20.1. The Committee considered a report providing an overview of the proposals for reconfiguring cardiology services currently provided by East Sussex Healthcare NHS Trust (ESHT).
20.2. The Committee asked what the impact of the reconfiguration would be on the current pressures on ambulance services and the EDs.
20.3. Prof. Nik Patel, Cardiology Clinical Lead at ESHT, explained that SECAmb, despite the pressures currently on it, is maintaining a very good service for patients having an acute heart attack. Prof. Patel agreed that the issue of bottlenecks at ED was exactly the area the reconfiguration aims to rectify through the creation of a cardiac response team within the ED. This will mean patients should be able to be seen in 30 minutes to an hour rather than more than four hours wait they currently experience, and this was demonstrated to work when the model was tested during the pandemic. The creation of hot clinics that allow imaging, mainly ultrasound, in ED will also mean decisions can be made more swiftly about what to do with a patient. Prof Patel added that the temporary reconfiguration of cath labs at times during the last 18 months have allowed the Trust to admit any patient arriving in cardiac arrest directly to a cath lab where cardiologists, nurses and anaesthetists are waiting on hand, rather than taking them to the ED and calling them all down to attend. SECAmb has helped improve this pathway and prefers to admit patients directly to the cath labs.
20.4. The Committee asked whether the reconfiguration would increase capacity for imaging and diagnostics such as MRI scans.
20.5. Prof Patel said ultrasound is the most important test for diagnosing cardiac conditions and the hot clinics will enable swifter use of ultrasound. The Trust has excellent magnetic resonance imaging (MRI) scanners, but the use of MRI scans is not necessary to make a cardiac diagnosis. In addition, ESHT’s computed tomography (CT) scanning times for acute stroke in 1 hour are one of the highest in the country and the Trust receives an A rating for it.
20.6. The Committee asked whether staff are being consulted on both proposed changes at ESHT.
20.7. Tom Gurney, Executive Director of Communications and Public Involvement, said there is a communications and engagement plan for staff separate to the public consultation. This engagement will focus on ESHT staff, but also to a lesser degree on all provider staff including those working for SECAmb. Joe Chadwick-Bell, Chief Executive of ESHT, added that both cardiology and ophthalmology have been driven by clinical teams themselves and are not top-down reorganisations, meaning the main affected teams have been fully engaged throughout the process. Dr Patel has also engaged with other specialities’ clinical teams across the Trust quite significantly over the last four years. The Chief Executive clarified that once a site is chosen by the CCG and Trust, there will need to be a further conversation with staff who will need to move site, however, this is a formal human resources-led consultation and cannot take place yet.
20.8. The Committee asked whether the weekend availability of cardiologists would improve under the new proposals.
20.9. Prof Nik Patel said nationally there is a move towards 24/7 consultant-led care in cardiology and this redesign will help move ESHT towards that model. The current arrangement has cardiologists on site doing ward rounds, out of hour remote access to cardiologists via telemedicine, and attendance of cardiologists in the event of a heart attack when it happens out of hours. There is also a multi- disciplinary team, including allied health professionals and specialist nurses, who help deliver the service out of hours.
20.10. The Committee asked whether the new cardiac response team is an improvement on what is currently available at EDs.
20.11. Prof. Nik Patel said currently patients in ED are seen by junior staff, then an ED consultant, and then referred to specialists within the cardiology service. The cardiac response team will be able to provide this specialist input at a much earlier stage in the process. The Trust has had the opportunity to test this model during the pandemic and there is confidence that it works well and provides a better patient experience and clinical expertise at the ED. Prof. Patel reminded the HOSC that the cardiac response teams will be at both EDs, and it is only the 2% of cardiac patients who need specialist intervention at the cath labs who will be affected by the proposals.
20.12. The Committee RESOLVED to:
1) agree that the proposals are a substantial variation to services;
2) agree to undertake a detailed review of the proposals in order to prepare a report and recommendations; and
3) agree to establish a Review Board to conduct the review comprising Cllrs Belsey, Robinson, Turner, di Cara, and Marlow-Eastwood.