Agenda and minutes

1.1          The minutes of the meeting held on 3^rd March 2022 were agreed as a correct record.

2.1          Apologies for absence were received from Cllr Christine Brett and Cllr Amanda Morris.

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 seeking agreement of the HOSC Review Board’s report on NHS proposals to reconfigure cardiology services in East Sussex.

5.2          The Committee asked for an outline of the next steps that would be taken before NHS representatives return to the HOSC with the final decisions for cardiology and ophthalmology.

5.3          Jessica Britton, Executive Managing Director of East Sussex Clinical Commissioning Group (CCG), explained that, should the HOSC agree the Review Board’s report and submit it to NHS Sussex (which replaces the CCG from 1^st July), there are a few activities that will take place. NHS Sussex will produce for both cardiology and ophthalmology a Decision Making Business Case (DMBC), which builds on the Pre-Consultation Business Case (PCBC) and will be informed by both the analysis of the public consultation and the HOSC recommendations, stating how the NHS will respond to the HOSC recommendations. In addition, for cardiology, the DMBC will be preceded by a site options appraisal, which is an extensive process to determine which of the two proposed sites would best deliver the outcomes agreed for the interventional element of cardiology.  The DMBC will then be agreed through NHS Sussex’s governance process culminating in the Integrated Care Board (ICB) meeting on 7^th September. The HOSC will then consider whether the ICB’s decision is in the best interest of health services locally at its meeting on 22^nd September [Note: the Committee has been subsequently advised that the decision will be reported to HOSC meeting on 15^th December].

5.4          Michael Farrer said that the Trust and CCG are in the process of drawing up a detailed implementation timeline as part of the DMBC, in consultation with the Trust’s Estates and Finance Teams. The intention is to implement the decisions, subject to endorsement by the HOSC, as soon as possible and in the right way for patients.

5.5          The Committee asked for clarification whether the impact on patient flows from the north of East Sussex (the High Weald area) as a result of the decision by Kent & Medway CCG to centralise interventional cardiology services provided by Maidstone and Tunbridge Wells NHS Trust (MTW) to Maidstone Hospital has been considered by the CCG.

5.6          Jessica Britton said that the impact of the MTW reconfiguration would feed into the options appraisal. Michael Farrer confirmed that patient flow modelling for patients in the north of the county had already been undertaken and the CCG and Trust were aware of the decision by MTW and the Kent and Medway CCG to move interventional cardiology services to Maidstone Hospital. Michael Farrer said that the CCG and Trust is confident that the changes to patient flows for patients in the north of the county would be negligible. He clarified that MTW does not provide Primary Percutaneous Coronary Interventions (PPCIs) at either of its sites – either in the current or future configuration – so the emergency patient flows for patients in the north of the county would not  ...  view the full minutes text for item 5.

6.1          The Committee considered a report seeking agreement of the HOSC Review Board’s report on NHS proposals to reconfigure ophthalmology services in East Sussex.

6.2          The Committee asked whether the proposed changes would help address the waiting lists for consultations and procedures in ophthalmology.

6.3          Richard Milner said that a key aim of the Trust this financial year is to reduce the waiting list across all specialities and not just ophthalmology. This will involve reducing the backlog of outstanding appointments caused by COVID-19 whilst also managing additional new appointments based on clinical need. This can be achieved in part by optimising the available medical workforce to see more patients, and one of the key aims of the ophthalmology proposals is to increase capacity of the existing workforce by concentrating them on two sites. In addition, there is a wider ophthalmology transformation programme across NHS Sussex to train community ophthalmologists to enable people to receive ophthalmology care in the high street, where appropriate. By consolidating the acute service, ESHT will be able to free up its consultant ophthalmologists to train some of the community ophthalmologists. This will not only increase capacity and help reduce the backlog but will also improve patient outcomes by allowing them to be treated earlier, quicker and closer to home.

6.4          The Committee asked for further details on the expansion of available parking at Bexhill Hospital as part of the proposals.

6.5          Michael Farrer said the Travel and Access Group’s remit included looking at the opportunities for increased parking at the Bexhill Hospital site. He said that the CCG and Trust know that the additional number of ophthalmology patients attending the site, based on an increase of eight patients per hour for the clinics, will equate to 10 additional parking spaces. The Trust is confident it can absorb that number of spaces on the site, however, that is a minimum number, and the Trust is exploring with its Estates Team options for further expansion of parking on the site. The parking details will be included in the DMBC.

6.6          The Committee asked whether data for ‘did not attend’ patients would be collected to understand what barriers there were for patients attending.

6.7          Michael Farrer said the CCG and Trust fully agreed with the HOSC Review Board’s recommendation around collecting ‘did not attend’ (DNA) data. At the moment, the Trust systems do not allow the collection of DNA data, as the patients did not attend an appointment to be asked that question. The Trust does, however, follow up DNAs to make sure they rebook their appointment and are not discharged back to their GPs, and there is an opportunity then to have a conversation about why they did not attend and to record that reason. Anecdotally, the reason people did not attend is not because they physically could not get to the Bexhill site, for example, during the pandemic when services were single-sited at Bexhill, there did not appear to be an increase in the number of  ...  view the full minutes text for item 6.

7.1          The Committee considered a report providing an overview of access to GP surgeries and appointments following the Covid-19 pandemic, including the challenges Practices are facing in returning services to pre-Covid levels and changes in working practices.

7.2          The Committee asked when the number of available appointments will recover to pre-pandemic levels.

7.3          Amy Galea explained that the data showed the number of available appointments has now returned to pre-pandemic levels. What has changed, however, is that individual practices are now operating virtual appointments alongside face-to-face appointments. This has advantages to some parts of population, but others still prefer face to face appointments. The CCG is working with Practices to understand what the right balance and mix of appointments could be for their practice list, which varies from practice to practice due to the demographic makeup of their lists.

7.4          Amy Galea added that the CCG is trying to understand the reasons why people are making GP appointments. The data shows half the appointments patients make are for the same day they contact the GP practice. This suggests there is unmet demand, if half the patients have to wait longer. It is also necessary to understand whether people who have a same day appointment need to have it on the same day, or whether it is less urgent. The healthcare needs of callers are being assessed as part of a piece of work being undertaken with some practices in Sussex. In addition, the CCG is working with ESHT to understand why some people are using the ED on the same day they have a GP appointment later in the day.

7.5          In addition to this work, Amy Galea said a pilot has begun in Brighton & Hove involving a team of healthcare workers either going to people’s homes or locations like a town hall to offer primary care services. This is designed to benefit people who may not want or be able to access a GP practice. If successful, it may be rolled out across Sussex.

7.6          The Committee asked for clarification how the needs of the 50% of patients who do not receive a same day appointment can be served.

7.7          Amy Galea clarified that whilst half of patients who call the practices are not getting a same day appointment, it is not necessarily the case that they all wanted to have one that day. Similarly, patients who did receive a same day appointment may not have needed one but were able to get through and book one. Furthermore, not all practices have the facility to book patients ahead and require patients to call up each day until they get an appointment for that day, which is unproductive for both the individual and practice.

7.8          Amy Galea said there is currently no way of measuring the telephony systems to understand in a systemic way why people requested an appointment on the day and whether the reason they did was appropriate or not.  The CCGs are working to understand these issues  ...  view the full minutes text for item 7.

8.1          The Committee considered its work programme.

8.2          The Committee RESOLVED to agree the work programme subject to the addition of the following items:

1) the addition of a report on SECAmb’s response to the Care Quality Commission (CQC) report at the 22^nd September meeting;

2) agree that the Chair, Vice-Chair and Cllr Hallett meet with relevant officers to discuss the Crowborough Minor Injuries Unit.