Agenda and minutes

15.1 The minutes of the meeting held on 23  September 2021 were agreed as a correct record.

16.1     Apologies for absence were received from Cllr Amanda Morris, Geraldine Des Moulins, and 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.

17.1       Cllr Richard Hallett declared a personal, non-prejudicial interest in item 8 as a member of Friends of Crowborough Hospital.

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 overview of the proposals to redesign cardiology services at Maidstone and Tunbridge Wells NHS Trust (MTW), which are used by some patients in East Sussex.

19.2.    The Committee asked what South East Coast Ambulance NHS Foundation Trust’s (SECAmb) views were of the requirement under the proposals to transfer some patients from the Emergency Department (ED) on the ‘cold’ site to the Coronary Care Unit or cath lab on the ‘hot’ site.

19.3.    Dr Laurence Nunn, Consultant Cardiologist and Clinical lead for Cardiology at MTW confirmed the Trust has designed the service to minimise the burden on SECAmb. The ambulance trust is fully involved with the plans and MTW has been meeting with them to discuss, amongst other things, the impact of the single siting; agreement of protocols for admitting patients directly to the specialist site; and how to enable SECAmb to contact the consultant cardiologists via telemedicine, which has been used successfully for stroke services and for tertiary cardiology centres like Ashford and Guys and St Thomas. He added the patients will receive emergency treatment at both sites and the ED on both sites will be able to use telemedicine to enable consultant cardiologists at the specialist site to determine whether the patient would need to be transferred to the Coronary Care Unit.

19.4.    The Committee asked how the proposed changes will impact travel times of patients.

19.5.    Jo Cutting, Programme Director for Cardiology at MTW, said the Trust had conducted robust analysis of the travel times both by car and public transport, and the time of day of the journey. This analysis showed that whichever option is chosen will result in extended travel for a small number of people, however, the clinical improvements, particularly the reduction in length of stay made possible by having expertise on site 24/7, will reduce the number of journeys families and friends have to make. The Trust will also look to mitigate the impact, for example, through hospital transport and dedicated car parking for whichever option is chosen.

19.6.    The Committee asked how the single site might achieve ‘centre of excellence’ status.

19.7.    Dr Laurence Nunn said the primary reason for the reconfiguration is to provide a robust cardiology service 24/7 for all cardiology emergencies, however, there is no reason why the services could not be enhanced further. Whilst no decision has been made on the site yet, one of the advantages of locating it at Maidstone Hospital would be to allow co-adjacency with stroke services that may allow for thrombectomies (mechanical removal of blood clots during a stroke) to be performed at the cardiology cath labs. Dr Peter Maskell, Medical Director at MTW, added that single siting expertise should allow for more complex procedures to be performed locally rather than having to transfer patients to London.

19.8.    The Committee asked how MTW was conducting its public engagement in East Sussex. 

19.9.    Jo Cutting explained that the engagement has been advertised very widely  ...  view the full minutes text for item 19.

20.1.    The Committee considered a report providing an overview of the proposals for reconfiguring cardiology services currently provided by East Sussex Healthcare NHS Trust (ESHT).

20.2.    The Committee asked what the impact of the reconfiguration would be on the current pressures on ambulance services and the EDs.

20.3.    Prof. Nik Patel, Cardiology Clinical Lead at ESHT, explained that SECAmb, despite the pressures currently on it, is maintaining a very good service for patients having an acute heart attack. Prof. Patel agreed that the issue of bottlenecks at ED was exactly the area the reconfiguration aims to rectify through the creation of a cardiac response team within the ED. This will mean patients should be able to be seen in 30 minutes to an hour rather than more than four hours wait they currently experience, and this was demonstrated to work when the model was tested during the pandemic. The creation of hot clinics that allow imaging, mainly ultrasound, in ED will also mean decisions can be made more swiftly about what to do with a patient. Prof Patel added that the temporary reconfiguration of cath labs at times during the last 18 months have allowed the Trust to admit any patient arriving in cardiac arrest directly to a cath lab where cardiologists, nurses and anaesthetists are waiting on hand, rather than taking them to the ED and calling them all down to attend. SECAmb has helped improve this pathway and prefers to admit patients directly to the cath labs.

20.4.    The Committee asked whether the reconfiguration would increase capacity for imaging and diagnostics such as MRI scans.

20.5.    Prof Patel said ultrasound is the most important test for diagnosing cardiac conditions and the hot clinics will enable swifter use of ultrasound. The Trust has excellent magnetic resonance imaging (MRI) scanners, but the use of MRI scans is not necessary to make a cardiac diagnosis. In addition, ESHT’s computed tomography (CT) scanning times for acute stroke in 1 hour are one of the highest in the country and the Trust receives an A rating for it.

20.6.    The Committee asked whether staff are being consulted on both proposed changes at ESHT.

20.7.    Tom Gurney, Executive Director of Communications and Public Involvement, said there is a communications and engagement plan for staff separate to the public consultation. This engagement will focus on ESHT staff, but also to a lesser degree on all provider staff including those working for SECAmb. Joe Chadwick-Bell, Chief Executive of ESHT, added that both cardiology and ophthalmology have been driven by clinical teams themselves and are not top-down reorganisations, meaning the main affected teams have been fully engaged throughout the process. Dr Patel has also engaged with other specialities’ clinical teams across the Trust quite significantly over the last four years. The Chief Executive clarified that once a site is chosen by the CCG and Trust, there will need to be a further conversation with staff who will need to move site, however, this is  ...  view the full minutes text for item 20.

21.1.    The Committee considered a report providing an overview of the proposals for reconfiguring ophthalmology services currently provided by ESHT.

21.2.    The Committee asked what the Trust was doing to attract more specialist nurses and consultants given the growing demand for ophthalmology.

21.3.    Mr Kash Qureshi, Clinical Lead for Ophthalmology at ESHT, said the Trust has been quite successful recruiting consultants because it offers an attractive job specification that allows consultants to focus on operating and seeing patients. The change in model will also provide optometrists, orthoptics and nursing staff with expanded roles that enable them to deliver clinical treatments and eye clinics themselves, which does not usually happen at other trusts and will make the roles more attractive. Mr Qureshi added that all three roles between them already provide the majority of injections for patients with macular degeneration, which patients prefer as it provides continuity of care. The ophthalmology service is also providing opportunities for community optometrists to learn new skills in the hospitals, such as training them to do laser interventions. Very few trusts offer this service and it benefits patients by increasing the skill set of community optometrists. 

21.4.    The Committee asked whether the new one stop clinics established at Bexhill Hospital and Eastbourne District General Hospital (EDGH) will be open seven days per week.

21.5.    Mr Kash Quershi said there is seven-day access for emergency and urgent eye care problems and waiting list activity is currently being carried out seven days per week due to the backlog, however, there are no plans to carry out routine care via a seven day service. The Trust is, however, planning to provide three sessions per day with the addition of an evening slot from 5-8pm, which will provide more capacity for adult clinics.

21.6.    The Committee asked whether the proposals will involve purchasing new equipment and whether this will be funded by additional capital investment.

21.7.    Mr Kash Quershi said rationalising services from three sites to two will mean the service will need less equipment and can use what it has more efficiently.  Joe Chadwick-Bell added that the capital funding is nationally allocated to Integrated Care Systems (ICS), which then allocate it to individual providers based on need. Each provider trust determines its capital needs through an annual process of prioritising investment for digital, medical equipment, and building works. Any replacement of ophthalmology equipment will be considered within this process. The Chief Executive added that charitable organisations also often provide equipment to the Trust, which the Trust is very grateful for.

21.8.    The Committee asked whether Bexhill Hospital will be able to accommodate the additional parking demands of staff from Conquest Hospital.

21.9.    Michael Farrer, Strategic Transformation Manager at ESHT, said a lot of the patients who attend Bexhill are driven there by family or friends, as many will not be able to travel home afterwards. Parking is an issue that will be picked up during the consultation process and possible solutions will be developed with stakeholders as the  ...  view the full minutes text for item 21.

22.1.    The Committee considered a report providing an overview of the East Sussex Winter Plan for 2021/22.

22.2.    The Committee asked how the NHS would deliver the new vaccine programme following the Omicron outbreak.

22.3.    Darrell Gale, Director of Public Health, said his view of the new variant was one of caution but not deep concern, as a lot of work is already being done to reduce the delta variant’s impact. He said the announcement to increase the booster programme in response to the Omicron variant has caused some confusion amongst residents, as it is not the case that people can just turn up at a vaccine site to receive the booster; people need to wait to be contacted by the NHS.  This is because not everyone is eligible yet and the vaccine programme cannot just double its capacity of vaccines, slots and staff overnight. Jessica Britton, Executive Director of East Sussex CCG, added that all residents will be eligible for the booster by the end of January and that to date 70% of those in Sussex over the age of 40 who are eligible have already had the booster. The Executive Director said the additional demand across the whole of Sussex for all patients who will eventually be eligible for a booster is 625,000 additional vaccines between now and the end of January. Currently 80-90,000 are delivered per week, meaning operations would need to be scaled up to deliver 120,000 per week to meet the target and plans are being developed to achieve this.

22.4.    The Committee asked about the progress of vaccines for patients in their own homes who are clinically vulnerable.

22.5.    Jessica Britton said the NHS is continuing with the Housebound programme and is on target to ensure all people who were part of the initial programme receive their booster by the end of December using additional resources provided to the Primary Care Networks (PCNs). Darrell Gale confirmed the Greater Wealden PCN will have completed all of its Housebound boosters by the weekend.

22.6.    The Committee asked what the NHS can do to improve the resilience of the care home sector and how oversees recruitment will get round the cap on visas.

22.7.    Mark Stainton, Director of Adult Social Care, said that the biggest issue facing the home care and care home sector is workforce. East Sussex County Council (ESCC) is providing information and support to providers individually and as a sector during the winter period. This includes using central government funding to provide both home care and care home providers with financial aid to support their resilience over the winter period that is designed to help them retain the workforce they already have. ESCC also has joint recruitment initiatives with the care sector providers including a Department for Work and Pensions pilot, the Armed Forces Network, and oversees recruitment all designed to tap into parts of the employment market not yet utilised to the fullest. The oversees recruitment is in areas with an established health  ...  view the full minutes text for item 22.

23.1.    The Committee considered a report providing an overview of community mental health services available to patients in East Sussex.

23.2.    The Committee asked how the Associate Director of Housing role will deliver additional resources and improvements to supported housing.

23.3.    John Child, Chief Delivery Officer at Sussex Partnership NHS Foundation Trust (SPFT), explained that the Trust would expect the role to help SPFT create more formal partnerships and arrangements with supported housing organisations, community and voluntary sector organisations; help provide supported housing organisations with more bespoke clinical input to the people they support in a more timely way; reduce reliance on inpatient mental health services and help people to leave hospitals and rehab sooner; and help reduce street homelessness.

23.4.    The Committee asked whether all residents have access to primary mental health care and whether the funding is sufficient to deliver additional services.

23.5.    John Child said the Emotional Wellbeing Service (EWS) will provide community based, primary care mental health care in East Sussex, however, it is an enhanced version of the existing Health in Mind primary mental health service that all GPs can already refer patients to for issues like anxiety and depression. PCNs have been given additional resources to hire mental health practitioners and this will be used to enhance the EWS. The £7m of funding is for this year only and there will be additional funding in future years as the programme is scaled up.

23.6.    The Committee RESOLVED to:

1)         Note the report;

2)         Request a future update on the Emotional Wellbeing Service and Primary Care Networks and on the future of mental health investment for later in 2022.

24.1.    The Committee considered a report requesting the Committee’s view whether the NHS decision on the future of inpatient mental health services is in the best interest of the health service in East Sussex.

24.2.    The Committee RESOLVED to:

1)         Agree the decision is in the best interests of health services locally;

2)         Request a future update via email on the progress of the development of the new facility; and

3)         Request a site visit of the new facility.

25.1.    The HOSC considered its work programme.

25.2.    The Committee RESOLVED to agree its work programme subject to the addition of a report on:

•           the Health and Care Act 2022