operating Officer, SPFT confirmed any benefits of a future single campus site would need to be weighed against travel arrangements for staff, patients, and their carers and families. Jessica Britton said further work will be done on understanding where people travel in the county to receive inpatient mental health care. Furthermore, any future plans for a single campus would look at the impact on patients and their families, including those from deprived areas.

42.8.      The Committee  ...  view the full minutes text for item 42.

43.1.      The Committee considered a report providing an update on the proposed development of Cardiology and Ophthalmology services at East Sussex Healthcare NHS Trust (ESHT).

43.2.      The Committee requested confirmation at its next meeting on the number of patients who would be affected by the proposals, particularly for cardiology; the location of these patients; the current number of cross-site transfers of patients; and whether the proposals will affect patient flows of cardiology services in East Sussex.

43.3.      Joe Chadwick-Bell confirmed that the impact on the population, changes in patient flows, including cross-site transfers, and impact on other NHS organisations is all considered during the options appraisal process and in the PCBC. These details will be made available to the HOSC at its 10^th June meeting.

43.4.      The Committee asked why ESHT’s cardiac cath labs do not carry out thrombectomies (mechanical removal of blood clots).

43.5.      Joe Chadwick-Bell clarified that clot busting procedures are available at ESHT but more complex tertiary procedures like cardiac surgery would not be provided on every NHS hospital site due to the low volumes and necessary high expertise of the surgeons who perform them. They would, however, be carried out at regional centres of excellence such as the Royal Sussex County Hospital (RSCH) in Brighton. The aim of the cardiology reconfiguration is not to ensure all cardiac procedures are provided at ESHT but that the services provided at its hospitals are best practice for a district general hospital.

43.6.      Joe Chadwick-Bell said the options appraisal and PCBC will make clear what services are provided on the sites currently and what will be in future. This will also include background information on what services are provided in specialist tertiary sites.

43.7.      The Committee asked whether South East Coast Ambulance NHS Foundation Trust (SECAmb) has concerns about longer travel times for patients needing cardiology treatment, and what advantages there might be if they receive care at a centre of excellence.

43.8.      Joe Chadwick-Bell explained that the operating model of the current cardiology services involves both hospital sites providing a weekday service for acute cardiac services, but evening and weekend services are provided from a single site that alternates between the two. SECAmb is involved in transporting patients under this configuration and has indicated it has no impact on their resources.

43.9.       Michael Farrer, Strategy, Innovation & Planning Team at ESHT, said that the PCBC will include modelling work on the impact of the proposals on patients, including travel time, but a full answer is not currently available on the potential impact. SECAmb will also be involved in the options appraisal process that precedes the PCBC to provide their opinion on the potential impact on their service for each option.

43.10.   The Committee asked how the CCG will have the capacity to run the inpatient mental health and cardiology/ophthalmology consultations at the same time.

43.11.   Jessica Britton said that the CCG, which is the responsible organisation for both consultations, will resource them jointly with the two trusts  ...  view the full minutes text for item 43.

44.1.      The Committee considered a report providing an update from SECAmb on a number of areas, including performance against national response times and the new NHS 111 service.

44.2.      Ray Savage, Strategy and Partnership Manager at SECAmb, clarified that there was an error in one of the tables in appendix A (p. 53). In the table ‘Sussex CCG performance 2020’, The East Sussex CCG entry for Category 1 said 00:18:18 but it should have read 00:08:18.

44.3.      The Committee asked whether there were sufficient resources to meet the category response targets consistently in the future in East Sussex.

44.4.      Mark Eley, Associate Director of Operations – East at SECAmb, said the Category 1 and 2 targets are challenging to achieve in East Sussex compared to other areas in its patch, such as Brighton & Hove, due to the rurality of the county. The low population density and country roads make it very challenging to reach a patient in the 7 minutes required for a Category 1 response. Staff sickness due COVID-19 and the winter weather has made it harder in the last few months to respond as quickly. He clarified that the 7-minute performance of SECAmb is taken as an average. Therefore, to balance out the slower response in rural areas, ambulance crews in urban areas such as Brighton & Hove are expected to respond in less time. He added that SECAmb aims to arrive as soon as possible, not just at the mandated response time.

44.5.      Mark Eley said the Trust continues to look at all opportunities to  improve its performance, including reviewing local standby points to make sure they are in the best place relative to population centres and that the appropriate number of ambulances are located closest to those areas that require them most often, for example, those with higher health inequalities.

44.6.      The Committee asked how many clinical staff are working for the Clinical Assessment Service (CAS) and whether they were working in a call centre or remotely.

44.7.      Simon Clarke, Head of Operations, Integrated Urgent Care, 999 & 111, said the CAS has approximately 130 whole time equivalent (WTE) clinicians, which is made up of many more individuals due to not all of them doing it full time. This workforce includes General Practitioners (GPs), Advanced Nurse Practitioners, midwives, dental nurses, pharmacists, mental health nurses, and urgent care practitioners. The majority are working remotely, in part due to COVID-19 restrictions, but a certain number are required in the Emergency Operations Centres to be able to give direct advice to call handlers in the call centres when immediate advice is needed for a challenging call.

44.8.      The Committee asked about the performance of Think NHS 111 First.

44.9.      Simon Clarke said that it launched officially in December, although there had been an earlier soft launch. The aim of Think NHS 111 First is to reduce ED attendance by providing anyone who calls 111 with a disposition that may require them to go to an ED with  ...  view the full minutes text for item 44.

45.1.      The Committee considered a report on the NHS response to COVID-19 in East Sussex and its ongoing impact on NHS services for East Sussex residents. The Committee also considered a presentation by Darrell Gale, Director of Public Health, on the current number of infections in East Sussex.

45.2.      The Committee asked whether there were any issues with capacity for the vaccine programme as people’s second jabs begin.

45.3.      Jessica Britton said that the local vaccine programme is on target to meet and in some cases exceed the national targets. The Executive Director said she is confident the current logistical set up will enable both first jabs and second jabs to take place in the coming weeks.

45.4.      The Committee asked whether the big difference in the death rate of the two waves may be in part due to less observation of the lockdown in the second wave.

45.5.      Darrell Gale said there had certainly been different behaviours between the lockdowns. The first lockdown was almost universally observed by people and people had been reluctant to travel to the coast, in part due to the early closure of activities by the local authorities. People, however, were far more reticent to go in to or observe the November lockdown. In addition, many employers had to stop trading in March but by the time of the second lockdown in November, a lot more businesses were open and requiring staff to go in.

45.6.      Darrell Gale added that the virology of the second variant was so different to the first that it was almost like a new pandemic with a much higher transmission rate and higher mortality rate.  Consequently, whilst the second lockdown did slow down the increase in cases from the original variant of the virus, the third lockdown over Christmas was in response to the new Kent variant but came too late to stop it. The third lockdown is also the predominant cause of the decline in infections currently being observed. This is because the vaccine is having an impact on hospitals and deaths nationally, but the numbers are too small to be able to see a definitive local trend.

45.7.      The Director of Public Health said he had been hearing anecdotally about a large numbers of visitors to the coast in the recent warmer weather. He reminded everyone that  the country is still in lockdown, so people are required to stay at home and only travel locally for essential supplies and exercise. 

45.8.      The Committee asked what the figures for uptake of the vaccine are in the Black, Asian and Minority Ethnic (BAME) community and how authorities planned to improve uptake amongst BAME residents.

45.9.      Darrell Gale said the figures nationally showed a poorer uptake in certain communities, particularly amongst the Black African community.  The data shows who has had the vaccine, but it takes a while to work out who has not and this task is more difficult where a population is small. The BAME population in East Sussex  ...  view the full minutes text for item 45.

46.1.      The Committee considered its work programme.

46.2.      The Committee RESOLVED to agree its work programme subject to the following changes:

• add reports on Cardiology and Ophthalmology and Inpatient Mental Health to 10^th June;
• combine the cancer services update report with a COVID-19 update on 10^th June;
• move transition services and Sussex-wide review of emotional health and wellbeing support for children and young people reports to a later meeting;
• provide an update on NHS 111 on 23^rd September; and
• move the Primary Care Led Hub report to the 23^rd September meeting.