Agenda and minutes

18.1     The minutes of the meeting held on 22 September 2022 were agreed as a correct record.

19.1     Apologies for absence were received from Councillor Mary Barnes and Councillor Candy Vaughan.

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.

20.1     There were no disclosures of interests.

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.

21.1     There were none.

22.1     The Committee considered a report on the NHS Sussex Winter Plan. The Winter Plan sets out how the local health and social care system plans to effectively manage the capacity and demand pressures anticipated during the Winter period. The Winter Plan is a whole system health and social care plan, recognising the interdependencies of the system to meet the needs of the local population and runs from October 2022 to April 2023.

22.2     The Committee welcomed the degree of collaboration and focus on admission avoidance in the Winter Plan and asked if there were any particular areas or specialities where there were concerns.

22.3     Adam Doyle, Chief Executive Officer NHS Sussex, outlined there were four main areas which the system is working on areas of risk. These are:

• The numbers of people having a response to an ambulance call out. Work started two months ago to reduce 60 minute handover delays to ensure patients are seen quickly and free ambulances to respond to other calls and also as part of the rapid improvement programmes looking at patients who could be seen by a different service (e.g. community nursing teams) rather than waiting for an ambulance.
• Work to monitor and reduce the number of people in Emergency Department (EDs) waiting over 12 hours for a bed. Performance against this measure is quite good in East Sussex.
• Working with the Sussex Partnership Foundation Trust (SPFT) on mental health presentations in emergency (ED) and urgent care pathways to make sure people are seen quickly.
• The risk to the workforce from staff shortages across the system and the affect on staff morale. There is a weekly leadership meeting which looks at staffing issues. This is also being addressed in longer term through the 10 year workforce plan.

22.4     The Committee asked what the position was for upper gastrointestinal (GI) surgery at the Royal Sussex Hospital after the suspension of some non-urgent surgery following the Care Quality Commission (CQC) inspection and the subsequent press release.

22.5     Adam Doyle outlined that NHS Sussex works very closely with the CQC and was aware of the inspection and suspension of some surgery. All patients who have been affected by this have been contacted to let them know what their care pathway will be. Communications were sent out by the University Hospitals Sussex Trust (UHSx) and NHS Sussex will review how communications are handled should a similar situation occur in future. Adam Doyle offered to speak to Cllr Osborne outside the meeting concerning the communications with GP practices in her area.

22.6     The Committee asked what the impact had been on bed occupancy and making sure patients are seen, as the Winter Plan had been operating since October.

22.7     Adam Doyle responded by providing an overview of the position. From October to the end of November all measures were tracking in the right direction in terms of the numbers of people waiting over 12 hours for a bed and over 60 minutes for a handover from an ambulance.  ...  view the full minutes text for item 22.

23.1     The Committee considered a report on the proposed changes to Cardiology services in East Sussex which have been agreed by the NHS Sussex Board.

23.2     The Committee asked about the implications of SECAmb ambulance response times on the door to balloon (treatment) times for those patients affected by the proposed changes to the location of specialist cardiac procedures, especially during busy periods.

23.3     Professor Nik Patel, Clinical Lead for Cardiology (ESHT) outlined that for heart attack management patients who need urgent treatment there are around 190 patients a year which is less than 3% of the total. At present, out of hours, these patients do travel to either the Eastbourne District General Hospital (EDGH) or the Conquest Hospital in Hasting for treatment. Irrespective of site the Trust is well within the 75% door to balloon and national target times for treatment. The Trust works very closely with SECAmb who prioritises heart attack patients and the Trust has worked with them on the proposed changes to the service in all the patient pathways. There is a pre-alert system in place to make sure patients are seen quickly and by the right people when they get to hospital. Patients are also assessed by ambulance crews who have access to specialist advice before they leave for the hospital. Professor Nik Patel confirmed that performance against door to balloon times (e.g. for primary angioplasty) during normal working hours and busy periods are within the national performance thresholds.

23.4     Some Committee members expressed concerns about the travelling times for patients experiencing a heart attack and asked if ambulance crews have a problem stabilising a patient whether they would be taken to the Conquest Hospital first and then transferred to EDGH.

23.5     Professor Patel responded that this will depend on the circumstances of the individual patient and the decision of the ambulance service at the time. In the last 12-18 months the Trust has had the opportunity to improve the pathway for patients experiencing a cardiac arrest with a pre-alert system. This enables ambulance crews to notify the hospital of a heart attack patient and have the right people in the right place to treat the patient. This has resulted in better outcomes for the patients and taking patients to the designated site first is preferred by SEACamb. This was made possible because the changes in the proposed model of care allow the right people to be in the right place to receive and treat patients when they get to hospital. It is not just about travel times but having the people with the right expertise to treat these highly complex conditions in order to achieve positive outcomes for patients.

23.6     The Committee asked how moving patient treatment from the Conquest Hospital to EDGH and patients having to travel further would help reduce health inequalities in Hastings which is one of the most deprived areas in the County.

23.7     Professor Patel outlined that the people who need urgent specialist treatment for heart attack management  ...  view the full minutes text for item 23.

24.1     The Committee considered a report on the proposed changes to Ophthalmology services in East Sussex which have been agreed by the NHS Sussex Board.

24.2     The Committee noted that under the proposals around nine to ten additional patients per hour will be attending the Bexhill Hospital site. It asked how many additional parking spaces, including disabled parking spaces, will be provided.

24.3     Jessica Britton outlined that additional parking at the Bexhill Hospital site has been factored into the Decision Making Business Case (DMBC) and capital money has been allocated for this to reduce the impact on local residents.

24.4     Mike Farrer, Head of Strategic Transformation, added that as a result of HOSC’s recommendations there will be an increase in the amount of parking available and this is reflected in the DMBC. There will be at least ten additional parking spaces and the Trust is looking at whether it might be possible to add more.

24.5     The Committee commented that the service is very good but waiting times needed to be lowered.

24.6     Mr Kashif Qureshi, ICS Speciality Clinical Lead for Ophthalmology acknowledged that waiting times were longer that the Trust would like. Reducing waiting times is one of the reasons for the proposed changes and is addressed by the DMBC. The new service model will have more space and a multi-disciplinary team which will be able to see more patients and provide faster diagnosis. At present there is a limit on the number of patients the service can see. The DMBC will address waiting times for procedures such as cataract surgery with more staff and the one-stop clinics which will speed up the assessment process.

24.7     The Committee asked what the timescales are for getting the Travel Liaison Officer role in place.

24.8     Michael Farrer outlined that the Travel Liaison Officer will be in place by the time the changes take place and patients are transferred from being seen at the Conquest Hospital. He added that this proposal is being taken further with the re-commissioning of the non-emergency Patient Transport Service which will have within it a single point of access for all patients when they come for their appointments. As well as having the Travel Liaison Officer for Cardiology and Ophthalmology patients the Trust is discussing with NHS Sussex having this role available for all outpatients and it looks like this might be possible as part of the re-commissioning of the non-emergency Patient Transport Service.

24.9     The Committee RESOLVED unanimously to agree that NHS Sussex’s decision as set out in paragraph 2.1 of the report in relation to the changes to the future provision of Ophthalmology services by the East Sussex Healthcare NHS Trust (ESHT) is in the best interest of the health service in East Sussex.

25.1     The Committee received a report which provided an update on access to Primary Care services in East Sussex, including GP appointments and surgeries, and access to NHS Dentistry.

25.2     The Committee asked what is going to change to increase access to regular NHS Dentistry appointments.

25.3     Amy Galea, Chief Primary Care Officer NHS Sussex, outlined that there two elements in the report that address this question. One is the number of units of NHS Dentistry activity commissioned across East Sussex and the other is an increase units of activity post pandemic at two dental practices, one in Hastings and the other in St. Leonards who have capacity to offer more NHS appointments. In the longer term the hope is that the reforms announced by Government will increase access. NHS Sussex is also exploring with dental practices what flexibility there is locally across East Sussex to increase access and what NHS Sussex can do to support this. NHS Dentistry has previously been commissioned through a national contract before it was delegated to NHS Sussex and NHS Sussex is working with colleagues in NHS England to see what can be done to improve access. NHS Dentistry is facing some of the same workforce challenges and pressures that the rest of the NHS is facing.

25.4     In terms of access to GP appointments, the Committee asked if online booking and e-consult services are widely available across East Sussex.

25.5     Amy Galea responded that although GP appointment levels are at the same level or higher than before the pandemic, there is some variability across East Sussex in the offer from GP practices and the tools they use. Although online booking and e-consult can be incredibly helpful, some practices have taken the decision not to use them and ‘switch them off’. All practices across East Sussex have the ability to use these facilities and NHS Sussex is trying to ensure that all GP practices are offering them to their patients by the end of January 2023. NHS Sussex is working with practices to improve the publicity of these facilities by including information on their web sites and include them within the literature and leaflets they give out within their practices. The other way of accessing GP services is through the NHS App and around 60% of people in East Sussex are using the app, which allows you to book an appointment at your GP practice.

25.6     The Committee asked if booking GP appointments by telephone will be restricted to particular times (e.g. 8.00am to 9.00am as some practices do) or will can people ring anytime.

25.7     Amy Galea outlined that NHS Sussex is aware that some practices only make e-consult available at some times of the day and are trying to make sure this additional functionality is available at all times of the day. The reason for this is that practices need time to think through how they are going to manage the different forms of access and communication channels with the resources they  ...  view the full minutes text for item 25.

26.1     The Committee discussed the future work programme and noted that reports will be added in line with paragraph 22.37 to have an update report on the NHS Winter Plan at the 2 March 2023 meeting and paragraph 25.32 above.

26.2     The Committee also agreed to add a report on Patient Transport Services to the work programme. The Senior Scrutiny Adviser will liaise with Claudia Griffith to agree a timescale for the report.

27.1     There were none.