Agenda item

23.1     The Committee considered a report on the proposed changes to Cardiology services in East Sussex which have been agreed by the NHS Sussex Board.

23.2     The Committee asked about the implications of SECAmb ambulance response times on the door to balloon (treatment) times for those patients affected by the proposed changes to the location of specialist cardiac procedures, especially during busy periods.

23.3     Professor Nik Patel, Clinical Lead for Cardiology (ESHT) outlined that for heart attack management patients who need urgent treatment there are around 190 patients a year which is less than 3% of the total. At present, out of hours, these patients do travel to either the Eastbourne District General Hospital (EDGH) or the Conquest Hospital in Hasting for treatment. Irrespective of site the Trust is well within the 75% door to balloon and national target times for treatment. The Trust works very closely with SECAmb who prioritises heart attack patients and the Trust has worked with them on the proposed changes to the service in all the patient pathways. There is a pre-alert system in place to make sure patients are seen quickly and by the right people when they get to hospital. Patients are also assessed by ambulance crews who have access to specialist advice before they leave for the hospital. Professor Nik Patel confirmed that performance against door to balloon times (e.g. for primary angioplasty) during normal working hours and busy periods are within the national performance thresholds.

23.4     Some Committee members expressed concerns about the travelling times for patients experiencing a heart attack and asked if ambulance crews have a problem stabilising a patient whether they would be taken to the Conquest Hospital first and then transferred to EDGH.

23.5     Professor Patel responded that this will depend on the circumstances of the individual patient and the decision of the ambulance service at the time. In the last 12-18 months the Trust has had the opportunity to improve the pathway for patients experiencing a cardiac arrest with a pre-alert system. This enables ambulance crews to notify the hospital of a heart attack patient and have the right people in the right place to treat the patient. This has resulted in better outcomes for the patients and taking patients to the designated site first is preferred by SEACamb. This was made possible because the changes in the proposed model of care allow the right people to be in the right place to receive and treat patients when they get to hospital. It is not just about travel times but having the people with the right expertise to treat these highly complex conditions in order to achieve positive outcomes for patients.

23.6     The Committee asked how moving patient treatment from the Conquest Hospital to EDGH and patients having to travel further would help reduce health inequalities in Hastings which is one of the most deprived areas in the County.

23.7     Professor Patel outlined that the people who need urgent specialist treatment for heart attack management under the proposed model of care will be transported very quickly to the right centre to get specialist treatment. Access to investigations (diagnostics) and outpatients will still be provided at both hospitals, as will the front door model and specialist cardiac response teams. Reducing health inequality is about access to care and education about heart conditions. The cardiology team spends a great amount of time with patients to help them manage their condition and understand the risk factors.  Cardiovascular disease is the number two killer after dementia in the world. Addressing hypertension through primary care and public health will have a far greater impact on health inequalities than the small number of patients treated with specialist interventional cardiac procedures.

23.8     The Committee asked if paramedics will be trained to see when a patient needs a specialist treatment such as angioplasty and be taken to EDGH, and how will they tell if this is needed.

23.9     Professor Patel outlined that main way of diagnosing a heart attack is on an ECG trace and paramedics have a degree of skill in doing that. Around 90% of patients brought into hospital use the pre-alert systems where the ECG reading can be sent to the receiving hospital before the ambulance leaves site for the hospital. The ECG can then by analysed if it is borderline or not very clear. For the majority it is usually very clear and the patient will be taken to a cath lab for treatment.

23.10   Jessica Britton commented further on the points made about travel times and health inequalities. In terms of travel times, the review of the proposed changes looked at travel times across the whole of East Sussex and mapped the ambulance travel times not just from Hastings and Eastbourne but where people live throughout the County. NHS Sussex is confident in the mapping data and the proposals enable a good delivery of specialist cardiac services. The proposals have paid close attention to health inequalities and a thorough health equality impact assessment has been undertaken. The NHS Board has looked at this carefully and recognises that there are pockets of deprivation in the County. Mitigations have been put in place as part of the proposals and in response to HOSC’s recommendations and feedback from the public consultation. Sustaining services and implementing a model of care that benefits the local population has been very important, as well taking into account the issue of health inequalities in the implementation of the proposals.

23.11   Some Committee members expressed concerns that the Conquest site would lose specialist staff and it would be less attractive for recruiting new staff.

23.12   Professor Patel responded that he understood the concerns but in fact the team was losing staff because it was not able currently to provide the required number of specialist procedures. Implementing the proposals will be important in attracting staff as it will support specialisms and new cardiology treatments. In fact, the plans for the proposed model of care have assisted in recent recruitment where people have returned to the Trust. The Trust has a high degree of specialism and specialist skills that do not exist in other Trusts. So the proposed model of care will attract junior doctors and will improve expertise going forward.

23.13   John Routledge, Healthwatch East Sussex, outlined that Healthwatch had been involved in the consultation on the proposals and had contributed to HOSC’s review of the proposals. In an ideal world it would be desirable to maintain specialist cardiac services at both hospital sites. However, having looked at all the evidence, overall the case is quite compelling considering the constraints on having the right number of highly specialist staff and equipment.

23.14   The Chair commented that there is agreement with the view that in an ideal world specialist cardiac services should be maintained at both sites. However, the Committee has heard evidence that Professor Patel and his team of specialists need to be able to carry out the required number of procedures, otherwise there is a risk that East Sussex may lose these specialist cardiac services altogether and people would have to travel to Brighton or Maidstone.

23.15   The Committee RESOLVED by a majority to agree that NHS Sussex’s decision as set out in paragraph 2.1 of the report in relation to the changes to the future provision of Cardiology services by the East Sussex Healthcare NHS Trust (ESHT) is in the best interest of the health service in East Sussex.