Agenda item

Report by the Assistant Chief Executive

To consider a progress report on the implementation of the service reconfiguration.

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38.1     The Committee considered a report of the Assistant Chief Executive updating it on the implementation of decisions made by East Sussex CCGs in relation to the configuration of maternity, paediatric and gynaecology services provided by ESHT.

Maternity pathways

38.2     In response to questions from HOSC there emerged the following clarifications and responses relating to maternity pathways:

• ESHT stated that it is examining the viability of providing sonography from the Crowborough Birthing Centre (CBC). However, there is a limited number of sonographers in East Sussex, meaning that ESHT will need to be first be certain that the availability of sonography to women elsewhere in the county would not compromised by opening a new service at the CBC.
• ESHT said that sonography at CBC will be dependent on cross-trust working, so firm dates for the start of a sonography service will require further discussion with the new Head of Midwifery at Maidstone and Tunbridge Wells NHS Trust (MTW) when they are in post and agreement over cross-border working.

• ESHT explained that it has developed pathways for cross-border working that work well, for example, women in the Seaford area wanting to use maternity services provided by Brighton & Sussex University Hospitals NHS Trust (BSUH) are able to access the Trust’s services seamlessly. ESHT intends to try to adopt the same model of cross-border working for maternity services in the North Weald area.
• ESHT stated that it is in the process of negotiating cross-border pathways with MTW. However, the situation had become challenging because MTW had not accepted ESHT’s proposed pathways. ESHT stated that discussions were progressing and that it was confident that it could satisfactorily address the outstanding problems given that it has the same aims as MTW. Further discussion will occur with the new Head of Midwifery at MTW.
• The HWLH CCG considered that if MTW were to take over maternity services at Crowborough, the ‘border’ (between MTW and ESHT) would ‘move south’ and simply displace any outstanding pathway problem to another geographical location. (However, HOSC considered that such a move would probably result in a more “natural” border were this to happen which would be welcome).

Serious incidents data (p53)

38.3     HOSC expressed concern at the serious incidents data. In response to questions from HOSC there emerged the following clarifications and responses:

• The CCGs acknowledged that the very small number of serious incidents made it difficult to demonstrate statistically significant impacts on safety since the reconfiguration. However, they had been looking at the pattern and nature of serious incidents, rather than just the number, and prior to the temporary reconfiguration a pattern of failure had begun to emerge that looked as though it would worsen unless the temporary reconfiguration was put in place. Since the reconfiguration, the pattern of serious incidents indicated that there had been improvements in safety.
• ESHT said that there is a clear national definition of a “serious incident”, for example, the admission of a baby or mother to intensive care, meaning that serious incidents could not be classified as a different event.
• ESHT said that all clinicians strive towards operating with zero serious incidents, but this will never be possible. However the Trust considered that there were too many serious incidents in the year preceding the temporary reconfiguration (22 between June 2012 and May 2013 compared with three between June 2013 and May 2014). ESHT, like the CCGs, did not look at the number of serious incidents but the nature of them.
• ESHT recently conducted a root cause analysis of every serious incident which demonstrated that the causes of serious incidents prior to the reconfiguration, such as staffing shortages, had not been the cause of any of the serious incidents that had occurred since the reconfiguration.
• ESHT stated that it undertakes to record, report and learn from any incident or ‘near miss’ that could potentially compromise patient care. This includes incidents that would not be classified as Serious Incidents such as Born Before Arrival (BBA) data, for example.  All incidents are graded and considered in clinical unit meetings and other internal clinical meetings. All staff are continually encouraged to report all incidents where they think that patient safety has been compromised.

Caesarean-section rate data (p56)

38.4     In response to questions from HOSC there emerged the following clarifications and responses relating to Caesarean-section rate data:

• Between 2009 and 2013 the rate of Caesarean sections (C-sections) at ESHT was increasing by 1% per year, from 20.49% in 2009 to 23.37% in 2013. Since the reconfiguration, the C-section rate has been 23.7% (for 2013/14), and is therefore stable compared with the previous upward trajectory of 1% per year. The C-section rate for the 2014 calendar year is 23%, which is at the national average.
• ESHT said that it is important to note that the Trust does not serve a national average population due to the high levels of deprivation, so C-section rates may reasonably be expected to be higher, when, in fact, they are at the national average.
• Since the reconfiguration, there have been:

• Increased consultant presence has had many effects, but ESHT considered that it was difficult to determine from the figures how it had influenced the  C-section rate. ESHT explained that it was focussed not so much on the rate of C-sections, but on ensuring that C-sections were performed (both elective and unplanned) only when required, after applying the correct clinical criteria.

Local services and transfers data (p57)

38.5     HOSC expressed concern at the reduction in number of births in Eastbourne District General Hospital (DGH) and questioned whether this could indicate problems with staffing, recruitment and safety. HOSC highlighted concerns at the potential for serious incidents occurring during transfer to consultant care.

38.6     In response to questions from HOSC there emerged the following clarifications and responses relating to local services and transfer data:

• ESHT confirmed that consultant-led maternity and paediatric services would not be returned to DGH. ESHT stated that this was because the data demonstrated that a single consultant-led site provided:
  • a substantially safer service;
  • increased consultant hours;
  • a better level of care;
  • better outcomes for patients, and;
  • easier recruitment of new staff.
• ESHT said that neither MTW nor BSUH had experienced a significant impact from East Sussex patients giving birth in their maternity units following the reconfiguration due to the large number of births both Trusts already handle (between 5,000 and 6,000). Both trusts had concluded that the reconfiguration posed no threat to the safety of their patients and they were no longer monitoring the numbers of additional births from East Sussex.
• HOSC highlighted an example where a mother and baby had been separated during the journey to the consultant-led unit. ESHT responded that there will always be a need to transfer some mothers and babies by ambulance to the consultant-led unit, although not always in an emergency situation, and such a decision would be taken on clinical grounds on a case-by-case basis.  ESHT stated that it works with the South East Coast Ambulance NHS Foundation Trust (SECAmb) to try to ensure that there are always facilities available to allow mother and baby to travel together in the same ambulance. However, this was not always possible when safety concerns for the patient were taken into consideration.

38.7     RESOLVED:

1) That the CCGs and ESHT be requested to note and act on the following key issues (as set out in appendix 1 of the report) as quickly and as practicably possible, and report back to HOSC as a matter of urgency:

·         resolution of the midwifery care pathway issues in the High Weald, taking lessons from elsewhere;

·         Access to emergency paediatric services, in particular the Short Stay Paediatrics Unit (SSPAU)

·         Communications and engagement

2) That the remaining issues be reported back to HOSC in a year’s time using the data pack format appended to this report.