Agenda and minutes

19.1     The minutes of the meeting held on 3 October 2024 were agreed as a correct record.

20.1     Apologies for absence were received from Councillor Sarah Osborne (Council Steve Murphy substituted), Councillor Christine Robinson, 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.

21.1     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.

22.1     There were no urgent items.

23.1     The Committee considered a report on the NHS Sussex Winter Plan 2024/25. 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 reflects on lessons learnt from previous winters and other system pressures.

23.2     The Committee asked what level of vaccine uptake was being aimed for over the winter and how vaccination take up compared with previous years’ levels.

23.3     Dr James Ramsay, NHS Sussex Chief Medical Officer, explained that vaccine uptake was monitored against national levels, and that NHS Sussex was in line with national averages despite a slow initial uptake. There was reduced uptake this year than in recent previous years, due to vaccine hesitancy and fatigue in both the general population and the workforce. NHS Sussex was working with providers to increase uptake within staff groups.

23.4     The Committee noted that the Joint Committee on Vaccination and Immunisation (JCVI) had announced that it was planning to tighten eligibility for vaccinations in 2025 and that this would need to be considered as part of on next year’s Winter Plan.

23.5     The Committee asked what was being done to improve vaccine take up with vulnerable groups.

23.6     Dr Ramsay confirmed that work was ongoing to increase vaccine uptake in vulnerable groups. People who were more likely to require acute services and healthcare over the winter, such as those with learning disabilities or frailty were being identified at a primary care level and support was being put in place to increase vaccine uptake in these people. In line with the general population there had been reduced uptake in these groups than in previous years, but that NHS Sussex continued to try and increase uptake.

23.7     The Committee asked for more information on temporary staffing levels that would be required over the winter period.

23.8     Richard Milner, ESHT Chief of Staff, noted that temporary staffing would not be coordinated system-wide but by individual provider trusts. ESHT sought to minimise its use of temporary staff and so had enhanced processes for booking staff rotas and managing staff leave over the period to have these set 6-8 weeks in advance. ESHT had a ‘bank’ system for permanent staff that wished to do additional hours which didn’t have the same associated cost as using temporary staff. Planning for staff levels began in August to ensure temporary staff were not required over the winter period. John Child, SPFT Chief Operating Officer, noted that the processes for SPFT were similar to ESHT to have staffing levels and rosters planned well in advance of winter. SPFT had ‘safer staffing numbers’ which mandated minimum staff levels for safety and quality of care, and processes in place to bring in temporary staff to meet patient need and acuity.

23.9     The Committee asked what the  ...  view the full minutes text for item 23.

24.1     The Committee considered an update report on the implementation of the new paediatric service model at EDGH. Since implementation there had been no adverse safety events nor complaints made about the service.

24.2     The Committee asked if patients, families and staff were positive about the new service model.

24.3     Dr Matthew Clark, Consultant Paediatrician and Head of Service, explained that staff were generally positive about the new service model. Patients and families had been positive as well and the model had received fewer complaints about the service than it previously had.

24.4     The Committee asked when ESHT expected to get to a seven-day a week paediatric service in ED.

24.5     Dr Clark explained that it was difficult to give an exact date when a seven-day a week service would be available, as it was a comparatively small team, so only a small number of people would have to be out of work for capacity to change. ESHT had recruited a number of trainee advanced nurse practitioners, and when they all qualified then in theory there would be sufficient staff for a seven-day a week service, hopefully within the next 18 months. This was dependent on them completing their training.

24.6     The Committee asked which Healthwatch recommendations had been taken forward.

24.7     Dr Clark explained that the implementation of recommendations 1 and 3 of the Healthwatch report were dependent on physical space, and that in an ideal world ESHT want a larger ED space. Recommendation 5 was dependent of staffing as outlined in the previous answer. Recommendations 2 and 4 were relatively simple fixes that were already being worked through. Recommendation 6 required some consideration, as there were some young people who would prefer to be in an adult’s waiting area than a children’s one, and options were being considered as to how to best accommodate young people of all ages.

24.8     The Committee asked whether ESHT could provide an update on patient pathways.

24.9     Dr Clark reassured the Committee that all necessary pathways were now in place, noting that they were internal procedural documents that would not normally be shared with HOSC. However, they could be provided if the Committee wished to see them. Paediatric surgery, imaging (such as MRI, CT, X-ray etc) continued to function at EDGH without any changes. There were also now systems in place to do paediatric endocrine testing, allergy testing and blood tests in out-patients, which were previously provided on the Short Stay Unit. Due to planned changes to specialist children’s cancer services in the South East, paediatric chemotherapy had been paused at EDGH as a wider review was ongoing.

24.10   The Committee asked for an update on the future use of the Scott Unit at EDGH.

24.11   Dr Clark confirmed that the Scott Unit remained a part of the paediatric division, but that detailed plans were still being developed as to how it would be used in future. Whatever plans were brought forward it was likely that capital funding would be required to  ...  view the full minutes text for item 24.

25.1     The Committee considered a report updating the HOSC on hospital handover delays at the Royal Sussex County Hospital (RSCH) and ongoing work between University Hospitals Sussex NHS Foundation Trust (UHSx) and South East Coast Ambulance NHS Foundation Trust (SECAmb) to reduce them.

25.2     The Committee asked whether it was a challenge working with three different social care authorities in discharging patients and ensuring patient flow.

25.3     Ali Robinson, UHSx Deputy Divisional Director of Operations, Medicine, said that it was a challenge working with three social care authorities, particularly at RSCH as it was the regional tertiary hospital. Proportionally there were more patients with No Criteria to Reside (NCtR) that were East Sussex residents. At RSCH there was a Transfer of Care Hub that worked across care providers and systems to match patient need as appropriate.

25.4     The Committee asked whether there would be a separate area in ED for patients with severe mental health issues.

25.5     Ali Robinson noted that this had been an area of sustained difficulty at the RSCH, and more recently UHSx had been working closely with SPFT to address estate issues. A section of the RSCH ED had been allocated to accommodate mental health patients, however this involved a trade-off with other physical health beds on the site which was another area of pressure. This area was staffed by a specific group of staff, separate from the main ED. The ICB was exploring whether there was scope to commission a specialist facility within Brighton & Hove that would ensure better support for patients in acute mental health crisis.

25.6     The Committee asked what learning had been taken from better performing hospital trusts with fewer delays.

25.7     Ali Robinson noted that UHSx and SECAmb had explored with a number of hospital sites about effective improvements and initiatives that had been implemented to reduce handover delays. The continuous flow model had been taken from another hospital.

25.8     The Committee asked what equipment ambulances carried to support patients with respiratory issues.

25.9     Paul Fisher responded that when an emergency call was received it would be triaged and SECAmb would aim to send the most appropriate resource. All ambulances carried oxygen and nebulisation was also available, although not all staff were authorised to deliver nebulised therapy. Critical care paramedics had advanced airway equipment and could attend emergency scenes as required, however in most circumstances a general response paramedic ambulance was able to support a patient with respiratory illness.

25.10   Cllr Turner requested follow up information on whether all emergency response ambulances carried CPAP equipment.

25.11   The Committee asked for clarification to whether the continuous flow model had gone live for the Surgical and Specialist divisions.

25.12   Ali Robinson confirmed that they had now gone live in the first week of December and had begun to have a marginal impact, with an expectation that they would further develop in time.

25.13   The Committee asked when the continuous flow model was expected to deliver an increase in total discharges.

25.14   Ali Robinson  ...  view the full minutes text for item 25.

26.1     The Committee considered a report about plans by UHSx to make changes to the provision of elective colorectal cancer surgery across its Sussex hospital sites. The proposals were to relocate all Elective Colorectal & Lower GI Cancer Surgery and Stoma Reversal Surgery from RSCH to the Worthing site, creating a centre of excellence for Colorectal Cancer Surgery delivered across Worthing and St Richard’s (Chichester) hospitals.

26.2     The Committee asked whether any East Sussex residents would be required to travel to Chichester for surgery.

26.3     Professor Katie Urch, UHSx Chief Medical Officer, explained that the impact on East Sussex residents was very small, as ESHT provided the majority of colorectal cancer surgery for the county. The move of surgery to Worthing would only affect a small number of patients from East Sussex (less than 1 per week) who would be treated at the Worthing site. The patients that would have to travel to St Richard’s Hospital in Chichester would not be East Sussex residents, and would be patients in West Sussex which were west of Worthing.

26.4     The Committee asked when the new theatre and additional bed capacity would in place at Worthing.

26.5     Prof Urch explained that the new theatre was empty theatre stock that UHSx already had, and the equipment required had already been purchased.

26.6     The Committee asked if the new theatre at Worthing would be dedicated to colorectal surgery.

26.7     Prof Urch explained that the reason for the move to Worthing was that currently there was a high number of short-notice cancellations due to emergency patients. Worthing has a much smaller volume of emergency patients compared to Brighton, so it was much less likely that operations would be subject to short-notice cancellation.

26.8     The Committee asked whether UHSx would be able to recruit enough specialists to support the proposal.

26.9     Prof Urch explained that UHSx had received a very good response and strong candidates to its recruitment and inquiries, as the model being proposed of a high-volume specialist centre was a place that people wanted to work.

26.10   The Committee asked what would make the provision at Worthing a Centre of Excellence.

26.11   Prof Urch explained that it would be deemed a Centre of Excellence by demonstrating that it was meeting national standards of excellence. This included high volume of activity per surgeon, better outcomes, shorter than average length of stays among other criteria. Worthing did not quite meet this at the moment as it did not have the volume of activity, but the implementation of the proposals would be the last element of the criteria to define it as a Centre of Excellence.

26.12   The Committee asked if anything was being moved from Worthing to make space.

26.13   Prof Urch explained that UHSx was not needing to move anything from Worthing as there was spare theatre capacity that was not being used. UHSx had already made the investment to expand the bed space for post-surgery patients. As patients stayed a relatively short time at Worthing post-op  ...  view the full minutes text for item 26.

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

27.2     The Committee raised concerns around the temporary stop to day surgery at Uckfield Hospital. Ashely Scarff noted that as this was a pilot, and the Committee should expect to receive a report once the pilot had been evaluated and consideration was being given to make it permanent. He also noted that the development of Integrated Community Teams (ICTs) was a standing item at the Health and Wellbeing Board, and the use and role of community hospitals was being considered through this avenue.

27.3     The Committee commented that there were various primary care estates issues across the county, including in Hailsham, Ticehurst and Seaford. Ashely Scarff agreed to provide updates in these areas in part of the primary care update scheduled for June 2025.

27.4     The Committee requested an update on the provision of NHS Sussex long-Covid services. Ashley Scarff agreed to provide a written briefing.

27.5     The Committee asked about Health and Wellbeing hubs and how these were being developed. Ashley Scarff noted that these were being developed within each of the ICT footprints and consideration would be given to when to provide an update to the Committee.

27.6     The Committee RESOLVED to agree the work programme and the inclusion of the amendment to the Primary Care update report agreed in minute 27.3 above.

28.1     None.