6.1 The Committee considered a report seeking agreement of the HOSC Review Board’s report on NHS proposals to reconfigure ophthalmology services in East Sussex.
6.2 The Committee asked whether the proposed changes would help address the waiting lists for consultations and procedures in ophthalmology.
6.3 Richard Milner said that a key aim of the Trust this financial year is to reduce the waiting list across all specialities and not just ophthalmology. This will involve reducing the backlog of outstanding appointments caused by COVID-19 whilst also managing additional new appointments based on clinical need. This can be achieved in part by optimising the available medical workforce to see more patients, and one of the key aims of the ophthalmology proposals is to increase capacity of the existing workforce by concentrating them on two sites. In addition, there is a wider ophthalmology transformation programme across NHS Sussex to train community ophthalmologists to enable people to receive ophthalmology care in the high street, where appropriate. By consolidating the acute service, ESHT will be able to free up its consultant ophthalmologists to train some of the community ophthalmologists. This will not only increase capacity and help reduce the backlog but will also improve patient outcomes by allowing them to be treated earlier, quicker and closer to home.
6.4 The Committee asked for further details on the expansion of available parking at Bexhill Hospital as part of the proposals.
6.5 Michael Farrer said the Travel and Access Group’s remit included looking at the opportunities for increased parking at the Bexhill Hospital site. He said that the CCG and Trust know that the additional number of ophthalmology patients attending the site, based on an increase of eight patients per hour for the clinics, will equate to 10 additional parking spaces. The Trust is confident it can absorb that number of spaces on the site, however, that is a minimum number, and the Trust is exploring with its Estates Team options for further expansion of parking on the site. The parking details will be included in the DMBC.
6.6 The Committee asked whether data for ‘did not attend’ patients would be collected to understand what barriers there were for patients attending.
6.7 Michael Farrer said the CCG and Trust fully agreed with the HOSC Review Board’s recommendation around collecting ‘did not attend’ (DNA) data. At the moment, the Trust systems do not allow the collection of DNA data, as the patients did not attend an appointment to be asked that question. The Trust does, however, follow up DNAs to make sure they rebook their appointment and are not discharged back to their GPs, and there is an opportunity then to have a conversation about why they did not attend and to record that reason. Anecdotally, the reason people did not attend is not because they physically could not get to the Bexhill site, for example, during the pandemic when services were single-sited at Bexhill, there did not appear to be an increase in the number of DNAs for travel and access reasons. Patients in fact appeared happier to attend the site, as it was away from the acute sites where COVID-19 was more prevalent.
6.8 Michael Farrer confirmed there is a Trust-wide programme being developed on how DNA data is collected and how it is monitored. This programme is aimed at identifying and mitigating any adverse reasons for patients not attending. It is likely this will involve the collection of DNA data through periodic audits of DNAs when there appears to be an increase in the number of them, rather than systemically recording the reasons for each DNA as it happens. He said DNA data will be included in the metrics to measure the success of the ophthalmology service in the future.
6.9 The Committee asked whether the reasons for a DNA could include the patient forgetting the date of their follow up appointment if it is booked too far in advance.
6.10 Michael Farrer explained that for many eye conditions, a patient will be on the Trust’s books for life. Depending on the severity of their condition, there may be a need for a patient to attend an appointment every 3, 6 or 12 months. Consequently, appointments are often booked 12 months or more in advance. ESHT has a system in place to remind patients of these longstanding appointments; patients are reminded via letter closer to the appointment date and may also receive a text message reminder if they stated that as a preferred contact method. Michael Farrer said the data shows this system works quite well, as patients frequently called the ophthalmology service during the pandemic to delay their appointments, showing they were aware of the dates. There has been some feedback from patients not receiving their notifications and the Trust is working to update contact details that may become out of date due to the longevity of the patient’s contact with the service.
6.11 The Committee asked whether patients may be referred for treatment in community ophthalmologists.
6.12 Michael Farrer said that independent sector ophthalmologists like SpaMedica are commissioned to complete a lot of high volume, low complexity work, whilst ESHT will perform the more complex cases. Patients at the point of referral should be given a choice of where to go, and those with less complex needs will often be happy to be referred to the independent sector if the wait times are shorter than at NHS facilities.
6.13 The Committee asked whether there is scope to provide outreach surgeries periodically in more rural settings for treatments such as macular injections.
6.14 Michael Farrer said that the Trust’s philosophy is to provide its services as close to the patient as possible, wherever possible. The pan-Sussex community ophthalmology training programme, therefore, is aiming to help provide greater ophthalmology care closer to patients. Conversely some services require specialist skills or equipment or have fewer patients using the service. The best way to provide a quality service in this instance is from a specialist site where there is sufficient staff to run it properly and maximise training and clinical capacity; and high utilisation rates from patients to ensure equipment is not sitting dormant for long periods of time. Macular injections, for example, are offered on the Bexhill site only because they are a very specialist procedure requiring specialist training and equipment within a mini-theatre setting where air flow is monitored, due to the invasiveness of the procedure. The other estates do not have suitable space for the procedure, nor is there sufficient staff or demand from patients to offer it elsewhere. If an increase in demand did occur, however, the Trust may review its position.
6.15 The Committee asked whether there will still be the staff and skills onsite at the Conquest Hospital to conduct emergency eye procedures after the reconfiguration.
6.16 Michael Farrer confirmed the emergency pathways are not changing as part of the reconfiguration, with particularly complex cases remaining at the Conquest Hospital. This includes specialist eye surgery for patients who require an anaesthetic and therefore need to use the Conquest’s main theatre and anaesthetist teams; and people who require an overnight stay in a surgical ward using a shared care arrangement with the surgical team and an ophthalmologist, due to their underlying conditions or high-risk characteristics. These two cohorts of patients amount to less than 100 patients per year and around half a theatre list per month.
6.17 Michael Farrer clarified there is no eye trauma unit at the Conquest ED, so eye trauma patients will continue to use the current pathway and go to the nearest centre at the Royal Sussex County Hospital (RSCH) in Brighton, which is a safe, robust and well embedded pathway. Ophthalmology is currently delivered at the Conquest ED largely via ED consultants themselves using on-call ophthalmologist support to aid their decision making. The community-based minor eye condition clinics that patients are referred to for urgent non-emergency cases will also continue as before.
6.18 The Committee asked how the Trust will provide information on patient choice and travel and access arrangements to the Bexhill Hospital in accordance with the Review Board’s recommendations.
6.19 Michael Farrer said that the Trust is developing a Trust-wide communications plan. This includes updating the website to make sure it is accessible in multiple languages, with Google Translate having gone live in the last couple of months. The Trust will signpost people to its website for information wherever possible, including in its referral letters and leaflets.
6.20 Michael Farrer explained that the CCG instructs referring organisations (GP practices) to offer patient choice at the point of referral. Whilst the Trust is not responsible for referrals, it will remind people as often as possible about patient choice and will put the information on its website. Jessica Britton added that the CCG works with GP practices in relation to patient choice. Any feedback the CCG receives on its communications is used to improve future communications. Both Jessica and Michael welcomed the HOSC Review Board’s recommendation.
6.21 Michael Farrer also said that a Sussex-wide plan is being developed to improve the quality of patient referrals by offering patients earlier access to the opinion of an ophthalmologist to see whether a further appointment is appropriate or not.
6.22 The Chair thanked Jessica Britton, Richard Milner and Michael Farrer for giving their time to support the two review boards.
6.23 The Committee RESOLVED 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.