Agenda and draft minutes

1.1 The minutes of the meeting held on 7 March 2024 were agreed as a correct record.

2.1 Apologies for absence were received from Councillor Christine Brett (Councillor Janet Baah substituting), Councillor Graham Shaw, 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.

3.1 Cllr Colin Belsey declared a personal non-prejudicial interest under agenda item 6 as he has a hearing problem and had previously visited East Sussex Hearing Resource Centre

3.2 Cllr Alan Shuttleworth declared a persona non-prejudicial interest under agenda item 6 as he has a hearing problem.

3.3 Cllr Mike Turner declared a personal non-prejudicial interest under agenda item 6 as he has a hearing problem.

3.4 Cllr Janet Baah declared a personal non-prejudicial interest as she is a Governor for Sussex Community NHS Foundation Trust.

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 updating on the outcomes of the changes to the paediatric service model at EDGH, and East Sussex Healthcare NHS Foundation Trust’s (ESHT) response to the recommendations of the Committee’s review report. Dr Matthew Clark, Chief of Women and Children Division ESHT, introduced the report and highlighted that there had been a slight decrease in the number of children being transferred to Conquest Hospital in Hastings, and that no patient safety incidents had been raised since the implementation of the new model.

5.2 The Committee asked for an update how the Scott Unit would be used in the future.

5.3 Dr Clark confirmed that the Scott Unit, which had previously housed the short-stay paediatric unit, was reserved for paediatric services. The area was currently being used as a paediatric outpatient area as the usual area on Friston Ward had needed to be temporarily closed for fire safety work. There was ongoing work on how the space could be used in the future to create a child-friendly environment for both acute and community paediatric services.

5.4 The Committee asked why the Committee’s recommendation of having the paediatric consultant responsible for GP telephone triage on-site at Eastbourne was not being progressed.

5.5 Dr Clark noted that presently there was a split between where the paediatric consultant doing telephone triage was located depending on where they were based. Roughly a third to half of the time the consultant was based at EDGH, and half to two thirds of the time they were based in Conquest. Having run the new model for six months there had been no noticeable advantage of having the consultant permanently based on-site at Eastbourne. Extensive discussions had taken place with the consultant body where there was an almost unanimous view that they did not need to be based at Eastbourne and the independent review had agreed. Dr Clark also confirmed that staffing of all services were under constant review, and where staff were based could and would be moved to match need and demand.

5.6 The Committee asked if ESHT had data on whether any families were travelling independently to Conquest Hospital in Hastings as a result of the changes.

5.7 Dr Clark noted that there was not a robust way for capturing this information, recognising that the ability of patients to choose where to be treated was a feature of how people accessed NHS healthcare. Dr Clarke added that if a child is unwell enough to be taken to hospital by ambulance, the ambulance would take them to the Conquest hospital and this has not changed.

5.8 The Committee asked for confirmation of whether there were any trainee paediatric consultants working at EDGH.

5.9 Dr Clark confirmed that there were currently no resident doctors (previously known as junior doctors) training to be paediatric consultants.

5.10     The Committee asked if there had been any changes in the number of complaints from staff, patients or families.

5.11     Dr Clark noted that the number of complaints  ...  view the full minutes text for item 5.

6.1 The Committee considered a report from NHS Sussex providing an overview of audiology services in East Sussex, including an outline of pathways, barriers to accessing audiology services and how services were commissioned including whether there were any commissioning gaps. The report also outlined future commissioning plans, noting the fragility of the provider market, and that NHS Sussex was seeking to implement a new model from July 2025.

6.2 The Committee noted that current audiology pathways were confusing to patients asked how this was being addressed.

Wendy Young, NHS Sussex Director of Acute Services Commissioning and Transformation, accepted that the pathways could be confusing for patients, as the Any Qualified Provider (AQP) contract model resulted in there being number providers. As part of the future commissioning of the service NHS Sussex aimed to make access to information and services much simpler, which would likely move away from the AQP model and to a single-Sussex model that would provide patients with a single point of entry for accessing the service.

6.3 The Committee raised concerns that there were insufficient levels of provision in some areas of the county, especially rural ones, and asked for comment.

6.4 Wendy Young noted that the current AQP model made it difficult to ensure there was sufficient coverage in areas with lower population density, because providers were paid based on activity, which made it more cost effective for them to be based in more densely populated areas. Wendy also noted that there was good coverage across East Sussex, but this could be improved under the new commissioning approach.

6.5 The Committee noted that in some cases people were being directed to private services where their GP practice did not provide earwax removal services and asked for explanation.

6.6 Wendy Young responded that the expectation of locally commissioned services was that if a particular practice did not offer earwax removal, then there should be an inter-practice referral to another practice that does offer it. There were ten practices in East Sussex that did not offer the service which should be offering inter-practice referral, and Wendy agreed to check that this was happening.

6.7 The Committee asked what services were available for people in domiciliary and care home settings.

6.8 Wendy Young explained there was a domiciliary service for patients unable to travel to appointments and this would continue under new commissioning arrangements. Wendy agreed to share the detail of the provision and criteria for access outside the meeting.

6.9 The Committee asked for detail on what the expected new commissioning model would look like.

6.10     Wendy Young responded that consideration was being given to a number of different commissioning models, noting that the AQP model incentivises providers to base themselves where they get the highest footfall and therefore highest income. It would most likely move towards a single-Sussex primary provider model, which would enable NHS Sussex to have more influence on the location of provider sites and ensure better access for patients.

6.11     The Committee noted that  ...  view the full minutes text for item 6.

7.1 The Committee considered a report providing an overview of SECAmb’s progress in its Improvement Journey following the findings of its 2022 CQC report, and updating on the latest performance figures of the Trust.

7.2 The Committee asked how SECAmb was working with other NHS bodies to prevent a loss of staff to other services, including GP practices.

7.3 Richard Harker, SECAmb Operating Unit Manager East Sussex, answered that staffing levels in East Sussex and across SECAmb were improving, following a fall in staff a few years ago. In the East Sussex area there was a fully established paramedic workforce. This was attributed to the improving culture within the service, and rising staff satisfaction. Matt Webb, SECAmb Associate Director of Strategy and Partnerships, added that the professional development offer at SECAmb, from working in a variety of healthcare settings, was one of its strengths and something that would improve staff retention levels.

7.4 The Committee asked how patients who had difficulty articulating their issues were triaged to ensure that the right support was sent to them.

7.5 Richard Harker noted that there was always a slight risk of mis-categorisation of priority, but call handlers were supported by the NHS Pathways system to ensure they were asking the right questions and people were correctly triaged. If there was any level of uncertainty that a patient could be in a higher category or a risk that they could deteriorate then an ambulance would always be dispatched. Matt Webb added that NHS Pathways was a tried and tested triaging system that was used nationally with a number of safety nets and a high risk threshold built. SECAmb’s service model of triaging quickly and accurately was to ensure patients were supported by the most appropriate clinician, as this was shown to be key to improved patient outcomes. An immediate physical response would not guarantee the right clinician was sent to a patient and therefore would not necessarily lead to the best patient outcome.

7.6 The Committee asked if there was always a paramedic present on every ambulance.

7.7 Richard Harker explained that there would not always be a registered paramedic onboard a dispatched ambulance. There were a number of grades below registered paramedic, such as associate ambulance practitioners and ambulance technicians who were qualified clinicians who could work on ambulances.

7.8 The Committee asked how ambulance crews had enough information to provide the correct support to patients.

7.9 Richard Harker explained that an ambulance crew would look for a number of different forms when it arrived at a scene, including ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), do not resuscitate, and treatment escalation plans. The condition of the patient would determine the urgency of asking for or finding these forms. SECAmb also had a service where these forms could be uploaded to its computer systems, giving ambulance crews advance sight of them prior to arrival on scene.

7.10     The Committee asked why the information referenced in the previous answer was not available  ...  view the full minutes text for item 7.

8.1 The Committee discussed the items on the future work programme.

8.2 The Committee noted that it had received a report outside of the meeting from NHS Sussex on access to diabetes technology and agreed that it was not necessary to have anything further on this issue on the work programme.

8.3 The Committee RESOLVED to amend the work programme in line with paragraphs 6.29 and 7.29.

9.1 None.