19.1. The Committee considered a report providing details of the proposed reconfiguration of Ear, Nose and Throat (ENT) services currently provided by East Sussex Healthcare NHS Trust (ESHT).
19.2. Joe Chadwick-Bell, Chief Operating Officer, explained that the proposed reconfiguration is driven by workforce challenges, in particular:
· A shortage of ENT consultants. There are currently three consultants covering the two sites, whereas there should be five or six. This makes it very hard to recruit any additional consultants as they would have to be on call on a 1-in-4 or 1-in-3 basis. One of the three consultants has retired and returned on an almost full time basis.
· A shortage of middle grade doctors. There are currently no registrars or training grade doctors to fill the six middle grade rota posts. Instead there are four speciality doctors, one of whom acts up to the consultant rota. They are also close to retirement age and could potentially hand in their notice, despite the current work they are doing now to support the service
· Reliance on the ad hoc support of 10 Sussex-based doctors, particularly at the A&E department at the Conquest Hospital.
· There are two trainee ENT doctors but there is a risk that the Deanery could remove them without providing them with more training opportunities.
19.3. Dr Adrian Bull, Chief Executive, and Joe Chadwick-Bell provided answers to a number of questions from HOSC.
Emergency ENT pathway
19.4. Joe Chadwick-Bell explained that patients currently present as emergency ENT patients either by calling 999 or attending A&E. South East Coast Ambulance NHS Foundation Trust (SECAmb) know to bring such patients to the Eastbourne District General Hospital (EDGH) where emergency admissions are currently located. Self-presenters at Conquest Hospital can mostly be dealt with on site but those few patients who need the intervention of an ENT surgeon would be transferred across via ambulance.
Ensuring Supportive Professional Activities (SPA) for consultants
19.5. Dr Adrian Bull said that Supportive Professional Activities (SPAs) are part of a consultant’s contract and the Trust is committed to protecting SPA time as an important part of the training process.
Recruitment difficulties due to sub-specialisation
19.6. Dr Bull explained that recruitment rates are improving across the trust except for in areas where there is an increasing tendency towards sub-specialisation, rather than generalisation, and in which there are more frequent on-call requirements; the ENT service is faced with both of these issues. Therefore, the future service needs to be attractive to surgeons who are looking to specialise in ear issues, nose issues, or throat issues, given the increasingly few number of ENT generalists.
Impact on deprived communities
19.7. Dr Adrian Bull said that he did not believe deprivation was relevant to the proposals, as the key consideration of the Trust is to provide a service that provides the right quality of care to residents of East Sussex. In addition, outpatient services would continue as before at Conquest Hospital so access to the opinion of an ENT consultant, who can provide an assessment and diagnosis for the residents of Hastings would continue. The difference is that patients who needed to receive planned surgery – the majority of which are day case patients or patients staying less than 2 days – would need to travel to the EDGH.
Impact on other services at Conquest Hospital
19.8. Dr Bull explained that local community groups and individuals from both Eastbourne and Hastings have expressed concerns to him about the majority of their town’s hospital services being moved to the other hospital, demonstrating it is a major concern in both towns. He said, however, that whilst the two major hospital sites would not be run as ‘mirror images’ of each other, the trust is committed to providing acute services across both sites. Dr Bull added that there is no prospect of acute services being removed from Hastings due to the geographical remoteness of the town, requiring the Conquest Hospital to be designated as a trauma unit, and provider of a number of other specialist services, for the population of the area. He assured the Committee that the reconfiguration of ENT services was absolutely not the first step in the removal of hospital services there.
Financial performance of the trust
19.9. Joe Chadwick-Bell explained that the ENT service had admitted fewer patients in the past year due to not having a sufficiently large consultant team to admit as many patients as the trust would like. The increase in the cost of the service during the same period was due to the reliance on the ad hoc hiring of staff from across Sussex to fill gaps in the rota, which is more costly than if they were substantive staff. The proposed reconfiguration would therefore cost less and be able to provide more activity.
Paediatric planned and emergency pathways
19.10. Joe Chadwick-Bell explained that paediatric day cases who did need to be admitted to the Conquest paediatric ward overnight would be admitted to the paediatric ward under the supervision of ENT consultants, if clinical judgement felt it was safe to do so, and as is currently the case. In addition, the ward at EDGH would be opened until 9pm to allow paediatric day case patients a little more recovery time; and children would be operated earlier in the morning, starting at around 8.30am, to reduce the need for cross-site transfers. She confirmed that this element of the pathway would continue to be refined during the detailed analysis stage.
19.11. Dr Bull explained that under the proposals if a child attended the A&E at the Conquest and it was judged to be an ENT condition requiring emergency admission, then they would be admitted to the specialist centre at the Royal Alexandra Children’s Hospital in Brighton.
The Committee RESOLVED to:
1) note the report; and
2) request an update on implementation of the proposals at the June 2019 meeting.