5.1 The Committee considered a report seeking agreement of the HOSC Review Board’s report on NHS proposals to reconfigure cardiology services in East Sussex.
5.2 The Committee asked for an outline of the next steps that would be taken before NHS representatives return to the HOSC with the final decisions for cardiology and ophthalmology.
5.3 Jessica Britton, Executive Managing Director of East Sussex Clinical Commissioning Group (CCG), explained that, should the HOSC agree the Review Board’s report and submit it to NHS Sussex (which replaces the CCG from 1st July), there are a few activities that will take place. NHS Sussex will produce for both cardiology and ophthalmology a Decision Making Business Case (DMBC), which builds on the Pre-Consultation Business Case (PCBC) and will be informed by both the analysis of the public consultation and the HOSC recommendations, stating how the NHS will respond to the HOSC recommendations. In addition, for cardiology, the DMBC will be preceded by a site options appraisal, which is an extensive process to determine which of the two proposed sites would best deliver the outcomes agreed for the interventional element of cardiology. The DMBC will then be agreed through NHS Sussex’s governance process culminating in the Integrated Care Board (ICB) meeting on 7th September. The HOSC will then consider whether the ICB’s decision is in the best interest of health services locally at its meeting on 22nd September [Note: the Committee has been subsequently advised that the decision will be reported to HOSC meeting on 15th December].
5.4 Michael Farrer said that the Trust and CCG are in the process of drawing up a detailed implementation timeline as part of the DMBC, in consultation with the Trust’s Estates and Finance Teams. The intention is to implement the decisions, subject to endorsement by the HOSC, as soon as possible and in the right way for patients.
5.5 The Committee asked for clarification whether the impact on patient flows from the north of East Sussex (the High Weald area) as a result of the decision by Kent & Medway CCG to centralise interventional cardiology services provided by Maidstone and Tunbridge Wells NHS Trust (MTW) to Maidstone Hospital has been considered by the CCG.
5.6 Jessica Britton said that the impact of the MTW reconfiguration would feed into the options appraisal. Michael Farrer confirmed that patient flow modelling for patients in the north of the county had already been undertaken and the CCG and Trust were aware of the decision by MTW and the Kent and Medway CCG to move interventional cardiology services to Maidstone Hospital. Michael Farrer said that the CCG and Trust is confident that the changes to patient flows for patients in the north of the county would be negligible. He clarified that MTW does not provide Primary Percutaneous Coronary Interventions (PPCIs) at either of its sites – either in the current or future configuration – so the emergency patient flows for patients in the north of the county would not change and they will continue going to the sites that they would have done previously. The pathways for non-elective (patients who arrive in the Emergency Department) living in the north of the county would remain unchanged, as the MTW model provides services for these patients on both sites. This means patients can continue to go to Pembury Hospital’s ED where onward care would then be arranged. Outpatient and diagnostics appointments at both sites would also remain unaffected. The only changes would be to elective and day-case patients, who may have to now travel further to Maidstone Hospital, but most likely for one or two procedures in a lifetime. He said it is unlikely patients would opt to receive these elective procedures from ESHT once under the care of MTW consultants, however, any patients who did elect to travel to ESHT could be absorbed by the Trust using existing capacity.
5.7 The Committee asked why retaining two cardiology sites was not an option and whether the New Hospitals Programme rebuild of the Eastbourne District General Hospital (EDGH) would mean that site should be chosen as the interventional cardiology site.
5.8 Jessica Britton said the proposed model was clinically driven by the cardiology service to deliver the best possible health outcomes for local people and was not resource driven. The proposals account for changes in staffing models, particularly in relation to the effect of specialisation on recruitment. The Executive Director said the site options appraisal would take into account a wide range of factors including population profile, consultation feedback, and deliverability of the changes on either site. The DMBC would make clear how each of these important factors have been balanced against each other.
5.9 Michael Farrer said that retaining all services on both sites was considered during the options development workshops, but it was quickly discounted as a viable option because a key clinical driver of the change is to provide sufficient training to staff. The staffing requirements of two sites and the fact that the population is not sufficient for two sites to both undertake the recommended volume of procedures means there is not enough capacity to provide the training needed to deliver the best quality of outcomes for patients. By consolidating interventional cardiology onto one site, however, the Trust can provide the volume of procedures and levels of supervision necessary to deliver sufficient training.
5.10 Richard Milner explained that the Department for Health and Social Care’s (DHSC) definition of a new hospital was not necessarily the same as the NHS definition. The DHSC guidance includes refurbishment and expansion of existing sites as a new hospital, in addition to building brand new hospitals from scratch. He said that the Trust did not have a preferred site for interventional cardiology and that this would be identified through an objective review of the weighted evidence across a number of parameters for both sites. Richard Milner further added that the higher number of preferences for EDGH as the cath lab site reflected the higher number of responses from the Eastbourne area and this would be balanced as part of options appraisal.
5.11 The Committee asked how consultation results would be weighted against other factors.
5.12 Jessica Britton explained that public consultations are incredibly useful but that, within the context of an engagement that aims to reach as many people as possible, the CCG only hears back from people who have chosen to respond. The themes and trends of the public consultation responses are taken into account alongside other factors, but there is not a mathematical weighting assigned to the consultation results compared to these other factors. The consultation analysis also recognises that the volume of residents responding in any particular area is not the same as the issues and themes feedback raised in the consultation responses, which require careful consideration.
5.13 The Committee asked when the Travel and Access Group will submit its findings, whether they will be accepted in full, and when they may be implemented, for example, the appointment of the travel liaison officer.
5.14 Jessica Britton confirmed the findings of the Travel and Access Group will be in the DMBC. The implementation of the recommendations will vary in length depending on what they are, with those that can be implemented quickly done so as soon as possible. Michael Farrer added that travel and access is a Trust-wide programme and in many cases the Trust will want all patients to benefit from these changes, not just cardiology and ophthalmology patients.
5.15 Michael Farrer said the travel and liaison officer will be recruited to as soon as possible subject to the approval of the DMBC. There are a number of different avenues of support available already for patients, so a key role of the travel and liaison officer will be to connect and signpost those patients to existing services. This post will also be able to escalate more complex personal circumstances to an appropriate level.
5.16 The Committee asked who is on the Travel and Access Group and whether the existing services available have the capacity to support additional patients with their travel arrangements.
5.17 Michael Farrer said the Travel and Access Group membership included patient and public representatives, Healthwatch, South East Coast Ambulance NHS Foundation Trust (SECAmb), PTS representatives, and ESHT community representatives.
5.18 Michael Farrer confirmed the Trust is looking at the capacity of existing services. The work will also feed into the recommissioning of the Patient Transport Service (PTS) that is due imminently, including around the capacity of that service to meet demand. He said there is capacity to signpost patients to these services and that the metrics of the service will be monitored during the pilot phase to ensure patients are able to access the transport services they need.
5.19 Two members of the Committee made the following comments against the Review Board’s recommendations:
5.20 The Committee RESOLVED by nine votes to one to:
36. 1) agree the report and recommendations of the HOSC Review Board attached as Appendix 1; and
37. 2) agree to refer the report to NHS Sussex for consideration as part of its decision making process.