Venue: Council Chamber, County Hall, Lewes
Contact: Martin Jenks Senior Scrutiny Adviser
1.1 The minutes of the meeting held on 2 March 2023 were agreed as a correct record.
Apologies for absence
2.1 Apologies for absence were received from Councillor Abul Azad, Jennifer Twist, Geraldine Des Moulins and Jessica Britton.
Disclosures of interests
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 Councillor Graham Shaw declared a personal, non-prejudicial interest under item 8 Child and Adolescent Mental Health Services (CAMHS) as his wife works for a charity that has a contract to deliver social prescribing services in schools in East Sussex, which is partially funded by NHS Sussex.
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 an update and evaluation report on the NHS Sussex Winter Plan. The Winter Plan set out how the local health and social care system plans to effectively manage capacity and demand pressures anticipated during the Winter period and ran from October 2022 to April 2023.
5.2 The Committee asked how information sharing could be improved between hospital Trusts and ambulance crews.
5.3 Claudia Griffith, Chief Delivery Officer NHS Sussex responded that there was a programme of work taking place across the whole system to improve digital integration of patient care records so that ambulance crews had access to them when they arrive at a scene, and this work was ongoing.
5.4 The Committee asked what impact the winter period had on elective surgery waiting times, and how many patients were waiting over a year for surgery.
5.5 Claudia Griffith explained that elective waiting times had grown significantly since the beginning of the pandemic, but that East Sussex Healthcare NHS Trust (ESHT) had met the nationally set target of no one waiting longer than 78 weeks by the end of March, and was ahead of schedule in meeting the target for this year of no patients waiting over 65 weeks. University Hospital Sussex NHS Foundation Trust (UHSx) had not been able to meet the 78 week target due to the impact of industrial action, but was expected to have cleared the backlog of patients waiting more than 78 weeks by the end of July. NHS Sussex was exploring all available options to make best use of capacity that could help reduce patient waiting times. Claudia agreed to provide the number of people waiting more than a year in East Sussex outside the meeting.
5.6 The Committee asked for further details on whether there were any differences in recovery and outcomes for patients being cared for via new ‘Virtual Wards’ service model in the community, as opposed to those in hospital.
5.7 Claudia Griffith answered that there was evaluation work both locally and nationally to understand the clinical and financial impact of virtual wards. Initial assessments suggested the impact had been positive, but NHS Sussex was also bringing in an external consultant to fully understand the impact of new service models in order to evaluate whether they should be expanded. The outcomes of this work could be fed back to the HOSC.
5.8 The Committee asked why patients who had contacted 111 and were given a reserved slot at the Emergency Department (ED) were arriving at hospital to find that they had to wait.
5.9 Claudia Griffith answered that while there was an option to book appointments at EDs, there was still a need for clinical prioritisation. Therefore, if booked slots coincided with surges in demand then clinicians would focus attention on those at greatest risk, and it would not always be possible to maintain the slot.
5.10 The Committee asked how many patients in East Sussex had NHS access to Livi on line consultations.
5.11 Claudia Griffith ... view the full minutes text for item 5.
6.1 The Committee considered a report providing an update on the work being undertaken to reduce Hospital Handover times between South East Coast Ambulance NHS Foundation Trust’s (SECAmb) ambulances and the EDs of the three hospital trusts that provide services to East Sussex residents.
6.2 The Committee asked how communication could be improved between EDs and the 111 service to prevent reserved time slots being given out at times of higher demand in the ED.
6.3 Ray Savage, SECAmb Head of Strategic Partnerships and System Engagement answered that it was possible to indicate times of pressure for specific service pathways to 111 call handlers, as well as remove the option to book appointment slots at peak times, on the Directory of Services. Ray agreed to check whether this was the same process for booking appointment slots at EDs.
6.4 The Committee asked why the report showed average response times increasing as of May 2023 and how those increases were being mitigated.
6.5 Ray Savage noted that hotter weather led to an increase in demand for health services generally, so the sustained period of hotter weather during May and June had caused the increase. Matt Webb, SECAmb Associate Director Strategic Partnerships and System Engagement also noted there had been an increase in the daily average number of calls since January, but that despite the increase, average ambulance response times remained within defined tolerances of targets.
6.6 The Committee asked why the Pembury hospital had a fewer number of delays and what learning could be applied from this to other hospital sites.
6.7 Ray Savage commented that handover delays where often a consequence of other challenges at a hospital site, and that Maidstone and Tunbridge Wells NHS Trust (MTW) had done a significant amount of work to improve patient flow through the hospital. Laura O’Mahony, MTW Deputy General Manager Emergency Medicine added that having a dedicated member of staff on duty to assist ambulance crews with administration had helped in reducing delays. Hospital avoidance work was also important, such as by using virtual wards and 111 integration to direct patients to Urgent Treatment Centres rather than EDs.
6.8 The Committee asked what was causing the high level of sickness among staff and what was being done to address it.
6.9 Laura O’Mahony explained that a lot of the problems with sickness was due to staff burnout and low moral across the workforce after a difficult few years in the health service. At MTW sickness levels were decreasing and the Trust continued to monitor the situation and was putting a lot of work into supporting staff wellbeing.
6.10 The Committee asked if there was detailed information of any differences in average ambulance response times in different areas of the county.
6.11 Ray Savage confirmed that SECAmb had to report its data across its whole operational footprint, so this was not broken down by specific areas. SECAmb did monitor its own local performance to understand how responses differed between urban and ... 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, which led to a rating of inadequate in the well-led domain.
7.2 The Committee asked what the current rates of staff turnover and sickness were.
7.3 Matt Webb responded that SECAmb’s annual rolling turnover rate was 18.2% against a target of 10%. Although retention issues were sector-wide, SECAmb was investing heavily in improving leadership visibility and exit interviews to understand what could be done to improve staff retention. Since the pandemic there had been a significant increase in staff citing burnout and exhaustion as reasons for leaving. As part of its improvement journey SECAmb had appointed a Programme Director for People and Culture whose role was to implement the People and Culture Strategy that included aiming to improve staff wellbeing and Freedom to Speak Up processes. Other work had been done to improve rotas and reduce the burden on staff.
7.4 The Committee asked how staff were being engaged in SECAmb’s Improvement Journey, what feedback had they received from staff since it began and how the bullying culture identified in the CQC report was being addressed.
7.5 Matt Webb explained that SECAmb is actively communicating with staff on how concerns that they had raised were being addressed. A challenge for SECAmb as part of its improvement journey was that the nature of the CQC report required the organisation to make a number of regulatory improvements. However, having improved in those regulatory areas SECAmb was now better placed to address cultural issues. Staff and unions were engaged to help feed staff views into a five-year strategy which will make any improvements sustainable in the long term. SECAmb has also been working with Healthwatch to make sure patient views are also taken into account.
7.6 The Committee asked if there would be value in SECAmb running its own staff survey in order to track improvements.
7.7 Matt Webb explained that the work on leadership visibility was a more effective way of gaining staff feedback, as the visits were targeted and scheduled and allowed for a dialogue between frontline staff and the organisation leadership. Staff feedback from these visits had been positive as staff felt they were being heard and ensured there was more direct feedback than would otherwise be received through an online survey. SECAmb was also trialling engagement software that focused on smaller teams to provide more granular detail on staff views.
7.8 The Committee asked how many SECAmb managers were yet to complete a sexual safety workshop.
7.9 Matt Webb answered that the training was mandatory for all managers and leaders in SECAmb, and the uptake had been very high with more than half (70% of managers) already having attended one. Ray Savage added that the fact the course was externally led had been beneficial for ensuring there was no unconscious bias involved.
7.10 The Committee asked whether SECAmb had schemes that allowed staff to ... view the full minutes text for item 7.
8.1 The Committee considered a report providing an update on the Child and Adolescent Mental Health Services (CAMHS) in East Sussex, including the progress being made to reduce assessment waiting times and the impact of additional investment in CAMHS on service provision and performance.
8.2 The Committee asked whether all children and young people with mental health problems were being supported by CAMHS.
8.3 Alison Nuttall, Sussex Partnership Foundation Trust (SPFT) Operational Director for CAMHS & Specialist Services, answered that there is a shared Single Point of Access (SPoA) for children and young people with emotional wellbeing and mental health needs. All referrals were triaged through the SPoA to identify where a child’s needs would be best met, which would not always be the specialist services provided by SPFT. Lou Carter, East Sussex County Council Assistant Director (Communication, Planning and Performance), added that there were a number of other support options for a child or young person as part of the Early Help service which could mean they do not need to be referred to CAMHS.
8.4 The Committee asked when all children in schools will be covered by Mental Health Support Teams (MHSTs) and how mental health support was being offered in schools.
8.5 Lou Carter confirmed that it was not possible to say when there might be full coverage of MHSTs, but there was ongoing system-working to improve the Early Help and prevention offer and to ensure schools were aware of the full support offer for different levels of need. A poster had been developed and is to be circulated to schools which would make it clearer what services are available for different levels of need, and a broader piece of work is ongoing to make it clear where support for children and young people could be accessed across Sussex. Lou agreed to share the poster with the Committee when it was finalised.
8.6 The Committee asked for more detail on how waiting times for CAMHS were handled.
8.7 Alison Wallis, SPFT Clinical Director for CAMHS & Specialist Services, answered that CAMHS was a needs-led service so that the children and young people seen first were those who were most unwell and for whom alternative services and support would not necessarily meet their need. CAMHS had well-known resource challenges that meant many children and young people were not being seen as soon as anyone would like. Those most in need waited between 0-13 weeks and represented the largest numbers on the waiting list. There were lower numbers of less unwell children who may wait longer. SPFT closely monitored those who are on waiting lists, and make proactive contact with families to reassure them that they remain on waiting lists and to remind them to contact CAMHS if their child has a change in presentation. John Child, SPFT Chief Operational Officer added that the complexity and acuity of need had increased since the pandemic which added to waiting list times as those with complex needs take longer to assess. ... view the full minutes text for item 8.
9.1 The Committee discussed the items on the future work programme. The Committee requested that the report on Hospital Handovers at the RSCH scheduled for the December 2023 be combined with a report on the University Hospitals Sussex NHS Foundation Trust’s response to the recent CQC report and in particular the actions being taken at the RSCH.
9.2 The Committee requested that an evaluation report of the NHS Sussex Virtual Ward programme be circulated for information for the HOSC to then subsequently decide whether to schedule an item to discuss it at a future meeting. The Committee also requested a report for information on the outcomes of the Admissions Avoidance programme. Both programmes are part of the NHS Sussex Winter Plan
9.3 The Committee requested that an update report on the ESHT Building for Our Future programme (including and other significant capital building projects e.g. the new Elective HUB) be added to the agenda for the 21 September 2023 HOSC meeting.
9.4 The Committee also discussed the need to schedule the update reports on access to NHS dentistry service and access to GPs and GP appointments.
9.5 The Committee RESOLVED to:
1) Amend the work programme in line with paragraphs 9.2 and 9.3 (above);
2) Add a report on the NHS Sussex 2023/24 Winter Plan to the agenda for the 14 December 2023 HOSC meeting (paragraph 5.20);
3) Add an update report on Hospital Handovers at the Royal Sussex County Hospital (RSCH) combined with the report on the CQC inspection of RSCH to the work programme for the 14 December 2023 HOSC meeting (paragraph 6.26 and 9.1 above); and
4) Add an update report on the SECAmb CQC report to the agenda for the 14 December 2023 HOSC meeting (paragraph 7.14).
Any other items previously notified under agenda item 4
10.1 There were none.